Instrument #3 - Baseline Survey

O MB No.: 0970-0403

Expiration Date: 10/31/2015

PACT

Responsible Fatherhood

Baseline Survey

October 19, 2012

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0970-0403. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

CONTENTS

Section Page

i. INTRODUCTION i

A. CONTACT INFORMATION 1 1

B. DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS 3

C. biological child roster 6

D. RELATIONSHIPS 17

E. NON-BIOLOGICAL, RESIDENTIAL CHILDREN 25

F. ECONOMIC STABILITY 26

G. FATHER BACKGROUND AND WELL BEING 29

H. Motivation to participate in program 34

i. contact information 2 35

INTERVIEWER SELECT STAFF NAME AND SITE NAME FROM DROP DOWN MENU.

PROGRAMMER: PRELOAD STAFF NAMES AND SITE NAMES.

INTERVIEWER: ASK PROGRAM STAFF: Does he have at least one living biological child under 18 years of age? IF YES, ASK PROGRAM STAFF TO PUT RESPONDENT ON THE PHONE AND START THE INTERVIEW. IF NO, TELL PROGRAM STAFF: He is ineligible for the study because he does not have a living biological child under 18 years old.

1. Hello, my name is [INTERVIEWER NAME], and I work for Mathematica Policy Research. I understand that you are interested in [PROGRAM NAME] and the Parents and Children Together study. Is that correct?

YES 1

NO 0 GO TO 6a

2. Great. Thanks for taking the time to talk to me today. I would like to tell you a little bit more about the study, which is called PACT for short. Please stop me at any time if you have a question.

The [PROGRAM NAME] program is part of the PACT study, a national study being conducted by the U.S. Department of Health and Human Services. The study is being done to learn more about which services help fathers build better relationships with their children and their families, as well as improve their economic stability. The Department of Health and Human Services asked a research team from Mathematica to assist with the study.

The [PROGRAM NAME] program is for fathers. If you want to be in the program, you have to agree to be a part of the PACT study. If you decide that you do not want to be a part of the study, you will not be able to participate in [PROGRAM NAME] program. You will be given information about other services that you can receive in the community.

If you decide to be in the [PROGRAM NAME] program and the study, I will ask you to complete a short survey on the telephone with me today. This will take about 30 minutes. You will receive $10 in appreciation of your time.

Do you have any questions about what I’ve said so far?

YES 1

NO 0 GO TO 3

2a. What is your question?

___________________________________________________________

INTERVIEWER: PRESS F10 TO ACCESS FAQ

3. Because the [PROGRAM NAME] program can only serve a limited number of fathers, a computer will randomly select whether or not you can participate in the program. The computer will place you into one of two groups. One of the groups will receive [PROGRAM NAME] program services at no cost to them. The other group will not receive [PROGRAM NAME] program services. The computer works like a flip of a coin—assignment to a group is completely random. The chance of being able to receive services is not influenced by what you say to program staff or to me. A staff member from [PROGRAM NAME] will let you know if you are assigned to the program group or not after today’s interview.

If you are not randomly assigned to participate in the [PROGRAM NAME] program, you will be provided with information on other services available to you in the community.

Do you have any questions at this time?

YES 1

NO 0 GO TO 4

3a. What is your question?

___________________________________________________________

INTERVIEWER: PRESS F10 TO ACCESS FAQ

4. Regardless of whether you can participate in services or not, the research team at Mathematica will contact you again by phone in about twelve months. At that time, you will be asked to complete a survey about topics such as your relationships and interactions with your child or children, your relationship with other family members, your employment, and services you receive.

You may also be asked to participate in focus groups, in-person interviews and to complete check lists about interactions with your child. Researchers may also ask for permission to interview your child. You will receive money as a token of appreciation for the time you spend in these activities.

The decision to participate in the survey in 12 months, the interviews, and the check lists is voluntary and will have no effect on your participation in the program, and you can decide in 12 months whether to participate in the survey, interviews, and check lists then.

Do you have any questions now?

YES 1

NO 0 GO TO 5

4a. What is your question?

___________________________________________________________

INTERVIEWER: PRESS F10 TO ACCESS FAQ

5. If you agree to be part of the study, it means you are giving permission for the [PROGRAM NAME] program to share information with the study team about you and the services you receive from the program. At any time, after you have been randomly assigned, you can call our study helpline to say that you no longer want the program to share information about you with the researchers, and that will have no effect on the services available to you.

The research team may also contact federal and state agencies for information about your employment and earnings, child support agreements, and criminal background.

Everything you tell the program staff or the researchers will be kept strictly private and will not be shared with anyone, except as required by law. However, if a person on the study team observes child abuse, it must be reported as required by law.

Only the researchers will be able to access information you give them and nothing will ever be said about you as an individual. Instead, information about you will be combined with information about everybody else in the study, so the researchers can say things like “30 percent of fathers in the program have two children.”

Your participation in the study could help in providing services in the future to other fathers like you.

There are no known risks of participating in this study, except that you may feel uncomfortable answering some questions in the interviews. You can refuse to answer those questions if you wish, and it will not change your participation in the program.

Your participation in the program and the study is strictly voluntary.

Do you have any questions now?

YES 1

NO 0 GO TO 6

5a. What is your question?

___________________________________________________________

INTERVIEWER: PRESS F10 TO ACCESS FAQ

6. Do you agree to be in the PACT study?

YES 1 GO TO A1

NO 0

6a. Please tell me why you are not interested in participating in the PACT study.

___________________________________________________________

6b. Your participation is important because it will help us learn about services for fathers like you in the future. All information we collect will be kept strictly private, and you will receive $10 for completing the survey today. Will you reconsider and agree to participate in the PACT study?

YES, I WILL PARTICIPATE 1 GO TO A1

NO, I WILL NOT PARTICIPATE 0

7. Thank you very much for your time. Can you please hand the phone back to the staff person at [PROGRAM NAME]?

INTERVIEWER: INFORM PROGRAM STAFF THAT RESPONDENT WILL NOT BE PART OF THE PACT STUDY AND WILL NOT BE IN THE PROGRAM BUT WILL RECEIVE INFORMATION ABOUT OTHER SERVICES IN THE COMMUNITY.

Thank you for agreeing to participate in the study. I would like to start by asking you some questions about yourself.

A1. What is your full name? Please spell that for me.

INSTRUCTION: CONFIRM LAST NAME GIVEN IS THEIR FULL LEGAL NAME (i.e. ARE THERE TWO LAST NAMES OR HYPHENATED LAST NAME).

FIRST NAME

MIDDLE INITIAL/NAME

LAST NAME

A1a. I want to make sure that we call you by the correct name. Do you go by another name?

YES 1

NO 0 GO TO A2

DON’T KNOW d GO TO A2

REFUSED r GO TO A2

A1b. Please spell that name for me.

NAME

DON’T KNOW d

REFUSED r

A2. What is your date of birth?

| | | / | | | / | | | | |

MONTH DAY YEAR

A3. What is your Social Security Number?

| | | | - | | | -| | | | |

A4. What is your address?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

A5. What is your home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

NO LANDLINE AT HOME, ONLY CELL PHONE 0

DON’T KNOW d

REFUSED r

A6a. Do you have a cell phone?

YES 1

NO 0 GO TO B1

DON’T KNOW d GO TO B1

REFUSED r GO TO B1

A6b. What is your cell phone number?

| | | | - | | | | -| | | | | TELEPHONE

DON’T KNOW d

REFUSED r

A

Youthbuild

7. I am going to ask you about the kind of cell phone service plan you have with your cell phone provider.

	YES	NO	DK	REF
a. Do you have a contract?	1	0	d	r
b. Do you have a ‘pay as you go’ plan?	1	0	d	r
c. Do you have unlimited calling?	1	0	d	r
d. Do you have unlimited texting?	1	0	d	r
e. OTHER (SPECIFY)	1	0	d	r

ASK IF A7d=0

A8. Is it okay for us to text you at this number?

Y

PACT developed

ES 1

NO 0

DON’T KNOW d

REFUSED r

Next, I would like to ask you some questions about your background.

B1. Are you Hispanic, Latino, or of Spanish origin?

OMB

INSTRUCTION: IF RESPONDENT ONLY SAYS “YES”, PROBE: Are you Mexican, Mexican American, Chicano, Puerto Rican, Cuban, or of other Hispanic, Latino or Spanish origin?

NO, NOT OF HISPANIC, LATINO OR SPANISH ORIGIN 0

YES, MEXICAN, MEXICAN AMERICAN, CHICANO 1

YES, PUERTO RICAN 2

YES, CUBAN 3

YES, ANOTHER HISPANIC, LATINO OR SPANISH ORIGIN 4

DON’T KNOW d

REFUSED r

B

OMB

2. What is your race?

AMERICAN INDIAN OR ALASKA NATIVE 1

ASIAN 2

BLACK OR AFRICAN AMERICAN 3

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 4

WHITE 5

OTHER (SPECIFY) 99

DON’T KNOW d

REFUSED r

B3. What country were you born in?

U

BSF

NITED STATES 1 GO TO B5

PUERTO RICO 2

CANADA 3

MEXICO 4

CUBA 5

DOMINICAN REPUBLIC 6

EL SALVADOR 7

HAITI 8

JAMAICA 9

GUATEMALA 10

NICARAGUA 11

OTHER COUNTRY (SPECIFY) 99

DON’T KNOW d

REFUSED r

B4. When did you first come to live in the United States?

I

BSF

NSTRUCTION: FIRST CODE IF ANSWER IS ‘SPECIFIC YEAR’ OR ‘NUMBER OF YEARS AGO’. YOU WILL BE ABLE TO ENTER SPECIFIC YEAR OR NUMBER OF YEARS ON THE NEXT SCREEN.

SPECIFY YEAR 1

SPECIFY NUMBER OF YEARS AGO 2

| | | | | YEAR

OR

| | | NUMBER OF YEARS AGO

DON’T KNOW d

REFUSED r

B

COBRA tailored for PACT

5. What is the highest level of education you have completed?

INSTRUCTION: IF RESPONDENT SAYS “HIGH SCHOOL,” PROBE: Did you receive a diploma or GED?

DID NOT COMPLETE HIGH SCHOOL OR GED 1

HIGH SCHOOL: DIPLOMA 2

HIGH SCHOOL: GENERAL EDUCATION DEVELOPMENT OR GED 3

SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL COURSES 4

2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE) 5

VOCATIONAL SCHOOL DIPLOMA 6

4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) 7

SOME GRADUATE WORK/NO GRADUATE DEGREE 8

GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D., JD, MD) 9

NEVER ATTENDED SCHOOL 10

DON’T KNOW d

REFUSED r

ASK B5a IF B3 (COUNTRY YOU WERE BORN IN) ≠1

B5a. Did you complete this education in the United States?

Y

PACT developed

ES 1

NO 0

DON’T KNOW d

REFUSED r

Now I’d like to start by asking you some questions about your biological children. We are interested in all of your living children under the age of 18, whether they live with you or not.

C

PACT developed

1. Do you have any living biological children under the age of 18? Please do not include any current pregnancies.

YES 1

NO 0 GO TO END2

DON’T KNOW d

REFUSED r

C

PACT developed

2. How many living biological children under the age of 18 do you have? Please do not include any current pregnancies.

IF NUMBER OF CHILDREN=0, GO TO END2.

| | | CHILDREN

DON’T KNOW d

REFUSED r

	CHILD 1	CHILD 2	CHILD 3
C3a. [Starting with the youngest child under the age of 18/Now thinking of the next youngest child under the age of 18,] please spell this child’s first and last name for me.	FIRST NAME LAST NAME DON’T KNOW d REFUSED r	FIRST NAME LAST NAME DON’T KNOW d REFUSED r	FIRST NAME LAST NAME DON’T KNOW d REFUSED r
C BSF 3b.[CHILD 1 ONLY: I want to make sure that we use [CHILD]’s correct first name.] Do you call [CHILD] by a different name?	YES 1 NO 0 GO TO C4 DON’T KNOW d GO TO C4 REFUSED r GO TO C4	YES 1 NO 0 GO TO C4 DON’T KNOW d GO TO C4 REFUSED r GO TO C4	YES 1 NO 0 GO TO C4 DON’T KNOW d GO TO C4 REFUSED r GO TO C4
C3c. Please spell that name for me.	NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY NICKNAME DON’T KNOW d REFUSED r	NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY NICKNAME DON’T KNOW d REFUSED r	NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY NICKNAME DON’T KNOW d REFUSED r
C4. Do you have another child under the age of 18?	YES 1 GO TO C3a, CHILD 2 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C3a, CHILD 3 NO 0 GO TO C5, CHILD 1 DON’T KNOW d REFUSED r	YES 1 GO TO C3a, CHILD 4 NO 0 GO TO C5, CHILD 1 DON’T KNOW d REFUSED r
Now that you’ve told me the names of all of your children, I’d like to ask you questions about each one. CODE SEX. IF NECESSARY ASK: C5. Is [CHILD FIRST NAME] a boy or girl?	BOY 1 GIRL 2 DON’T KNOW d REFUSED r	BOY 1 GIRL 2 DON’T KNOW d REFUSED r	BOY 1 GIRL 2 DON’T KNOW d REFUSED r
C6. What is [CHILD FIRST NAME]’s date of birth?	PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C8 MONTH DAY YEAR DECEASED 1 GO TO C5, CHILD 2, IF C4, CHILD 1 =1, OR GO TO END2 IF C4, CHILD 1=0 INTERVIEWER: IF C6=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C8 MONTH DAY YEAR DECEASED 1 GO TO D5, CHILD 3, IF C4, CHILD 2 =1 INTERVIEWER: IF C6=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C8 MONTH DAY YEAR DECEASED 1 GO TO C5, CHILD 4, IF C4, CHILD 3 =1 INTERVIEWER: IF C6=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r
C7. How old is [CHILD FIRST NAME]? Is that weeks, months or years?	| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C5, CHILD 2, IF C4, CHILD 1 =1 OR GO TO END2 IF C4, CHILD 1=0 INTERVIEWER: IF C7=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C5, CHILD 3, IF C4, CHILD 2 =1 INTERVIEWER: IF C7=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C5, CHILD 4, IF C4, CHILD 3 =1 INTERVIEWER: IF C7=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r

	CHILD 4	CHILD 5	CHILD 6
C3a. [Starting with the youngest child under the age of 18/Now thinking of the next youngest child under the age of 18,] please spell this child’s first and last name for me.	FIRST NAME LAST NAME DON’T KNOW d REFUSED r	FIRST NAME LAST NAME DON’T KNOW d REFUSED r	FIRST NAME LAST NAME DON’T KNOW d REFUSED r
C BSF 3b. [CHILD 1 ONLY:] I want to make sure that we use [CHILD]’s correct first name.] Do you call [CHILD] by a different name?	YES 1 NO 0 GO TO C4 DON’T KNOW d GO TO C4 REFUSED r GO TO C4	YES 1 NO 0 GO TO C4 DON’T KNOW d GO TO C4 REFUSED r GO TO C4	YES 1 NO 0 GO TO C4 DON’T KNOW d GO TO C4 REFUSED r GO TO C4
C3c. Please spell that name for me.	NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY NICKNAME DON’T KNOW d REFUSED r	NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY NICKNAME DON’T KNOW d REFUSED r	NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY NICKNAME DON’T KNOW d REFUSED r
C4. Do you have another child under the age of 18?	YES 1 GO TO C3a, CHILD 5 NO 0 GO TO C5, CHILD 1 DON’T KNOW d REFUSED r	YES 1 GO TO C3a, CHILD 6 NO 0 GO TO C5, CHILD 1 DON’T KNOW d REFUSED r	YES 1 GO TO C3a, CHILD 7 NO 0 GO TO C5, CHILD 1 DON’T KNOW d REFUSED r
Now that you’ve told me the names of all of your children, I’d like to ask you questions about each one. CODE SEX. IF NECESSARY ASK: C5. Is [CHILD FIRST NAME] a boy or girl?	BOY 1 GIRL 2 DON’T KNOW d REFUSED r	BOY 1 GIRL 2 DON’T KNOW d REFUSED r	BOY 1 GIRL 2 DON’T KNOW d REFUSED r
C6. What is [CHILD FIRST NAME]’s date of birth?	PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C8 MONTH DAY YEAR DECEASED 1 GO TO C5, CHILD 5, IF C4, CHILD 4 =1 , INTERVIEWER: IF C6=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C8 MONTH DAY YEAR DECEASED 1 GO TO C5, CHILD 6, IF C4, CHILD 5 =1 , INTERVIEWER: IF C6=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TOC8 MONTH DAY YEAR DECEASED 1 GO TO C5, CHILD 7, IF C4, CHILD 6 =1 , INTERVIEWER: IF C6=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r
C7. How old is [CHILD FIRST NAME]? Is that weeks, months or years?	| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TOC5, CHILD 5, IF C4, CHILD 4 =1 INTERVIEWER: IF C7=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C5, CHILD 6, IF C4, CHILD 5 =1 , INTERVIEWER: IF C7=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C5, CHILD 7, IF C4, CHILD 6 =1 , INTERVIEWER: IF C7=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r

	CHILD 1	CHILD 2	CHILD 3
C8. Please tell me [CHILD FIRST NAME]’s mother’s first and last name. PROBE: Please spell that for me.	FIRST NAME LAST NAME DON’T KNOW d REFUSED r
C9. Is [CHILD FIRST NAME]’s mother the same as . . .		[CHILD 1]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r	[CHILD 1]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 2]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r
C9a. Please tell me [CHILD FIRST NAME]’s mother’s first and last name. PROBE: Please spell that for me.		FIRST NAME LAST NAME DON’T KNOW d REFUSED r	FIRST NAME LAST NAME DON’T KNOW d REFUSED r
ASK C10 FOR THE LAST CHILD LISTED AT C3a. C10. Is there another child?	IF C4, CHILD 1=0 AND C10, CHILD 1=1, GO TO C3a, CHILD 2 YES 1 NO 0 DON’T KNOW d REFUSED r	IF C4, CHILD 2=0 AND C10, CHILD 2=1, GO TO C3a, CHILD 3 YES 1 NO 0 DON’T KNOW d REFUSED r	IF C4, CHILD 3=0 AND C10, CHILD 3=1, GO TO C3a, CHILD 4 YES 1 NO 0 DON’T KNOW d REFUSED r

	CHILD 4	CHILD 5	CHILD 6
C8. Please tell me [CHILD FIRST NAME]’s mother’s first and last name. PROBE: Please spell that for me.
C9. Is [CHILD FIRST NAME]’s mother the same as . . .	[CHILD 1]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 2]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 3]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r	[CHILD 1]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 2]? YES 1 GO TO C10 NO 0 [ DON’T KNOW d REFUSED r [CHILD 3]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 4]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r	[CHILD 1]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 2]? YES 1 GO TO C10 NO 0 ] DON’T KNOW d REFUSED r [CHILD 3]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 4]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r [CHILD 5]? YES 1 GO TO C10 NO 0 DON’T KNOW d REFUSED r
C9a. Please tell me [CHILD FIRST NAME]’s mother’s first and last name. PROBE: Please spell that for me.	FIRST NAME LAST NAME DON’T KNOW d REFUSED r	FIRST NAME LAST NAME DON’T KNOW d REFUSED r	FIRST NAME LAST NAME DON’T KNOW d REFUSED r
ASK C10 FOR THE LAST CHILD LISTED AT C3a. C10. Is there another child?	IF C4, CHILD 4=0 AND C10, CHILD 4=1, GO TO C3a, CHILD 5 YES 1 NO 0 DON’T KNOW d REFUSED r	IF C4, CHILD 5=0 AND C10, CHILD 5=1, GO TO C3a, CHILD 6 YES 1 NO 0 DON’T KNOW d REFUSED r	IF C4, CHILD 6=0 AND C10, CHILD 6=1, GO TO C3a, CHILD 7 YES 1 NO 0 DON’T KNOW d REFUSED r

	CHILD 1	CHILD 2	CHILD 3
C BSF 11. Were you and [MOTHER FIRST NAME] married when [CHILD FIRST NAME] was born?	YES 1 GO TO C14, CHILD 1 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 2 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 3 NO 0 DON’T KNOW d REFUSED r
C BSF 12. Did you and [MOTHER FIRST NAME] ever sign a birth certificate or document that identifies you as the legal father of [CHILD FIRST NAME]?	YES 1 GO TO C14, CHILD 1 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 2 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 3 NO 0 DON’T KNOW d REFUSED r
C BSF 13. Has a court ruled that you are [CHILD FIRST NAME]’s father?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r
FFCWS tailored for PACT C14. Who does [CHILD FIRST NAME] live with? By this we mean who has primary responsibility for [fill his if C5 = 1 or her if C5 = 2] care? CODE ALL THAT APPLY	RESPONDENT 1 CHILD’S BIOLOGICAL MOTHER 2 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER CARE 9 GROUP HOME 10 CHILD ON OWN/LIVING WITH A FRIEND 11 INCARCERATED 12 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r	RESPONDENT 1 CHILD’S BIOLOGICAL MOTHER 2 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER CARE 9 GROUP HOME 10 CHILD ON OWN/LIVING WITH A FRIEND 11 INCARCERATED 12 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r	RESPONDENT 1 CHILD’S BIOLOGICAL MOTHER 2 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER CARE 9 GROUP HOME 10 CHILD ON OWN/LIVING WITH A FRIEND 11 INCARCERATED 12 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r
FFCWS tailored for PACT C15. How many nights in the past month did you and [CHILD FIRST NAME] stay in the same place?	| | | TIMES GO TO C16 DON’T KNOW d REFUSED r	| | | TIMES GO TO C16 DON’T KNOW d REFUSED r	| | | TIMES GO TO C16 DON’T KNOW d REFUSED r
WFNJ tailored for PACT C15a. I just need to know a range, can you tell me if it was…?	1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r	1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r	1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r
A FFCWS SK IF C14 ≠ 1 C16. Have you ever lived with [CHILD FIRST NAME]?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r

	CHILD 4	CHILD 5	CHILD 6
C BSF 11. Were you and [MOTHER FIRST NAME] married when [CHILD FIRST NAME] was born?	YES 1 GO TO C14,CHILD 4 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 5 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 6 NO 0 DON’T KNOW d REFUSED r
C BSF 12. Did you and [MOTHER FIRST NAME] ever sign a birth certificate or document that identifies you as the legal father of [CHILD FIRST NAME]?	YES 1 GO TO C14, CHILD 4 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 5 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C14, CHILD 6 NO 0 DON’T KNOW d REFUSED r
C BSF 13. Has a court ruled that you are [CHILD FIRST NAME]’s father?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r
FFCWS tailored for PACT C14. Who does [CHILD FIRST NAME] live with? By this we mean who has primary responsibility for [fill his if C5 = 1 or her if C5 = 2] care? CODE ALL THAT APPLY	RESPONDENT 1 CHILD’S BIOLOGICAL MOTHER 2 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER CARE 9 GROUP HOME 10 CHILD ON OWN/LIVING WITH A FRIEND 11 INCARCERATED 12 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r	RESPONDENT 1 CHILD’S BIOLOGICAL MOTHER 2 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER CARE 9 GROUP HOME 10 CHILD ON OWN/LIVING WITH A FRIEND 11 INCARCERATED 12 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r	RESPONDENT 1 CHILD’S BIOLOGICAL MOTHER 2 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER CARE 9 GROUP HOME 10 CHILD ON OWN/LIVING WITH A FRIEND 11 INCARCERATED 12 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r
FFCWS tailored for PACT C15. How many nights in the past month did you and [CHILD FIRST NAME] stay in the same place?	| | | TIMES GO TO C16 DON’T KNOW d REFUSED r	| | | TIMES GO TO C16 DON’T KNOW d REFUSED r	| | | TIMES GO TO C16 DON’T KNOW d REFUSED r
WFNJ tailored for PACT C15a. I just need to know a range, can you tell me if it was…?	1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r	1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r	1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r
A FFCWS SK IF C14 ≠ 1 C16. Have you ever lived with [CHILD FIRST NAME]?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r

	CHILD 1	CHILD 2	CHILD 3
I BSF, EHS f C14 ≠ 1, ask C17. In the past month, how often have you spent time with [CHILD FIRST NAME] in person? Would you say, every day or almost every day, a few times a week, a few times a month, once or twice, or never?	EVERY DAY OR ALMOST EVERY DAY 1 GO TO C19, CHILD 1 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 GO TO C19, CHILD 2 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 GO TO C19, CHILD 3 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r
I EHS tailored for PACT f C14 ≠ 1, ask C18. In the past month, how often have you had contact with [CHILD FIRST NAME]? This would include having talked on the phone, sent letters, sent birthday cards, or sent text messages. Would you say, every day or almost every day, a few times a week, a few times a month, once or twice, or never?	EVERY DAY OR ALMOST EVERY DAY 1 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r
C BSF tailored for PACT GO TO C20, CHILD 1 IF C14, CHILD 1 ≠1 AND C17, CHILD 1 ≠1 OR GO TO C5, CHILD 2 IF C14, CHILD 1 =1 OR C17, CHILD 1 =1 AND C4, CHILD 1 =1 OR C10, CHILD 1=1 OR GO TO D1, IF C14, CHILD 1=1 OR C17, CHILD 1=1 AND C4, CHILD 1=0 AND C10, CHILD 1=0 GO TO C 20, CHILD 2 IF C14, CHILD 2 ≠1 AND C17, CHILD 2 ≠1 OR GO TO C5, CHILD 3 IF C14, CHILD 2 =1 OR C17, CHILD 2 =1 AND C4, CHILD 2 =1 OR C10, CHILD 2=1 OR GO TO D1, IF C14, CHILD 2=1 OR C17, CHILD 2=1 AND C4, CHILD 2=0 AND C10, CHILD 2=0 GO TO C20, CHILD 3 IF C14, CHILD 3 ≠1 AND C17, CHILD 3 ≠1 OR GO TO C5, CHILD 4 IF C14, CHILD 3 =1 OR C17, CHILD 3 =1 AND C4, CHILD 3 =1 OR C10, CHILD 3=1 OR GO TO D1, IF C14, CHILD 3=1 OR C17, CHILD 3=1 AND C4, CHILD 3=0 AND C10, CHILD 3=0 19. In the past month, did you buy things for [CHILD FIRST NAME] that (he/she) needed like clothes, school supplies, medicine, or other things (he/she) needed?	YES 1 GO TO C19a, CHILD 1 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C19a, CHILD 2 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C19a, CHILD 3 NO 0 DON’T KNOW d REFUSED r
C GO TO C20, CHILD 1 IF C14, CHILD 1 ≠1 AND C17, CHILD 1 ≠1 OR GO TO C5, CHILD 2 IF C14, CHILD 1 =1 OR C17, CHILD 1 =1 AND C4, CHILD 1 =1 OR C10, CHILD 1=1 OR GO TO D1, IF C14, CHILD 1=1 OR C17, CHILD 1=1 AND C4, CHILD 1=0 AND C10, CHILD 1=0 BSF GO TO C20, CHILD 2 IF C14, CHILD 2 ≠1 AND C17, CHILD 2 ≠1 OR GO TO C5, CHILD 3 IF C14, CHILD 2 =1 OR C17, CHILD 2 =1 AND C4, CHILD 2 =1 OR C10, CHILD 2=1 OR GO TO D1, IF C14, CHILD 2=1 OR C17, CHILD 2=1 AND C4, CHILD 2=0 AND C10, CHILD 2=0 GO TO C20, CHILD 3 IF C14, CHILD 3 ≠1 AND C17, CHILD 3 ≠1 OR GO TO C5, CHILD 4 IF C14, CHILD 3 =1 OR C17, CHILD 3 =1 AND C4, CHILD 3 =1 OR C10, CHILD 3=1 OR GO TO D1, IF C14, CHILD 3=1 OR C17, CHILD 3=1 AND C4, CHILD 3=0 AND C10, CHILD 3=0 19a. How much money did you spend? PROBE: Your best guess is fine.	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r

	CHILD 4	CHILD 5	CHILD 6
C BSF, EHS 17. In the past month, how often have you spent time with [CHILD FIRST NAME] in person? Would you say, every day or almost every day, a few times a week, a few times a month, once or twice, or never?	EVERY DAY OR ALMOST EVERY DAY 1 GO TO C19, CHILD 4 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 GO TO C19, CHILD 5 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 GO TO C19, CHILD 6 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r
I EHS tailored for PACT f C14 ≠ 1, ask C18. In the past month, how often have you had contact with [CHILD FIRST NAME]? This would include having talked on the phone, sent letters, sent birthday cards, or sent text messages. Would you say, every day or almost every day, a few times a week, a few times a month, once or twice, or never?	EVERY DAY OR ALMOST EVERY DAY 1 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r	EVERY DAY OR ALMOST EVERY DAY 1 A FEW TIMES A WEEK 2 A FEW TIMES A MONTH 3 ONCE OR TWICE 4 NEVER 5 DON’T KNOW d REFUSED r
C BSF tailored for PACT GO TO C20, CHILD 4 IF C14, CHILD 4 ≠1 AND C17, CHILD 4 ≠1 OR GO TO C5, CHILD 5 IF C14, CHILD 4 =1 OR C17, CHILD 4 =1 AND C4, CHILD 4 =1 OR C10, CHILD 4=1 OR GO TO D1, IF C14, CHILD 4=1 OR C17, CHILD 4=1 AND C4, CHILD 4=0 AND C10, CHILD 4=0 GO TO C20, CHILD 5 IF C14, CHILD 5 ≠1 AND C17, CHILD 5 ≠1 OR GO TO C5, CHILD 6 IF C14, CHILD 5 =1 OR C17, CHILD 5 =1 AND C4, CHILD 5 =1 OR C10, CHILD 5=1 OR GO TO D1, IF C14, CHILD 5=1 OR C17, CHILD 5=1 AND C4, CHILD 5=0 AND C10, CHILD 5=0 GO TO C20, CHILD 6 IF C14, CHILD 6 ≠1 AND C17, CHILD 6 ≠1 OR GO TO C5, CHILD 7 IF C14, CHILD 6 =1 OR C17, CHILD 6 =1 AND C4, CHILD 6 =1 OR C10, CHILD 6=1 OR GO TO D1, IF C14, CHILD 6=1 OR C17, CHILD 6=1 AND C4, CHILD 6=0 AND C10, CHILD 6=0 19. In the past month, did you buy things for [CHILD FIRST NAME] that (he/she) needed like clothes, diapers, school supplies, medicine, or other things (he/she) needed?	YES 1 GO TO C23a, CHILD 4 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C23a, CHILD 5 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO C23a, CHILD 6 NO 0 DON’T KNOW d REFUSED r
C BSF GO TO C20, CHILD 4 IF C14, CHILD 4 ≠1 AND C17, CHILD 4 ≠1 OR GO TO C5, CHILD 5 IF C14, CHILD 4 =1 OR C17, CHILD 4 =1 AND C4, CHILD 4 =1 OR C10, CHILD 4=1 OR GO TO D1, IF C14, CHILD 4=1 OR C17, CHILD 4=1 AND C4, CHILD 4=0 AND C10, CHILD 4=0 GO TO C20, CHILD 5 IF C14, CHILD 5 ≠1 AND C17, CHILD 5 ≠1 OR GO TO C5, CHILD 6 IF C14, CHILD 5 =1 OR C17, CHILD 5 =1 AND C4, CHILD 5 =1 OR C10, CHILD 5=1 OR GO TO D1, IF C14, CHILD 5=1 OR C17, CHILD 5=1 AND C4, CHILD 5=0 AND C10, CHILD 5=0 GO TO C20, CHILD 6 IF C14, CHILD 6 ≠1 AND C17, CHILD6 ≠1 OR GO TO C5, CHILD 7 IF C14, CHILD 6 =1 OR C17, CHILD6 =1 AND C4, CHILD 6 =1 OR C10, CHILD 6=1 OR GO TO D1, IF C14, CHILD 6=1 OR C17, CHILD 6=1 AND C4, CHILD 6=0 AND C10, CHILD 6=0 19a. How much money did you spend? PROBE: Your best guess is fine.	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r

Some fathers find it hard to spend as much time as they want with their children. I’m going to read you a list of reasons some fathers have given us. For each one, please tell me if you strongly agree, mildly agree, mildly disagree or strongly disagree with this reason.

	CHILD 1	CHILD 2	CHILD 3
C EHS 20. I live too far away to see [CHILD FIRST NAME] more. Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r
EHS tailored for PACT C21. [MOTHER FIRST NAME] makes it hard for me to see [CHILD FIRST NAME]. Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	FILL [MOTHER NAME] FROM C8 OR C9a STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	FILL [MOTHER NAME] FROM C8 OR C9a STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	FILL [MOTHER NAME] FROM C8 OR C9a STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r
EHS tailored for PACT C22. Another family member makes it hard for me to see [CHILD FIRST NAME]. Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r
EHS tailored for PACT GO TO C5, CHILD 2, IF C4, CHILD 1=1 OR C10, CHILD 1=1. OR GO TO D1, IF C4, CHILD 1=0 OR C10, CHILD 1=0. GO TO C5, CHILD 3, IF C4, CHILD 2=1 OR C10, CHILD 2=1. OR GO TO D1, IF C4, CHILD 2=0 OR C10, CHILD 2=0. GO TO C5 CHILD 4, IF C4, CHILD 3=1 OR C10, CHILD 3=1. OR GO TO D1, IF C4, CHILD 3=0 OR C10, CHILD 3=0. C23. It’s hard to see [CHILD FIRST NAME] because I cannot financially provide for (him/her). Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r

Some fathers find it hard to spend as much time as they want with their children. I’m going to read you a list of reasons some fathers have given us. For each one, please tell me if you strongly agree, mildly agree, mildly disagree or strongly disagree with this reason.

	CHILD 4	CHILD 5	CHILD 6
C EHS 20. I live too far away to see [CHILD FIRST NAME] more. Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r
EHS tailored for PACT C21. [MOTHER FIRST NAME] makes it hard for me to see [CHILD FIRST NAME]. Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	FILL [MOTHER NAME] FROM C8 OR C9a STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	FILL [MOTHER NAME] FROM C8 OR C9a STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	FILL [MOTHER NAME] FROM C8 OR C9a STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r
EHS tailored for PACT C22. Another family member makes it hard for me to see [CHILD FIRST NAME]. Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r
EHS tailored for PACT GO TO C5 CHILD 7, IF C4, CHILD 6=1 OR C10, CHILD 6=1. OR GO TO D1, IF C4, CHILD 6=0 OR C10, CHILD 6=0. GO TO C5, CHILD 6, IF C4, CHILD 5=1 OR C10, CHILD 5=1. OR GO TO D1, IF C4, CHILD 5=0 OR C10, CHILD 5=0. GO TO C5, CHILD 5, IF C4, CHILD 4=1 OR C10, CHILD 4=1. OR GO TO D1, IF C4, CHILD 4=0 OR C10, CHILD 4=0. C23. It’s hard to see [CHILD FIRST NAME] because I cannot financially provide for (him/her). Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this reason?	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 MILDLY AGREE 2 MILDLY DISAGREE 3 STRONGLY DISAGREE 4 DON’T KNOW d REFUSED r

I’d like to talk to you about some of the relationships in your life, thinking about the women you have had children with. You told us [Fill MOTHER FIRST NAME AND LAST NAME(S) from C8 OR C9a.] (is/are) the mother(s) of your (child/children) that (is/are) under the age of 18.

	MOTHER 1	MOTHER 2	MOTHER 3
D1. Is there anyone we missed? PROGRAMMER NOTE: FILL [MOTHER FIRST AND LAST NAME] FROM C8 AND C9a AS ADDITIONAL SCREEN FOR DUPLICATE NAMES.	YES 1 GO TO C3a, CHILD 7 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2	YES 1 GO TO C3a, CHILD 8 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2	YES 1 GO TO C3a, CHILD 9 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2
BSF tailored for PACT D2. Let’s talk about [MOTHER FIRST NAME]. Are you and [MOTHER FIRST NAME] married, divorced, separated, or have you never been married to each other?	MARRIED 1 GO TO D5 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, MOTHER 2 IF C9a=MOTHER NAME WRITTEN OR GO TO D15 IF C9a=NO MOTHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	DELETE MARRIED IF D2, MOTHER 1 = 1 OR 3 MARRIED 1 GO TO D5 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, MOTHER 3 IF C9a= HAS TWO MOTHER NAMES WRITTEN OR GO TO D15 IF C9a=NO MOTHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	DELETE MARRIED IF D2, MOTHER 1 OR 2 = 1 OR 3 MARRIED 1 GO TO D5 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, MOTHER 4 IF C9a= HAS THREE MOTHER NAMES WRITTEN OR GO TO D15 IF C9a=NO MOTHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r
I IF D3=1 OR 2, GO TO D5 IF D3=3, D, OR R, GO TO D4 IF D3=1 OR 2, GO TO D5 IF D3=3, D, OR R, GO TO D4 IF D3=1 OR 2, GO TO D5 IF D3=3, D, OR R, GO TO D4 BSF F D2=1, GO TO D7 D3. How would you describe your current relationship with [MOTHER FIRST NAME]? We are romantically involved on a steady basis, we are involved in an on- again, off-again romantic relationship, or we are not in a romantic relationship.	ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 DON’T KNOW d REFUSED r	ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 DON’T KNOW d REFUSED r	ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 DON’T KNOW d REFUSED r
A PACT developed SK IF D3=3 D4. Do you have any contact with [MOTHER FIRST NAME]?	YES 1 NO 0 GO TO D11 DON’T KNOW d GO TO D11 REFUSED r GO TO D11	YES 1 NO 0 GO TO D11 DON’T KNOW d GO TO D11 REFUSED r GO TO D11	YES 1 NO 0 GO TO D11 DON’T KNOW d GO TO D11 REFUSED r GO TO D11
BSF tailored for PACT D5. Do you live with [MOTHER FIRST NAME] all of the time? By this I mean you do not have another place that you consider your home. PROBE: This is where you receive your mail, have keys, pay rent.	YES 1 GO TO D8 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO D8 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO D8 NO 0 DON’T KNOW d REFUSED r

	MOTHER 4	MOTHER 5	MOTHER 6
D1. Is there anyone we missed? PROGRAMMER NOTE: FILL [MOTHER FIRST AND LAST NAME] FROM C10 AND C11a AS ADDITIONAL SCREEN FOR DUPLICATE NAMES.	YES 1 GO TO C3a, CHILD 10 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2	YES 1 GO TO C3a, CHILD 11 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2	YES 1 GO TO C3a, CHILD 12 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2
BSF tailored for PACT D2. Let’s talk about [MOTHER FIRST NAME]. Are you and [MOTHER FIRST NAME] married, divorced, separated, or have you never been married to each other?	DELETE MARRIED IF D2, MOTHER 1, 2 OR 3 = 1 OR 3 MARRIED 1 GO TO D5 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, MOTHER 5 IF C9a= HAS FOUR MOTHER NAMES WRITTEN OR GO TO D15 IF C9a=NO MOTHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	DELETE MARRIED IF D2, MOTHER 1, 2, 3 OR 4 = 1 OR 3 MARRIED 1 GO TO D5 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, MOTHER 6 IF C9a= HAS FIVE MOTHER NAMES WRITTEN OR GO TO D15 IF C9a=NO MOTHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r	DELETE MARRIED IF D2, MOTHER 1, 2, 3, 4, OR 5 = 1 OR 3 MARRIED 1 GO TO D5 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, MOTHER 7 IF C9a= HAS SIX MOTHER NAMES WRITTEN OR GO TO D15 IF C9a=NO MOTHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r
I IF D3=1 OR 2, GO TO D5 IF D3=3, D, OR R, GO TO D4 IF D3=1 OR 2, GO TO D5 IF D3=3, D, OR R, GO TO D4 IF D3=1 OR 2, GO TO D5 IF D3=3, D, OR R, GO TO D4 BSF F D2=1, GO TO D7 D3. How would you describe your current relationship with [MOTHER FIRST NAME]? We are romantically involved on a steady basis, we are involved in an on- again, off-again romantic relationship, or we are not in a romantic relationship.	ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 DON’T KNOW d REFUSED r	ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 DON’T KNOW d REFUSED r	ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 DON’T KNOW d REFUSED r
A PACT developed SK IF D3=3 D4. Do you have any contact with [MOTHER FIRST NAME]?	YES 1 NO 0 GO TO D11 DON’T KNOW d GO TO D11 REFUSED r GO TO D11	YES 1 NO 0 GO TO D11 DON’T KNOW d GO TO D11 REFUSED r GO TO D11	YES 1 NO 0 GO TO D11 DON’T KNOW d GO TO D11 REFUSED r GO TO D11
BSF tailored for PACT D5. Do you live with [MOTHER FIRST NAME] all of the time? By this I mean you do not have another place that you consider your home. PROBE: This is where you receive your mail, have keys, pay rent.	YES 1 GO TO D8 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO D8 NO 0 DON’T KNOW d REFUSED r	YES 1 GO TO D8 NO 0 DON’T KNOW d REFUSED r

	MOTHER 1	MOTHER 2	MOTHER 3
D PACT developed 6. How many nights a week do you stay with [MOTHER FIRST NAME] in the same place?	0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 DON’T KNOW d REFUSED r	0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 DON’T KNOW d REFUSED r	0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 DON’T KNOW d REFUSED r
WFNJ-EC1 D7. Does [MOTHER FIRST NAME] live with a romantic partner all or some of the time?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r
FFCWS D8. In general, would you say your relationship with [MOTHER FIRST NAME] is excellent, very good, fair, or poor?	EXCELLENT 1 VERY GOOD 2 FAIR 3 POOR 4 DON’T KNOW d REFUSED r	EXCELLENT 1 VERY GOOD 2 FAIR 3 POOR 4 DON’T KNOW d REFUSED r	EXCELLENT 1 VERY GOOD 2 FAIR 3 POOR 4 DON’T KNOW d REFUSED r
N PAM ow, I would like to talk about you and [MOTHER FIRST NAME] as parents. D9. For the following statement, please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree. [MOTHER FIRST NAME] and I are a good parenting team.	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r
FFCWS tailored for PACT D10. For the following statement, please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree. [MOTHER FIRST NAME] supports you in the way you want to raise your children.	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r

	MOTHER 4		MOTHER 5		MOTHER 6
D PACT developed 6. How many nights a week do you stay with [MOTHER FIRST NAME] in the same place?	0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 DON’T KNOW d REFUSED r		0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 DON’T KNOW d REFUSED r		0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 DON’T KNOW d REFUSED r
WFNJ-EC1 D7. Does [MOTHER FIRST NAME] live with a romantic partner all or some of the time?	YES 1 NO 0 DON’T KNOW d REFUSED r		YES 1 NO 0 DON’T KNOW d REFUSED r		YES 1 NO 0 DON’T KNOW d REFUSED r
FFCWS D8. In general, would you say your relationship with [MOTHER FIRST NAME] is excellent, very good, fair, or poor?	EXCELLENT 1 VERY GOOD 2 FAIR 3 POOR 4 DON’T KNOW d REFUSED r		EXCELLENT 1 VERY GOOD 2 FAIR 3 POOR 4 DON’T KNOW d REFUSED r		EXCELLENT 1 VERY GOOD 2 FAIR 3 POOR 4 DON’T KNOW d REFUSED r
N PAM ow, I would like to talk about you and [MOTHER FIRST NAME] as parents. D9. For the following statement, please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree. [MOTHER FIRST NAME] and I are a good parenting team.	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r		STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r		STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r
FFCWS tailored for PACT D10. For the following statement, please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree. [MOTHER FIRST NAME] supports you in the way you want to raise your children.	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r	STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r		STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r

	MOTHER 1	MOTHER 2	MOTHER 3
BSF tailored for PACT Now, I’m going to ask you some questions about the financial support you may provide to your (child/children). D11. Do you have a legal arrangement or child support order that requires you to provide financial support for any children you have with [MOTHER FIRST NAME]?	SKIP D11-14 IF D2, MOTHER 1=1 YES 1 NO 0 GO TO D14 DON’T KNOW d GO TO D14 REFUSED r GO TO D14	SKIP D11-14 IF D2, MOTHER 2=1 YES 1 NO 0 GO TO D14 DON’T KNOW d GO TO D14 REFUSED r GO TO D14	SKIP D11-14 IF D2, MOTHER 3=1 YES 1 NO 0 GO TO D14 DON’T KNOW d GO TO D14 REFUSED r GO TO D14
D BSF 12. In the past month, how much did you pay for that order or agreement you had with [MOTHER FIRST NAME]?	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r
IF D13 = 0, D, R: Go to D2, MOTHER 2 if C9a = one mother name Or Go to D15 if C9a = no mother name If D13 = 0, d, r: Go to D2, Mother 3 if C9a = two mother names Or Go to D15 if C9a = one mother name If D13 = 0, d, r: Go to D2, Mother 4 if C9a = three mother names Or Go to D15 if C9a = two mother names FFCWS D13. In the past month, have you given financial support to [MOTHER FIRST NAME] directly instead of or in addition to any formal child support you may have paid?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r
Go to D2, Mother 2 if C9a = one mother name Or Go to D15 if C9a = no mother name Go to D2, Mother 3 if C9a = two mother names Or Go to D15 if C9a = one mother name Go to D2, Mother 4 if C9a = three mother names Or Go to D15 if C9a = two mother NAMES FFCWS D14. [IF D11=1, THEN READ Not including money that you paid as part of the formal child support,] How much money did you give [MOTHER FIRST NAME] in the past month?	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r

	MOTHER 4	MOTHER 5	MOTHER 6
BSF tailored for PACT Now, I’m going to ask you some questions about the financial support you may provide to your (child/children). D11. Do you have a legal arrangement or child support order that requires you to provide financial support for any children you have with [MOTHER FIRST NAME]?	SKIP D11-14 IF D2, MOTHER 4=1 YES 1 NO 0 GO TO D14 DON’T KNOW d GO TO D14 REFUSED r GO TO D14	SKIP D11-14 IF D2, MOTHER 5=1 YES 1 NO 0 GO TO D14 DON’T KNOW d GO TO D14 REFUSED r GO TO D14	SKIP D11-14 IF D2, MOTHER 6=1 YES 1 NO 0 GO TO D14 DON’T KNOW d GO TO D14 REFUSED r GO TO D14
D BSF 12. In the past month, how much did you pay for that order or agreement you had with [MOTHER FIRST NAME]?	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r
If D13 = 0, d, r: Go to D2, Mother 5 if C9a = four mother names Or Go to D15 if C9a = three mother names. If D13 = 0, d, r: Go to D2, Mother 6 if C9a = five mother names Or Go to D15 if C9a = four mother names If D13 = 0, d, r: Go to D2, Mother 7 if C9a = six mother names Or Go to D15 if C9a = five mother names FFCWS D13. In the past month, have you given financial support to [MOTHER FIRST NAME] directly instead of or in addition to any formal child support you may have paid?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r
FFCWS D Go to D2, Mother 5 if C9a = four mother names Or Go to D15 if C9a = THREE MOTHER names Go to D2, Mother 6 if C9a = five mother names Or Go to D15 if C9a = four mother names Go to D2, Mother 7 if C9a = six mother names Or Go to D15 if C9a = five mother names 14. [IF D11=1, THEN READ Not including money that you paid as part of the formal child support,] How much money did you give [MOTHER FIRST NAME] in the past month?	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r	$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r

Now, I’m going to ask about women you may have romantic relationships with who are not the mothers of your children.

IF D2=1 OR D3=1 OR 2, THEN FILL [MOTHER’S NAME/MOTHERS’ NAMES].

D15. Are you in a romantic relationship with someone other than [MOTHER’S NAME/MOTHERS’ NAMES]?

Y

PACT developed

ES 1

NO 0 GO TO E1

DON’T KNOW d GO TO E1

REFUSED r GO TO E1

Some people may have a romantic relationship with more than one partner. If you have a relationship with more than one partner that we haven’t already talked about, please think about the romantic relationship that you consider to be the most serious.

D

WFNJ-EC1

16. Please spell that person’s first name.

FIRST NAME

DON’T KNOW d

REFUSED r

IF D2, [MOTHER 1], [MOTHER 2], [MOTHER 3], [MOTHER 4], [MOTHER 5], OR [MOTHER 6] ≠ 1 OR 3 FILL MARRIED.

D

BSF tailored for PACT

17. Are you and [D16 FIRST NAME] married, divorced, separated, or have you never been married to each other?

MARRIED 1 GO TO D19

DIVORCED 2

SEPARATED 3

ANNULLED 4

NEVER MARRIED 5

DON’T KNOW d

REFUSED r

D

BSF

18. How would you describe your current relationship with [D16 FIRST NAME]? We are romantically involved on a steady basis, we are involved in an on-again, off-again romantic relationship, or we are not in a romantic relationship.

ROMANTICALLY INVOLVED ON STEADY BASIS 1

INVOLVED ON-AND-OFF AGAIN 2

NOT IN ROMANTIC RELATIONSHIP 3

DON’T KNOW d

REFUSED r

D

BSF tailored for PACT

19. Do you live with [D16 NAME] all of the time? By this I mean that you do not have another place that consider your home.

PROBE: You do not have another place where you receive your mail, have keys, pay rent.

YES 1

NO 0

DON’T KNOW d

REFUSED r

D

EHS tailored for PACT

20. Please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree with the following statement. [D16 FIRST NAME] makes it hard for me to see my child/children.

STRONGLY AGREE 1

MILDLY AGREE 2

MILDLY DISAGREE 3

STRONGLY DISAGREE 4

DON’T HAVE ONE 5

DON’T KNOW d

REFUSED r

Now I would like to ask you some questions about children who live with you other than your biological children.

E

PACT developed

1. Are there any children under the age of 18 who live with you all or most of the time?

YES 1

NO 0 GO TO F1

DON’T KNOW d GO TO F1

REFUSED r GO TO F1

E

PACT developed

2. How many of these children under the age of 18 live with you?

| | | CHILDREN

DON’T KNOW d

REFUSED r

SKIP E3 if D15=0 or DON’T KNOW OR REFUSED

E

PACT developed

3. How many of these children are [D16 FIRST NAME]’s children?

| | | CHILDREN

DON’T KNOW d

REFUSED r

The next questions are about work you have done for pay.

F

WFNJ tailored for PACT

1. In the past month have you worked for pay? Please include any regular paid jobs, odd jobs, temporary jobs, work in your own business, “under the table” work, “informal” work, or any other types of work you have done.

YES 1 GO TO F3

NO 0

DON’T KNOW d

REFUSED r

F2. In what month and year did you last work for pay? Please include any regular paid jobs, odd jobs, temporary jobs, work in your own business, “under the table” work, “informal” work, or any other types of work you have done.

|

WFNJ

___|___| / |___|___|___|___| GO TO F6

MONTH YEAR

DON’T KNOW d GO TO F6

REFUSED r GO TO F6

F

WFNJ tailored for PACT

3. In the past month, how much money did you make? Please include tips, bonuses, commissions, and regular overtime pay and count all money you received before taxes and deductions. If you held more than one job, include your total earnings from all of your work during the past month.

$ | | | | , | | | | AMOUNT GO TO F6

DON’T KNOW d

REFUSED r

F

WFNJ tailored for PACT

4. I just need to know a range. Can you tell me if it was . . .

$0 - $500, 1 GO TO F6

$501 - $1,000, 2 GO TO F6

$1,001 to $2,000, 3 GO TO F6

$2,001 to $3,000, 4 GO TO F6

$3,001 to $4,000, 5 GO TO F6

$4,001 to $5,000, or 6 GO TO F6

more than $5,000? 7 GO TO F6

DON’T KNOW d

REFUSED r

F

WFNJ

4a. How many weeks this past month did you work?

| | | WEEKS

DON’T KNOW d GO TO F6

REFUSED r GO TO F6

F

RWTW tailored for PACT

4b. How many hours do you usually work in a week? Your best estimate is fine.

| | | HOURS PER WEEK

99 OR MORE HOURS PER WEEK 99

DON’T KNOW d GO TO F6

REFUSED r GO TO F6

F

RWTW tailored for PACT

4c. What is your current hourly rate of pay, before taxes and deductions?

$ | | | | . | | | PER HOUR

DON’T KNOW d GO TO F6

REFUSED r GO TO F6

F

RWTW

4d. Based on what you’ve told me, last month you made about [fill AMOUNT CALCULATED FROM F4a, F4b, F4c]. Is that correct?

YES 1

NO 0 GO TO F4a

DON’T KNOW d GO TO F4a

REFUSED r GO TO F4a

NOTE: IF F4d=NO, DON’T KNOW, OR REFUSED TWICE, GO TO F5.

F

RWTW tailored for PACT

5. In addition to your pay, do you get tips, bonuses, or commissions?

YES 1

NO 0 GO TO F6

DON’T KNOW d GO TO F6

REFUSED r GO TO F6

F

RWTW tailored for PACT

5a. In the past month, how much did you receive in tips, bonuses, or commissions?

$ | | | | , | | | | AMOUNT Go to F6

DON’T KNOW d

REFUSED r

F5b. I just need to know a range. Can you tell me if it was . . .

WFNJ tailored for PACT

$0 - $100, 1

$101 - $200, 2

$201 - $300, 3

$301 - $400, 4

$401 - $500, 5

$501 - $1,000, 6

$1,001 to $2,000, 7

$2,001 to $3,000, 8

$3,001 to $4,000, 9

$4,001 to $5,000, or 10

more than $5,000? 11

DON’T KNOW d

REFUSED r

The next questions are about where you live.

F

WFNJ

6. Do you currently own your home, rent it, pay some amount toward rent, live rent free with a friend or relative, or do you have some other arrangement?

OWN OR HAVE MORTGAGE 1

RENT 2

PAY SOME OF THE RENT 3

LIVE RENT FREE (SOMEONE ELSE RENTS/OWNS HOUSE) 4

LIVE IN SHELTER 5

LIVE ON STREETS 6

LIVE IN ABANDONED BUILDING/CAR 7

OTHER (SPECIFY) 99

DON’T KNOW d

REFUSED r

F

HII

7. Do you expect that you will be able to stay in your current housing for the next year?

YES 1

NO 0

DON’T KNOW d

REFUSED r

The next questions are about your relationship with your biological father.

G

PACT developed

1. When you were growing up, would you say your biological father was . . .

very involved, 1

somewhat involved, or 2

not at all involved? 3 GO TO G3

DON’T KNOW d GO TO G3

REFUSED r GO TO G3

G

PACT developed

2. Would you say that the general quality of your relationship with your biological father while you were growing up was . . .

excellent, 1

very good, 2

good, 3

fair or, 4

poor? 5

we did not have a relationship 6

DON’T KNOW d

REFUSED r

The next questions are about how you are doing.

G

PHQ-8

3. Over the last two weeks, how often have you been bothered by any of the following problems? Would you say that the problem happened not at all, several days, more than half the days, or nearly every day?

	SELECT ONE RESPONSE PER ROW
	NOT AT ALL	SEVERAL DAYS	MORE THAN HALF THE DAYS	NEARLY EVERY DAY	DK	REF
a. Little interest or pleasure in doing things	0	1	2	3	d	r
b. Feeling down, depressed, or hopeless	0	1	2	3	d	r
c. Trouble falling or staying asleep, or sleeping too much	0	1	2	3	d	r
d. Feeling tired or having little energy	0	1	2	3	d	r
e. Poor appetite or overeating	0	1	2	3	d	r
f. Feeling bad about yourself — or that you are a failure or have let yourself or your family down	0	1	2	3	d	r
g. Trouble concentrating on things, such as reading the newspaper or watching television	0	1	2	3	d	r
h. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual	0	1	2	3	d	r

G

PSI

4. For each of the following statements, tell me if you strongly agree with the statement, agree with the statement, disagree with the statement, or strongly disagree with the statement. While you may not find a response that exactly states your feelings, give the response that comes closest to describing how you feel.

	SELECT ONE RESPONSE PER ROW
	STRONGLY AGREE	SOMEWHAT AGREE	SOMEWHAT DISAGREE	STRONGLY DISAGREE	DK	REF
a. I feel trapped by my responsibilities as a parent.	1	2	3	4	d	r
b. Sometimes I feel my (child/children) (doesn’t/don’t) like me and (doesn’t/don’t) want to be close to me.	1	2	3	4	d	r
c. When I do things for my (child/children), I get the feeling that my efforts are not appreciated very much.	1	2	3	4	d	r

G5. For each of the following statements, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree.

	SELECT ONE RESPONSE PER ROW
	STRONGLY AGREE	SOMEWHAT AGREE	SOMEWHAT DISAGREE	STRONGLY DISAGREE	DK	REF
FFCWS a. I have little control over the things that happen to me.	1	2	3	4	d	r
FFCWS b. There is really no way I can solve some of the problems I have.	1	2	3	4	d	r
FFCWS c. There is little I can do to change many of the important things in my life.	1	2	3	4	d	r
FFCWS d. I often feel helpless in dealing with problems.	1	2	3	4	d	r
FFCWS e. Sometimes I feel that I’m being pushed around.	1	2	3	4	d	r
PACT developed f. There is so much to take care of now that it’s hard for me to make plans for the future.	1	2	3	4	d	r

G

BSF

6. The following question is about any religious services you may attend. In the past year, about how often have you attended religious services? Was it . . .

never, 0

a few times a year, 1

a few times a month, or 2

once a week or more? 3

DON’T KNOW d

REFUSED r

I would like to ask you a few questions about your experience with the criminal justice system.

G

BSF

7. Have you ever been arrested?

YES 1

NO 0 GO TO H1

DON’T KNOW d

REFUSED r

G

SVORI

8. How many times in your life have you been arrested?

INTERVIEWER CODE 0 IF TIMES = 0

| | | TIMES GO TO G9

NEVER ARRESTED 0 GO TO H1

DON’T KNOW d

REFUSED r

G

SVORI tailored for PACT

8a. Would you say . . .

once or twice, 1

3 to 5 times, 2

6 to 10 times, or 3

more than 10 times? 4

DON’T KNOW d

REFUSED r

G

SVORI

9. How many times in your life have you been convicted of a crime?

INTERVIEWER CODE 0 IF TIMES = 0

| | | TIMES GO TO G10

NEVER CONVICTED 0 GO TO H1

DON’T KNOW d

REFUSED r

G9a. Would you say . . .

SVORI tailored for PACT

once or twice, 1

3 to 5 times, 2

6 to 10 times, or 3

more than 10 times? 4

DON’T KNOW d

REFUSED r

G

SVORI tailored for PACT

10. Please think of the longest time that you were in an adult correctional institution like a county, state or federal jail or prison. During that time period, how long were you in an adult correctional institution?

INTERVIEWER: IF LESS THAN 1 WEEK, ENTER 1 WEEK.

INTERVIEWER: FIRST ENTER IF RESPONSE IS WEEKS, MONTHS AND/OR YEARS. YOU WILL ENTER THE NUMBER OF YEARS AND/OR MONTH ON NEXT TWO SCREENS.

| | | |

WEEKS 1

MONTHS 2

YEARS 3

NEVER INCARCERATED 0

DON’T KNOW d

REFUSED r

G

SVORI

11. Are you currently on parole or probation?

YES 1

NO 0

DON’T KNOW d

REFUSED r

Now, I am going to ask you some questions about your interest in [PROGRAM NAME].

H

PACT developed

1. Please rate the following items on a scale of 1 to 4, with one being the area of your life you would most like to change and four being the area you would least like to change.

	CODE ONE PER ROW
	NUMBER	DK	REF
a. Your relationship with your child(ren)	| |	d	r
b. Your job situation	| |	d	r
c. Your relationship with your child(ren)’s mother(s)	| |	d	r
d. Your child support issues	| |	d	r

H2. Please tell me how much you agree with the following statements. Do you strongly agree, agree, disagree, or strongly disagree?

PACT developed	CODE ONE PER ROW
	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE	DK	REF
a. Making time to come to this program is a top priority for me. (Do you strongly agree, agree, disagree, or strongly disagree?)	1	2	3	4	d	r
b. I already know that I have other things going on that will make it hard for me to attend regularly. (Do you strongly agree, agree, disagree, or strongly disagree?)	1	2	3	4	d	r
c. Transportation problems will make it hard for me to attend regularly. (Do you strongly agree, agree, disagree, or strongly disagree?)	1	2	3	4	d	r

To thank you for your time, we would like to send you $10.

I1. What is your address?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

I2. Do you want us to send your $10 to that address?

YES 1 GO TO I3

NO 0

DON’T KNOW d

REFUSED r

I2a. What address would you like us to mail your $10 to?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

I3. What is your email address?

DON’T HAVE ONE 0

DON’T KNOW d

REFUSED r

We have a couple of questions that will help us contact you in about a year. Do you have any of the following social networking accounts?

I

Youthbuild

4. Do you have a Facebook account?

YES 1

NO 0 GO TO I5

DON’T KNOW d GO TO I5

REFUSED r GO TO I5

I4a. What name do you use on Facebook?

DON’T KNOW d

REFUSED r

I5. Do you have a MySpace account?

YES 1

NO 0 GO TO I6

DON’T KNOW d GO TO I6

REFUSED r GO TO I6

I5a. What name do you use on MySpace?

DON’T KNOW d

REFUSED r

I6. Do you have a Twitter account?

YES 1

NO 0 GO TO I7

DON’T KNOW d GO TO I7

REFUSED r GO TO I7

I6a. What name do you use on Twitter?

DON’T KNOW d

REFUSED r

I7. Do you have a social networking account other than Facebook, MySpace, or Twitter?

YES 1

NO 0 GO TO I8a

DON’T KNOW d GO TO I8a

REFUSED r GO TO I8a

I7a. What social networking provider do you use?

DON’T KNOW d

REFUSED r

We would like to contact you in about a year to see how you are doing. In case we have trouble reaching you, we would like to have the names of three people who would most likely know where you are or who you keep in close contact with, such as a grandmother or grandfather, other relative, or friend. We will not contact these people for any other reason.

I8a. What is the full name of the first person we should contact?

FIRST NAME

MIDDLE INITIAL/NAME

LAST NAME

DON’T KNOW d

REFUSED r

I8b. What is (his/her) address?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

I8c. What is (his/her) relationship to you?

WIFE/GIRLFRIEND/FIANCÉE 1

MOTHER 2

FATHER 3

SISTER/BROTHER 4

GRANDMOTHER/GRANDFATHER 5

FRIEND 6

OTHER (SPECIFY) 99

DON’T KNOW d

REFUSED r

I8d. What is (his/her) home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

NO LANDLINE, ONLY CELL PHONE 0

DON’T KNOW d

REFUSED r

I8e. Does (he/she) have a cell phone?

YES 1

NO 0 GO TO I8g

DON’T KNOW d GO TO I8g

REFUSED r GO TO I8g

I8f. Can I have that number?

| | | | - | | | | -| | | | | TELEPHONE

DON’T KNOW d

REFUSED r

I8g. What is (his/her) work telephone number?

| | | | - | | | | -| | | | | TELEPHONE

NO WORK NUMBER 0

DON’T KNOW d

REFUSED r

I8h. What is (his/her) email address?

EMAIL ADDRESS

DOESN’T HAVE ONE 0 GO TO I8j

DON’T KNOW d GO TO I8j

REFUSED r GO TO I8j

I8i. Does (he/she) have another email address?

EMAIL ADDRESS

DON’T KNOW d

REFUSED r

I8j. Which of the following is the primary social network used by this person?

Facebook, 1

Twitter, 2

MySpace, 3

personal blog, or 4

other (SPECIFY) 99

NONE 0 GO TO I9a

DON’T KNOW d GO TO I9a

REFUSED r GO TO I9a

I8k. What name does this person use in that social network?

NAME

DON’T KNOW d

REFUSED r

SECOND CONTACT

I9a. What is the full name of the second person we should contact?

FIRST NAME

MIDDLE INITIAL/NAME

LAST NAME

DON’T KNOW d

REFUSED r

I9b. What is (his/her) address?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

I9c. What is (his/her) relationship to you?

WIFE/GIRLFRIEND/FIANCÉE 1

MOTHER 2

FATHER 3

SISTER/BROTHER 4

GRANDMOTHER/GRANDFATHER 5

FRIEND 6

OTHER (SPECIFY) 99

DON’T KNOW d

REFUSED r

I9d. What is (his/her) home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

NO LANDLINE, ONLY CELL PHONE 0

DON’T KNOW d

REFUSED r

I9e. Does (he/she) have a cell phone?

YES 1

NO 0 GO TO I9g

DON’T KNOW d GO TO I9g

REFUSED r GO TO I9g

I9f. Can I have that number?

| | | | - | | | | -| | | | | TELEPHONE

DON’T KNOW d

REFUSED r

I9g. What is (his/her) work telephone number?

| | | | - | | | | -| | | | | TELEPHONE

NO WORK NUMBER 0

DON’T KNOW d

REFUSED r

I9h. What is (his/her) email address?

EMAIL ADDRESS

DOESN’T HAVE ONE 0 GO TO I9j

DON’T KNOW d GO TO I9j

REFUSED r GO TO I9j

I9i. Does (he/she) have another email address?

EMAIL ADDRESS

DON’T KNOW d

REFUSED r

I9j. Which of the following is the primary social network used by this person?

Facebook, 1

Twitter, 2

MySpace, 3

personal blog, or 4

other (SPECIFY) 99

NONE 0 GO TO I10a

DON’T KNOW d GO TO I10a

REFUSED r GO TO I10a

I9k. What name does this person use in that social network?

NAME

DON’T KNOW d

REFUSED r

THIRD CONTACT

I10a. What is the full name of the third person we should contact?

FIRST NAME

MIDDLE INITIAL/NAME

LAST NAME

DON’T KNOW d

REFUSED r

I10b. What is (his/her) address?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

I10c. What is (his/her) relationship to you?

WIFE/GIRLFRIEND/FIANCÉE 1

MOTHER 2

FATHER 3

SISTER/BROTHER 4

GRANDMOTHER/GRANDFATHER 5

FRIEND 6

OTHER (SPECIFY) 99

DON’T KNOW d

REFUSED r

I10d. What is (his/her) home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

NO LANDLINE, ONLY CELL PHONE 0

DON’T KNOW d

REFUSED r

I10e. Does (he/she) have a cell phone?

YES 1

NO 0 GO TO I10g

DON’T KNOW d GO TO I10g

REFUSED r GO TO I10g

I10f. Can I have that number?

| | | | - | | | | -| | | | | TELEPHONE

DON’T KNOW d

REFUSED r

I10g. What is (his/her) work telephone number?

| | | | - | | | | -| | | | | TELEPHONE

NO WORK NUMBER 0

DON’T KNOW d

REFUSED r

I10h. What is (his/her) email address?

EMAIL ADDRESS

DOESN’T HAVE ONE 0 GO TO I10j

DON’T KNOW d GO TO I10j

REFUSED r GO TO I10j

I10i. Does (he/she) have another email address?

EMAIL ADDRESS

DON’T KNOW d

REFUSED r

I10j. Which of the following is the primary social network used by this person?

Facebook, 1

Twitter, 2

MySpace, 3

personal blog, or 4

other (SPECIFY) 99

NONE 0 GO TO END1

DON’T KNOW d GO TO END1

REFUSED r GO TO END1

I10k. What name does this person use in that social network?

NAME

DON’T KNOW d

REFUSED r

END OF CALL

END1. Those are all of the questions I have. You will receive $10 as a token of our appreciation. We will be in touch with you again in about a year to see how you are doing. As I mentioned earlier, a computer will randomly assign you to one of two study groups. Please hand the phone back to the staff person at [PROGRAM NAME], and he or she will let you know which group you have been assigned to. Thank you.

INTERVIEWER: INFORM PROGRAM STAFF THAT RESPONDENT HAS COMPLETED THE INTERVIEW AND HE OR SHE CAN CONTINUE WITH RANDOM ASSIGNMENT.

END2. Thank you very much for your time. Those are all of the questions I have. Can you please hand the phone back to the staff person at [PROGRAM NAME]?

INTERVIEWER: INFORM PROGRAM STAFF THAT RESPONDENT IS NOT ELIGIBLE TO PARTICIPATE IN THE PACT STUDY BECAUSE HE DOES NOT HAVE ANY BIOLOGICAL CHILDREN.