Download:
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pdfPARENT DATA COLLECTION
Survey Section
Screener
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Question item/Instrument
Hello. My name is __________ from Mathematica Policy Research. May I
please speak with [SM NAME]?
Hello. My name is __________ from Mathematica Policy Research. I am
calling to talk about (your experiences/[CHILD] and [CHILD]’s experiences)
at [PROGRAM NAME]. Are you [SM NAME]?
Thank you for returning our call. My name is _______ at Mathematica Policy
Research. Are you [SM NAME]?
Last spring we interviewed [SM NAME] about his/her experiences at
[PROGRAM NAME]. Is [SM NAME] the person who is mainly in charge of
[CHILD]'s care?
Last spring we interviewed [SM NAME] as the person mainly in charge of
[CHILD]'s care. Is [SM NAME] still the person who is mainly in charge of
[CHILD]'s care?
Hello. My name is ______ at Mathematica Policy Research. Are you [SM
NAME]?
Who is mainly in charge of [CHILD]'s care?
Hello. My name is ________ at Mathematica Policy Research. I'd like to
confirm that you are the person mainly in charge of[CHILD]'s care. Are you
that person?
I would like to talk with the person mainly in charge of [CHILD]'s care. Are
you that person?
Last spring we interviewed you about your experiences at [PROGRAM
NAME]. Are you the person who is mainly in charge of [CHILD]'s care?
Last spring we interviewed you as the person who is mainly in charge of
[CHILD]'s care. Are you still the person who is mainly in charge of
[CHILD]'s care?
Is this a good time to talk with you?
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Is [CHILD] still enrolled in the same child care program as since spring
[YEAR OF INTERVIEW], or has (he/she) stopped going to that program?
Before we get started, I would like to make sure we have your name recorded
correctly.
May I have the correct spelling of your name?
Do you go by any other name?
Can you give me that name?
Enter name
What is your birth date?
How old are you?
CODE IF OBVIOUS: Are you male or female?
Are you currently pregnant?
Are you pregnant with multiples?
Screener
CODE IF KNOWN BIOLOGICAL MOTHER: What is your relationship to
[CHILD]?
Screener
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
[SM NAME] Answers, [SM NAME] Comes To The Phone, [SM NAME]
Not Available, [SM NAME] Has Moved, [SM NAME] Does Not Speak
English/Spanish, Person Never Heard Of [SM NAME], If Asks Question
0, 1
CATI CATI
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Yes, no
0, 1
CATI
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Yes, no
0, 1
CATI CATI
CATI
Yes Ask To Speak With SM/SM Comes To Phone, Yes Ask To Speak With
SM/Not Available, No SM Not In Charge
0
CATI
Yes Ask To Speak With SM/SM Comes To Phone, Yes Ask To Speak With
SM/Not Available, No SM No Longer In Charge
0, 1
CAPI CAPI
Yes, no
Gives Name/ Or Indicate Self
0, 1
0, 1
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Yes, no
0, 1
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Yes, no
0, 1
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Yes, no
0
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Yes, no
Yes, no, hung up, if asks question
0, 1
0, 1
Still going to same program, Stopped going to that program
0, 1
Name correct, name incorrect
0, 1
Verbatim
0, 1
Yes, no
0, 1
Yes, no
0, 1
Verbatim
0, 1
mm/dd/yyyy
0, 1
Verbatim
0, 1
MALE, FEMALE
0, 1
Yes, no
Yes, no
Mother/female guardian, Father/male guardian, Sister, Brother, Girlfriend or
partner of child's parent/guardian, Boyfriend or partner of child's
parent/guardian, Grandmother, Grandfather, Aunt, Uncle, Cousin, Other
relative, Other non-relative
0, 1
D.3
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PARENT DATA COLLECTION
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Survey Section
Question item/Instrument
Screener
Are you [CHILD]'s…
Question response
Birth mother, Adoptive mother, Stepmother, or Foster mother or female
guardian?
0, 1
CATI
CATI
Screener
Screener
Are you [CHILD]'s…
Are you [CHILD]'s…
Birth father, Adoptive father, Stepfather, or Foster father or male guardian? 0, 1
Full sister, Half sister, Stepsister, Adoptive sister, or Foster sister?
0, 1
CATI
CATI
CATI
CATI
Screener
Are you [CHILD]'s…
Full brother, Half brother, Stepbrother, Adoptive brother, or Foster brother? 0, 1
CATI
CATI
Screener
Now, I would like to make sure we have [CHILD]'s name recorded correctly.
Name correct, name incorrect
0, 1
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CATI CAPI CAPI
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About Household
May I have the correct spelling of (your youngest child/[CHILD])'s name?
Verbatim
0, 1
What is [CHILD]’s birth date?
mm/dd/yyyy
0, 1
ASK IF NOT OBVIOUS: Is [CHILD] a boy or a girl?
Girl, boy
0, 1
We have listed that you (and [CHILD]) currently live in this household. Please
tell me the names and ages of all the other people who normally live here.
Please do not include anyone staying here temporarily who usually lives
somewhere else.
Full name
0, 1
How old is [NAME]?
Age
0, 1
CODE IF OBVIOUS: Is [NAME] male or female?
MALE, FEMALE
0, 1
Have we missed anyone who usually lives here who is temporarily away from
home or living in a dorm at school, or any babies or small children?
YES, NO
0, 1
Do you have a spouse or partner who lives in this household?
YES, NO
0, 1
Who in the household is your spouse or partner?
Name
0, 1
At [LAST INTERVIEW DATE], you said the following people normally lived
in your household. As I read their names, please tell me if they are still living
in your household.
0, 1
Mother/female guardian, Father/male guardian, Sister, Brother, Girlfriend or
partner of child's parent/guardian, Boyfriend or partner of child's
parent/guardian, Grandmother, Grandfather, Aunt, Uncle, Cousin, Other
relative, Other non-relative
0, 1
What is [NAME]’s relationship to (your unborn child/[CHILD])?
Birth mother, Adoptive mother, Stepmother, or Foster mother or female
Is [NAME] (your unborn child/[CHILD])'s…
guardian?
0, 1
About Household
About Household
Is [NAME] (your unborn child/[CHILD])'s…
Is [NAME] (your unborn child/[CHILD])'s…
About Household
Is [NAME] (your unborn child/[CHILD])'s…
About Household
About Household
About Household
About Household
About Household
About Household
About Household
About Household
About Household
About Household
About Household
CATI
CATI CAPI CAPI
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Birth father, Adoptive father, Stepfather, or Foster father or male guardian? 0, 1
Full sister, Half sister, Stepsister, Adoptive sister, or Foster sister?
0, 1
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
Full brother, Half brother, Stepbrother, Adoptive brother, or Foster brother? 0, 1
GIRLFRIEND OR PARTNER OF CHILD'S PARENT/GUARDIAN,
BOYFRIEND OR PARTNER OF CHILD'S PARENT GUARDIAN,
FEMALE GUARDIAN, MALE GUARDIAN, DAUGHTER/SON OF
CHILD'S PARENT'S PARTNER, OTHER RELATIVE OF CHILD'S
PARENT'S PARTNER, OTHER NON-RELATIVE
0, 1
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0, 1
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0, 1
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CODE NON-RELATIVE RELATIONSHIP BELOW IF MORE
DESCRIPTIVE
(Is/Are) (you/[MOTHER]/[FATHER]/ [SPOUSE/PARTNER]) of Spanish,
Hispanic, or Latino origin?
Yes, no
Which one of these best describes (your/[MOTHER]'s/[FATHER]'s/
[SPOUSE/PARTNER]'s) Spanish, Hispanic, or Latino origin. Would you say . Mexican/Mexican American/Chicano, Puerto Rican, Cuban, or another
..
Spanish/Hispanic/Latino group? (SPECIFY)
D.4
PARENT DATA COLLECTION
Survey Section
About Household
About Household
About Household
About Household
About Household
Question item/Instrument
Question response
White, Black Or African American, American Indian Or AlaskaNative
(Specify), Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese,
What is (your/[MOTHER]'s/[FATHER]'s/ [SPOUSE/PARTNER]'s) race? You Asian (Not Further Specified), Native Hawaiian, Guamanian Or Chamorro,
may name more than one if you like.
Samoan, Other Pacific Islander (Specify), Another Race (Specify)
USA, Mexico, Guatemala, Cuba, Dominican Republic, India, China,
In what country (was/were) (you/[MOTHER]/[FATHER]/
Philippines, Japan, Korea, Vietnam, Other Asian (Not Further Specified),
[SPOUSE/PARTNER]) born?
Guam, Samoa,
How many years have (you/[MOTHER]/[FATHER]/ [SPOUSE/PARTNER])
lived in the United States?
Number
Is [CHILD] of Spanish, Hispanic, or Latino origin?
Yes, no
Mexican/Mexican American/Chicano, Puerto Rican, Cuban, or Some other
Which one of these best describes [CHILD]’s Spanish, Hispanic, or Latino
Spanish/Hispanic/
origin. Would you say . . .
Latino group? (SPECIFY)
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
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0, 1
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0, 1
0, 1
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0, 1
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About Household
About Household
About Household
What is [CHILD]’s race? You may name more than one if you like.
Please tell me what country [CHILD] was born in.
How many years has [CHILD] lived in the United States?
White, Black Or African American, American Indian Or AlaskaNative
(Specify), Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese,
Asian (Not Further Specified), Native Hawaiian, Guamanian Or Chamorro,
Samoan, Other Pacific Islander (Specify), Another Race (Specify)
0, 1
USA, Another Country (Specify)
0, 1
Number
0, 1
About Household
I see that [CHILD]’s mother does not live in the home with (him/her). How
long has it been since [CHILD] last had contact with (his/her) mother?
Number of days ago, Number of weeks ago, Number of months ago,
Number of years ago, Child never had contact, Child's mother is deceased
0, 1
CATI
CATI
About Household
About Household
About Household
I see that [CHILD]’s father does not live in the home with (him/her). How
long has it been since [CHILD] last had contact with (his/her) father?
(Are/Were) (you/[CHILD]’s mother) and (you/[CHILD]’s father) . . .
Is any language other than English spoken in your home?
Number of days ago, Number of weeks ago, Number of months ago,
Number of years ago, Child never had contact, Child's father is deceased
married, divorced, separated, never married
Yes, no
0, 1
0, 1
0, 1
CATI
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About Household
What other languages are spoken in your home?
About Household
What is your first language?
About Household
What language do you usually speak to [CHILD] in at home?
About Household
What was the first language [CHILD] learned to speak?
About Household
Which of the languages you told me about did [CHILD] first learn to speak
along with English? Was it . . .
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify) 0, 1
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify),
English
0, 1
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify),
English
0, 1
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify),
English
0, 1
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify),
English
0, 1
D.5
CATI
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CAPI CAPI
CAPI CAPI
PARENT DATA COLLECTION
Survey Section
Question item/Instrument
About Household
Which of the languages you told me about did [CHILD] first learn to speak?
Was it . .
About Household
What language does [CHILD] speak most at home now?
About Household
Which of the languages you told me about does [CHILD] speak most at home
along with English? Is it . . .
About Household
Which of the languages you told me about does [CHILD] speak most at home?
Is it . . .
How well do you understand English?
How well do you speak English?
How well do you read English?
How well do you read your first language?
How well do you write your first language?
The next few questions I am going to ask are about (child’s) activities AT
HOME. How many books for children are there in your home?
About Household
What language(s) are these books in?
About Household
How often does an adult/older sibling read or look at books with your child in
SPANISH?
About Household
About Household
How often does an adult/older sibling read or look at books with your child in
ENGLISH?
Does your child watch television at home?
About Household
If yes, what language(s) are the programs s/he watches in?
About Household
How many hours does your child spend watching television each day?
About Household
How often does your child HEAR Spanish at home?
About Household
How often does your child SPEAK Spanish at home?
About Household
Which of the following best describes your child’s speaking skills in Spanish?
About Household
Which of the following best describes your child’s comprehension skills in
Spanish?
About Household
About Household
About Household
About Household
About Household
About Household
Age
Question response
Cohort
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify),
English
0, 1
English, Spanish, English And Spanish Equally, English And Another,
Language Equally, Another Language (Specify), Mostly English But Some
Spanish/(Other Language), Mostly Spanish/(Other Language) But Some
English
0, 1
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify),
English
0, 1
Spanish, Cantonese, Mandarin, Tagalog, Japanese, Korean, Vietnamese,
Other Asian Language (Specify), Armenian, Persian/Farsi, Hmong,
Russian, First Other Language (Specify), Second Other Language (Specify),
English
0, 1
Not at all, not well, well, very well
0, 1
Not at all, not well, well, very well
0, 1
Not at all, not well, well, very well
0, 1
Not at all, not well, well, very well
0, 1
Not at all, not well, well, very well
0, 1
0-4, 5-10, 11-25, More than 25
0, 1
Only Spanish, Mostly Spanish, English and Spanish Equally, Mostly
English, Only English, Not applicable
0, 1
Almost never, Once a month, 2-3 times a month, 1-2 times a week, Almost
every day
0, 1
Almost never, Once a month, 2-3 times a month, 1-2 times a week, Almost
every day
0, 1
Yes, no
0, 1
Only Spanish, Mostly Spanish, English and Spanish Equally, Mostly
English, Only English, Not applicable
0, 1
less than 1 hour, 1-3 hours, 3-5 hours, more than 5 hours
0, 1
Never, Very little, Sometimes, Most of the time, All of the time
0, 1
Never, Very little, Sometimes, Most of the time, All of the time
0, 1
Cannot speak it, Speaks only a few words or phrases, Speaks it, but has
limited vocabulary, Speaks it and has good vocabulary
0, 1
Cannot understand what is said, Only understands a few words,
Understands the general idea of what is said, Understands most or all of
what is said
0, 1
D.6
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
CAPI CAPI
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PARENT DATA COLLECTION
Survey Section
Question item/Instrument
About Household
How often does your child HEAR English at home?
Question response
Never, Very little, Sometimes, Most of the time, All of the time
Age
Cohort
0, 1
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
CATI
CATI CAPI CAPI
Never, Very little, Sometimes, Most of the time, All of the time
About Household
How often does your child SPEAK English at home?
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
Cannot speak it, Speaks only a few words or phrases, Speaks it, but has
limited vocabulary, Speaks it and has good vocabulary
About Household
About Household
About Household
About Household
About Household
About Household
About Household
Raising a Child
Raising a Child
Raising a Child
Which of the following best describes your child’s speaking skills in English?
Which of the following best describes your child’s comprehension skills in
English?
What language do ([fill other adults from household grid]) use when (he/she)
speaks to your child at home?
Cannot understand what is said, Only understands a few words,
Understands the general idea of what is said, Understands most or all of
what is said
Only Spanish, Mostly Spanish, English and Spanish Equally, Mostly
English, Only English, Not applicable
0, 1
Only Spanish, Mostly Spanish, English and Spanish Equally, Mostly
What language does your child use when s/he speaks to (YOU/[fill other adults English, Only English, Not applicable
from household grid]) at home?
Only Spanish, Mostly Spanish, English and Spanish Equally, Mostly
What language do OTHER CHILDREN in your household use when they
English, Only English, Not applicable
speak to your child at home?
Only Spanish, Mostly Spanish, English and Spanish Equally, Mostly
What language does this child use when s/he speaks to OTHER CHILDREN in English, Only English, Not applicable
your household at home?
What language does your child use when s/he speaks to his/her FRIENDS
Only Spanish, Mostly Spanish, English and Spanish Equally, Mostly
outside of the home?
English, Only English, Not applicable
Parental Modernity Scale (10 items)
Schaefer, Earl S., & Edgerton, M. (1985). Parent and child correlates of
parental modernity. In I. E. Sigel (Ed.),
Parental belief systems: Psychological consequences for children (pp. 287318). Hillsdale, NJ: Lawrence
Erlbaum.
Parenting Stress Index (11 items)
Abidin, Richard R. Parenting Stress Index, Third Edition. Odessa, FL:
Psychological Assessment Resources, 1995.
HOME (2 items on discipline)
Strongly agree, mildly agree, not sure, mildly disagree, strongly disagree
CATI
CATI CAPI CAPI
0, 1
0, 1
CAPI CAPI
CATI
CATI CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CATI
CATI
strongly agree, mildly agree, [not sure] mildly disagree, or strongly disagree 0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
Caldwell, B. M., & Bradley, R. H. (2003). Administration manual: Home
observation for measurement of the environment. Little Rock, AR: University
Varies
of Arkansas at Little Rock.
Parenting Alliance Measure (10 items)
Abidin, R. R., & Konold, T. R. (1999). Parenting alliance measure professional
manual. Lutz, FL: Psychological Assessment Resources, Inc.
Raising a Child
strongly agree, agree, [not sure], disagree, or strongly disagree
MacArthur-Bates CDI MacArthur Bates CDI short-form vocabulary checklist: Level II, Form B (101
items)
SF
Yes, no
D.7
0, 1
SAQ
SAQ
PARENT DATA COLLECTION
Survey Section
Question item/Instrument
MacArthur-Bates CDI
SF
Fenson, L., Pethick, S., Renda, C., & Cox, J. L. (2000). Short-form versions of
First, let's talk about [CHILD]'s health. Overall, would you say [CHILD]'s
health is . . .
Child Health
Child Health
How much did [CHILD] weigh when (he/she) was born?
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Was [CHILD]'s birth weight . .
Was [CHILD] born more than two weeks before or two weeks after the doctor
expected?
How many weeks (early/late) was [CHILD]?
Did (you/[CHILD]'s mother) ever breast-feed CHILD?
(Are you/Is [CHILD]'s mother) still breast-feeding CHILD now?
For how many months did (you/[CHILD]'s mother) breast-feed (him/her)?
During the past 7 days, was CHILD breast-fed, formula-fed, or fed regular
cow's milk?
How old was [CHILD] in months when you began feeding (him/her) formula?
How old was [CHILD] in months when you began feeding (him/her) cow's
milk?
How old was [CHILD] in months when solid food was first introduced? Solid
foods include cereal and baby foods in jars, but not finger foods.
How old was [CHILD] in months when (he/she) was first given finger foods,
such as Cheerios, teething biscuits, crackers, bread, noodles, rice, grits,
tortillas, or potatoes?
Since ([CHILD] was released from the hospital after he/she was born, his/her
X birthday), how many different times has [CHILD] stayed in a hospital for at
least one night?
Altogether, (since (his/her) X birthday), how many nights did (CHILD) stay in
a hospital?
Was this/Were any of these hospitalization(s) because of an accident or injury?
How many of the (NUMBER IN Q2.11A) hospitalizations were because of an
accident or injury?
Were [CHILD]'s activities restricted as a result of this injury?
Did [CHILD] miss going to Early Head Start as a result of this injury?
How many of the (NUMBER IN Q2.11A) hospitalizations were because of
dehydration/diarrhea?
How many of the (NUMBER IN Q2.11A) hospitalizations were because of
asthma/pneumonia/acute respiratory infection/bronchitis/breathing problems?
How many of the (NUMBER IN Q2.11A) hospitalizations were because of
jaundice (yellowing of skin)?
How many of the (NUMBER IN Q2.11A) hospitalizations were because of ear
infection (otitis media)?
How many of the (NUMBER IN Q2.11A) hospitalizations were because of
surgery or an operation?
Question response
Age
Cohort
Not yet, Sometimes, Often
0, 1
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
SAQ
SAQ
Exellent, very good, good, fair, poor
0, 1
Number of pounds/ounces or number of kilograms
0, 1
normal (5 1/2 lbs. [2.5 kilograms] or more), low (between 3 1/2 [1.5
kilograms and 5 1/2 lbs. [2.5 kilograms]), or very low (under 3 1/2 lbs. [1.5
kilograms])?
0, 1
CATI
CATI
CATI CAPI CAPI
CATI
CATI
CATI
YES, BEFORE; YES, AFTER
Number of weeks
Yes, no
Yes, no
0,1
0,1
0,1
0,1
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CATI
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CATI
CATI
CATI
Number of months
0,1
CATI
CATI
breast-fed, formula-fed, cow's milk
0,1
CATI
CATI
Number of months
0,1
CATI
CATI
Number of months
0,1
CATI
CATI
Number of months
0,1
CATI
CATI
Number of months
0,1
CATI
CATI
Number of times
0, 1
CATI
CATI CAPI CAPI
Number of nights
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Number of times
Yes, no
Yes, no
0, 1
0, 1
0, 1
CATI
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CATI CAPI CAPI
Number of times
0, 1
CATI
CATI
Number of times
0, 1
CATI
CATI CAPI CAPI
Number of times
0, 1
CATI
CATI
Number of times
0, 1
CAPI CAPI
Number of times
0, 1
CAPI CAPI
D.8
PARENT DATA COLLECTION
Survey Section
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Question item/Instrument
How many of the (NUMBER IN Q2.11A) hospitalizations were because of
high fever of unknown cause?
How many of the (NUMBER IN Q2.11A) hospitalizations were because of
some other reason?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
asthma?
Has a doctor, nurse, or other medical professional told you that [CHILD] has a
respiratory or breathing illness, such as bronchitis, pneumonia, or
bronchiolitis?
Has a doctor, nurse, or other medical professional told you that [CHILD] has a
severe stomach or gastrointestinal illness, as indicated by frequent vomiting,
diarrhea, or dehydration?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
an ear infection?
How many times has a doctor, nurse, or other medical professional told you
that [CHILD] has an ear infection?
Has a doctor, nurse, or other medical professional told you that [CHILD] has a
problem with muscles or with moving such as cerebral palsy?
Has a doctor, nurse, or other medical professional told you that [CHILD] has a
developmental delay?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
epilepsy or seizures?
Has a doctor, nurse, or other medical professional told you that [CHILD] has a
heart defect?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
mental retardation or cognitive impairment?
Has a doctor, nurse, or other medical professional told you that [CHILD] has a
lactose intolerance?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
other food allergy or sensitivity such as to peanuts?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
problem with allergies other than foods, such as to dust, animals, or medicine?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
attention deficit, hyperactivity, ADD or ADHD?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
diabetes?
Has a doctor, nurse, or other medical professional told you that [CHILD] has
sleep apnea?
Has a doctor, nurse, or other medical professional told you that [CHILD]'s
weight is too low?
Has a doctor, nurse, or other medical professional told you that [CHILD]'s
weight is too high?
Did [CHILD] miss regular Early Head Start activities as a result of [FILL D13
a - n]?
Are [CHILD]'s activities restricted as a result of any impairment or health
problem?
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Question response
Age
Cohort
Number of times
0, 1
CATI
CATI CAPI CAPI
Number of times
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CAPI CAPI
Yes, no
0, 1
CAPI CAPI
Yes, no
0, 1
CAPI CAPI
Yes, no
0, 1
CAPI CAPI
Number
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CAPI CAPI
Yes, no
0, 1
CAPI CAPI
Yes, no
0, 1
CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
D.9
PARENT DATA COLLECTION
Survey Section
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Question item/Instrument
Has [CHILD] missed going to Early Head Start as a result of any impairment
or health problem?
Since [[THIS MONTH LAST YEAR]) Has [CHILD] been evaluated by a
doctor, psychologist or other health professional because of a concern about
(his/her) ability to pay attention or learn?
Did you obtain a diagnosis of a problem from a doctor, psychologist or other
health professional?
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Question response
Age
Cohort
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Mental Retardation or Cognitive Impairment, Emotional/Behavior
Disability, Autism or Pervasive Developmental Delay (PDD), Traumatic
Brain Injury, Oppositional Defiant Disorder, Other (Specify)
0, 1
CATI
CATI CAPI CAPI
What was the diagnosis?
(Since [THIS MONTH LAST YEAR]) Has [CHILD] been evaluated by a
psychologist or health professional because of a concern about (his/her) overall
activity level?
Yes, no
Did you obtain a diagnosis of a problem from a doctor, psychologist, or health
professional?
Yes, no
Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder
What was the diagnosis?
(ADHD), Other (Specify)
Since [THIS MONTH LAST YEAR])Has [CHILD] been evaluated by a doctor
or other health professional because of a concern about the way (he/she) uses
(his/her) arms or legs?
Yes, no
Did you obtain a diagnosis of a problem from a doctor, psychologist, or health
professional?
Yes, no
Cerebral Palsy, Epilepsy Or Seizures, Another Developmental Delay
What was the diagnosis?
(Specify)
Does [CHILD] use special equipment, such as a brace, a wheelchair, or
corrective shoes?
Yes, no
Since [THIS MONTH LAST YEAR ] Has [CHILD] been evaluated by a
doctor or other health professional because of a concern about (his/her) ability
to communicate?
Yes, no
Did you obtain a diagnosis of a problem from a doctor, psychologist, or health
professional?
Yes, no
Speech Impairment, Language Impairment, Autism Or Pervasive
Developmental Delay (Pdd), Mental Retardation Or Cognitive Impairment,
What was the diagnosis?
Emotional/Behavior Disability, Other (Specify)
Does [CHILD] have difficulty hearing and understanding speech in a normal
conversation?
Yes, no
Since [THIS MONTH LAST YEAR] Has [CHILD] been evaluated by a doctor
or other health professional because of a concern about (his/her) ability to hear
and understand speech in a normal conversation?
Yes, no
Did you obtain a diagnosis of a problem from a doctor or other health
professional?
Yes, no
Ear Infection, Hearing Impairment/Hard Of Hearing, Deafness, Language
Impairment, Autism Or Pervasive Developmental, Delay (PDD), Mental
What was the diagnosis?
Retardation, Emotional/Behavior Disability
Does [CHILD] usually wear a hearing aid?
Yes, no
Does [CHILD] have cochlear implants?
Yes, no
D.10
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
PARENT DATA COLLECTION
Survey Section
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Child Health
Question item/Instrument
Question response
What is the effect of the device on [CHILD]'s ability to hear and understand
greatly improve (his/her) hearing, somewhat improve (his/her) hearing,
speech in normal conversations? Does it . . .
minimally improve (his/her) hearing, or does not improve (his/her) hearing?
Now I want to ask you about [CHILD]’s vision. Does [CHILD] have difficulty
seeing objects in the distance or letters on paper?
Yes, no
Since [THIS MONTH LAST YEAR] Has [CHILD]'s vision been evaluated by
a doctor or other health professional?
Yes, no
Did you obtain a diagnosis of a problem from a doctor or other health
professional?
Yes, no
What was the diagnosis?
Near Sighted, Far Sighted, Legally Blind, Other (Specify)
Does [CHILD] usually wear glasses or contact lenses?
Yes, no
correctable with glasses, improvable with glasses, or not correctable with
Which of these best describes [CHILD]'s eyesight with glasses? Is it . . .
glasses?
Does [CHILD] regularly snore? PROBE: This does not include temporary
snoring due to a cold or congestion.
Yes, no
Since [THIS MONTH LAST YEAR] Has [CHILD]'s snoring been evaluated
by a doctor or other health professional?
Yes, no
Did you obtain a diagnosis of a problem from a doctor or other health
professional?
Yes, no
Obstructive Sleep Apnea Syndrome, nasal obstruction, enlarged adenoids
What was the diagnosis?
and/or tonsils, Other (Specify)
Did [PROGRAM] help you get this evaluation for [CHILD]'s [FILL
SCREENING]?
Yes, no
Provided information, including brochures, meetings, or conversations,
Made referrals, for example, phone calls, Provided evaluation directly,
How did they help you?
Helped in some other way (Specify)
How helpful was the [information/referral/direct evaluation/{other}]? Would
you say that it was very helpful, somewhat helpful, or not at all helpful?
{IF 34=No} Why is that?
Has [CHILD] ever received speech or language therapy?
Has [CHILD] ever received occupational therapy or OT?
Has [CHILD] or ever received physical therapy or PT?
Has [CHILD] ever received vision services?
Has [CHILD] ever received hearing or audiology services?
Have you (or other parent) ever received social work services?
Have you (or other parent) ever received psychological services?
Have you (or other parent) ever received parent support or training?
Has [CHILD] ever taken part in special classes with other children, some or all
of whom also had special needs?
{IF LEARNING DISABLED} Has [CHILD] ever received private tutoring or
schooling for learning problems?
Has [CHILD] ever received instruction in Braille?
{IF DEAF} Has [CHILD] ever received instruction in sign language, cued
speech, ASL, or TOCO?
Did [PROGRAM] help [CHILD] or your family get [FILL SERVICE] for
[CHILD]?
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CAPI CAPI
0, 1
0, 1
0, 1
CAPI CAPI
CAPI CAPI
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
Very Helpful, Somewhat Helpful, Not At All Helpful
Used my own health care provider, Other (Specify)
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
Yes, no
0, 1
0, 1
CAPI CAPI
CAPI
Yes, no
0, 1
CAPI CAPI
0, 1
D.11
CATI
CATI
CATI
CATI CAPI CAPI
PARENT DATA COLLECTION
Age
Question response
Cohort
Provided information, including brochures, meetings, or conversations,
Made referrals, for example, phone calls, Provided services directly, Helped
in some other way (Specify)
0,1
Survey Section
Question item/Instrument
Child Health
How did they help you?
Child Health
How helpful was the [information/referral/direct service/{other}]? Would you
say that it was very helpful, somewhat helpful, or not at all helpful?
Very Helpful, Somewhat Helpful, Not At All Helpful
Child Health
{IF D41a-l = No} Why is that?
Child Health
Child Health
Child Health
Child Health
Child Health
Child Care
Child Care
Child Care
Child Care
Child Care
Is [CHILD] currently participating in an early intervention program or
regularly receiving any services for (his/her) condition(s) from your local
school district, a state or local health agency or social service agency?
Is [CHILD] currently participating in an early intervention program or
regularly receiving any services for (his/her) condition(s) from a doctor, clinic,
or other health care provider?
Is [CHILD] currently participating in an early intervention program or
regularly receiving any services for (his/her) condition(s) from some other
source? (SPECIFY)
Since [THIS MONTH LAST YEAR]) Has anyone (ever) suggested that you
get [CHILD] evaluated for a possible special condition or need?
What special condition or need?
Is [CHILD] now attending a day care center, nursery school, preschool, or pre
kindergarten program on a regular basis?
Not including Early Head Start, how many different day care centers, nursery
schools, preschools, or pre-kindergarten programs does [CHILD] currently go
to?
(Thinking about the center that [CHILD] goes to the most,) how many days
each week does [CHILD] go to that program?
How many hours each week does [CHILD] go to that program?
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
CATI
CATI CAPI CAPI
0,1
CATI
CATI CAPI CAPI
Received services through my own health care provider, Other (Specify)
0,1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Behavior Problem, Emotional Problem, Attention Problem, Developmental
Delay, Problem With Use Of Arms Or Legs, Oppositional Defiant Disorder,
Speech Problem, Hearing Problem, Vision Problem, Other (Specify)
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
One, two, three, four or more
0, 1
CATI
CATI CAPI CAPI
Number
Number
Before Early Head Start, After Early Head Start, Both Before/After Early
Head Start
0, 1
0, 1
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
One, two, three, four or more
0, 1
CATI
CATI CAPI CAPI
grandparent, aunt, uncle, brother, sister, or another relative? (SPECIFY)
Own home, other home, both/varies
Yes, no
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
Child Care
Child Care
Child Care
Is [CHILD] in that program before or after Early Head Start?
Is [CHILD] now receiving care from a relative other than (a parent/you) on a
regular basis, for example from grandparents, brothers or sisters, or any other
relative in the morning before or in the afternoon after (he/she) comes to Early
Head Start?
How many different regular care arrangements do you currently have with
relatives for [CHILD]?
Let's talk about the relative who provides the most care for [CHILD] now. Is
that relative [CHILD]'s
Is the care provided by (that relative) in your home or another home?
Does this person who cares for [CHILD] live in your household?
Child Care
How many days each week does [CHILD] receive care from that relative?
Number
0, 1
CATI
CATI CAPI CAPI
Child Care
How many hours each week does [CHILD] receive care from that relative?
Number
0, 1
CATI
CATI CAPI CAPI
Child Care
Child Care
D.12
PARENT DATA COLLECTION
Survey Section
Question item/Instrument
Child Care
Is [CHILD] cared for by a relative before or after Early Head Start?
Question response
Before Early Head Start, After Early Head Start, Both Before/After Early
Head Start
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
One, two, three, four or more
0, 1
CATI
CATI CAPI CAPI
Child Care
Child Care
Is [CHILD] now receiving care on a regular basis from anyone else in a private
home before in the morning or after in the afternoon Early Head Start?
How many different regular care arrangements do you currently have with non
relatives for [CHILD]?
Let's talk about the non-relative who provides the most care for [CHILD]. Is
that care provided in your home or another home?
Does this person who cares for [CHILD] live in your household?
Respondent's home, other home, both/varies
Yes, no
0, 1
0, 1
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
Child Care
How many days each week does [CHILD] receive care from that person?
Number
0, 1
CATI
CATI CAPI CAPI
Child Care
Number
Before Early Head Start, After Early Head Start, Both Before/After Early
Head Start
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
Number
0, 1
CATI
CATI CAPI CAPI
Child Care
How many hours each week does [CHILD] receive care from that person?
Is [CHILD] cared for by someone other than a relative before or after Early
Head Start?
Thinking of all the child care you use for [CHILD] before or after Early Head
Start, how many days a week is (he/she) in child care before or after Early
Head Start?
And, all together, how many hours a week is [CHILD] typically in before or
after Early Head Start care?
Number
0, 1
CATI
CATI CAPI CAPI
Child Care
Is there any charge or fee for any of the care [CHILD] receives from [FILL IF
E1=1 a center, IF E6=1 a relative, IF E13=1 or someone who is not a relative]? Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
Child Care
Child Care
Child Care
Child Care
Number per hour/day/week/bi-weekly/month/year/other(Specify)
0, 1
CATI
CATI CAPI CAPI
Child Care
Child care is paid for in different ways. Please tell me the ways [CHILD]'s
child care is paid for. Do you pay for some or all of it yourself?
Does a government agency pay for some or all of it?
Does an employer pay for some or all of it?
Does someone else pay for some or all of it?
Do you trade child care with someone else?
Any other way? (SPECIFY)
Thinking about the child care arrangements we just talked about that you have
for [CHILD] both before and after Head Start, how much does your household
pay for this child care?
Is this amount for [CHILD] only, or does it include other children in the
household?
Child only, child and others
0, 1
CATI
CATI CAPI CAPI
About Child's Mother
How many times have you been pregnant (since [REFERENCE DATE])?
Number
0,1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Are you currently pregnant?
Yes, no
0, 1
CATI
CATI CAPI CAPI
About Child's Mother
Yes, no
0, 1
CATI
CATI CAPI CAPI
About Child's Mother
Are you pregnant with multiples?
How many living children have you given birth to (since [REFERENCE
DATE])?
PROBE: Please do not include miscarriages or stillbirths.
Number
0,1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Have you had a miscarriage or stillbirth (since [REFERENCE DATE])?
Yes, no
0,1
CATI CATI
CATI CAPI CAPI
Child Care
Child Care
Child Care
Child Care
Child Care
Child Care
Child Care
D.13
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
PARENT DATA COLLECTION
Survey Section
Question item/Instrument
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
About Child's Mother
How many miscarriages have you had (since [REFERENCE DATE])?
Number
0,1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Have you had an abortion (since [REFERENCE DATE])?
Yes, no
0,1
CATI CATI
CATI CAPI CAPI
About Child's Mother
How many abortions have you had (since REFERENCE DATE])?
Number
0,1
CATI CATI
CATI CAPI CAPI
About Child's Mother
What (is [CHILD]'s mother/ was [CHILD]'s mother's) birth date?
mm/dd/yyyy
0, 1
CATI
About Child's Mother
How old (were you/was she) when (you/she) gave birth for the first time?
Number
0, 1
CATI
About Child's Mother
(Is she/Was she) of Spanish, Hispanic, or Latino origin?
Yes, no
Which one of these best describe(s/d) her Spanish, Hispanic, or Latino origin. Mexican/Mexican American/Chicano, Puerto Rican, Cuban, or another
Would you say . . .
Spanish/Hispanic/Latino group? (SPECIFY)
0, 1
CATI
0, 1
CATI
White, Black Or African American, American Indian Or AlaskaNative
(Specify), Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese,
Asian (Not Further Specified), Native Hawaiian, Guamanian Or Chamorro,
Samoan, Other Pacific Islander (Specify), Another Race (Specify)
0, 1
USA, Mexico, Guatemala, Cuba, Dominican Republic, India, China,
Philippines, Japan, Korea, Vietnam, Other Asian (Not Further Specified),
Guam, Samoa,
0, 1
CATI
CATI
Number
0, 1
CATI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Number
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
About Child's Mother
What (is/was) her race? You may name more than one if you like.
About Child's Mother
In what country was she born?
About Child's Mother
About Child's Mother
How many years (has she/did she) live(d) in the United States?
Did (you/[CHILD]'s mother) work at a job for pay or income, including selfemployment, (in the past 12 months/since [MONTH AND YEAR] of last
interview)?
About how many total hours per week (do you/does she) usually work for pay
or income, counting all jobs?
During the past week, did (you/[CHILD]'s mother) work at a job for pay or
income, including self employment?
About Child's Mother
(Were you/Was she) on leave or vacation from a job for the past week?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
(Have you/Has she) actively been looking for work in the past four weeks?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Last week, (did you/did [CHILD]'s mother) work in the morning?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Last week, (did you/did [CHILD]'s mother) work in the afternoon?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Last week, (did you/did [CHILD]'s mother) work in the evening?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Last week, (did you/did [CHILD]'s mother) work in the night?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
Can (you/she) change (your/her) schedule for family reasons?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
About Child's Mother
About Child's Mother
D.14
PARENT DATA COLLECTION
About Child's Mother
Age
Question response
Cohort
Up To 8th Grade, 9th To 11th Grade, 12Th Grade But No Diploma, High
School Diploma/Equivalent, Voc/Tech Program After High School, But No
The next questions are about the kinds of educational activities (you/she) may Voc/Tech Diploma, Voc/Tech Diploma After High School, Some College
take part in. We will talk about degree programs and classes in colleges and But No Degree, Associate’s Degree, Bachelor’S Degree, Graduate Or
vocational schools, courses or training sessions related to work or personal
Professional, School But No Degree, Master’S Degree (MA, MS),
interest, and other ways of learning new information or skills. What is the
Doctorate Degree (PhD, EdD), Degree (Medicine/Md; Dentistry/DDS;
highest grade or year of school that (you/she) completed?
Law; JD; LLB; etc.)
0, 1
About Child's Mother
Which (do you/does she) have, a high school diploma or a GED?
About Child's Mother
((Are you/Is she) now attending or enrolled)/(Since [MONTH AND YEAR OF
LAST INTERVIEW] (did you/she)) attend or enroll)) in any courses, classes,
or workshops for work-related reasons or personal interest? Some examples
include college or university degree or certificate programs, computer courses,
job training courses, basic reading or math classes, family literacy classes or
GED preparation classes?
Yes, no
Survey Section
About Child's Mother
About Child's Mother
About Child's Mother
About Child's Mother
About Child's Mother
About Child's Mother
About Child's Father
About Child's Father
About Child's Father
Question item/Instrument
(Are you/Is she) currently taking courses full-time or part-time?
Full-time, part-time
(Are you/Is she) currently participating in a job-training or on-the-job-training
program?
Yes, no
(Have you/Has she) received a certificate, diploma, or degree since [MONTH
AND YEAR OF LAST INTERVIEW]?
Yes, no
Trade License Or Certificate, GED Certificate Or Equivalent, High School
Diploma, Associate’S Degree, Child Development Associate (CDA),
What kind of certificate, diploma, or degree (did you/did she) receive?
Bachelor’S Degree, Graduate Degree, Other (Specify)
Did Early Head Start help (you/her) to take or locate the programs, courses,
classes, or workshops that (you are/she is) taking?
Yes, no
Admission Requirement/Qualification, Too Old To Take Any Courses,
Health Problem/Disability, Don’t Like Learning, Lack Of Confidence, No
Adults sometimes find it hard to take part in educational activities, even if they Information About Offering, Lack Of Child Care, Time Constraints (Home
want to. What was the main reason (you/she) did not take any programs,
Or Work), Cost, Inconvenient Location/Transportation Not Available, Did
courses, classes, or workshops?
Not Need More, Other (Specify)
What (is [CHILD]'s father's/was [CHILD]'s father's) birth date?
mm/dd/yyyy
(Is he/Was he) of Spanish, Hispanic, or Latino origin?
Yes, no
Which one of these best describe(s/d) his Spanish, Hispanic, or Latino origin. Mexican/Mexican American/Chicano, Puerto Rican, Cuban, or another
Would you say . . .
Spanish/Hispanic/Latino group? (SPECIFY)
About Child's Father
What (is/was) his race? You may name more than one if you like.
About Child's Father
About Child's Father
In what country was he born?
How many years (has he/did he) live(d) in the United States?
During the past week, did (you/[CHILD]'s father) work at a job for pay or
income, including self employment?
(Were you/Was he) on leave or vacation from a job for the past week?
About Child's Father
About Child's Father
High school diploma, GED
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI
CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
0, 1
0, 1
CATI CATI
CATI
CATI
CATI CAPI CAPI
CATI
CATI
0, 1
CATI
CATI
White, Black Or African American, American Indian Or AlaskaNative
(Specify), Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese,
Asian (Not Further Specified), Native Hawaiian, Guamanian Or Chamorro,
Samoan, Other Pacific Islander (Specify), Another Race (Specify)
0, 1
USA, Mexico, Guatemala, Cuba, Dominican Republic, India, China,
Philippines, Japan, Korea, Vietnam, Other Asian (Not Further Specified),
Guam, Samoa,
0, 1
Number
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
Yes, no
Yes, no
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
0, 1
0, 1
D.15
PARENT DATA COLLECTION
Survey Section
Question item/Instrument
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
About Child's Father
(Have you/Has he) actively been looking for work in the past four weeks?
Did (you/[CHILD]'s father) work at a job for pay or income, including selfemployment, [in the past 12 months/since MONTH AND YEAR of last
interview]?
About how many total hours per week (do you/does he) usually work for pay
or income, counting all jobs?
Last week, (did you/did [CHILD]'s father) work in the morning?
Last week, (did you/did [CHILD]'s father) work in the afternoon?
Last week, (did you/did [CHILD]'s father) work in the evening?
Last week, (did you/did [CHILD]'s father) work in the night?
Can (you/he) change (your/his) schedule for family reasons?
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Number
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Up To 8th Grade, 9th To 11th Grade, 12Th Grade But No Diploma, High
School Diploma/Equivalent, Voc/Tech Program After High School, But No
Voc/Tech Diploma, Voc/Tech Diploma After High School, Some College
But No Degree, Associate’s Degree, Bachelor’S Degree, Graduate Or
Professional, School But No Degree, Master’S Degree (MA, MS),
Doctorate Degree (PhD, EdD), Degree (Medicine/Md; Dentistry/DDS;
Law; JD; LLB; etc.)
High school diploma, GED
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
0, 1
0, 1
CATI CATI
CATI
CATI CAPI CAPI
CATI
Yes, no
Full-time, part-time
0, 1
0, 1
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
Trade License Or Certificate, GED Certificate Or Equivalent, High School
Diploma, Associate’S Degree, Child Development Associate (CDA),
Bachelor’S Degree, Graduate Degree, Other (Specify)
0, 1
CATI
CAPI CAPI
CATI
CAPI CAPI
CATI CATI
CATI CAPI CAPI
CATI CATI
CATI CAPI CAPI
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
The next questions are about the kinds of educational activities (you/he) may
take part in. We will talk about degree programs and classes in colleges and
vocational schools, courses or training sessions related to work or personal
interest, and other ways of learning new information or skills. What is the
highest grade or year of school that (you/he) completed?
Which (do you/does he) have, a high school diploma or a GED?
((Are you/Is he)now attending or enrolled)/(Since [MONTH OF LAST
INTERVIEW] (did you/he)) attend or enroll)) in any courses, classes, or
workshops for work-related reasons or personal interest? Some examples
include college or university degree or certificate programs, computer courses,
job training courses, basic reading or math classes, family literacy classes or
GED preparation classes?
(Are you/Is he) currently taking courses full-time or part-time?
(Are you/Is he) currently participating in a job-training or on-the-job-training
program?
(Have you/Has he) received a certificate, diploma, or degree since [MONTH
OF LAST INTERVIEW]?
What kind of certificate, diploma, or degree (did you/did he) receive?
Did Early Head Start help (you/him) to take or locate the programs, courses,
classes, or workshops that (you are/he is) taking?
Yes, no
0, 1
Admission Requirement/Qualification, Too Old To Take Any Courses,
Health Problem/Disability, Don’t Like Learning, Lack Of Confidence, No
Adults sometimes find it hard to take part in educational activities, even if they Information About Offering, Lack Of Child Care, Time Constraints (Home
want to. What was the main reason (you/he) did not take any programs,
Or Work), Cost, Inconvenient Location/Transportation Not Available, Did
courses, classes, or workshops?
Not Need More, Other (Specify)
0, 1
How soon after you found out you were pregnant, did [CHILD]'s father learn Within One Week, Within One Month, More Than A Month Later, , After
that you were pregnant?
Baby Was Born, Never Learned
0, 1
Was (his/her) father present when [CHILD] was born, either in the hospital or
wherever the birth was?
Yes, no
0, 1
When [CHILD] was in the hospital/birthplace after (he/she) was born, did
(his/her) father come to see (him/her)?
Yes, no
0, 1
D.16
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
PARENT DATA COLLECTION
Survey Section
About Child's Father
Question item/Instrument
While you were pregnant, did [CHILD]'s father do any of the following?
Discuss how your pregnancy was going with you?
Go to the doctor with you?
Attend child birth or Lamaze classes with you?
In the first three months of (his/her) life, about how often did [CHILD] see
[you/(his/her) father]? Was it
In the last three months, about how often has [CHILD] seen (his/her) father?
Was it
In a typical day, does [FATHER] give you a lot, some, or no help in caring for
[CHILD]?
In the past month, how often has [FATHER] taken care of [CHILD] while you
did other things? Was it . . .
About Child's Father
(In the past year/Since [MONTH AND YEAR FATHER LEFT], [MONTH
AND YEAR OF LAST INTERVIEW]), (have you/has your family) received
any child support payments for [CHILD] from (his/her) father?
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Child's Father
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
(In the past year/Since [MONTH AND YEAR FATHER LEFT], [MONTH
AND YEAR OF LAST INTERVIEW]), (have you/has your family) received
any other financial support for [CHILD] from (his/her) father?
Next, I have some questions about [NAME of spouse/partner], including
questions about his education and employment. Has [NAME of
spouse/partner] always lived with you since [CHILD] was born?
Since [CHILD] was born, how many months has he lived with you?
During the past week, did he work at a job for pay or income, including self
employment?
Was he on leave or vacation from a job for the past week?
Has he actively been looking for work in the past four weeks?
Did [NAME of spouse/partner] work at a job for pay or income, including selfemployment, [in the past 12 months/since MONTH AND YEAR of last
interview]?
About how many total hours per week (do you/does he) usually work for pay
or income, counting all jobs?
Last week, did he work in the morning?
Last week, did he work in the afternoon?
Last week, did he work in the evening?
Last week, did he work in the night?
Can he change his schedule for family reasons?
About Father Figure
About Father Figure
The next questions are about the kinds of educational activities he may take
part in. We will talk about degree programs and classes in colleges and
vocational schools, courses or training sessions related to work or personal
interest, and other ways of learning new information or skills. What is the
highest grade or year of school that he completed?
Which does he have, a high school diploma or a GED?
About Child's Father
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Yes, no
Yes, no
Yes, no
Every day or almost every day, A few times a week, A few times a month,
About once a month, Less often than that, or Never?
Every day or almost every day, A few times a week, A few times a month,
About once a month, Less often than that, or Never?
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
0, 1
CATI
CATI
0, 1
CATI
CATI CAPI CAPI
A lot, some, no help
Every day or almost every day, A few times a week, A few times a month,
Once or twice, or Never?
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI
CATI CAPI CAPI
YES, NO
Number of months
0, 1
0, 1
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
CATI CATI
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Number
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Up To 8th Grade, 9th To 11th Grade, 12Th Grade But No Diploma, High
School Diploma/Equivalent, Voc/Tech Program After High School, But No
Voc/Tech Diploma, Voc/Tech Diploma After High School, Some College
But No Degree, Associate’s Degree, Bachelor’S Degree, Graduate Or
Professional, School But No Degree, Master’S Degree (MA, MS),
Doctorate Degree (PhD, EdD), Degree (Medicine/Md; Dentistry/DDS;
Law; JD; LLB; etc.)
High school diploma, GED
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
0, 1
0, 1
CATI CATI
CATI CATI
D.17
CATI
CATI
CATI
CATI
CATI
CATI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CATI CAPI CAPI
CATI CAPI CAPI
PARENT DATA COLLECTION
Survey Section
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Father Figure
About Respondent
About Respondent
About Respondent
About Respondent
About Respondent
About Respondent
About Respondent
About Respondent
About Respondent
Question item/Instrument
((Are you/Is he)now attending or enrolled)/(Since [MONTH OF LAST
INTERVIEW] (did you/he)) attend or enroll)) in any courses, classes, or
workshops for work-related reasons or personal interest? Some examples
include college or university degree or certificate programs, computer courses,
job training courses, basic reading or math classes, family literacy classes or
GED preparation classes?
(Are you/Is he) currently taking courses full-time or part-time?
(Are you/Is he) currently participating in a job-training or on-the-job-training
program?
(Have you/Has he) received a certificate, diploma, or degree since [MONTH
OF LAST INTERVIEW]?
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Yes, no
Full-time, part-time
0, 1
0, 1
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
Trade License Or Certificate, GED Certificate Or Equivalent, High School
Diploma, Associate’S Degree, Child Development Associate (CDA),
Bachelor’S Degree, Graduate Degree, Other (Specify)
0, 1
CATI
CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
CATI CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI CATI
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CATI
CATI CAPI CAPI
CATI CATI
CATI CAPI CAPI
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
What kind of certificate, diploma, or degree (did you/did he) receive?
Did Early Head Start help him take or locate the programs, courses, classes, or
workshops that he is taking?
Yes, no
Admission Requirement/Qualification, Too Old To Take Any Courses,
Health Problem/Disability, Don’t Like Learning, Lack Of Confidence, No
Adults sometimes find it hard to take part in educational activities, even if they Information About Offering, Lack Of Child Care, Time Constraints (Home
want to. What was the main reason he did not take any programs, courses,
Or Work), Cost, Inconvenient Location/Transportation Not Available, Did
classes, or workshops?
Not Need More, Other (Specify)
0, 1
Is there anyone else who is like a father to [CHILD]?
Yes, no
0, 1
you, your spouse or partner, a relative of [CHILD], or a friend of the
Who is this person? Is he . . .
family?
0, 1
During the past week, did you work at a job for pay or income, including self
employment?
Yes, no
0, 1
Were you on leave or vacation from a job for the past week?
Yes, no
0, 1
Have you actively been looking for work in the past four weeks?
Yes, no
0, 1
Did you work at a job for pay or income, including self employment, (in the
past 12 months/since MONTH AND YEAR of last interview]?
Yes, no
0, 1
About how many total hours per week do you usually work for pay or income,
counting all jobs?
Number
0, 1
Up To 8th Grade, 9th To 11th Grade, 12Th Grade But No Diploma, High
School Diploma/Equivalent, Voc/Tech Program After High School, But No
The next questions are about the kinds of educational activities you may take Voc/Tech Diploma, Voc/Tech Diploma After High School, Some College
part in. We will talk about degree programs and classes in colleges and
But No Degree, Associate’s Degree, Bachelor’S Degree, Graduate Or
vocational schools, courses or training sessions related to work or personal
Professional, School But No Degree, Master’S Degree (MA, MS),
interest, and other ways of learning new information or skills. What is the
Doctorate Degree (PhD, EdD), Degree (Medicine/Md; Dentistry/DDS;
highest grade or year of school that you completed?
Law; JD; LLB; etc.)
0, 1
Which do you have, a high school diploma or a GED?
High school diploma, GED
0, 1
(Are you now attending or enrolled)/(Since [MONTH AND YEAR OF LAST
INTERVIEW] did you attend or enroll)) in any courses, classes, or workshops
for work-related reasons or personal interest? Some examples include college
or university degree or certificate programs, computer courses, job training
courses, basic reading or math classes, family literacy classes or GED
preparation classes?
Yes, no
0, 1
Are you currently taking courses full-time or part-time?
Full-time, part-time
0, 1
D.18
CATI CAPI CAPI
PARENT DATA COLLECTION
Survey Section
About Respondent
About Respondent
About Respondent
About Respondent
About Respondent
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Question item/Instrument
Are you currently participating in a job-training or on-the-job-training
program?
Have you received a certificate, diploma, or degree since [MONTH AND
YEAR OF LAST INTERVIEW]?
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
Trade License Or Certificate, GED Certificate Or Equivalent, High School
Diploma, Associate’S Degree, Child Development Associate (CDA),
Bachelor’S Degree, Graduate Degree, Other (Specify)
0, 1
CATI
CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
CATI CATI
CATI CAPI CAPI
CATI CATI
CATI CAPI CAPI
CATI CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI CATI
CATI CAPI CAPI
CAPI CAPI
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
What kind of certificate, diploma, or degree did you receive?
Did Early Head Start help you to take or locate the programs, courses, classes,
or workshops that you are taking?
Yes, no
Admission Requirement/Qualification, Too Old To Take Any Courses,
Health Problem/Disability, Don’t Like Learning, Lack Of Confidence, No
Adults sometimes find it hard to take part in educational activities, even if they Information About Offering, Lack Of Child Care, Time Constraints (Home
want to. What was the main reason you did not take any programs, courses,
Or Work), Cost, Inconvenient Location/Transportation Not Available, Did
classes, or workshops?
Not Need More, Other (Specify)
0, 1
The next questions are about ([CHILD]'s and) your health care. First, do you
have a regular health care provider?
Yes, no
0, 1
A Private Doctor/Private Clinic/HMO, An Outpatient Clinic Run By A
Hospital, The Emergency Room At A Hospital, Public Health Department
Or Community Health Center, A Migrant Health Clinic, The Indian Health
Where do you usually go for health care?
Service, Someplace Else (Specify)
0, 1
Does [CHILD] have a regular health care provider?
Yes, no
0, 1
A Private Doctor/Private Clinic/HMO, An Outpatient Clinic Run By A
Hospital, The Emergency Room At A Hospital, Public Health Department
Where does [CHILD] go for routine medical care, like well-child care or
Or Community Health Center, A Migrant Health Clinic, The Indian Health
regular check-ups?
Service, Someplace Else (Specify)
0, 1
Has Early Head Start helped/(ELSE)Did Early Head Start help] you find a
regular health care provider for [CHILD]?
Yes, no
0, 1
Provided Information Including Brochures/Meetings/Conversations, Made
Referrals For Example Phone Calls, Provided Health Care Directly, Helped
How did they help you?
In Some Other Way (Specify)
0, 1
Had A Health Care Provider Prior To Enrollment, Found A Health Care
Why is that?
Provider On My Own, Other (Specify)
0, 1
6 months ago or less, more than 6 months ago but not more than 1 year ago,
When was the last time [CHILD] saw a doctor for a regular checkup? Was it . more than 1 year ago but not more than 2 years ago, more than 2 years ago,
..
or never?
0, 1
Have you or other members of your family who live with you visited a dentist
since [REFERENCE DATE]?
Yes, no
0, 1
Did [CHILD] go to the dentist since [REFERENCE DATE]?
Yes, no
0, 1
How many other members of your family visited the dentist since
[REFERENCE DATE]?
Number
0, 1
Did you or other members of your family see a doctor, nurse, or other medical
person for a health problem or check-up since [REFERENCE DATE]?
Yes, no
Which members of your family visited a doctor, nurse, or other medical
professional since [REFERENCE DATE]?
Verbatim
How many times did (you/[NAME]) visit a doctor, nurse, or other health
professional since [REFERENCE DATE]?
Number
D.19
CATI CAPI CAPI
PARENT DATA COLLECTION
Survey Section
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Number
0, 1
CATI CATI
CATI CAPI CAPI
Number
0, 1
CATI CATI
CATI CAPI CAPI
Number
0, 1
CATI CATI
CATI CAPI CAPI
Number
0, 1
CATI CATI
CATI CAPI CAPI
Number
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
Never, Once or twice, 3-4 times, 5-9 times, or 10 times or more?
completely up-to-date, mostly up-to-date (has received a majority of
required shots), somewhat up-to-date ( has received less than half of
required shots), never received any immunizations
unable to schedule or attend appointments, too costly, worried about
complications (illness, disabilities), religious beliefs
0, 1
0, 1
CATI CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
Yes, no
Yes, no
Yes, no
Self, children, other family members
0, 1
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
Health Care Services
Health Care Services
Question item/Instrument
(Was that visit/How many of those [NUMBER FROM k10] visits were) for a
routine check-up?
[Was that visit/How many of the [NUMBER FROM k10] visits by
(you/[NAME]) were] for acute or chronic health problems or for other
reasons?
[Was that visit/How many of the [NUMBER FROM k10] visits by
(you/[NAME]) were visits] to a hospital emergency room?
Did you receive treatment for an emotional, personal, or mental problem, not
including drug or alcohol treatment, since [REFERENCE DATE]?
Did [CHILD]'s (mother/father) receive treatment for an emotional, personal, or
mental problem, not including drug or alcohol treatment, since [REFERENCE
DATE]?
Did you receive treatment for a drug or alcohol problem since [REFERENCE
DATE]?
Did [CHILD]'s (mother/father) receive treatment for a drug or alcohol problem
since [REFERENCE DATE]?
HOME (1 item on well-child visits)
Health Care Services
What is your child's immunization status?
Health Care Services
What are the reason(s) [CHILD] has incomplete immunization status?
The next questions are about the health insurance plans for you and your
household. Do you or anyone in your household have coverage through the
following? A private health insurance plan (from employer, workplace, or
purchased directly, or purchased through a state or local government program
or community program?
Yes, no
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Health Care Services
A Medicaid plan such as [STATE PROGRAM NAME FROM BOX P9b]?
CHIP (Children's Health Insurance Program) or [NAME OF STATE
PROGRAM FROM BOX P9c]?
Military health care/TRICARE/CHAMPUS/CHAMP-VA?
Indian Health Service?
Another government program such as Medicare? (SPECIFY)
Who does this health insurance plan cover?
About how many months has it been since [CHILD] last had health care
coverage or health insurance?
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
Number of months
0, 1
GOT DIVORCED/SEPARATED/WIDOWED, GOT MARRIED OR
REMARRIED, PERSON IN FAMILY WITH INSURANCE LOST JOB
OR CHANGED EMPLOYERS, EMPLOYER DOES NOT OFFER
COVERAGE, NOT ELIGIBLE FOR COVERAGE, COST IS TOO HIGH,
INSURANCE COMPANY REFUSED COVERAGE, LOST MEDICAID
OR MEDICAL PLAN BECAUSE OF NEW JOB OR INCREASE IN
INCOME, LOST MEDICAID (OTHER REASON), BECAME
INELIGIBLE FOR CHIP, OTHER REASON (SPECIFY)
0, 1
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
Please tell me the reason(s) (he/she) is not covered by health insurance.
Since ([CHILD] was born/[REFERENCE DATE]), was there any time when
(he/she) did not have any health insurance or coverage?
Yes, no
About how many months was [CHILD] without health insurance or health care
coverage?
Number of months
D.20
PARENT DATA COLLECTION
Survey Section
Health Care Services
Health Care Services
Health Care Services
Health Care Services
Family Routines
Family Routines
Family Routines
Family Routines
Question item/Instrument
Age
Question response
Cohort
GOT DIVORCED/SEPARATED/WIDOWED, GOT MARRIED OR
REMARRIED, PERSON IN FAMILY WITH INSURANCE LOST JOB
OR CHANGED EMPLOYERS, EMPLOYER DOES NOT OFFER
COVERAGE, NOT ELIGIBLE FOR COVERAGE, COST IS TOO HIGH,
INSURANCE COMPANY REFUSED COVERAGE, LOST MEDICAID
OR MEDICAL PLAN BECAUSE OF NEW JOB OR INCREASE IN
INCOME, LOST MEDICAID (OTHER REASON), BECAME
INELIGIBLE FOR CHIP, OTHER REASON (SPECIFY)
0, 1
Please tell me the reason(s) (he/she) was not covered by health insurance for
this period of time.
Was there ever a time when [CHILD] needed health care, but you couldn't
obtain it?
Yes, no
Are you [or other members of your family] currently covered by dental
insurance, either through a health insurance plan or an HMO?
Yes, no
Who does the dental insurance cover?
Self, children, other family members
Now I have some questions about you and [CHILD] at home. How many days
in a typical week do you or other family members read to [CHILD]. Would
you say . . .
every day, 3-6 days, 1-2 days, or never?
On the days someone reads to [CHILD], about how many minutes per day is
(she/he) read to?
Number
My next questions are about some of the typical routines in your household. In
a typical week, please tell me the number of days at least some of the family
eats the evening meal together.
Number
When does [CHILD] usually eat in a typical day?
hh:mm, no usual times
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
0, 1
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
0, 1
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
Now, I’d like to ask you about [CHILD]’s eating habits. I want to know about
the food [CHILD] ate or drank during the past 7 days. Think about all the
meals and snacks [CHILD] had from the time (he/she) got up until (he/she)
went to bed. Be sure to include food [CHILD] ate at home, (Early Head Start),
restaurants, play dates, anywhere else, and over the weekend.
Family Routines
Let’s start with the kinds of milk [CHILD] drinks. Include all types of milk,
including cow’s milk, soy milk, or any other kind of milk. Include the milk
four or more times a day, two to three times a day, once a day, almost every
(he/she) drank in a glass or cup, from a carton, or with cereal.
day, 1 to 3 times during the past 7 days, or (he/she) does not drink milk?
During the past 7 days, how many times did [CHILD] drink milk? Was it . . .
0, 1
WHOLE MILK, 2% MILK, SKIM MILK, LOW FAT OR 1% MILK, SOY
MILK, BOTH REGULAR COW’S MILK AND SOY MILK,
SOME OTHER KIND OF MILK (SPECIFY), LACTAID
0, 1
What kind of milk did [CHILD] usually drink during the past 7 days?
Family Routines
During the past 7 days, how many times did [CHILD] drink 100% fruit juice? four or more times a day, two to three times a day, once a day, almost every
Was it . . .
day, 1 to 3 times during the past 7 days, or (he/she) does not drink juice?
0, 1
Family Routines
During the past 7 days, how many times did [CHILD] drink fruit drinks that
are not 100% fruit juice (for example, Kool Aid, Sunny Delight, Hi-C,
Fruitopia, or Fruitworks), sports drinks (for example, Gatorade), or soda pop
(for example, Coke, Pepsi, or Mountain Dew)?
Family Routines
four or more times a day, two to three times a day, once a day, almost every
day, 1 to 3 times during the past 7 days, or (he/she) did not drink these
beverages?
0, 1
D.21
CAPI CAPI
PARENT DATA COLLECTION
Survey Section
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Family Routines
Question item/Instrument
Question response
During the past 7 days, how many times did [CHILD] eat a meal or snack from
a fast food restaurant with no wait service such as McDonald’s, Pizza Hut,
Burger King, Kentucky Fried Chicken, Taco Bell, Wendy’s and so on?
four or more times a day, two to three times a day, once a day, almost every
Consider eating in, carry out, and delivery of meals to your residence.
day, 1 to 3 times during the past 7 days, or (he/she) did not eat fast food?
During the past 7 days, how many times did [CHILD] eat candy (including
Fruit Roll-Ups and similar items), ice cream, cookies, cakes, brownies, or other four or more times a day, two to three times a day, once a day, almost every
sweets?
day, 1 to 3 times during the past 7 days, or (he/she) did not eat candy?
During the past 7 days, how many times did [CHILD] eat potato chips, corn
four or more times a day, two to three times a day, once a day, almost every
chips such as Fritos or Doritos, Cheetos, pretzels, popcorn, crackers or other
day, 1 to 3 times during the past 7 days, or (he/she) did not eat salty snack
salty snack foods? Was it . . .
foods?
four or more times a day, two to three times a day, once a day, almost every
During the past 7 days, how many times did [CHILD] eat fresh, canned or
day, 1 to 3 times during the past 7 days, or (he/she) did not eat salty snack
frozen fruit like bananas, peaches, or apples?
foods?
During the past 7 days, how many times did [CHILD] eat vegetables other than
potatoes (for example, carrots, tomatoes, or green beans)? Please count fresh four or more times a day, two to three times a day, once a day, almost every
or frozen vegetables served raw or cooked.
day, 1 to 3 times during the past 7 days, or (he/she) did not eat vegetables?
How many times do you offer a new food before you decide [CHILD] does not ONCE, TWICE, THREE TO FIVE TIMES, SIX TO TEN TIMES, MORE
like it?
THAN TEN TIMES, CHILD LIKES EVERYTHING
Do you consider [CHILD]…
A very picky eater, A somewhat picky eater, or Not a picky eater?
When is [CHILD]'s regular bedtime?
hh:mm, no usual time
How many times in the last week, Monday through Friday, was [CHILD] put
to bed at that time?
Number
During a typical night, about how many times does [CHILD] wake up and
need someone to help (him/her) settle back to sleep?
Number
How long does [CHILD] usually sleep each night?
hh:mm, no usual hours
How many naps does [CHILD] take in a typical day?
Number
How long does each nap usually last?
hh:mm, child does not nap
How old was [CHILD] when (he/she) stopped taking naps?
Years
Family Environment Scale- conflict subscale (5 items)
Moos, R. H., & Moos, B. S. (2002). Family environment scale manual:
Development, applications, and research (3rd ed.). Menlo Park, CA: Mind
Garden.
CHAOS Scale (15 items)
strongly agree, mildly agree, mildly disagree, or strongly disagree
Matheny, A. P., Wachs, T. D., Ludwig, J. L., & Phillips, K. (1995). Bringing
order out of chaos: Psychometric characteristics of the confusion, hubbub, and
Very much like own home, Somewhat like own home, A little like own
order scale. Journal of Applied Developmental Psychology, 16, 429-444.
home, Not at all like own home
(3 items on exposure to violence from ITSEA + 1 item new to school-age
instrument)
Carter, A. S., & Briggs-Gowan, M. (2000). The Infant-Toddler Social and
Emotional Assessment (ITSEA). Unpublished Manual. University of
Massachusetts Boston Department of Psychology, Boston, MA, Yale
University, New Haven, CT.
Yes, no
D.22
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
0, 1
CATI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
0, 1
CAPI
0, 1
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
PARENT DATA COLLECTION
Survey Section
HOME
Child Behavior
Child Behavior
Question item/Instrument
HOME, Language Stimulation/Support of Literacy Combination Subscale (8
interview items)
Question response
Caldwell, B. M., & Bradley, R. H. (2003). Administration manual: Home
observation for measurement of the environment. Little Rock, AR: University
Varies
of Arkansas at Little Rock.
BITSEA (42 items)
Briggs-Gowan, M. J., & Carter, A. S. (2002). The brief infant-toddler social
and emotional assessment (BITSEA) manual, version 2.0. New Haven, CT:
Yale University.
ASQ (30 items)
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
Not true or rarely, somewhat true or sometimes, or very true or often
Bricker, D., & Squires, J. (1999). The ages & stages questionnaires (ASQ): A
parent-completed, child monitoring system (2nd ed. ed.). Baltimore, MD: Paul
Yes, sometimes, or not yet
H. Brookes.
Behavior Problems Index (28 items)
CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
Zill, N. (1985). Behavior problem scales developed from the 1981 child health
supplement to the national health interview survey Child Trends, Inc.
Child Behavior
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Now, let’s talk about your health. Would you say your health in general is . . .
During (this/your most recent) pregnancy, did you see a physician or go to a
clinic for prenatal care?
In which month of (this/your most recent) pregnancy did you first see a
physician or go to a clinic for prenatal care?
How many times (did you visit/have you visited) a physician or clinic for
prenatal care during (this/that) pregnancy?
Has a doctor ever told you that you have . . . asthma?
allergies?
a serious mental illness, such as schizophrenia, a paranoid disorder, a bipolar
disorder, or manic episodes?
diabetes?
major depression?
a learning disability?
CES-D Short Form (20 items)
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for
research in the general population. Applied Psychological Measurement, 1,
385-401
Adult Attachment Inventory (18 items)
Often true, sometimes true, not true
0, 1
excellent, very good, good, fair, or poor?
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
First, Second, Third, Fourth, Fifth, Sixth, Seventh, Eighth, Ninth, Did Not
See A Physician or go to a clinic
0, 1
CATI
CATI
0, 1
CATI
CATI
Number of visits
Yes, no
Yes, no
0, 1
0, 1
0, 1
CATI
CATI CATI
CATI CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
CATI
rarely or never, some or a little of the time, occasionally or a moderate
amount of time, or most or all of the time
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
0, 1
CATI
CATI
0, 1
CATI
Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item-response
theory analysis of self-report measures of adult attachment. Journal of
7-point scale from disagree strongly (1) to agree strongly (7)
Personality and Social Psychology, 78, 350-365.
Have you smoked at least 100 cigarettes in your entire life?
Yes, no
In the 3 months before you got pregnant, how many cigarettes or packs did you
smoke on an average day?
Number of cigarettes, number of packs
D.23
CAPI
CAPI
PARENT DATA COLLECTION
Survey Section
Parent Health
Parent Health
Question item/Instrument
Question response
In the last 3 months of your pregnancy, how many cigarettes or packs did you
smoke on an average day?
Number of cigarettes, number of packs
In the last 30 days, did you smoke tobacco such as cigarettes or cigars?
Yes, no
Parent Health
How many cigarettes or packs of cigarettes do you smoke on an average day? Number of cigarettes, number of packs
Family Goals
The next questions are about how frequently you drink alcoholic beverages.
By a "drink" we mean either a bottle of beer, a wine cooler, a glass of wine, a
shot of liquor, or a mixed drink. In the 3 months before you got pregnant, how
many alcoholic drinks did you have in an average week?
In the last 3 months of your pregnancy, how many how many alcoholic drinks
did you have in an average week?
During the last 30 days, how often, if ever, did you drink alcoholic beverages,
including beer, wine or liquor? Would you say . . .
On the days that you drank alcoholic beverages (including beer, wine, and
liquor) in the last 30 days, how many drinks did you usually have?
Before I ask you the next question, I'd like to remind you that all the
information you give us on this interview is confidential and will not be shared
with Early Head Start or any other program. The next question is about your
use of drugs on your own. By "on your own" we mean either without a
doctor's prescription, in larger amounts than prescribed, or for a longer period
than prescribed. With this definition in mind, did you ever use drugs on your
own during the past 12 months?
This next part of the interview is about your family’s goals. Most families
have goals or hopes for the future. When you think of you and your family five
years from now, how do you hope your lives will be different? Do you hope
to... obtain more education?
Acquire new job skills?
Find a job?
Find a better job?
Have more income or not have to worry about money?
Get off of public assistance?
Get married?
Have more children?
Have different living arrangements?
Move to different type of housing?
Live in a different place?
Have more leisure time?
Get along better with family or friends?
Have better health?
Do something else (SPECIFY) (Probe: Is there anything else you hope will
change for your family in the next five years?)
Family Goals
From the goals you mention: (FILL GOALS FROM 1a-o), which three are
most important for you and your family?
Parent Health
Parent Health
Parent Health
Parent Health
Parent Health
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
0, 1
CATI
0, 1
CATI
Number of drinks
0, 1
CATI
Number of drinks
less than once a week, 1 or 2 days per week, 3 or 4 days per week, 5 or 6
days per week, every day, or never?
0, 1
CATI
0, 1
Number
0, 1
CATI
Yes, no
0,1
CATI
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
Yes, no
0, 1
Code: a) Obtain more education, b) Acquire new job skills, c) Find a job,
d)Find a better job, e) Have more income or not have to worry about
money, f) Get off of public assistance, g) Get married, h) Have more
children, i) Have different living arrangements, j) Move to different type of
housing, k) Live in a different place, l) Have more leisure time, m) Get
along better with family or friends, n) Have better health, o) Do something
else (SPECIFY)
0,1
CATI
CATI
CATI
CATI
D.24
CATI
CATI
CATI
CATI
CATI
PARENT DATA COLLECTION
Survey Section
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Family Goals
Other Services
Other Services
Question item/Instrument
Age
Question response
Cohort
Finish High School Or High School Diploma, Get A Ged, Attend Two-Year
College Or Associate’S Degree, Attend Four-Year College Or Bachelor’S
Degree, Attend Graduate School Or Ma/Ph.D./Md,
Vocational/Technical/Trade/Business Or Secretarial
Diploma/Certificate/Degree, Take Course Only/No Degree, Eighth, Nursing
Degree/Rn/Lpn, Other (Specify)
0, 1
You mentioned that one of your goals is to obtain more education. What is
the highest level of education you would like to get?
[You (also) mentioned that you would like to acquire new job skills.] Do you
want to obtain skills in a new occupation or do you want to improve your skills Get Training For New Occupation, Improve Skills In Current Occupation,
in your current occupation?
Other (Specify)
0, 1
What type of job training program would you like to attend?
Other (Specify)
0, 1
Job With Better Pay, Job With More Convenient Hours, Full-Time Job, Job
You (also) mentioned you would like to find a better job. How would you like Closer To Home, Job With Better Benefits, Job With More Security, More
your job to be better?
Interesting Or Challenging Job, Other (Specify)
0, 1
Increase Number Of Household Members Who Work, Increase Own Hours
[You (also) mentioned you would like more income.] How do you want to
Worked, Increase Hourly Wage, Receive Higher Public Assistance Benefits,
increase your income?
Hit The Lottery, Other (Specify)
0, 1
[You (also) mentioned you would like to be independent of public assistance.] Find A Job, Find Higher Paying Job, Find More Secure Job, Get Married,
How do you want to get off of public assistance?
Other (Specify)
0, 1
[You (also) mentioned that you would like to get married.] Do you want to
marry your current (boyfriend/girlfriend) or are you hoping to find the right
Marry Current Boyfriend/Girlfriend, Find The Right Partner And Get
partner in the future?
Married, Other (Specify)
0, 1
[You (also) mentioned that you would like to have more children.] How many
more children would you like to have?
Number
0, 1
When would you like to have your next child?
Number [of months from now]
0, 1
[You (also) mentioned that you would like different living arrangements.]
What type of living arrangement would you like?
You (also) mentioned that you would like a different type of housing. What
type of housing would you like to live in?
You (also) mentioned that you would like to move. Where would you like to
move?
On [LAST INTERVIEW DATE], you mentioned that one of your goals was to
[FILL GOAL FROM 1a-o]. Is that still one of your goals?
(Have you/Has your) [FILL GOAL ATTAINED] since LAST INTERVIEW
DATE?
How many more children do you want?
Have you made progress since LAST INTERVIEW DATE toward [FILL
CURRENT GOAL]?
Move Into Own Home Or Apartment, Move In With Boyfriend/Girlfriend,
Move In With Relatives, Move In With Friends, Other (Specify)
0, 1
Permanent Housing, Apartment Or Condominium, House, Other (Specify) 0, 1
Different Neighborhood Within Same City Or Metropolitan Area, Different
City Within State, Different State, Other (Specify)
0, 1
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
Yes, no
0, 1
CATI
CAPI CAPI
Yes, no
Number
0, 1
0, 1
CATI
CAPI CAPI
CAPI CAPI
Yes, no
0, 1
Open-ended. Code: 1) Obtain more education, 2) Acquire new job skills,
3) Find a job, 4)Find a better job, 5) Have more income or not have to
worry about money, 6) Get off of public assistance, 7) Get married, 8) Have
Do you have any new goals or hopes for the future for your family that we
more children, 9) Have different living arrangements, 10) Move to different
haven't already talked about? PROBE: Is there anything else you hope will be type of housing, 11) Live in a different place, 12) Have more leisure time,
different for you or your family five years from now? PROBE: Is there
13) Get along better with family or friends, 14) Have better health, 0) Do
anything else?
something else (SPECIFY)
0, 1
Does [CHILD] have an Individualized Education Program or Plan (IEP) or an
Individual Family Service Plan (IFSP)?
Yes, no
0, 1
Did you or another family member participate in developing an IEP or an IFSP
for [CHILD]?
Yes, no
0, 1
CATI
CAPI CAPI
CATI
CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
D.25
PARENT DATA COLLECTION
Survey Section
Other Services
Question item/Instrument
Question response
Was this plan developed with Early Head Start staff, or with some other person
or agency?
School staff, non-school staff
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
CATI
CATI CAPI CAPI
0, 1
very satisfied, somewhat satisfied, somewhat dissatisfied, or very
dissatisfied?
0, 1
Home-based services in which Early Head Start services are provided in
[CHILD]’s home, Center-based services in which Early Head Start services
are provided in a child development center, Family child care in which
Which of the following best describes the kind of care [CHILD] receives from Early Head Start services are provided primarily in a family child care
[PROGRAM NAME]?
home, Some other program option (SPECIFY)
0, 1
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
0, 1
CATI
CATI CAPI CAPI
none of the services identified in the IEP or IFSP, some of the services,
most of the services, or all of the services identified in the IEP or IFSP?
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Is [CHILD] receiving . . .
How satisfied (are you/have you been) with those services? (Are you/Have
you been) . . .
Do these home-based services also include Early Head Start services such as
center-based care, family child care, respite care or similar services?
Do these [center-based services/family child care services] also include home
visits?
Yes, no
Yes, no
Other Services
When did [CHILD] first start receiving these services from [PROGRAM]?
mm/yyyy
Has anyone from Early Head Start visited you and [CHILD] at home since
[DATE FROM A1/LAST INTERVIEW DATE]?
Yes, no
Home visitors may have come to do activities with you and [CHILD] or talk to
you about how (he/she) is doing or about how your family is getting along. Has
anyone from Early Head Start visited you at home since [DATE FROM
A1/LAST INTERVIEW DATE]?
Yes, no
Has anyone from Early Head Start visited you and CHILD at another place,
such as CHILD’s child care or another person’s home, since [DATE FROM
A1/LAST INTERVIEW DATE]?
Yes, no
ONLY ONCE, TWO OR THREE TIMES A WEEK , ONCE A WEEK,
How many times did someone visit you and [CHILD] since [LAST
TWO OR THREE TIMES A MONTH, ONCE A MONTH, LESS THAN
INTERVIEW DATE]?
ONCE A MONTH, OTHER (SPECIFY)
Did the same person visit you at home each time?
Yes, no
What [is/are] the name(s) of the [person/people] who visited you?
Verbatim
About how long did (that/each) visit last?
hh:mm
How many different classrooms has [CHILD] been in since [DATE IN
Q2/LAST INTERVIEW DATE]?
Number
How many paid child care staff and volunteers regularly provide care to
[CHILD] in (his/her) classroom? Please exclude administrative staff, cooks,
and janitors who do not provide direct child care.
Number
Altogether, how many different adults does [CHILD] interact with in the
classroom in a typical week?
Number
What are the names and positions of the staff and regular volunteers who
Verbatim. Positions coded as: Lead/Head Teacher, Assistant Teacher,
provide care in [CHILD]'s classroom?
Aide/Caregiver, Volunteer, Other (Specify)
Other Services
Which person would you say spends the most time taking care of [CHILD]?
Other Services
How long has [PERSON FROM A8] been a child care provider for [CHILD]? Number of years and/or months and/or weeks
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Verbatim or All the same
D.26
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
PARENT DATA COLLECTION
Survey Section
Question item/Instrument
Other Services
Other Services
Other Services
(In the past year/Since [LAST INTERVIEW DATE]), how often have you or
other family members participated in the following activities at (PROGRAM)?
For each one, tell me if you did not participate at all or if you participated once
or twice, or three or more times. Attend group activities for parents and their
children. PROBE IF RESPONSE IS 3 OR MORE TIMES: Would you say
you participated at least monthly or more often than monthly?
Attend parent education meetings or workshops on topics such as job skills or
child-rearing
Attended an Early Head Start social event
Volunteered in an Early Head Start classroom
Volunteered to help out at the (LOCAL EHS PROGRAM) or served on a
committee, but not in a classroom or on Policy Council
Participated on the (PROGRAM) Policy Council
Take part in center activities in some other way? (SPECIFY) PROBE IF
RESPONSE IS 3 OR MORE TIMES: Would you say you participated at least
monthly or more often than monthly?
What did you like most about the program?
Now I have some questions about your household's experiences with various
community agencies. Since [you became pregnant with [CHILD]/[CHILD]
was born/[CHILD] began living in your household], have you or anyone in
your household received . . .Prenatal education and information about
breastfeeding?
Help finding good child care?
Transportation assistance?
Disability services?
Emergency assistance?
Employment assistance?
Education or job training?
Legal assistance?
Housing assistance?
Financial counseling?
Family literacy training?
English Language Learner (ELL) training?
Some other service? (SPECIFY)
Did [PROGRAM] provide [fill service from Q9a-n] directly or refer you to
another agency for this service?
The next questions are about income support you or someone in your
household may have received. In the past six months, did you or anyone in
your household receive any income or support from… [State Welfare name
from Box Q21a] or welfare?
Unemployment insurance?
Food Stamps?
Other Services
Other Services
Other Services
Other Services
Other Services
WIC - Special supplemental food program for Women, Infants, and Children?
Child support?
SSI or Social Security Retirement, Disability, or Survivor's benefits?
Payments for providing foster care?
Energy assistance?
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Other Services
Question response
Age
Cohort
Not at all, once or twice, three or more times, at least monthly, more than
once a month
0, 1
Not at all, once or twice, three or more times
Not at all, once or twice, three or more times
Not at all, once or twice, three or more times
0, 1
0, 1
0, 1
Not at all, once or twice, three or more times
Not at all, once or twice, three or more times
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
CATI
CATI CAPI CAPI
x
x
CATI
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
0, 1
0, 1
x
x
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
0, 1
0, 1
x
x
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
0, 1
x
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
Provided Service Directly, Referred To Another Agency, Other (Specify)
0, 1
CATI
CATI CAPI CAPI
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
x
x
x
CATI
CATI
CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
Yes, no
Yes, no
Yes, no
Yes, no
Yes, no
0, 1
0, 1
0, 1
0, 1
0, 1
x
x
x
x
x
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
Not at all, once or twice, three or more times, at least monthly, more than
once a month
D.27
x
x
x
x
x
x
x
x
x
x
x
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
PARENT DATA COLLECTION
Survey Section
Other Services
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Needs and Resources
Question item/Instrument
Did [PROGRAM] refer you to another agency for [fill income support from
M1a-h]?
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Yes, no
0, 1
x
CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
The next part of the interview is about whether you or your family have
adequate resources, such as time, money, and energy, to meet the needs of
your family as a whole, as well as the needs of individual family members. For
each question, please describe how well your needs are met on a consistent
basis, month-in and month-out, by indicating whether the way the need is met
is not at all adequate, seldom adequate, sometimes adequate, usually adequate,
or almost always adequate. To what extent are the following resources
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate for your family? Food for two meals a day?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Your house or apartment?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Enough money to buy necessities?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Enough clothes for your family?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Enough heat for your house or apartment?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Your indoor plumbing or water?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Money to pay monthly bills?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
A good job for yourself or your spouse or partner?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Medical care for your family?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Public assistance like SSI, AFDC, Medicaid, or Food Stamps?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Dependable transportation?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Time to get enough sleep or rest?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Furniture for your house or apartment?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Time to be by yourself?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Time for your family to be together?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Time to be with your (child/children)?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Time to be with your spouse or partner?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Time to be with close friends?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Telephone or access to a telephone?
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
Babysitting for your (child/children)?
adequate, or almost always adequate
D.28
PARENT DATA COLLECTION
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
Yes, no
0, 1
CATI CATI
CATI CAPI CAPI
How many times have you moved since [REFERENCE DATE]?
Number of times
0, 1
CATI CATI
CATI CAPI CAPI
When was the last time you moved?
mm/yyyy
0, 1
CATI CATI
CATI CAPI CAPI
Survey Section
Question item/Instrument
Needs and Resources
Child care or day care for your (child/children)?
Needs and Resources
Money to buy special equipment or supplies for your (child/children)?
Needs and Resources
Dental care for your family?
Needs and Resources
Someone to talk to?
Needs and Resources
Time to socialize?
Needs and Resources
Time to keep in shape and look nice?
Needs and Resources
Toys for your (child/children)?
Needs and Resources
Money to buy things for yourself?
Needs and Resources
Money for family entertainment?
Needs and Resources
Money to save?
Needs and Resources
Time and money for travel or vacation?
Needs and Resources
Needs and Resources
Your English speaking and reading skills?
Your opportunities to participate in community groups, such as religious,
school, or social groups?
Needs and Resources
Your information or access to information about parenting?
Needs and Resources
The disability assistance available to you and your family?
Needs and Resources
The help you need for a child with special needs?
Question response
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Not at all adequate, seldom adequate, sometimes adequate, usually
adequate, or almost always adequate
Needs and Resources
Have you moved since [REFERENCE DATE]?
Needs and Resources
Needs and Resources
0, 1
CATI CATI
CATI CAPI CAPI
Needs and Resources
I am going to read you several statements that people have made about their
food situation. For these statements, please tell me whether the statement was
often true, sometimes true, or never true for (you/your household) in the last 12
months, that is, since last [CURRENT MONTH]. (I/We) worried whether
(my/our) food would run out before (I/we) got money to buy more.
often true, sometimes true, never true
The food that (I/we) bought just didn't last, and (I/we) didn't have money to get
more.
often true, sometimes true, never true
0, 1
CATI CATI
CATI CAPI CAPI
Needs and Resources
(I/We) couldn't afford to eat balanced meals.
0, 1
CATI CATI
CATI CAPI CAPI
Needs and Resources
often true, sometimes true, never true
D.29
PARENT DATA COLLECTION
Survey Section
Needs and Resources
Needs and Resources
Staff-Parent
Relationships
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Tracking Information
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
0, 1
CATI CATI
CATI CAPI CAPI
0, 1
CATI CATI
CATI CAPI CAPI
Strongly disagree, disagree, somewhat agree, agree, strongly agree
0, 1
CATI
CATI CAPI CAPI
Telephone number
Verbatim
Telephone number
Verbatim
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
Cell number, Beeper number
Name, address
Yes, no
Telephone number
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
Verbatim
0, 1
CATI CATI
CATI CAPI CAPI
How is this person related to you?
What is that person's telephone number?
Please give me their permanent address.
What is the name of a second person?
Biological Mother, Biological Father, Adoptive Mother, Adoptive Father,
Stepmother, Stepfather, Grandmother., Grandfather, Great Grandmother,
Great Grandfather, Sister/Stepsister, Brother/Stepbrother, Other Relative Or
In-Law (Female), Other Relative Or In-Law (Male), Foster Parent (Female),
Foster Parent (Male), Other Non-Relative (Female), Other Non-Relative
(Male), Parent’s Partner (Female), Parent’s Partner (Male)
Telephone number
Address
Verbatim
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
How is this person related to you?
What is that person's telephone number?
Please give me their permanent address.
What is the name of a third person?
Biological Mother, Biological Father, Adoptive Mother, Adoptive Father,
Stepmother, Stepfather, Grandmother., Grandfather, Great Grandmother,
Great Grandfather, Sister/Stepsister, Brother/Stepbrother, Other Relative Or
In-Law (Female), Other Relative Or In-Law (Male), Foster Parent (Female),
Foster Parent (Male), Other Non-Relative (Female), Other Non-Relative
(Male), Parent’s Partner (Female), Parent’s Partner (Male)
Telephone number
Address
Verbatim
0, 1
0, 1
0, 1
0, 1
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CATI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
CAPI
Question item/Instrument
Question response
(I/We) relied on only a few kinds of low-cost food to feed (my
child/[CHILD]/the children) because (I was/we were) running out of money to
buy food.
often true, sometimes true, never true
(I/We) couldn't feed (my child/[CHILD]/the children) a balanced meal because
(I/we) couldn't afford that.
often true, sometimes true, never true
PCRS (27 items, confidence and collaboration subscales)
Elicker, J. et al. (1997) The Parent-Caregiver Relationship Scale: Rounding
Out the Relationship System in Infant Child Care. Early Education and
Development, 8, 83-100
First, I would like to verify your telephone number. What is your telephone
number?
Whose name is that number listed under?
Can you give me a number where you can be reached?
Whose telephone is that?
Do you have another phone number like a beeper number or cell phone
number?
Please give me your full name and permanent address.
May we call you at your work number?
What is your work telephone number?
Please tell me the names, addresses and telephone numbers of three people
who do not live with you but who will know how to contact you a year from
now? This will help us contact you so we can still complete an interview with
you if you move. What is the name of the first person who will know how we
can reach you?
D.30
PARENT DATA COLLECTION
Survey Section
Tracking Information
Tracking Information
Tracking Information
Question item/Instrument
Question response
Age
Cohort
Mode of Administration
Age 1
Age
Perina (follow3.5
tal
up)
Age 1 Age 2 Age 3 Exit
Biological Mother, Biological Father, Adoptive Mother, Adoptive Father,
Stepmother, Stepfather, Grandmother., Grandfather, Great Grandmother,
Great Grandfather, Sister/Stepsister, Brother/Stepbrother, Other Relative Or
In-Law (Female), Other Relative Or In-Law (Male), Foster Parent (Female),
Foster Parent (Male), Other Non-Relative (Female), Other Non-Relative
(Male), Parent’s Partner (Female), Parent’s Partner (Male)
0, 1
Telephone number
0, 1
Address
0, 1
CATI CATI
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
Scale: high (7) to low (1)
Scale: high (7) to low (1)
Scale: high (7) to low (1)
0, 1
0, 1
0, 1
CATI CATI
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
CATI CAPI CAPI
Scale: high (7) to low (1)
Scale: high (7) to low (1)
0, 1
0, 1
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
Interviewer Ratings
How is this person related to you?
What is that person's telephone number?
Please give me their permanent address.
The respondent (was/had) . . .able to understand questions easily/hardly able to
understand
The respondent (was/had) . . .truthful/untruthful
The respondent (was/had) . . . accurate/inaccurate
The respondent (was/had) . . . interested in the interview/not interested in the
interview
The respondent (was/had) . . . cooperative/uncooperative
The respondent (was/had) . . .no English language problem/spoke English with
great difficulty
Scale: high (7) to low (1)
0, 1
CATI CATI
CATI CAPI CAPI
Interviewer Ratings
Interviewer Ratings
The respondent (was/had) . . interviewed without interruption/interrupted often Scale: high (7) to low (1)
your opinion about the overall quality of the data
Scale: high (7) to low (1)
0, 1
0, 1
CATI CATI
CATI CATI
CATI CAPI CAPI
CATI CAPI CAPI
Interviewer Ratings
Interviewer Ratings
Interviewer Ratings
Interviewer Ratings
Interviewer Ratings
D.31
| File Type | application/pdf |
| File Title | Microsoft Word - OMB#2-APA-CP.doc |
| Author | CMcClure |
| File Modified | 2008-09-26 |
| File Created | 2008-09-26 |