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ACS Respondent Burden Cognitive Testing

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Round 3: Year of Naturalization and Year of Entry (Group 1), Weeks Worked and Income (Group 2)







American Community Survey

Cognitive Test

Interviewer-administered Survey


Round 3:
Year of Naturalization and Year of Entry (Group 1) - Versions 1 and 2
Weeks Worked and Income (Group 2)



June 9, 2017


























Year of Naturalization and Year of Entry (Group 1) - Version 1


Participant ID #: |___|___|___|___|___|___|___|___|___|___|

DETAILED QUESTIONS-PERSON 1


NAME ____________________



7a. I will now be asking a series of questions about you.

The next few questions deal with your place of birth and citizenship...

Where were you born?



ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.




_______ State = Go to 10a1

OR

Not born in the US = Go to 7b




7b. In what country were you born?


___________ Country


INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a.

OTHERWISE GO TO QUESTION 8a.



8a. Are you a citizen of the United States?

Yes = Go to 8b

No = Go to 9a



8b. Were you born abroad of U.S. citizen parent or parents, or did you become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents = Go to 9a

Citizen by naturalization = Go to 8c

(YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1996, between 1997 and 2004, or 2005 or later?

IF THIS PERSON WAS BORN BETWEEN 1985 AND 1996, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1985 and 1996, between 1997 and 2004, or 2005 or later?

IF THIS PERSON WAS BORN BETWEEN 1997 AND 2004, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1997 and 2004, or 2005 or later?


Before 1985 = Go to 9a

1985 – 1996 = Go to 9a

1997 – 2004 = Go to 9a

2005 or later = Go to 8d


*8d. In what year was that?



ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.




_______________ Year

(YEAR OF ENTRY: 9a – 9b)


IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did you come to live in the United States? Was it before 1985, between 1985 and 1996, between 1997 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.

IF THIS PERSON WAS BORN BETWEEN 1985 AND 1996, READ THIS:

*9a. In what year did you come to live in the United States? Was it between 1985 and 1996, between 1997 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.

IF THIS PERSON WAS BORN BETWEEN 1997 AND 2004, READ THIS:

*9a. In what year did you come to live in the United States? Was it between 1997 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.


Before 1985 = Go to 10a1

1985 - 1996 = Go to 10a1

1997 - 2004 = Go to 10a1

2005 or later = Go to 9b


*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


_________________ Year


10a1. The next questions are about schooling and

education. 


At any time IN THE LAST 3 MONTHS, have you

attended school or college?  Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that leads to a high school diploma or a college degree. 





Yes

No = Go to 11


10a2. Was that a public school or college, a private

school or college, or home school?



Public school or college

Private school or college or home school



10b. What grade or level were you attending?


Nursery school or preschool

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

College undergraduate years, that is a college freshman to senior

Graduate or professional school beyond a bachelor’s degree, for example a Master’s or PhD program or medical or law school



11. What is the highest degree or level of school you have COMPLETED?



No schooling completed

Nursery school

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12, no diploma

Regular high school diploma

GED or alternative credential

Some college, no degree

Associate’s degree (for example: AA, AS)

Bachelor’s degree (for example: BA, BS).

Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)

Doctorate degree (for example: PhD, EdD)

Vocational or technical license


INSTRUCTION E

IF RESPONSE TO QUESTION 11 IS BACHELOR’S DEGREE OR HIGHER, ASK QUESTION 12.

OTHERWISE GO TO QUESTION 13.



12. This question focuses on your BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES you have received? For example, chemical engineering, elementary teacher education, or organizational psychology.


IF THIS PERSON HAS MORE THAN ONE MAJOR OR BACHELOR’S DEGREE, ASK FOR ALL MAJOR FIELDS.



____________________________

____________________________

____________________________



13. What is your ancestry or ethnic origin?

(For example: Italian, Jamaican, African-American, Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian and so on.)






____________________________

___________________________

_



14a. Do you speak a language other than English at home?



Yes

No = Go to INSTRUCTION F




14b. What is this language?




__________________________



14c. How well do you speak English – very well, well, not well, not at all?

Very well

Well

Not well

Not at all

INSTRUCTION F

If there is another person to collect detailED person data for, Continue to person 2.

Otherwise, end interview.

























DETAILED QUESTIONS-PERSON 2


NAME ____________________



7a. I will now be asking a series of questions about <Name>.

The next few questions deal with <Name’s> place of birth and citizenship...

Where was <Name> born?



ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.




_______ State = Go to 10a1

OR

Not born in the US = Go to 7b




7b. In what country was <Name> born?


___________ Country


INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a.

OTHERWISE GO TO QUESTION 8a.



8a. Is <Name> a citizen of the United States?

Yes = Go to 8b

No = Go to 9a



8b. Was <Name> born abroad of U.S. citizen parent or parents, or did <Name> become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents = Go to 9a

Citizen by naturalization = Go to 8c

(YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1996, between 1997 and 2004, or 2005 or later?

IF THIS PERSON WAS BORN BETWEEN 1985 AND 1996, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1985 and 1996, between 1997 and 2004, or 2005 or later?

IF THIS PERSON WAS BORN BETWEEN 1997 AND 2004, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1997 and 2004, or 2005 or later?


Before 1985 = Go to 9a

1985 – 1996 = Go to 9a

1997 – 2004 = Go to 9a

2005 or later = Go to 8d


*8d. In what year was that?



ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.




_______________ Year

(YEAR OF ENTRY: 9a – 9b)


IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it before 1985, between 1985 and 1996, between 1997 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.

IF THIS PERSON WAS BORN BETWEEN 1985 AND 1996, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it between 1985 and 1996, between 1997 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.

IF THIS PERSON WAS BORN BETWEEN 1997 AND 2004, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it between 1997 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


Before 1985 = Go to 10a1

1985 - 1996 = Go to 10a1

1997 - 2004 = Go to 10a1

2005 or later = Go to 9b


*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


_________________ Year

10a1. The next questions are about schooling and

education. 


At any time IN THE LAST 3 MONTHS, has <Name> attended school or college?  Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that leads to a high school diploma or a college degree. 





Yes

No = Go to 11



10a2. Was that a public school or college, a private

school or college, or home school?



Public school or college

Private school or college or home school



10b. What grade or level was <Name> attending?


Nursery school or preschool

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

College undergraduate years, that is a college freshman to senior

Graduate or professional school beyond a bachelor’s degree, for example a Master’s or PhD program or medical or law school



11. What is the highest degree or level of school <Name> has COMPLETED?



No schooling completed

Nursery school

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12, no diploma

Regular high school diploma

GED or alternative credential

Some college, no degree

Associate’s degree (for example: AA, AS)

Bachelor’s degree (for example: BA, BS).

Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)

Doctorate degree (for example: PhD, EdD)

Vocational or technical license


INSTRUCTION E

IF RESPONSE TO QUESTION 11 IS BACHELOR’S DEGREE OR HIGHER, ASK QUESTION 12.

OTHERWISE, GO TO QUESTION 13.


12. This question focuses on <Name’s> BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES <Name> has received? For example, chemical engineering, elementary teacher education, or organizational psychology.


IF THIS PERSON HAS MORE THAN ONE MAJOR OR BACHELOR’S DEGREE, ASK FOR ALL MAJOR FIELDS.



____________________________

____________________________

____________________________



13. What is <Name’s> ancestry or ethnic origin?

(For example: Italian, Jamaican, African-American, Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian and so on.)






____________________________

____________________________



14a. Does <Name> speak a language other than English at home?



Yes

No = Go to INSTRUCTION F



14b. What is this language?




__________________________



14c. How well does <Name> speak English – very well, well, not well, not at all?

Very well

Well

Not well

Not at all

INSTRUCTION F

If there is another person to collect detailED person data for, Continue to person 3.

Otherwise, end interview.

























DETAILED QUESTIONS-PERSON 3


NAME ____________________



7a. I will now be asking a series of questions about <Name>.

The next few questions deal with <Name’s> place of birth and citizenship...

Where was <Name> born?



ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.




_______ State = Go to 10a1

OR

Not born in the US = Go to 7b




7b. In what country was <Name> born?


___________ Country


INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a.

OTHERWISE, GO TO QUESTION 8a.



8a. Is <Name> a citizen of the United States?

Yes = Go to 8b

No = Go to 9a



8b. Was <Name> born abroad of U.S. citizen parent or parents, or did <Name> become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents = Go to 9a

Citizen by naturalization = Go to 8c

(YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1996, between 1997 and 2004, or 2005 or later?

IF THIS PERSON WAS BORN BETWEEN 1985 AND 1996, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1985 and 1996, between 1997 and 2004, or 2005 or later?

IF THIS PERSON WAS BORN BETWEEN 1997 AND 2004, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1997 and 2004, or 2005 or later?


Before 1985 = Go to 9a

1985 – 1996 = Go to 9a

1997 – 2004 = Go to 9a

2005 or later = Go to 8d


*8d. In what year was that?



ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.




_______________ Year

(YEAR OF ENTRY: 9a – 9b)


IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it before 1985, between 1985 and 1996, between 1997 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.

IF THIS PERSON WAS BORN BETWEEN 1985 AND 1996, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it between 1985 and 1996, between 1997 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.

IF THIS PERSON WAS BORN BETWEEN 1997 AND 2004, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it between 1997 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


Before 1985 = Go to 10a1

1985 - 1996 = Go to 10a1

1997 - 2004 = Go to 10a1

2005 or later = Go to 9b


*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


_________________ Year

10a1. The next questions are about schooling and

education. 


At any time IN THE LAST 3 MONTHS, has <Name> attended school or college?  Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that leads to a high school diploma or a college degree. 






Yes

No = Go to 11


10a2. Was that a public school or college, a private

school or college, or home school?



Public school or college

Private school or college or home school



10b. What grade or level was <Name> attending?


Nursery school or preschool

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

College undergraduate years, that is a college freshman to senior

Graduate or professional school beyond a bachelor’s degree, for example a Master’s or PhD program or medical or law school



11. What is the highest degree or level of school <Name> has COMPLETED?



No schooling completed

Nursery school

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12, no diploma

Regular high school diploma

GED or alternative credential

Some college, no degree

Associate’s degree (for example: AA, AS)

Bachelor’s degree (for example: BA, BS).

Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)

Doctorate degree (for example: PhD, EdD)

Vocational or technical license


INSTRUCTION E

IF RESPONSE TO QUESTION 11 IS BACHELOR’S DEGREE OR HIGHER, ASK QUESTION 12.

OTHERWISE, GO TO QUESTION 13.



12. This question focuses on <Name’s> BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES <Name> has received? For example, chemical engineering, elementary teacher education, or organizational psychology.


IF THIS PERSON HAS MORE THAN ONE MAJOR OR BACHELOR’S DEGREE, ASK FOR ALL MAJOR FIELDS.



____________________________

____________________________

____________________________



13. What is <Name’s> ancestry or ethnic origin?

(For example: Italian, Jamaican, African-American, Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian and so on.)






____________________________

____________________________



14a. Does <Name> speak a language other than English at home?



Yes

No = Go to INSTRUCTION F




14b. What is this language?




__________________________



14c. How well does <Name> speak English – very well, well, not well, not at all?

Very well

Well

Not well

Not at all

INSTRUCTION F

end interview.












Year of Naturalization and Year of Entry (Group 1) - Version 2


Participant ID #:|___|___|___|___|___|___|___|___|___|___|

DETAILED QUESTIONS-PERSON 1


NAME ____________________



7a. I will now be asking a series of questions about you.



The next few questions deal with your place of birth and citizenship...

Where were you born?



ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.




_______ State = Go to 10a1

OR

Not born in the US = Go to 7b




7b. In what country were you born?


___________ Country


INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a.

OTHERWISE GO TO QUESTION 8a.



8a. Are you a citizen of the United States?

Yes = Go to 8b

No = Go to 9a



8b. Were you born abroad of U.S. citizen parent or parents, or did you become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents = Go to 9a

Citizen by naturalization = Go to 8c

YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1995 and 1999, between 2000 and 2004, or 2005 or later?


Before 1985  Go to 9a

1985 – 1989  Go to 9a

1990 – 1994  Go to 9a

1995 – 1999  Go to 9a

2000 – 2004  Go to 9a

2005 or later  Go to 8d



*8d. In what year was that?



ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.




_______________ Year

(YEAR OF ENTRY: 9a – 9b)


IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did you come to live in the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*9a. In what year did you come to live in the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*9a. In what year did you come to live in the United States? Was between 1990 and 1994, 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*9a. In what year did you come to live in the United States? Was between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.



Before 1985  Go to 10a1

1985 - 1989  Go to 10a1

1990 - 1994  Go to 10a1

1995 - 1999  Go to 10a1

2000 - 2004  Go to 10a1

2005 or later  Go to 9b


*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


_________________ Year


10a1. The next questions are about schooling and

education. 


At any time IN THE LAST 3 MONTHS, have you

attended school or college?  Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that leads to a high school diploma or a college degree. 





Yes

No = Go to 11



10a2. Was that a public school or college, a private

school or college, or home school?



Public school or college

Private school or college or home school



10b. What grade or level were you attending?


Nursery school or preschool

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

College undergraduate years, that is a college freshman to senior

Graduate or professional school beyond a bachelor’s degree, for example a Master’s or PhD program or medical or law school



11. What is the highest degree or level of school you have COMPLETED?



No schooling completed

Nursery school

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12, no diploma

Regular high school diploma

GED or alternative credential

Some college, no degree

Associate’s degree (for example: AA, AS)

Bachelor’s degree (for example: BA, BS).

Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)

Doctorate degree (for example: PhD, EdD)

Vocational or technical license


INSTRUCTION E



IF RESPONSE TO QUESTION 11 IS BACHELOR’S DEGREE OR HIGHER, ASK QUESTION 12.

OTHERWISE, GO TO QUESTION 13.



12. This question focuses on your BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES you have received? For example, chemical engineering, elementary teacher education, or organizational psychology.


IF THIS PERSON HAS MORE THAN ONE MAJOR OR BACHELOR’S DEGREE, ASK FOR ALL MAJOR FIELDS.



____________________________

____________________________

____________________________



13. What is your ancestry or ethnic origin?

(For example: Italian, Jamaican, African-American, Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian and so on.)






____________________________

____________________________



14a. Do you speak a language other than English at home?



Yes

No = Go to INSTRUCTION F




14b. What is this language?




__________________________



14c. How well do you speak English – very well, well, not well, not at all?

Very well

Well

Not well

Not at all

INSTRUCTION F

If there is another person to collect detailED person data for, Continue to person 2.

Otherwise, end interview.























DETAILED QUESTIONS-PERSON 2


NAME ____________________



7a. I will now be asking a series of questions about <Name>.

The next few questions deal with <Name’s> place of birth and citizenship...

Where was <Name> born?



ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.




_______ State = Go to 10a1

OR

Not born in the US = Go to 7b




7b. In what country was <Name> born?


___________ Country


INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a.

OTHERWISE GO TO QUESTION 8a.



8a. Is <Name> a citizen of the United States?

Yes = Go to 8b

No = Go to 9a



8b. Was <Name> born abroad of U.S. citizen parent or parents, or did <Name> become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents = Go to 9a

Citizen by naturalization = Go to 8c

(YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 2000 and 2004, or 2005 or later?




Before 1985  Go to 9a

1985 – 1989  Go to 9a

1990 – 1994  Go to 9a

1995 – 1999  Go to 9a

2000 – 2004  Go to 9a

2005 or later  Go to 8d


*8d. In what year was that?



ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.




_______________ Year

IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 1990 and 1994, 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


Before 1985  Go to 10a1

1985 - 1989  Go to 10a1

1990 - 1994  Go to 10a1

1995 - 1999  Go to10a1

2000 - 2004  Go to 10a1

2005 or later  Go to 9b



*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


_________________ Year

10a1. The next questions are about schooling and

education. 


At any time IN THE LAST 3 MONTHS, has <Name> attended school or college?  Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that leads to a high school diploma or a college degree. 





Yes

No = Go to 11


10a2. Was that a public school or college, a private

school or college, or home school?


Public school or college

Private school or college or home school



10b. What grade or level was <Name> attending?


Nursery school or preschool

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

College undergraduate years, that is a college freshman to senior

Graduate or professional school beyond a bachelor’s degree, for example a Master’s or PhD program or medical or law school



11. What is the highest degree or level of school <Name> has COMPLETED?



No schooling completed

Nursery school

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12, no diploma

Regular high school diploma

GED or alternative credential

Some college, no degree

Associate’s degree (for example: AA, AS)

Bachelor’s degree (for example: BA, BS).

Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)

Doctorate degree (for example: PhD, EdD)

Vocational or technical license


INSTRUCTION E

IF RESPONSE TO QUESTION 11 IS BACHELOR’S DEGREE OR HIGHER, ASK QUESTION 12.

OTHERWISE, GO TO QUESTION 13.



12. This question focuses on <Name’s> BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES <Name> has received? For example, chemical engineering, elementary teacher education, or organizational psychology.


IF THIS PERSON HAS MORE THAN ONE MAJOR OR BACHELOR’S DEGREE, ASK FOR ALL MAJOR FIELDS.



____________________________

____________________________

____________________________



13. What is <Name’s> ancestry or ethnic origin?

(For example: Italian, Jamaican, African-American, Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian and so on.)






____________________________

____________________________



14a. Does <Name> speak a language other than English at home?



Yes

No = Go to INSTRUCTION F




14b. What is this language?




__________________________



14c. How well does <Name> speak English – very well, well, not well, not at all?

Very well

Well

Not well

Not at all

INSTRUCTION F

If there is another person to collect detailED person data for, Continue to person 3.

Otherwise, end interview.











DETAILED QUESTIONS-PERSON 3


NAME ____________________



7a. I will now be asking a series of questions about <Name>.

The next few questions deal with <Name’s> place of birth and citizenship...

Where was <Name> born?



ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.




_______ State = Go to 10a1

OR

Not born in the US = Go to 7b




7b. In what country was <Name> born?


___________ Country



INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a.

OTHERWISE, GO TO QUESTION 8a.



8a. Is <Name> a citizen of the United States?

Yes = Go to 8b

No = Go to 9a



8b. Was <Name> born abroad of U.S. citizen parent or parents, or did <Name> become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents = Go to 9a

Citizen by naturalization = Go to 8c

(YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 2000 and 2004, or 2005 or later?



Before 1985 = Go to 9a

1985 – 1989 = Go to 9a

1990 – 1994 = Go to 9a

1995 – 1999 = Go to 9a

2000 – 2004 = Go to 9a

2005 or later = Go to 8d


*8d. In what year was that?



ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.




_______________ Year

(YEAR OF ENTRY: 9a – 9b)


IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 1990 and 1994, 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


Before 1985  Go to 10a1

1985 - 1989  Go to 10a1

1990 - 1994  Go to 10a1

1995 - 1999  Go to 10a1

2000 - 2004  Go to 10a1

2005 or later  Go to 9b


*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


_________________ Year

10a1. The next questions are about schooling and

education. 


At any time IN THE LAST 3 MONTHS, has <Name> attended school or college?  Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that leads to a high school diploma or a college degree. 





Yes

No = Go to 11


10a2. Was that a public school or college, a private

school or college, or home school?


Public school or college

Private school or college or home school



10b. What grade or level was <Name> attending?


Nursery school or preschool

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

College undergraduate years, that is a college freshman to senior

Graduate or professional school beyond a bachelor’s degree, for example a Master’s or PhD program or medical or law school


11. What is the highest degree or level of school <Name> has COMPLETED?


No schooling completed

Nursery school

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12, no diploma

Regular high school diploma

GED or alternative credential

Some college, no degree

Associate’s degree (for example: AA, AS)

Bachelor’s degree (for example: BA, BS).

Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)

Doctorate degree (for example: PhD, EdD)

Vocational or technical license


INSTRUCTION E

IF RESPONSE TO QUESTION 11 IS BACHELOR’S DEGREE OR HIGHER, ASK QUESTION 12.

OTHERWISE, GO TO QUESTION 13.



12. This question focuses on <Name’s> BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES <Name> has received? For example, chemical engineering, elementary teacher education, or organizational psychology.


IF THIS PERSON HAS MORE THAN ONE MAJOR OR BACHELOR’S DEGREE, ASK FOR ALL MAJOR FIELDS.



____________________________

____________________________

____________________________



13. What is <Name’s> ancestry or ethnic origin?

(For example: Italian, Jamaican, African-American, Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian and so on.)






____________________________

____________________________



14a. Does <Name> speak a language other than English at home?



Yes

No = Go to INSTRUCTION F




14b. What is this language?




__________________________



14c. How well does <Name> speak English – very well, well, not well, not at all?

Very well

Well

Not well

Not at all

INSTRUCTION F

end interview.













Weeks Worked and Income (Group 2)



Participant ID #: |___|___|___|___|___|___|___|___|___|___|


DETAILED QUESTIONS-PERSON 1


NAME ___________


29a. Now, I am going to ask a series of questions about employment…

LAST WEEK, did you work for pay at a job or business?


(Include any work even if you worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or were on active duty in the Armed Forces.)

Yes = go to 31

No


29b. LAST WEEK, did you do ANY work for pay, even for as little as one hour?



Yes

No = go to 35a



31. LAST WEEK, how did you USUALLY get to work?


(If you usually used more than one method of transportation during the trip, report the one used for most of the distance.)




Car, truck, or van

Bus or trolley bus

Streetcar or trolley car

Subway or elevated

Railroad

Ferryboat

Taxicab

Motorcycle

Bicycle

Walked

Worked at home = go to 39

Other method


INSTRUCTION M

IF RESPONSE TO QUESTION 31 IS “CAR, TRUCK, OR VAN”, GO TO QUESTION 32.

OTHERWISE, GO TO QUESTION 33.



32. LAST WEEK, how many people including yourself usually rode to work together?



____


33. LAST WEEK, what time did you usually leave for work?


(What hour?)

(How many minutes past the hour?)

(Was that AM or PM?)


Hour Minute

__ : __ a.m.

p.m.

 p.m.


34. LAST WEEK, how many minutes did it usually take you to get from home to work?


ENTER A ONE-WAY COMMUTE TIME FOR THE PERSON’S USUAL DAILY COMMUTE FROM HOME TO WORK LAST WEEK.



___ Minutes


INSTRUCTION N

IF RESPONSE TO QUESTION 29B IS “NO” ASK QUESTION 35A.

OTHERWISE, GO TO QUESTION 39.



35a. LAST WEEK, were you on layoff from a job?



Yes = go to 35c

No



35b. LAST WEEK, were you TEMPORARILY absent from a job or business because of vacation, temporary illness, maternity leave, other family or personal reasons, bad weather, etc.?


Yes = go to 38

No = go to 36



35c. Have you been informed that you will be recalled to work within the next 6 months OR been given a date to return to work?


Yes = go to 37a

No




36. During the LAST 4 WEEKS, have you been ACTIVELY looking for work?


Yes

No = go to 38




37a. LAST WEEK, could you have started a job if offered one (or returned to work if recalled)?


Yes = go to 38

No



37b. Why was that?


Own temporary illness

Going to school or some other reason


38. When did you last work, even for a few days?




Within the past 12 months

Between 1 and 5 years ago

Over 5 years ago or never worked = go to 47e


(WEEKS WORKED AND HOURS WORKED: 39 – 40c)


*39. During the 52 weeks covering 2016, that is from January 1, 2016 to December 31, 2016, in the weeks you worked, how many hours did you usually work each week?


____ Usual hours each week



*40a. During the 52 weeks covering 2016, did you work EVERY week? Count paid vacation, paid sick leave, and military service as work.


__Yes = go to 41a

__ No


*40b. During the 52 weeks covering 2016, how many WEEKS did you work? Include paid time off and include weeks when you only worked for a few hours. If you would rather give your answer in months, you may do so.


IF THE ANSWER IS BETWEEN 1 AND 12, READ:

(Is that weeks or months?)




__Weeks

__Months


41a. The next series of questions are about the type of business you worked for and the type of work that you did last.

If you had more than one job, describe the one at which the most hours were worked.

Let’s start with the first question. I am going to read 5 categories. Please pick the one that best describes who you worked for

- a private organization or company, government, the U.S. Armed Forces (active duty), self-employed, or working without pay in a family business.


Private organization or company

Government = go to 41c

U.S. Armed Forces (active duty) = go to 42b

Self-employed = go to 41d

Working without pay in a family business = go to 42a


41b. Was this a non-profit organization or for-profit company?


Non-profit organization = go to 42a

For-profit company = go to 42a


41c. Was this for Local, State, or the Federal Government?


Local = go to 42a

State = go to 42a

Federal = go to 42a


41d. Was this self-employment incorporated or not incorporated?


Incorporated

Not incorporated



42a. What was the name of your company, business or other employer?



_____________________ = go to 43


42b. Which branch of the Armed Forces do you work for?


U.S. Army = go to 45

U.S. Navy = go to 45

U.S. Air Force = go to 45

U.S. Marine Corps = go to 45

U.S. Coast Guard = go to 45



43. What kind of business or industry was this? For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank.



_____________________


44. Is this business mainly -- manufacturing, wholesale trade, retail trade or some other kind of business?



Manufacturing

Wholesale trade

Retail trade

Other (agriculture, construction, service, government, etc.)


45. What kind of work were you doing at this job? For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant.



_________________________


46. What were your most important activities or duties at this job? For example, patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records.


__________________________

__________________________

__________________________

(INCOME: 47a - 48)


The next few questions are about income received in 2016, that is from January 1, 2016 to December 31, 2016…


*47a. Did you receive any wages or salary?




Yes

No


If “yes” to 47a, read:

*47b. Did you receive any additional tips, bonuses or commissions in 2016?



If “No” to 47a, read:

*47b. Did you receive any tips, bonuses or commissions in 2016?




Yes

No


*47c. Did you receive any self-employment income in 2016, including work that was paid for in cash? Consider income from own businesses (farm or non-farm) including proprietorships and partnerships.



Yes

No = go to 47e



*47d. Was this income a loss?


Yes

No


*47e.

if “OVER 5 YEARS AGO OR NEVER WORKED” TO 38 READ:

The next few questions are about income received in 2016, that is from January 1, 2016 to December 31, 2016…


Did you receive any interest or dividends? Consider even small amounts credited to an account.


Otherwise, READ:

Did you receive any interest or dividends in 2016? Consider even small amounts credited to an account.




Yes

No




*47f. Did you receive any net rental income in 2016?


Yes

No = go to 47h



*47g. Was this income a loss?


Yes

No


*47h. Did you receive any royalty income or income from estates and trusts in 2016?



Yes

No


*47i. Did you receive any Social Security or Railroad Retirement benefits in 2016?



Yes

No


*47j. Did you receive any Supplemental Security Income (SSI) payments in 2016?



Yes

No


*47k. Did you receive any public assistance or public welfare payments from the state or local welfare office in 2016?




Yes

No

*47l . Did you receive any retirement, survivor, or disability pensions in 2016?


(Do not include Social Security.)



Yes

No

*47m. Did you receive income on a REGULAR basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support or alimony in 2016?


(Do not include lump sum payments such as money from an inheritance or sale of a home.)



Yes

No

*48.

If “Yes” to ONLY 47A or 47b (either one or both), READ:

What was your TOTAL income in 2016? Include amount from all jobs before taxes and other deductions.


If “Yes” to ONLY 47c, Read:

What was your TOTAL self-employment income in 2016, including amount received in cash? Report total after operating expenses.


If “Yes” to ONLY 47c And 47D (BOTH), Read:

What was your TOTAL self-employment income in 2016, including amount received in cash? Report total after operating expenses and report losses as a negative amount.


OTHERWISE, continue as follows:


Read:

What was your total income in 2016 from all of the sources you just mentioned?


If “Yes” to 47A or 47b, READ:

Include amount from all jobs before taxes and other deductions.


If “Yes” to 47c, Read:

For self-employment income, include amount received in cash and report the total after operating expenses.


If “Yes” to 47D or 47g, Read: Subtract the loss amount from the total.


If “Yes” to 47E, 47F, OR 47H, Read:

For income received jointly, include the appropriate portion for you in the total.







$_________________________

Total Income

If net income was a loss precede amount with a '-'

INSTRUCTION O

If there is another person to collect detailED person data for, Continue to person 2.

Otherwise, end interview.














DETAILED QUESTIONS-PERSON 2


NAME ___________


29a. Now, I am going to ask a series of questions about <Name’s> employment…

LAST WEEK, did <Name> work for pay at a job or business?


(Include any work even if <Name> worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or was on active duty in the Armed Forces.)

Yes = go to 31

No


29b. LAST WEEK, did <Name> do ANY work for pay, even for as little as one hour?



Yes

No = go to 35a



31. LAST WEEK, how did <Name> USUALLY get to work?


(If <Name> usually used more than one method of transportation during the trip, report the one used for most of the distance.)




Car, truck, or van

Bus or trolley bus

Streetcar or trolley car

Subway or elevated

Railroad

Ferryboat

Taxicab

Motorcycle

Bicycle

Walked

Worked at home = go to 39

Other method


INSTRUCTION M

IF RESPONSE TO QUESTION 31 IS “CAR, TRUCK, OR VAN”, GO TO QUESTION 32.

OTHERWISE, GO TO QUESTION 33.



32. LAST WEEK, how many people including <Name> usually rode to work together?



____


33. LAST WEEK, what time did <Name> usually leave for work?


(What hour?)

(How many minutes past the hour?)

(Was that AM or PM?)


Hour Minute

__ : __ a.m.

p.m.

 p.m.


34. LAST WEEK, how many minutes did it usually take <Name> to get from home to work?


ENTER A ONE-WAY COMMUTE TIME FOR THE PERSON’S USUAL DAILY COMMUTE FROM HOME TO WORK LAST WEEK.


___ Minutes


INSTRUCTION N

IF RESPONSE TO QUESTION 29B IS “NO” ASK QUESTION 35A.

OTHERWISE, GO TO QUESTION 39.




35a. LAST WEEK, was <Name> on layoff from a job?



Yes = go to 35c

No



35b. LAST WEEK, was <Name> TEMPORARILY absent from a job or business because of vacation, temporary illness, maternity leave, other family or personal reasons, bad weather, etc.?


Yes = go to 38

No = go to 36



35c. Has <Name> been informed that she/he will be recalled to work within the next 6 months OR been given a date to return to work?


Yes = go to 37a

No




36. During the LAST 4 WEEKS, has <Name> been ACTIVELY looking for work?


Yes

No = go to 38




37a. LAST WEEK, could <Name> have started a job if offered one (or returned to work if recalled)?


Yes = go to 38

No



37b. Why was that?


Own temporary illness

Going to school or some other reason


38. When did <Name> last work, even for a few days?




Within the past 12 months

Between 1 and 5 years ago

Over 5 years ago or never worked = go to 47e


(WEEKS WORKED AND HOURS WORKED: 39 – 40c)


*39. During the 52 weeks covering 2016, that is from January 1, 2016 to December 31, 2016, in the weeks <Name> worked, how many hours did <Name> usually work each week?


____ Usual hours each week



*40a. During the 52 weeks covering 2016, did <Name> work EVERY week? Count paid vacation, paid sick leave, and military service as work.


__Yes = go to 41a

__ No


*40b. During the 52 weeks covering 2016, how many WEEKS did <Name> work? Include paid time off and include weeks when <Name> only worked for a few hours. If you would rather give your answer in months, you may do so.


IF THE ANSWER IS BETWEEN 1 AND 12, READ:

(Is that weeks or months?)




__Weeks

__Months


41a. The next series of questions are about the type of business <Name> worked for and the type of work that <Name> did last.

If <Name> had more than one job, describe the one at which the most hours were worked.

Let’s start with the first question. I am going to read 5 categories. Please pick the one that best describes who <Name> worked for

- a private organization or company, government, the U.S. Armed Forces (active duty), self-employed, or working without pay in a family business.


Private organization or company

Government = go to 41c

U.S. Armed Forces (active duty) = go to 42b

Self-employed = go to 41d

Working without pay in a family business = go to 42a


41b. Was this a non-profit organization or for-profit company?


Non-profit organization = go to 42a

For-profit company = go to 42a


41c. Was this for local, state, or the federal government?


Local = go to 42a

State = go to 42a

Federal = go to 42a


41d. Was this self-employment incorporated or not incorporated?


Incorporated

Not incorporated



42a. What was the name of <Name’s> company, business or other employer?



_____________________ = go to 43


42b. Which branch of the Armed Forces does <Name> work for?


U.S. Army = go to 45

U.S. Navy = go to 45

U.S. Air Force = go to 45

U.S. Marine Corps = go to 45

U.S. Coast Guard = go to 45



43. What kind of business or industry was this? For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank.



_____________________


44. Is this business mainly -- manufacturing, wholesale trade, retail trade or some other kind of business?



Manufacturing

Wholesale trade

Retail trade

Other (agriculture, construction, service, government, etc.)


45. What kind of work was <Name> doing at this job? For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant.



_________________________


46. What was <Name’s> most important activities or duties at this job? For example, patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records.


__________________________

__________________________

__________________________

(INCOME: 47a - 48)


The next few questions are about income received in 2016, that is from January 1, 2016 to December 31, 2016…


*47a. Did <Name> receive any wages or salary?




Yes

No


If “yes” to 47a, read:

*47b. Did <Name> receive any additional tips, bonuses or commissions in 2016?



If “No” to 47a, read:

*47b. Did <Name> receive any tips, bonuses or commissions in 2016?




Yes

No


*47c. Did <Name> receive any self-employment income in 2016, including work that was paid for in cash? Consider income from own businesses (farm or non-farm) including proprietorships and partnerships.



Yes

No = go to 47e



*47d. Was this income a loss?


Yes

No


*47e.

if “OVER 5 YEARS AGO OR NEVER WORKED” TO 38 READ:

The next few questions are about income received in 2016, that is from January 1, 2016 to December 31, 2016…


Did <Name> receive any interest or dividends? Consider even small amounts credited to an account.


Otherwise, READ:

Did <Name> receive any interest or dividends in 2016? Consider even small amounts credited to an account.




Yes

No




*47f. Did <Name> receive any net rental income in 2016?


Yes

No = go to 47h



*47g. Was this income a loss?


Yes

No


*47h. Did <Name> receive any royalty income or income from estates and trusts in 2016?



Yes

No


*47i. Did <Name> receive any Social Security or Railroad Retirement benefits in 2016?



Yes

No


*47j. Did <Name> receive any Supplemental Security Income (SSI) payments in 2016?



Yes

No


*47k. Did <Name> receive any public assistance or public welfare payments from the state or local welfare office in 2016?




Yes

No

*47l . Did <Name> receive any retirement, survivor, or disability pensions in 2016?


(Do not include Social Security.)



Yes

No

*47m. Did <Name> receive income on a REGULAR basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support or alimony in 2016?


(Do not include lump sum payments such as money from an inheritance or sale of a home.)



Yes

No

*48.

If “Yes” to ONLY 47A or 47b (either one or both), READ:

What was <Name’s> TOTAL income in 2016? Include amount from all jobs before taxes and other deductions.


If “Yes” to ONLY 47c, Read:

What was <Name’s> TOTAL self-employment income in 2016, including amount received in cash? Report total after operating expenses.


If “Yes” to ONLY 47c And 47D (BOTH), Read:

What was <Name’s> TOTAL self-employment income in 2016, including amount received in cash? Report total after operating expenses and report losses as a negative amount.


OTHERWISE, continue as follows:


Read:

What was <Name’s> total income in 2016 from all of the sources you just mentioned?


If “Yes” to 47A or 47b, READ:

Include amount from all jobs before taxes and other deductions.


If “Yes” to 47c, Read:

For self-employment income, include amount received in cash and report the total after operating expenses.


If “Yes” to 47D or 47g, Read: Subtract the loss amount from the total.


If “Yes” to 47E, 47F, OR 47H, Read:

For income received jointly, include the appropriate portion for <Name> in the total.







$_________________________

Total Income

If net income was a loss precede amount with a '-'

INSTRUCTION O

end interview.





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