2018 ASR Questionnaire (English)
Note to reviewers: yellow highlights represent updates since the last version.
ANNUAL SURVEY OF REFUGEES
OMB Number: 0970-0033
Expiration Date: 02/28/2019
The government estimates that this survey should take an average of 30 minutes to complete, including any time you needed to collect information to be able to answer our questions. Any agency that is collecting information has to have a valid OMB Control Number, which means that it has received approval for the activity. The OMB Control Number for this project is 0970-0033.
If you have any comments about how long this survey took or any other aspect of this survey, including suggestions for how to reduce the time needed, you can send comments to the Reports Clearance Office, Administration for Children and Families, Department of Health and Human Services, at 330 C ST SW, Washington D.C. 20201; and the Office of Management and Budget at Paperwork Reduction Project, OMB Control Number 0970-0033, Washington D.C. 20403.
S1. Hi. I’m ________ calling from SSRS on behalf of the Office of Refugee Resettlement, how are you today? We are doing a study about refugees’ adjustment to life in the United States.
Is this (INSERT NAME FROM SAMPLE)?
(INTERVIEWER: If respondent not on phone, ask “May I speak with him/her?”. Repeat intro if respondent comes to phone.)
1 Respondent is on the phone [CONTINUE TO S2]
2 Respondent is not available right now [SET UP CALLBACK]
3 Respondent no longer lives here [CONTINUE TO S1a]
9 (DO NOT READ) Refused [THANK & TERM]
(ASK IF S1=3)
S1a. Do you have a phone number where I can reach (INSERT NAME FROM SAMPLE)?
___________ [Enter new telephone number]
9 (DO NOT READ) Don’t know/Refused
(ASK IF S1=1)
S2. Great! Hopefully you recently received a letter from us telling you about the survey. And just to confirm, did you enter the US since 2012 as a refugee?
1 Respondent is a refugee [CONTINUE TO S3]
2 Respondent not a refugee [THANK & TERM]
9 (DO NOT READ) Don’t know/Refused [THANK & TERM]
(ASK IF S2=1)
S3. Ok, thank you. And to confirm, is your date of birth (INSERT DATE OF BIRTH FROM SAMPLE).
1 Confirmed date of birth [CONTINUE TO INTRO]
2 Confirmed year but not month [CONTINUE TO INTRO]
3 Confirmed month but not year [CONTINUE TO S3a]
4 Incorrect month and year [CONTINUE TO S3b]
9 (DO NOT READ) Refused [INTERVIEWER: IF RESPONDENT REFUSES ONCE, READ PROBE FROM Q*Q. IF STILL REFUSED CONTINUE WITH THE SURVEY]
(ASK IF S3=3)
S3a. What is your age?
INTERVIEWER: PLEASE ENTER AGE AS A 3 DIGIT CODE. FOR INSTANCE 003, 016, 078..ETC.)
1 [ENTER AGE]
9 (DO NOT READ) Refused [INTERVIEWER: IF RESPONDENT REFUSES ONCE, READ PROBE FROM Q*Q. IF STILL REFUSED CONTINUE WITH THE SURVEY]
[PN: IF AGE GIVEN AT S3a IS WITHIN 5 YEARS OF SAMPLE AGE, CONTINUE TO INTRO. IF OUTSIDE OF 5 YEARS, ASK S3b.]
[PN: TO CALCULATE SAMPLE AGE, USE: (Current date – Arrival date) + Age at arrival]
(ASK IF S3=4 OR S3a= MORE THAN 5 YEARS FROM SAMPLE AGE)
S3b. What year did you arrive in the U.S.?
(DO NOT READ: Year of arrival: [INSERT YEAR OF ARRIVAL FROM SAMPLE])
1 Confirmed year of arrival [CONTINUE TO INTRO]
2 Unable to confirm year of arrival [THANK & TERM]
9 (DO NOT READ) Refused [INTERVIEWER: IF RESPONDENT REFUSES ONCE, READ PROBE FROM Q*Q. IF STILL REFUSED CONTINUE WITH THE SURVEY]
IF S3A<18 OR ‘AGE’ FROM SAMPLE <18 PLEASE ASK MINOR
MINOR. May I speak with your parent or guardian?
Yes
No [END INTERVIEW AND DISPO AS INITIAL REFUSAL]
Parent/Guardian is not available right now [SET UP CALLBACK]
9 (DO NOT READ) Refused [THANK & TERM]
IF MINOR=1
WHEN PARENT/GUARDIAN COME TO THE PHONE PLEASE READ
PARENT. Hi. I’m ________ calling on behalf of the Office of Refugee Resettlement, how are you today? We are doing a study about refugees’ adjustment to life in the United States.
Can you answer questions on behalf of (INSERT NAME FORM SAMPLE)?
Yes
No [DISPO AS INITIAL REFUSAL]
9 (DO NOT READ) Refused [DISPO AS INITIAL REFUSAL]
CREATE ‘PROXY’ VARIABLE AND ASSIGN CODE 1 IF PARENT =1.
PROGRAMMER:IF PROXY =1 PLEASE DISPAY ‘PROXY’ ON THE TOP OF THE SCREEN
INTERVIWER: PLEASE EDIT INTRODUCTION TEXT AS NECESSARY
INTRO. We would like you to be in a voluntary study about how refugees adapt to life in the U.S. It is funded by the Office of Refugee Resettlement and being conducted by two research organizations, the Urban Institute and SSRS.
We would like to ask some questions about your education and work and any help you are getting from the government. It takes up to 30 minutes, but it’s sometimes shorter and we will send you a $25 gift card to thank you for participating.
Before we start we just need to tell you a few things. You don’t have to answer any questions you don’t want to answer and you can stop the interview at any time. The answers you give will be private and will not have your name on them. Federal law keeps your answers private. You will continue to receive social services and benefits regardless of your decision to participate in the study.
Your responses will be combined with others and used in a report to the U.S. Congress. The data without your name will be stored for future research.
Finally, there is little risk associated with your participation because of the care we are taking to keep your name and your answers safe. There are no direct benefits to you, but you will be helping the Office of Refugee Resettlement understand what refugees like you are going through.
Do you have any questions about the study or the interview?
(READ TO ALL)
We would like to start by asking you a few questions about each person who lives here, or who is staying or visiting here and has no other home.
(ASK ALL)
[PN: ALLOW UP TO 5 NAMES TO BE ENTERED. NAMES WILL BE PIPED IN FOR SUBSEQUENT QUESTIONS.]
Q1a. Let's start with you. <Auto-fill name of Respondent> Not counting you, tell me the names of each person who lives there starting with the oldest person.
(INTERVIEWER: If respondent does not want to provide names of household members, tell them we are only using the name to refer to the correct person in later questions. IF RESPONDENT STILL RELUCTANT TO PROVIDE NAMES: Just a first name or initials are fine.)
(PROBE: ARE THERE OTHER PERSONS WHO USUALLY LIVE HERE BUT ARE TEMPORARILY ABSENT?)
1 [AUTO-POPULATE RESPONDENT NAME]
2 [RECORD HH MEMBER #2 IF APPLICABLE] [PN: PERSON B FOR PIPE-INS]
3 [RECORD HH MEMBER #3 IF APPLICABLE] [PN: PERSON C FOR PIPE-INS]
4 [RECORD HH MEMBER #4 IF APPLICABLE] [PN: PERSON D FOR PIPE-INS]
5 [RECORD HH MEMBER #5 IF APPLICABLE] [PN: PERSON E FOR PIPE-INS]
[PN: ASK Q1b through Q1k for each HH member named in Q1a.]
(ASK ALL)
[PN: AUTO POPULATE RESPONDENT (Q1BA) WITH CODE 01]
Q1b(a-e). What is (INSERT NAME)’s relationship to you?
(DO NOT READ LIST)
01 Self [DO NOT SHOW – AUTO-POPULATE FOR Q1ba]
02 Spouse (wife/husband)
03 Unmarried partner / significant other
04 Child / stepchild / foster child / ward
05 Parent / Stepparent / foster parent / guardian
06 Sibling / Stepsister / Stepbrother
07 Grandparent / Step-grandparent
08 Grandchild / Step-grandchild
09 Son-in-law / Daughter-in-law
10 Father-in-law / Mother-in-law
11 Other relative
12 Employer
13 Employee (maid, nanny, au pair, housekeeper, etc.)
14 Professional caregiver (nurse, aide, etc.)
15 Other non-relative
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q1d(a-e). What was (INSERT NAME)’s age at last birthday?
___________ [RANGE 1-110]
000 Less than one year
998 (DO NOT READ) Don’t know
999 (DO NOT READ) Refused
(ASK ALL)
Q1e(a-e). What was (INSERT NAME)’s date of birth?
1 ENTER 2-DIGIT MONTH
2 ENTER 2-DIGIT DAY
3 ENTER 4-DIGIT YEAR
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q1d = AGE 15 OR OLDER AND NOT ALREADY COMMUNICATED ABOVE IN RELATIONSHIP) IFQ1b=2 AUTOPOPULATE AS CODE 1
Q1c(a-e). What is (INSERT NAME)’s current marital status?
1 Now married (note: spouse need not live in household)
2 Divorced
3 Legally separated
4 Never married
5 Widowed
6 Other (SPECIFY) _______________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q1f(a-e). Is (INSERT NAME) male or female?
[INTERVIEWER: CONFIRM BASED ON NAME; PROBE AS APPROPRIATE AND EXPLAIN NEED FOR ASKING THIS QUESTION]
1 Male
2 Female
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
[PN: AUTO-POPULATE FOR PERSONS B-E WITH RESPONDENT RESPONSE IF Q1gaa=1]
[PN: SAME SET UP AS Q7 IN Q1097]
Q1g(a-e). What is (INSERT NAME)’s country of birth?
01 Afghanistan
02 Bhutan
03 Burma
04 Burundi
05 Cuba
06 Democratic Republic of the Congo
07 Eritrea
08 Ethiopia
09 Iran
10 Iraq
11 Jordan
12 Kenya
13 Malaysia
14 Nepal
15 Rwanda
16 Somalia
17 Sudan
18 Syria
19 Tanzania
20 Thailand
21 Uganda
22 Ukraine
23 Other (SPECIFY) _______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q1g(a)=1-23)
[PN: IF Q1gaa=1 DO NOT ASK Q1g(B-E). IF Q1gaa=2-99 ASK Q1g(B-E) FOR REMAINING HH MEMBERS]
[PN: SAME SET UP AS Q7A IN Q1097]
Q1gaa. Were all members of this household born in [INSERT COUNTRY NAME] or were any members born in another country?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER HH MEMBERS)
1 Yes
2 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
[PN: AUTO-POPULATE FOR PERSONS B-E WITH RESPONDENT RESPONSE IF Q1haa=1]
[PN: SAME SET UP AS Q12 IN Q1097]
Q1h(a-e). What is (INSERT NAME)’s country of citizenship?
01 Afghanistan
02 Bhutan
03 Burma
04 Burundi
05 Cuba
06 Democratic Republic of the Congo
07 Eritrea
08 Ethiopia
09 Iran
10 Iraq
11 Jordan
12 Kenya
13 Malaysia
14 Nepal
15 Rwanda
16 Somalia
17 Sudan
18 Syria
19 Tanzania
20 Thailand
21 Uganda
22 Ukraine
23 Other (SPECIFY) _______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q1h(a)=1-23)
[PN: IF Q1haa=1 DO NOT ASK Q1h(B-E). IF Q1haa=2-99 ASK Q1h(B-E) FOR REMAINING HH MEMBERS]
[PN: SAME SET UP AS Q12A IN Q1097]
Q1haa. Do all members of this household have citizenship from [INSERT CITIZENSHIP COUNTRY NAME] or do some members have a different citizenship?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER HH MEMBERS)
1 Yes
2 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
[PN: AUTO-POPULATE FOR PERSONS B-E WITH RESPONDENT RESPONSE IF Q1iaa=1]
[PN: SAME SET UP AS Q13 IN Q1097]
[PN: SHOW CODES 37, 98, 99 FOR ALL]
[PN: IF Q1g=01 SHOW CODES 16, 27, 32;
IF Q1g=02 OR Q1g=14 SHOW CODE 24;
IF Q1g=03 SHOW CODES 09, 20, 21;
IF Q1g=04 SHOW CODES 05, 17, 34;
IF Q1g=05 SHOW CODE 10;
IF Q1g=06 SHOW CODES 05, 06, 34;
IF Q1g=07 SHOW CODES 22, 30, 33;
IF Q1g=08 SHOW CODES 11, 30, 33;
IF Q1g=09 SHOW CODES 02, 12, 28;
IF Q1g=10 SHOW CODES 01, 08, 31;
IF Q1g=11 SHOW CODES 01, 08, 13;
IF Q1g=12 SHOW CODES 04, 11, 15, 26;
IF Q1g=13 SHOW CODES 09, 19, 29;
IF Q1g=15 SHOW CODES 17, 34;
IF Q1g=16 SHOW CODES 03, 11, 15;
IF Q1g=17 SHOW CODES 13, 25, 36;
IF Q1g=18 SHOW CODES 01, 08, 23;
IF Q1g=19 SHOW CODES 06, 17;
IF Q1g=20 SHOW CODES 07, 20, 21;
IF Q1g=21 SHOW CODES 03, 11, 15, 17, 34;
IF Q1g=22 SHOW CODES 14, 18, 35;
IF Q1g=23,98,99 ONLY SHOW 37, 98, 99]
Q1i(a-e). What is (INSERT NAME)’s ethnic origin?
01 Arab
02 Armenian
03 Asharaf
04 Bantu
05 Banyamulenge, Banyamulengue
06 Bembe, Bemba, Mbembe
07 Burmese
08 Chaldean
09 Chin
10 Cuban
11 Darod
12 Fars
13 Fur
14 Great Russian
15 Hawiye
16 Hazara
17 Hutu
18 Jewish
19 Kachin
20 Karen
21 Karen Ni (Kayar)
22 Kunama
23 Kurd
24 Lhotsampa
25 Massalit
26 Oromo
27 Pashtoon
28 Persian
29 Rohingya
30 Saho
31 Siryac
32 Tajik
33 Tigrinya
34 Tutsi
35 Ukrainian
36 Zagawa
37 Other (SPECIFY) _______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q1i(a)=1-37)
[PN: IF Q1iaa=1 DO NOT ASK Q1i(B-E). IF Q1iaa=2-99 ASK Q1i(B-E) FOR REMAINING HH MEMBERS]
[PN: SAME SET UP AS Q13A IN Q1097]
Q1iaa. Are all members of this household of [INSERT ETHNIC ORIGIN FROM Q1h(a)] origin, or do some members have a different ethnic origin?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER HH MEMBERS)
1 Yes
2 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q1j(a-e). What month and year did (INSERT NAME) enter the U.S. to stay?
1 [ENTER 2-DIGIT MONTH]
2 [ENTER 4-DIGIT YEAR]
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
[PN: AUTO-POPULATE FOR PERSONS B-E WITH RESPONDENT RESPONSE IF Q1kaa=1]
[PN: SAME SET UP AS Q11 IN Q1097]
Q1k(a-e). In what State did (INSERT NAME) originally resettle?
[PN: SHOW STATE LIST]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF ALL EXCEPT RESPONDENT. RESPONDENT DOES NOT GET THIS QUESTION
Q1l(a-e). Is (INSERT NAME) a refugee who has entered the U.S. between 2012 and 2016?
(INTERVIEWER: The primary concern with this question is determining the refugee status of the household member in question.)
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(READ TO ALL)
Now I want to ask some questions only of persons in your household who are 16 years old or older and entered the U.S. as refugees between 2012 and 2016.
[PN: ASK Q2A THROUGH Q29D ONLY FOR HOUSEHOLD MEMBERS 16 OR OLDER AND A REFUGEE (Q1d(a-e)=16-110 AND Q1l(a-e)=2). IF RESPONDENT AND Q1D IS DK/REF BUT PERSON IS A REFUGEE ASK Q2A-29]
RESPONDENT GETS ASKED Q2-29 IF q1D=16-110, DK, REF
(ASK ALL)
*Q2a(a-e). How many years of schooling did (INSERT NAME) complete before coming to the U.S.?
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
*Q2b(a-e). What was the highest degree or certificate that (INSERT NAME) obtained before coming to the U.S.?
(DO NOT READ LIST)
01 None
02 Primary
03 Training in refugee camp
04 Technical school certification
05 Secondary (or high school diploma)
06 University degree (other than medical)
07 Medical degree
08 Other (SPECIFY) ______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
*Q3a(a-e). Before coming to the U.S., was (INSERT NAME):
(INTERVIEWER: If in a refugee camp prior to the U.S., what type of employment did the person hold before that?)
(READ LIST)
01 Not employed
02 Civil servant (civilian in local or national government)
03 In the military
04 Employee in private sector
05 Self-employed
06 Student
07 Other (SPECIFY) ___________________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q3a=2-99)
*Q3b(a-e). What kind of work (activities) did (INSERT NAME) perform before coming to the U.S.? (e.g., lawyer, typist, farmer, teacher, electrician, student)
__________ (RECORD TYPE OF WORK)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q3c and Q3d DELETED FOR 2016
(ASK ALL)
*Q4a(a-e). At the time of arrival in the U.S., how well did (INSERT NAME) speak English?
1 Very well
2 Well
3 Not well
4 Not at all
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q4b(a-e). How well does (INSERT NAME) speak English now?
1 Very well
2 Well
3 Not well
4 Not at all
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q4ba DELETED FOR 2016
(ASK ALL)
*Q4c(a-e). Before coming to the U.S. did (INSERT NAME) have any English language instruction?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q4d DELETED FOR 2016
(ASK ALL)
Q4e(a-e). Within the past 12 months, has (INSERT NAME) attended an English language training program?
1 No
2 Yes
6 (DO NOT READ) High school student
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q4f, Q4g, Q4h DELETED FOR 2016
(ASK IF Q4e=2,8,9)
Q4j(a-e). Is (INSERT NAME) currently enrolled in an English language training program?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q4ja, Q4k DELETED FOR 2016
(ASK ALL)
Q5a(a-e). Did (INSERT NAME) work at a job anytime last week?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q5a=2)
Q5b(a-e). Did (INSERT NAME) work at more than one job last week?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q5b=2)
Q5c(a-e). How many jobs did (INSERT NAME) work at last week?
________ (RANGE: 2-10)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q5a=2)
Q6a(a-e). How many hours did (INSERT NAME) work at his/her primary job last week?
(IF NECESSARY: Primary job means the job worked at for the greatest number of hours)
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q5b=2)
Q6b(a-e). How many hours did (INSERT NAME) work at all jobs last week?
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q5a=2)
Q7(a-e). How much money per hour did (INSERT NAME) receive at his/her primary job last week?
________ (RANGE: 0-96) PN: PLEASE ALLOW UPTO 2 DECIMALS
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q7=98,99)
Q8a(a-e). How much did (INSERT NAME) earn before taxes from that job?
________ (RANGE: 0-999,996)
9999998 (DO NOT READ) Don’t know
9999999 (DO NOT READ) Refused
(ASK IF Q7=98,99)
Q8b(a-e). On what basis is that amount computed?
1 Weekly
2 Bi-weekly
3 Monthly
4 Annually
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(PN: IF WORKED AT SECOND JOB LAST WEEK, GO TO Q.9)
(PN: IF WORKED ONLY ONE JOB LAST WEEK, SKIP TO Q.18a)
(ASK IF Q5b=2)
Q9(a-e). How much money per hour did (INSERT NAME) receive from his/her second job last week?
________ (RANGE: 0-96) PN: PLEASE ALLOW UPTO 2 DECIMALS
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q9=98,99)
Q10a(a-e). How much did (INSERT NAME) earn before taxes from that job?
________ (RANGE: 0-999,996)
9999998 (DO NOT READ) Don’t know
9999999 (DO NOT READ) Refused
(ASK IF Q9=98,99)
Q10b(a-e). On what basis is that amount computed?
1 Weekly
2 Bi-weekly
3 Monthly
4 Annually
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(PN: IF ANSWERED Q.10b, SKIP TO Q.18a)
(ASK IF Q5a=1,8,9)
Q11a(a-e). Has (INSERT NAME) ever worked since coming to the U.S. to stay?
1 Never worked in the U.S.
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q11a=2)
Q11aa(a-e). How many weeks has it been since (INSERT NAME) had a job?
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q11b DELETED FOR 2016
(ASK IF Q11a=2,8,9)
Q12(a-e). Was (INSERT NAME) temporarily absent or on layoff from a job or business last week?
1 Temporarily absent
2 On layoff
3 No, was not temporarily absent or on layoff
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q5a=1,8,9)
Q13(a-e). Has (INSERT NAME) been looking for work during the last 4 weeks?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q14, Q15, Q16 DELETED FOR 2016
(SKIP TO Q.18a IF WORKED OR SKIP TO Q.24a IF NEVER WORKED)
(ASK IF Q13=1,8,9)
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
Q17. Why is (INSERT NAME) not looking for a job?
(INTERVIEWER: multiple answers may be given)
DO NOT READ LIST. PROBE FOR MORE THAN ONE RESPONSE
01 Limited English
02 Attending school or training
03 Poor health or handicap
04 Child care or family responsibilities
05 Believes no work is available
06 Tried to find work but couldn’t
08 Age
0797 Other
(SPECIFY) ______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(SKIP TO Q.24a IF NEVER WORKED)
[FOR ALL PERSONS WHO HAD WORKED IN THE U.S. -- IF DID NOT WORK LAST WEEK, ASK ABOUT LAST JOB. GO TO Q.24a IF INDIVIDUAL NEVER WORKED IN THE U.S.]
(ASK IF Q5a=2 OR Q11a=2)
Q18a(a-e). In the last year, how many weeks did (INSERT NAME) work?
________ (RANGE: 0-52)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q5a=2 OR Q11a=2)
Q18b(a-e). How many hours per week did (INSERT NAME) usually work?
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q5a=2 OR Q11a=2)
Q18c(a-e). What were (INSERT NAME)'s total earnings before taxes from all jobs in the past 12 months?
________ (RANGE: 0-999,996)
9999998 (DO NOT READ) Don’t know
9999999 (DO NOT READ) Refused
(ASK IF Q5a=2 OR Q11a=2)
Q18d(a-e). When did (INSERT NAME) get his/her first job in the U.S.?
01 [RECORD MONTH]
02 [RECORD YEAR]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q5a=2 OR Q11a=2)
Q18e(a-e). Did the income that (INSERT NAME) received from his/her first job disqualify (INSERT NAME) from receiving cash assistance (IF NECESSARY: such as RCA, TANF, or GA)?
1 No
2 Yes
3 Was not receiving cash assistance at that time
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q5a=2 OR Q11a=2)
Q19b(a-e). What kind of business or industry is this?
(IF NECESSARY: e.g., hospital, electronic parts manufacturing, social service agency)
________ (RECORD INDUSTRY)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q19c DELETED FOR 2016
(ASK IF Q5a=2 OR Q11a=2)
[PN: IF Q5a=2 INSERT “Is”]
[PN: IF Q11a=2 INSERT “Was”]
Q20(a-e). (Is/Was) (INSERT NAME) a:
01 Employee of a private company, business, or individual
02 Federal government employee
03 State government employee
04 Local government employee
05 Self-employed
06 Working without pay in family business
07 Other (SPECIFY) _____________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q21, Q22a DELETED FOR 2016
(ASK ALL)
Q24a(a-e). Within the past 12 months, has (INSERT NAME) attended any job training program?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q24a=2)
Q24b(a-e). How many weeks did that training last?
________ (RANGE: 0-52)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q24c, Q24d, Q24e DELETED FOR 2016
(ASK ALL)
Q25a(a-e). Within the past 12 months, has (INSERT NAME) attended school or university (IF NECESSARY: other than to take English language training or the job-training class indicated in the previous question)?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q25a=2)
Q25b(a-e). Was (INSERT NAME) attending school or university in order to obtain a degree or certificate?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q25b=2)
Q25c(a-e). What degree or certificate was (INSERT NAME) attempting to earn?
(READ LIST)
1 High school certificate or equivalency
2 Associate degree
3 Bachelor's degree
4 Master's or Doctorate degree
5 Professional school degree (e.g., MD, LLB, DDS)
6 Other (SPECIFY) ___________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q25b=2)
Q25d(a-e). Has (INSERT NAME) received this degree or certificate?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q25e DELETED FOR 2016
(ASK ALL)
Q26b(a-e). How many months has (INSERT NAME) lived at this residence/neighborhood?
________ (RANGE: 1-96)
00 Less than 1 month
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q26c DELETED FOR 2016
(ASK IF Q26b=0-11,98,99)
(PN: IF Q26b(a-e)=12-96 GEN IN CODE 2)
Q26d(a-e). Did (INSERT NAME) live in this state a year ago?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q26d=1,8,9)
Q26e(a-e). In which state did (INSERT NAME) live a year ago?
1 Not in the U.S.
2 Specify state___________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q26ea DELETED for 2016
(ASK ALL)
Q26f(a-e). What was the primary reason that (INSERT NAME) moved to this state?
(DO NOT READ LIST)
1 Employment opportunities
2 Better public assistance
3 Reunification with relatives
4 Other (SPECIFY) ___________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q26g DELETED FOR 2016
(ASK ALL)
Q26h(a-e). Does (INSERT NAME) participate in their children’s education?
1 No
2 Yes
7 (DO NOT READ) Not applicable
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q26h=2)
[PN: ALLOW MULTIPLE RESPONSES – CODES 8-9 MUTUALLY EXCLUSIVE]
Q26ha(a-e). If yes, how?
(INTERVIEWER: multiple answers may be given)
DO NOT READ LIST
1 Attend parent- teacher meetings
2 Volunteer your time
3 Help with homework
4 Other (SPECIFY) ___________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q26i DELETED FOR 2016
(ASK ALL)
Q27a(a-e). Has (INSERT NAME) applied to adjust his/her immigration status to that of a permanent U.S. resident?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q27a=2)
Q27b(a-e). When did (INSERT NAME) apply for adjustment to permanent resident status?
01 [RECORD MONTH]
02 [RECORD YEAR]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q27a=1,8,9 OR Q27b=98,99)
Q27c(a-e). Does (INSERT NAME) plan to adjust his/her immigration status in the future?
1 No
2 Yes
3 Did not know he/she had to apply to become a permanent resident
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q28(a-e). Does (INSERT NAME) have a physical, mental, or other health condition that has lasted for 6 or more months and which [INSERT ITEM]
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
a. Limits the kind or amount of work this person can do at a job?
b. Prevents this person from working at a job?
(ASK ALL)
[PN: ALLOW MULTIPLE RESPONSES – CODES 01,98,99 MUTUALLY EXCLUSIVE]
Q29a(a-e). During the past 12 months, how were (INSERT NAME)'s medical expenses paid?
(INTERVIEWER: May indicate more than one)
DO NOT READ LIST
01 No medical expenses
02 Self or household members
03 Other relatives or friends
04 Sponsor/sponsoring agency
05 Religious organization
06 Medicaid
07 Refugee Medical Assistance (RMA)
08 Co-payments
09 Other government source
10 Insurance through own employment (e.g., Blue Cross)
11 Insurance through family member's employment
12 Other source (SPECIFY) __________________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q29b(a-e). What is (INSERT NAME)’s usual source of medical care?
READ LIST ONLY IF NECESSARY
1 No regular source
2 Private physician
3 Emergency room at a hospital
4 Health clinic
5 Folk healer
6 Other (SPECIFY) __________________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q29c(a-e). In the past 12 months, was (INSERT NAME) covered either by Refugee Medical Assistance, Medicaid, or private health insurance?
1 Yes - covered in all months
2 No - number of months not covered (SPECIFY): _______ (RANGE: 02-11)
3 Not covered 1 month or less
4 Not covered in any month
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q29c=1-3,8-9)
[PN: ALLOW MULTIPLE RESPONSES – CODES 7,8,9 MUTUALLY EXCLUSIVE]
Q29d(a-e). What type of health insurance coverage did (INSERT NAME) have in the past 12 months?
(INTERVIEWER: Indicate all that apply)
READ LIST ONLY IF NECESSARY
1 Insurance through own or family member's employment
2 Private insurance unrelated to employment
3 Medicaid or Refugee Medical Assistance
4 Other government health care
5 Other insurance (SPECIFY) ________________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q30a. In the past 12 months, have one or more persons in your household received food stamps?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q30a=2)
Q30b. Who received them?
[PN: SHOW HOUSEHOLD ROSTER, ALLOW MULTIPLE RESPONSES]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q30c DELETED FOR 2016
(ASK IF Q30a=2)
Q30d. How many months in the past 12 months were food stamps received?
________ (RANGE: 1-12)
00 Less than one month
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q31a. In the past 12 months, have one or more persons in your household received cash assistance through the Temporary Assistance to Needy Families (TANF) Program?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q31a=2)
Q31b. Which household members received such assistance?
[PN: SHOW HOUSEHOLD ROSTER, ALLOW MULTIPLE RESPONSES]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q31c DELETED FOR 2016
(ASK IF Q31a=2)
Q31d. How many months in the past 12 months was the TANF received?
________ (RANGE: 1-12)
00 Less than one month
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q31a=2)
Q31e. In the last month, was TANF received?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q31f. Since coming to the United States, in how many months have one or more persons in your household received TANF?
1 Every month
2 No months
3 Number of months (SPECIFY): ____________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q32a. In the past 12 months, have one or more persons in your household received assistance through the Refugee Cash Assistance (RCA) program?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q32a=2)
Q32b. Which household members received such assistance?
[PN: SHOW HOUSEHOLD ROSTER, ALLOW MULTIPLE RESPONSES]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q32c DELETED FOR 2016
(ASK IF Q32a=2)
Q32d. How many months in the past 12 months was RCA received?
________ (RANGE: 1-12)
00 Less than one month
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q32a=2)
Q32e. In the last month, was RCA received?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q33a. In the past 12 months, have one or more persons in your household received Supplemental Security Income (SSI)?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q33a=2)
Q33b. Which household members received such assistance?
[PN: SHOW HOUSEHOLD ROSTER, ALLOW MULTIPLE RESPONSES]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q33c DELETED FOR 2016
(ASK IF Q33a=2)
Q33d. How many months in the past 12 months was SSI received?
________ (RANGE: 1-12)
00 Less than one month
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q33a=2)
Q33e. In the last month, was SSI received?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q33f. Since coming to the U.S., in how many months have one or more persons in your household received SSI?
1 Every month
2 No months
3 Number of months (SPECIFY): ____________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q34a. In the past 12 months, have one or more persons in your household received income from General Assistance (GA)?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q34a=2)
Q34b. Which household members received such assistance?
[PN: SHOW HOUSEHOLD ROSTER, ALLOW MULTIPLE RESPONSES]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q34c DELETED FOR 2016
(ASK IF Q34a=2)
Q34d. How many months in the past 12 months was GA received?
________ (RANGE: 1-12)
00 Less than one month
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q34a=2)
Q34e. In the last month, was GA received?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q34f. Since coming to the U.S., in how many months have one or more persons in your household received GA?
1 Every month
2 No months
3 Number of months (SPECIFY): ____________
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK ALL)
Q35a. In the past 12 months; have one or more persons in your household received cash assistance directly from a voluntary agency, sponsor, religious organization, or MAA?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
Q35b, Q35c, Q35d, Q35e DELETED FOR 2016
Q36a, Q36b, Q36c, Q36d, Q36f DELETED FOR 2016
(ASK ALL)
Q38a. Is this house or apartment…
(READ LIST)
1 Rented for cash rent
2 Owned by you or someone in this household with or without a mortgage or loan
3 Occupied without payment of cash rent
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
(ASK IF Q38a=1,2,8,9)
Q38b. How much is the total monthly payment for this housing unit?
(INTERVIEWERS: For owners, include total mortgage payment, taxes, insurance and utilities; for renters include rent plus utilities - gas, electricity and heating oil - if paid separately)
________ (RANGE: 0-99,996)
999998 (DO NOT READ) Don’t know
999999 (DO NOT READ) Refused
(ASK ALL)
Q38c. Is this housing unit in a public housing project, that is, is it owned by a local housing authority or other local public agency?
1 No
2 Yes
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
PROGRAMER: IF S3=9 OR S3A=9 OR S3B=9 RE-ASK S3, S3A, AND S3B WITH THE SAME SKIP PATTERNS. WE NEED A FLAG TO IDENTIFY THESE RESPONDENTS
(ASK ALL)
IN1. We would you like to send you $25 for your contribution to this important research. You would receive a gift card in approximately 4 to 6 weeks. Can you confirm we have the correct mailing address?
[PN: INSERT SAMPLE MAILING ADDRESS – FULL NAME, STREET, CITY, STATE, ZIP]
1 Correct name/address
2 Incorrect name/address
3 Respondent does not wish to receive gift card
9 (DO NOT READ) Don’t know/Refused
(ASK IF IN1=2)
IN2. May I please have your name?
(VERIFY SPELLING)
1 Answer given (SPECIFY) _________________
R (DO NOT READ) Refused
May I please have your address?
(VERIFY SPELLING)
1 Street: ______________________________
2 City: _______________________________
3 State: _______________________________
4 Zip code:____________________________
R (DO NOT READ) Don’t know
(READ TO ALL)
CLOSE: That was our final question.
Thank you very much for your participation in this survey.
| File Type | application/msword |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |