Appendix C-4: Final Interview Income Questions
Final interview income questions
*********FIRST PASS****************;
[EARNINGS FROM WORK]
F1. Next are questions about your household’s income. When we say “income” we mean earnings from work, unemployment, welfare, child support, retirement income, disability income, investment income, and any type of income even if you do not get it regularly.
First, did {you/anyone in your household} have earnings from work in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F1_2
NO->GO TO F1_1
Don’t Know->GO TO F1_1
Refused->GO TO F1_1
F1_1. Did {you/anyone in your household} have earnings from work in the last 12 months, that is, since (month) 1st of (YEAR)?
YES->GO TO SKIP INSTRUCTION BEFORE F1_2
NO->GO TO F2
Don’t Know->GO TO F2
Refused->GO TO F2
IF HOUSEHOLD SIZE>1 THEN ASK F1_2. ELSE GO TO F2.
F1_2. Who had earnings from work {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OTPIONS FOR INTERVIEWERS TO CHOOSE FROM
[UNEMPLOYMENT COMPENSATION]
F2. Did {you/anyone in your household} receive income from unemployment compensation in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F2_2
NO->GO TO F2_1
Don’t Know->GO TO F2_1
Refused->GO TO F2_1
F2_1. Did {you/anyone in your household} receive income from unemployment compensation in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F2_2
NO->GO TO F3
Don’t Know->GO TO F3
Refused->GO TO F3
IF HOUSEHOLD SIZE>1 THEN ASK F2_2. ELSE GO TO F3.
F2_2. Who received income from unemployment compensation {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[WORKERS COMPENSATION]
F3. Did {you/anyone in your household} receive income from workers compensation in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F3_2
NO->GO TO F3_1
Don’t Know->GO TO F3_1
Refused->GO TO F3_1
F3_1. Did {you/anyone in your household} receive income from workers compensation in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F3_2
NO->GO TO F4
Don’t Know->GO TO F4
Refused->GO TO F4
IF HOUSEHOLD SIZE>1 THEN ASK F3_2. ELSE GO TO F4.
F3_2. Who received income from workers compensation {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[TANF]
F4. Did {you/anyone in your household} receive income from the Temporary Assistance for Needy Families (TANF) program or {STATE TANF PROGRAM NAME} in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F4_2
NO->GO TO F4_1
Don’t Know->GO TO F4_1
Refused->GO TO F4_1
F4_1. Did {you/anyone in your household} receive income from the TANF program in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F4_2
NO->GO TO F5
Don’t Know->GO TO F5
Refused->GO TO F5
IF HOUSEHOLD SIZE>1 THEN ASK F4_2. ELSE GO TO F5.
F4_2. Who received income from the TANF program {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[GENERAL ASSISTANCE]
F5. {Other than TANF, did/Did} {you/anyone in your household} receive income from General Assistance, General Relief, or the GA program in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F5_2
NO->GO TO F5_1
Don’t Know->GO TO F5_1
Refused->GO TO F5_1
F5_1. Did {you/anyone in your household} receive income from General Assistance, General Relief, or the GA program in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE 5_2
NO->GO TO F6
Don’t Know->GO TO F6
Refused->GO TO F6
IF HOUSEHOLD SIZE>1 THEN ASK F5_2. ELSE GO TO F6.
F5_2. Who received income from General Assistance, General Relief, or the GA program {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[CHILD SUPPORT]
F6. Did {you/anyone in your household} receive income from child support in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F6_2
NO->GO TO F6_1
Don’t Know->GO TO F6_1
Refused->GO TO F6_1
F6_1. Did {you/anyone in your household} receive income from child support in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F6_2
NO->GO TO F7
Don’t Know->GO TO F7
Refused->GO TO F7
IF HOUSEHOLD SIZE>1 THEN ASK F6_2. ELSE GO TO F7.
F6_2. Who received income from child support {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[ALIMONY]
F7. Did {you/anyone in your household} receive income from alimony in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F7_2
NO->GO TO F7_1
Don’t Know->GO TO F7_1
Refused->GO TO F7_1
F7_1. Did {you/anyone in your household} receive income from alimony in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F7_2
NO->GO TO F8
Don’t Know->GO TO F8
Refused->GO TO F8
IF HOUSEHOLD SIZE>1 THEN ASK F7_2. ELSE GO TO F8.
F7_2. Who received income from alimony {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[DISABILITY OR SSI]
F8. Did {you/anyone in your household} receive disability income or Supplemental Security Income (SSI) in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F8_2
NO->GO TO F8_1
Don’t Know->GO TO F8_1
Refused->GO TO F8_1
F8_1. Did {you/anyone in your household} receive disability income or SSI in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F8_2
NO->GO TO F9
Don’t Know->GO TO F9
Refused->GO TO F9
IF HOUSEHOLD SIZE>1 THEN ASK F8_2. ELSE GO TO F8_3.
F8_2. Who received disability income or SSI {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
FOR EACH PERSON SELECTED AT F8_2, ASK F8_3. ELSE GO TO F9.
F8_3. What was the source of that income received by {NAME}? SELECT ALL THAT APPLY.
SOCIAL SECURITY DISABILITY RELIEF (SSDI)
BLACK LUNG BENEFITS
SSI
[SOCIAL SECURITY]
F9. Did {you/anyone in your household} receive income from social security in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F9_2
NO->GO TO F9_1
Don’t Know->GO TO F9_1
Refused->GO TO F9_1
F9_1. Did {you/anyone in your household} receive income from social security in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F9_2
NO->GO TO F10
Don’t Know->GO TO F10
Refused->GO TO F10
IF HOUSEHOLD SIZE>1 THEN ASK F9_2. ELSE GO TO F10.
F9_2. Who received income from social security {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[RETIREMENT AND PENSIONS]
F10. Did {you/anyone in your household} receive pensions and retirement income in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F10_2
NO->GO TO F10_1
Don’t Know->GO TO F10_1
Refused->GO TO F10_1
F10_1. Did {you/anyone in your household} receive pensions and retirement income in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F10_2
NO->GO TO F11
Don’t Know->GO TO F11
Refused->GO TO F11
IF HOUSEHOLD SIZE>1 THEN ASK F10_2. ELSE GO TO F10_3.
F10_2. Who received pensions and retirement income {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
FOR EACH PERSON SELECTED AT F10_2, ASK F10_3. ELSE GO TO F11.
F10_3. What was the source of that income received by {NAME}? SELECT ALL THAT APPLY.
SOCIAL SECURITY RETIREMENT BENEFITS (SSA)
PENSIONS
OTHER RETIREMENT INCOME
[INVESTMENT]
F11. Did {you/anyone in your household} receive investment income in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F11_2
NO->GO TO F11_1
Don’t Know->GO TO F11_1
Refused->GO TO F11_1
F11_1. Did {you/anyone in your household} receive investment income in the last 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F11_2
NO->GO TO F12
Don’t Know->GO TO F12
Refused->GO TO F12
IF HOUSEHOLD SIZE>1 THEN ASK F11_2. ELSE GO TO F11_3.
F11_2. Who received investment income {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
[OTHER INCOME]
F12. Did {you/anyone in your household} receive income from other sources in the last month?
YES->GO TO SKIP INSTRUCTION BEFORE F12_2
NO->GO TO F12_1
Don’t Know->GO TO F12_1
Refused->GO TO F12_1
F12_1. Did {you/anyone in your household} receive income from other sources in the 12 months?
YES->GO TO SKIP INSTRUCTION BEFORE F12_2
NO->GO TO F13
Don’t Know->GO TO F13
Refused->GO TO F13
IF HOUSEHOLD SIZE>1 THEN ASK F12_2. ELSE GO TO F12_3.
F12_2. Who received income from other sources {in the last month/in the last 12 months}?
SHOW HOUSEHOLD MEMBERS >=16 AS REPSONSE OPTIONS FOR INTERVIEWERS TO CHOOSE FROM
FOR EACH PERSON SELECTED AT F12_2, ASK F12_3. ELSE GO TO F13.
F12_3. What was the source of that income received by {NAME}? SELECT ALL THAT APPLY.
STRIKE BENEFITS
FUEL ASSISTANCE
ROOMERS, LODGERS, OR TENANTS
EDUCATIONAL GRANTS
INSURANCE SETTLEMENT PAYMENTS
VETERANS AFFAIRS BENEFITS
LOTTERY WINNINGS
TRUST FUND PAYMENT
EMPLOYMENT BONUSES
REFUSED
DON’T KNOW
***********START SECOND PASS************
[EARNINGS FROM WORK]
IF F1=1 OR F1_1=1, THEN ASK F13. ELSE GO TO SKIP INSTRUCTION BEFORE F14.
FOR EACH PERSON SELECTED AT F1_2, ASK F13-F13_4.
F13. What is the easiest way for you to tell us {NAME}’s earnings from work before taxes; hourly, weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Hourly
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F13_1. How much did {NAME} receive {per hour/per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in earnings from work before taxes?
$_____________
IF F13 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F13_2. ELSE GO TO SKIP INSTRUCTION BEFORE F13_2a.
F13_2. {IF F1=1, ASK: How many payments did you receive in the last month?/IF F1_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
IF F13 IS HOURLY ASK F13_2A. ELSE GO TO SKIP INSTRUCTION BEFORE F13_3.
F13_2A. {IF F1=1, ASK: How many hours did {NAME} work in the last pay period?/IF F1_1=1, ASK: How many hours did {NAME} work in a typical pay period?}
____________HOURS
F13_2B. {IF F1=1, ASK: How many pay periods were there in the last month?/IF F1_1=1, ASK: How many pay periods were there in a typical month?}
____________HOURS
IF F13=MONTHLY, QUARTERLY, SEMI-ANNUALLY, YEARLY, GO TO F14. ELSE CALCULATE VERIFICATION TOTAL AND ASK F13_3.
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F13=HOURLY, VERIFICATION AMOUNT=F13_1*F13_2A*F13_2b.
IF F13=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F1=1 THEN VERIFICATION AMOUNT=F13_1*F13_2.
IF F13=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F1_1=1 THEN VERIFICATION AMOUNT=(F13_1*F13_2)/12.]
F13_3. According to our calculations, {NAME} received [TOTAL] altogether from earnings from work {in the last month/per month in the last 12 months} before taxes. Does that sound about right?
YESGO TO F14
NOASK F13_4
DON’T KNOWASK F13_4
REFUSEDASK F13_4
F13_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months} before taxes?
$___________________________
[UNEMPLOYMENT COMPENSATION]
IF F2=1 OR F2_1=1, THEN ASK F14. ELSE GO TO SKIP INSTRUCTION BEFORE F15.
FOR EACH PERSON SELECTED AT F2_2, ASK F14-F14_4.
F14. What is the easiest way for you to tell us {NAME}’s income from unemployment compensation; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F14_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in unemployment compensation?
$_____________
IF F14 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F14_2. ELSE GO TO F15.
F14_2. {IF F2=1, ASK: How many payments did you receive in the last month?/IF F2_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F14=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F2=1 THEN VERIFICATION AMOUNT=F14_1*F14_2.
IF F14=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F2_1=1 THEN VERIFICATION AMOUNT=(F14_1*F14_2)/12.]
F14_3. According to our calculations, {NAME} received [TOTAL] altogether from unemployment compensation {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F15
NOASK F14_4
DON’T KNOWASK F14_4
REFUSEDASK F14_4
F14_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[WORKERS COMPENSATION]
IF F3=1 OR F3_1=1, THEN ASK F15. ELSE GO TO SKIP INSTRUCTION BEFORE F16.
FOR EACH PERSON SELECTED AT F3_2, ASK F15-F15_4.
F15. What is the easiest way for you to tell us {NAME}’s income from workers compensation; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F15_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in workers compensation?
$_____________
IF F15 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F15_2. ELSE GO TO F16.
F15_2. {IF F3=1, ASK: How many payments did you receive in the last month?/IF F3_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F15=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F3=1 THEN VERIFICATION AMOUNT=F15_1*F15_2.
IF F15=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F3_1=1 THEN VERIFICATION AMOUNT=(F15_1*F15_2)/12.]
F15_3. According to our calculations, {NAME} received [TOTAL] altogether from workers compensation {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F16
NOASK F15_4
DON’T KNOWASK F15_4
REFUSEDASK F15_4
F15_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[TANF]
IF F4=1 OR F4_1=1, THEN ASK F16. ELSE GO TO SKIP INSTRUCTION BEFORE F17.
FOR EACH PERSON SELECTED AT F4_2, ASK F16-F16_4.
F16. What is the easiest way for you to tell us {NAME}’s income from TANF; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F16_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in TANF?
$_____________
IF F16 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F16_2. ELSE GO TO F17.
F16_2. {IF F4=1, ASK: How many payments did you receive in the last month?/IF F4_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F16=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F4=1 THEN VERIFICATION AMOUNT=F16_1*F16_2.
IF F16=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F4_1=1 THEN VERIFICATION AMOUNT=(F16_1*F16_2)/12.]
F16_3. According to our calculations, {NAME} received [TOTAL] altogether from TANF {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F17
NOASK F16_4
DON’T KNOWASK F16_4
REFUSEDASK F16_4
F16_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[GENERAL ASSISTANCE]
IF F5=1 OR F5_1=1, THEN ASK F17. ELSE GO TO SKIP INSTRUCTION BEFORE F18.
FOR EACH PERSON SELECTED AT F5_2, ASK F17-F17_4.
F17. What is the easiest way for you to tell us {NAME}’s income from the General Assistance program; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F17_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in the General Assistance program?
$_____________
IF F17 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F17_2. ELSE GO TO F18.
F17_2. {IF F5=1, ASK: How many payments did you receive in the last month?/IF F5_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F17=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F5=1 THEN VERIFICATION AMOUNT=F17_1*F17_2.
IF F17=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F5_1=1 THEN VERIFICATION AMOUNT=(F17_1*F17_2)/12.]
F17_3. According to our calculations, {NAME} received [TOTAL] altogether from the General Assistance program {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F18
NOASK F17_4
DON’T KNOWASK F17_4
REFUSEDASK F17_4
F17_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[CHILD SUPPORT]
IF F6=1 OR F6_1=1, THEN ASK F18. ELSE GO TO SKIP INSTRUCTION BEFORE F19.
FOR EACH PERSON SELECTED AT F6_2, ASK F18-F18_4.
F18. What is the easiest way for you to tell us {NAME}’s income from child support; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F18_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in child support?
$_____________
IF F18 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F18_2. ELSE GO TO F19.
F18_2. {IF F6=1, ASK: How many payments did you receive in the last month?/IF F6_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F18=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F5=1 THEN VERIFICATION AMOUNT=F18_1*F18_2.
IF F18=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F5_1=1 THEN VERIFICATION AMOUNT=(F18_1*F18_2)/12.]
F18_3. According to our calculations, {NAME} received [TOTAL] altogether from child support {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F19
NOASK F18_4
DON’T KNOWASK F18_4
REFUSEDASK F18_4
F18_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[ALIMONY]
IF F7=1 OR F7_1=1, THEN ASK F19. ELSE GO TO SKIP INSTRUCTION BEFORE F20.
FOR EACH PERSON SELECTED AT F7_2, ASK F19-F19_4.
F19. What is the easiest way for you to tell us {NAME}’s income from alimony; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F19_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in alimony?
$_____________
IF F19 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F19_2. ELSE GO TO F20.
F19_2. {IF F7=1, ASK: How many payments did you receive in the last month?/IF F7_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F19=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F7=1 THEN VERIFICATION AMOUNT=F19_1*F19_2.
IF F19=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F7_1=1 THEN VERIFICATION AMOUNT=(F19_1*F19_2)/12.]
F19_3. According to our calculations, {NAME} received [TOTAL] altogether from alimony {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F20
NOASK F19_4
DON’T KNOWASK F19_4
REFUSEDASK F19_4
F19_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[DISABILITY OR SSI]
IF F8=1 OR F8_1=1, THEN ASK F20. ELSE GO TO SKIP INSTRUCTION BEFORE F21.
FOR EACH PERSON SELECTED AT F8_2, ASK F20-F20_4.
F20. What is the easiest way for you to tell us {NAME}’s income from disability or SSI; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F20_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in disability income?
$_____________
IF F20 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F20_2. ELSE GO TO F21.
F20_2. {IF F8=1, ASK: How many payments did you receive in the last month?/IF F8_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F20=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F8=1 THEN VERIFICATION AMOUNT=F20_1*F20_2.
IF F20=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F8_1=1 THEN VERIFICATION AMOUNT=(F20_1*F20_2)/12.]
F20_3. According to our calculations, {NAME} received [TOTAL] altogether from disability {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F21
NOASK F20_4
DON’T KNOWASK F20_4
REFUSEDASK F20_4
F20_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[SOCIAL SECURITY]
IF F9=1 OR F9_1=1, THEN ASK F21. ELSE GO TO SKIP INSTRUCTION BEFORE F22.
FOR EACH PERSON SELECTED AT F9_2, ASK F21-F21_4.
F21. What is the easiest way for you to tell us {NAME}’s income from social security; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F21_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in social security?
$_____________
IF F21 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F21_2. ELSE GO TO F22.
F21_2. {IF F9=1, ASK: How many payments did you receive in the last month?/IF F9_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F21=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F9=1 THEN VERIFICATION AMOUNT=F21_1*F21_2.
IF F21=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F9_1=1 THEN VERIFICATION AMOUNT=(F21_1*F21_2)/12.]
F21_3. According to our calculations, {NAME} received [TOTAL] altogether from social security {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F22
NOASK F21_4
DON’T KNOWASK F21_4
REFUSEDASK F21_4
F21_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[PENSIONS AND RETIREMENT]
IF F10=1 OR F10_1=1, THEN ASK F22. ELSE GO TO SKIP INSTRUCTION BEFORE F23.
FOR EACH PERSON SELECTED AT F10_2, ASK F22-F22_4.
F22. What is the easiest way for you to tell us {NAME}’s income from pensions and retirement; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F22_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in pensions and retirement?
$_____________
IF F22 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F22_2. ELSE GO TO F23.
F22_2. {IF F10=1, ASK: How many payments did you receive in the last month?/IF F10_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F22=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F10=1 THEN VERIFICATION AMOUNT=F22_1*F22_2.
IF F22=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F10_1=1 THEN VERIFICATION AMOUNT=(F22_1*F22_2)/12.]
F22_3. According to our calculations, {NAME} received [TOTAL] altogether from pensions and retirement {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F23
NOASK F22_4
DON’T KNOWASK F22_4
REFUSEDASK F22_4
F22_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[INVESTMENT INCOME]
IF F11=1 OR F11_1=1, THEN ASK F23. ELSE GO TO SKIP INSTRUCTION BEFORE F24.
FOR EACH PERSON SELECTED AT F11_2, ASK F23-F23_4.
F23. What is the easiest way for you to tell us {NAME}’s investment income; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F23_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in investment?
$_____________
IF F23 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F23_2. ELSE GO TO F24.
F23_2. {IF F11=1, ASK: How many payments did you receive in the last month?/IF F11_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F23=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F11=1 THEN VERIFICATION AMOUNT=F23_1*F23_2.
IF F23=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F11_1=1 THEN VERIFICATION AMOUNT=(F23_1*F23_2)/12.]
F23_3. According to our calculations, {NAME} received [TOTAL] altogether from investment {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO F24
NOASK F23_4
DON’T KNOWASK F23_4
REFUSEDASK F23_4
F23_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
[OTHER INCOME]
IF F12=1 OR F12_1=1, THEN ASK F24. ELSE GO TO NEXT SECTION].
FOR EACH PERSON SELECTED AT F12_2, ASK F24-F24_4.
F24. What is the easiest way for you to tell us {NAME}’s income from other sources; weekly, every other week, twice a month, monthly, quarterly, semi-annually or yearly?
Weekly
Every other week
Twice a month
Monthly
Quarterly
Semi-annually
Yearly
F24_1. How much did {NAME} receive {per week/every other week/twice a month/per month/per quarter/semi-annually/per year} in other sources of income?
$_____________
IF F24 IS WEEKLY, EVERY OTHER WEEK, TWICE A MONTH, ASK F24_2. ELSE GO TO NEXT SECTION.
F24_2. {IF F12=1, ASK: How many payments did you receive in the last month?/IF F12_1=1, ASK: How many payments did you receive in the last 12 months?}
____________PAYMENTS
[CAPI COMPUTE A LAST MONTH OR MONTHLY INCOME FOR VERIFICATION PURPOSE:
IF F24=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F12=1 THEN VERIFICATION AMOUNT=F24_1*F24_2.
IF F24=WEEKLY, EVERY OTHER WEEK, TWICE A MONTH AND F12_1=1 THEN VERIFICATION AMOUNT=(F24_1*F24_2)/12.]
F24_3. According to our calculations, {NAME} received [TOTAL] altogether from other sources of income {in the last month/per month in the last 12 months}. Does that sound about right?
YESGO TO NEXT SECTION
NOASK F24_4
DON’T KNOWASK F24_4
REFUSEDASK F24_4
F24_4. What is your best estimate of the correct total amount {NAME} received {in the last month/per month in the last 12 months}?
$___________________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ting Yan |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |