Ehc

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

RES_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

RESIDENCEID
**NON-DISPLAYED ITEM**

RESIDENCECODE
**NON-DISPLAYED ITEM**

INTRO
^RESINTROTEXT

INFO
All months of the reference period must be accounted for; this includes both ^YR_FIL PLUS any
months to date in ^INTYEARFIL.
A maximum of 5 addresses is collected per household member for the reference period.
When recording changes in residences, FROM and TO months should be selected for the residence
Page 1 of 162

where the respondent lived for the majority of the month.

SCREENER
^RESSCREENERTEXT
1. Yes
2. No

BMONTH
^RESFROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^RESTOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
Page 2 of 162

4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

PICK_ADDRESS
? [F1]
What was the address where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH?
Select from below list of previously entered addresses OR select 'Add new address' to enter a new
address.

EHC_CNTRY
? [F1]
In what country did ^TEMPNAME live ^BETWEEN_BMONTH_EMONTH?
1. United States (US, USA)
2. Afghanistan
3. American Samoa
4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
Page 3 of 162

11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
42. Great Britain
43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
Page 4 of 162

50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
Page 5 of 162

89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other

EHC_COUNTRY
EHC_HNO
What was the house number where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH?

EHC_STRNAME
What was the street name (where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH)?

EHC_HNOSUF
What was the house number suffix (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
Page 6 of 162

(For example, did this address have an apartment/unit number?)

EHC_PO
What was the city (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?

EHC_NONCITYADD
? [F1]
What was the non-city address (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
(For example, any description you can add to the address to make it more specific.)

EHC_ST
What was the state (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
1. Alabama
2. Alaska
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
11. Florida
12. Georgia
13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
Page 7 of 162

24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
40. Oklahoma
41. Oregon
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
50. U.S. Virgin Islands
51. Utah
52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming

EHC_STATE
EHC_CNTY
What was the county (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
Page 8 of 162

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

EHC_ZIP
What was the zip code (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?

EHC_LIVEWITH
? [F1]
Ask or verify
During this period, (^BETWEEN_BMONTH_ALTEMONTH,) did ^TEMPNAME live with any of the
following people?
Read answer list
Mark all that apply.

1. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

2. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

3. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

4. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

5. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

6. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

7. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

8. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

9. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

10. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

11. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

12. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

13. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

14. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

15. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

16. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

17. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

18. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

19. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

20. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
Page 9 of 162

21. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

22. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

23. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

24. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =

25. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
26. Did not live with any of these people/Lived alone

PRVLVQRT
^ASKORVERIFY
What type of living quarters ISWAS

Read address?

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. House, apartment, flat
2. Unit in rooming house, hotel, motel, etc.
3. Mobile home or trailer
4. Other housing unit
5. Correctional institution
6. Medical institution/nursing home
7. Military quarters (barracks, ship at sea)
8. Student quarters
9. Other group quarters unit
10. Emergency or transitional shelter
11. Unoccupied tent or trailer site
12. Car, van, or other non-permanent accommodations

EHC_TEN
^ASKORVERIFY
C_ISWAS

Read address: Read answer categories?

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

Page 10 of 162

1. Owned or being bought by someone in the household
2. Rented
3. Occupied without payment of rent

EHC_RENTSUB
^ASKORVERIFY
^EHCRENTSUBQTEXT
Include respondents who live in a building owned by a Public Housing Authority (i.e. the housing
authority is the respondent's landlord) as receiving a rent subsidy.
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. Yes
2. No

EHC_VOUCHER
^ASKORVERIFY
C_DOESDID ^PTEMPNAME household receive a housing voucher for

Read address?

A housing voucher gives a renter the right to choose where to live AND it helps pay the rent.
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. Yes
2. No

EHC_WHY
W, ? [F1]

What was the main reason ^TEMPNAME moved to

Read address?

Page 11 of 162

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. Change in marital/relationship status
2. To move into own apartment or house
3. Other family-related reason
4. New job or job transfer
5. To look for work or lost job
6. To be closer to work or school
7. Other job-related reason
8. Wanted to own home, not rent
9. Wanted a better quality apartment or house
10. Wanted a better neighborhood
11. Cheaper housing
12. Other housing-/neighborhood-related reason
13. Disaster loss (fire, flood, hurricane, etc.)
14. Eviction/foreclosure
15. Always lived here (never moved)
16. Other reason (specify)

EHC_WHYOT
What was the other reason ^TEMPNAME moved?

EHC_MVYR
What year did ^TEMPNAME move to

Read address?

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

EHC_MVMO
What month did ^TEMPNAME move to

Read address?

Address:
Page 12 of 162

^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

EHC_PVTEN
? [F1]
Was the address ^TEMPNAME lived in before

Read address: Read answer categories?

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. Owned or being bought by someone in the household
2. Rented
3. Occupied without payment of rent

RESIDENCYCONTINUE
Enter '1' to continue.
1. Continue

Page 13 of 162

NOMORESPELLS
The residences topic is complete. Enter 1 to continue.
1. Continue

ANYMORESPELLS
Now let's talk about the other places ^TEMPNAME lived since ^MONTH1 1st
^CALENDAR_YRFIL.
Enter 1 to return to calendar and enter a new residence spell.
1. Continue

HOWMANY
We've talked about five residences. In how many more residences did ^TEMPNAME live since
^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

MARITAL_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

Page 14 of 162

INTRO
Let's talk about ^YOURHISHER marital history since ^MONTH1 1st ^CALENDAR_YRFIL.

INFO
All people age 15 and over should complete the marital status section since it also asks about
cohabitation during the reference period.

SCREENER
^MHXSCREEN_QTEXT
Enter 1 to continue
1. Continue
3. Refused

BMONTH
When did that start?
If prior to ^MONTH1 ^CALENDAR_YRFIL, select ^MONTH1 ^CALENDAR_YRFIL

EMONTH
^MARITALTOTEXT

MS_EHC
? [F1]
What ISWAS ^PTEMPNAME marital status ^BETWEEN_BMONTH_EMONTH?
Read answer categories
1. Married
2. Married, spouse absent -- DO NOT READ
3. Widowed
4. Divorced
5. Separated
6. Never Married

Page 15 of 162

WHO_SPOUSE_EHC
Who ISWAS ^PTEMPNAME spouse (^BETWEEN_BMONTH_EMONTH)?
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
26. Someone not listed

GOT_PARTNER
? [F1]
During this period, (^BETWEEN_B_EMONTH,) did ^TEMPNAME have a boyfriend, girlfriend, or
partner who lived in the household?
1. Yes
2. No

WHO_PARTNER_EHC
Page 16 of 162

Who ISWAS ^PTEMPNAME ^PARTNER?
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
26. Someone not listed

REGDOMPARTNER
IS/WAS for partnership question ^PTEMPNAME relationship with ^PARTNMFIL a registered
domestic partnership or civil union?
If it is necessary to clarify this question, please be aware that we are intending to capture couples who
registered with a government (city, state) rather than those who are allowed to list their partner on their
health insurance through their employer, but have not registered with the state.
1. Yes
2. No

Page 17 of 162

NOMORESPELLS
The marital history topic is complete. Enter '1' to continue.
1. Continue

ANYMORESPELLS
Now let's talk about the rest of ^PTEMPNAME marital history since ^MONTH1 1st
^CALENDAR_YRFIL.
Enter '1' to return to the calendar and enter a new marital history spell.
1. Continue

HOWMANY
We've talked about three different marital statuses. How many other marital statuses ^HAVEHAS
^TEMPNAME had since ^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

ED_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

Page 18 of 162

INTRO
^ENROLLINTROTEXT

INFO
(Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that
leads to a high school diploma, a college or graduate degree, or an educational certificate.)

SCREENER
C_AREIS ^YOUHESHE currently attending ^ENROLLSCREENERTEXT?
1. Yes
2. No

SCREENER2
^ENROLLSCREENER2TEXT
1. Yes
2. No

BMONTH
^FROMTEXT

EMONTH
^TOTEXT

GRADE
? [F1]
What level of school ISAREWASWERE ^TEMPNAME enrolled in
^BETWEEN_BMONTH_EMONTH?
1. 1st
2. 2nd
3. 3rd
4. 4th
Page 19 of 162

5. 5th
6. 6th
7. 7th
8. 8th
9. 9th
10. 10th
11. 11th
12. 12th
13. College year 1 (Freshman)
14. College year 2 (Sophomore)
15. College year 3 (Junior)
16. College year 4 (Senior)
17. College year 5 (First year graduate or professional school)
18. College year 6+ (Second year or higher in graduate or professional school)
19. Enrolled in college, but not working towards degree
20. Vocational, technical, or business school beyond high school level
21. Nursery school or preschool
22. Kindergarten

EDTYPE
What type of school ISAREWASWERE ^TEMPNAME enrolled in

Read answer categories?

If the respondent is enrolled in more than one type of school, select the type of school in which he/she
was enrolled for the most time.
1. Public
2. Private
3. Charter school
4. Home school

CRED
What degree or certificate ISAREWASWERE ^TEMPNAME working on?
1. Associate's Degree
2. Bachelor's Degree
3. Master's Degree
4. Doctoral or Professional Degree (Including JD)
5. Undergraduate certificate or diploma leading to a license (for example: nursing, mechanics, cosmetology)
6. Undergraduate certificate or diploma, NOT including those leading to a license
Page 20 of 162

7. Post-baccalaureate certificate
8. Post-master's certificate
9. Not enrolled for a degree or certificate

EDHEADST
Some preschool programs are federally sponsored and are primarily for children from
low-income families. Some examples of these are Head Start, Even Start and Fair Start.
C_ISWAS ^TEMPNAME enrolled in a federally-sponsored program like this?
1. Yes
2. No

EDGRADE1
**NON-DISPLAYED ITEM**

EDGRADE2
**NON-DISPLAYED ITEM**

GRADEREP
You said that ^TEMPNAME WASWERE enrolled in the same grade at the beginning and end
^CALENDAR_YRFIL. Was this because ^YOUHESHE had to repeat a grade or WASWERE held
back for any reason?

1. Yes-repeated grade or was held back
2. No-enrolled in same grade
3. No-grade entered for ^BMONTH to ^EMONTH is incorrect
4. No-grade entered in previously recorded spell is incorrect

PREV_GRADE
What is the correct grade?
This refers to the grade of the previous spell.
1. 1st
2. 2nd
Page 21 of 162

3. 3rd
4. 4th
5. 5th
6. 6th
7. 7th
8. 8th
9. 9th
10. 10th
11. 11th
12. 12th
13. College year 1 (Freshman)
14. College year 2 (Sophomore)
15. College year 3 (Junior)
16. College year 4 (Senior)
17. College year 5 (First year graduate or professional school)
18. College year 6+ (Second year or higher in graduate or professional school)
19. Enrolled in college, but not working towards degree
20. Vocational, technical, or business school beyond high school level
21. Nursery school or preschool
22. Kindergarten

FTPT
C_ISAREWASWERE ^TEMPNAME enrolled full-time or part-time?
1. Full-time
2. Part-time

NOMORESPELLS
The enrollment topic is complete. Enter '1' to continue.
1. Continue

ANYMORESPELLS
Did ^TEMPNAME attend school or college at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No
Page 22 of 162

HOWMANY
We've talked about three periods of school enrollment. How many other times WASWERE
^TEMPNAME enrolled in school since ^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

JOBNUM
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

JOB_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

PVJOBBLANK
JOBID
**NON-DISPLAYED ITEM**

INTRO
^JOBINTROTEXT

INFO
Page 23 of 162

If necessary probe with additional question: Did ^YOUHESHE have a paid job, or do any work at
all, no matter how small, that earned some money?

SCREENER
^JOBSCREENER
1. Yes
2. No

SCREENER2
^JOBSCREENER2

1. Yes
2. No

BMONTH
^FROMTEXT

EMONTH
^TOTEXT

COPYJOB
Enter 1 to continue

JBORSE
? [F1]
C_DIDDODOES ^TEMPNAME work for an employer, or ISAREWASWERE ^YOUHESHE
self-employed, or DIDDODOES ^YOUHESHE have some other work arrangement?

1. Employer
2. Self-employed (owns a business)
3. Other work arrangement

Page 24 of 162

CONCHK1
?[F1]
C_DIDDODOES ^TEMPNAME have a definite arrangement with one or more employers to work on
an ongoing basis?
1. Yes
2. No

STARTJAN
Did ^TEMPNAME begin this JOBBUS in ^MONTH1 ^CALENDAR_YRFIL?
1. Yes
2. No

STARTYEAR
In what year did ^TEMPNAME begin this JOBBUS?

STARTMONTH
In what month did ^TEMPNAME begin this JOBBUS?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

STARTWEEK
T
During which week did ^TEMPNAME begin this JOBBUS?
Page 25 of 162

^ASKORVERIFY

ENDWEEK
T
During which week did ^TEMPNAME end this JOBBUS?

RSEND
G, ? [F1]
What is the main reason ^YOUHESHE stopped working for ^YOURHISHER employer?

1. Plant or company closed down or moved
2. Slack work or business conditions
3. Position or shift abolished
4. Temporary or seasonal job completed
5. Discharged or fired
6. Other involuntary reason
7. Quit to take another job
8. Unsatisfactory work arrangements
9. Quit for some other reason
10. Retirement
11. Childcare problems
12. Other family/personal obligations
13. Own illness
14. Own injury
15. School or training
16. Other personal reason

RENDB
G
What is the main reason ^TEMPNAME gave up or ended this business?
1. Retirement
2. Childcare problems
3. Other family/personal oroblems
Page 26 of 162

4. Own illness
5. Own injury
6. School or training
7. Went bankrupt or business failed
8. Sold business or transferred ownership
9. To start other business or take a job
10. Season ended for a seasonal business
11. Quit for some other reason

EMPBSNAME
? [F1]
What ISWAS the name of ^PTEMPNAME Fill for Employer/Business?
^EBSNAMEFILL

JBADDSTRNUM
? [F1]
What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?
Street Number

JBADDSTRNAME
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Street Name

JBADDNUMSUF
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Suite or Office Number

JBADDCITY
Page 27 of 162

? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
City

JBADDST
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
State

AL. Alabama
AK. Alaska
AZ. Arizona
AR. Arkansas
CA. California
CO. Colorado
CT. Connecticut
DC. District of Columbia
DE. Delaware
FL. Florida
GA. Georgia
HI. Hawaii
ID. Idaho
IL. Illinois
IN. Indiana
IA. Iowa
KS. Kansas
KY. Kentucky
LA. Louisiana
ME. Maine
MD. Maryland
MA. Massachusetts
MI. Michigan
MN. Minnesota
MS. Mississippi
MO. Missouri
MT. Montana
Page 28 of 162

NE. Nebraska
NV. Nevada
NH. New Hampshire
NJ. New Jersey
NM. New Mexico
NY. New York
NC. North Carolina
ND. North Dakota
OH. Ohio
OK. Oklahoma
OR. Oregon
PA. Pennsylvania
RI. Rhode Island
SC. South Carolina
SD. South Dakota
TN. Tennessee
TX. Texas
UT. Utah
VT. Vermont
VA. Virginia
WA. Washington
WV. West Virginia
WI. Wisconsin
WY. Wyoming

JBADDZIP5
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Zip code

CLWRK
? [F1]
^CUREMONTH ISWAS ^EMPNAME:
Read answer list
Page 29 of 162

1. a government organization (includes Armed Forces)
2. a private, for profit company
3. a non-profit organization, including tax exempt and charitable organizations

KINDG
? [F1]
What type of government DIDDODOES ^TEMPNAME work for ^INEMONTHFILL?
Read answer list

1. Federal Military Departments (CIVILIAN ONLY) (ex. Dept. of Defense, Dept. of Army, and other military departme
2. All other Federal Departments (CIVILIAN ONLY)
3. State Government
4. Local Government
5. U.S. Armed Forces (ACTIVE DUTY ONLY)

KINDG2
What type of government DIDDODOES ^TEMPNAME work for ^INEMONTHFILL?
Read answer list

1. Federal Military Departments (CIVILIAN ONLY) (ex. Dept. of Defense, Dept. of Army, and other military departme
2. U.S. Armed Forces (ACTIVE DUTY ONLY)

KNDIN
? [F1]
^CUREMONTH what kind of business or industry or organization ISWAS this?
Read if necessary: What do they make or do where ^TEMPNAME WORKSWORKED?

TYPIN
? [F1]
C_ISWAS this kind of business or industry or organization mainly --Page 30 of 162

Read answer list
Read if necessary: "^C_BETWEEN_BMONTH_EMONTH, when this JOBBUS was held, at the location
where ^TEMPNAME WORKSWORKED, what ISWAS this ^EMPBUSPOS primary activity?

1. Manufacturing
2. Wholesale trade
3. Retail trade
4. Service
5. Or something else (agriculture, construction, government, etc.)

KNDWK
? [F1]
What kind of work DIDDODOES ^TEMPNAME do ^INEMONTHFILL, that is, what ISWAS
^YOURHISHER occupation?
(For example: bookkeeper, plumber, registered nurse)

ACTVT
? [F1]
What ^AREWERE ^YOURHISHER usual activities at ^EMPNAME ^INEMONTHFILL?
(For example: keeping account books, repairing pipes, patient care)

UNION
? [F1]
At ^EMPNAME, ISAREWASWERE ^TEMPNAME a member of either a labor union or an employee
association like a union?

1. Yes
2. No

Page 31 of 162

CNTRC
? [F1]
C_ISAREWASWERE ^TEMPNAME covered by either a union contract or something like a union
contract?

1. Yes
2. No

EMPLOC
Does ^EMPNAME operate in more than one location?

1. Yes
2. No

EMPALL
? [F1]
About how many people are employed by ^EMPNAME at ALL LOCATIONS together?

1. Less than 10
2. 10 to 25
3. 26 to 50
4. 51 to 100
5. 101 to 200
6. 201 to 500
7. 501 to 1000
8. Greater than 1000

EMPSIZE
? [F1]
About how many people ^AREWERE employed by ^EMPNAME at the location
where ^TEMPNAME WORKSWORKED?

1. Less than 10
2. 10 to 25
Page 32 of 162

3. 26 to 50
4. 51 to 100
5. 101 to 200
6. 201 to 500
7. 501 to 1000
8. Greater than 1000

EMPB
^C_BETWEEN_BMONTH_EMONTH, what is the maximum number of employees,
including ^TEMPNAME, working for ^EMPNAME at any one time?
1. 1 (Only self)
2. 2 to 9
3. 10 to 25
4. 26 to 50
5. 51 to 100
6. 101 to 200
7. 201 to 500
8. 501 to 1000
9. Greater than 1000

INCPB
? [F1]
Is ^EMPNAME incorporated?
1. Yes
2. No

PROPB
? [F1]
DIDDODOES ^TEMPNAME own ^EMPNAME Fill for SELF or ISWAS it a partnership?
1. Alone
2. Partnership

Page 33 of 162

HPRTB
C_ISWAS any other member of this household an owner or partner in ^EMPNAME?
1. Yes
2. No

PARTB
Who ISWAS that?
Mark all that apply.

1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or
26. Someone not listed

BSLRYB
Page 34 of 162

DIDDODOES ^YOUHESHE draw a regular salary from ^EMPNAME - that is, take a regular
paycheck, as opposed to just treating the profits as ^YOURHISHER income?
1. Yes
2. No

TYPPAY
Which of the following types of pay DIDDODOES ^TEMPNAME receive ^INEMONTHFILL?
Read answer list
Mark all that apply
If payment is given per service or per unit of production, enter commission and collect monthly total
amounts.
1. Salary/hourly rate
2. Commission
3. Tips
4. Overtime
5. Bonus pay

PAYHR1
H, ? [F1]
Ask or verify
The next questions are about ^PTEMPNAME gross income from ^EMPNAME before taxes and
other deductions. What is the easiest way for you to report ^YOURHISHER pay rate or salary
information?
Read answer list
1. Annual salary (pay rate for the year)
2. Actual gross amount earned in the year
3. Pay per hour
4. Pay per week
5. Pay every two weeks
6. Pay per month
7. Pay twice a month
8. Some other way (report monthly average)
Page 35 of 162

PYRAT1
? [F1]
What ISWAS the gross dollar amount of ^PTEMPNAME PHRFILL1 before any taxes and other
deductions?

PYRAT1_RANGEANN
C_ISWAS the annual amount...
Read Answer List
1. Less than $20,000
2. Between $20,000 and $34,999
3. Between $35,000 and $49,999
4. $50,000 or more

PYRAT1_RANGEHOUR
C_ISWAS this hourly wage...
Read Answer List
1. Less than $9 per hour
2. Between $9 and $11.99 per hour
3. Between $12 and $16.99 per hour
4. $17 Per hour or more

PYRAT1_RANGEWKLY
C_ISWAS this weekly pay...
Read Answer List
Page 36 of 162

1. Less than $400 per week
2. Between $400 and $599 per week
3. Between $600 and $999 per week
4. $1000 or more per week

PYRAT1_RANGEBWKLY
C_ISWAS this PHRFILL1 ...
Read Answer List
1. Less than $800 per period
2. Between $800 and $1199 per period
3. Between $1200 and $1999 per period
4. $2000 or more per period

PYRAT1_RANGEMTHLY
C_ISWAS this PHRFILL1...
Read Answer List
1. Less than $1500 per month
2. Between $1500 and $2499 per month
3. Between $2500 and $4499 per month
4. $4500 Or more per month

TAKEHOME1
? [F1]
C_ISWAS this take-home pay or ISWAS it gross pay before any taxes and other deductions
^AREWERE taken out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

JOBHRS1
? [F1]

Page 37 of 162

How many hours per week DIDDODOES ^TEMPNAME usually work at ^EMPNAME
^INEMONTHFILL?
^JOBHRSFILL

PTYN1
? [F1]
C_DIDDODOES ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME?

1. Yes
2. No

PTRESN1
I, ? [F1]
What ISWAS the main reason ^TEMPNAME WORKSWORKED less than 35 hours per week?
For those respondents who work part-time because they have multiple jobs, select option #2 (wanted
to work part-time).
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

CHEARN1
You said ^TEMPNAME ISAREWASWERE paid ^PYRAT1FIL ^PAYHR1FIL ^INEMONTHFILL. Did
^YOURHISHER pay rate change ^BETWEEN_BMONTH_ALTEMONTH?

Page 38 of 162

1. Yes
2. No

CHERMNTH1
In what month was ^PTEMPNAME most recent pay rate change?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

CHERWEEK1
T
In which week did ^PTEMPNAME pay rate change?

PAYHR2
H, ? [F1]
What type of pay rate or salary did ^TEMPNAME have at ^EMPNAME ^CHERMNTH1?
Read answer list
1. Paid an annual salary
2. Paid by the hour
Page 39 of 162

3. Paid by the week
4. Paid once every 2 weeks
5. Paid once a month
6. Paid twice a month
7. Paid some other way (report monthly average)

PYRAT2
? [F1]
What was the gross dollar amount of ^PTEMPNAME PHRFILL2 before any taxes and other
deductions at ^EMPNAME ^CHERMNTH1?

PYRAT2_RANGEANN
Was the annual salary amount...
Read Answer List
1. Less than $20,000
2. Between $20,000 and $34,999
3. Between $35,000 and $49,999
4. $50,000 or more

PYRAT2_RANGEHOUR
Was this hourly wage...
Read Answer List
1. Less than $9 per hour
2. Between $9 and $11.99 per hour
Page 40 of 162

3. Between $12 and $16.99 per hour
4. $17 Per hour or more

PYRAT2_RANGEWKLY
Was this weekly pay...
Read Answer List
1. Less than $400 per week
2. Between $400 and $599 per week
3. Between $600 and $999 per week
4. $1000 or more per week

PYRAT2_RANGEBWKLY
Was this PHRFILL2 ...
Read Answer List
1. Less than $800 per period
2. Between $800 and $1199 per period
3. Between $1200 and $1999 per period
4. $2000 or more per period

PYRAT2_RANGEMTHLY
Was this PHRFILL2...
Read Answer List
1. Less than $1500 per month
2. Between $1500 and $2499 per month
3. Between $2500 and $4499 per month
4. $4500 Or more per month

TAKEHOME2
? [F1]
Was this take-home pay or was it gross pay before any taxes and other deductions were taken
out?
Page 41 of 162

1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

CHHOUR1
^CHHOUR1FILL
1. Yes
2. No

CHHOMON1
In what month did ^PTEMPNAME hours change?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

CHHOWEEK1
T
In which week did ^PTEMPNAME hours change?

Page 42 of 162

JOBHRS2
? [F1]
How many hours per week did ^TEMPNAME usually work at ^EMPNAME before ^CHHOMON1?
^JOBHRSFILL

PTYN2
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME before this change?

1. Yes
2. No

PTRESN2
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

CHEARN2
You said ^TEMPNAME WASWERE paid ^PYRAT2FIL ^PAYHR2FIL ^CHERMNTH1. Did
^PTEMPNAME pay rate change ^BTWN_BMONTH_CHERMNTH1?
1. Yes
2. No

Page 43 of 162

CHERMNTH2
When did ^PTEMPNAME pay rate change ^BTWN_BMONTH_CHERMNTH1?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

CHERWEEK2
T
In which week did ^PTEMPNAME pay rate change?

PAYHR3
H, ? [F1]
What type of pay rate or salary did ^TEMPNAME have at ^EMPNAME ^CHERMNTH2?
Read answer list
1. Paid an annual salary
2. Paid by the hour
3. Paid by the week
4. Paid once every 2 weeks
5. Paid once a month
6. Paid twice a month
Page 44 of 162

7. Paid some other way (report monthly average)

PYRAT3
? [F1]
What was the gross dollar amount of ^PTEMPNAME PHRFILL3 before any taxes and other
deductions ^CHERMNTH2?

PYRAT3_RANGEANN
Was the annual salary amount...
Read Answer List
1. Less than $20,000
2. Between $20,000 and $34,999
3. Between $35,000 and $49,999
4. $50,000 or more

PYRAT3_RANGEHOUR
Was this hourly wage...
Read Answer List
1. Less than $9 per hour
2. Between $9 and $11.99 per hour
3. Between $12 and $16.99 per hour
4. $17 Per hour or more

PYRAT3_RANGEWKLY
Page 45 of 162

Was this weekly pay...
Read Answer List
1. Less than $400 per week
2. Between $400 and $599 per week
3. Between $600 and $999 per week
4. $1000 or more per week

PYRAT3_RANGEBWKLY
Was this PHRFILL3...
Read Answer List
1. Less than $800 per period
2. Between $800 and $1199 per period
3. Between $1200 and $1999 per period
4. $2000 or more per period

PYRAT3_RANGEMTHLY
Was this PHRFILL3...
Read Answer List
1. Less than $1500 per month
2. Between $1500 and $2499 per month
3. Between $2500 and $4499 per month
4. $4500 Or more per month

TAKEHOME3
? [F1]
Was this take-home pay or was it gross pay before any taxes and other deductions were taken
out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

Page 46 of 162

CHHOUR2
^CHHOUR2FILL
1. Yes
2. No

CHHOMON2
When did ^PTEMPNAME hours change CHHOMONFILL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

CHHOWEEK2
T
In which week did ^PTEMPNAME hours change?

JOBHRS3
? [F1]
How many hours per week did ^TEMPNAME usually work ^CHHOMON2?
^JOBHRSFILL
Page 47 of 162

PTYN3
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME ^CHHOMON2?

1. Yes
2. No

PTRESN3
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

CHHOUR3
^CHHOUR3FILL
1. Yes
2. No

CHHOMON3
When did ^PTEMPNAME hours change CHHOMON3FILL?

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 48 of 162

5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

CHHOWEEK3
T
In which week did ^PTEMPNAME hours change?

JOBHRS4
? [F1]
How many hours per week did ^TEMPNAME usually work ^CHHOMON3?
^JOBHRSFILL

PTYN4
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME before ^CHHOMON3?

1. Yes
2. No

PTRESN4
I
Page 49 of 162

What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

JOBNUM
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

BMONTH
**NON-DISPLAYED ITEM**

EMONTH
Page 50 of 162

**NON-DISPLAYED ITEM**

TYPPAYCODE
**NON-DISPLAYED ITEM**

TYPEXPAY
Earlier you said ^TEMPNAME received ^TYPEXPAY_FILL while working at ^EMPNAME. Did
these ^TYPEXPAY_FILL ^PAYMENTS occur every month?
1. Yes
2. No

EXEARNAMT1
^EXEARNFILL much did ^TEMPNAME usually earn per month in ^TYPEXPAY_FILL?

EXEARNMNTH
During which months did ^TEMPNAME earn ^TYPEXPAY_FILL while working for ^EMPNAME?
One Month Spell Fill
Mark all that apply
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 51 of 162

17. May ^INTYEARFIL
18. June ^INTYEARFIL

EXEARNAMT2
How much ^SPELL_AREWERE these ^TYPEXPAY_FILL ^PAYMENTS ^EXEARNMNTH_FILL?

OINCB
? [F1]
Besides what has already been reported, did ^TEMPNAME receive any other income for Fill for
SELF out of the money that ^EMPNAME brought in?
1. Yes
2. No

OINCAMT
What was the average monthly amount of other income ^YOUHESHE usually received from
^EMPNAME?

PRFTLOSS
? [F1]
Did ^EMPNAME make a net profit, net loss, or break even for the year ^CALENDAR_YRFIL?

1. Profit (positive)
2. Loss (negative)
3. No profit/break even

PRFTB
? [F1]
For ^EMPNAME, what was the dollar amount of ^PTEMPNAME share of the ^PRFTLOSSFIL for
the year ^CALENDAR_YRFIL?

Page 52 of 162

PRFTBCHK
C_ISWAS ^HISHER own income from ^EMPNAME (that we talked about earlier) reported in this
^PRFTLOSSFIL? Or do we need to subtract ^HISHER income to get a total ^PRFTLOSSFIL?
1. Salary/draw is included in the net profit/loss amount
2. Subtract salary/draw to get total ^PRFTLOSSFIL

FPAWOPYN1
? [F1]
^C_FPAWOPYN1FILL, did ^TEMPNAME have any time away without pay from ^EMPNAME for a
period of at least two weeks?
1. Yes
2. No

FPAWOPSM1
^C_BEMIN which month did the most recent period of leave without pay begin?
FR Note for FPAWOPSM
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 53 of 162

FPAWOPSW1
T
In which week did this period of leave without pay begin?
FR notes for FPAWOPSW

FPAWOPEM1
Between ^FPAWOPSM1 and ^EMONTHFILL, in which month did the most recent period of leave
without pay end?
FR note for FPAWOPEM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FPAWOPEW1
T
In which week did this period of leave without pay end?
FR note for FPAWOPEW

FPAWOPRE1
Page 54 of 162

J
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff (temporary or indefinite)
2. Slack work/business conditions
3. Vacation/scheduled time off/personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own injury/own illness/medical problems
6. Taking care of children/childcare problems
7. Caring for an elderly/disabled family member
8. Pregnancy/childbirth/maternity or paternity leave
9. Labor dispute
10. Bad weather
11. Civic/Jury/Military duty
12. Other

FPAWOPCH1
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No

FPAWOPYN2
? [F1]
^C_FPAWOPYN2FILL ^TEMPNAME have a second period of time away without pay from
^EMPNAME for at least two weeks?
1. Yes
2. No

FPAWOPSM2
^C_FPAWOPSM2FILL what month did the second period of leave without pay begin?
FR Note for FPAWOPSM

Page 55 of 162

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FPAWOPSW2
T
In which week did the second period of leave without pay begin?
FR notes for FPAWOPSW

FPAWOPEM2
^C_FPAWOPEM2FILL, in which month did the second period of leave without pay end?
FR note for FPAWOPEM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
Page 56 of 162

8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FPAWOPEW2
T
In which week did the second period of leave without pay end?
FR note for FPAWOPEW

FPAWOPRE2
J
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff (temporary or indefinite)
2. Slack work/business conditions
3. Vacation/scheduled time off/personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own injury/own illness/medical problems
6. Taking care of children/childcare problems
7. Caring for an elderly/disabled family member
8. Pregnancy/childbirth/maternity or paternity leave
9. Labor dispute
10. Bad weather
11. Civic/Jury/Military duty
12. Other

FPAWOPCH2
Page 57 of 162

Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No

FPAWOPYN3
? [F1]
^C_FPAWOPYN3FILL ^TEMPNAME have a third period of time away without pay from
^EMPNAME for at least two weeks?
1. Yes
2. No

FPAWOPSM3
^C_FPAWOPSM3FILL which month did the third period of leave without pay begin?
FR Note for FPAWOPSM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 58 of 162

FPAWOPSW3
T
In which week did the third period of leave without pay begin?
FR notes for FPAWOPSW

FPAWOPEM3
^C_FPAWOPEM3FILL, in which month did the third period of leave without pay end?
FR note for FPAWOPEM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FPAWOPEW3
T
In which week did the third period of leave without pay end?
FR note for FPAWOPEW

FPAWOPRE3
Page 59 of 162

J
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff (temporary or indefinite)
2. Slack work/business conditions
3. Vacation/scheduled time off/personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own injury/own illness/medical problems
6. Taking care of children/childcare problems
7. Caring for an elderly/disabled family member
8. Pregnancy/childbirth/maternity or paternity leave
9. Labor dispute
10. Bad weather
11. Civic/Jury/Military duty
12. Other

FPAWOPCH3
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

JOBNUMBER
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

Page 60 of 162

PERIODNUM
**NON-DISPLAYED ITEM**

BMONTH
**NON-DISPLAYED ITEM**

EMONTH
**NON-DISPLAYED ITEM**

PVWORKTRAN
U, ? [F1]
Let's talk about ^PTEMPNAME commuting expenses, job-related expenses and work schedule
with ^EMPNAME.
During a typical week, how DIDDODOES ^TEMPNAME get to work?
Mark all that apply.
Include all work-related travel.

1. Drove own vehicle
2. Rider in someone else's vehicle/van pool
3. Bus
4. Rail
5. Other public transportation
6. Walked
7. Bicycled
8. Drove company vehicle
9. Worked at home
10. Other

PVTRANPRIM
? [F1]
Which of these methods ^ACCOUNTSACCOUNTED for the greatest distance travelled as part of
^PTEMPNAME work commute?

Page 61 of 162

1. Drove own vehicle
2. Rider in someone else's vehicle/van pool
3. Bus
4. Rail
5. Other public transportation
6. Walked
7. Bicycled
8. Drove company vehicle
9. Worked at home
10. Other

PVTIME
? [F1]
How many minutes ^DIDDOES it usually take ^TEMPNAME to get from home to work as part of
^YOURHISHER work commute?

PVMILE
? [F1]
How many miles DIDDODOES ^TEMPNAME drive from home to work as part of ^YOURHISHER
work commute?

PVREIMBMI
? [F1]
^DIDDOES ^EMPNAME reimburse ^TEMPNAME for the miles driven to work?
1. Yes
2. No

PVREIMBMIC
? [F1]
How many of those PVMILES miles ^AREWERE reimbursed by ^EMPNAME?

Page 62 of 162

PVPARK
? [F1]
DIDDODOES ^TEMPNAME have to pay for parking or tolls as a part of ^YOURHISHER
work-commuting expenses?
Enter 1 for "yes" if ANY parking costs or tolls are out of pocket; enter 2 for "no" if ALL such costs are
reimbursed.
1. Yes
2. No

PVPARKC
? [F1]
Typically, how much DIDDODOES^TEMPNAME spend per day for parking or tolls?
Include only costs that were NOT reimbursed.

PVOTHRC
? [F1]
In a typical day,PVOTHRCFILL about how much ^AREWERE ^PTEMPNAME PVOTHRCFILL2 work
commuting expensesPVOTHRCFILL3?
Enter 0 for "none." Include only work-commuting expenses that were NOT reimbursed.

PVOEXPNS
? [F1]
^C_BETWEEN_BMONTH_EMONTH, not counting expenses ^PTEMPNAME employer ^PAYSPAID,
DIDDODOES ^TEMPNAME have any work-related expenses such as licenses, permits, union
dues, special tools, or uniforms for ^YOURHISHER work at ^EMPNAME?

1. Yes
2. No

PVOEXPNSC
Page 63 of 162

? [F1]
Altogether, ^BETWEEN_BMONTH_EMONTH, how much ^AREWERE ^PTEMPNAME expenses for
such items?
Include only work-related expenses that were required for employment and were NOT reimbursed.

WSWHDY
? [F1]
During a typical week at ^EMPNAME, which days DIDDODOES ^TEMPNAME work?
Mark all that apply.
If the days that the respondent ^WRKD varies, enter the days that ^HESHE most recently worked for
this job.

1. Monday through Friday
2. Sunday
3. Monday
4. Tuesday
5. Wednesday
6. Thursday
7. Friday
8. Saturday
9. All seven days (every day in a typical week)

WSBEG
? [F1]
(During a typical week at ^EMPNAME,) what time DIDDODOES ^TEMPNAME usually begin work?
Enter the time followed by a.m. or p.m.
12:00 a.m. is midnight and 12:00 p.m. is noon.
If the start time varies, enter the most common start time for this job.

Page 64 of 162

WSEND
? [F1]
(During a typical week at ^EMPNAME,) what time DIDDODOES ^TEMPNAME usually end work?
Enter the time as well as a.m. or p.m.
12:00 a.m. is midnight and 12:00 p.m. is noon.
If the end time varies, enter the most common end time for this job.

WSHMWRK
? [F1]
As part of ^PTEMPNAME typical work schedule for ^EMPNAME, ^AREWERE there any days
when ^TEMPNAME WORKSWORKED only at home?

1. Yes
2. No

WSHOMDY
? [F1]
Which days DIDDODOES ^TEMPNAME work only from home?
Mark all that apply.

1. Monday through Friday
2. Sunday
3. Monday
4. Tuesday
5. Wednesday
6. Thursday
7. Friday
8. Saturday
9. All seven days (every day in a typical week)

Page 65 of 162

WSJOB
M, ? [F1]
Which of the following best describes ^PTEMPNAME work schedule at ^EMPNAME?
Mark variable work schedules as 6 ("Irregular").

1. Regular daytime schedule
2. Regular evening shift
3. Regular night shift
4. Rotating shift (one that changes regularly from days to evenings to nights)
5. Split shift (one that consists of two distinct periods each day)
6. Irregular schedule (one that changes from day to day)
7. Other - specify

WSOTH
Please describe the 'other' type of work schedule.

WSMNR
What is the MAIN reason ^TEMPNAME WORKSWORKED this type of schedule?
DO NOT read answer categories.

1. Requirement of the job
2. Could not get any other job
3. Other involuntary reasons
4. Better pay
5. Better child care arrangements
6. Better arrangements for care of other family members
7. Allows time for school
8. Other voluntary reasons

ANYMORESPELLS
Did ^TEMPNAME work for ^EMPNAME2 at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
Page 66 of 162

2. No

HOWMANY
We've talked about two periods working for ^EMPNAME2. How many other times did
^TEMPNAME work for ^EMPNAME2 since ^MONTH1 1st ^CALENDAR_YRFIL?

ANYOTHERWORK
^OTHERWORK
1. Yes
2. No

NOMORESPELLS
The jobs and no job topics are complete. Enter '1' to continue.

NJSCREEN
I'm showing ^TEMPNAME WASWERE not working for pay during the following ^TIME_S since
^MONTH1 1st ^CALENDAR_YRFIL:
^LFGAPS_TEXTFIL
Have we talked about all times, since ^MONTH1 1st ^CALENDAR_YRFIL, when ^YOUHESHE
worked for pay?

1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
Page 67 of 162

**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
^OJINTRO_QTEXT

INFO
This job line collects summary information about all remaining jobs and businesses beyond the 7 jobs
reported on lines 1-7. Ask respondent to think about and report all of ^HISHER work as a WHOLE rather
than separately.
Record separate spells when ^HESHE reports disconnected time periods of employment for these
additional employers.

SCREENER2
Did ^YOUHESHE have any more time working for pay since ^MONTH1 1st ^CALENDAR_YRFIL
that you have not yet told me about?
1. Yes
2. No

BMONTH
EMONTH

STARTJAN
Did ^TEMPNAME begin this work in ^MONTH1 ^CALENDAR_YRFIL?
1. Yes
2. No

STARTWEEK
Page 68 of 162

T
During which week did ^TEMPNAME begin this other work?

ENDWEEK
T
During which week did ^TEMPNAME end this other work?

NUMBER_OF_JOBS
How many additional jobs, businesses, or other arrangements DIDDODOES ^TEMPNAME have
^BETWEEN_BMONTH_EMONTH?

JBORSEOTH
? [F1]
^OTHJBFIL you reported ^BETWEEN_BMONTH_EMONTH for ^EMPLOYER, was it
self-employment, was it some other kind of arrangement, or a combination of these?
Mark all that apply

1. Employer
2. Self-employed (owns a business)
3. Other work arrangement

EARN
Including all wages, salaries, tips, commissions, bonuses, and profits, what ISWAS the total
amount of ^YOURHISHER gross earnings from ^NOTHJOB ^BETWEEN_BMONTH_EMONTH?
Gross earnings are earnings before any taxes or other deductions.

TAKEHOME
C_ISWAS this a take-home amount or ISWAS it a gross amount before any taxes and deductions
^AREWERE taken out?

1. Take-home pay (net, after deductions)
Page 69 of 162

2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

HOURS
^C_BETWEEN_BMONTH_EMONTH, DIDDODOES ^YOUHESHE usually work 35 hours or more per
week at ^NOTHJOB?
1. Yes
2. No

PTRESN
What ISWAS the main reason ^TEMPNAME WORKSWORKED fewer than 35 hours per week at
^NOTHJOB?
1. Worked at one or more other jobs or businesses
2. Could not find full-time job
3. Wanted to work part-time
4. Temporarily unable to work full-time because of injury
5. Temporarily unable to work full-time because of illness
6. Unable to work full-time because of chronic health condition/disability
7. Taking care of children/other persons
8. Full-time work week is less than 35 hours
9. Slack work or material shortage
10. Participated in a job-sharing arrangement
11. On vacation
12. In school
13. Other

NOMORESPELLS
The job and no job topics are complete. Enter '1' to continue.
1. Continue

ANYMORESPELLS
Did ^TEMPNAME work at ^NOTHJOB at any other times since ^MONTH1 1st ^CALENDAR_YRFIL
that you have not yet told me about?

Page 70 of 162

1. Yes
2. No

HOWMANY
We've talked about three periods of employment at ^NOTHJOB. How many other times, since
^MONTH1 1st ^CALENDAR_YRFIL, WASWERE ^YOUHESHE employed at ^NOTHJOB?

NJSCREEN
I'm showing ^TEMPNAME WASWERE not working for pay during the following ^TIME_S since
^MONTH1 1st ^CALENDAR_YRFIL:
^LFGAPS_TEXTFIL
Have we talked about all times, since ^MONTH1 1st, when ^YOUHESHE worked for pay?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
Now I'm going to talk to you about time when ^YOUHESHE WASWERE not working for pay.

SCREENER
Page 71 of 162

Read if necessary:
C_AREIS ^YOUHESHE currently not working for pay?
1. Yes
2. No

SCREENER2
Did ^YOUHESHE not work for pay at any time since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No

BMONTH
When did this period of not working for pay start?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
When did the period ^YOUHESHE did not work for pay end?
1. January ^CALENDAR_YRFIL
Page 72 of 162

2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

NOWRK_1
K
Why This is the fill for DIDDODONT ^TEMPNAME work for pay
^NWBETWEEN_BMONTH_EMONTH?
Read or show the respondent the answer list. After each response, ask: "Any other reason?"
1. Temporarily unable to work because of an injury
2. Temporarily unable to work because of an illness
3. Unable to work because of chronic health condition or disability
4. Retired
5. Pregnancy/childbirth
6. Taking care of children/other persons
7. Going to school
8. Unable to find work
9. On layoff (temporary or indefinite)
10. Not interested in working at a job
11. Usually worked 15 or more hours per week without pay in a family business or farm
12. Other

Page 73 of 162

UNPDWRKYN
? [F1]
C_DIDDODOES ^TEMPNAME work 15 or more hours per week without pay in a related household
member's family business or farm ^BETWEEN_BMONTH_ALTEMONTH?
1. Yes
2. No

FAM_BUS_KNDIN_1
? [F1]
What kind of business or enterprise is the family business?
(What do they make or do?)

FAM_BUS_TYPIN_1
Is it mainly ---

Read answer list

1. Manufacturing
2. Wholesale trade
3. Retail trade
4. Service
5. Or something else (agriculture, construction, government, etc.)

FAM_BUS_KNDWK_1
What kind of work DIDDODOES ^TEMPNAME do? That is, what ISWAS ^YOURHISHER
occupation?
(For example: bookkeeper, plumber, registered nurse)

FAM_BUS_ACTVT_1
What ^AREWERE ^YOURHISHER usual work activities?
(For example: Keeping account books, repairing pipes, patient care)

LAYOFF_1
? [F1]
Page 74 of 162

^LAYOFFFILL ^TEMPNAME spend any time on layoff from a job?
1. Yes
2. No

LAYOFF_TYPE_1
When ^TEMPNAME WASWERE laid off, WASWERE ^YOUHESHE either informed that
^YOUHESHE would be recalled to work within 6 months, or given a date to return to work?
1. Yes
2. No

LAYOFF_DURATION
C_WASWERE ^TEMPNAME on layoff for the entire period?
1. Yes
2. No

LAYOFF_ENDMNTH
In which month did the layoff end?
FR note for ENDMONTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
Page 75 of 162

15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

LAYOFF_ENDWEEK
T
In which week did the layoff end?
FR note for ENDWEEK

LKWRK_1
? [F1]
^LKWRKFILL ^TEMPNAME ACTIVELY look for work in one or more weeks?
1. Yes
2. No

FROM_LKMNTH_11
^C_BEMIN what month did ^TEMPNAME FIRST begin looking for work?
FR note for FROM_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
Page 76 of 162

15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_11
T
In which week did ^TEMPNAME first begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_11
From ^FROM11FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TO_LKWEEK_11
T
Page 77 of 162

In which week did ^TEMPNAME stop looking for work?
FR note for TO_LKWEEK

MORE_STRETCH_12
^C_BTWN_TO11_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No

FROM_LKMNTH_12
^C_LKMNTH12 what month did ^TEMPNAME begin looking for work for the second time?
FR note for FROM_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_12
T
Page 78 of 162

In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_12
From ^FROM12FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TO_LKWEEK_12
T
In which week did ^TEMPNAME stop looking for work?
FR note for TO_LKWEEK

MORE_STRETCH_13
^C_BTWN_TO12_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
Page 79 of 162

1. Yes
2. No

FROM_LKMNTH_13
^C_LKMNTH13 what month did ^TEMPNAME begin looking for work for the third time?
FR note for FROM_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_13
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_13
From ^FROM13FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?

Page 80 of 162

FR Note for TO_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TO_LKWEEK_13
T
In which week did ^TEMPNAME stop looking for work?
FR note for TO_LKWEEK

MORE_STRETCH_14
^C_BTWN_TO13_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No

FROM_LKMNTH_14
^C_LKMNTH14 what month did ^TEMPNAME begin looking for work for the fourth time?
Page 81 of 162

FR note for FROM_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_14
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_14
From ^FROM14FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
Page 82 of 162

3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TO_LKWEEK_14
T
In which week did ^TEMPNAME stop looking for work?
FR note for TO_LKWEEK

NOMORESPELLS
The no jobs topic is complete. Enter '1' to continue.
1. Continue

ANYMORESPELLS
Did ^TEMPNAME have any other times not working for pay since ^MONTH1 1st
^CALENDAR_YRFIL?

HOWMANY
We've talked about six periods of time not working for pay. How many other times, since
^MONTH1 1st ^CALENDAR_YRFIL, did ^YOUHESHE spend not working for pay?

Page 83 of 162

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

SSI_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
(Next are some questions about assistance programs for people in need.) ^SSIINTROTEXT

INFO
(SSI is not the same as Social Security. Income from Social Security is asked about later.
SSI provides assistance to low-income children and adults who are blind or disabled, as well as
low-income people over age 65 who are not blind or disabled.)
Do NOT include SSI received on behalf of someone else.

SCREENER
AREIS ^YOUHESHE currently receiving SSI?
Do NOT include disability, retirement, or survivor income from Social Security.
1. Yes
2. No
Page 84 of 162

SCREENER2
Did ^YOUHESHE receive SSI ^SCREENER2TEXT?
Do NOT include disability, retirement, or survivor income from Social Security.

BMONTH
^FROMTEXT

EMONTH
^TOTEXT

SSI_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving SSI
continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

SSI_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving SSI
continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

SSI_WHY
Why did ^TEMPNAME begin receiving SSI in ^SSI_BMONTHFIL?
Page 85 of 162

1. Disabled
2. Blind
3. Aged (65 and over)
4. Other

SSI_STOP
? [F1]
What were the reasons ^TEMPNAME stopped receiving SSI in ^EMONTHFILL?
1. Increased earned income (wages from a job)
2. Increased unearned income (benefits from a program, such as Social Security)
3. Increased resources (assets, such as a car)
4. No longer disabled
5. Other program requirements not met
6. Chose not to collect/the money is not worth it
7. Other

SSI_PAYMENT
C_DIDDODOES ^TEMPNAME receive ^PTEMPNAME monthly SSI benefit in one or two
payments?
1. One
2. Two

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
Page 86 of 162

**NON-DISPLAYED ITEM**

SSI1_AMT
(Let's talk about the first payment you reported.)
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

SSI1_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI1_AMT1_START
When did ^TEMPNAME start receiving ^SSIAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 87 of 162

17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_AMT2
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

SSI1_AMT2_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI1_AMT2_START
When did ^TEMPNAME start receiving ^SSIAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 88 of 162

17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_AMT3
How much did ^TEMPNAME receive before ^SSI_AMT2_STARTFIL?

SSI1_AMT3_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI1_AMT3_START
When did ^TEMPNAME start receiving ^SSIAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 89 of 162

17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_AMT4
How much did ^TEMPNAME receive before ^SSI_AMT3_STARTFIL?

SSI1_AMT4_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI1_AMT4_START
When did ^TEMPNAME start receiving ^SSIAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 90 of 162

17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_STARTAMT
How much did ^TEMPNAME receive in ^BMONTHFILL?

SSI1_SRC
^SSISRC

Read answer categories?

1. Federal Government
2. State Government
3. Combined (both federal and state)

SSI1_AMT(copy)
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

SSI2_AMT
Let's talk about the second payment you reported earlier.
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

Page 91 of 162

SSI2_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT1_START
When did ^TEMPNAME start receiving ^SSIAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_AMT2
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

SSI2_AMT2_GUESS
Page 92 of 162

L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT2_START
When did ^TEMPNAME start receiving ^SSIAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_AMT3
How much did ^TEMPNAME receive before ^SSI_AMT2_STARTFIL?

SSI2_AMT3_GUESS
Page 93 of 162

L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT3_START
When did ^TEMPNAME start receiving ^SSIAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_AMT4
How much did ^TEMPNAME receive before ^SSI_AMT3_STARTFIL?

SSI2_AMT4_GUESS
Page 94 of 162

L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT4_START
When did ^TEMPNAME start receiving ^SSIAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_STARTAMT
How much did ^TEMPNAME receive in ^BMONTHFILL?

SSI2_SRC
Page 95 of 162

^SSISRC

Read answer categories?

1. Federal Government
2. State Government
3. Combined (both federal and state)

SSI_OWNER
Who received payments on behalf of ^TEMPNAME?

1. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

2. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

3. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

4. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

5. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

6. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

7. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

8. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

9. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

10. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

11. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

12. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

13. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

14. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

15. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

16. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

17. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

18. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

19. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

20. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

21. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

22. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

23. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

24. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER

25. ^LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER
26. Someone not listed

NOMORESPELLS
The SSI topic is complete. Enter 1 to continue.
Page 96 of 162

1. Continue

ANYMORESPELLS
Did ^TEMPNAME receive SSI at any other times since the ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of SSI receipt. How many other times did ^YOUHESHE receive
SSI since ^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

FS_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
(Next are some questions about assistance programs for people in need.) ^FSINTROTEXT

Page 97 of 162

INFO
(The Food Stamp Program, or Supplemental Nutrition Assistance Program - SNAP, was created to
assist low-income households in buying the food they need for good health and nutrition. The benefit
amount allowed to a household varies by the household's size and monthly cash income. Benefits are
generally provided through plastic electronic card called an Electronic Benefit Transfer (EBT).)

SCREENER
C_AREIS ^YOUHESHEFAM currently receiving Food Stamp/SNAP benefits?

1. Yes
2. No

SCREENER2
Did ^YOUHESHEFAM receive Food Stamps/SNAP benefits ^SCREENER2TEXT?

1. Yes
2. No

BMONTH
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
Page 98 of 162

16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving Food
Stamps/SNAP continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

FS_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving Food
Stamps/SNAP continuously?
1. January
Page 99 of 162

2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

FS_BEGIN
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to receive Food Stamps/SNAP in
^BMONTHFILL?

1. New Child (or other dependent) or pregnancy
2. Separation, divorced or widowed
3. Job loss / layoff or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

FS_STOP
What were the reasons ^TEMPNAME stopped receiving Food Stamps/SNAP ^SPELLEND?
1. Became ineligible because of an increase in income
2. Became ineligible because of family changes (family member left, over age limit, etc)
3. Still eligible but could not / chose not to collect
4. Became ineligible because program requirements were not met (did not attend school, job training, etc)
5. Eligibility ran out because of time limits
6. The money/benefits were not worth the trouble to continue enrollment
7. Other

Page 100 of 162

FS1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

FS1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT1_START
When did ^TEMPNAME start receiving ^FSAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS2_AMT
Page 101 of 162

How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

FS2_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT2_START
When did ^TEMPNAME start receiving ^FSAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS3_AMT
Page 102 of 162

How much did ^TEMPNAME receive before ^AMT2_STARTFIL?

FS3_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT3_START
When did ^TEMPNAME start receiving ^FSAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS4_AMT
Page 103 of 162

How much did ^TEMPNAME receive before ^AMT3_STARTFIL?

FS4_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT4_START
When did ^TEMPNAME start receiving ^FSAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS_COV
Page 104 of 162

Please list everyone (including yourself) who ^AREWERE_COV covered by ^YOURHISHER benefits
at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply

1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
26. Someone not listed

FS_OWNER
In whose name ^AREWERE benefits received?
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
Page 105 of 162

3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older

NOMORESPELLS
The Food Stamps/SNAP topic is complete. Enter 1 to continue.
1. Continue

ANYMORESPELLS
Did ^TEMPNAME receive Food Stamps/SNAP benefits at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
Page 106 of 162

We've talked about three periods of Food Stamps/SNAP benefit receipt. How many other times
did ^YOUHESHE receive Food Stamps/SNAP benefits since ^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

TANF_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
(Next are some questions about assistance programs for people in need.) ^TANFINTROTEXT.

INFO
(In this area you may know this as TANF FIL1 or TANF FILL or TANF FILL (PACASH1, PATANF).
Pass-through child support is also called called bonus child support and disregard payments).

SCREENER
C_AREIS ^YOUHESHEFAM currently receiving TANF benefits, or any other cash assistance from
a state or local welfare program^TANFLE18FIL?

1. Yes
Page 107 of 162

2. No

SCREENER2
Did ^YOUHESHEFAM receive TANF benefitsclosing text for the second TANF screener?

1. Yes
2. No

BMONTH
^FROMTEXT

EMONTH
^TOTEXT

TANF_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving
payments continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

TANF_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start
receiving payments continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
Page 108 of 162

11. November
12. December

TANF_BEG
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need assistance in
^BMONTHFILL?
Mark all that apply.
1. New child (or other dependent) or pregnancy
2. Separation, divorce, or widowed
3. Job loss or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

TANF_STOP
What were the reasons ^TEMPNAME stopped receiving payments ^SPELLEND?
Mark all that apply.
1. Got a job or earnings increased
2. Family situation changed
3. Others in the household earned enough money
4. Penalized or sanctioned for non-cooperation
5. Time limit expired
6. Didn't want to use up time limit
7. Chose not to participate
8. The money is not worth it
9. Other

TANF1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

Page 109 of 162

TANF1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT1_START
When did ^TEMPNAME start receiving ^TANFAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

TANF2_GUESS
Page 110 of 162

L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT2_START
When did ^TEMPNAME start receiving ^TANFAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?

TANF3_GUESS
Page 111 of 162

L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT3_START
When did ^TEMPNAME start receiving ^TANFAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?

TANF4_GUESS
Page 112 of 162

L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT4_START
When did ^TEMPNAME start receiving ^TANFAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF_ADULT_KID
Do these benefits cover children only, both children and adults, or only a pregnant woman?
1. Only children
2. Only a pregnant or nursing woman
3. Both a woman and children
Page 113 of 162

TANF_COV
Please list coverage roster fill for TANF_COV question who ^AREWERE_COV covered by
^YOURHISHER benefits at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply

1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
26. Someone not listed

TANF_OWNER
In whose name ^AREWERE benefits received?
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
Page 114 of 162

4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older

PASSTHRU_YN
? [F1]
Now I am going to ask you questions about receipt of pass-through child support
^BETWEEN_BMONTH_EMONTH.
At any time during this period, DIDDODOES ^TEMPNAME receive any child support as a bonus
or pass-through from a state or county welfare program, or any disregard payment?
(Pass-through child support may also be known as "bonus child support" or "disregard payments.")

1. Yes
2. No

PASSTHRU_KID_COV
Page 115 of 162

Which person or people under the age of 22 are or were covered by pass-through child support
payments ^BETWEEN_BMONTH_EMONTH?
Mark all that apply.

1. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

2. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

3. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

4. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

5. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

6. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

7. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

8. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

9. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

10. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

11. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

12. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

13. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

14. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

15. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

16. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

17. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

18. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

19. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

20. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

21. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

22. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

23. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

24. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P

25. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
26. Someone not listed

PASSTHRU_TYPE
Do the TANF FIL1 amounts you just reported include ^PTEMPNAME pass-through child support
payments?
1. Yes, bonus/pass through amounts are included
2. No, amounts do not include bonus/pass through
3. Did not receive any bonus/pass through income

Page 116 of 162

PASSTHRU1_AMT
How much pass-through child support DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

PASSTHRU1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PASSTHRU_AMT1_START
When did ^TEMPNAME start receiving ^PTAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

PASSTHRU2_AMT
Page 117 of 162

How much pass-through child support did ^TEMPNAME receive before ^AMT1_STARTFIL?

PASSTHRU2_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PASSTHRU_AMT2_START
When did ^TEMPNAME start receiving ^PTAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

PASSTHRU3_AMT
Page 118 of 162

How much pass-through child support did ^TEMPNAME receive before ^AMT2_STARTFIL?

PASSTHRU3_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PASSTHRU_AMT3_START
When did ^TEMPNAME start receiving ^PTAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

PASSTHRU4_AMT
Page 119 of 162

How much pass-through child support did ^TEMPNAME receive before ^AMT3_STARTFIL?

PASSTHRU4_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PASSTHRU_AMT4_START
When did ^TEMPNAME start receiving ^PTAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

PTAGENCY1_AMT
Page 120 of 162

Now I am going to ask you about the child support that the government agency
COLLECTSCOLLECTED on ^PTEMPNAME behalf. How much child support ISWAS collected by
the agency on ^PTEMPNAME behalf ^IN_EMONTHFIL?

PTAGENCY1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PTAGENCY_AMT1_START
When did the agency start receiving ^PTAAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 121 of 162

PTAGENCY2_AMT
How much did the agency receive on ^PTEMPNAME behalf before ^AMT1_STARTFIL?

PTAGENCY2_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PTAGENCY_AMT2_START
When did the agency start receiving ^PTAAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

PTAGENCY3_AMT
Page 122 of 162

How much did the agency receive on ^PTEMPNAME behalf before ^AMT2_STARTFIL?

PTAGENCY3_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PTAGENCY_AMT3_START
When did the agency start receiving ^PTAAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

PTAGENCY4_AMT
Page 123 of 162

How much did the agency receive on ^PTEMPNAME behalf before ^AMT3_STARTFIL?

PTAGENCY4_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

PTAGENCY_AMT4_START
When did the agency start receiving ^PTAAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

NOMORESPELLS
Page 124 of 162

The TANF topic is complete. Enter 1 to continue.
1. Continue

ANYMORESPELLS
Did ^TEMPNAME receive TANF at any other times since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of TANF receipt. How many other times did ^TEMPNAME
receive TANF since ^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

GA_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
Page 125 of 162

(Next are some questions about assistance programs for people in need.) ^GAINTROTEXT.

INFO
(General Assistance or General Relief - which can be called something different depending on where
you live - is a program for people who do not qualify for federal assistance. It may help the disabled,
elderly, and unemployed, as well as families with children. Assistance may be cash or non-cash and
may be a one-time emergency payment or regular monthly payments.)

SCREENER
C_AREIS ^YOUHESHEFAM currently receiving General Assistance (either for ^YOURHIMHERSELF
or on behalf of a child)?

1. Yes
2. No

SCREENER2
Did ^YOUHESHEFAM receive General Assistance ^GASCREENER2TEXT?

1. Yes
2. No

BMONTH
^FROMTEXT

EMONTH
^TOTEXT

GA_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving General
Assistance continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

Page 126 of 162

GA_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving
General Assistance continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

GA_BEG
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need assistance in
^BMONTHFILL?
Mark all that apply.
1. New child (or other dependent) or pregnancy
2. Separation, divorce, or widowed
3. Job loss or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

GA_STOP
What were the reasons ^TEMPNAME stopped receiving General Assistance ^SPELLEND?
Mark all that apply.
1. Got a job or earnings increased
2. Family situation changed
Page 127 of 162

3. Others in the household earned enough money
4. Penalized or sanctioned for non-cooperation
5. Time limit expired
6. Didn't want to use up time limit
7. Chose not to participate
8. The money is not worth it
9. Other

GA1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

GA1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

GA_AMT1_START
When did ^TEMPNAME start receiving ^GAAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 128 of 162

12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

GA2_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

GA_AMT2_START
When did ^TEMPNAME start receiving ^GAAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 129 of 162

12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?

GA3_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

GA_AMT3_START
When did ^TEMPNAME start receiving ^GAAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 130 of 162

12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?

GA4_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

GA_AMT4_START
When did ^TEMPNAME start receiving ^GAAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 131 of 162

12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA_COV
Please list everyone (including yourself) who ^AREWERE_COV covered by ^YOURHISHER benefits
at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply.

1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T

25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
Page 132 of 162

26. Someone not listed

GA_OWNER
In whose name ^AREWERE benefits received?
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older

NOMORESPELLS
The General Assistance topic is complete. Enter 1 to continue.
1. Continue

Page 133 of 162

ANYMORESPELLS
Did ^TEMPNAME receive General Assistance benefits at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of General Assistance benefit receipt. How many other times
did ^TEMPNAME receive General Assistance benefits since ^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

WIC_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
(Next are some questions about assistance programs for people in need.) ^WICINTROTEXT.

INFO
(The WIC program serves low-income pregnant or nursing women, and infants and children up to age 5,
Page 134 of 162

by providing nutritious foods to supplement diets.)

SCREENER
C_AREIS ^YOUHESHE currently receiving WIC benefits^WICLT5FIL?
1. Yes
2. No

SCREENER2
Did ^YOUHESHE receive WIC benefits closing text for the second WIC screener?
1. Yes
2. No

BMONTH
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 135 of 162

EMONTH
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

WIC_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving WIC
continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

WIC_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving WIC
continously?
1. January
2. February
3. March
4. April
5. May
6. June
Page 136 of 162

7. July
8. August
9. September
10. October
11. November
12. December

WIC_BEGIN
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need assistance in
^BMONTHFILL?
1. New Child (or other dependent) or pregnancy
2. Separation, divorced or widowed
3. Job loss / layoff or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

WIC_STOP
What were the reasons ^TEMPNAME stopped receiving WIC ^SPELLEND?
1. Became ineligible because of an increase in income
2. Became ineligible because of family changes (family member left, over age limit, etc)
3. Still eligible but could not / chose not to collect
4. Became ineligible because program requirements were not met (did not attend school, job training, etc)
5. Eligibility ran out because of time limits
6. The money/benefits were not worth the trouble to continue enrollment
7. Other

WIC_COV
Do these benefits cover only children, only pregnant or nursing women aged 15 or older, or
both?

WIC_ADULT_COV
Page 137 of 162

Ask or verify
Which woman ^DIDDOES ^PTEMPNAME benefits cover?

1. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

2. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

3. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

4. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

5. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

6. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

7. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

8. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

9. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

10. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

11. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

12. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

13. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

14. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

15. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

16. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

17. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

18. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

19. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

20. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

21. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

22. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

23. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

24. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

25. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
26. Someone not listed

WIC_KID_COV
Which child or children DODID ^PTEMPNAME benefits cover?
Mark all that apply.

1. ^LNO ^FNAME ^LNAME of all childen AGE < 5 on (the final HH roster, excluding the respondent, where PEOPLE

2. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

3. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

4. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
Page 138 of 162

5. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

6. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

7. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

8. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

9. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

10. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

11. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

12. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

13. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

14. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

15. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

16. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

17. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

18. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

19. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

20. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

21. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

22. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

23. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

24. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL

25. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
26. Other child not listed

NOMORESPELLS
The WIC topic is complete. Enter 1 to continue.
1. Continue

ANYMORESPELLS
Did ^TEMPNAME receive WIC at any other times since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of WIC receipt. How many other times did ^TEMPNAME receive
WIC since ^MONTH1 1st ^CALENDAR_YRFIL?
Page 139 of 162

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

PRIV1_COVFLAG
*Non-Displayed Field*

PRIV2_COVFLAG
*Non-Displayed Field*

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

PRIVNUMBER
**NON-DISPLAYED ITEM**

PRIV_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
^PRIVATE_INTROQTEXT

INFO
(Private health insurance includes comprehensive medical insurance plans provided through an
employer or union, as well as plans purchased directly from an insurance company individually or as part
Page 140 of 162

of a group.)
DO NOT include plans that contain only one type of coverage, like dental-only or vision-only plans.

SCREENER
C_AREIS ^YOUHESHE currently covered by a private health insurance plan?
Do NOT include Military/VA coverage, or coverage through a Medicare Supplement, Medigap, or
Medicare Advantage (Part C) plan.
1. Yes
2. No

SCREENER2
^PRIVATE_SCREENER2QTEXT
1. Yes
2. No

BMONTH
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 141 of 162

17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

OWNINS
? [F1]
(Health insurance plans are usually obtained in one person's name even if other family members are
covered. That person is called the policyholder.) Who ISWAS the policyholder for this plan?

1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
Page 142 of 162

7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
26. Someone outside of the household

PRIVTYPE
? [F1]
What ISWAS the source of ^HIPHOLDER coverage Health Insurance fill used to specify the
specific month(s) of coverage (during, if covered 1 month) (from...through, if covered 2 or more
month? ISWAS it through:
Read answer list

1. an Employer or Union ^DURINGTHISTIME
2. a Former Employer or Former Union
3. a Business Association
4. Bought it directly
5. School
6. or Something else

PRIVOTH
Page 143 of 162

You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.

HICOST
? [F1]
C_DOESDID ^HIPHOLDER ^EMPUNION pay all, part, or none of the premium of the plan?
1. All
2. Part
3. None

PRIVUNIT
? [F1]
Other than ^TEMPNAME, who else ISWAS covered by this plan Health Insurance fill used to
specify the specific month(s) of coverage (during, if covered 1 month) (from...through, if covered
2 or more month?
Mark all that apply.

HIOTHR
C_DOESDID this plan also cover anyone else who ^DIDDOES NOT live in this household?
1. Yes
2. No

HIWHO
Who outside of this household ^DIDDOES the plan cover?

Mark all that apply.
1. Child under 18
2. Child 18-25
3. Child 26 or over
4. Spouse/partner
5. Other

Page 144 of 162

PRIVPLAN
? [F1]
C_ISWAS this plan:
Read answer list
Ask if necessary (Please check ^YOURHISHER insurance card for type of coverage plan).

1. an HMO (Health Maintenance Organization)/IPA (Individual Practice Association)
2. a PPO (Preferred Provider Organization)
3. a POS (Point-of-service)
4. a Fee-for-service/Indemnity
5. some other kind of plan

HDEDPLN
? [F1]
Is the ^HDEDFILL1 annual deductible for medical care for this plan ^HDEDFILL2 or more?
1. Yes (^HDEDFILL2 or more)
2. No (Less than ^HDEDFILL2)

HLTHSAV
? [F1]
As part of this plan, ISWAS there a special account or fund used to pay for medical expenses?
(These accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement
Accounts (HRAs), Personal Care Accounts, Personal Medical Funds, or Choice Funds and are different
from Flexible Spending Accounts.)

1. Yes
2. No

PRIVEND
? [F1]

Page 145 of 162

What was the reason this insurance plan coverage ended?
Mark all that apply.
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. ^WAITING
6. Other

NOMORESPELLS
^PRIVATE_NOMOREFRNOTE

1. Continue

ANYMORESPELLS
C_WASWERE ^TEMPNAME covered by another private health insurance plan since ^MONTH1 1st
^CALENDAR_YRFIL?
^PRIVATE_ANYMOREFIL

1. Yes
2. No

HOWMANY
^PRIVATE_HOWMANYQTEXT

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

Page 146 of 162

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

MEDICARE_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
^MEDICAREINTROTEXT

INFO
Respondents may confuse MediCAID, the health insurance program for low-income people, with
MediCARE. Medicare is mostly for the elderly, and it is NOT based on income. Respondents may have
both Medicare and Medicaid. Please report Medicare here, and Medicaid on the Medical Assistance
line.

SCREENER
C_AREIS ^YOUHESHE currently covered by Medicare?
Include coverage through any type of Medicare plan, such as a Medicare Supplement, Medigap, or
Medicare Advantage (Part C).

1. Yes
2. No

BMONTH
^FROMTEXT

Page 147 of 162

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^MEDICARE_TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 148 of 162

17. May ^INTYEARFIL
18. June ^INTYEARFIL

MCPART
AA
The Medicare Program contains a number of different kinds of plans. Please tell me which of
these plan types ^YOUHESHE ISAREWASWERE covered by:
Read answer list
Mark all that apply

1. Part A (Hospital Insurance)
2. Part B (Medical Insurance)
3. Medigap (Supplemental Insurance)
4. Part C (Advantage Plan)
5. Part D (Prescription Drug Coverage)

NOMORESPELLS
The medicare topic is complete. Enter 1 to continue.

1. Continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

MED_COVFLAG
*Non-Displayed Field*

SPELLNUMBER
Page 149 of 162

**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

MEDICAID_RETURNING
**NON-DISPLAYED ITEM**

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
^MEDICAIDINTROTEXT

INFO
Respondents may have both Medicare and Medicaid. Please report Medicaid here, and Medicare
plans on the Medicare line above.

SCREENER
C_AREIS ^YOUHESHE currently covered by Medicaid, or S-CHIP, or any other government
program that helps pay health care costs for low-income people?
(For example, Medical Assistance programs in ^STATE are called

Read list:)

Display program names as defined in Special Instructions below.
1. Yes
2. No

SCREENER2
Were ^YOUHESHE covered by Medicaid, or S-CHIP, or any other government program that helps
pay health care costs for low-income people ^SCREENER2TEXT?
(For example, Medical Assistance programs in ^STATE are called Read list:)
Display program names as defined in Special Instructions below.

Page 150 of 162

1. Yes
2. No

BMONTH
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
Page 151 of 162

9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

MDUNIT
Other than ^TEMPNAME, who else ISWAS covered by this plan Health Insurance fill used to
specify the specific month(s) of coverage (during, if covered 1 month) (from...through, if covered
2 or more month?
Mark all that apply.

0. Nobody

1. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

2. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

3. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

4. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

5. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

6. LNO FNAMEL NAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

7. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

8. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

9. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

10. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

11. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

12. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

13. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

14. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

15. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

16. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

17. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

18. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

19. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

20. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo
Page 152 of 162

21. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

22. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

23. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

24. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

25. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 f
26. Someone outside of the household
27. All household members

MDPLAN
? [F1]
C_ISWAS this plan:
Read answer list

1. an HMO (Health Maintenance Organization)
2. a Fee-for-service Plan
3. another Managed-care Type Program
4. some other kind of plan

MDEND
? [F1]
What was the reason this coverage ended?
Mark all that apply.
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. ^WAITING
6. Other

NOMORESPELLS
The Medicaid topic is complete. Enter 1 to continue
Page 153 of 162

1. Continue

ANYMORESPELLS
WASWERE ^TEMPNAME covered by Medicaid, or S-CHIP, or any other government program that
helps pay health care costs for low-income people at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?

1. Yes
2. No

HOWMANY
We've talked about six periods of Medicaid coverage. How many other times WASWERE
^TEMPNAME covered by Medicaid since ^MONTH1 1st ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

MIL_COVFLAG
*Non-Displayed Field*

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

MILI_RETURNING
**NON-DISPLAYED ITEM**

Page 154 of 162

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

INTRO
^MILIINTROTEXT

INFO
("CHAMPVA" is the civilian health and medical program of the Department of Veterans Affairs.)

SCREENER
C_AREIS ^YOUHESHE currently covered by any health insurance through one of those sources?
1. Yes
2. No

SCREENER2
Were ^YOUHESHE covered by health insurance provided by the military or Department of
Veterans Affairs ^SCREENER2TEXT?
1. Yes
2. No

BMONTH
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
Page 155 of 162

11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

MILITYPE
What type of health coverage DIDDODOES ^YOUHESHE have Health Insurance fill used to
specify the specific month(s) of coverage (during, if covered 1 month) (from...through, if covered
2 or more month?
Read answer list

Page 156 of 162

1. TRICARE or CHAMPUS
2. CHAMPVA
3. VA
4. Other

MILIOTH
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.

MOWNINS
? [F1]
Who ISWAS the policyholder or sponsor for this plan?

1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER

25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
Page 157 of 162

26. Someone outside of the household

MILIUNIT
Other than ^TEMPNAME, who else ISWAS covered by this plan Health Insurance fill used to
specify the specific month(s) of coverage (during, if covered 1 month) (from...through, if covered
2 or more month?
Mark all that apply.

MHIOTH
C_DOESDID this plan also cover anyone else who ^DIDDOES NOT live in this household?
1. Yes
2. No

MHIWHO
Who outside of this household ^DIDDOES the plan cover?
1. Child under 18
2. Child 18-25
3. Child 26 or over
4. Spouse/partner
5. Other

MILIEND
? [F1]
What was the reason this Military-based health coverage ended?
Mark all that apply.
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. ^WAITING
6. Other
Page 158 of 162

NOMORESPELLS
The military insurance topic is complete. Enter 1 to continue
1. Continue

ANYMORESPELLS
WASWERE ^TEMPNAME covered by any of these sources (such as TRICARE, CHAMPUS,
CHAMPVA, VA, or military health care) at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?

1. Yes
2. No

HOWMANY
We've talked about four periods of military health care coverage. How many other times
WASWERE ^TEMPNAME covered by military health care coverage since ^MONTH1 1st
^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INFO
DO NOT include plans that contain only one type of coverage, like dental-only or vision-only plans.

Page 159 of 162

SCREENER
(Other than what we've already talked about,) AREIS ^YOUHESHE currently covered by any other
type of health insurance plan? (Perhaps a government program, Indian Health Services, or a policy
through a parent, a foreign government, or any other source?)
1. Yes
2. No

SCREENER2
C_WASWERE ^YOUHESHE covered by any other type of health insurance plan at any time since
^MONTH1 1st ^CALENDAR_YRFIL? (Perhaps a government program, Indian Health Services, or a
policy through a parent, a foreign government, or any other source?)

1. Yes
2. No

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 160 of 162

EMONTH
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

OTHCOVTYPE
? [F1]
What type of health coverage is this?
Read answer list

1. Government/public assistance
2. Through someone else (parent, relative)
3. Foreign government/country
4. Indian Health Services
5. Other

OTHCOVOTH
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.

Page 161 of 162

OTHEND
What was the reason this insurance plan coverage ended?
Mark all that apply.
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. ^WAITING
6. Other

NOMORESPELLS
The other health insurance topic is complete. Enter 1 to continue.
1. Continue

ANYMORESPELLS
WASWERE ^TEMPNAME covered by another health insurance plan at any other times since
^MONTH1 1st ^CALENDAR_YRFIL? (Perhaps a government program, Indian Health Services, or a
policy through a parent, a foreign government, or any other source?)
1. Yes
2. No

HOWMANY
We've talked about four periods of other health care coverage. How many other times
WASWERE ^TEMPNAME covered by other health insurance since ^MONTH1 1st
^CALENDAR_YRFIL?

Page 162 of 162