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pdfATTACHMENT A
NBS INSTRUMENT
OMB No. 0960-NEW
Expiration Date: MM/DD/YYYY
NATIONAL BENEFICIARY SURVEY
July 2022
Round 8
Representative Beneficiary and Successful Worker Combined Questionnaire
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid
OMB control number for this information collection is 0960-NEW. The time required to complete this information collection is estimated to average 50 to 70 minutes per
response.
NATIONAL BENEFICIARY SURVEY
- TABLE OF CONTENTS -
Contents
SECTION A: SCREENER ........................................................................................................................1
SECTION B: DISABILITY AND CURRENT WORK STATUS ....................................................................... 60
SECTION C: CURRENT EMPLOYMENT .............................................................................................. 105
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS............................................................................ 144
SECTION D: JOBS/OTHER JOBS DURING 2022 .................................................................................. 186
SECTION SC: BENEFIT SUSPENSE .................................................................................................... 213
SECTION SA: QUESTIONS APPLICABLE TO ALL EXPERIENCING RECENT SUSPENSE ................ 215
SECTION SS: QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT
INTERVIEW .............................................................................................................................. 216
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE
RECEIVING BENEFITS AT INTERVIEW ...................................................................................... 221
SECTION E: AWARENESS OF SSA PROGRAMS .................................................................................. 229
SECTION F: REMOVED FROM THE NBS ............................................................................................ 241
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022 ................................. 242
SECTION H: REMOVED FROM THE NBS............................................................................................ 252
SECTION I: HEALTH AND FUNCTIONAL STATUS ................................................................................ 253
SECTION J: HEALTH INSURANCE ...................................................................................................... 281
SECTION K: INCOME AND OTHER ASSISTANCE ................................................................................ 286
SECTION L: SOCIODEMOGRAPHIC INFORMATION ........................................................................... 296
SECTION M: CLOSING INFORMATION AND OBSERVATIONS ............................................................. 310
SECTION A: SCREENER
SECTION A: SCREENER
PRELOADED INFORMATION
S1
(A01_a)
CLUSTERED SAMPLE
YES = 01
NO = 00
S9
(A04_b)
FIRSTNAME (original – may be updated in another block: Current First Name)—CREATE NAME
USING FIRSTNAME AND LASTNAME
S10
(A04_c)
LASTNAME (original – may be updated in another block: Current Last Name)
S11
(A04_d)
BIRTHDATE (original – may be updated in another block: Current Birth Date)
S13
(A04_f)
BSTATUS (Benefit Type)
BSTATUS = 01 – SSI ONLY BENEFITS
BSTATUS = 02 – SSDI ONLY BENEFITS
BSTATUS = 03 – CONCURRENT (BOTH SSI AND SSDI) BENEFITS
S14
(A04_g) SSIAGE (from SSI records –age first received SSI benefits)—CREATE SSIAGE FROM DATE OF
BIRTH AND DATE FIRST RECEIVED SSI
S18
(A04_k)
STATE MED (STATE NAME FOR MEDICAID) (based on state of residence at A67a)
S19
(A04_l)
VRNAME (STATE NAME FOR VRA) (based on state of residence at A67a)
S20
(A04_m)
Sample Member’s Address at time sample was drawn (may be updated in Section A)
S21
(A04_n)
Sample Member’s Phone Number at time sample was drawn
SampGrp
Sample Group (Sample Group Type)
SampGrp=01– Representative Beneficiary Sample
SampGrp=02 – Successful Worker Sample
Prepay
Prepay incentive type
01= received $2 prepay incentive
00= did not receive $2 prepay incentive
1
SECTION A: SCREENER
STORING KEY SCREENER VARIABLES IN KEY ITEMS UPON ANSWERING:
(NOTE: Once answered in screener and stored, the stored answers will remain, even if the instrument takes a different
path, so stored answers MAY have conflicting data. An example would be if SM says "DK" to A68 (birth
month), the next question will be A69 (age). The A68 and A69 will be recorded in the KeyItems.
If the age is off by more than 2 years, the case will exit and we will need to try for a proxy. When
Proxy answers A68, A68a, A68b with a full birth date, the birthdate recorded in A68, A68a & A68b
will be stored in KeyItems. Since A69 is no longer on route and A69 already has an answer, the
A69 answer will still be stored in KeyItems.
A68
A68a
A68b
A69
A73b
A74
A76
A77
A77a
A78
A78a
Also added to Key Items
SMCognitiveFail (if this flag = 1, then SM failed Cognitive Barrier questions A74-A78a)
Also adding up to 3 Proxy names for Proxy’s that fail Cognitive Barrier questions
BadProxyFullName1
BadProxyFullName2
BadProxyFullName3
2
SECTION A: SCREENER
RTYPE: Set at A110 or A110a.
PROGRAMMER: A CURRENT CONTACT BLOCK WILL STORE ANY UPDATES TO S8, S9, S10, S11, S20, and
S21. UPDATES TO THE OTHER CURRENT CONTACT BLOCK CAN COME FROM THE
SCREENER OR LOCATING.
PROGRAMMER: STORE UPDATED NAME, ADDRESS, AGE, PROXY, ETC. INFORMATION IN ADDRESS
UPDATE BLOCK OR NAME UPDATE BLOCK.
PROGRAMMER: POPLULATE KEY ITEMS VARIABLE FOR EACH PROXY NAME ENTERED IN CASE.
PROGRAMMER: IF RTYPE=PROXY ALREADY, LEAVE AS PROXY. DO NOT RE-SET TO SAMPLE MEMBER
PROGRAMMER: ON CALL HISTORY SCREEN:
IF RTYPE=PROXY, SHOW THIS TEXT: THIS CASE REQUIRES A PROXY
IF RTYPE=PROXY AND PROXY FAILED SCREENER, SHOW THIS TEXT: THIS CASE
REQUIRES A PROXY OTHER THAN {NAME1, [NAME2]}.
PROGRAMMER: ON “FINISHED” SCREEN:
IF RTYPE=PROXY, SHOW THIS TEXT: THIS CASE REQUIRES A PROXY. PLEASE INCLUDE CLEAR
NOTES ABOUT PROXY.
IF RTYPE=PROXY AND PROXY FAILED SCREENER, SHOW THIS TEXT: THIS CASE
REQUIRES A PROXY OTHER THAN {NAME1, [NAME2]}. PLEASE INCLUDE CLEAR NOTES ABOUT
PROXY.
(All)
A0.
CALL SCREEN. PROGRAMMER, DISPLAY: INTERVIEWER: YOU ARE CALLING…(ONE ONLY) NOTE:
01, 04, 07 THROUGH 15 ARE SET IN OVERNIGHT PROCESSING. 02, 03, 05 AND 06 WOULD BE IN THE
FRONT END FOR THE INTERVIEWER TO SELECT.
SITUATION
DISPLAY, CALLING FOR
GO TO
01
NEW SCREENER FOR NAME
CALL TO {RESPONDENT
NAME}
A1
02
CATI CALL-IN
{NAME} CALLING IN
A11
03
CAPI INTERVIEW
{NAME – CAPI}
A64
04
CALL NAME AFTER REMAIL
{NAME , AFTER REMAIL}
A1
05
RELAY CALL IN
{NAME} CALLING IN – RELAY
A11
06
TTY CALL IN
{NAME} CALLING IN – TTY
A11
07
CALL NAME USING RELAY
{NAME} – RELAY
A10
08
CALL NAME USING TTY
{NAME} – TTY
A10
09
CALL NAME USING AMPLIFIER
{NAME} – AMPLIFIER
A1
10
CALL TO IDENTIFIED PROXY
PROXY NAME
A56
11
CALLBACK TO PROXY AFTER REMAIL
PROXY NAME
A56
12
INFORMANT/PROXY CALL IN
13
CALL TO NEW PROXY
PROXY NAME
A56
14
CALL INTERPRETER
INTERPRETER NAME
A8
15
CALL TO NEW / UNNAMED
INTERPRETER
INTERPRETER NAME
A4b
A11
3
SECTION A: SCREENER
CALL TO RESPONDENT
(A0 = 01, 04, OR 09)
A1.
Hello, my name is _________. I’m calling on behalf of the Social Security Administration. May I please speak
with {IF RTYPE=PROXY AND WE DON’T HAVE PROXY NAME: someone who can answer questions about
{NAME’s} health, daily activities, and any jobs {he/she} might have?}, else: {FIRST NAME} {LAST NAME}?
Hola, mi nombre es ________________. Llamo de parte de la Administración del Seguro Social o Social
Security Administration. ¿Puedo hablar con {IF RTYPE=PROXY AND WE DON’T HAVE PROXY NAME:
alguien que pueda contestar preguntas sobre la salud y las actividades diarias de {NAME} y sobre cualquier
trabajo que {él/ella} tenga?}, else: {FIRST NAME} {LAST NAME}?
INTERVIEWER: We are not selling anything or asking for money.
No estamos vendiendo nada ni pidiendo una contribución.
SPEAKING .........................................................................
WANTS MORE INFORMATION .........................................
{RESPONDENT NAME} COMES TO PHONE ...................
CALL BACK LATER ...........................................................
(A100), IF RTYPE=PROXY, SET A100 = 2
{NAME} MOVED.................................................................
POSSIBLE PARTICIPATION PROBLEM ...........................
HOSPITALIZED..................................................................
{NAME} DECEASED ..........................................................
{NAME} INCARCERATED..................................................
LANGUAGE BARRIER (NOT SPANISH) ...........................
INSTITUTIONALIZED ........................................................
MILITARY DUTY ................................................................
SWITCH TO AMPLIFIER / CONTINUE ..............................
NO SUCH PERSON AT THIS NUMBER ............................
OTHER: SUPERVISOR REVIEW NEEDED......................
HUNG UP DURING INTRODUCTION ...............................
UNAVAILABLE DURING FIELD PERIOD ..........................
LIVING OUTSIDE USA ......................................................
REFUSED ..........................................................................
4
01 (A10)
02
03 (A10)
04 IF RTYPE = SM, SET A100 = 01
05
06
07
08
09
10
11
12
13
14
15
16
17
18
r
(A30)
(A13)
(A27a)
(A103a)
SET A103 = 01(A103)
(A3)
(A27a)
SET A103 = 02 (A103)
(A10)
SET A102 = 01 (A102)
SET A106 = 05 (A106)
SET STATUS = 1240 (END)
SET A104 = 06 (A104)
SET A103 = 03 (A103)
SET A105 = 02 (A105)
SECTION A: SCREENER
REQUESTS INFORMATION
(A1=02)
A2.
Social Security just sent {NAME} a letter about an important national health study. I work for Mathematica, a
well-known research company based in Princeton, New Jersey. We were hired by Social Security to conduct
this survey. This is a scientific study. We are not selling anything or asking for money.
Social Security, el Seguro Social, recientemente le envió a [usted/NAME] una carta informándole que
estaríamos llamando para pedir su participación en un importante estudio nacional de salud que estamos
conduciendo para ellos. Yo trabajo para Mathematica, una compañía de estudios investigativos conocida
nacionalmente y basada en Princeton, New Jersey. Fuimos contratados por la Seguro Social para realizar
esta encuesta. Estamos conduciendo un estudio científico. No estamos vendiendo nada ni pidiendo una
contribución.
PROBE:
(IF PREPAY=1): Social Security sent a letter with $2 as a thank you. We will send you a $30 gift
card after you complete the survey.
El Seguro Social le envió una carta con $2 como agradecimiento. Nosotros vamos a mandarle una
tarjeta de regalo de $30 después de que complete la entrevista.
INTERVIEWER INSTRUCTION (PRE-PAY=1): IF SAMPLE MEMBER SAYS HE/SHE DID NOT RECEIVE
GIFT CARD AND WILL NOT COMPLETE THE INTERVIEW UNTIL WE SEND A GIFT CARD, SCHEDULE
APPOINTMENT TO CALL BACK.
{NAME} SPEAKING ...........................................................
{NAME} COMES TO PHONE .............................................
CALL BACK LATER ...........................................................
(A100), IF RTYPE=PROXY, SET A100 = 2
{NAME} MOVED.................................................................
POSSIBLE PARTICIPATION PROBLEM ...........................
HOSPITALIZED..................................................................
{NAME} DECEASED ..........................................................
{NAME} INCARCERATED..................................................
LANGUAGE BARRIER (NOT SPANISH) ...........................
INSTITUTIONALIZED ........................................................
MILITARY DUTY ................................................................
SWITCH TO AMPLIFIER / CONTINUE ..............................
NO SUCH PERSON AT THIS NUMBER ............................
OTHER: SUPERVISOR REVIEW NEEDED......................
HUNG UP DURING INTRODUCTION ...............................
UNAVAILABLE DURING FIELD PERIOD ..........................
LIVING OUTSIDE USA ......................................................
DID NOT RECEIVE LETTER .............................................
REFUSED ..........................................................................
01 (A10)
03 (A10)
04 IF RTYPE = SM, SET A100 = 01
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
r
(A30)
(A13)
(A27a)
(A103a)
SET A103 = 01 (A103)
(A27a)
SET A103 = 02 (A103)
(A10)
SET A102 = 01 (A102)
SET A106 = 05 (A106)
SET STATUS = 1640 (END)
SET A104 = 06 (A104)
SET A103 = 03 (A103)
A20
SET A105 = 02 (A105)
LANGUAGE BARRIER
(A1 = 10) OR (A2 = 10)
A3.
Can someone there speak English?
¿Hay alguien ahí que puede hablar inglés?
INTERVIEWER NOTE: IF THIS CASE REQUIRES A SPANISH-SPEAKING INTERVIEWER,
RETURN TO PREVIOUS QUESTION. CLICK THE FLAG AT THE TOP OF THE SCREEN TO
CHANGE LANGUAGE TO SPANISH AND SCHEDULE A CALL BACK LATER. DO NOT
CODE LANGUAGE BARRIER IF THIS CASE REQUIRES A SPANISH-SPEAKING
INTERVIEWER
PERSON COMES TO PHONE........................................... 01
5
SECTION A: SCREENER
CALL BACK LATER ........................................................... 02 IF RTYPE = SM, SET A100 =
01 (A100), IF RTYPE=PROXY, SET A100 = 2 (A100)
NO ONE SPEAKS ENGLISH ............................................. 03 SET A106 = 01 (A106)
REFUSED/HUNG UP .........................................................
r SET A106 = 01 (A106)
6
SECTION A: SCREENER
POSSIBLE INTERPRETER COMES TO PHONE
(A3 = 01)
A4.
Hello, my name is _____________. I’m calling on behalf of the Social Security Administration. Social Security
just sent {NAME} a letter about an important national health survey. I work for Mathematica, a well-known
research company based in Princeton, New Jersey. We were hired by Social Security to conduct this survey.
We are looking for someone who is 18 years or older to help {him/her} by interpreting the survey for us. Are
you 18 years of age or older?
Hola, mi nombre es ________________. Llamo de parte de la Administración de Seguro. Recientemente,
Seguro Social le envió una carta a {NAME} explicando una importante encuesta que estamos llevando a
cabo para ellos. Yo trabajo para Mathematica, una compañía de estudios investigativos conocida
nacionalmente y basada en Princeton, New Jersey. Fuimos contratados por la Seguro Social para realizar
esta encuesta. Estamos buscando alguien de la edad de 18 (dieciocho) años o más, que pueda ayudar
[él/ella] y traducir la entrevista para nosotros. ¿Usted tiene 18 o más años de edad?
YES .................................................................................... 01 (A4b)
NO ...................................................................................... 00
REFUSED/HUNG UP .........................................................
r SET A106 = 01 (A106)
(A4 = 00)
A4a.
Is there someone else who is 18 years or older who could come to the phone and help with the survey?
¿Hay alguna otra persona de 18 o más años de edad que puede venir al teléfono y ayudar con la entrevista?
YES, PERSON COMES TO PHONE ................................. 01
CALL BACK LATER ........................................................... 02 (A6)
NO ONE SPEAKS ENGLISH ............................................. 03 SET A106 = 01 (A106)
REFUSED/HUNG UP .........................................................
r SET A106 = 01 (A106)
(A0 = 15) OR (A4 = 01) OR (A4a = 01)
A4b.
IF (A0=15) or (A4a=01) FILL {Hello, my name is _____________. I’m calling on behalf of the Social Security
Administration. Social Security just sent {NAME} a letter about an important national health study. I work for
Mathematica, a well-known research company based in Princeton, New Jersey. We were hired by Social
Security to conduct this survey. We are looking for an interpreter who is 18 years or older to help {him/her}
with the survey.} Would you be able to help {NAME} by interpreting the questions?
Hola, mi nombre es ________________. Llamo de parte de la Administración de Seguro. Recientemente,
Seguro Social le envió una carta a {NAME} explicando una importante encuesta que estamos llevando a
cabo para ellos. Yo trabajo para Mathematica, una compañía de estudios investigativos conocida
nacionalmente y basada en Princeton, New Jersey. Fuimos contratados por la Seguro Social para realizar
esta encuesta. Estamos buscando alguien de la edad de 18 (dieciocho) años o más, que pueda ayudar
[él/ella] y traducir la entrevista para nosotros. ¿Usted tiene 18 o más años de edad?
PROBE: We are not selling anything or asking for money.
No estamos vendiendo nada ni pidiendo una contribución.
PROBE (PREPAY=1): Social Security sent a letter with $2 as a thank you. We will send you a $30 gift card
after you complete the survey.
El Seguro Social le envió una carta con $2 como agradecimiento. Nosotros vamos a mandarle una
tarjeta de regalo de $30 después de que complete la entrevista.
YES ....................................................................................
CALL BACK LATER ...........................................................
NO ONE +18 SPEAKS ENGLISH ......................................
{NAME} MOVED.................................................................
POSSIBLE PARTICIPATION PROBLEM ...........................
HOSPITALIZED..................................................................
{NAME} DECEASED ..........................................................
7
01
02
03
04
05
06
07
(A6)
SET A106 = 01 (A106)
(A30)
(A13)
(A27a)
(A103a)
SECTION A: SCREENER
{NAME} INCARCERATED..................................................
INSTITUTIONALIZED ........................................................
MILITARY DUTY ................................................................
NO SUCH PERSON AT THIS NUMBER ............................
OTHER: SUPERVISOR REVIEW NEEDED......................
UNAVAILABLE DURING FIELD PERIOD ..........................
LIVING OUTSIDE USA ......................................................
REQUESTS IN-PERSON INTERVIEW ..............................
REFUSED ..........................................................................
08
09
10
11
12
13
14
15
r
SET A103 = 01 (A103)
(A27a)
SET A103 = 02 (A103)
SET A102 = 01 (A102)
SET A106 = 05 (A106)
SET A104 = 06 (A104)
SET A103 = 03 (A103)
(A39)
SET A105 = 02 (A105)
(A4b = 01)
A5.
If {NAME} is available and you are ready to interpret, we can begin now. If you or {NAME} get tired or need a
break at any time, please tell me, and we will call back later to finish.
Si [NAME] está disponible ahora, y usted/ está preparado para traducir, podemos empezar ahora. Si usted o
{NAME} se cansa o necesita un descanso en cualquier momento, por favor dígame y llamaremos de vuelta
más tarde para completar la entrevista.
CONTINUE ......................................................................... 01
CALL BACK LATER ........................................................... 02
INTERPRETER REFUSED ................................................
r SET A105 = 02 (A105)
(A4a = 02) OR (A4b = 02) OR (A5 = 01 OR 02)
A6.
{IF A5 = 01 DISPLAY Before we begin, please tell me your name.}
Antes de comenzar, por favor dígame su nombre.
{IF A4a = 02 DISPLAY Please tell me that person’s name so we can ask for them when we call back later /
Por favor dígame el nombre de esa persona para que podamos preguntar por ella cuando volvamos a llamar
más tarde.
IF A5 = 02 OR A4b = 02 DISPLAY: Please tell me your name so we can ask for you when we call back later}.
Por favor dígame su nombre para que podamos preguntar por usted cuando volvamos a llamar más tarde.
PROBE: IF PERSON IS RELUCTANT TO GIVE NAME, SAY: The first name is all we need.
Sólo necesitamos el nombre.
IF NAME IS REFUSED, CODE AS REFUSED AND CONTINUE
FIRST, MIDDLE, LAST
DON’T KNOW ....................................................................
REFUSED ..........................................................................
d
r
PROGRAMMER: STORE INTERPRETER NAME IN S25 AND LOCATOR
(A6 = ANSWER OR r)
A7.
And, what is {IF A5 = 01 OR 2) OR (A4b = 02) FILL your / IF A4a = 02 FILL their} relationship to {NAME}?
¿Y cuál es su parentesco o relación de familia con {NAME}?
{NAME’S} SPOUSE............................................................
NAME’S} MOTHER ............................................................
{NAME’S} FATHER ............................................................
{NAME’S} CHILD ................................................................
GRANDPARENT OF {NAME} ............................................
BROTHER/SISTER (NATURAL/STEP) OF {NAME} ..........
AUNT/UNCLE OF {NAME} .................................................
OTHER RELATIVE.............................................................
NOT RELATED ..................................................................
STAFF AT RESIDENCE .....................................................
DON’T KNOW ....................................................................
REFUSED ..........................................................................
(A7 = ANSWER OR d OR r)
A7a.
PROGRAMMER:
8
01
02
03
04
05
06
07
08
09
10
d
r
SECTION A: SCREENER
IF A5 = 01 (CONTINUE) ..................................................... 01 (A10)
ELSE CALLBACK TO INTERPRETER .............................. 02 SET A100 = 03 (A100)
CALLBACK TO NAMED INTERPRETER
(A0=14)
A8.
Hello, my name is ___________________. I’m calling on behalf of the Social Security Administration. May I
please speak to {INTERPRETER’S NAME}?
Hola, mi nombre es ________________. Llamo de parte de la Administración de Seguro. ¿Puedo hablar con
[INTERPRETER’S NAME], por favor?
PROBE:
We are not selling anything or asking for money.
No estamos vendiendo nada ni pidiendo una contribución.
SPEAKING .........................................................................
INTERPRETER COMES TO PHONE ................................
CALL BACK LATER ...........................................................
HUNG UP DURING INTRODUCTION ..............................
INTERPRETER REFUSED ................................................
01
02
03 SET A100 = 03 (A100)
04 SET STATUS = 1640 (END)
r SET A105 = 02 (A105)
(A8 =01 OR 02)
A9.
{IF A8 = 02 DISPLAY: Hello, my name is ________________. I’m calling on behalf of the Social Security
Administration.} When we last spoke with you, you said this would be a good time for you to interpret the
National Beneficiary Survey for {NAME}. Are you and {NAME} ready to begin?
Hola, mi nombre es ________________. Llamo de parte de la Administración de Seguro. Cuando hablamos
con usted recientemente, usted dijo que ahora sería un tiempo conveniente para usted para interpretar la
Encuesta Nacional de Beneficiarios o National Beneficiary Survey para {NAME}. ¿Usted y {NAME} están
listos para empezar?
PROBE:
If you or {NAME} get tired or need a break at any time, please tell me, and we will call back later
to finish.
Si usted se cansa o necesita un descanso en cualquier momento, por favor dígame y llamaremos
de vuelta más tarde para completar la entrevista.
YES, CONTINUE................................................................ 01
CALL BACK LATER ........................................................... 03 SET A100 = 03 (A100)
HUNG UP DURING INTRODUCTION ............................... 04 SET STATUS = 1640 (END)
INTERPRETER REFUSED ................................................ 05
SET A105 = 02 (A105)
9
SECTION A: SCREENER
SPEAKING TO NAME OR INTERPRETER / NAME OR INTERPRETER COMES TO PHONE / TO NAME AFTER
REMAIL
PROGRAMMER: REMOVE RTYPE CODE HERE [PREVIOUSLY CODED IF ((A0 = 07 or 08) OR (A1 = 01, 03 or
13) OR (A2 = 01, 03 or 13)) THEN RType & KeyItems.RType = SM ELSE RType & KeyItems.RType = Proxy]
A10.
{PROGRAMMER, IF A7a = 01 DISPLAY “Please tell {NAME} that I said….”} {(IF A0 = 07 OR 08, OR 09) OR
(A1 = 03) OR (A2 = 03 OR 13) DISPLAY Hello, my name is ________________. I’m calling on behalf of the
Social Security Administration.} {IF A2 = 01 or A2=13 BEGIN HERE} Social Security just sent (you/NAME)
{PROGRAMMER IF A0 = 04 USE another} a letter about an important national health study. I work for
Mathematica, a well-known research company based in Princeton, New Jersey. We were hired by Social
Security to conduct this survey. The National Beneficiary Survey is about (your/NAME’S) health, daily
activities, and any jobs (you/NAME) may have. It also asks about Social Security programs and services
(you/NAME) may use. I’m calling to ask you to take part (on behalf of NAME). The answers you and other
people give us will be used to help Social Security learn how well its programs meet the needs of people with
disabilities.
{PROGRAMMER, IF A7a = 01 DISPLAY “Por favor dígale a {NAME} que dije….”} {(IF A0 = 07 OR 08, OR 09)
OR (A1 = 03) OR (A2 = 03 OR 13) DISPLAY Hola, mi nombre es ________________. Llamo de parte de la
Administración de Seguro.} {IF A2 = 01 or A2=13 BEGIN HERE} Recientemente, Seguro Social le envió
{PROGRAMMER IF A0 = 04 USE otra} una carta explicando una importante encuesta que estamos llevando
a cabo para ellos. Yo trabajo para Mathematica, una compañía de estudios investigativos conocida
nacionalmente y basada en Princeton, New Jersey. Fuimos contratados por la Seguro Social para realizar
esta encuesta. La Encuesta Nacional de Beneficiarios se trata de su salud, actividades diarias, cualquier
trabajo que pueda tener, y cualquier programa o servicio de Seguro Social que pueda usar. Estoy llamando
para pedirle que participe. La información que usted y otros participantes nos proporcionan se usará para
evaluar programas de Seguro Social para beneficiarios con incapacidades.
PROBE:
We are not selling anything or asking for money.
No estamos vendiendo nada ni pidiendo una contribución.
The interview {IF A0 = 08 FILL will take around 2 to 3 hours because we are using TTY / IF A0 = 07 FILL will
take around 2 to 3 hours because we are using Relay. / IF (A0 = 04) OR (A1 = 01, 03 OR 13) OR (A2 = 01
OR 03 OR 13) FILL: will take about 60 minutes. But it may be shorter or longer based on the questions you
answer.} {IF PREPAY = 0: To thank you for your time, we will mail you a gift card for $30 when you finish the
interview. / IF PREPAY = 1: Security sent a letter with $2 as a thank you. We will send you a $30 gift card
after you complete the survey.} The questions are easy. If you get tired or need a break at any time, please
tell me, and we will call back later to finish. This interview may be recorded for quality assurance. Let’s start
now.
La entrevista {IF A0 = 08 FILL llevará entre 2 y 3 horas porque estamos usando TTY / IF A0 = 07 FILL llevará
entre 2 y 3 horas porque estamos usando retransmisión / IF (A0 = 04) OR (A1 = 01, 03 OR 13) OR (A2 = 01
OR 03 OR 13) FILL: llevará unos 60 minutos.} Pero puede ser más corto o más largo dependiendo de las
preguntas que responda. IF PRE-PAY=0 {Para agradecerle por su tiempo, le enviaremos una tarjeta de
regalo de $30 cuando terminemos la entrevista}/ IF PRE-PAY=1: {Como muestra de agradecimiento, le
enviamos recientemente una carta con $2. Le enviaremos una tarjeta adicional de $30 después de que usted
complete la entrevista.} Las preguntas son fáciles. Si usted se cansa o necesita un descanso en cualquier
momento, por favor dígame y llamaremos de vuelta más tarde para completar la entrevista. Esta entrevista
puede ser grabada para garantía de calidad. Empecemos ahora.
CONTINUE ....................................................... 01 (A64)
{RESPONDENT NAME} WILL CALL MPR....... 02 SET A108 = 01 (A108)
CALL BACK LATER ......................................... 03 (IF A1 = 01, 03, 13 OR A2 = 01, 03, A13A;
OR A0 = 07, 08, 09 SET A100 = 01 (A100)
IF A7a = 01 OR A9 = 02 SET A100 = 03
(A100))
10
SECTION A: SCREENER
DID NOT RECEIVE LETTER/DOES NOT
RECALL LETTER .........................................
REQUESTS PROXY ........................................
REQUESTS IN-PERSON INTERVIEW ............
POSSIBLE PARTICIPATION PROBLEM .........
REFUSED ........................................................
11
04
05
06
07
r
(A20)
(A39)
(A39)
(A13)
(IF A1 = 01, 03, 13 OR
A2 = 01, 03, A13A; OR A0 = 07, 08, 09
SET A105 = 01 (A105) / IF A7a = 01 OR
A9 = 01 SET A105 = 02 (A105)
SECTION A: SCREENER
NAME OR UNKNOWN INFORMANT CALLS IN
(A0=02, 05, OR 06)
A11.
INTERVIEWER: CODE BASED ON SUPERVISOR INSTRUCTION.
SAMPLE MEMBER .......................................... 01
SAMPLE MEMBER USING TTY ...................... 02
SAMPLE MEMBER USING RELAY ................ 03
INFORMANT / POSSIBLE PROXY .................. 04 (A13a)
(A11 = 01, 02, OR 03)
A12.
Hello, my name is ________________________. I’ll be your interviewer today. I work for Mathematica, a wellknown research company based in Princeton, New Jersey. We were hired by Social Security to conduct this
survey. The National Beneficiary Survey is about your health, daily activities, and any jobs you may have. It
also asks about Social Security programs and services you may use. The answers you and other people give
us will help Social Security learn how well its programs meet the needs of people with disabilities.
The interview {PROGRAMMER, IF A11 = 01 FILL will take about 60 minutes. But it may be shorter or longer
based on the questions that you answer/ IF A11 = 02 USE will take around 2 to 3 hours because we are using
TTY / IF A11 = 03 FILL will take around 2 to 3 hours because we are using Relay.} {IF PREPAY=0 To thank
you, we will mail you a $30 gift card when we finish the interview/ IF PREPAY=1: Social Security sent you a
letter with $2 as a thank you. We will send you a $30 gift card after you complete the survey.} The questions
are easy. If you get tired or need a break at any time, please tell me, and we will call back later to finish. This
interview may be recorded for quality assurance. Let’s start now.
Hola mi nombre es____________________. Seré su entrevistador(a) hoy. Yo trabajo para Mathematica, una
compañía de estudios investigativos conocida nacionalmente y basada en Princeton, New Jersey. Fuimos
contratados por la Seguro Social para realizar esta encuesta. La Encuesta Nacional de Beneficiarios se trata
de su salud, actividades diarias, cualquier trabajo que pueda tener. También hace preguntas sobre su uso de
programas y servicios de Seguro Social. La información que usted y otros participantes nos proporcionan se
usará para ayudar a evaluar programas de Seguro Social para beneficiarios con incapacidades.
La entrevista {IF A11 = 01 FILL llevará entre 60 minutos. Pero puede ser más corto o más largo dependiendo
de las preguntas que responda. / IF A11 = 02 USE llevará entre 2 y 3 horas porque estamos usando TTY/
/ IF A11 = 03 FILL llevará entre 2 y 3 horas porque estamos usando retransmisión} IF PRE-PAY=0 {Para
agradecerle por su tiempo, le enviaremos una tarjeta de regalo de $30 cuando terminemos la entrevista}/ IF
PRE-PAY=1:{Como muestra de agradecimiento, le enviamos recientemente una carta con $2. Le enviaremos
una tarjeta adicional de $30 después de que usted complete la entrevista.} Las preguntas son fáciles. Si usted
se cansa o necesita un descanso en cualquier momento, por favor dígame y llamaremos de vuelta más tarde
para completar la entrevista. Esta entrevista puede ser grabada para garantía de calidad. Empecemos ahora.
CONTINUE ....................................................... 01 (A64)
WANTS TO SCHEDULE INTERVIEW ............. 02 IF A11 = 01 SET A100 = 01 (A100)
IF A11 = 02 SET A100 = 04 (A100)
IF A11 = 03 SET A100 = 05 (A100)
NEEDS PROXY ............................................... 03
NEEDS IN-PERSON ........................................ 04 (A39)
POSSIBLE PARTICIPATION PROBLEM ......... 05 (A13)
REFUSED ........................................................
r IF A11 = 01, 02, 03 SET A105 = 01 (A105)
IF A11 = 04 SET A105 = 02 (A105)
DIFFICULTY PARTICIPATING (SPEAKING WITH NAME / INFORMANT / UNKNOWN PROXY WHO CALLS IN)
(A1 = 06) OR (A2 = 06) OR (A4b = 05) OR (A10 = 07) OR (A11 = 04) OR (A12 = 05)
A13.
INTERVIEWER: WHO ARE YOU SPEAKING WITH?
INTERVIEWER NOTE: IF SM COGNITIVE FAIL FLAG=1 AND INTERVIEWER ANSWERS 1 TO THIS
QUESTION, PLEASE DISPLAY HARD CHECK WITH THE FOLLOWING TEXT: “SAMPLE
MEMBER FAILED COGNITIVE SCREENER. THIS INTERVIEW MUST BE COMPLETED
12
SECTION A: SCREENER
BY PROXY”
{NAME} / INTERPRETER ................................ 01
INFORMANT/POSSIBLE PROXY .................... 02
13
SECTION A: SCREENER
(A11 = 04) OR (A13 = 01 OR 02)
A13a. INTERVIEWER: IF BARRIER ALREADY STATED, CODE RESPONSE THEN CONFIRM BY READING
APPROPRIATE CATEGORY BELOW.
{PROGRAMMER: IF A11 = 04, USE: PROBE: Thank you very much for calling and offering to help.
Muchas gracias por llamar y ofrecer su ayuda.
IF NEEDED: What problem does {NAME} have that might prevent {him/her} from taking part for
{himself/herself}?
¿Qué problema tiene {NOMBRE} que pueda impedir que participe {él mismo/ella misma}?
IF (A1 = 06) OR (A2 = 06) OR (A4b = 05) OR (A10 = 07) OR (A12 = 05) FILL
PROBE:
Why {IF A13 = 01 FILL would you/ IF A13 = 02 FILL would {NAME}} have a problem taking part
in the survey?
¿Por qué tendría {IF A13 = 01, FILL tendría usted/ IF A13 = 002 FILL tendría {NAME}} problema en
participar en la encuesta?
INTERVIEWER: PROBE FOR DON’T KNOW. IF MORE THEN ONE PROBLEM, PROBE FOR THE MAIN
PROBLEM.
HEARING DIFFICULTY ...................................
SPEECH DIFFICULTY .....................................
COGNITIVE BARRIER .....................................
PHYSICAL BARRIER .......................................
INCARCERATED .............................................
INSTITUTIONALIZED ......................................
HOSPITALIZED ...............................................
DECEASED ......................................................
SERVING IN MILITARY ...................................
LIVING OUTSIDE USA ....................................
DON’T KNOW ..................................................
REFUSED ........................................................
14
01
02
03
04
06
07
08
09
10
11
d
r
(A46)
SET A103 = 01 (A103)
(A27a)
(A27a)
(A103a)
SET A103 = 02 (A103)
SET A103 = 03 (A103)
SET A105 = 02 (A105)
SECTION A: SCREENER
(A13a = 01, 02, 04, OR d)
A14.
Social Security just sent {IF A13 = 01 FILL you / IF A13 = 02 FILL {NAME} a letter about an important national
health survey.} I work for Mathematica, a well-known research company based in Princeton, New Jersey that
was hired by Social Security to conduct this survey. {IF A12 = 05 START HERE} We would like {IF A13 = 01
FILL you to have / IF A13 = 02 FILL {NAME} to have} the chance to answer the questions for {IF A13 = 01
FILL yourself / IF A13 = 02 FILL himself / herself} if at all possible. I’m going to read some ways that we can
arrange for {IF A13 = 01 FILL you / IF A13 = 02 FILL {NAME}} to take part in the study.
Recientemente, Seguro Social le envió una carta explicando una importante encuesta que estamos llevando
a cabo para ellos. Yo trabajo para Mathematica, una compañía de estudios investigativos conocida
nacionalmente y basada en Princeton, New Jersey. Fuimos contratados por la Seguro Social para realizar
esta encuesta. Quisieramos que {NAME} tenga la oportunidad de contestar las preguntas que tenemos por
si mism[o/a], si eso es posible. Le voy a leer algunas de las formas en las que podemos hacer arreglos para
que {NAME} tome parte en el estudio.
PROBE: What would work best?
¿Cuál sería la más conveniente?
PROBE (PREPAY=1): Social Security sent a letter with $2 as a thank you. We will send {you/NAME} a $30
gift card after {you/NAME} complete the survey.
El Seguro Social le envió una carta con $2 como agradecimiento. Nosotros vamos a mandarle una tarjeta de
regalo de $30 después de que complete la entrevista
INTERVIEWER: READ LIST AND CODE ONE ONLY. IF MORE THAN ONE MENTIONED, ASK WHAT IS
EASIEST FOR {NAME}.
We can break the interview into a few short calls to {IF
A13 = 01 FILL you / IF A13 = 02 FILL {NAME}
Podemos separar la entrevista en unas pocas
llamadas cortas para {IF A13 = 01 FILL usted / IF
A13 = 02 FILL {NAME}............................................ 01 (A64)
We can use Relay or TTY for the interview
Podemos utilizar Relay o TTY para la encuesta ............. 02 (A16)
{PROGRAMMER, DISPLAY 03 ONLY IF A13a = 01} I
can switch to a phone amplifier now
Puedo cambiar a un teléfono con amplificador ahora...... 03 (A64)
{PROGRAMMER, DISPLAY 04 ONLY IF A13a = 01}
We can call later using a phone amplifier
Podemos llamar más tarde usando un teléfono con
amplificador............................................................. 04 SET A100 = 06 (A100)
{PROGRAMMER, DISPLAY 05 ONLY IF IN
CLUSTERED SAMPLE S1 = 01 We could send
an interviewer to {{IF A13 = 01 FILL your / IF
A13 = 02 FILL {his/her} home
Podríamos mandar un entrevistador a {{IF A13 = 01
FILL your / IF A13 = 02 FILL {su} casa ................... 05 (A42)
{PROGRAMMER DISPLAY 06 ONLY IF A13 = 02}
INFORMANT OFFERS TO BE PROXY .................. 06 (A39)
{PROGRAMMER, DISPLAY 07 ONLY IF SAMPLE
TYPE = UNCLUSTERED, S1 = 02 AND A13
= 01} {NAME} REQUESTS IN-PERSON
INTERVIEW ............................................................ 07 (A40)
{PROGRAMMER DISPLAY 08 ONLY IF A13 = 01}
{NAME} REQUESTS PROXY ................................. 08 (A39)
PHYSICAL PROBLEM: {NAME} UNABLE TO
PARTICIPATE ........................................................ 09 (A46)
15
SECTION A: SCREENER
SUGGESTS ANOTHER WAY {SPECIFY__) .................. 10
DON’T KNOW .................................................................
d (A39)
REFUSED .......................................................................
r IF A13 = 01 SET A105 = 01 (A105) /
IF A13 = 02 SET A105 = 02 (A105)
(A14 = 10)
A14a. What is that way?
¿Cuál es esa manera?
02) OR (A67 = d)
A72
PROGRAMMER CHECK: IS {NAME’S} IDENTITY VERIFIED (NAME VERIFIED {A66 = 01 OR 02} AND IS
BIRTHDATE VERIFIED (A70 = 01) OR (A71 = 02 OR 03)?
YES (VERIFIED) .............................................. 01
NO (FAILED VERIFICATION) .......................... 00 SET A102 = 04 (A102)
PROGRAMMER: CALCULATE AGE AT INTERVIEW (CURRENTAGE) USING DATE OF INTERVIEW - SELFREPORTED DATE OF BIRTH GIVEN IN A68 (TO BE USED IN SECTION E). DO NOT
RE-CALCULATE UPON RE-ENTRY.
(SampGrp = 02) AND (A72 = 1 OR A45 = ANSWERED OR A44 = r)
A73a. The survey we are conducting is only for people who have worked recently so, [IF A45 = ANSWERED OR
A44 = r: before we begin,] I need to know if {you/NAME} have worked recently. Please note that answering
any question is completely voluntary and you can refuse to answer any question. Whether you choose to
answer or not, {your/NAME’s} disability benefits will not be affected in any way, and we will keep any answers
you provide completely confidential.
{Are you/Is NAME} currently working at a job or business for pay or profit?
La encuesta que estamos realizando es sólo para gente que ha trabajado recientemente, por lo que [IF A45
= ANSWERED OR A44 = r: antes de empezar,] necesito saber si usted ha trabajado recientemente. Por favor,
tenga en cuenta que contestar cualquiera pregunta es completamente voluntario y puede negarse a contestar
cualquiera pregunta. Si decide contestar o no, {sus beneficios por discapacidad/los beneficios por
discapacidad de [NAME]} no se verán afectados en ninguna forma, y mantendremos las respuestas que nos
proporcione completamente confidenciales.
[¿Está usted/ Está [NAME]] trabajando actualmente en un empleo o negocio por pago o ganancia?
PROBE: We are interested in both full-time and part-time work for pay or profit
Estamos interesados en trabajo a tiempo completo o a tiempo parcial
YES ..........................................................................................
NO ............................................................................................
DON’T KNOW ..........................................................................
REFUSED ................................................................................
41
01
00
d
r
Programmer box A73c
A73b
A73b
A73b
SECTION A: SCREENER
(SampGrp=02) AND (A73a = 0, d, r)
A73b. Did {you/NAME} work for pay or profit at any time during the last 6 months?
¿Hizo {usted / NAME} trabajo por pago o para tener ganancias en cualquier momento durante los últimos 6
meses?
PROBE: We are interested in both full-time and part-time work for pay or profit.
Estamos interesados en trabajo a tiempo completo o a tiempo parcial
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
42
Programmer box A73c
A73c
A73c
A73c
SECTION A: SCREENER
(SampGrp=02) AND (A73a=00, d, or r) AND (A73b=00, d, OR r)
A73c. I’m sorry, we are only interviewing people who are working now or worked in the past 6 months. Thank you
for your help.
Lo siento, sólo estamos entrevistando a personas que están trabajando ahora o trabajaron en los últimos 6
meses. Gracias por su ayuda.
INTERVIEWER NOTE: IF YOU SUSPECT THE RESPONDENT DID NOT UNDERSTAND THE QUESTIONS AS YOU
READ THEM, CODE 02 BELOW.
PRESS 1 TO CONTINUE ......................................................................... 01
END CALL. STATUS “INELIGIBLE” 2460.
POSSIBLE COGNITIVE ISSUE, SUPERVISOR TO REVIEW ................. 02
SET STATUS 1380
PROGRAMMER BOX A73c
IF A72 = 1: GO TO A73
IF (A45 = 01, 02, OR d): SET A107 = 01 (A107)
IF (A45 = r) OR (A44 = r) AND (A13 = 01): SET A105 = 01 (A105)
IF (A45 = r) OR (A44 = r) AND (A13 = 02): SET A105 = 03 (A105)
NAME/PROXY COGNITIVE TEST
(A72 = 01)
A73.
INTERVIEWER: WHO ARE YOU SPEAKING WITH?
INTERVIEWER NOTE: IF SM COGNITIVE FAIL FLAG=1 AND INTERVIEWER ANSWERS 1 TO THIS
QUESTION, PLEASE DISPLAY HARD CHECK WITH THE FOLLOWING TEXT: “SAMPLE
MEMBER FAILED COGNITIVE SCREENER. THIS INTERVIEW MUST BE COMPLETED
BY PROXY”
INTERVIEWER: IF YOU ARE SPEAKING WITH AN INTERPRETER, CODE SPEAKING WITH {NAME}.
NAME – CATI OR CAPI INTERVIEW ..............
NAME, TTY INTERVIEW .................................
NAME, RELAY INTERVIEW ............................
PROXY (CATI) .................................................
PROXY (CAPI) .................................................
01
02 SET A110 = 01
03 SET A110 = 01
04
05
(A73=4 OR 5 AND WE HAVEN’T ASKED FOR RTYPE NAME YET)
A73x. Before we start, please tell me your name.
Antes de empezar, por favor dígame su nombre.
FIRST, MIDDLE, LAST
DON’T KNOW .................................................. d
REFUSED ........................................................ r
(A73=01, 02, 03, 04 OR 05)
A74.
Next, I will explain some facts about the survey. After I explain, I will ask you three questions so I can be sure
my explanation was clear.
Here’s the first explanation. The survey asks about {IF (A73 = 03) FILL your / IF (A73 = 04 OR 05) FILL
{NAME’s}} health, daily activities, and any jobs {IF (A73 = 03) FILL you / IF (A73 = 04 OR 05) FILL {NAME}}
might have. Please tell me in your own words what the survey is about.
Ahora, explicaré algunos datos acerca de la encuesta. Después de la explicación, le voy a hacer tres
preguntas para estar seguro que mi explicación fue clara.
Aquí está la primera explicación. La encuesta pregunta acerca de {su/la} salud {de NAME}, de sus actividades
cotidianas o diarias, y cualquier empleo (o trabajo) que {usted/NAME} quizás tiene. ¿Por favor dígame en sus
propias palabras, ¿de qué trata la encuesta?
43
SECTION A: SCREENER
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE ....................................................
LISTS ONLY 1 TOPIC ......................................
LISTS ANY 2 TOPICS ......................................
LISTS 3 TOPICS ..............................................
REFUSED ........................................................
00
01
02 (A77)
03 (A77)
r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
A75 IS DELETED
(A74 = 00 OR 01)
A76.
INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. The survey asks about {your/NAME}’s health, daily activities, and any jobs {IF (A73 = 03)
FILL you / IF (A73 = 04 OR 05) FILL {NAME}} might have. Please tell me in your own words, what the survey
is about.
Vamos a tratar otra vez. La encuesta pregunta acerca de {su/la} salud {de NAME}, de sus actividades
cotidianas o diarias, y cualquier empleo (o trabajo) que {usted/NAME} quizás tiene. ¿Por favor dígame en sus
propias palabras, ¿de qué trata la encuesta?
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE ....................................................
LISTS ONLY 1 TOPIC ......................................
LISTS ANY 2 TOPICS ......................................
LISTS 3 TOPICS ..............................................
REFUSED ........................................................
00 (A80)
01 (A80)
02
03
r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
(A74 = 02 OR 03) OR (A76=02 OR 03)
A77.
Here is the next explanation. Taking part in the survey is completely voluntary. Completely voluntary means
you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions
you do not like. You can also stop the interview at any time. Whether you choose to take part or not,
{your/NAME’s} disability benefits will not be affected in any way.
When I say your taking part is completely voluntary, what does that mean to you?
Esta es la siguiente explicación. Tomar parte en la encuesta es un acto completamente voluntario.
Completamente voluntario significa que usted puede escoger si quiere tomar parte o no tomar parte. Si usted
decide tomar parte, usted puede negarse a contestar cualquier pregunta que no le gusta, y puede poner un
alto a la entrevista en cualquier momento que usted quiere. Si usted escoge tomar parte o no, sus beneficios
por incapacidad no serán afectados en cualquier forma.
Cuando yo digo que tomar parte es completamente voluntario, ¿qué significa eso para usted?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part.
I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will take away my
benefits if I refuse, etc.
INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 (A78)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
(A77=02)
A77a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
44
SECTION A: SCREENER
Let’s try that again. Taking part in the survey is completely voluntary. Completely voluntary means you can
choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do
not like. You can also stop the interview at any time. Whether you choose to take part or not, {your/NAME’s}
disability benefits will not be affected in any way. When I say your taking part is completely voluntary, what
does that mean to you?
Vamos a tratar otra vez. Tomar parte en la encuesta es un acto completamente voluntario. Completamente
voluntario significa que usted puede escoger si quiere tomar parte o no tomar parte. Si usted decide tomar
parte, usted puede negarse a contestar cualquier pregunta que no le gusta, y puede poner un alto a la
entrevista en cualquier momento que usted quiere. Si usted escoge tomar parte o no, {sus/NAME} beneficios
por incapacidad no serán afectados en cualquier forma. Cuando yo digo que tomar parte es completamente
voluntario, ¿qué significa eso para usted?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part.
I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will take away my
benefits if I refuse, etc.
INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01
INACCURATE ANSWER ................................. 02 (A80)
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
45
SECTION A: SCREENER
(A77 = 01 OR A77a = 01)
A78.
Here’s the last explanation. All your answers will be kept confidential and used only for the research purposes
of the study. When I say that your answers will be kept confidential, what does that mean to you?
Esta es la última explicación. . Todas sus respuestas serán confidenciales, y serán usadas solamente para
los propósitos de estudio. Cuando yo digo que sus respuestas serán confidenciales, ¿qué significa eso para
usted?
PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only
researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.
INTERVIEWER: IF RESPONDENT SAYS: “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 (A110)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
(A78 = 02)
A78a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. All your answers will be kept confidential and used only for the research purposes of the
study.
Vamos a tratar eso otra vez. Todas sus respuestas serán confidenciales, y serán usadas solamente para los
propósitos de estudio.
When I say that your answers will be kept confidential, what does that mean to you?
Cuando yo digo que sus respuestas serán confidenciales, ¿qué significa eso para usted?
PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers
will see what I said. What I say will be (kept) private. It will only be used for research; etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 IF A73 = 03 SET A110 = 01 (A110) /
IF A73 = 04 OR 05 SET A110 = 02 (A110)
INACCURATE ANSWER - FAILED .................. 02
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
A79 IS DELETED
RESPONDENT OR PROXY FAILS COGNITIVE TEST. FIND A PROXY/ANOTHER PROXY
PROGRAMMER: IF RTYPE=SM AT THE TIME OF THE FAILED SCREENER, CHANGE RTYPE TO PROXY AND
DO NOT ALLOW TO SWITCH BACK TO SAMPLE MEMBER.
(A76 = 00 OR 01) OR (A77a = 02 OR A78a = 02)
A80.
Thank you. Our study rules say that we need to find {IF (A73 = 03) USE someone / IF (A73 = 04) USE someone
else} who can help {IF (A64 = 01) FILL you / IF (A64 = 02) FILL {NAME}} answer the survey questions. Is
there someone there who could answer questions about {(IF A64 = 01) FILL your / IF (A64 = 02) FILL
{NAME’s}} health, daily activities, and any jobs {IF (A64 = 01) FILL you / IF (A64 = 02) FILL he/she} might
have?
Muchas gracias. Las reglas de nuestro estudio dicen que necesitamos encontrar alguien que pueda ayudarle
a contestar las preguntas de la encuesta. ¿Hay alguien allí que puede contestar preguntas acerca de
46
SECTION A: SCREENER
{su/NAME} salud, de sus actividades cotidianas o diarias, y cualquier empleo (o trabajo) que {él/ella} quizás
tiene?
PROBE:
This might be someone who lives with {you/NAME}, a friend, or someone like a social worker or
case worker.
Esta persona podría ser alguien que vive con {usted/NAME}, una amistad, o quizás alguien como
una asistente o trabajadora social o 'social worker' o encargado/administrador de casos (case
worker).
YES, PROXY COMES TO PHONE ..................
YES, CALL BACK PROXY LATER...................
YES, PROXY LIVES ELSEWHERE .................
NO PROXY AVAILABLE ..................................
DON’T KNOW ..................................................
REFUSED ........................................................
47
01
02
03
04
d
r
(A85)
(A82)
SET A106 = 04 (A106)
SET A106 = 04 (A106)
IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
SECTION A: SCREENER
PROGRAMMER: SET RTYPE AT A80 (IF A80≠
LOGICALLY SKIPPED, SET RTYPE TO PROXY
(A80 = 02)
A81.
What is that person’s name so that we can call back and ask for them?
¿Cómo se llama esta persona? Necesitamos el nombre para que podamos llamar y pedir hablar con él o ella?
NAME: PREFIX, FIRST, `MIDDLE, LAST, SUFFIX
PROGRAMMER: RECORD NAME LOCATING DATABASE
SET A100 = 02 (A100)
(A80 = 03)
A82.
Do you have that person’s name and/or telephone number? If you don’t have all the information, please tell
me what you can.
¿Tiene usted el nombre y número de teléfono de esa persona? Si usted no tiene toda la información, por
favor dígame lo que pueda.
(A82 = 01)
A83.
YES .................................................................. 01
NO .................................................................... 00 SET A102 = 07 (A102)
PREFIX, FIRST, MIDDLE, LAST, SUFFIX
DON’T KNOW ..................................................
REFUSED ........................................................
d
r
Please give me the telephone number, area code first.
¿Por favor dígame el número de teléfono con el código de área primero?
TELEPHONE NUMBER: | | | |-| | |
DON’T KNOW ..................................................
REFUSED ........................................................
|-|
d
r
|
|
|
|
PROGRAMMER: STORE 3 PROXY NAME AND PHONE NUMBER IN LOCATING
DATABASE.
IF BOTH NAME AND PHONE NUMBER REFUSED, SET A106 = 05 (A106)
(A83 = ANSWER)
A84.
PROGRAMMER: WHAT KIND OF PROXY CONTACT INFORMATION DOES A83 CONTAIN?
VALID PHONE NUMBER ................................. 01 SET A101 = 02 (A101)
INVALID PHONE NUMBER ............................. 02 SET A106 = 05 (A106)
NO PHONE NUMBER ...................................... 03 SET A106 = 05 (A106)
48
SECTION A: SCREENER
CALL TO NEW PROXY/NEW PROXY COMES TO PHONE
(A1 = 13) OR (A56 = 01 OR O2) OR (A80 = 01)
A85.
{IF (A56 = 01 OR 02) OR (A80 = 01) USE Hello, my name is ________________. I’m calling on behalf of the
Social Security Administration.} Social Security just sent {NAME} a letter about an important national health
survey. I work for Mathematica, a well-known research company that was hired by Social Security to conduct
this survey. The National Beneficiary Survey is about beneficiaries’ health, daily activities, and any jobs they
may have. It also asks about Social Security programs or services {he/she} may use. I’ve been told that you
know about these topics and are the best person to answer the survey on behalf of {NAME}.
The interview will take about 60 minutes. But it may be shorter or longer based on the questions you answer.
[IF PREPAY = 0: To thank you for your time, we will mail you a gift card for $30 when we finish the interview./
IF PREPAY = 1: Social Security sent {NAME} a letter with a $2 as a thank you. We will send {NAME} a $30
gift card after you complete the survey.] Would you be able to help us?
{IF (A56 = 01 OR 02) OR (A80 = 01) USE Hola, mi nombre es_____________________. Llamo de parte de
la Administración de Seguro Social.} Seguro Social acaba de enviar una carta a {NAME} acerca de una
importante encuesta que estamos llevando a cabo para ellos. Yo trabajo para Mathematica, una compañía
de estudios investigativos conocida nacionalmente y basada en Princeton, New Jersey. Fuimos contratados
por la Seguro Social para realizar esta encuesta. La encuesta Nacional sobre Beneficiarios se trata de la
salud y actividades diarias de beneficiarios, y de cualquier trabajo que puedan tener. También pregunta
acerca de los programas o servicios de Seguro Social que {él/ella} pueda usar. Me han dicho que usted es
una persona entendida sobre estos temas y es la mejor persona para contestar la encuesta de parte de
{NAME}.
La entrevista llevará 60 minutos. Pero puede ser más corto o más largo dependiendo de las preguntas que
responda. IF PRE-PAY=0 {Para agradecerle por su tiempo, le enviaremos una tarjeta de regalo de $30
cuando terminemos la entrevista}/ IF PRE-PAY=1: El Seguro Social le envió {a NAME} una carta con $2 como
agradecimiento. Nosotros vamos a mandarle una tarjeta de regalo de $30 después de que complete la
entrevista.]
YES .................................................................. 01
CALL BACK LATER ......................................... 02 SET A100 = 02 (A100)
DON’T KNOW .................................................. d SET A106 = 03 (A106)
REFUSED ........................................................ r SET A105 = 03 (A105)
(A85=01)
A85a. Before we start, please tell me your name.
Antes de empezar, por favor dígame su nombre.
FIRST, MIDDLE, LAST
DON’T KNOW ..................................................
REFUSED ........................................................
d
r
NEW PROXY / NEW PROXY COMES-TO-PHONE COGNITIVE TEST
(A85 = 01)
A86.
Next, I will explain some facts about the survey. After I explain, I will ask you three questions so I can be sure
my explanation was clear.
Here’s the first explanation. The survey asks about {NAME’s} health, daily activities, and any jobs {he/she}
might have. Please tell me in your own words what the survey is about.
Ahora, explicaré algunos datos acerca de la encuesta. Después de la explicación, le voy a hacer tres
preguntas para estar seguro que mi explicación fue clara.
Aquí está la primera explicación. La encuesta pregunta acerca de {su/la} salud {de NAME}, de sus actividades
cotidianas o diarias, y cualquier empleo (o trabajo) que {usted/NAME} quizás tiene. ¿Por favor dígame en sus
propias palabras, ¿de qué trata la encuesta?
49
SECTION A: SCREENER
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “LISTS NONE”
A87 IS DELETED
LISTS NONE ....................................................
LISTS ONLY 1 TOPIC ......................................
LISTS ANY 2 TOPICS ......................................
LISTS 3 TOPICS ..............................................
REFUSED ........................................................
50
00
01
02 (A89)
03 (A89)
r SET A105 = 03 (A105)
SECTION A: SCREENER
(A86 = 00 OR 01)
A88.
INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. The survey asks about {NAME}’s health, daily activities, and any jobs {he/she} might have.
Please tell me in your own words what the survey is about.
Vamos a tratar otra vez. La encuesta pregunta acerca de {su/la} salud {de NAME}, de sus actividades
cotidianas o diarias, y cualquier empleo (o trabajo) que {usted/NAME} quizás tiene. ¿Por favor dígame en sus
propias palabras, ¿de qué trata la encuesta?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: health, my disability, health problems; daily
activities, things I do every day; jobs, whether I work or not
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE .................................................... 00 (A92)
LISTS ONLY 1 TOPIC ...................................... 01 (A92)
LISTS ANY 2 TOPICS ...................................... 02
LISTS 3 TOPICS .............................................. 03
REFUSED ........................................................ r SET A105 = 03 (A105)
(A86 = 02 OR 03) OR (A88 = 02 OR 03)
A89.
Here is the next explanation. Taking part in the survey is completely voluntary. Completely voluntary means
you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions
you do not like. You can also stop the interview at any time. Whether you choose to take part or not, {NAME’s}
disability benefits will not be affected in any way.
When I say your taking part is completely voluntary, what does that mean to you?
Esta es la siguiente explicación. Tomar parte en la encuesta es un acto completamente voluntario.
Completamente voluntario significa que usted puede escoger si quiere tomar parte o no tomar parte. Si usted
decide tomar parte, usted puede negarse a contestar cualquier pregunta que no le gusta, y puede poner un
alto a la entrevista en cualquier momento que usted quiere. Si usted escoge tomar parte o no, {sus/NAME}
beneficios por incapacidad no serán afectados en cualquier forma.
Cuando yo digo que tomar parte es completamente voluntario, ¿qué significa eso para usted?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part.
I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will
take away my benefits if I refuse, etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 (A90)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r SET A105 = 03 (A105)
(A89 = 02)
A89a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. Taking part in the survey is completely voluntary. Completely voluntary means you can
choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do
not like. You can also stop the interview at any time. Whether you choose to take part or not, {NAME’s}
disability benefits will not be affected in any way. When I say your taking part is completely voluntary, what
does that mean to you?
Esta es la siguiente explicación. Tomar parte en la encuesta es un acto completamente voluntario.
Completamente voluntario significa que usted puede escoger si quiere tomar parte o no tomar parte. Si usted
decide tomar parte, usted puede negarse a contestar cualquier pregunta que no le gusta, y puede poner un
alto a la entrevista en cualquier momento que usted quiere. Si usted escoge tomar parte o no, {sus/NAME}
51
SECTION A: SCREENER
beneficios por incapacidad no serán afectados en cualquier forma. Cuando yo digo que tomar parte es
completamente voluntario, ¿qué significa eso para usted?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part.
I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will
take away my benefits if I refuse, etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01
INACCURATE ANSWER ................................. 02 (A92)
REFUSED ........................................................ r SET A105 = 03 (A105)
52
SECTION A: SCREENER
(A89a = 01)
A90.
Here’s the last explanation. All your answers will be kept confidential and used only for the research purposes
of the study. When I say that your answers will be kept confidential, what does that mean to you?
Esta es la última explicación. . Todas sus respuestas serán confidenciales, y serán usadas solamente para
los propósitos de estudio. Cuando yo digo que sus respuestas serán confidenciales, ¿qué significa eso para
usted?
PROBE: IF RESPONDENT SAYS: It is confidential, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers
will see what I said. What I say will be (kept) private. It will only be used for research; etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 SET A110 = 02 (A110)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r SET A105 = 03 (A105)
(A90 = 02)
A90a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. All your answers will be kept confidential and used only for the research purposes of the
study.
Vamos a tratar eso otra vez. Todas sus respuestas serán confidenciales, y serán usadas solamente para los
propósitos de estudio.
When I say that your answers will be kept confidential, what does that mean to you?
Cuando yo digo que sus respuestas serán confidenciales, ¿qué significa eso para usted?
PROXY: IF RESPONDENT SAYS: It is confidential, PROBE: What does that mean?
¿Qué significa eso?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers
will see what I said. What I say will be (kept) private. It will only be used for research; etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 SET A110 = 02 (A110)
INACCURATE ANSWER ................................. 02 (A92)
REFUSED ........................................................ r SET A105 = 03 (A105)
A91 IS DELETED
(A88 = 00 OR 01) OR (A89a = 02) OR (A90a = 02)
A92.
Thanks for your patience. There seems to be a problem, and I need to check with my supervisor about what
to do next. My supervisor will get back to you.
Muchas gracias por su paciencia. Parece que hay un problema, y necesito hablar con mi supervisor(a) acerca
de qué hacer. Mi supervisor(a) se comunicará con usted.
PROXY FAILED COGNITIVE TEST................. 01 SET A106 = 04 (A106)
53
SECTION A: SCREENER
CALL BACK LATER TO SAME NUMBER
(INTERIM)
(A1 = 04) OR (A3 = 02) OR (A5 = 02) OR (A7a = 01) OR (A8 = 03) OR (A9=03) OR (A10 = 03) OR (A12 = 02) OR
(A14 = 04) OR (A17 = 01, 02, 03 OR 04) OR (A18=01 or 02 or 03) OR (A20 = 02; OR A27b = 01) OR (A28 =
ANSWER) OR (A47 = ANSWER) OR (A52 = 01) OR (A55 = 02) OR (A56 = 03) OR (A57 = 02) OR (A58 = 02) OR
(A81 = ANSWER) OR (A84 = 01) OR (A85 = 02)
A100.
(INTERNAL VARIABLE – NOT DISPLAYED FOR USER – SHOW FOR TESTING PURPOSES ONLY)
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.
START NEXT SCREENER AT…
{YOUR NAME} ...........................................................................
{PROXY NAME} .........................................................................
{INTERPRETER NAME} ...........................................................
{NAME} using TTY .....................................................................
{NAME} using Relay ...................................................................
{NAME} using a phone amplifier ................................................
{NEW PROXY NAME} AFTER FIRST PROXY FAILED
COGNITIVE TEST ..............................................................
{NAME} at {IF A1 = 07; OR A2 = 07; OR A4b = 07;
OR A13a = 08 FILL HOSPITAL NAME FROM A28/
IF A1 = 11; OR A2 = 11; OR A4b = 09; OR A13a = 07
FILL INSTITUTION NAME FROM A28 ...............................
IF A4a = 02 AND A6 = ANSWER {NEW INTERPRETER
NAME} ................................................................................
01
02
03
04
05
06
A0 = 01
A0 = 10
A0 = 14
A0 = 08
A0 = 07
A0 = 09
07 A0 = 10
08 A0 = 01
09 A0 = 15
PROGRAMMER: SEND TO CALLBACK SCREEN AND INTERVIEWER WILL SET CALL BACK STATUS THERE.
GO TO END
NEW PHONE NUMBER FOR NAME/PROXY/LEAD TO NAME/LEAD TO PROXY
(A36 = 01) OR (A38 = ANSWER) OR (A52 = 01) OR (A62 = 03, 05, OR 09) OR (A84 = 03, 05, OR 09)
A101. Thank you very much. We will be calling {NAME/PROXY/LEAD FROM BELOW} shortly.
Muchas gracias. Estaremos llamándole a {NAME/PROXY/LEAD FROM BELOW} dentro de poco.
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND 01 OR 02 VALUES BELOW. 03 SHOULD NOT BE
DISPLAYED.
START NEXT SCREENER AT…
{NAME} ...................................................................................... 01 A0 = 01
{PROXY} WHO LIVES ELSEWHERE ........................................ 02 A0 = 10
LEAD .......................................................................................... 03 SET A106 = 06
(A106)
54
SECTION A: SCREENER
A101a. PROGRAMMER: GO TO END.
SEND TO LOCATING: NAME OR PROXY (INTERIM)
(A1 = 14) OR (A2 = 14) OR (A4b = 11) OR (A24 = 00) OR (A36 = 00) OR (A37 = 00 OR d) OR (A52 = 00) OR (A56
= 07) OR (A62 = 01, OR 02) OR (A72 = 00) OR (A82 = 00) OR (A84 = 01, 02, 04, 05, 07, OR 08)
A102. Thank you very much. Goodbye.
Muchas gracias. Adiós.
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.
INTERVIEWER: PRESS 1 TO CONTINUE
START NEXT SCREENER AT…
{NAME}: NO SUCH PERSON HERE .....................
{NAME}: NEED PHONE NUMBER ONLY ..............
{NAME} NEED ALL CONTACT INFORMATION ....
{NAME} FAILED VERIFICATION – FIND NAME ...
{PROXY}: NO SUCH PERSON HERE ...................
{PROXY}: NEED PHONE NUMBER .....................
01
02
03
04
05
06
SET STATUS = 1530 (END) A0 = 01
SET STATUS = 1530 (END) A0 = 01
SET STATUS = 1530 (END) A0 = 01
SET STATUS = 1380 (END) A0 = 01
SET STATUS = 1380 (END) A0 = 13
SET STATUS = 1380 (END) A0 = 13
PROGRAMMER: FOR 05 – 06 SUPERVISOR WILL SET NEXT
STARTING QUESTION AND MAY OVERWRITE CODES
INELIGIBLE (INTERIM / POSSIBLE FINAL)
(A1 = 09, 12, OR 18) OR (A2 = 09, 12, OR 18) OR (A4b = 08,10, OR 14) OR (A13a = 06, 10 OR 11) OR (A26 = 01)
OR (A33 = 01)
A103. Thank you for explaining. That’s all the questions we have for you. Goodbye.
Gracias por la explicación. Esas son todas las preguntas que tenemos para usted. Adiós.
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.
NOTE:
PROGRAMMER, THESE CASES ARE INTERIM UNTIL AFTER SUPERVISOR REVIEW. THEY
WILL
NOT
CYCLE
THROUGH
THE
SCREENER
AGAIN
UNLESS
SUPERVISOR/PROGRAMMER RESETS CASE STATUS.
INTERVIEWER: PRESS ENTER TO CONTINUE
INCARCERATED ...................................................
IN ACTIVE MILITARY ............................................
LIVING OUTSIDE THE USA ..................................
01
02
03
SET STATUS = 1421 (END)
SET STATUS = 1422 (END)
SET STATUS = 1450 (END)
(A1=08) OR (A2=08) 0R (A4b=07) OR (A13a=09)
A103a. I am sorry to hear {NAME} has passed away. I was calling about a study we are conducting for the Social
Security Administration. You might have seen a letter Social Security sent [NAME} explaining the study. When
did {NAME} pass away?
Me apena oir que {NAME} falleció. Estaba llamando acerca de un estudio que estamos conduciendo para la
Social Security Administration (Administración del Seguro Social). Usted quizás vió la carta de Social Security
Administration (Administración del Seguro Social) que enviamos a {NAME} explicando acerca del estudio.
¿Cuándo falleció {NAME}?
|__|__| / |__|__| / |__|__|__|__|
MONTH DAY
YEAR
(1 – 12) (1 – 31) (2000 – 2023)
DON’T KNOW ........................................................
REFUSED ..............................................................
Thank you. Please accept my condolences. Goodbye.
55
d
r
SECTION A: SCREENER
Gracias. Por favor acepte mis condolencias. Adiós
PROGRAMMER: SET STATUS = 2440.
GO TO END
56
SECTION A: SCREENER
BARRIERS TO PARTICIPATION – (INTERIM NON-RESPONSE / POSSIBLE FINAL NON-RESPONSE)
(A1 = 17) OR (A2 = 17) OR (A4b = 13) OR (A46 = 05, 06, 07, 08, OR 09) OR (A56 = 06)
A104. Thank you very much for explaining. That’s all the questions I have. Thanks for your time. Goodbye.
Gracias por la explicación. Esas son todas las preguntas que tenemos para usted. Gracias por su tiempo.
Adiós
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.
PROGRAMMER, THESE CASES ARE INTERIM UNTIL AFTER SUPERVISOR REVIEW.
THEY WILL NOT CYCLE
THROUGH THE SCREENER AGAIN UNLESS SUPERVISOR/PROGRAMMER RESETS
CASE STATUS.
INTERVIEWER: PRESS ENTER TO CONTINUE
HOSPITALIZED ........................................
INSTITUTIONALIZED ...............................
COGNITIVE BARRIER ..............................
HEARING/SPEECH BARRIER .................
PHYSICAL BARRIER ................................
UNAVAILABLE DURING FP .....................
FINAL LANGUAGE BARRIER ..................
01
02
03
04
05
06
07
SET STATUS = 1420 (END)
SET STATUS = 1420 (END)
SET STATUS = 1412 (END)
SET STATUS = 1411 (END)
SET STATUS = 1410 (END)
SET STATUS = 1430 (END)
SET STATUS = 1400 (END)
REFUSALS (INTERIM / FINAL)
(IF ANY OF THE FOLLOWING QUESTIONS = r: A1, A2, A4b, A5, A8, A9, A10, A12, A13a, A14, A17, A18, A20,
A21, A22, A27b, A29, A30, A37, A40, A41, A43, A44, A45, A46, A48, A49, A50, A53, A56, A57, A58, A60, A61,
A66, A67, A67a, A68, A74, A76, A77, A78, A78a, A80, A85, A86, A88, A89, A89a, A90, A90a)
A105.
Thank you for your time. Goodbye.
Gracias por su tiempo. Adiós
PROGRAMMER:
GO TO REFUSAL SCREEN SO INTERVIEWER CAN RECORD REASON FOR
REFUSAL. WHILE THE CASE IS STILL IN INTERIM STATUS, THESE CASES WILL
BE SUBJECT TO CALL SCHEDULER RULES THAT WILL DETERMINE WHETHER
AND WHEN TO START THE NEXT SCREENER CALL (A0 – 01 OR A0 = 10) OR SET
AS 860 (END) (REVIEW NEEDED FOR FIELD BY SUPERVISOR , AKA HOLD FOR
CAPI)
START NEXT SCREENER AT:
{NAME} REFUSED.................................... 01
{UNKNOWN} REFUSED ........................... 02
{PROXY} REFUSED ................................. 03
SET STATUS = 1200 (REFUSAL SCREEN) A0 = 01
SET STATUS = 1220 (REFUSAL SCREEN) A0 = 01
SET STATUS = 1210 (REFUSAL SCREEN) A0 = 10
INTERVIEWER: PRESS ENTER TO RECORD REASONS FOR REFUSAL IN REFUSAL SCREEN.
SUPERVISOR REVIEW (INTERIM)
(A1 = 15) OR (A2 = 15) OR (A3 = 03 OR r) OR (A4 = r) OR (A4a = 03 OR r) OR (A4b = 03 OR 12) OR (A15 =
ANSWER) OR (A18 = 05 OR d) OR (A24 = r) OR (A26=r) OR (A28 = r) OR (A29 = r) OR (A47 = d OR r) OR (A50 =
2) OR (A51 = r) OR (A56 = 05 OR 08) OR (A60 = 00 OR d) OR (A80 = 04 OR d) OR (A101 = 03)
A106.
Thank you for your time. Goodbye.
Gracias por su tiempo. Adiós
INTERVIEWER: IF CASE NEEDS A SPANISH INTERVIEWER, PLEASE RECORD IN APPOINTMENT OR
EXIT, AS APPROPRIATE.
POSSIBLE LANGUAGE PROBLEM ................ 01 SET STATUS = 1380 (END)
CALL INFORMANT TO SET TTY/RELAY
CALL BACK TIME.................................... 02 SET STATUS = 1380 (END)
NEED TO LOCATE NEW PROXY ................... 03 SET STATUS = 1380 (END)
57
SECTION A: SCREENER
PROXY FAILED COGNITIVE TEST / NO
OTHER PROXY AVAILABLE................... 04 SET STATUS = 1380 (END)
OTHER SUPERVISOR REVIEW ..................... 05 SET STATUS = 1380 (END)
CALL LEAD FOR NAME/PROXY INFO ........... 06 SET STATUS = 1380 (END)
58
SECTION A: SCREENER
HOLD FOR CAPI (INTERIM - REQUIRES SUPERVISOR REVIEW)
(A29 = ANSWER) OR (A45 = 01,02, OR d)
A107. Thank you very much. Our field interviewer will call to arrange a time for the interview.
Muchas gracias. Nuestro entrevistador de campo llamará para organizar una hora para la entrevista.
PROGRAMMER: IN ADDITION TO THESE CASES BEING HELD FOR CAPI, REFUSALS AND
UNLOCATABLES WILL ALSO BE HELD FOR CAPI UNDER CERTAIN
CIRCUMSTANCES THAT THE SUPERVISORS WILL DECIDE. NOTE ALSO THAT ALL
CAPI CASES WILL START THE CAPI SCREENER AT A0 = 01.
INTERVIEWER:
PRESS 1TO CONTINUE
HOLD FOR CAPI..............................................
0 SET STATUS = 1860 (END) A0 = 01
RESPONDENT WILL CALL MPR (INTERIM)
(A10 = 02) OR (A17 = 05 OR 06)
A108. Thanks for offering to call in. Please write down our toll-free number. {IF (A10 = 02 OR A17 = 06) FILL 877293-5740. / IF (A17 = 05) FILL Call 877-293-5741 for a TTY interview.} [CONFIRM NUMBERS] We are
available days, evenings, and weekends. If you call after hours, please leave a message. We will get back to
you the next day.
Gracias por ofrecer a llamar. Por favor apunta nuestro número gratis. {IF (A10 = 02 OR A17 = 06) FILL 877293-5740. / IF (A17 = 05) FILL Llame al 877-293-5741 para una entrevista TTY.} [CONFIRM NUMBERS]
Estamos disponibles durante el día, en las noches, y en los fines de semana. Si llama fuera del horario laboral,
por favor deje un mensaje. Nos comunicaremos con usted al día siguiente.
INTERVIEWER: PRESS ENTER TO CONTINUE
{NAME} WILL CALL ......................................... 01 SET STATUS = 1830 (END) A0 = 02
{NAME} WILL CALL/TTY.................................. 02 SET STATUS = 1830 (END) A0 = 08
{NAME} WILL CALL/RELAY............................. 03 SET STATUS = 1830 (END) A0 = 07
REQUEST FOR LETTER (INTERIM)
(A22 = 01) OR (A25 = 00) OR (A26 = r) OR (A59 = 02)
A109. You should receive the letter from Social Security in about a week. Thank you for your time. Goodbye.
Usted debe de recibir la carta en una semana, más o menos. O, le puedo leer la carta ahora, y podemos
empezar la entrevista. Gracias por su tiempo. Adiós
INTERVIEWER: PRESS 1 TO CONTINUE
START NEXT SCREENER AT…
{NAME} REQUESTS LETTER ......................... 01 SET STATUS = 1831 (END) A0 = 04
PROXY REQUESTS LETTER ......................... 02 SET STATUS = 1831 (END) A0 = 11
CONTINUE WITH INTERVIEW
(A78a = 01) OR (A90a = 01)
A110. RESPONDENT CHECK SCREEN
INTERVIEWER: WE SHOW THE RESPONDENT IS
(IF A73 = 01, 02; OR A73 = 03 AND A78a = 01 FILL {NAME}
(IF A73 = 04 OR 05 AND A78a = 01; OR A90a = 01 FILL PROXY
INTERVIEWER: IS THIS INFORMATION CORRECT?
YES .................................................................. 01 (B1)
NO ................................................................. 00
(A110 = 00)
A110a. INTERVIEWER: WHO IS THE RESPONDENT?
SAMPLE MEMBER .......................................... 01 (B1)
PROXY ............................................................. 02
59
SECTION B: DISABILITY AND WORK STATUS
SECTION B: DISABILITY AND CURRENT WORK STATUS
DISABILITY STATUS
(All)
B1.
First, I have some questions about how {your/NAME’s} health affects {your/his/her} daily activities. Does a
physical or mental condition limit the kind or amount of work or other daily activities {you/NAME} can do?
Primero, tengo algunas preguntas acerca de como su salud afecta las actividades diarias de [usted/NAME].
¿Alguna condición física o mental limita el tipo o la cantidad de trabajo u otras actividades diarias que
[usted/NAME] puede hacer?
PROBE 1: In other words, are there things {you/NAME} can’t do as much or can’t do at all that people the
same age can?
En otras palabras, ¿hay cosas que {usted/NAME} no puede hacer, o que no puede hacer tanto
como gente de la misma edad puede hacer?
PROBE 2: Daily activities include cooking, shopping, getting around the home, paying bills, or working at a
job.
Actividades diarias incluyen cocinar, ir de compras, moverse dentro de su hogar, pagar cuentas,
o trabajar en un empleo (o trabajo).
YES ............................................................................................ 01
NO .............................................................................................. 00 (B5)
DON’T KNOW ............................................................................ d (B5)
REFUSED .................................................................................. r (B5)
(B1=01)
B2.
What physical or mental condition is the main reason {you are/NAME is} limited?
¿Qué condición física o mental es la razón principalE por la cual [usted/NAME] está (limitado/limitada)?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
¿Cuál es el NAME que los doctores llaman a la condición de salud que [usted/NAME] tiene?
PROBE 2: What causes this condition?
¿Qué es lo que causa esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (B2a)
r (B2a)
(B1=01)
B2a.
How much does this condition limit the kind or amount of work or other daily activities {you/NAME} can do?
Please provide a number from 0 to 100 to answer this. Where 0 is “not at all limiting” and 100 is “cannot do
work or daily activities at all.”
¿Cuánto limita esta condición el tipo o la cantidad de trabajo u otras actividades diarias que puede hacer
{usted/NAME}? Por favor deme un número de 0 a 100 para responder esto. Donde 0 “no limita nada” y 100
es “no puede hacer para nada trabajo ni actividades diarias”.
PROBE: If {your/NAME’s} condition varies, your best guess for a typical day is fine.
Si la condición de {usted/ NAME} varía, su mejor estimación para un día típico está bien.
|
|
|
|
NUMBER FROM 0 TO 100, 0=”NOT AT ALL LIMITING” AND
100=”CANNOT DO WORK OR DAILY ACTIVITIES AT ALL”
(B3)
MISSING .................................................................................... m (B3)
60
SECTION B: DISABILITY AND WORK STATUS
(B1=01)
B3.
{Do you/Does NAME} have any other physical or mental conditions that limit the kind or amount of work or
other daily activities {you/he/she} can do?
¿Tiene [usted/NAME] alguna otra condición física o mental que limita al tipo o la cantidad de trabajo u otras
actividades diariasque [usted/NAME] puede hacer?
PROBE 1: In other words, are there things {you/NAME} can’t do as much or can’t do at all that people the
same age can?
En otras palabras, ¿hay cosas que [usted/NAME] no puede hacer, o que no puede hacer tanto
como gente de la misma edad puede hacer?
PROBE 2: Daily activities include cooking, shopping, getting around the home, paying bills, or working at a
job.
Actividades diarias incluyen cocinar, ir de compras, moverse dentro de su hogar, pagar cuentas,
o trabajar en un empleo (o trabajo).
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)
61
SECTION B: DISABILITY AND WORK STATUS
(B1=01 and B3=01)
B4.
What are those conditions?
¿Cuáles son esas condiciones?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
Cuál es el NAME que los doctores llaman a la condición de salud que [usted/NAME] tiene?
PROBE 2: What causes this condition?
Qué es lo que causa esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
GO TO B18_age
(B1=00, d, r)
B5.
{Are you/Is NAME} currently receiving disability benefits from Social Security?
¿Actualmente recibe [usted/NAME] beneficios por incapacidad o disability benefits del Social Security/Seguro
Social?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B9)
DON’T KNOW ............................................................................ d (B9)
REFUSED .................................................................................. r (B9)
(B1=00, d, r and B5=01)
B6.
What physical or mental condition is the main reason {you are/NAME is} became eligible for disability benefits?
¿Qué condición física o mental es la razón principal por la cual [usted/NAME] es elegible para recibir
beneficios por incapacidad o disability benefits?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
¿Cuál es el NAME que los doctores llaman a la condición de salud que [usted/NAME] tiene?
PROBE 2: What causes this condition?
Qué es lo que causa esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B1=00, d, r and B5=01)
B7.
{Do you/Does NAME} have any other physical or mental conditions that made {you/him/her} eligible for
disability benefits?
¿Tiene [usted/NAME] alguna otra condición física o mental que [lo/la] hacen elegible para recibir beneficios
por incapacidad o disability benefits?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)
(B1=00, d, r and B5=01 and B7=01)
B8.
What are those conditions?
¿Cuáles son esas condiciones? ENTER VERBATIM RESPONSE
62
SECTION B: DISABILITY AND WORK STATUS
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
Cuál es el NAME que los doctores llaman a la condición de salud que [usted/NAME] tiene?
PROBE 2: What causes this condition?
¿Qué es lo que causa esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
GO TO B18_ age
63
d
r
SECTION B: DISABILITY AND WORK STATUS
(B1=00, d, r and B5=00, d, r)
B9.
{Have you/Has NAME} received disability benefits from Social Security at any time during the last five years?
¿Recibió [usted/NAME] beneficios por incapacidad o disability benefits del Social Security/Seguro Social en
cualquier momento durante los últimos cinco años?
YES ............................................................................................ 01 (B11)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B1=00, d, r and B5=00, d, r and B9=00, d, r)
B10.
We are only interviewing people who have received disability benefits in the past five years. I need to check
with my supervisor and get back to you. Thank you for your help.
Solamente estamos entrevistando a personas que recibieron beneficios por incapacidad en los últimos cinco
años. Necesito hablar con mi supervisor(a) y volver a llamarle. Le agradezco mucho por su ayuda.
PRESS 1 TO CONTINUE ........................................................... 01
END CALL. STATUS ”SUPERVISOR REVIEW 1380.”
(B1=00, d, r and B5=00, d, r and B9=01)
B11.
{Do you/Does NAME} still have the physical or mental conditions that made {you/him/her} eligible for Social
Security disability benefits?
¿ [usted/NAME] aún tiene (o sufre de) las condiciones físicas o mentales que [lo/la] hicieron elegible para
recibir beneficios por incapacidad del Seguro Social?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B15)
DON’T KNOW ............................................................................ d (B15)
REFUSED .................................................................................. r (B15)
(B1=00, d, r and B5=00, d, r and B9=01 and B11=01)
B12.
What physical or mental condition is the main reason {you were/NAME was} eligible for disability benefits?
¿Qué condición física o mental es la razón principalE por la cual [usted/NAME] era elegible para recibir
beneficios por incapacidad?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
Cuál es el NAME que los doctores llaman a la condición de salud que [usted/NAME] tiene?
PROBE 2: What causes this condition?
¿Qué es lo que causa esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B1=00, d, r and B5=00, d, r and B9=01 and B11=01)
B13.
{Do you/Does NAME} have any other physical or mental conditions that made {you/him/her} eligible for
disability benefits?
¿Tiene [usted/NAME] alguna otra condición física o mental que [lo/la] hizo elegible para recibir beneficios por
incapacidad?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)
64
SECTION B: DISABILITY AND WORK STATUS
65
SECTION B: DISABILITY AND WORK STATUS
(B1=00, d, r and B5=00, d, r and B9=01 and B11=01 and B13=01)
B14.
What are those conditions?
¿Cuáles son esas condiciones?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
Cuál es el NAME que los doctores llaman a la condición de salud que [usted/NAME] tiene?
PROBE 2: What causes this condition?
Qué es lo que causa esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
GO TO B18_age
(B1=00, d, r and B5=00, d, r and B9=01 and B11=00, d, r)
B15.
What physical or mental condition was the main reason {you were/NAME was} limited when {you/he/she} first
started getting disability benefits from Social Security?
¿Qué condición ficica o mental era la razón principal por la cual {usted/NAME} estaba limitada cuando empezó
a recibir beneficios por incapacidad?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name did doctors call {your/NAME’s} health condition?
¿Cuál es el nombre que los doctores llamaron a la condición de salud que {usted/NAME} tenía?
PROBE 2: What caused this condition?
¿Qué causó esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B1=00, d, r and B5=00, d, r and B9=01 and B11=00, d, r)
B16.
Did {you/NAME} have any other physical or mental conditions that limited the kind or amount of work or other
daily activities {you/he/she} could do when {you/he/she} first started getting disability benefits?
¿Tenía [usted/NAME] alguna otra condición física o mental que limitaba el tipo o la cantidad de trabajo u otras
actividades diarias que [usted/él/ella] podía hacer cuando empezó a recibir beneficios por incapacidad?
PROBE:
Daily activities include cooking, shopping, getting around the home, or paying bills.
Actividades diarias incluyen cocinar, hacer compras, desplazarse dentro de la casa, o pagar las
cuentas.
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)
(B1=00, d, r and B5=00, d, r and B9=01 and B11=00, d, r and B16=01)
B17.
What were those conditions?
¿Cuáles condiciones eran esas?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name did doctors call {your/NAME’s} health condition?
66
SECTION B: DISABILITY AND WORK STATUS
Cuál es el NAME que los doctores llamaron a la condición de salud que [usted/NAME] tenía?
PROBE 2: What caused this condition?
¿Qué causó esta condición?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
67
d
r
SECTION B: DISABILITY AND WORK STATUS
(All)
B18_age. How old {were you/was NAME} when {you/he/she} first became limited in the kind or amount of work or
other daily activities {you/he/she} could do? Your best estimate is fine.
¿Cuántos años tenía [usted/NAME] cuando por primera vez estaba limitad[o/a] en el tipo o la cantidad de
trabajo u otras actividades diarias que [usted/él/ella] podía hacer? La mejor estimación que me puede dar
está bien.
INTERVIEWER: IF AGE IS NOT KNOWN, ENTER ‘99’ TO PROBE FOR A YEAR.
INTERVIEWER: IF LESS THAN ONE YEAR OR SINCE BIRTH, ENTER ‘0’ IN AGE.
|
|
| (B20 IF AGE 0-67)
AGE
(0-67) (or ‘99’ to probe for year)
SINCE BIRTH ............................................................................. 00 (B20)
DON’T KNOW ............................................................................ d (B19)
REFUSED .................................................................................. r (B19)
PROGRAMMER: SET 99 (AGE NOT KNOWN) TO MISSING (.M) IN DATA
(B18_age=99)
B18_year.
PROBE: READ IF NECESSARY: In what year?
¿En qué año?
| | | | |
YEAR
(1956-2023) (B20)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B18_age=d, r) or (B18_age=99 and B18_year=d, r)
B19.
Did {you/NAME} become limited before the age of 18 or after age 18?
¿Empezó [usted/NAME] a estar limitad[o/a] antes de cumplir los 18 (dieciocho) años, o después de ya tener
18 años de edad?
PROBE:
Your best guess is fine.
La mejor estimación que me puede dar está bien.
LESS THAN 18 .......................................................................... 01
18 OR OLDER ........................................................................... 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
PROGRAMMER: CALCULATE AGE OF ONSET BASED ON B18_AGE AND B18_YEAR:
If B18_age=0-64, then B18_age_calc=B18_age. Else if B18_age=99 and B18_yr ≠ d or r and B18_year=A68b,
B18_age_calc=0. Else if B18_age=99 and B18_yr ≠ d or r and B18_year ≠ A68b, B18_age_calc= B18yr - A68b. Else,
if B18_age=99 and B18_yr=d or r, B18_age_calc= B18_yr. Else, if B18_age=d or r, B18_age_calc=B18_age.
B20.
SOFT EDIT: B18_age_calc SHOULD NOT EXCEED CURRENT AGE. IF B18_age_calc>CURRENTAGE_
TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER: AGE OF DISABILITY ONSET IS
GREATER THAN CURRENT AGE. CHECK ENTRY. IF NECESSARY READ: I must have recorded an
incorrect answer. I show that {you are/NAME is} now (CURRENTAGE), and {you/he/she} became limited
when {you were/(he/she) was} (B18_age_calc). Should I change {your/NAME’s} the age when {you/NAME}
first became limited?
68
SECTION B: DISABILITY AND WORK STATUS
Debo haber anotado una respuesta incorrecta. Anoté que {usted/NAME} tiene (CURRENTAGE) ahora, y
{usted/él/ella} se convirtió incapacitado(a) cuando tenía (B18_age_calc). ¿Debo cambiar {su edad/la edad de
{NAME}} cuando se convirtió incapacitado(a) por primera vez?
CHANGE AGE WHEN FIRST BECAME LIMITED ..................... 01
(CHANGE B18_age) SUPPRESS .............................................. 02
B21.
CHECK: HAS {NAME} BEEN LIMITED SINCE ADULTHOOD (B18_age_calc NE D OR R, AND
B18_age_calcIS > OR = 18) OR (IF B18_age_calc=D OR R and B19=02)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B24)
(B21=01)
B22.
{Were you/Was NAME} working at a job for pay or profit before {you/he/she} started receiving disability
benefits?
¿Estaba {usted/NAME} trabajando en un empleo (o trabajo) por pago cuando por primera vez que comenzó
a recibir beneficios por incapacidad?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B24)
DON’T KNOW ............................................................................ d (B24)
REFUSED .................................................................................. r (B24)
(B22=01)
BP1.
{Are you/Is NAME} now able to do the same kind of work {you/he/she} did before {you/he/she} started
receiving Social Security disability benefits? (NSHA WS-56 modified)
¿ Es {NAME} ahora capaz de hacer el mismo tipo de trabajo {usted / él / ella} –hacia antes que {usted / él /
ella} comenzó a recibir beneficios por discapacidad del Seguro Social?
PROBE: {Are you/Is NAME} able to do the same type of job activities {you were/he was/she was} doing
before?
¿Está usted / es NAME} capaces de hacer el mismo tipo de actividades de trabajo que {estabas /
estaba} haciendo antes?
YES ............................................................................................ 01 (B24)
NO .............................................................................................. 00 (BP1b)
DON’T KNOW ............................................................................ d (B24)
REFUSED .................................................................................. r (B24)
(BP1=00)
BP1b. Why {are you/is NAME} no longer able to do the kind of work {you/he/she} did before {you/he/she} started
receiving Social Security disability benefits?
¿Por que {usted/ NAME} ya no es capaz de hacer el tipo de trabajo que hacia antes de comencar a recibir
beneficios por discapacidad del Seguro Social?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿Alguna otra cosa?
HEALTH CONDITION DOES NOT ALLOW JOB PERFORMANCE...........
LACKS THE PHYSICAL ENERGY, STRENGTH OR
STAMINA REQUIRED ................................................................................
69
01 (B23)
02 (B23)
SECTION B: DISABILITY AND WORK STATUS
PAIN INTERFERES WITH A JOB OR WORK SCHEDULE .......................
JOB IS TOO STRESSFUL .........................................................................
MEDICAL AND THERAPY APPOINTMENTS INTERFERE WITH
A REGULAR WORK SCHEDULE ..............................................................
THE TIME NEEDED FOR PERSONAL CARE AND MAINTAINING
HEALTH IS TOO SUBSTANTIAL/INTERFERES WITH A REGULAR
WORK SCHEDULE ....................................................................................
HEALTH GOES UP AND DOWN IN UNPREDICTABLE WAYS ................
UNABLE TO GET THE MEDICAL TREATMENT NEEDED TO
IMPROVE YOUR HEALTH ENOUGH TO GO TO WORK .........................
UNABLE TO GET MEDICAL DEVICE NEEDED TO WORK ......................
OTHER (SPECIFY) ....................................................................................
(BP1b=10)
BP1b_oth.
03 (B23)
04 (B23)
05 (B23)
06 (B23)
07 (B23)
08 (B23)
09 (B23)
10 (BP1B_oth)
What other reason?
¿Por qué otra razón?
__________________________________________
DON’T KNOW ............................................................................
REFUSED ..................................................................................
70
(B23)
d (B23)
r (B23)
SECTION B: DISABILITY AND WORK STATUS
(B21=01 and B22=01)
B23.
Did the job {you/NAME} had before {you/he/she} started receiving Social Security disability require
{you/him/her} to use a computer?
El trabajo que {usted / NAME} tenía antes que comenzó a recibir beneficios de Seguro Social le requiere
utilizar una computadora?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
CURRENT WORK STATUS
(All)
IF SampGrp = 02 AND A73a = 01, FILL: “Earlier you mentioned {you were/NAME was} currently working at a
job or business for pay or profit. I just want to confirm.”
IF SampGrp = 02 AND A73a = 00, d, OR r, FILL: “Earlier you mentioned {you were/NAME was} not currently
working at a job or business for pay or profit. I just want to confirm.”
B24.
These next questions are about {your/NAME’s} personal goals and {your/his/her} current work-related
activities. {Earlier you mentioned {you were/NAME was} {not} currently working at a job or business for pay or
profit. I just want to confirm.} {Are you/Is NAME} currently working at a job or business for pay or profit?
Estas próximas preguntas son acerca de [las/sus] metas personales [de NAME] y de sus actividades actuales
relacionadas al trabajo. Antes usted mencionó que {usted/NAME} {no} está trabajando actualmente en un
empleo o negocio por pago o para tener ganancais. Solo quiero confirmar. ¿Trabaja [usted/NAME]
actualmente en un empleo o negocio por pago o para tener ganancias?
PROBE: We are interested in both full-time and part-time work for pay or profit
Estamos interesados en trabajo a tiempo completo o a tiempo parcial
YES ............................................................................................ 01 (B30)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B24 = 0, d, r)
IF SampGrp = 02 AND A73b = 01, FILL: “Earlier you mentioned {you have/NAME has} worked for pay or profit during
the last 6 months. I just want to confirm.”
B24b.
{Earlier you mentioned {you have/NAME has} worked for pay or profit during the last 6 months. I just want to
confirm.} Did {you/NAME} work for pay or profit at any time during the last 6 months?
Antes usted mencionó que {usted/NAME} ha trabajado por pago o para tener ganancias durante los últimos
6 meses. Solo quiero confirmar. ¿Hizo {usted / NAME} trabajo por pago o para tener ganancias en cualquier
momento durante los últimos 6 meses?
PROBE: We are interested in both full-time and part-time work for pay or profit.
Estamos interesados en trabajo a tiempo completo o a tiempo parcial
YES ............................................................................................ 01 (B28)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B24=00, d, or r and B24b=00, d, or r and SampGrp=02)
B24c. I’m sorry, we are only interviewing people who are working now or worked in the past 6 months. Thank you
for your help.
Lo siento, sólo estamos entrevistando a personas que están trabajando ahora o trabajaron en los últimos 6
meses. Gracias por su ayuda.
71
SECTION B: DISABILITY AND WORK STATUS
PRESS 1 TO CONTINUE ........................................................... 01
END CALL. STATUS ”INELIGIBLE”: 2460
B25. ITEM MOVED TO FOLLOW B29_10_Other
B26. ITEM MOVED TO FOLLOW B25
B27. ITEM MOVED TO FOLLOW B26
72
SECTION B: DISABILITY AND WORK STATUS
(B24=00, d, r or B24b=01, 00, d, or r)
B28.
{Have you/Has NAME} been looking for paid work during the last four weeks?
¿ [Usted/NAME] ha estado buscando trabajo durante las últimas cuatro semanas?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B25, new position)
DON’T KNOW ............................................................................ d (B25, new position)
REFUSED .................................................................................. r (B25, new position)
(B28=01)
B28a. Are {you/NAME} looking for part-time or full-time work?
¿Está [usted/NAME] buscando trabajo a tiempo completo o a tiempo parcial?
FULL-TIME ................................................................................. 01 (B29)
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d (B29)
REFUSED .................................................................................. r (B29)
(B28=01 and B28a=2)
B28b. About how many hours per week would {you/NAME} like to work?
¿Más o menos cuántas horas por semana quisiera [usted/NAME] trabajar?
| | |
HOURS
(1-60)
(1-168)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
73
d
r
SECTION B: DISABILITY AND WORK STATUS
(B28=01)
B29.
Next, I am going to read you a list of things that some people do to look for work. Please tell me whether or
not {you/NAME} did any of these things during the last four weeks. To look for work in the last four weeks did
{you/NAME}:
YES
NO
DON’T
KNOW
REFUSED
a.
Contact {your/NAME’S} state’s unemployment office?
01
00
d
r
b.
Ask friends or relatives?
01
00
d
r
c.
Look through job advertisements in a newspaper or on the
Internet?
01
00
d
r
d.
Contact the State Vocational Rehabilitation Agency or
{VRNAME FROM {NAME’S} CURRENT STATE}?
01
00
d
r
e.
Contact a local independent living center?
01
00
d
r
f.
Contact a private employment agency or program?
01
00
d
r
01
00
d
r
f1. Contact a former employer in person, by mail or email, or by
phone?
g.
Contact any other employers in person, by mail or email, or
by phone?
01
00
d
r
h.
Do anything else that I didn’t mention?
01
00
d
r
PROGRAMMER: IF B29h=01, GO TO B29h_other. OTHERWISE, GO TO B29_1a.
Ahora le voy a leer una lista de cosas que algunas personas hacen para buscar trabajo. Por favor dígame si
[usted/NAME] hizo alguna de estas cosas durante las últimas cuatro semanas. Para buscar trabajo en las
últimas cuatro semanas, …
a. ¿contactó [usted/NAME] a la oficina de desempleo o
unemployment office de su estado?
b. ¿preguntó
[usted/NAME]
parientes/familiares?
a
amistades
o
c. ¿miró [usted/NAME] en los anuncios de trabajo o
empleo en un periódico o en el Internet?
d. ¿contactó [usted/NAME] a la Agencia Estatal de
Rehabilitación Vocacional (Vocational Rehabilitation
Agency) o SampleInfo.VRName?
e.
¿contactó [usted/NAME] a un Centro de Vida
Independiente (Independent Living Center) local?
f.
¿contactó [usted/NAME] a una agencia privada de
empleo (private employment agency) o a un programa
de empleo?
f1. Contactar a un empleador previo en persona, por
correo o correo electrónico, o por teléfono?
g. Contactar a cualquier otro empleador en persona, por
correo o correo electrónico, o por teléfono?
h. ¿hizo [usted/NAME] alguna otra cosa que no he
mencionado?
74
YES
NO
DON’T KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
SECTION B: DISABILITY AND WORK STATUS
(B28=01 and B29_h=01)
B29h_Other. What was it?
¿Qué es lo que hizo?
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B28=01)
B29_1a.
d
r
{Have/Has} {you/NAME} received any job offers within the past four weeks?
¿Recibió [usted/NAME] alguna oferta de empleo o trabajo en las últimas cuatro semanas?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B29_7)
DON’T KNOW ............................................................................ d (B25, new position)
REFUSED .................................................................................. r (B25, new position)
(B29_1a=01)
B29_1b.
Did {you/NAME} turn any of these job offers down?
¿Rechazó o no aceptó [usted/NAME] cualquiera de estas ofertas de empleo o trabajo?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B30)
DON’T KNOW ............................................................................ d (B25, new position)
REFUSED .................................................................................. r (B25, new position)
75
SECTION B: DISABILITY AND WORK STATUS
(B29_1a=01 and B29_1b=01)
B29_2. Now, I am going to read you a list of reasons why people sometimes do not accept a job offer. Please tell me
if any of these are reasons why {you/NAME} did not accept a job that {you/he/she} {were/was} offered in the
past four weeks.
YES
NO
DON’T
KNOW
REFUSED
{You/NAME} would have needed special equipment or
medical devices that {you do / he does /s he does} not
currently have in order to do the work
01
00
d
r
[You/NAME} did not have the personal assistance
[you/he/she] needed to get ready for work each day
(EXAMPLE IF NEEDED: This includes things like dressing
and bathing)
01
00
d
r
c.
{You/NAME} could not get the help that {you/he/she] needed
caring for children or others
01
00
d
r
d.
{You/NAME} did not have reliable transportation to and from
the job
01
00
d
r
e.
The job did not offer a flexible enough schedule
01
00
d
r
f.
Job did not pay enough.
01
00
d
r
g.
The job did not offer health insurance benefits
01
00
d
r
h.
{You/NAME} would have lost benefits (you need / he needs /
she needs) like Social Security, disability insurance, workers’
compensation, or Medicaid, if [you/he/she] accepted the job
01
00
d
r
Is there anything else that I did not mention that made
{you/NAME} turn down a recent job offer
01
00
d
r
a.
b.
i.
Ahora le voy a leer una lista de razones por las cuales a veces alguien no acepta una oferta de empleo o
trabajo. Por favor dígame si alguna de estas es una razón por la cual [usted/NAME] no aceptó un empleo o
trabajo que le fue ofrecido en las últimas cuatro semanas.
a.
YES
NO
DON’T
KNOW
REFUSED
01
00
d
r
[Usted/NAME] no tenía la asistencia o ayuda personal que
[usted/él/ella] necesitaba para prepararse para el trabajo todos los
días. (EJEMPLO, SI ES NECESARIO: Esto incluye cosas tales
como ayuda para vestirse y bañarse).
01
00
d
r
[usted/NAME] no aceptó un empleo o trabajo que le fue ofrecido
en las últimas cuatro semanas. [Usted/NAME] no podía
conseguir la ayuda que [usted/él/ella] necesitaba para cuidar a
niños o a otras personas.
01
00
d
r
[Usted/NAME] hubiera necesitado equipo especial o aparatos
médicos que [usted/él/ella] actualmente no tiene para poder hacer
el trabajo.
b.
c.
76
SECTION B: DISABILITY AND WORK STATUS
d.
[usted/NAME] no aceptó un empleo o trabajo que le fue ofrecido
en las últimas cuatro semanas. [Usted/NAME] no tenía
transporte en el que podía confiar, para ir y regresar del trabajo.
01
00
d
r
e.
[usted/NAME] no aceptó un empleo o trabajo que le fue ofrecido
en las últimas cuatro semanas. El empleo o trabajo no ofrecía un
horario con suficiente flexibilidad.
01
00
d
r
f.
[usted/NAME] no aceptó un empleo o trabajo que le fue ofrecido
en las últimas cuatro semanas. El trabajo no pagaba suficiente.
01
00
d
r
g.
[usted/NAME] no aceptó un empleo o trabajo que le fue ofrecido
en las últimas cuatro semanas. El empleo no ofrecía beneficios
de seguro de salud o seguro médico.
01
00
d
r
h.
[usted/NAME] no aceptó un empleo o trabajo que le fue ofrecido en
las últimas cuatro semanas.
[Usted/NAME] hubiera perdido
beneficios que [usted/él/ella] necesita, tal como Social Security o
Seguro Social, seguro por incapacidad, compensación de
trabajadores o Medicaid, si [usted/él/ella] aceptaría el empleo o
trabajo.
01
00
d
r
[usted/NAME] no aceptó un empleo o trabajo que le fue ofrecido en
las últimas cuatro semanas. ¿Hay alguna otra cosa que no he
mencionado, por la cual [usted/NAME] rechazó una reciente oferta
de empleo o trabajo?
01
00
d
r
i.
(B29_2_i=01)
B29_2_i_Oth. What other reasons?
¿Qué otras razones?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B29_1a=01 and B29_1b=01)
B29_2CHECK.CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (B29_5CHECK)
NO .............................................................................................. 00
(B29_1a=01 and B29_1b=01 AND RTYPE=01)
B29_3CHECK: IS PAY A REASON RESPONDENT DID NOT ACCEPT JOB (B29_2f=01)?
YES ............................................................................................ 01 (B29_3a)
NO .............................................................................................. 00 (B29_3b)
77
SECTION B: DISABILITY AND WORK STATUS
(B29_2f=01 AND RTYPE=01)
B29_3a. You said that one of the reasons you did not accept a job you were offered was because it did not pay enough.
What is the lowest wage or salary you would have accepted for this job?
Usted dijo que una de las razones por la cual no aceptó un empleo que le ofrecieron era porque no pagaba
suficiente. ¿Cuál es el más bajo sueldo o salario que usted hubiera aceptado para este empleo?
INTERVIEWER: Read only if necessary, otherwise code:
$|
|
|
|,|
|
|
|.|
|
|
DON’T KNOW .........................................
REFUSED ...............................................
B29_3ahop.
d
r
(B29_5CHECK)
(B29_5CHECK)
Is this:
Es esto
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY (EVERY TWO WEEKS) ......
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................
DON’T KNOW .........................................
REFUSED ...............................................
01
02
03
04
05
06
07
d
r
(1-25)
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(B29_4a)
(B29_4a)
(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)
(B29_5CHECK)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_2f=00, d, OR r AND RTYPE=01)
B29_3b. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary you
would be willing to accept for such a job?
Si usted recibiera una oferta de empleo que corresponde a sus necesidades y habilidades corrientes, ¿cuál
es el sueldo o salario más bajo que usted aceptaría para tal empleo?
INTERVIEWER: If they hesitate or seem to be having difficulty, add: If you have no idea, just say so.
IF THEY HESITATE OR SEEM TO BE HAVING DIFFICULTY, ADD: Si usted no tiene idea, diga.
INTERVIEWER: Read only if necessary, otherwise code:
$|
|
|
|,|
|
|
|.|
|
DON’T KNOW .........................................
REFUSED ...............................................
B29_3bhop
|
d
r
(Skip to B29_5CHECK)
(Skip to B29_5CHECK)
Is this:
Es esto:
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY (EVERY TWO WEEKS) ......
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................
DON’T KNOW .........................................
REFUSED ...............................................
78
01
02
03
04
05
06
07
d
r
(1-25)
(1-384
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(B29_4a)
(B29_4a)
(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)
(B29_5CHECK)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
SECTION B: DISABILITY AND WORK STATUS
PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_3ahop or B29_3bhop OUT OF RANGE
B29_3check:
Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary
you would have accepted for this job is [insert ((B29_3a and B29_3ahop) OR (B29_3b and
B29_3hop)). Is this correct?”
Permítame verificar que no cometí ningún error. Usted acaba de indicar que el salario o sueldo que
hubiera aceptado en este trabajo es [insert ((B29_3a and B29_3ahop) O B29_3b and B29_3hop)).
¿Es eso correcto?
CHANGE LOWEST WAGE OR SALARY ................................... 01 (CHANGE B29_3a
OR B29_3b)
CHANGE PAY PERIOD ............................................................. 02 (CHANGE B29_3ahop
OR B29_3bhop)
SUPPRESS ................................................................................ 03
(B29_3ahop=02, 03, 04, 05, 06, 07, d or r) or (B29_3bhop=02, 03, 04, 05, 06, 07, d, or r)
B29_4a.
How many hours per week would you expect to work for this amount of pay?
¿Cuántas horas por semana piensa usted que trabajaría para esta suma en pago?
| | |
HOURS
(1-99)
(Skip to B29_5CHECK)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B29_4a=d or r)
B29_4b.
Would you expect to work full-time or part-time?
d (B29_4b)
r (B29_4b)
¿Piensa usted que trabajaría a tiempo completo o a tiempo parcial?
FULL-TIME ................................................................................. 01
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
79
SECTION B: DISABILITY AND WORK STATUS
(B29_1a=00)
B29_7. Now, I am going to read you a list of reasons why people are sometimes unable to find a job. Please tell me
if any of these are reasons why {you/NAME} {have/has} not found a job that {you/he/she} {think/thinks} is right
for {you/him/her}.
YES
NO
DON’T
KNOW
REFUSED
01
00
d
r
(Example if needed: This includes things like dressing and
bathing)
01
00
d
r
c.
{You/NAME} cannot get the help that {you need/ he needs/
she needs] caring for children or others
01
00
d
r
d.
{You/NAME] [do/does] not have reliable transportation to and
from work
01
00
d
r
e.
The jobs that are available do not offer a flexible enough
schedule.
01
00
d
r
f.
{You/NAME} cannot find a job {you are/he is/she is} qualified
for.
01
00
d
r
g.
The jobs that are available do not pay enough
01
00
d
r
h.
Employers will not give {you/NAME} a chance to show that
{you/he/she} can work.
01
00
d
r
i.
The jobs that are available do not offer health insurance
benefits.
01
00
d
r
j.
{You/NAME} would lose benefits (you need / he needs / she
needs) like Social Security, disability insurance, workers’
compensation, or Medicaid if {you/he/she} took a job
01
00
d
r
Is there anything else that I did not mention that is a reason
why (you/Name) (have/has) not been able to find a job?
01
00
d
r
a.
b.
k.
{You/NAME} would need special equipment or medical
devices to work which {you do /he does /she does} not
currently have
[You/NAME} [do/does] not have the personal assistance
[you/he/she] [need/needs] to get ready for work each day
Ahora le voy a leer una lista de razones por las cuales a veces alguien no puede encontrar empleo o trabajo.
Por favor dígame si alguna de estas es una razón por la cual [usted/NAME] no encontró un empleo o trabajo
que [usted/él/ella] piensa es adecuado para [usted/él/ella].
YES
NO
DON’T
KNOW
REFUSED
a.
[Usted/NAME] necesitaría equipo especial o aparatos
médicos que [usted/él/ella] actualmente no tiene.
01
00
d
r
b.
[Usted/NAME] no tiene la asistencia o ayuda personal que
[usted/él/ella] necesita para prepararse para el trabajo todos
los días. Esto incluye cosas tales como ayuda para vestirse y
bañarse.
01
00
d
r
c.
[Usted/NAME] no puede conseguir la ayuda que
[usted/él/ella] necesita para cuidar a niños o a otras
personas.
01
00
d
r
d.
[Usted/NAME] no tiene transporte en el que podía confiar,
para ir y regresar del trabajo.
01
00
d
r
80
SECTION B: DISABILITY AND WORK STATUS
e.
Los empleos o trabajos que hay no ofrecen un horario con
suficiente flexibilidad.
01
00
d
r
f.
[Usted/NAME] no puede encontrar un empleo o trabajo para
el cual [usted/él/ella] está calificad[o/a].
01
00
d
r
g.
Los empleos o trabajos que hay no pagan suficiente.
01
00
d
r
h.
Empleadores no le dan a [usted/NAME] una oportunidad para
demostrar que [usted/él/ella] puede trabajar.
01
00
d
r
i.
Los empleos o trabajos que hay no ofrecen beneficios de
seguro de salud o seguro médico.
01
00
d
r
j.
[Usted/NAME] perdiría beneficios que [usted/él/ella] necesita,
tal como Social Security o Seguro Social, seguro por
incapacidad, compensación de trabajadores o Medicaid, si
[usted/él/ella] aceptaría un empleo o trabajo.
01
00
d
r
¿Hay alguna otra cosa que no he mencionado, por la cual
[usted/NAME] no ha podido encontrar un empleo o trabajo?
01
00
d
r
k.
(B29_7_k=01)
B29_7_k_Oth. What other reasons?
¿Qué otras razones?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B29_1a=00)
B29_7CHECK.
d
r
CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (B29_9CHECK)
NO .............................................................................................. 00
(B29_1a=00 AND RTYPE=01)
B29_8CHECK: IS PAY A REASON RESPONDENT DID NOT ACCEPT JOB (B29_7g=1)?
YES ............................................................................................ 01 (B29_8a)
NO .............................................................................................. 00 (B29_8b)
81
SECTION B: DISABILITY AND WORK STATUS
(B29_7g=01 AND RTYPE=01)
B29_8a. You said that one of the reasons you are unable to find a job is that the jobs that are available do not pay
enough. What is the lowest wage or salary you would accept for a job that matched your current needs
and abilities?
Usted dijo que una de las razones por la cual usted no puede encontra un empleo o trabajo, es porque los
trabajos que hay no pagan suficiente. ¿Cuál es el más bajo sueldo o salario que usted aceptaría para un
empleo que corresponde a sus necesidades y habilidades corrientes?
INTERVIEWER: Read only if necessary, otherwise code:
$|
|
|
|,|
|
|
|.|
|
|
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (B29_9CHECK)
r (B29_9CHECK)
B29_8ahop. Is this:
¿Es esto . . .
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY (EVERY TWO WEEKS) ......
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................
01
02
03
04
05
06
07
(1-25)
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B29_9CHECK)
(B29_8c)
(B29_8c)
(B29_8c)
(B29_8c)
(B29_8c)
(B29_8c)
d (B29_8c)
r (B29_8c)
(B29_7g=00, d, OR r AND RTYPE=01)
B29_8b. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary
you would be willing to accept for such a job?
Si usted recibiera una oferta de empleo que corresponde a sus necesidades y habilidades corrientes, ¿cuál
es el sueldo o salario más bajo que usted aceptaría para tal empleo?
INTERVIEWER: IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: If you have no idea, just
say so.
IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: Si usted no tiene idea, diga.
IF R SAYS HAS NO INTEREST IN WORKING, CODE AS DON’T KNOW.
INTERVIEWER: Read only if necessary, otherwise code:
$|
|
|
|,|
|
|
|.|
|
|
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (B29_9CHECK)
r (B29_9CHECK)
B29_8bhop. Is this:
¿Es esto . . .
HOURLY ................................................. 01 (1-25)
(1-300)
(B29_9CHECK)
DAILY ...................................................... 02 (1-384)
(1-1,922)
(B29_8c)
WEEKLY ................................................. 03 (1-1,923)
(1-9,615)
(B29_8c)
BI-WEEKLY (EVERY TWO WEEKS) ...... 04 (1-4,166)
(1-20,833)
(B29_8c)
TWICE A MONTH ................................... 05 (1-4,166)
(1-20,833)
(B29_8c)
MONTHLY ............................................... 06 (1-8,333)
(1-41,666)
(B29_8c)
ANNUALLY.............................................. 07 (1-100,000) (1-500,000) (B29_8c)
DON’T KNOW ............................................................................ d (B29_8c)
REFUSED .................................................................................. r (B29_8c)
82
SECTION B: DISABILITY AND WORK STATUS
PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_8ahop or B29_8bhop) OUT OF RANGE
B29_8check: Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary you
would have accepted for this job is [insert ((B29_8a and B29_8ahop) OR (B29_8b and
B29_8hop)). Is this correct?”
Permítame verificar que no cometí ningún error. Usted acaba de indicar que el salario o sueldo
que hubiera aceptado en este trabajo es [insert ((B29_8a and B29_8ahop) O B29_8b and
B29_8hop)). ¿Es eso correcto?
CHANGE LOWEST WAGE OR SALARY ................................... 01 (CHANGE B29_8a
OR B29_8b)
CHANGE PAY PERIOD ............................................................. 02 (CHANGE B29_8ahop
OR B29_8bhop)
SUPPRESS ................................................................................ 03
(B29_8ahop=02, 03, 04, 05, 06, 07, d, or r) or (B29_8bhop=02, 03, 04, 05, 06, 07, d, or r)
B29_8c. How many hours per week would you expect to work for this amount of pay?
¿Cuántas horas por semana piensa usted que trabajaría para esta suma en pago?
|
| |
HOURS
(1-99)
(Skip TO B29_9CHECK)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (B29_8d)
r (B29_8d)
(B29_8c=d or r)
B29_8d. Would you expect to work full-time or part-time?
¿Piensa usted que trabajaría a tiempo completo o a tiempo parcial?
FULL-TIME ................................................................................. 01
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B29_1a=00)
B29_9CHECK.
IS LOSING BENEFITS REASON DID NOT ACCEPT JOB (B29_7=j)?
YES ............................................................................................ 01 (B29_9)
NO .............................................................................................. 00 (B30)
(B29_7j=01)
B29_9. You said that one of the reasons {you/NAME} {have/has} not been able to find a job is because {you/he/she}
would lose benefits (you need / he needs / she needs) such as Social Security, disability insurance, workers’
compensation, or Medicaid if {you/he/she} did get a job. There are many ways people find out about how
working will affect their benefits. For example, some people call the Social Security office, some search the
Internet, and others contact disability service organizations. {Have/Has} {you/NAME} contacted anyone or
done any of these things in order to find out how {your/his/her} benefits will be affected if {you/he/she} did go
to work?
Usted dijo que una de las razones por la cual [usted/NAME] no ha podido encontrar un empleo o trabajo era
porque [usted/él/ella] perdería beneficios que [usted/él/ella] necesita, tal como Social Security o Seguro
Social, seguro por incapacidad, compensación de trabajadores o Medicaid, si [usted/él/ella] encontraría un
empleo o trabajo. Hay muchas formas en las cuales se puede averiguar cómo trabajar puede afectar a sus
beneficios. Por ejemplo, hay gente que llama a la oficina del Social Security o Seguro Social, algunos buscan
en el Internet, y otros se comunican con organizaciones de servicio a incapacitados. ¿Se comunicó
[usted/NAME] con alguien, o hizo alguna de estas cosas para averiguar cómo sus beneficios serían afectados
si [usted/él/ella] trabajaría?
83
SECTION B: DISABILITY AND WORK STATUS
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
84
SECTION B: DISABILITY AND WORK STATUS
(B29_7j=01)
B29_10. What benefits {are/is} {you/NAME} most worried about losing?
¿Acerca de cuáles beneficios está [usted/NAME] más preocupad[o/a] que pudiera perder?
INTERVIEWER: MARK ALL THAT APPLY
PRIVATE DISABILITY INSURANCE .......................................... 01
WORKERS’ COMPENSATION .................................................. 02
VETERANS’ BENEFITS ............................................................. 03
MEDICARE................................................................................. 04
MEDICAID .................................................................................. 05
SOCIAL SECURITY DISABILITY BENEFITS (SSI OR SSDI) .... 06
PUBLIC ASSISTANCE OR WELFARE ...................................... 07
FOOD STAMPS ......................................................................... 08
PERSONAL ASSISTANCE SERVICES (PAS) ........................... 09
UNEMPLOYMENT BENEFITS ................................................... 10
OTHER STATE DISABILITY BENEFITS .................................... 11
OTHER GOVERNMENT PROGRAMS ...................................... 12
OTHER (SPECIFY) .................................................................... 13 (B29_10_oth)
(B29_10=13)
B29_10_Oth: What other benefits?
¿Qué otros beneficios?
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
GO TO B30
85
SECTION B: DISABILITY AND WORK STATUS
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B25.
Other beneficiaries have said that they are not working for a number of reasons. I am going to read you a list
of these reasons. For each, please tell me if it is a reason why {you are/NAME is} not currently working. {Are
you/ Is NAME} not working because
PROBE: I need to read the entire list even though some of the reasons may not apply to {you/NAME}. If a
reason does not apply to {you/NAME}, please just say so.
INTERVIEWER: IF RESPONDENTS SAYS 'DOES NOT APPLY' CODE AS 'NO'.
YES
NO
DON’T
KNOW
REFUSED
a.
A physical or mental condition prevents {you/NAME} from
working
01
00
d
r
b.
{You/NAME} cannot find a job that {you are/ he is /she is}
qualified for
01
00
d
r
c.
{You do/NAME does} not have reliable transportation to and
from work
01
00
d
r
d.
{You are/NAME is} caring for children or others
01
00
d
r
e.
ITEM DELETED
01
00
d
r
f.
{You/NAME} cannot find a job {you want / he wants / she
wants}
01
00
d
r
g.
{You are/NAME is} waiting to finish school or a training
program
01
00
d
r
h.
Workplaces are not accessible to people with {your/NAME’s}
disability
01
00
d
r
i.
{You do/NAME does} not want to lose benefits (you need / he
needs / she needs) like Social Security, disability insurance,
workers’ compensation, or Medicaid
01
00
d
r
j.
{Your/NAME’s} previous attempts to work have been
discouraging
01
00
d
r
k.
ITEM DELETED
01
00
d
r
l.
Others do not think {you/NAME} can work
01
00
d
r
01
00
d
r
m. Employers will not give {you/NAME} a chance to show that
{you/he/she} can work
n.
{You/NAME} does not have the special equipment or medical
devices that {you/he/she} would need to work
01
00
d
r
o.
{You/NAME} cannot get the help {you need / he needs / she
needs} with personal care. This includes things like help
dressing and bathing to get ready for work or eating lunch
and using the restroom at work.
01
00
d
r
{You/NAME} cannot get help {you need/he needs/she needs}
with tasks you would do at work. This includes having
someone help you with things like writing, reading, lifting or
reaching.
01
00
d
r
p.
86
SECTION B: DISABILITY AND WORK STATUS
Otros beneficiarios han dicho que no están trabajando por un número de razones. Le voy a leer una lista de
esas razones. Para cada una, por favor dígame si es una razón por la cual [usted/NAME] actualmente no
trabaja.
¿ [usted/NAME] no trabaja porque ...
PROBE: ?Necesito leer la lista entera, aún si algunas de las razones quizás no son aplicables a
[usted/NAME]. Si hay alguna razón que no aplica a [usted/NAME], por favor dígame.
YES
NO
DON’T
KNOW
REFUSED
a.
una condición física o mental le impide trabajar
01
00
d
r
b.
[Usted/NAME] no puede encontrar un empleo (o trabajo) para
el cual [usted/él/ella] está calificad[o/a].
01
00
d
r
c.
[Usted/NAME] no tiene transporte en el que puede confiar
para ir y regresar del trabajo.
01
00
d
r
d.
[Usted/NAME] está cuidando a niños o atendiendo a otra
persona.
01
00
d
r
f.
[Usted/NAME] no puede encontrar un empleo (o trabajo) que
[usted/él/ella] quiere.
01
00
d
r
g.
[Usted/NAME] está esperando hasta que termine sus
estudios o un programa de entrenamiento/capacitación.
01
00
d
r
h.
lugares de trabajo no son accesibles para personas con la
incapacidad que [usted/NAME] tiene.
01
00
d
r
i.
[Usted/NAME] no quiere perder beneficios que [usted/él/ella]
necesita, tal como Social Security o Seguro Social, seguro por
incapacidad, compensación de trabajadores o Medicaid.
01
00
d
r
j.
as previas veces que [Usted/NAME] intentó trabajar, los
resultados no [lo/la] alentaron.
01
00
d
r
l.
Otras personas no creen que [usted/NAME] puede trabajar.
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
m. empleadores (o patrones) no le dan a [usted/NAME] una
oportunidad para demostrar que [usted/él/ella] puede trabajar.
n.
[Usted/NAME] no tiene el equipo especial o aparatos médicos
que [usted/él/ella] necesitaría para trabajar.
o.
No se puede obtener la ayuda que necesita con el cuidado
personal. Esto incluye cosas como ayuda para vestirse y
bañarse para prepararse para el trabajo o almorzar y usar el
baño en el trabajo.
p.
No se puede obtener la ayuda que necesita con tareas del
trabajo. Esto incluye tener a alguien que te ayude con cosas
como la escritura, la lectura, la elevación, o alcanzar.
87
SECTION B: DISABILITY AND WORK STATUS
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B26.
Are there any other reasons why {you are/NAME is} not working that I did not mention?
¿Hay otras razones por las cuales [usted/NAME] no trabaja, y que no mencioné?
YES ............................................................................................ 01 (B27)
NO .............................................................................................. 00 (B29_11aCHECK)
DON’T KNOW ............................................................................ d (B29_11aCHECK)
REFUSED .................................................................................. r (B29_11aCHECK)
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) AND (B26=01)
B27.
What are they?
¿Cuáles son las razones?
INTERVIEWER: ENTER VERBATIM RESPONSE
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B29_11aCHECK. IS PHYSICAL OR MENTAL CONDITION REASON NOT WORKING (B25a=01)?
YES ............................................................................................ 01 (BP3)
NO .............................................................................................. 00 (B29_11CHECK)
((B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)) AND (B25_a=01)
BP3.
You said that one of the reasons {you are/NAME is} not working is because a physical or mental health
condition prevents {you/him/her} from working. I am going to read you a list of reasons why some people say
their health prevents them from working. For each, please tell me “yes” if it is a reason why {your/NAME’s}
health prevents {you/him/her} from working. You may say yes to more than one reason.
YES
NO
DON’T
KNOW
REFUSED
a.
{Your/NAME’s} health would interfere with job performance
01
00
d
r
b.
{You do/NAME does} not have the physical energy or stamina
required to work at a job
01
00
d
r
c.
{You experience/NAME experiences} severe pain that interferes
with a job or work schedule
01
00
d
r
d.
Working at a job is too stressful
01
00
d
r
e.
Work would be physically harmful to {your/NAME’s} health
01
00
d
r
f.
Medical and therapy appointments {you need/NAME needs} for
your health condition interfere with a regular work schedule
01
00
d
r
g.
The time {you need/NAME needs} for personal care and to take
care of {your/his/her} health interferes with a regular work
schedule
01
00
d
r
h.
{Your/NAME’s} health goes up and down in unpredictable ways
01
00
d
r
i.
{You are/NAME is} unable to get the medical treatment {you
need/he needs/she needs} to improve {your/his/her} health
enough to go to work
01
00
d
r
j.
Any other reasons not mentioned?
01
00
d
r
88
SECTION B: DISABILITY AND WORK STATUS
Usted dijo que una de las razones que [usted /NAME } no esta trabajando es por una su salud física o mental
impide su abilidad de trabajar. Voy a leer una lista de razones por las que algunas personas dicen que su
salud les impide trabajar. Para cada una, por favor dígame "sí" si es una razón por la cual sus salud previene
{usted/Name} trabajar. Usted puede decir que sí a más de una razón
YES
NO
DON’T
KNOW
REFUSED
a.
Su salud interfería con su desempeño en el trabajo
01
00
d
r
b.
Usted / NAME} no tiene la energía física o la resistencia
necesaria para trabajar en un empleo
01
00
d
r
c.
Usted sintió un dolor intenso que interfiere con el trabajo o el
horario del trabajo
01
00
d
r
d.
Trabajando es demasiado estresante
01
00
d
r
e.
El trabajo sería físicamente perjudicial para la salud de
usted/NAME
01
00
d
r
f.
Citas médicas y de terapia que necesita interfieren con un
horario de trabajo regular
01
00
d
r
g.
El tiempo que necesita para el cuidado personal y para cuidar de
su salud} interfiere con un horario de trabajo regular
01
00
d
r
h.
Su salud sube y baja de manera impredecible
01
00
d
r
i.
{Usted es / NAME} es incapaz de recibir el tratamiento médico
que necesita para mejorarsu salud suficiente para ir al trabajo
01
00
d
r
j.
Algún otro razon no mencionados
01
00
d
r
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) and (BP3_j=01)
BP3._Oth
What other reasons?
¿Qué otras razones
DON’T KNOW .................................................................
REFUSED .......................................................................
89
d
r
SECTION B: DISABILITY AND WORK STATUS
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B29_11CHECK. IS LOSING BENEFITS REASON NOT WORKING (B25i=01)?
YES ............................................................................................ 01 (B29_11a)
NO .............................................................................................. 00 (B29_12CHECK)
((B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)) AND (B25i=01)
B29_11a. You said that one of the reasons {you/he/NAME} {are/is} not working is because {you do / he does / she
does} not want to lose benefits (you need / he needs / she needs) such as Social Security, disability
insurance, workers’ compensation, or Medicaid. There are many ways people find out about how working
will affect their benefits. For example, some people call Social Security, some search the Internet, and
others contact disability service organizations like Work Incentives Planning and Assistance programs. Did
{you/NAME} contact anyone or do any of these things in order to find out how {your/his/her} benefits would
be affected if {you/he/she} went to work?
Usted dijo que una de las razones por la cual [usted/NAME] no trabaja es porque [usted/él/ella] no quiere
perder beneficios que [usted/él/ella] necesita, tal como Social Security o Seguro Social, seguro por
incapacidad, compensación de trabajadores o Medicaid. Hay muchas formas en las cuales se puede
averiguar cómo trabajar puede afectar a sus beneficios. Por ejemplo, hay gente que llama a la oficina del
Social Security o Seguro Social, algunos buscan en el Internet, y otros se comunican con organizaciones
de servicio a incapacitados, como los programas de Planificación de Incentivos Laborales y Asistencia
(Work Incentives Planning and Assistance). ¿Se comunicó [usted/NAME] con alguien, o hizo alguna de
estas cosas para averiguar cómo sus beneficios serían afectados si [usted/él/ella] trabajaría?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
((B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)) AND (B25i=01) AND B29_11a=response
B29_11b. What benefits {were/was} {you/NAME} most worried about losing?
¿Acerca de cuáles beneficios está [usted/NAME] más preocupad[o/a] que pudiera perder?
INTERVIEWER: MARK ALL THAT APPLY.
PRIVATE DISABILITY INSURANCE .......................................... 01
WORKERS’ COMPENSATION .................................................. 02
VETERANS’ BENEFITS ............................................................. 03
MEDICARE................................................................................. 04
MEDICAID .................................................................................. 05
SOCIAL SECURITY DISABILITY BENEFITS (SSI OR SSDI) .... 06
PUBLIC ASSISTANCE OR WELFARE ...................................... 07
FOOD STAMPS ......................................................................... 08
PERSONAL ASSISTANCE SERVICES (PAS) .......................... 09
UNEMPLOYMENT BENEFITS ................................................... 10
OTHER STATE DISABILITY BENEFITS .................................... 11
OTHER GOVERNMENT PROGRAMS ...................................... 12
OTHER (SPECIFY)
13
(B29_11b_oth)
((B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)) AND (B25i=01) AND (B29_11b=13)
B29_11b_Oth: What other benefits?
¿Qué otros beneficios?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
90
d
r
SECTION B: DISABILITY AND WORK STATUS
B29_12CHECK. CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (B30)
NO .............................................................................................. 00
91
SECTION B: DISABILITY AND WORK STATUS
((B28=00, d, or r) OR (B29_1a= d or r) OR (B29_1b=d or r) AND (RTYPE=01)
B29_8CHECK: DID RESPONDENT GIVE PHYSICAL OR MENTAL CONDITION AS ONLY REASON NOT
WORKING (( (B25_b, B25_c, B25_d, B25_f, B25_g, B25_h, B25_i, B25_j, B25_l, B25_m, B25_n, B25_o=00, d, OR
r) and (B26 0, d, r)?
YES ............................................................................................ 01 (B30)
NO .............................................................................................. 00 (B29_12a)
RTYPE = 1 AND ((at least one item in B25_b, B25_c, B25_d, B25_f, B25_g, B25_h, B25_i, B25_j, B25_l, B25_m,
B25_n, B25_o= 1) or B26 = 1)
B29_12a. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary
you would be willing to accept for such a job?
Si usted recibiera una oferta de empleo que corresponde a sus necesidades y habilidades corrientes, ¿cuál
es el sueldo o salario más bajo que usted aceptaría para tal empleo?
INTERVIEWER: IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: If you have no idea, just
say so. IF R SAYS HAS NO INTEREST IN WORKING, CODE AS DON’T KNOW.
IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: Si usted no tiene idea, diga.
INTERVIEWER: Read only if necessary, otherwise code:
$|
|
|
|,|
|
|
|.|
|
|
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (B30)
r (B30)
B29_12ahop. Is this:
¿Es esto. . . .
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY (EVERY TWO WEEKS) ......
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................
DON’T KNOW .........................................
REFUSED ...............................................
01
02
03
04
05
06
07
d
r
(1-25)
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(B29_12b)
(B29_12b)
(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)
(B30)
(B29_12b)
(B29_12b)
(B29_12b)
(B29_12b)
(B29_12b)
(B29_12b)
PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_12ahop OUT OF RANGE
B29_12check
Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary
you would have accepted for this job is [insert ((B29_12a and B29_12ahop). Is this correct?”
Permítame verificar que no cometí ningún error. Usted acaba de indicar que el salario o sueldo que
hubiera aceptado en este trabajo es [insert ((B29_12a and B29_12ahop)). ¿Es eso correcto?
CHANGE LOWEST WAGE OR SALARY ................................... 01 (CHANGE B29_12a)
CHANGE PAY PERIOD ............................................................. 02 (CHANGE B29_12ahop)
SUPPRESS ................................................................................ 03
(B29_12ahop=02, 03, 04, 05, 06, 07, d, or r)
B29_12b. How many hours per week would you expect to work for this amount of pay?
¿Cuántas horas por semana piensa usted que trabajaría para esta suma de pago?
| | |
(B30)
HOURS
(1-99)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B29_12b=d or r)
92
d (B29_12c)
r (B29_12c)
SECTION B: DISABILITY AND WORK STATUS
B29_12c.
Would you expect to work full-time or part-time?
¿Piensa usted que trabajaría a tiempo completo o a tiempo parcial?
FULL-TIME ................................................................................. 01
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
93
SECTION B: DISABILITY AND WORK STATUS
(All)
B30.
Did {you/NAME} work at a job or business for pay or profit anytime in 2022?
¿Trabajó [usted/NAME] en un empleo (o trabajo), o en un negocio, por pago o para ganancias en cualquier
momento en el año 2022?
YES ............................................................................................ 01 (B33)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
PROGRAMMER NOTE: If B24=01 or B24b = 1 or B30=01, go to B33. Else, go to B30_b.
(B24 = 0, d, r, AND B24b=0, d, r AND B30=0, d, r)
B30_b. {Have you/Has NAME} worked for pay or profit since {you/NAME} started receiving disability benefits?
¿ [Usted/NAME] ha trabajado por pago o ganancia desde que empezó a recibir beneficios por incapacidad?
(All)
B33.
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00 (B33)
DON’T KNOW ............................................................................ d (B33)
REFUSED .................................................................................. r (B33)
CHECK: WAS {NAME} WORKING BEFORE LIMITATION BEGAN (B22=01)?
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00
(B33=00)
B34
CHECK: IS {NAME} CURRENTLY WORKING (B24=01) OR WORKED IN PAST 6 MONTHS (B24b=01)?
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00
(B33=00 and B34=00)
B35.
CHECK: DID {NAME} WORK IN 2022 (B30=01)?
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00
(B30b=00, d, or r) or (B33=00 and B34=00 and B35=00)
B36.
{Have you/Has NAME} ever worked for pay or profit?
¿Alguna vez trabajó [usted/NAME] por pago o ganancia?
YES ............................................................................................ 01 (B36b)
NO .............................................................................................. 00 (B37)
DON’T KNOW ............................................................................ d (B37)
REFUSED .................................................................................. r (B37)
94
SECTION B: DISABILITY AND WORK STATUS
(B36=01)
B36b. In what year did {you/NAME} last work for pay or profit?
¿En qué año fue la última vez que {ustsed/NAME} a trabajado para pago o para tener ganancias
PROBE: We are interested in both full-time and part-time work for pay or profit.
PROBE: Did {you/NAME} last work for pay or profit more than 5 years ago? More than 10 years
ago? More than 20 years ago?
Estamos interesados en trabajo a tiempo completo o a tiempo parcial
Era la última vez que {ustsed/NAME} a trabajado para pago o para tener ganancias mas de 5
años? Mas de 10 año?
| | | | | .............................................................. (B37)
YEAR (1956-2023)
DON’T KNOW ................................................................. d (B37)
REFUSED ....................................................................... r
(B37)
(All)
B37.
Do {your/NAME’s} personal goals include working at a job, moving up in a job, or learning new job skills?
¿Incluyen {sus/las} metas personales {de NAME} trabajar en un empleo, ascender en un trabajo, o aprender
nuevas habilidades de trabajo?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
B37a.
(All)
B38.
Do {your/NAME’s} personal goals include someday working and earning enough to stop receiving Social
Security disability benefits?
¿Las metas personales que {usted/NAME} tiene incluyen trabajar y ganar suficiente dinero algún dia para
dejar de recibir beneficios por incapacidad del Seguro Social?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
{Do you/Does NAME} ever discuss work and career goals with family, friends, or anyone else?
¿Alguna vez habla [usted/NAME] de los temas de metas de trabajo y carrera con su familia, amistades, o
alguna otra persona
YES ............................................................................................ 01
NO .............................................................................................. 00 (B47)
DON’T KNOW ............................................................................ d (B47)
REFUSED .................................................................................. r (B47)
(B38=01)
B39.
Who is the main person {you discuss/NAME discusses} work goals with?
¿Con quién habla [usted/NAME] lo más acerca de sus metas de trabajo?
INTERVIEWER: MARK ONLY ONE.
PARENT/GUARDIAN ................................................................. 01 (B40)
SPOUSE/PARTNER .................................................................. 02 (B40)
FRIEND ...................................................................................... 03 (B40)
95
SECTION B: DISABILITY AND WORK STATUS
JOB COACH...............................................................................
EMPLOYER/SUPERVISOR .......................................................
OTHER RELATIVE.....................................................................
CASEWORKER/COUNSELOR/PROGRAM STAFF ..................
MEDICAL PROVIDER ................................................................
OTHER NON-RELATIVE (SPECIFY) .........................................
OTHER (SPECIFY) ...................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
96
04
05
06
07
08
10
09
d
r
(B40)
(B40)
(B40)
(B40)
(B40)
(B39_oth)
(B39_oth)
(B47)
(B47)
SECTION B: DISABILITY AND WORK STATUS
(B38=01 and (B39=09 OR B39=10))
B39_oth. Who was it?
¿Quién era esa persona?
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B38=01 and B39=01-10)
B40.
Please tell me how much you agree or disagree with the following statement. Would you say you strongly
agree, agree, disagree, or strongly disagree? {Your/NAME’s} {RESPONSE FROM B39 OR B39_oth} thinks
{your/NAME’s} personal goals should include working at a job, moving up in a job, or learning new job skills.
Por favor dígame cuánto está usted de acuerdo o en desacuerdo con la siguiente frase. ¿Diría usted que está
muy de acuerdo, de acuerdo, en desacuerdo, o muy en desacuerdo? {Su/el/la} {RESPONSE FROM B39 OR
B39_oth} {de NAME} piensa que las metas personales que [usted/NAME] tiene deben de incluir trabajar en
un empleo (o trabajo), avanzar en un empleo (o trabajo), o aprender nuevas destrezas de empleo (o trabajo).
STRONGLY AGREE ..................................................................
AGREE.......................................................................................
DISAGREE .................................................................................
STRONGLY DISAGREE ............................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
B47.
01
02
03
04
d
r
(B47)
(B47)
(B47)
(B47)
(B47)
(B47)
Please tell me how much you agree or disagree with the following statements. Would you say you strongly
agree, agree, disagree, or strongly disagree?
a.
STRONGLY
AGREE
AGREE
DISAGREE
STRONGLY
DISAGREE
DON’T
KNOW
REFUSED
01
02
03
04
d
r
You see {yourself/NAME}
working and earning enough
to stop receiving disability
benefits in the next two years.
01
02
03
04
d
r
You see {yourself/NAME} {(IF
B24=01) continuing to work/
(IF B24=00,d, r) working} for
pay in the next five years.
01
02
03
04
d
r
01
02
03
04
d
r
You see {yourself/NAME} {(IF
B24=01) continuing to work/
(IF B24=00,d, r) working} for
pay in the next two years.
(ASK B47b IF B47a=01,02,
OTHERWISE GO TO B47c)
b.
c.
{ASK B47d IF B47c=01,02,
OTHERWISE GO TO B48)
d.
You see {yourself/NAME}
working and earning enough
to stop receiving disability
benefits in the next five years
97
SECTION B: DISABILITY AND WORK STATUS
Por favor dígame cuánto está usted de acuerdo o desacuerdo con las siguientes frases. ¿Diría usted que está
muy de acuerdo, de acuerdo, en desacuerdo, o muy en desacuerdo?
a. Usted {se ve/le ve a NAME}
trabajando por pago en los
próximos dos años.
(ASK B47b IF B47a=01,02,
OTHERWISE GO TO B47c)
b. Usted aB47 trabajando bastante
para dejar de recibir beneficios por
incapacidad en los próximos dos
años.
c. Usted {se ve/le ve a NAME}
trabajando por pago en los
próximos cinco años.
{ASK B47d IF B47c=01,02,
OTHERWISE GO TO B48)
d. Usted piensa que {usted/NAME}
estará trabajando y ganando
suficiente para dejar de recibir
beneficios por incapacidad dentro
de los próximos cinco años.
STRONGLY
STRONGLY DON’T
AGREE
AGREE DISAGREE DISAGREE KNOW
REFUSED
01
02
03
04
d
r
01
02
03
04
d
r
01
02
03
04
d
r
01
02
03
04
d
r
98
SECTION B: DISABILITY AND WORK STATUS
(B47_a=3 OR 4) AND (B47c=3 OR 4)
BP4a1. You said that you don’t see {yourself/NAME} working in the near future. {Do you/Does NAME} have any
problems with {your/NAME’s} health, that may prevent {you/him/her} from working in the near future?
Usted dijo que no se ve {a NAME} trabajando en un futuro cercano. ¿Tiene {usted/NAME} algún problema
con su salud que pueda impedirle trabajar en un futuro cercano?
YES ................................................................................................................. 01
NO ................................................................................................................... 00
DON’T KNOW.................................................................................................. d
REFUSED ....................................................................................................... r
(BP4a1=1)
BP4a1_1. What is it about {your/NAME’s} health that may prevent {you/NAME} from working?
¿Que es sobre {su salud/ la salud de NAME} que pueda impedirle trabajar?
PROBE: Anything else?
¿Algo mas?
INTERVIEWER: CODE ALL THAT APPLY.
EXISTING HEALTH PROBLEM GETS WORSE ..................................
GET INJURED ......................................................................................
WORK HAS A NEGATIVE IMPACT ON HEALTH ................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ..........................................
HEALTH INTERFERES WITH JOB PERFORMANCE. ........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG ..................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY .........................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
WORK IS TOO STRESSFUL ...............................................................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW.......................................................................................
REFUSED ............................................................................................
01
02
03
04
05
06
07
08
09
10
11
12 (Bp4a1_oth)
d
r
(BP4a1_1=12)
BP4a1_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B47_a=3 OR 4) AND (B47c=3 OR 4)
BP4a2. {Do you/Does NAME} have any job related problems that may prevent {you/him/her} from working in the near
future?
¿Tiene {usted/NAME} algún problema con su empleo/trabajo que pueda impedirle trabajar en un futuro
cercano?
YES ................................................................................................................. 01
NO ................................................................................................................... 00
DON’T KNOW.................................................................................................. d
REFUSED ....................................................................................................... r
99
SECTION B: DISABILITY AND WORK STATUS
(BP4a2=1)
BP4a2_1. What was it about a job that may prevent {you/NAME} from working?
¿Que es sobre {su empleo/el empleo de NAME} que pueda impedirle trabajar?
PROBE: Anything else?
¿Algo mas?
INTERVIEWER: CODE ALL THAT APPLY
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
HEALTH INTERFERES WITH JOB PERFORMANCE .........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .................
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ................................................................................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
PERSONALITY CONFLICTS WITH OTHERS AT WORK....................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW.......................................................................................
REFUSED ............................................................................................
01
02
03
04
05
06
07
08 (Bp4a2_oth)
d
r
(BP4a2_1=08)
BP4a2_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B47_a=3 OR 4) AND (B47c=3 OR 4)
BP4a3. {Do you/ Does NAME} have any problems with {your/NAME’s} personal circumstances, that may prevent
{you/him/her} from working in the near future?
¿Tiene {usted/NAME} algún problema con sus circunstancias personales que pueda impedirle trabajar en un
futuro cercano?
YES ................................................................................................................. 01
NO ................................................................................................................... 00
DON’T KNOW.................................................................................................. d
REFUSED ....................................................................................................... r
100
SECTION B: DISABILITY AND WORK STATUS
(BP4a3=1)
BP4a3_1. What was it about {your/NAME’s} personal circumstances that may prevent {you/NAME} from working?
¿Que es sobre {sus circunstancias personales/ los circunstancias personales de NAME} que pueda impedirle
trabajar?
PROBE: Anything else?
¿Algo mas?
INTERVIEWER: CODE ALL THAT APPLY
NEED TO CARE FOR CHILDREN OR OTHERS .................................
NEED PERSONAL ASSISTANCE TO GET READY FOR
WORK EACH DAY ...............................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE.............................................................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK ..............................................................................
DRUG/ALCOHOL RELAPSE ...............................................................
WOULD RATHER DO OTHER THINGS THAN WORK .......................
DO NOT LIKE WORKING ....................................................................
WORK IS TOO STRESSFUL ...............................................................
MOVED TO ANOTHER AREA (NEW)..................................................
LOSS OR POTENTIAL LOSS OF
GOVERNMENT BENEFITS (NEW) ......................................................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW.......................................................................................
REFUSED ............................................................................................
(BP4a3_1=09)
BP4a3_oth..
01
02
03
04
05
06
07
08
19
21
09 (Bp4a3_oth)
d
r
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(If B47a=01 OR 02 and B47_b=03 OR 04) OR (B47_c=01 OR 02 and B47_d=03 OR 04)
BP4b1. You said that you don’t see {yourself/NAME} working enough to stop receiving disability benefits in the near
future. {Do you/Does NAME} have any problems with {your/NAME’s} health, that may cause {you/him/her} to
not work enough to leave benefits?
Usted dijo que no se ve {a NAME} trabajando suficiente para dejar de recibir los beneficios por incapacidad
en un futuro próximo. ¿Tiene {usted/NAME} algún problema con su salud que pueda hacer que no trabaje
suficiente para dejar los beneficios?
YES ................................................................................................................. 01
NO ................................................................................................................... 00
DON’T KNOW.................................................................................................. d
REFUSED ....................................................................................................... r
101
SECTION B: DISABILITY AND WORK STATUS
(BP4b1=1)
BP4b1_1. What is it about {your/NAME’s} health that may cause {you/NAME} to not work enough to leave benefits?
¿Que es sobre {su salud/ la salud de NAME} que pueda hacer que no trabaje suficiente para dejar los
beneficios?
PROBE: Anything else?
¿Algo mas?
INTERVIEWER: CODE ALL THAT APPLY.
EXISTING HEALTH PROBLEM GETS WORSE ..................................
GET INJURED ......................................................................................
WORK HAS A NEGATIVE IMPACT ON HEALTH ................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ..........................................
HEALTH INTERFERES WITH JOB PERFORMANCE .........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG ..................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY .........................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
WORK IS TOO STRESSFUL ...............................................................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW.......................................................................................
REFUSED ............................................................................................
01
02
03
04
05
06
07
08
09
10
11
12 (Bp4b1_oth)
d
r
(BP4b1_1=12)
BP4b1_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(If B47a=01 OR 02 and B47_b=03 OR 04) OR (B47_c=01 OR 02 and B47_d=03 OR 04)
BP4b2. {Do you/Does NAME} have any job-related problems {your/NAME’s}, that may cause {you/him/her} to not
work enough to leave benefits?
¿Tiene {usted/NAME} algún problema con su empleo/trabajo que pueda hacer que no trabaje suficiente para
dejar los beneficios?
YES ................................................................................................................. 01
NO ................................................................................................................... 00
DON’T KNOW.................................................................................................. d
REFUSED ....................................................................................................... r
102
SECTION B: DISABILITY AND WORK STATUS
(BP4b2=1)
BP4b2_1. What is it about a job that may cause {you/NAME} to not work enough to leave benefits?
¿Que es sobre {su empleo/el empleo de NAME} que pueda hacer que no trabaje suficiente para dejar los
beneficios?
PROBE: Anything else?
¿Algo mas?
INTERVIEWER: CODE ALL THAT APPLY.
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
HEALTH INTERFERES WITH JOB PERFORMANCE .........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .................
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ................................................................................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
PERSONALITY CONFLICTS WITH OTHERS AT WORK....................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW.......................................................................................
REFUSED ............................................................................................
01
02
03
04
05
06
07
08 (Bp4b2_oth)
d
r
(BP4b2_1=08)
BP4b2_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(If B47a=01 OR 02 and B47_b=03 OR 04) OR (B47_c=01 OR 02 and B47_d=03 OR 04)
BP4b3. {Do you/Does NAME} have any problems with {your/NAME’s} personal circumstances that may cause
{you/him/her} to not work enough to leave benefits?
¿Tiene {usted/NAME} algún problema con sus circunstancias personales que pueda hacer que no trabaje
suficiente para dejar los beneficios?
YES ................................................................................................................. 01
NO ................................................................................................................... 00
DON’T KNOW.................................................................................................. d
REFUSED ....................................................................................................... r
103
SECTION B: DISABILITY AND WORK STATUS
(BP4b3=1)
BP4b3_1. What is it about {your/NAME’s} personal circumstances that may cause {you/NAME} to not work enough to
leave benefits?
¿Que es sobre {sus circunstancias personales/ las circunstancias personales de NAME} que pueda hacer
que no trabaje suficiente para dejar los beneficios?
PROBE: Anything else?
¿Algo mas?
INTERVIEWER: CODE ALL THAT APPLY.
NEED TO CARE FOR CHILDREN OR OTHERS .................................
NEED PERSONAL ASSISTANCE TO GET READY FOR
WORK EACH DAY ...............................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE.............................................................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK ..............................................................................
DRUG/ALCOHOL RELAPSE ...............................................................
WOULD RATHER DO OTHER THINGS THAN WORK .......................
DO NOT LIKE WORKING ....................................................................
WORK IS TOO STRESSFUL ...............................................................
MOVED TO ANOTHER AREA (NEW)..................................................
LOSS OR POTENTIAL LOSS OF
GOVERNMENT BENEFITS (NEW) ......................................................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW.......................................................................................
REFUSED ............................................................................................
(BP4b3_1=09)
BP4b3_oth..
01
02
03
04
05
06
07
08
19
21
09 (Bp4b3_oth)
d
r
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
B48.
d
r
CHECK: IS {NAME} CURRENTLY WORKING (B24 = 01)?
YES ............................................................................................ 01 (C1)
NO .............................................................................................. 00
(B48=00)
B48a. CHECK: WAS (NAME) WORKING IN THE LAST 6 MONTHS (B24b=01)?
YES ............................................................................................ 01 (C_B_1)
NO .............................................................................................. 00
B49.
CHECK: WAS {NAME} WORKING IN 2022 (B30 = 01)?
YES ............................................................................................ 01 (D1)
NO .............................................................................................. 00 (SC1CHECK)
104
SECTION C: CURRENT EMPLOYMENT
SECTION C: CURRENT EMPLOYMENT
(B24=01)
C1.
Now I am going to ask some questions about the jobs {you/NAME} currently {have/has}. When answering
these questions, please include both part-time and full-time jobs, but only include jobs {you hold/NAME holds}
for pay or profit.
How many jobs {do you/does NAME} currently have?
Ahora le voy a hacer algunas preguntas acerca de los trabajos o empleos que {usted/NAME} tiene
actualmente. Cuando contesta a estas preguntas, por favor incluya ambos a trabajos o empleos a tiempo
parcial y a tiempo completo, pero solamente incluya los empleos (o trabajos) en los que [usted/NAME] trabaja
por pago o para tener ganancias.
¿Cuántos empleos (o trabajos) tiene {usted/NAME} actualmente?
|__|__| NUMBER OF JOBS (1-15)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B24=01)
C1a. What are the main reasons {you/NAME} decided to work?
¿Cuáles son las razónes principales por que {usted / NAME} decidido trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
TO HAVE MORE INCOME .............................................
TO FEEL BETTER ABOUT MYSELF/IMPROVE
WELL BEING ..................................................................
TO FEEL MORE INDEPENDENT ...................................
TO ACHIEVE PERSONAL CAREER GOALS .................
ENJOY WORKING/PERSONAL SATISFACTION ..........
DON’T WANT TO RELY ON BENEFITS.........................
HEALTH IMPROVED ......................................................
HAD MORE TIME/STOPPED DOING
SOMETHING ELSE ........................................................
OTHER (SPECIFY) .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01 (C2)
02
03
04
05
06
07
(C2)
(C2)
(C2)
(C2)
(C2)
(C2)
08
09
d
r
(C2)
(C1a_oth)
(C2)
(C2)
(C1a=09)
C1a_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
105
d
r
SECTION C: CURRENT EMPLOYMENT
PROGRAMMER: C2 THROUGH C14 ASKED FOR ALL JOBS WHEN C1>01
(B24=01)
C2.
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND FIRST JOB:
Let us start with {your/NAME’s} main job – that is, the job at which {you work/(he/she) works} the most hours.
What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?
Comencemos con su trabajo principal {/ del NAME} - es decir, el trabajo en el que {usted/él/ella} trabaja más
horas.
¿Qué tipo de trabajo {hace/ hace NAME}, o sea cuál es su ocupación
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
Now I would like to ask about {your/NAME’S} {second/third/fourth} job.
Ahora me gustaría preguntar acerca de su {NAME} {segundo/ tercer/ cuarto} trabajo.
What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}?
ELSE (C1=01):
What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high
school; sales clerk in a women’s shoe store.
Por ejemplo: proveedora de 'child-care' o cuidado de niños en un programa preescolar de una
escuela privada, maestro(a) de geometría en un 'public high school' o escuela secundaria pública;
vendedor(a) en una tienda de zapatos de mujeres.
PROBE 2: What are {your/NAME’S} main activities or duties? What else {do you/does NAME} do? What
else? {Do you /Does NAME} supervise anyone?
¿Cuáles son su/sus actividades u obligaciones principales?
¿Qué más hace? ¿Algo más? ¿Es supervisor(a) de alguien?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B24=01)
C3.
What kind of business is this?
d
r
¿Qué tipo de negocio es este?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For what type of organization or industry {do you/does NAME} work? For example: accounting
firm, daycare center, educational facility, food services.
Para qué tipo de organización o industria trabaja? Por ejemplo: una firma de contabilidad, un
centro de 'daycare' para el cuidado de niños, una institución educacional, servicio de comida
PROBE 2: What do they make, sell, or do where {you work/NAME works}?
¿Qué es lo que producen, venden, o hacen en el lugar donde {usted/NAME} trabaja?
PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses), or
retail trade (selling to customers) or something else?
106
SECTION C: CURRENT EMPLOYMENT
¿Es este un negocio de manufactura (fabrican un producto), negocio de venta al por mayor
(venden a otros negocios), o venta al por menor (venta a clientes) o alguna otra cosa?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B24=01)
C4mth. In what month and year did {you/NAME} start working there?
d
r
¿En qué mes y año empezó {usted/NAME} a trabajar allí?
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................
107
d
r
SECTION C: CURRENT EMPLOYMENT
(B24=01)
C4yr.
PROBE 1: In what month and year did {you/NAME} start working there?
¿En qué mes y año empezó {usted/NAME} a trabajar allí?
INTERVIEWER: ENTER YEAR
PROBE 2: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
|__|__|__|__|
YEAR
(1956-2023)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B24=01)
C5.
SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (C4yr) SHOULD BE GREATER THAN OR
EQUAL TO YEAR OF BIRTH (A04_d) PLUS 14 YEARS. IF RESPONDENT FAILS EDIT, INTERVIEWER
READ: Let me make sure I did not make a mistake. You just indicated that you started working there in (C4yr).
Is this correct?
Debo haber anotado una respuesta incorrecta. Anoté que {usted/NAME} nació en (A04_d) y {usted/NAME}
empezó a trabajar en este trabajo en (C4yr), lo que significa que {usted/NAME} empezó a trabajar en este
trabajo cuando {usted/él/ella} tenía (PROGRAMMER CALCULATE AND FILL AGE: C4YR – YEAR OF
BIRTH)) años. ¿Es eso correcto?
YES ............................................................................................ 01
NO .............................................................................................. 02 (CHANGE C4YR)
SUPPRESS ................................................................................ 03
(B24=01)
C5A.
Beneficiaries do not always know that they should report a change in work status to Social Security. Around
that time did {you/NAME} let Social Security know that {you were/ (he/she) was} working?
Beneficiarios no siempre saben que deben de notificar al Social Security (Seguro Social) acerca de cambios
en su 'estatus' o condición de trabajo. ¿Notificó {usted/NAME} al Social Security alrededor de ese tiempo
que {usted/ (él/ella)} estaba trabajando?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C6)
DON’T KNOW ............................................................................ d (C6)
REFUSED .................................................................................. r (C6)
(C5a=01)
C5B.
How soon after {you/NAME} started this job did {you/NAME} tell Social Security {you were/(he/she) was}
working?
¿Cuánto tiempo después de que {usted/NOMBRE} empezara este trabajo, le dijo al Social Security que
{USTED/él/ella} estaba trabajando?
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: IF R TOLD SSA BEFORE STARTED WORKING, CODE AS 1 WEEK.
WEEKS ...................................................................................... 01 (C5BWeek)
MONTHS .................................................................................... 02 (C5BMonth)
DON’T KNOW ............................................................................ d (C5c)
REFUSED .................................................................................. r (C5c)
(C5a=01 and C5b=01)
C5BWEEK. INTERVIEWER: ENTER NUMBER OF WEEKS
| | | WEEKS
(1-52)
DON’T KNOW ............................................................................
108
d (C5c)
SECTION C: CURRENT EMPLOYMENT
REFUSED ..................................................................................
109
r (C5c)
SECTION C: CURRENT EMPLOYMENT
(C5a=01 and C5b=02)
C5BMonth. INTERVIEWER: ENTER NUMBER OF MONTHS
| | | WEEKS/MONTHS
(1-12)
DON’T ........................................................................................
REFUSED ..................................................................................
d (C5c)
r (C5c)
(C5a=01)
C5C.
How did {you/NAME} let Social Security know {you were/(he/she) was} working?
¿Cómo le dejo saber {usted/NAME} al Social Security que estaba trabajando?
PROBE: Did {you/NAME} call, visit, or write the Social Security Administration, go online or use a mobile app,
or did your employer or someone else report you working?
¿{Usted/NAME} llamó, visitó o escribió a la Administración del Seguro Social, se comunicó por Internet o
utilizó una aplicación móvil, o su empleador u otra persona reportó que {usted/NAME} estaba trabajando?
INTERVIEWER: CODE ALL THAT APPLY.
CALLED SSA/REPORTED BY PHONE .....................................
VISITED SSA FIELD OFFICE/REPORTED IN PERSON ..........
WROTE SSA/REPORTED BY MAIL ..........................................
REPORTED ONLINE OR USING MOBILE APP ........................
EMPLOYER REPORTED TO SSA ............................................
SERVICE PROVIDER REPORTED TO SSA .............................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
d
r
(B24=01)
C6.
{Are you/Is NAME} self-employed at this job? Self-employed means that {you work/NAME works} for
{yourself/themselves} or {own your/owns their} own business.
¿Está {usted/NAME} autoempleado/autoempleada en este trabajo? Autoempleado/ Autoempleada, o Selfemployed en inglés, significa que {usted/NAME} trabaja para {usted/él mismo/ella misma} o es {dueño/ dueña}
de su propio negocio.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B24=01)
C8.
How many hours per week {do you/does NAME} usually work at this job?
¿Cuántas horas por semana generalmente trabaja {usted/NAME} en este empleo?
PROBE: Include overtime if {you/he/she} usually {work/works} overtime.
Incluya 'overtime' o sobretiempo si {usted/ (él/ella)} generalmente trabaja horas extra.
|
|
|
| HOURS PER WEEK (1-60)
(1-168)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(B24=01)
C9.
How many weeks per year {do you/does NAME} usually work at this job, including paid vacation and holidays?
110
SECTION C: CURRENT EMPLOYMENT
¿Cuántas semanas por año generalmente trabaja {usted/NAME} en este empleo, incluyendo vacaciones
pagadas y feriados?
PROBE 1: There are 52 weeks in a year.
Hay 52 (cincuentaidos) semanas en un año
PROBE 2: Please include time off for vacation and holidays if {you are/NAME is} paid for that time.
Por favor incluya tiempo libre por vacaciones y feriados si {usted/NAME} recibe pago por ese
tiempo.
PROBE 3: If {you have/NAME has} worked less than a year, please answer for the number of weeks
{you expect/NAME expects} to work.
Si {usted/NAME} ha trabajado por menos de un año, por favor conteste en relación al número
de semanas que {usted/NAME} espera trabajar.
|
|
| WEEKS PER YEAR (1-52)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
111
d
r
SECTION C: CURRENT EMPLOYMENT
(B24=01)
C10.
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND FIRST JOB:
For the purpose of this survey, it is important to obtain some information on how much {you are/NAME is} paid
on this job. On {your/NAME’s} main job {are you/is (he/she} paid by the hour?
Para el propósito de esta encuesta, es importante obtener alguna información acerca de lo que le pagan a
usted en este trabajo. En { su / del NAME} trabajo principal le pagan a {usted/NAME} por hora?
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
For the purpose of this survey, it is important to obtain some information on how much {you are/NAME is} paid
on {your/(his/her)} {second/third/fourth} job. On {your/NAME’s} {second/third/fourth} job {are you/is (he/she}
paid by the hour?
Para el propósito de este estudio, es importante para obtener información sobre cuánto {eres / NAME} pagado
en su {segundo/ tercer/ cuarto } trabajo}. En {su {segundo/ tercer/ cuarto } está usted / es (él / ella} pagado
por hora?
ELSE (C1=01): For the purpose of this survey, it is important to obtain some information on how much {you
are/NAME is} paid on {your/(his/her)} current job. On {your/NAME’s} current job {are you/is (he/she} paid by
the hour?
Para el propósito de este estudio, es importante para obtener información sobre cuánto {eres / NAME} pagado
en su trabajo actual. En {su {trabajo actual está usted / es (él / ella} pagado por hora?
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:
{Your/NAME’s} main job is the job we have been talking about. The one at which {you
work/(he/she) works} the most hours.
{Su trabajo principal/El trabajo principal de NAME} es el trabajo de que hemos estado hablando.
En el que {usted/él/ella} trabaja la mayor cantidad de horas.
YES ............................................................................................ 01
NO .............................................................................................. 00 (C12amt)
DON’T KNOW ............................................................................ d (C12amt)
REFUSED .................................................................................. r (C12amt)
(C10=01)
C11.
What is {your/NAME’s} regular hourly pay, including tips and commissions?
¿Cuál es {su sueldo regular/el sueldo regular de NAME} por hora , incluyendo propinas y comisiones?
PROBE: IF LESS THAN $5.00 AN HOUR: Does this include tips and commissions?
IF LESS THAN $5.00 AN HOUR: ¿Esto incluye propinas y comisiones?
INTERVIEWER: IF ENTERING AN AMOUNT WITH CENTS, PLEASE ENTER DECIMAL POINT
$|
|
|
|.|
|
| PER HOUR (1 – 25.00) (1 - 300.00)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
Programmer box C11: IF C1>1 AND HAVE NOT ASKED ABOUT ALL JOBS,
LOOP BACK TO C2.
ELSE, GO TO C15
(C10=00, d, or r)
C12amt. Before taxes and other deductions how much {are you/is NAME} paid on this job, including tips and
commissions.
Antes de impuestos y otras deducciones, ¿cuánto le pagan a {usted/NAME} en este empleo, incluyendo
propinas y comisiones?
PROBE:
Is that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
¿Esa suma es su pago por día, por semana, por cada dos semanas, dos veces por mes, por
mes, o por año?
112
SECTION C: CURRENT EMPLOYMENT
INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|
|
|
|.|
|
|
| . 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
113
SECTION C: CURRENT EMPLOYMENT
(C10=00, d, or r)
C12hop. INTERVIEWER: ENTER HOW OFTEN PAID
DAILY...................................................................
WEEKLY ..............................................................
BI-WEEKLY (EVERY TWO WEEKS) ...................
TWICE A MONTH ................................................
MONTHLY ...........................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................
01
02
03
04
05
06
d
r
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)
PROGRAMMER: CALCULATE MONTHLY PRE-TAX PAY BASED ON C12AMT AND C12HOP FOR EACH JOB:
If C10=01, and C11and C8≠d or r, C_JobMnthPay(1)=c11*c8*4.35.
If C10=01 and C8 or C11=d, C_JobMnthPay(1)=d.
If C10=01 and C8 or C11=r and neither are d, C_JobMnthPay(1)=r.
If C10=00, d, or r and C12amt or C12hop=d, C_JobMnthPay(1)=d.
If C10=00, d, or r and C12amt or C12hop=r, and neither are d, C_JobMnthPay(1)=r.
If C10=00, d, or r and c12hop=1, C_JobMnthPay(1)=c12amt*21.74.
If C10=00, d, or r and c12hop=2, C_JobMnthPay(1)=c12amt*4.35.
If C10=00, d, or r and c12hop=3, C_JobMnthPay(1)=c12amt*2.17.
If C10=00, d, or r and c12hop=4, C_JobMnthPay(1)=c12amt*2.
If C10=00, d, or r and c12hop=5, C_JobMnthPay(1)=c12amt.
If C10=00, d, or r and c12hop=6, C_JobMnthPay(1)=c12amt/12.
(C10=00, d, or r)
C13amt. For this job, about how much is left as take-home pay after taxes and other deductions?
En este empleo, ¿más o menos cuánto le queda de su pago para llevar a casa, después de impuestos y otras
deducciones?
PROBE:
Is that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
Esa suma es su pago por día, por semana, por cada dos semanas, dos veces por mes, por mes, o por año?
INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|
|
|
|.|
|
|
| . 00
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C10=00, d, or r)
C13hop. INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY (EVERY TWO WEEKS) ...................
TWICE A MONTH ................................................
MONTHLY ............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................
114
01
02
03
04
05
06
d
r
(1-346)
(1-1,730)
(1-3,750)
(1-3,750)
(1-7,500)
(1-90,000)
(1-1,730)
(1-8,653)
(1-18,750)
(1-18,750)
(1-37,500)
(1-450,000)
SECTION C: CURRENT EMPLOYMENT
PROGRAMMER: CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON C13AMT AND C13HOP:
If C10=01 and C11 and C8≠d or r, C_JobMnthPayTH(1)=c11*c8*4.35.
If C10=01 and C8_1 or C11=d, C_JobMnthPayTH(1)=d.
If C10=01 and C8_1 or C11=r and neither are d, C_JobMnthPayTH(1)=r.
If C10=00, d, or r and C13amt or C13hop=d, C_JobMnthPayTH(1)=d.
If C10=00, d, or r and C13amt or C13hop=r, and neither are d, C_JobMnthPayTH(1)=r.
If C10=00, d, or r and c13hop=1, C_JobMnthPayTH(1)=c13amt*21.74.
If C10=00, d, or r and c13hop=2, C_JobMnthPayTH(1) =c13amt*4.35.
If C10=00, d, or r and c13hop=3, C_JobMnthPayTH(1)=c13amt*2.17.
If C10=00, d, or r and c13hop=4, C_JobMnthPayTH(1)=c13amt*2.
If C10=00, d, or r and c13hop=5, C_JobMnthPayTH(1)=c13amt.
If C10=00, d, or r and c13hop=6, C_JobMnthPayTH(1)=c13amt/12.
(C10=00, d, or r) and (C12hop=01, 02, 03, 04, 05, or 06) and (C13hop=01, 02, 03, 04, 05, or 06)
C14.
SOFT EDIT: AMOUNT OF TAKE-HOME PAY MUST BE LESS THAN OR EQUAL T0 PRE-TAX PAY. IF
AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND
AMOUNT OF CALCULATED MONTHLY PRE-TAX PAY (C_JobMnthPay(1)) NE D OR R, AND
C_JobMnthPayTH(1) > C_JobMnthPay(1), TRIGGER EDIT AND DISPLAY FOLLOWING TEXT:
INTERVIEWER, AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY IS GREATER THAN AMOUNT
OF CALCULATED PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an
incorrect answer. You said that {you are/NAME is} paid (C12amt) per (C12hop) before taxes and other
deductions which would be about (C_JobMnthPay(1) per month and that (C13amt) per (C13hop), or about
(C_JobMnthPayTH(1) per month, is left as take-home pay after taxes and other deductions. Based on what I
recorded, your take home pay is more than your pre-tax pay. Should I change the amount {you are/NAME is}
paid before taxes and other deductions or the amount {you take/NAME takes} home after taxes and other
deductions?
Debo haber anotado una respuesta incorrecta. Dijo que a {usted/NAME} se le pagan (C12amt) por (C12hop)
antes de impuestos y otras deducciones, lo que sería aproximadamente (C_JobMnthPay(1) por mes y que
(C13amt) por (C13hop), o aproximadamente (C_JobMnthPayTH(1) por mes, sobra como sueldo neto
después de impuestos y otras deducciones. Basado en lo que anoté, su sueldo neto es más que su sueldo
antes de impuestos. ¿Debo cambiar la cantidad que se le pagan a {usted/NAME] antes de los impuestos y
otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS .................................................................... 01 CHANGE C12amt)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE C13amt)
SUPPRESS ................................................................................ 03
115
SECTION C: CURRENT EMPLOYMENT
(C10=00, d, or r) and (C12hop=01, 02, 03, 04, 05, or 06) and (C13hop=01, 02, 03, 04, 05, or 06)
C14a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND
CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF TAKE MONTHLY
HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY
(C_JobMnthPay(1)) NE D OR R, AND (C_JobMnthPay(1) - C_JobMnthPayTH(1) / C_JobMnthPayTH(1) >
.30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER, DIFFERENCE IN AMOUNT OF
CALCULATED MONTHLY TAKE HOME PAY AND CALCULATED MONTHLY PRE-TAX PAY IS GREATER
THAN 30%. CHECK ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said
that {you are/NAME is} paid (C12amt) per (C12hop) before taxes and other deductions which would be about
(C_JobMnthPay(1) per month and that (C13amt) per (C13hop), or about (C_JobMnthPayTH(1) per month is
left as take-home pay after taxes and other deductions. Is this correct or should I change the amount {you
are/NAME is} paid before taxes and other deductions or the amount {you take/NAME takes} home after taxes
and other deductions?
Debo haber anotado una respuesta incorrecta. Dijo que a {usted/NAME} se le pagan (C12amt) por (C12hop)
antes de impuestos y otras deducciones, lo que sería aproximadamente (C_JobMnthPay(1) por mes y que
(C13amt) por (C13hop), o aproximadamente (C_JobMnthPayTH(1) por mes, sobra como sueldo neto
después de impuestos y otras deducciones. Basado en lo que anoté, su sueldo neto es más que su sueldo
antes de impuestos. ¿Debo cambiar la cantidad que se le pagan a {usted/NAME] antes de los impuestos y
otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS .................................................................... 01 CHANGE C12amt)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE C13amt)
SUPPRESS ................................................................................ 03
PROGRAMMER: CALCULATE TOTAL MONTHLY PAY FROM ALL JOBS COMBINED (TO BE USED LATER IN
SECTION K):
If C_JobMnthPay(1) or C_JobMnthPay(2) or C_JobMnthPay(3) (for all jobs listed)=d,
C_CurMnthPay=d.
If C_JobMnthPay(1) or C_JobMnthPay(2) or C_JobMnthPay(3) (for all jobs listed)=r, and none=d,
C_CurMnthPay=r. Else, C_CurMnthPay=Sum of (C_JobMnthPay(1) AND C_JobMnthPay(2) AND
C_JobMnthPay(3), etc. (for all jobs listed)).
Programmer box C14a: IF C1>1 AND HAVE NOT ASKED ABOUT ALL
JOBS, LOOP BACK TO C2.
ELSE, GO TO C15
(B24=01)
C15.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (CP4)
NO .............................................................................................. 00 (CP2)
(C1=>1 AND C15 = 00)
CP2.
How did {you/NAME} find {your/his/her} {main/current} job?
¿Cómo {usted / NAME} {encontrar su trabajo} {principal / actual}?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
INTERVIEWER: CODE ALL THAT APPLY.
THROUGH STATE’S UNEMPLOYMENT OFFICE ....................
AMERICAN JOBCENTER / A STATE OR LOCAL
WORKFORCE CENTER ............................................................
THROUGH FRIENDS OR RELATIVES .....................................
THROUGH JOB ADVERTISEMENTS IN A NEWSPAPER
OR ON THE INTERNET ............................................................
116
01 (CP2a)
02 (CP2a)
03 (CP2a)
04 (CP2a)
SECTION C: CURRENT EMPLOYMENT
THROUGH THE STATE VOCATIONAL REHABILITATION
AGENCY OR {VRSTATE FROM {NAME’S} CURRENT
STATE} ......................................................................................
THROUGH AN EMPLOYMENT AGENCY, PROGRAM, OR
EMPLOYMENT NETWORK (EN)...............................................
THROUGH THE TICKET TO WORK (TTW) PROGRAM ...........
BY CONTACTING A FORMER EMPLOYER .............................
BY CONTACTING ANY OTHER EMPLOYERS .........................
OTHER (SPECIFY) ....................................................................
(CP2=10)
CP2_Oth.
05 (CP2a)
06
07
08
09
10
(CP2a)
(CP2a)
(CP2a)
(CP2a)
(CP2_Oth)
What other way did {you/NAME} find this job?
¿Qué otro manera lo hizo {usted / NAME} para encontrar este trabajo?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C1=>1 AND C15 = 00)
CP2a. CHECK: DID {NAME} MENTION MORE THAN ONE WAY FOUND MAIN/CURRENT JOB IN CP2?
YES ............................................................................................ 01 (CP2b)
NO .............................................................................................. 00 (CP3)
(C1=>1 AND C15 = 00 AND CP2a= 01)
CP2b. What was the main way {you/NAME} found {your/his/her} {main/current} job?
¿Cuál fue la forma principal que {usted / NAME} {encontrado su trabajo} {principal / actual}?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
INTERVIEWER: CODE ALL THAT APPLY.
THROUGH STATE’S UNEMPLOYMENT OFFICE ....................
AMERICAN JOB CENTER / A STATE OR LOCAL
WORKFORCE CENTER ............................................................
THROUGH FRIENDS OR RELATIVES .....................................
THROUGH JOB ADVERTISEMENTS IN A NEWSPAPER OR
ON THE INTERNET ...................................................................
THROUGH THE STATE VOCATIONAL REHABILITATION
AGENCY OR {VRSTATE FROM {NAME’S} CURRENT
STATE} ......................................................................................
THROUGH AN EMPLOYMENT AGENCY, PROGRAM, OR
EMPLOYMENT NETWORK (EN)...............................................
THROUGH THE TICKET TO WORK (TTW) PROGRAM ...........
BY CONTACTING A FORMER EMPLOYER .............................
BY CONTACTING ANY OTHER EMPLOYERS .........................
OTHER (SPECIFY) ....................................................................
(CP2b=10)
CP2_Oth.
01 (CP3)
02 (CP3)
03 (CP3)
04 (CP3)
05 (CP3)
06
07
08
09
10
(CP3)
(CP3)
(CP3)
(CP3)
(CP2_Oth)
What other way did {you/NAME} find this job?
¿Qué otro manera lo hizo {usted / NAME} para encontrar este trabajo?
DON’T KNOW .................................................................
REFUSED .......................................................................
117
d (CP3)
r (CP3)
SECTION C: CURRENT EMPLOYMENT
(C1=>1 AND C15 = 00)
CP3.
I am going to read a list of things that some people use or receive to help them find or keep a job. Please tell
me if {you/NAME} used or received any of them to help find or keep working at {your/his/her} {main/current}
job. Did {you/NAME}…
Voy a leer una lista de las cosas que algunas personas utilizan o reciben para ayudarles a encontrar o
mantener un empleo. Por favor, dígame si {usted / NAME} utilizado alguna vez o ha recibido alguna de esas
cosas para ayudar a e ¿{Usted/NAME}…
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES
NO
NOT
APPLICABLE
DON’T
KNOW
REFUSED
…have a job coach to help {you/him/her} learn how
to do {your/his/her} job?
…usó un entrenador de empleo (job coach) para
ayudarle a aprender a hacer su trabajo?
01
00
02
d
r
…use a sign language interpreter?
…usó un intérprete de lenguaje de signos?
01
00
d
r
…use a reader or interpreter for the blind?
…usóun lector o intérprete para los ciegos?
01
00
d
r
…use an assistant or caregiver for personal care? (IF
NEEDED: This includes help bathing and dressing to
get ready for work and eating lunch or using the
restroom at work)
…usó un asistente o cuidador para el cuidado
personal? (IF Needed: ayuda para bañarse, vestirse,
o la preparación de comidas)
01
00
02
d
r
e. …use a personal care assistant or direct support
professional at work to help with job-related tasks?
(IF NEEDED: This includes help with writing, reading,
lifting, or reaching).
…usó un asistente personal en el trabajo para ayudar
con las tareas relacionadas con el trabajo? (IF
NEEDED: Esto incluye ayuda con la escritura, la
lectura, el levantamiento o alcance.)
01
00
02
d
r
01
00
d
r
d
r
d
r
d
r
d
r
a.
b.
c.
d.
f.
g.
h.
i.
j.
02
02
…receive on the job training?
…recibió capacitación en el trabajo?
02
…receive counseling about how work will affect your
benefits?
…recibió asesoramiento sobre cómo el trabajo
afectará sus beneficios?
02
01
00
…receive help with transportation?
…recibió ayuda con el transporte?
01
00
02
…receive help with child or family care?
…recibió ayuda con cuidado de niños o la familia?
02
01
00
… use special equipment or devices?
…usó equipos o aparatos especiales?
01
00
02
(C1=>1 AND C15 = 00) AND (CP3j=01)
CP3k.1. What special equipment or devices did you use?
¿Qué equipaje o dispositivos especiales usó usted?
INTERVIEWER: CODE ALL THAT APPLY.
BRACE ....................................................................................... 01
CANE/CRUTCHES/WALKER..................................................... 02
118
SECTION C: CURRENT EMPLOYMENT
WHEELCHAIR............................................................................
MODIFIED COMPUTER HARDWARE .......................................
MODIFIED COMPUTER SOFTWARE .......................................
HEARING AID/DEVICE ..............................................................
SPECIAL GLASSES...................................................................
SPECIAL CHAIR/BACK SUPPORT ...........................................
SPECIAL SHOES/STOCKINGS .................................................
OTHER (SPECIFY) __________________________________
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(CP3k.1=06)
CP3k.1_oth.
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
119
d
r
03
04
05
07
08
09
10
06 (CP3k.1_oth)
d
r
SECTION C: CURRENT EMPLOYMENT
(C1=>1 AND C15 = 00)
CP3l.
Did {you/NAME} use or receive anything else to help find or keep working at {your/his/her} {main/current}
job?
Hizo {usted / NAME} uso de o recibir cualquier otra cosa para ayudar a encontrar o seguir trabajando en su
trabajo} (principal / actual)?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES .................................................................................
NO ...................................................................................
NOT APPLICABLE ..........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01 (CP3lm_oth)
00
na
d
r
(CP3l=01)
CP3lm_oth. INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C1=>1 AND C15 = 00 or 01)
CP4.
Did a friend, family member, coworker, caseworker, or anyone else help {you/him/her} find or keep working
[IF C15=00 keep working} {your/his/her} {main/current} job?
Un amigo, un familiar, compañero de trabajo, trabajador social, o cualquier otra persona le ayudó a {usted /
él / ella} encontrar o seguir trabajando en su trabajo} (principal / actual)?
PROBE: Help could include telling you about a job, helping you get ready for an interview, making a
connection for you, or giving you support or encouragement.
Ayuda podría incluir que le dice acerca de un trabajo, ayudando a prepararse para una entrevista, haciendo
una conexión para usted, o dar apoyo y estímulo.
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES ...................................................................................
NO ....................................................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................
(CP4=01)
CP5.
Who did {you/NAME} get help from?
01
00
d
r
(CP5)
(CP8)
(CP8)
(CP8)
De quien {ha/NAME} recibido ayuda?
CODE ALL THAT APPLY
A PARENT OR GUARDIAN ............................................
A SPOUSE OR PARTNER .............................................
ANOTHER RELATIVE ....................................................
A FRIEND OR MENTOR.................................................
AN EMPLOYER OR SUPERVISOR................................
A CO-WORKER ..............................................................
A CASEWORKER OR COUNSELOR .............................
A JOB COACH ................................................................
A MEDICAL PROVIDER .................................................
OTHER (SPECIFY) .........................................................
(CP5=10)
120
01
02
03
04
05
06
07
08
09
10 (CP5_oth.)
SECTION C: CURRENT EMPLOYMENT
CP5_oth.
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
121
d
r
SECTION C: CURRENT EMPLOYMENT
(CP4=01)
CP6.
What kind of help did {you/NAME} get from this person/these people?
¿Qué tipo de ayuda ha {usted / NAME} recibido de esta{s} persona{s}?
INTERVIEWER: CODE ALL THAT APPLY.
HELP CARING FOR CHILDREN OR OTHERS ..............
HELP WITH PERSONAL CARE .....................................
TRANSPORTATION .......................................................
HELP FINDING A JOB ....................................................
TRAINING .......................................................................
SOMEONE TO TALK TO/GET ADVICE .........................
HELP GETTING ACCOMMODATIONS ..........................
FINANCIAL ASSISTANCE ..............................................
OTHER (SPECIFY) .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
02
03
04
05
06
07
08
09 (CP6_oth)
d
r
(CP6=09)
CP6_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C1=>1 AND C15 = 00)
CP8.
How comfortable or uncomfortable {do you/does NAME} feel about discussing {your/his/her} disability or
health condition with others at {your/his/her} (current/main} job? Would you say…
¿Qué tan cómodo o incómodo {se/NAME} siente(s) acerca de discutir su condición de discapacidad o de su
salud con los demás en su empleo (principal/actual)? ¿Diría que…
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Very comfortable, ............................................................
Comfortable,....................................................................
Neither comfortable nor uncomfortable, ..........................
Uncomfortable, or ............................................................
Very uncomfortable .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
02
03
04
05
d
r
(C1=>1 AND C15 = 00)
CP7.
As far as you know does anyone at {your/NAME’s} {main/current} job know that {you have/he has/she has} a
disability?
En lo que usted sabe, ¿alguien de {su / del NAME} trabajo (principal / actual) sabe que {usted/él/ella} tiene
una discapacidad?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
122
01
00
d
r
SECTION C: CURRENT EMPLOYMENT
(C1=>1 AND C15 = 00)
CP9a.
At this job, do most of the other workers have disabilities?
En este trabajo, ¿la mayoría de los demás trabajadores tienen discapacidades?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C1=>1 AND C15 = 00)
CP9b.
Could this job have been taken by anybody who applied for it and was qualified, including someone who
does not have a disability?
¿Podría haber tomado este trabajo cualquier persona que lo solicitara y estuviera calificada, incluso
alguien que no tenga una discapacidad?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C1=>1 AND C15=00)
C16.
{Have you/Has NAME} received any promotions at {your/his/her} {main/current} job during the past 12
months?
¿Recibió [usted/NAME] alguna promoción en este empleo durante los últimos 12 (doce) meses?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B24=01)
C17.
CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (C19)
NO .............................................................................................. 00
(C1>=1 AND C17=00)
C18.
Taking all things into account, how satisfied are you with your {main/current} job? Would you say
Tomando todo en cuenta, ¿cuán satisfecha(o) está {usted/NAME} en su empleo {principal/actual}? ¿Diría
usted:
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Very satisfied,
Muy satisfecho, .........................................................................
Somewhat satisfied,
algo satisfecho, .........................................................................
Not very satisfied, or
no muy satisfecho, o..................................................................
Not at all satisfied?
nada satisfecho? .......................................................................
DON’T KNOW ...........................................................................
REFUSED .................................................................................
123
01
02
03
04
d
r
SECTION C: CURRENT EMPLOYMENT
(B24=01)
C19.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (C21)
NO .............................................................................................. 00
(C1>=1 AND C19=00)
C20.
I am going to read to you a list of benefits that some employers offer their employees. Please tell me whether
or not {your/NAME’s} {main/current} employer offers {you/him/her} any of these benefits.
Ahora quisiera hacer algunas preguntas más acerca {de su/del} empleo {principal/actual} {de NAME}. Le voy
a leer una lista de beneficios que algunos empleadores ofrecen a sus empleados. Por favor dígame si {su
empleador/el empleador} {principal/actual} {de NAME} le ofrece cualquiera de estos beneficios.
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Does {your/NAME’s} employer offer {you/NAME}
¿{Su empleador principal/el empleador principal de {NAME} le ofreció a {usted/NAME}…
PROBE:
Please answer ‘yes’ if {you are/NAME is} eligible for the benefit but {haven’t/hasn’t} yet started to
receive it.
Por favor conteste 'sí', si {usted/NAME} es elegible para el beneficio, pero aún no empezó a
recibirlo.
a.
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
Dental benefits?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Beneficios dentales (atención para los dientes)?
c.
NO
Health care insurance? (IF NECESSARY: medical and/or
hospital)
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Seguro médico o 'Health care insurance'? (IF NECESSARY:
de salud y/o de hospital)
b.
YES
Sick days with pay?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Días de enfermedad con pago?
d.
Paid vacation?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Vacaciones pagadas?
e.
Free or low-cost childcare?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
'Childcare' o cuidado de niños gratis o de bajo costo?
f.
Transportation, a transportation allowance, or transportation
discounts?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Transporte, un subsidio de transporte, o transporte con
descuento?
g.
Long-term disability benefits?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Beneficios por incapacidad de plazo-largo (long-term
disability)?
124
SECTION C: CURRENT EMPLOYMENT
h.
Pension or retirement benefits?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Pensión o beneficios de jubilación?
i.
01
00
d
r
01
00
d
r
Flexible health or dependent care spending accounts?
¿Ofrece {su/el} empleador {principal/actual} {de NAME} . . .
Cuentas de gastos médicos flexibles o para la atención médica
de dependientes
(C1>=1)
C21.
CHECK: DOES {NAME} HAVE MORE THAN ONE CURRENT JOB (C1>01)?
YES ............................................................................................ 01
NO .............................................................................................. 00
(C1>=1)
C32.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (C34)
NO .............................................................................................. 00
125
SECTION C: CURRENT EMPLOYMENT
(C1>=1 AND C32=00)
C33.
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Please tell me whether or not {your/NAME’s} {main/current} employer has made any of these changes
because of {your/his/her} physical or mental health condition. Has {your/NAME’s} employer because of
{your/his/her} physical or mental health condition…
Por favor dígame si {su/el} empleador {principal/actual} {de NAME} hizo o no hizo cualquiera de estos
cambios por causa de su condición física o mental. ¿Por causa de su condición física o mental {su
empleador/el empleador de NAME}. ..
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:
{Your/NAME’s} main job is the job we have been talking about.
{you work/(he/she) works} the most hours.
The one at which
{Su trabajo principal/El trabajo principal de NAME} es el trabajo de que hemos estado hablando.
En el que {usted/él/ella} trabaja la mayor cantidad de horas.
a.
YES
NO
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
cambió las tareas que {usted/NAME} recibe o la forma en la
que se desempeñan las tareas? (PROBE: Por ejemplo: un
trabajo más ligero o con tareas menos difíciles, para
acomodar en el lugar de trabajo a la condición de
[usted/NAME].
01
00
d
r
Made any changes to the physical work environment to make
things easier for {you/NAME}?
01
00
d
r
Provided {you/NAME} with any special equipment or assistive
technology?
(PROBE: For example special tools or equipment, software,
or devices to accommodate {your/NAME’s} condition in the
workplace.)
ha proporcionado a {usted/NAME} algún aparato o equipo
especial o alguna tecnología de asistencia? (PROBE: Por
ejemplo herramientas o equipos especiales, programas de
computadora (software), o aparatos que sirven para
acomodar en el lugar de trabajo a la condición {suya/de
NAME} )
b.
Made any changes in {your/NAME’s} work schedule?
(PROBE: For example, working fewer hours, changing the
time {you arrive or leave/(he/she) arrives or leaves}, or taking
more breaks to accommodate {your/NAME’s} condition in the
workplace.)
ha hecho algún cambio en {su/el} horario de trabajo {de
NAME} ? (PROBE: Por ejemplo: trabajar menos horas,
cambió la hora que {usted/(él/ella)} llega al trabajo o la hora
que termina el trabajo, o tomar más recreos o descansos
(breaks) para acomodar en el lugar de trabajo a la condición
{suya/de NAME}.
c.
d.
Made any changes to the tasks {you were/NAME was}
assigned or how they are performed?
(PROBE: For example, a light duty job or less demanding job
tasks to accommodate {your/NAME’s} condition in the
workplace.)
126
SECTION C: CURRENT EMPLOYMENT
(PROBE: For example, modifying {your/his/her} work area,
improving accessibility in the building, or providing assigned
parking to accommodate {your/NAME’s} condition in the
workplace.)
hizo cambios físicos en el ambiente de trabajo para que le
sea más fácil a {usted/NAME}? (PROBE: Por ejemplo,
haciendo modificaciones en su área de trabajo, mejorando la
accesabilidad al edificio, o proporcionando un lugar de
estacionamiento asignado para acomodar en el lugar de
trabajo a la condición {suya/de NAME}..
e.
Arranged for co-workers or others to assist {you/NAME}?
(PROBE: For example, providing a personal care attendant,
interpreter, or job coach while at work.)
hizo arreglos para que colegas de trabajo u otras personas
(lo/la) ayuden a {usted/NAME} ? (PROBE: Por ejemplo:
proporcionando un(a) asistente de atención personal, un
intérprete, o un job coach o entrenador de empleo, mientras
está trabajando.)
f.
01
00
d
r
01
00
d
r
Made any other changes that I didn’t mention to
accommodate {your/NAME’s} condition in the workplace?
hizo algún otro cambio que no mencioné para acomodar la
condición que {usted/NAME}tiene en su lugar de trabajo?
PROGRAMMER: IF C33f=01, GO TO C33f_Other, ELSE GO TO C34.
(C32=00 and C33f=01)
C33f_Other. What other changes?
¿Qué otros cambios?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
127
d
r
SECTION C: CURRENT EMPLOYMENT
(C1>=1)
C34.
Are there any changes in {your/NAME’s} {main/current} job or workplace related to {your/his/her} physical or
mental health condition that {you need/(he/she) needs}, but that have not been made?
¿Hay cualquier cambio relacionado a su condición física o mental que {usted/NAME} necesita en su lugar de
empleo (o trabajo) {principal/actual}, pero que no se ha hecho?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:
{Your/NAME’s} main job is the job that we have been talking about.
{you work/(he/she) works} the most hours.
The one at which
{Su trabajo principal/El trabajo principal de NAME} es el trabajo de que hemos estado hablando.
En el que {usted/él/ella} trabaja la mayor cantidad de horas.
YES ............................................................................................ 01
NO .............................................................................................. 00 (CP12)
DON’T KNOW ............................................................................ d (CP12)
REFUSED .................................................................................. r (CP12)
(C34=01)
C35.
What are those changes?
¿Cuáles son esos cambios?
PROBE:
Anything else?
¿Algo más?
INTERVIEWER: ENTER VERBATIM RESPONSE
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C34=01)
C36.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (C38)
NO .............................................................................................. 00
(C34=01 and C36=00)
C37.
Did {you/NAME} or anyone else ask {your/his/her} employer for (any of) these changes?
¿ {Usted/NAME}o alguna otra persona pidió a su empleador que haga (cualquiera de) estos cambios?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C1=>1)
CP12. Is there anything special about {your/NAME’s} {main/current} job that helps {you/NAME} to keep working with
a disability?
¿Hay algo especial acerca de su trabajo (principal / actual) que permite {usted / NAME} trabajar con una
discapacidad?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES ............................................................................................ 01
NO .............................................................................................. 00 (CP13a)
DON’T KNOW ............................................................................ d (CP13a)
128
SECTION C: CURRENT EMPLOYMENT
REFUSED ..................................................................................
129
r (CP13a)
SECTION C: CURRENT EMPLOYMENT
(CP12=01)
CP12a. What is special about {your/NAME’s} {main/current} job that helps {you/NAME} to keep working with a
disability?
¿Qué tenía de especial el trabajo (principal/actual) que ayuda {ha usted / ha NAME} seguir trabajar con una
discapacidad?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿Algo más?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
MODIFIED JOB DUTIES.................................................
SPECIAL EQUIPMENT OR MODIFIED SPACE .............
FLEXIBLE SCHEDULE ...................................................
WORK AT HOME ............................................................
HEALTH INSURANCE ....................................................
SICK LEAVE ...................................................................
SUPERVISOR UNDERSTANDS DISABILITY NEEDS ...
CO-WORKER ASSISTANCE ..........................................
OTHER(SPECIFY) .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
02
03
04
05
06
07
08
09 (CP12a_oth)
d
r
(CP12a=09)
CP12a_oth. What else about {your/NAME’s} {main/current} job allows {you/NAME} to keep working?
¿Qué más ayudó {usted / NAME} para seguir trabajando en su trabajo (principal/actual)?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C1=>1)
CP13a. Next I am going to ask you about types of problems some people experience that could cause them to work
less or stop working. During the past year, did {you/NAME} have any problems with {your/NAME’s} health,
that caused {you/him/her} to work less or stop working, for example worsening illness or the need to go to
medical appointments?
A continuación, voy a preguntarle acerca de los tipos de problemas que algunas personas experimentan, que
puede causarles a trabajar menos o dejar de trabjar. Durante el pasado año, {usted / NAME} ha tenido algún
problema con {su/NAME’S} salud que causó {usted / él / ella} trabajar menos o dejar de trabajar, por ejemplo,
la enfermedad empeora o la necesidad de ir a las citas médicas?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
130
01
00
d
r
SECTION C: CURRENT EMPLOYMENT
(CP13a=01)
CP13.a1.What was it about {your/NAME’s} health that might have caused {you/NAME} to have to work less or stop
working?
¿Qué es de {su/NAME} salud que podrían causado que trabaje menos o dejar de trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿Algo más?
EXISTING HEALTH PROBLEM GETS WORSE ........................
NEW HEALTH PROBLEM STARTS ..........................................
GET INJURED ...........................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH .........................
NEED TO BE HOSPITALIZED ...................................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG .......................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY...............
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ...............................
WORK IS TOO TIRING OR STRESSFUL .................................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15 (CP13.a1_oth)
d
r
(CP13.a1=15)
CP13.a1_Oth. INTERVIEWER: Please specify.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C1=>1)
CP13b. During the past year, did {you/NAME} have any problems with {your/NAME’s} job, that caused {you/him/her}
to work less or stop working, for example the need for accommodations, or problems with {your/NAME’s} coworkers?
¿Durante el pasado año, {usted / NAME} ha tenido algún problema con su trabajo que causó {usted / él / ella}
trabajar menos o dejar de trabajar, por ejemplo por la necesidad de arreglos o problemas con compañeros
de trabajo?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
131
01
00
d
r
SECTION C: CURRENT EMPLOYMENT
(CP13b=01)
CP13.b1. What was it about {your/NAME’s} {main/current} job that might have caused {you/NAME} to have to work
less or stop working?
¿Qué es de {su/NAME} trabajo (actual/principal) que podrían causado que trabaje menos o dejar de trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿Algo más?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
JOB DOES NOT PAY ENOUGH ................................................ 01
JOB DOES NOT OFFER HEALTH INSURANCE BENEFITS .... 02
NEED A DIFFERENT SCHEDULE OR SHIFT ........................... 03
NEED TIME TO GO TO MEDICAL APPOINTMENTS ............... 04
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................ 05
HEALTH INTERFERES WITH JOB PERFORMANCE............... 06
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK ....................................... 07
PAIN INTERFERES WITH WORKING A SET SCHEDULE ....... 08
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ...................................................................... 09
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ............................... 10
FOUND ANOTHER JOB (NEW) ................................................ 20
WORK SCHEDULE (NEW) ........................................................ 22
DID NOT LIKE/GET ALONG WITH CO-WORKERS (NEW) ...... 23
DID NOT LIKE/GET ALONG WITH MANAGER, SUPERVISOR,
OR BOSS (NEW) ....................................................................... 24
DID NOT LIKE/GET ALONG WITH OTHER STAFF
RESPONSIBLE FOR HIRING OR PROVIDING
ACCOMMODATIONS (SUCH AS HUMAN RESOURCES) (NEW) 25
OTHER (SPECIFY) .................................................................... 11 (CP13b1_oth)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(CP13.b1=11)
CP13.b1_Oth. INTERVIEWER: Please specify.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C1=>1)
CP13c. During the past year, did {you/NAME} have any problems with {Your/NAME’s} personal circumstances, that
caused {you/him/her} to work less or stop working, for example the need for childcare, not having reliable
transportation, or worry about losing other benefits?
Durante el pasado año, {usted / NAME} ha tenido algún problema con circunstancias personales que causó
{usted / él / ella} trabajar menos o deja de trabajar, por ejemplo la necesidad de cuidado de los hijos, no tener
transporte confiable, o preocuparse por la pérdida de otros beneficios?
132
SECTION C: CURRENT EMPLOYMENT
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
00
d
r
(CP13c=01)
CP13.c1.What was it about {your/NAME’s} personal circumstances that might have caused {you/NAME} to have to
work less or stop working?
¿Qué es de {su/NAME} circunstancias personales que podrían causado que trabaje menos o dejar de
trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿Algo más?
NEED HELP CARING FOR CHILDREN OR OTHERS ..............
NEED PERSONAL ASSISTANCE .............................................
GET INJURED ...........................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE ..................................................
PERSONALITY CONFLICTS WITH OTHERS AT THE JOB .....
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB ..................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK ....................................................................
DRUG/ALCOHOL RELAPSE .....................................................
WOULD RATHER DO OTHER THINGS THAN WORK .............
DO NOT LIKE WORKING ..........................................................
WORK IS TOO TIRING OR STRESSFUL .................................
MOVED TO ANOTHER AREA (NEW) .......................................
LOSS OR POTENTIAL LOSS OF
GOVERNMENT BENEFITS (NEW) ...........................................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
21
12 (CP13.c1_oth)
d
r
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(CP13.c1=12)
CP13.c1_Oth. INTERVIEWER: Please specify.
01
02
03
04
05
06
07
08
09
10
11
19
133
SECTION C: CURRENT EMPLOYMENT
(CP13a=01 or CP13b=01 or CP13c=01)
CP14. What {did you/NAME do} or what things helped {you/NAME} to be able to keep working?
Que {hiciste usted/ hiso NAME} o que cosas le ayudo para seguir trabajando?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿Algo más?
(CP14=19)
CP14_oth.
WORKING FEWER HOURS A DAY ..........................................
WORKING FEWER DAYS A WEEK ..........................................
WORKING A DIFFERENT SHIFT ..............................................
A MORE FLEXIBLE SCHEDULE/ABLE TO START DAY LATER
HAVING/HAVING MORE SICK OR OTHER LEAVE .................
PERSONAL CARE ATTENDANT/PERSONAL ASSISTANT
TO HELP WITH GETTING READY AND/OR DO
HOUSEHOLD TASKS ................................................................
ASSISTANCE WITH WORK TASKS..........................................
MORE UNDERSTANDING EMPLOYER/CO-WORKERS .........
ASSISTIVE DEVICE AT WORK .................................................
PHYSICAL MODIFICATIONS OF WORKSPACE ......................
JOB COACH ..............................................................................
SIGN LANGUAGE INTERPRETER ...........................................
READER/INTERPRETER FOR THE BLIND ..............................
ON THE JOB TRAINING............................................................
BEHAVIORAL COACHING ........................................................
BENEFITS COUNSELING .........................................................
TRANSPORTATION ASSISTANCE...........................................
CHILD/FAMILY CARE ASSISTANCE ........................................
OTHER.......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
d
r
(CP14_Oth)
What other things helped {you/NAME} be able to keep working?
¿Qué otras cosas ayudaron {usted / NAME} para poder seguir trabajando?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C1>=1)
C38.
CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (C39a2)
NO .............................................................................................. 00
134
SECTION C: CURRENT EMPLOYMENT
(C1>=1 AND RTYPE=01)
C39.
Again, thinking about your {main/current} job, how much do you agree or disagree with each of the following
statements? Would you say you strongly agree, agree, disagree, or strongly disagree?
Otra vez, pensando acerca de su empleo (o trabajo) {principal/actual}, ¿cuánto está de acuerdo o desacuerdo
con cada una de las siguientes frases? ¿Diría que está muy de acuerdo, de acuerdo, en desacuerdo, o muy
en desacuerdo?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:
Your main job is the job that we have been talking about. The one at which you work the most
hours.
Su trabajo principales el trabajo de que hemos estado hablando. En el que ustedtrabaja la mayor
cantidad de horas.
a. You have a chance to develop your
abilities
b. Usted tiene una oportunidad de
desarrollar sus habilidades.
c. You have recognition or respect from
others
d. Usted tiene el reconocimiento o
respeto de otros.
e. You can work on your own in your job
if you want to
f. Usted puede trabajar
independientemente en su trabajo si
quiere.
g. You can work with others in a group
or team if you want to
h. Usted puede trabajar con otros en un
grupo o equipo si quiere.
i. Your work is interesting or enjoyable
j. Su trabajo es interesante o
agradable.
k. Your work gives you a feeling of
accomplishment or contribution
l. Su trabajo le da una sensación de
logro o contribución.
m. IF {NAME} IS NOT SELFEMPLOYED (C6=00, d, or r): Your
supervisor is supportive
Su supervisor le da apoyo.
ELSE: SKIP TO C39_h
n. Your co-workers are friendly and
supportive
o. Sus compañeros de trabajo son
amigables y dan apoyo.
STRONGLY
AGREE
AGREE
DISAGREE
STRONGLY
DISAGREE
NA
DON’T
KNOW
REFUSED
01
02
03
04
05
d
r
01
02
03
04
05
d
r
01
02
03
04
05
d
r
01
02
03
04
05
d
r
01
02
03
04
05
d
r
01
02
03
04
05
d
r
01
02
03
04
05
d
r
01
02
03
04
05
d
r
(C1>=1)
C39a2. Sometimes people work fewer hours or earn less money than they could in order to care for family members,
keep the cash benefits they need, or just to have more free time. In (your/NAME’s) {main/current} job, {do
you/ does he/ does she} work fewer hours or earn less money than {you/he/she} could for any reason?
135
SECTION C: CURRENT EMPLOYMENT
Algunas personas a veces trabajan menos horas o ganan menos dinero de lo que pudieran, para poder cuidar
o atender a miembros de su familia, o para recibir beneficios en efectivo que necesitan, o simplemente para
tener más tiempo libre. En {el/su} trabajo o empleo {principal/actual} {de NAME}, ¿trabaja {usted/NAME}
menos horas o gana menos dinero de lo que {usted/(él/ella)} pudiera, por cualquier razón?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES ............................................................................................ 01
NO .............................................................................................. 00 (C39_1)
DON’T KNOW ............................................................................ d (C39_1)
REFUSED .................................................................................. r (C39_1)
136
SECTION C: CURRENT EMPLOYMENT
(C1>=1 AND C39a2=01)
C39b. (Do you/Does NAME) work fewer hours or earn less money than (you/he/she) could because (you/he/she)…
¿Trabaja {usted/NAME} menos horas o gana menos dinero de lo que {usted/(él/ella)} podría, porque . . .
PROBE:
I need to ask everyone in our study the same questions, even if they don’t seem to apply to
(you/NAME).
Necesito hacer las mismas preguntas a todos los participantes en nuestro estudio, aún si no
parece que se aplican a {usted/NAME} .
INTERVIEWER NOTE: CODE NO IF NOT APPLICABLE
a.
{Are/Is} taking care of children or others?
está cuidando a niños o a otras personas?
b.
NO
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
{Are/Is} enrolled in school or a training program?
está (matriculado/matriculada) en un programa de estudio o
entretenimiento?
c.
YES
Want(s) to keep Medicare or Medicaid coverage?
quiere continuar teniendo su cobertura de Medicare o
Medicaid?
d1. Want(s) to keep Social Security disability cash benefits?
Quiere conservar los beneficios en efectivo por incapacidad
del Seguro Social?
d2. Want(s) to keep other benefits like food stamps, housing
assistance, or workers’ compensation?
Quiere continuar recibiendo otros beneficios, tal como
estampillas de comida o cupones de alimentos, asistencia
para la vivienda, o compensación de trabajadores?
e.
Just (do/does) not want to work more?
simplemente porque {usted/(él/ella)} no quiere trabajar más?
g.
{Are/is} in poor health or [have/has] health concerns?
¿{Usted/NAME} está en mal estado de salud o tiene
preocupaciones en relación a su salud?
f.
Are there any reasons I didn’t mention why (you are/NAME
is) working or earning less than (you/he/she) could?
¿Hay alguna otra razón que no he mencionado, y por la cual
{usted/NAME} trabaja menos o gana menos de lo que
{usted/(él/ella)}pudiera?
PROGRAMMER: IF C39b_f=01 GO TO C39f_Other, ELSE SKIP TO C39_1
(C39b_f=01)
C39f_Other What other reason?
¿Qué otra razón?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(C1>=1)
137
d
r
SECTION C: CURRENT EMPLOYMENT
C39_1. Have any of {your/NAME’s} disability-related benefits been reduced or ended because of {your/his/her}
{main/current} job?
¿Alguno de los beneficios que {usted/NAME} recibe relacionados a incapacidad, han sido reducidos o
terminados por causa de su empleo o trabajo {principal/actual}?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES ............................................................................................ 01
NO .............................................................................................. 00 (C39_3)
DON’T KNOW ............................................................................ d (C39_3)
REFUSED .................................................................................. r (C39_3)
138
SECTION C: CURRENT EMPLOYMENT
(C1>=1 AND C39_1=01)
C39_2 What benefits have been reduced or ended as a result of {your/NAME’s} {main/current} job?
¿Qué beneficios han sido reducidos o terminados como resultado del empleo o trabajo {principal/actual} que
{usted/NAME} tiene
INTERVIEWER: MARK ALL THAT APPLY.
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
PRIVATE DISABILITY INSURANCE..........................................
WORKERS’ COMPENSATION ..................................................
VETERANS’ BENEFITS.............................................................
MEDICARE ................................................................................
MEDICAID..................................................................................
SOCIAL SECURITY DISABILITY BENEFITS (SSI OR SSDI) ...
PUBLIC ASSISTANCE OR WELFARE ......................................
FOOD STAMPS .........................................................................
PERSONAL ASSISTANCE SERVICES (PAS) ..........................
UNEMPLOYMENT BENEFITS ..................................................
OTHER STATE DISABILITY BENEFITS ...................................
OTHER GOVERNMENT PROGRAMS ......................................
OTHER (SPECIFY) ....................................................................
01
02
03
04
05
06
07
08
09
10
11
12
13
(C39_2=13)
C39_2_Oth What other benefits?
¿Qué otros beneficios?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C1>=1)
C39_3. Now, I am going to read you a list of things that sometimes help people to work more hours or earn more
money. If any of these do not apply to {you/NAME}, please just say so. At [your/NAME’s] {main/current} job,
do you think that [you/she/he] could work or earn more if you/he/she had.
Ahora le voy a leer una lista de cosas que a veces ayudan a gente a trabajar más horas, o ganar más dinero.
Si alguno de estos no son aplicables a {usted/NAME} , por favor diga. En su empleo o trabajo¿cree usted
que {usted/NAME} pudiera trabajar o ganar más si {usted/(él/ella)} tuviera . . .
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
a.
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
Help with {your/his/her} own personal care such as bathing,
dressing, preparing meals, and doing housework?
ayuda para su atención o cuidado personal, tal como para
bañarse, vestirse, preparar comidas, y hacer quehaceres
domésticos?
c.
NO
Help caring for {your/his/her} children or others in the
household?
ayuda para cuidar a niños o a otros miembros de su hogar?
b.
YES
Reliable transportation to and from work?
transporte en el que puede confiar, para ir y regresar del
trabajo?
139
SECTION C: CURRENT EMPLOYMENT
d.
Better job skills?
mejores destrezas de empleo?
e.
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
Help with finding and getting a better job?
ayuda para encontrar y obtener un mejor empleo o trabajo?
g.
00
A job with a flexible work schedule?
un empleo o trabajo con un horario flexible de trabajo?
f.
01
Any special equipment or medical devices?
algún equipo especial o aparato médico?
PROGRAMMER: IF C39_3g=01, GO TO C39_3g_Other,
ELSE GO TO C39_3h.
h.
Is there anything else that I didn’t mention that would help
[you/NAME] work or earn more?
¿Hay alguna otra cosa que no he mencionado que le
ayudaría a {usted/NAME} trabajar o ganar más?
PROGRAMMER: IF C39_3h=01, GO TO C39_3h_Other, ELSE GO TO C39_4.
(C39_3g=01)
C39_3g_Other. What other special equipment or medical devices?
¿Qué otro equipo especial o aparato médico?
(C39_3h=01)
C39_3h_Other
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
What else?
¿Qué más?
(C1>=1)
C39_4.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
One last question about (your / NAME’s) {main/current} job. Because of {your/his/her} work, has Social
Security needed to make any changes to the amount of {your/his/her} disability benefits?
Una última pregunta acerca del empleo o trabajo que {usted/NAME} tiene. Por causa de su trabajo, ¿el
Seguro Social o Social Security ha necesitado hacer algún cambio en la suma que recibe por sus beneficios
por incapacidad?
PROBE: Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?
PROBE: ¿La suma del beneficio que {usted/NAME} recibe fue reducida o perdió [usted/él/ella] todos sus
beneficios?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
YES ............................................................................................ 01
NO .............................................................................................. 00 (C39_5)
DON’T KNOW ............................................................................ d (C39_5)
REFUSED .................................................................................. r (C39_5)
(C39_4=01)
C39_4a. Because of these changes has the Social Security Administration paid {you/NAME} the wrong benefit
amount?
140
SECTION C: CURRENT EMPLOYMENT
Por causa de estos cambios, la Administración del Seguro Social o Social Security Administration le pagó
a {usted/NAME} la suma equivocada en beneficios?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C1>=1)
C39_5.
{Were you/Was NAME} asked to re-pay benefits because the Social Security Administration overpaid
{you/him/her}?
¿Le pidieron que {usted/NAME} pague de vuelta los beneficios que le fueron sobre-pagados por la
Administración del Seguro Social o Social Security Administration?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C40a)
DON’T KNOW ............................................................................ d (C40a)
REFUSED .................................................................................. r (C40a)
(C39_5=01)
C39_6.
{Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/(he
was/she was} working while receiving benefits?
¿Le pidieron a {usted/NAME} que pague de vuelta a la Administración del Seguro Social o Social Security
Administration, porque {usted/(él/ella)}estaba trabajando mientras recibía beneficios?
YES ............................................................................................ 01 (C39_7)
NO .............................................................................................. 00 (C40a)
DON’T KNOW ............................................................................ d (C40a)
REFUSED .................................................................................. r (C40a)
141
SECTION C: CURRENT EMPLOYMENT
(C39_6=01)
C39_7.
Did {you/NAME} try to appeal or challenge the request to re-pay benefits to the Social Security
Administration?
¿{Usted/NAME} intentó apelar u objetar cuando le pidieron que pagara de vuelta los beneficios a la
Administración del Seguro Social o Social Security Administration?
YES ............................................................................................ 01 (C39_8)
NO .............................................................................................. 00 (CP16)
DON’T KNOW ............................................................................ d (CP16)
REFUSED .................................................................................. r (CP16)
(C39_7=01)
C39_8.
Did {you/NAME} end up repaying the full benefit amount, repaying some of the benefit amount, or did you
not repay any amount?
¿Terminó {you/NAME} pagando de vuelta la cantidad total de los beneficios, pagando de vuelta parte de
la cantidad total de los beneficios, o no pagó nada de vuelta?
REPAY FULL BENEFIT AMOUNT ............................................. 01
REPAY SOME BENEFIT AMOUNT ........................................... 02
DID NOT REPAY AND BENEFIT AMOUNT............................... 03
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C39_6=01)
CP16. Did {you/NAME} change how much {you/he/she} worked because {you were/he was/she was} asked to repay the Social Security Administration?
¿Cambió {Usted/NAME} cuánto {usted/(él/ella)} trabajó, porque se le pidió a {usted/(él/ella)} que devolviera
pagos a la Administración del Seguro Social?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C40a)
DON’T KNOW ............................................................................ d (C40a)
REFUSED .................................................................................. r (C40a)
(CP16=01)
CP16a. What did {you/NAME} change about the hours {you/he/she} worked? Did {you/he/she}….
¿Qué cambió {usted/NAME} acerca de las horas que trabajó? {Usted/(Él/Ella)}…
Reduce {your/his/her} work hours by a little,
Reducir sus horas de trabajo por un poco ..................................
Reduce {your/his/her} work hours by a lot,
Reducir sus horas de trabajo por mucho, ...................................
Increase {your/his/her} work hours by a little, or
Aumentar sus horas de trabajo por un poco ...............................
Increase {your/his/her} work hours by a lot?
Aumentar sus horas de trabajo por mucho .................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
d
r
(B24=01)
C40a. CHECK: WAS {NAME} WORKING DURING THE PAST 6 MONTHS (B24B = 01)?
YES ............................................................................................ 01 (C_B1)
NO .............................................................................................. 00 (C40b)
(B24=01)
C40b. CHECK: WAS {NAME} WORKING IN 2022 (B30 = 01)?
142
SECTION C: CURRENT EMPLOYMENT
YES ............................................................................................ 01 (D1)
NO .............................................................................................. 00 (SC1)
143
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
NOTE: This section asked of those working in the past 6 months but not currently working (B24=00 and
B24b=01)
(B24=00 and B24b=01, D, or R)
C_B1. Now I am going to ask some questions about the jobs {you/NAME} had during the last 6 months. When
answering these questions, please include both part-time and full-time jobs, but only include jobs {you /NAME}
held for pay or profit.
How many jobs did {you/NAME} have during the past 6 months?
Ahora voy a hacer algunas preguntas sobre los puestos de trabajo {usted / NAME} ha tenido durante los
últimos 6 meses. Al contestar estas preguntas, por favor incluya los dos trabajos a tiempo parcial y de tiempo
completo, pero sólo incluyen trabajos por pago o para tener ganancias.
¿Cuántos empleos [has usted / ha NAME} tenido durante los últimos 6 meses?
|__|__| NUMBER OF JOBS (1-15)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C_B1=>1)
C_B1a. What are the main reasons {you/NAME} decided to work?
¿Cuáles son las razónes principales por que {usted / NAME} decidido trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
TO HAVE MORE INCOME .............................................
TO FEEL BETTER ABOUT MYSELF/IMPROVE
WELL BEING ..................................................................
TO FEEL MORE INDEPENDENT ...................................
TO ACHIEVE PERSONAL CAREER GOALS .................
ENJOY WORKING/PERSONAL SATISFACTION ..........
DON’T WANT TO RELY ON BENEFITS.........................
HEALTH IMPROVED ......................................................
HAD MORE TIME/STOPPED DOING SOMETHING
ELSE ...............................................................................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
02
03
04
05
06
07
08
09
d
r
(C_B1a=09)
C_B2a_oth. INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
144
d
r
(C_B2a_oth)
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
PROGRAMMER: C_B2 THROUGH C_B14 ASKED FOR ALL JOBS WHEN C_B1>01
(C_B1=>1)
C_B2. PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB:
Let us start with {your/NAME’s} main job – that is, the job at which {you/(he/she)} worked the most hours.
What kind of work did {you/ NAME} do, that is, what was {your/NAME’s} occupation?
Comencemos con su trabajo principal {/ del NAME} - es decir, el trabajo en el que {usted/él/ella} trabaja más
horas.
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}?
PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
Now I would like to ask about {your/NAME’S} {second/third/fourth} job.
Ahora me gustaría preguntar acerca de su {NAME} {segundo/ tercer/ cuarto} trabajo.
What kind of work did {you/NAME} do, that is, what was {your/NAME’s} occupation?
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}?
ELSE (C_B1=01):
What kind of work did {you/NAME} do, that is, what was {your/NAME’s} occupation?
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high
school; sales clerk in a women’s shoe store.
PROBE 2: What were {your/NAME’S} main activities or duties? What else did {you/NAME} do? What else?
Did {you/NAME} supervise anyone?
Por ejemplo: proveedora de 'child-care' o cuidado de niños en un programa preescolar de una escuela
privada, maestro(a) de geometría en un 'public high school' o escuela secundaria pública; vendedor(a) en
una tienda de zapatos de mujeres.
¿Cuáles son su/sus actividades u obligaciones principales? ¿Qué más hace? ¿Algo más? ¿Es supervisor(a)
de alguien?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C_B1=>1)
C_B3. What kind of business was this?
¿Qué tipo de negocio es este?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For what type of organization or industry did {you/NAME} work? For example: accounting firm,
daycare center, educational facility, food services.
PROBE 2: What do they make, sell, or do where {you/NAME} worked?
PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses), or
retail trade (selling to customers) or something else?
Para qué tipo de organización o industria trabaja? Por ejemplo: una firma de contabilidad, un centro de
'daycare' para el cuidado de niños, una institución educacional, servicio de comida.
¿Qué es lo que producen, venden, o hacen en el lugar donde {usted/NAME} trabaja?
145
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
¿Es este un negocio de manufactura (fabrican un producto), negocio de venta al por mayor (venden a otros
negocios), o venta al por menor (venta a clientes) o alguna otra cosa?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(C_B1=>1)
C_B4amth.In what month and year did {you/NAME} start working there?
d
r
¿En qué mes y año empezó {usted/NAME} a trabajar allí?
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................
146
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1)
C_B4ayr.
PROBE 1: In what month and year did {you/NAME} start working there?
¿En qué mes y año empezó {usted/NAME} a trabajar allí?
INTERVIEWER: ENTER YEAR
PROBE 2: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
|__|__|__|__|
YEAR
(1956-2023)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C_B1=>1)
C_B5. SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (C_B4ayr) SHOULD BE GREATER THAN
OR EQUAL TO YEAR OF BIRTH (A04_d) PLUS 14 YEARS. IF RESPONDENT FAILS EDIT, INTERVIEWER
READ: I must have recorded an incorrect answer. I show that {you were/NAME was} born in (A04_d) and
{you/NAME} started working at this job in (C_B4ayr), which means {you/NAME} started working at this job
when {you were/he was/she was} (PROGRAMMER CALCULATE AND FILL AGE: C_B4aYR – YEAR OF
BIRTH) years old. Is that correct?
Debo haber anotado una respuesta incorrecta. Anoté que {usted/NAME} nació en (A04_d) y {usted/NAME}
empezó a trabajar en este trabajo en (C_B4yr), lo que significa que {usted/NAME} empezó a trabajar en este
trabajo cuando {usted/(él/ella)} tenía (PROGRAMMER CALCULATE AND FILL AGE: C_B4YR – YEAR OF
BIRTH)) años. ¿Es eso correcto?
YES ............................................................................................ 01
NO .............................................................................................. 02 (CHANGE C_B4ayr)
SUPPRESS ................................................................................ 03
(C_B1=>1)
C_B4bmth. In what month and year did {you/NAME} stop working there?
¿En qué mes y año {usted / NOMBRE} dejó de trabajar allí?
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C_B1=>1)
C_B4byr. PROBE 1: In what month and year did {you/NAME} stop working there?
¿En qué mes y año {usted / NOMBRE} dejó de trabajar allí?
PROBE 2: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: ENTER YEAR
|__|__|__|__|
YEAR
(1956-2023)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
147
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
C_B5acheck1. SOFT EDIT: DATE {NAME} STOPPED WORKING AT THIS JOB (C_B4bmth, C_B4byr) SHOULD
BE LATER THAN DATE {NAME} STARTED WORKING AT THIS JOB (C_B4amth, C_Ba4yr). IF
RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I
show that {you/NAME} started working at this job in (C_B4amth, C_Ba4yr) and that (you/NAME)
stopped working at this job in (C_B4bmth, C_B4byr). Is that correct?
Debo haber anotado una respuesta incorrecta. Anoté que {usted/NAME} empezó a trabajar en este
trabajo en (C_B4amth, C_Ba4yr) y que (usted/NAME) dejó de trabajar en este trabajo en (C_B4mth,
C_B4byr). ¿Es eso correcto?
YES ............................................................................................
NO, CHANGE ANSWER TO C_B4b ..........................................
NO, CHANGE ANSWER TO CB4a ............................................
NO, CHANGE ANSWERS FOR BOTH C_B4a AND CB4b ........
SUPPRESS ................................................................................
148
01
02 (CHANGE C_B4b)
03 (CHANGE C_B4a)
04 (CHANGE C_B4a, C_B4b)
05
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
C_B5acheck2. SOFT EDIT: IF DATE {NAME} STOPPED WORKING AT THIS JOB (C_B4bmth, C_B4byr) AND
DATE {NAME} STARTED WORKING AT THIS JOB (C_B4amth, C_Ba4yr) ARE THE SAME
(C_B4amth, C_Ba4yr – C_B4bmth, C_B4byr = 0), INTERVIEWER READ: You said that
{you/NAME} started and stopped working at this job in (CB4a_mth, CB4a_yr). I’d like to verify that
{you/NAME} worked at this job for less than one month. Is this correct?
Usted dijo que {NAME} empezó y dejó de trabajar en este trabajo en (CB4a_mth, CB4a_yr). Me
gustaría verificar que {usted/NAME} trabajó en este trabajo por menos de un mes. ¿Es eso
correcto?
YES, WORKED AT JOB FOR LESS THAN ONE MONTH ........ 01
NO, WORKED AT JOB FOR MORE THAN ONE MONTH ......... 02 (CHANGE B4b or
B4a)
SUPPRESS ................................................................................ 03
C_B5acheck3. SOFT EDIT: IF YEAR {NAME} STOPPED WORKING AT THIS JOB MORE THAN 6 MONTHS AGO
(CURRENT DATE - C_B4bmth, C_B4byr => 7), INTERVIEWER READ: You said that {you/NAME}
stopped working at this job in (C_B4bmth,C_B4byr). That is more than six months ago. Is this
correct?
Usted dijo que {usted/NAME} dejó de trabajar en este trabajo en (C_B4bmth, C_B4byr). Eso es más
de seis meses atrás. ¿Es eso correcto?
YES, JOB ENDED MORE THAN 6 MONTHS AGO ................... 01 (C_B5d)
NO, JOB DID ENDED WITHIN THE PAST 6 MONTHS ............ 02
SUPPRESS ................................................................................ 03
C_B5d. CHECK: DID THIS JOB END MORE THAN 6 MONTHS AGO (CB5acheck3=01)?
YES ............................................................................................ 01 (CHANGE B24b)
NO .............................................................................................. 00
(C_B1=>1)
C_B5A. Beneficiaries do not always know that they should report a change in work status to Social Security. Did
{you/NAME} let Social Security know that {you were/ (he/she) was} working?
Beneficiarios no siempre saben que deben de notificar al Social Security (Seguro Social) acerca de cambios
en su 'estatus' o condición de trabajo. ¿Notificó {usted/NAME} al Social Security alrededor de que tiempo
que {usted/(él/ella)}estaba trabajando?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B6)
DON’T KNOW ............................................................................ d (C_B6)
REFUSED .................................................................................. r (C_B6)
(C_B5a=01)
C_B5B. How soon after {you/NAME} started this job did {you/NAME} tell Social Security {you were/(he/she) was}
working?
Cuánto tiempo después de que {usted/NOMBRE} empezara este trabajo, le dijo al Social Security que
{USTED/él/ella} estaba trabajando?
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: IF R TOLD SSA BEFORE STARTED WORKING, CODE AS 1 WEEK.
WEEKS ...................................................................................... 01 (C_B5BWeek)
MONTHS .................................................................................... 02 (C_B5BMonth)
DON’T KNOW ............................................................................ d (C_B5C)
REFUSED .................................................................................. r (C_B5C)
(C_B5a=01 and C_B5b=01)
C_B5BWEEK. INTERVIEWER: ENTER NUMBER OF WEEKS
149
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
| | | WEEKS
(1-52)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
150
d (C_B5C)
r (C_B5C)
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B5a=01 and C_B5b=02)
C_B5BMonth. INTERVIEWER: ENTER NUMBER OF MONTHS
| | | MONTHS
(1-12)
DON’T ........................................................................................
REFUSED ..................................................................................
d (C_B5C)
r (C_B5C)
(C_B5a=01)
C_B5C. How did {you/NAME} let Social Security know {you were/(he/she) was} working?
PROBE: Did {you/NAME} call, visit, or write the Social Security Administration, go online or use a mobile app,
or did your employer or someone else report you working?
¿Cómo le dejo saber {usted/NAME} al Social Security que estaba trabajando?
PROBE: ¿{Usted/NAME} llamó, visitó o escribió a la Administración del Seguro Social, se comunicó por
Internet o utilizó una aplicación móvil, o su empleador u otra persona reportó que {usted/NAME} estaba
trabajando?
INTERVIEWER: CODE ALL THAT APPLY.
CALLED SSA/REPORTED BY PHONE .....................................
VISITED SSA FIELD OFFICE/REPORTED IN PERSON ..........
WROTE SSA/REPORTED BY MAIL ..........................................
REPORTED ONLINE OR USING MOBILE APP ........................
EMPLOYER REPORTED TO SSA ............................................
SERVICE PROVIDER REPORTED TO SSA .............................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
d
r
(C_B1=>1)
C_B6. {Were you/Was NAME} self-employed at this job? Self-employed means that {you work/NAME works} for
{yourself/themselves} or {own your/owns their} own business.
¿Estaba {usted/NAME} autoempleado/autoempleada en este trabajo? Autoempleado/Autoempleada, o
Self-employed en inglés, significa que {usted/NAME} trabaja para {usted/él mismo/ella misma} o es {dueño/
dueña} de su propio negocio.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B1=>1)
C_B8. How many hours per week did {you/NAME} usually work at this job?
¿Cuántas horas por semana generalmente trabajó {usted/NAME} en este empleo?
PROBE: Include overtime if {you/he/she} usually worked overtime.
Incluya 'overtime' o sobretiempo si {usted/(él/ella)} generalmente trabaja horas extra
|
|
|
| HOURS PER WEEK (1-60)
(1-168)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C_B1=>1)
C_B9. How many weeks per year did {you/NAME} usually work at this job, including paid vacation and holidays?
¿Cuántas semanas por año generalmente trabajó {usted/NAME} en este empleo, incluyendo vacaciones
pagadas y feriados?
151
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
PROBE 1: There are 52 weeks in a year.
PROBE 2: Please include time off for vacation and holidays if {you were/NAME was} paid for that time.
PROBE 3: If {you/NAME} worked less than a year, please answer for the number of weeks {you/NAME}
worked.
Hay 52 (cincuentaidos) semanas en un año.
Por favor incluya tiempo libre por vacaciones y feriados si {usted/NAME} recibe pago por ese tiempo.
Si {usted/NAME} ha trabajado por menos de un año, por favor conteste en relación al número de
semanas que {usted/NAME} espera trabajar.
|
|
| WEEKS PER YEAR (1-52)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
152
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1)
C_B10. PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME was}
paid for this job. For {your/NAME’s} main job {you/he/she} held in the past six months {were you/was (he/she}
paid by the hour?
Para el propósito de este estudio, es importante para obtener información sobre cuánto
fue pagado en este trabajo. En { su / NAME} trabajo principal que {usted NAME} usted tuvo en los últimos
seis meses te pagaron por hora?
PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME was}
paid for {your/(his/her)} {second/third/fourth} job. For {your/NAME’s} {second/third/fourth} job {were you/was
(he/she} paid by the hour? ELSE (C_B1=01): For the purpose of this survey, it is important to obtain some
information on how much {you were/NAME was} paid for this job. For this job {were you/was (he/she} paid by
the hour?
Para el propósito de este estudio, es importante para obtener información sobre cuánto le paga {Name} en
{segundo/ tercer/cuarto} trabajo. En {su / del NAME} {segundo/ tercer/cuarto} trabajo está {usted / es (él / ella}
pagado por hora? ELSE (C_B1=01): Para los propósitos de esta encuesta, es importante obtener algo de
información sobre cuánto le pagaron {a usted/a NAME} por este trabajo. ¿Para este trabajo le pagaron por
hora?
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB.
PROBE:
{Your/NAME’s} main job is the job we have been talking about. The one at which {you /(he/she)}
worked the most hours.
{Su trabajo principal/El trabajo principal de NAME} es el trabajo de que hemos estado hablando.
En el que {usted/él/ella} trabaja la mayor cantidad de horas.
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B12amt)
DON’T KNOW ............................................................................ d (C_B12amt)
REFUSED .................................................................................. r (C_B12amt)
(C_B10=01)
C_B11. What was {your/NAME’s} regular hourly pay, including tips and commissions?
¿Que fue {su/el} sueldo regular por hora {de NAME}, incluyendo propinas y comisiones?
PROBE: IF LESS THAN $5.00 AN HOUR: Did this include tips and commissions?
¿Esto incluye propinas y comisiones?
INTERVIEWER: IF ENTERING AN AMOUNT WITH CENTS, PLEASE ENTER DECIMAL POINT
$|
|
|
|.|
|
| PER HOUR (1 – 25.00) (1 - 300.00)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C_B10=00, d, or r)
C_B12amt.
Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips
and commissions.
Antes de impuestos y otras deducciones, ¿cuánto le pagan a {usted/NAME} en este empleo,
incluyendo propinas y comisiones?
PROBE:
Was that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
¿Esa suma es su pago por día, por semana, por cada dos semanas, dos veces por mes, por
mes, o por año?
153
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|
|
|
|.|
|
|
| . 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B10=00, d, or r)
C_B12hop.
INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY (EVERY TWO WEEKS) ...................
TWICE A MONTH ................................................
MONTHLY............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................
154
01
02
03
04
05
06
d
r
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
PROGRAMMER: CALCULATE MONTHLY PRE-TAX PAY BASED ON C_B12AMT AND C12HOP FOR EACH JOB:
If C_B10=01, and C_B11and C_B8≠d or r, C_B _JobMnthPay(1)=c_B11*c_B8*4.35.
If C_B10=01 and C_B8 or C_B11=d, C_B_JobMnthPay(1)=d.
If C_B10=01 and C_B8 or C_B11=r and neither are d, C_B_JobMnthPay(1)=r.
If C_B10=00, d, or r and C_B12amt or C_B12hop=d, C_B_JobMnthPay(1)=d.
If C_B10=00, d, or r and C_B12amt or C_B12hop=r, and neither are d, C_B_JobMnthPay(1)=r.
If C_B10=00, d, or r and c_B12hop=1, C_B_JobMnthPay(1)=c_B12amt*21.74.
If C_B10=00, d, or r and c_B12hop=2, C_B_JobMnthPay(1)=c_B12amt*4.35.
If C_B10=00, d, or r and c_B12hop=3, C_B_JobMnthPay(1)=c_B12amt*2.17.
If C_B10=00, d, or r and c_B12hop=4, C_B_JobMnthPay(1)=c_B12amt*2.
If C_B10=00, d, or r and c_B12hop=5, C_B_JobMnthPay(1)=c_B12amt.
If C_B10=00, d, or r and c_B12hop=6, C_B_JobMnthPay(1)=c_B12amt/12.
(C_B10=00, d, or r)
C_B13amt.
For this job, about how much was left as take-home pay after taxes and other deductions?
En este empleo, ¿más o menos cuánto le queda de su pago para llevar a casa, después de
impuestos y otras deducciones?
PROBE:
Was that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
Era suma es su pago por día, por semana, por cada dos semanas, dos veces por mes, por mes,
o por año?
INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|
|
|
|.|
|
|
| . 00
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(C_B10=00, d, or r)
C_B13hop. INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY (EVERY TWO WEEKS) ...................
TWICE A MONTH ................................................
MONTHLY ............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................
155
01
02
03
04
05
06
d
r
d
r
(1-346)
(1-1,730)
(1-3,750)
(1-3,750)
(1-7,500)
(1-90,000)
(1-1,730)
(1-8,653)
(1-18,750)
(1-18,750)
(1-37,500)
(1-450,000)
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
PROGRAMMER: CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON C13AMT AND C13HOP:
If C_B10=01 and C_B11 and C_B8≠d or r, C_B_JobMnthPayTH(1)=c_B11*c_B8*4.35.
If C_B10=01 and C_B8_1 or C_B11=d, C_B_JobMnthPayTH(1)=d.
If C_B10=01 and C_B8_1 or C_B11=r and neither are d, C_B_JobMnthPayTH(1)=r.
If C_B10=00, d, or r and C_B13amt or C_B13hop=d, C_B_JobMnthPayTH(1)=d.
If C_B10=00, d, or r and C_B13amt or C_B13hop=r, and neither are d, C_B_JobMnthPayTH(1)=r.
If C_B10=00, d, or r and c_B13hop=1, C_B_JobMnthPayTH(1)=c_B13amt*21.74.
If C_B10=00, d, or r and c_B13hop=2, C_B_JobMnthPayTH(1) =c_B13amt*4.35.
If C_B10=00, d, or r and c_B13hop=3, C_B_JobMnthPayTH(1)=c_B13amt*2.17.
If C_B10=00, d, or r and c_B13hop=4, C_B_JobMnthPayTH(1)=c_B13amt*2.
If C_B10=00, d, or r and c_B13hop=5, C_B_JobMnthPayTH(1)=c_B13amt.
If C_B10=00, d, or r and c_B13hop=6, C_B_JobMnthPayTH(1)=c_B13amt/12.
(C_B10=00, d, or r) and (C_B12hop=01, 02, 03, 04, 05, or 06) and (C_B13hop=01, 02, 03, 04, 05, or 06)
C_B14. SOFT EDIT: AMOUNT OF TAKE-HOME PAY MUST BE LESS THAN OR EQUAL T0 PRE-TAX PAY. IF
AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND
AMOUNT OF CALCULATED MONTHLY PRE-TAX PAY (C_JobMnthPay(1)) NE D OR R, AND
C_JobMnthPayTH(1) > C_JobMnthPay(1), TRIGGER EDIT AND DISPLAY FOLLOWING TEXT:
INTERVIEWER, AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY IS GREATER THAN AMOUNT
OF CALCULATED PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an
incorrect answer. You said that {you were/NAME was} paid (C_B12amt) per (C_B12hop) before taxes and
other deductions which would be about (C_B_JobMnthPay(1) per month and that (C_B13amt) per
(C_B13hop), or about (C_B_JobMnthPayTH(1) per month, is left as take-home pay after taxes and other
deductions. Based on what I recorded, {your/NAME’s} take home pay was more than {your/NAME’s} pre-tax
pay. Should I change the amount {you were/NAME was} paid before taxes and other deductions or the amount
{you/NAME} took home after taxes and other deductions?
Debo haber anotado una respuesta incorrecta. Dijo que a {usted/NAME} se le pagan (C_B12amt) por
(C_B12hop) antes de impuestos y otras deducciones, lo que sería aproximadamente (C_JobMnthPay(1) por
mes y que (C_B13amt) por (C_B13hop), o aproximadamente (C_BJobMnthPayTH(1) por mes, sobra como
sueldo neto después de impuestos y otras deducciones. Basado en lo que anoté, su sueldo neto es más que
su sueldo antes de impuestos. ¿Debo cambiar la cantidad que se le pagan a {usted/NAME] antes de los
impuestos y otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ...........................................................................
CHANGE AMOUNT OF TAKE-HOME PAY ...............................
SUPPRESS ................................................................................
156
01 CHANGE C_B12amt)
02 (CHANGE C_B13amt)
03
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B10=00, d, or r) and (C_B12hop=01, 02, 03, 04, 05, or 06) and (C_B13hop=01, 02, 03, 04, 05, or 06)
C_B14a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND
CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF TAKE MONTHLY
HOME PAY (C_B_JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY
(C_B_JobMnthPay(1)) NE D OR R, AND (C_B_JobMnthPay(1) – C_B_JobMnthPayTH(1) /
C_B_JobMnthPayTH(1) > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER,
DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND CALCULATED
MONTHLY PRE-TAX PAY IS GREATER THAN 30%. CHECK ENTRY. IF NECESSARY READ: I may have
recorded an incorrect answer. You said that {you were/NAME was} paid (C_B12amt) per (C_B12hop) before
taxes and other deductions which would be about (C_B_JobMnthPay(1) per month and that (C_B13amt) per
(C_B13hop), or about (C_B_JobMnthPayTH(1) per month was left as take-home pay after taxes and other
deductions. Is this correct or should I change the amount {you were/NAME was} paid before taxes and other
deductions or the amount {you/NAME} took home after taxes and other deductions?
Debo haber anotado una respuesta incorrecta. Dijo que a {usted/NAME} se le pagan (C_B12amt) por
(C_B12hop) antes de impuestos y otras deducciones, lo que sería aproximadamente (C_JobMnthPay(1) por
mes y que (C_B13amt) por (C_B13hop), o aproximadamente (C_BJobMnthPayTH(1) por mes, sobra como
sueldo neto después de impuestos y otras deducciones. Basado en lo que anoté, su sueldo neto es más que
su sueldo antes de impuestos. ¿Debo cambiar la cantidad que se le pagan a {usted/NAME] antes de los
impuestos y otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ...........................................................................
CHANGE AMOUNT OF TAKE-HOME PAY ...............................
SUPPRESS ................................................................................
01 CHANGE C_B12amt)
02 (CHANGE C_B13amt)
03
PROGRAMMER: CALCULATE TOTAL MONTHLY PAY FROM ALL JOBS COMBINED (TO BE USED LATER IN
SECTION K):
If C_B_JobMnthPay(1) or C_B_JobMnthPay(2) or C_B_JobMnthPay(3) (for all jobs listed)=d,
C_B_CurMnthPay=d.
If C_B_JobMnthPay(1) or C_B_JobMnthPay(2) or C_B_JobMnthPay(3) (for all jobs listed)=r, and
none=d, C_B_CurMnthPay=r. Else, C_B_CurMnthPay=Sum of (C_B_JobMnthPay(1) AND
C_B_JobMnthPay(2) AND C_B_JobMnthPay(3), etc. (for all jobs listed)).
IF C_B1 = 1, GO TO C_B15.
IF C_B1>1 AND HAVE NOT ASKED ABOUT ALL JOB, LOOP BACK TO C_B2.
(C_B1=>1)
C_B15. CHECK: WAS {NAME} SELF EMPLOYED (C_B6=01)?
YES ............................................................................................ 01 (C_BP4)
NO .............................................................................................. 00
157
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1 AND C_B15=00)
C_BP2. How did {you/NAME} find {your/his/her} [main] job?
¿Cómo {usted / NAME} encontró su trabajo principal?
PROGRAMMER: USE “MAIN” IF C_B1>01.
INTERVIEWER: CODE ALL THAT APPLY.
THROUGH STATE’S UNEMPLOYMENT OFFICE .........
AMERICAN JOBCENTER / A STATE/LOCAL
WORKFORCE CENTER .................................................
THROUGH FRIENDS OR RELATIVES ..........................
THROUGH JOB ADVERTISEMENTS IN A
NEWSPAPER OR ON THE INTERNET..........................
THROUGH THE STATE VOCATIONAL
REHABILITATION AGENCY OR {VRNAME
FROM {NAME’S} CURRENT STATE}.............................
THROUGH AN EMPLOYMENT AGENCY,
PROGRAM, OR EMPLOYMENT NETWORK (EN) .........
THROUGH THE TICKET TO WORK (TTW)
PROGRAM ......................................................................
BY CONTACTING A FORMER EMPLOYER ..................
BY CONTACTING ANY OTHER EMPLOYERS ..............
OTHER............................................................................
(C_BP2=10)
C_BP2_Oth.
01
02
03
04
05
06
07
08
09
10
(C_BP2_Oth)
What other way did {you/NAME} find this job?
¿Qué otro manera lo hizo {usted / NAME} para encontrar este trabajo?
Other (SPECIFY)
DON’T KNOW ................................................................. d (C_BP3)
REFUSED ....................................................................... r
(C_BP3)
(C_B1=>1 AND C_B15=00)
C_BP2a. CHECK: DID {NAME} MENTION MORE THAN ONE WAY FOUND MAIN JOB?
YES ............................................................................................ 01 (C_BP2b)
NO .............................................................................................. 00 (C_BP3)
158
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_BP2a = 01)
C_BP2b. What was the main way {you/NAME} found {your/his/her} [main] job?
¿Cuál fue la forma principal que {usted / NAME} {encontrado su/his/her trabajo} principal?
INTERVIEWER: CODE ALL THAT APPLY.
PROGRAMMER: USE “MAIN” IF C_B1>01.
THROUGH STATE’S UNEMPLOYMENT OFFICE .........
AMERICAN JOB CENTER / A STATE/LOCAL
WORKFORCE CENTER .................................................
THROUGH FRIENDS OR RELATIVES ..........................
THROUGH JOB ADVERTISEMENTS IN A
NEWSPAPER OR ON THE INTERNET..........................
THROUGH THE STATE VOCATIONAL
REHABILITATION AGENCY OR {VRSTATE
FROM {NAME’S} CURRENT STATE}.............................
THROUGH AN EMPLOYMENT AGENCY,
PROGRAM, OR EMPLOYMENT NETWORK (EN) .........
THROUGH THE TICKET TO WORK (TTW)
PROGRAM ......................................................................
BY CONTACTING A FORMER EMPLOYER ..................
BY CONTACTING ANY OTHER EMPLOYERS ..............
OTHER............................................................................
(C_BP2b=10)
C_BP2_Oth.
01
02
03
04
05
06
07
08
09
10
(C_BP2_Oth)
What other way did {you/NAME} find this job?
¿Qué otro manera lo hizo {usted / NAME} para encontrar este trabajo?
Other (SPECIFY)
DON’T KNOW.......................................................................................
REFUSED ............................................................................................
159
d (C_B P3)
r (C_BP3)
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1 AND C_B15=00)
C_BP3. I am going to read a list of things that some people use or receive to help them find or keep a job. Please tell
me if {you/NAME} used or received any of them to help find or work at {your/his/her} [main] job. Did
{you/NAME}…
Voy a leer una lista de las cosas que algunas personas utilizan o reciben para ayudarles a encontrar o
mantener un empleo. Por favor, dígame si {usted / NAME} utilizado alguna vez o ha recibido alguna de las
siguientes para ayudar a encontrar o seguir trabajando en el puesto de trabajo (principal) (que tiene / (él / ella
tiene) ahora. Hizo
PROGRAMMER: USE “MAIN” IF C_B1>01.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
YES
NO
NA
DON’T
KNOW
REFUSED
…have a job coach to help {you/him/her} learn how
to do {your/his/her} job?
…usó un entrenador de empleo (job coach) para
ayudarle a aprender a hacer su trabajo
01
00
02
d
r
…use a sign language interpreter?
…usó un intérprete de lenguaje de signos?
01
00
d
r
…use a reader or interpreter for the blind?
…usóun lector o intérprete para los ciegos?
01
00
d
r
d
r
d
r
d
r
d
r
d
r
d
r
d
r
…use an assistant or caregiver for personal care (IF
NEEDED: This includes help bathing or dressing to
get ready for work and eating lunch or using the
restroom at work)?
…usó un asistente o cuidador para el cuidado
personal?(IF Needed: ayuda para bañarse, vestirse,
o la preparación de comidas)
02
02
02
01
00
…use a personal care assistant or direct support
professional at work to help with job-related tasks?
(IF NEEDED: This includes help with writing, reading,
lifting, or reaching.)
…usó un asistente personal en el trabajo para ayudar
con las tareas relacionadas con el trabajo? (IF
NEEDED: Esto incluye ayuda con la escritura, la
lectura, el levantamiento o alcance.)
02
01
00
…receive on the job training?
…recibió capacitación en el trabajo?
01
00
02
…receive counseling about how work will affect your
benefits?
…recibió asesoramiento sobre cómo el trabajo
afectará sus beneficios?
02
01
00
…receive help with transportation?
…recibió ayuda con el transporte?
01
00
02
…receive help with child or family care?
…recibió ayuda con cuidado de niños o la familia?
02
01
00
… use special equipment or devices?
…usó equipos o aparatos especiales?
01
00
02
(C_BP3j=01)
C_BP3k.1.
What special equipment or devices did you use?
¿Qué equipaje o dispositivos especiales usó usted?
INTERVIEWER: CODE ALL THAT APPLY.
BRACE ....................................................................................... 01
CANE/CRUTCHES/WALKER..................................................... 02
WHEELCHAIR............................................................................ 03
160
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
MODIFIED COMPUTER HARDWARE .......................................
MODIFIED COMPUTER SOFTWARE .......................................
HEARING AID/DEVICE ..............................................................
SPECIAL GLASSES...................................................................
SPECIAL CHAIR/BACK SUPPORT ...........................................
SPECIAL SHOES/STOCKINGS .................................................
OTHER ___________________________________________
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(C_BP3k.1=06)
C_BP3k.1_oth.
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
161
d
r
04
05
07
08
09
10
06 (C_BP3k.1_oth.)
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1 AND C_B15=00)
C_BP3l. Did {you/NAME} use or receive anything else to help find or keep working at {your/his/her} [main] job?
Hizo {usted / NAME} uso de o recibir cualquier otra cosa para ayudar a encontrar o seguir trabajando en
su/his/her trabajo} (principal / actual)?
PROGRAMMER: USE “MAIN” IF C_B1>01.
YES .................................................................................
NO ...................................................................................
NA ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP3l=01)
C_BP3lm_oth.
01
00
na
d
r
(C_BP3lm_oth)
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C_B1=>1 AND C_B15=00 or 01)
C_BP4. Did a friend, family member, coworker, caseworker, or anyone else help {you/NAME} find {your/his/her} [main]
job?
Hizo un amigo, un familiar, compañero de trabajo, trabajador social, o cualquier otra persona ayuda {usted /
él / ella} encontrar o seguir trabajando en su trabajo} (principal / actual)?
PROBE: Help could include telling you about a job, helping you get ready for an interview, making a
connection for you, or giving you support or encouragement.
Ayuda podría incluir que le dice acerca de un trabajo, ayudando a prepararse para una entrevista, haciendo
una conexión para usted, o dar apoyo y estímulo.
PROGRAMMER: USE “MAIN” IF C_B1>01.
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP4=01)
C_BP5. Who did {you/NAME} get help from?
01
00
d
r
(C_BP5)
(C_BP8)
(C_BP8)
(C_BP8)
01
02
03
04
05
06
07
08
09
10
(C_BP5_oth)
De quien {ha/NAME} recibido ayuda?
INTERVIEWER: CODE ALL THAT APPLY
(C_BP5=10)
A PARENT OR GUARDIAN ............................................
A SPOUSE OR PARTNER .............................................
ANOTHER RELATIVE ....................................................
A FRIEND OR MENTOR.................................................
AN EMPLOYER OR SUPERVISOR................................
A CO-WORKER ..............................................................
A CASEWORKER OR COUNSELOR .............................
A JOB COACH ................................................................
A MEDICAL PROVIDER .................................................
OTHER............................................................................
162
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
C_BP5_oth.
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
163
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_BP4=01)
C_BP6. What kind of help did {you/NAME} get from these people?
¿Qué tipo de ayuda ha {usted / NAME} recibido de estas personas?
INTERVIEWER: CODE ALL THAT APPLY.
HELP CARING FOR CHILDREN OR OTHERS ................
HELP WITH PERSONAL CARE .......................................
TRANSPORTATION .........................................................
HELP FINDING A JOB......................................................
TRAINING .........................................................................
SOMEONE TO TALK TO/GET ADVICE ...........................
HELP GETTING ACCOMMODATIONS ............................
FINANCIAL ASSISTANCE................................................
OTHER .............................................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................
(C_BP6=09)
C_BP6_oth.
01
02
03
04
05
06
07
08
09
d
r
(C_BP6_oth)
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C_B1=>1 AND C_B15=00)
C_BP8. How comfortable or uncomfortable did {you/NAME} feel about discussing {your/his/her} disability or health
condition with others at {your/his/her} [main] job? Would you say…
¿Qué tan cómodo o incómodo {se/NAME} (sentiste, sintió} acerca de discutir su condición de discapacidad o
de su salud con los demás en su/his/her empleo principal/actual? ¿Diría que…
PROGRAMMER: USE “MAIN” IF C_B1>01
Very comfortable,
Muy cómodo, ....................................................................
Comfortable,
Cómodo, ...........................................................................
Neither comfortable nor uncomfortable,
Ni cómodo ni incómodo,....................................................
Uncomfortable, or
Incómodo, .........................................................................
Very uncomfortable
Muy incómodo...................................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................
01
02
03
04
05
d
r
(C_B1=>01 AND C_B15=00)
C_BP7. As far as you know did anyone at {your/NAME’s} [main] job know that {you have/he has/she has} a
disability?
En lo que usted sabe, ¿alguien de {su / del NAME} trabajo (principal / actual) sabía que usted tiene una
discapacidad?
PROGRAMMER: USE “MAIN” IF C_B1>01
YES .................................................................................
164
01
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
165
00
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1 AND C_B15 = 00)
C_BP9a. At this job, do most of the other workers have disabilities?
En este trabajo, ¿la mayoría de los demás trabajadores tienen discapacidades?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B1=>1 AND C_B15 = 00)
C_BP9b. Could this job have been taken by anybody who applied for it and was qualified, including someone who
does not have a disability?
¿Podría haber tomado este trabajo cualquier persona que lo solicitara y estuviera calificada, incluso
alguien que no tenga una discapacidad?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B1=>1 AND C_B15=00)
C_B16. Did {you/NAME} receive any promotions at this job?
¿Recibió {usted/NAME} alguna promoción en este empleo?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
166
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1 )
C_B19. CHECK: IS {NAME} SELF EMPLOYED (C_B6=01)?
YES ............................................................................................ 01 (CB_21)
NO .............................................................................................. 00
(C_B19=00)
C_B20. I am going to read to you a list of benefits that some employers offer their employees. Please tell me whether
or not {your/NAME’s} {main} employer offered {you/him/her} any of these benefits.
Le voy a leer una lista de beneficios que algunos empleadores ofrecen a sus empleados. Por favor dígame
si {su/el} empleador {principal/actual} {de NAME} le ofreció cualquiera de estos beneficios.
PROGRAMMER: USE “MAIN” IF C_B1>01
Did {your/NAME’s} (main) employer offer {you/NAME}
¿Ofrece {su/el} empleador {principal/actual} {de NAME}
PROBE:
Please answer ‘yes’ if {you were/NAME was} eligible for the benefit but didn’t yet start to receive
it when you stopped working at that job.
Por favor responda ‘sí’ si {uste/NAME} era elegible para el beneficio pero todavía no empezó a
recibirlo cuando dejó de trabajar en ese empleo.
a.
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
Pension or retirement benefits?
Pensión o beneficios de jubilación?
i.
r
Long-term disability benefits?
Beneficios por incapacidad de plazo-largo (long-term
disability)?
h.
d
Transportation, a transportation allowance, or transportation
discounts?
Transporte, un subsidio de transporte, o transporte con
descuento?
g.
00
Free or low-cost childcare?
'Childcare' o cuidado de niños gratis o de bajo costo?
f.
01
Paid vacation?
Vacaciones pagadas?
e.
REFUSED
Sick days with pay?
Días de enfermedad con pago?
d.
DON’T
KNOW
Dental benefits?
Beneficios dentales (atención para los dientes)?
c.
NO
Health care insurance? (IF NECESSARY: medical and/or
hospital)
Seguro médico o 'Health care insurance'? (IF NECESSARY:
de salud y/o de hospital)
b.
YES
Flexible health or dependent care spending accounts?
Cuentas de gastos médicos flexibles o para la atención médica
de dependientes?
(C_B1=>1)
167
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
C_B32. CHECK: WAS {NAME} SELF EMPLOYED (C_B6=01)?
YES ............................................................................................ 01 (C_B34)
NO .............................................................................................. 00
168
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B32=00)
C_B33. PROGRAMMER: USE “MAIN” IF C_B1>01.
Please tell me whether or not {your/NAME’s} {main} employer made any of these changes because of
{your/his/her} physical or mental health condition. Did {your/NAME’s} employer, because of {your/his/her}
physical or mental health condition, …
Por favor dígame si {su/el} empleador {principal/actual} {de NAME} hizo o no hizo cualquiera de estos
cambios por causa de su condición física o mental. ¿Por causa de su condición física o mental {su/el}
empleador {de NAME}. ..
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB.
PROBE:
{Your/NAME’s} main job was the job we have been talking about. The one at which {you/(he/she)}
worked the most hours.
{Su trabajo principal/El trabajo principal de NAME} es el trabajo de que hemos estado hablando.
En el que {usted/él/ella} trabaja la mayor cantidad de horas.
a.
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
Make any changes in {your/NAME’s} work schedule?
(PROBE: For example, working fewer hours, changing the
time {you arrive or leave/(he/she) arrives or leaves}, or taking
more breaks to accommodate {your/NAME’s} condition in the
workplace.)
ha hecho algún cambio en {su/el} horario de trabajo {de
NAME}? Por ejemplo: trabajar menos horas, cambió la hora
que {usted/(él/ella)} llega al trabajo o la hora que termina el
trabajo, o tomar más recreos o descansos (breaks) para
acomodar en el lugar de trabajo a la condición de
{usted/NAME}
c.
NO
Provide {you/NAME} with any special equipment or assistive
technology?
(PROBE: For example special tools or equipment, software,
or devices to accommodate {your/NAME’s} condition in the
workplace.)
ha proporcionado a {usted/NAME} algún aparato o equipo
especial o alguna tecnología de asistencia? Por ejemplo
herramientas o equipos especiales, programas de
computadora (software), o aparatos que sirven para
acomodar en el lugar de trabajo a la condición de
{usted/NAME}
b.
YES
Make any changes to the tasks {you were/NAME was}
assigned or how they are performed?
(PROBE: For example, a light duty job or less demanding job
tasks to accommodate {your/NAME’s} condition in the
workplace.)
cambió las tareas que {usted/NAME} recibe o la forma en la
que se desempeñan las tareas? Por ejemplo: un trabajo más
ligero o con tareas menos difíciles, para acomodar en el lugar
de trabajo a la condición de {usted/NAME}.
d.
Make any changes to the physical work environment to make
things easier for {you/NAME}?
(PROBE: For example, modifying {your/his/her} work area,
169
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
improving accessibility in the building, or providing assigned
parking to accommodate {your/NAME’s} condition in the
workplace.)
hizo cambios físicos en el ambiente de trabajo para que le
sea más fácil a {usted/NAME} ? Por ejemplo, haciendo
modificaciones en su área de trabajo, mejorando la
accesabilidad al edificio, o proporcionando un lugar de
estacionamiento asignado para acomodar en el lugar de
trabajo a la condición de {usted/NAME}.
e.
Arrange for co-workers or others to assist {you/NAME}?
(PROBE: For example, providing a personal care attendant,
interpreter, or job coach while at work.)
hizo arreglos para que colegas de trabajo u otras personas
(lo/la) ayuden a {usted/NAME} ? Por ejemplo:
proporcionando un(a) asistente de atención personal, un
intérprete, o un job coach o entrenador de empleo, mientras
está trabajando.
f.
Make any other changes that I didn’t mention to
accommodate {your/NAME’s} condition in the workplace?
hizo algún otro cambio que no mencioné para acomodar la
condición que {usted/NAME} tiene en su lugar de trabajo?
01
00
d
r
01
00
d
r
PROGRAMMER: IF C33f=01, GO TO C33f_Other, ELSE GO TO C34.
(C_B32=00 and C_B33f=01)
C_B33f_Other. What other changes?
¿Qué otros cambios?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
170
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1)
C_B34. Were there any changes in {your/NAME’s} {main} job or workplace related to {your/his/her} physical or mental
health condition that {you/(he/she)} needed, but that were not made?
¿Hubo algún cambio relacionado a su condición física o mental que {usted/NAME} necesita en su lugar de
empleo (o trabajo), pero que no se ha hecho?
PROGRAMMER: USE “MAIN” IF C_B1>01.
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB.
PROBE:
{Your/NAME’s} main job was the job that we have been talking about. The one at which {you
/(he/she)} worked the most hours.
{Su trabajo principal/El trabajo principal de NAME} es el trabajo de que hemos estado hablando.
En el que {usted/él/ella} trabaja la mayor cantidad de horas.
(C_B34=01)
C_B35_oth.
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_BP12)
DON’T KNOW ............................................................................ d (C_BP12)
REFUSED .................................................................................. r (C_BP12)
What are those changes?
¿Cuáles son esos cambios?
PROBE:
Anything else?
¿Algo más?
INTERVIEWER: ENTER VERBATIM RESPONSE
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(C_B34 = 01)
C_B36. CHECK: WAS {NAME} SELF EMPLOYED (C_B6=01)?
d
r
YES ............................................................................................ 01 (C_B38)
NO .............................................................................................. 00
(C_B34=01 and C_B36=00)
C_B37. Did {you/NAME} or anyone else ask {your/his/her} employer for (any of) these changes?
¿ {Usted/NAME} o alguna otra persona pidió a suempleador que haga (cualquiera de) estos cambios?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B1=>1)
C_BP12. Was there anything special about {your/NAME’s} [main] job that helped {you/him/her} to work with a
disability?
¿Hubo algó especial acerca de su trabajo (principal) que permite {usted / NAME} trabajar con una
discapacidad?
PROGRAMMER: USE “MAIN” IF C_B1>01
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_BP13a)
DON’T KNOW ............................................................................ d (C_BP13a)
REFUSED .................................................................................. r (C_BP13a)
171
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
172
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_BP12=01)
C_BP12a. What was special about {your/NAME’s} [main] job that helped {you/him/her} to work with a disability?
¿Qué tenía de especial el trabajo principal/actual que ayuda {ha usted / ha NAME} trabajar con una discapacidad?
PROGRAMMER: USE “MAIN” IF C_B1>01
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿Algo más?
Modified job duties ..........................................................
Special equipment or modified space..............................
Flexible schedule ............................................................
Work at home ..................................................................
Health insurance .............................................................
Sick leave ........................................................................
Supervisor understands disability needs .........................
Co-worker assistance ......................................................
Other ...............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
02
03
04
05
06
07
08
09 (C_BP12a_oth)
d
r
(C_BP12a=09)
C_BP12a_oth. What else about {your/NAME’s} [main] job allowed {you/him/her} to work?
¿Qué más ayudó {usted / NAME} para seguir trabajando?
PROGRAMMER: USE “MAIN” IF C_B1>01
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C_B1=>1)
C_BP13a. You said that {you/NAME} worked at this job within the past six months, but that {you are/he is/she is} not
currently working. Did {you/NAME} have any problems with {your/NAME’s} health, that caused {you/him/her}
to stop working, for example worsening illness or the need to go to medical appointments?
Usted dijo que {usted / NAME} trabajó en este trabajo en los últimos seis meses, pero que no está trabajando
ahora. Tuvó algún problema con su salud, que podría haber causado {usted / él / ella} a deja de trabajar? por
ejemplo, la enfermedad empeora o la necesidad de ir a las citas médicas
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
173
01
00
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_BP13a=01)
C_BP13a1.What was it about {your/NAME’s} health that caused {you/him/her} to stop working?
¿Qué es de {su/NAME} salud que podrían causado {usted/él/ella} a dejar de trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿Algo más?
EXISTING HEALTH PROBLEM GETS WORSE .............
NEW HEALTH PROBLEM STARTS ...............................
GET INJURED ................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH ..............
NEED TO BE HOSPITALIZED ........................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ....
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION .....................
HEALTH INTERFERES WITH JOB PERFORMANCE....
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK ............................
PAIN INTERFERES WITH WORKING A SET
SCHEDULE .....................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG ............................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY....
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ....................
WORK IS TOO TIRING OR STRESSFUL ......................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP13.a1=15)
C_BP13.a1_oth.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
d
r
(C_BP13.a1_oth.)
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C_B1=>1)
C_BP13b. You said that {you/NAME} worked at this job within the past six months, but that {you are/he is/she is} not
currently working. Did {you/NAME} have any problems with {your/NAME’s} job, that caused {you/him/her} to
stop working, for example the need for accommodations or problems with {your/his/her} co-workers?
Usted dijo que {usted / NAME} trabajó en este trabajo en los últimos seis meses, pero que no está trabajando
ahora. Tuvó algún problema con Su trabajo, que podría haber causado {usted / él / ella} a deja de trabajar?
Por ejemplo por la necesidad de arreglos o problemas con compañeros de trabajo?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
174
01
00
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_BP13b=01)
C_BP13.b1. What was it about {your/NAME’s} job that caused {you/him/her} to stop working?
¿Qué es de {su/NAME} trabajo que podrían causado {usted/él/ella} a dejar de trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿Algo más?
JOB DOES NOT PAY ENOUGH .....................................
JOB DOES NOT OFFER HEALTH INSURANCE
BENEFITS.......................................................................
NEED A DIFFERENT SCHEDULE OR SHIFT ................
NEED TIME TO GO TO MEDICAL
APPOINTMENTS ............................................................
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION .....................
HEALTH INTERFERES WITH JOB
PERFORMANCE ............................................................
DO NOT HAVE THE STRENGTH, PHYSICAL
ENERGY OR STAMINA REQUIRED TO WORK ............
PAIN INTERFERES WITH WORKING A SET
SCHEDULE .....................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKE TOO LONG ...............................................
DO NOT HAVE DEVICES NEEDED IN ORDER TO
WORK .............................................................................
FOUND ANOTHER JOB (NEW) .....................................
WORK SCHEDULE (NEW) .............................................
DID NOT LIKE/GET ALONG WITH CO-WORKERS
(NEW) .............................................................................
DID NOT LIKE/GET ALONG WITH MANAGER,
SUPERVISOR, OR BOSS (NEW) ...................................
DID NOT LIKE/GET ALONG WITH OTHER STAFF
RESPONSIBLE FOR HIRING OR PROVIDING
ACCOMMODATIONS (SUCH AS HUMAN
RESOURCES) (NEW).....................................................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP13.b1=11)
C_BP13.b1_oth.
01
02
03
04
05
06
07
08
09
10
20
22
23
24
25
11 (C_BP13.b1_oth.)
d
r
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C_B1=>1)
C_BP13c. You said that {you/NAME} worked at this job within the past six months, but that {you are/he is/she is} not
currently working. Did {you/NAME} have any problems with {Your/NAME’s} personal circumstances that
caused {you/him/her} to stop working, for example the need for childcare, not having reliable transportation,
or worry about losing other benefits?
175
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
Usted dijo que {usted / NAME} trabajó en este trabajo en los últimos seis meses, pero que no está trabajando
ahora. Tuvó algún problema con circunstancias personales, que podría haber causado {usted / él / ella} a
deja de trabajar? Por ejemplo, la necesidad de cuidado de los hijos, no tener transporte confiable, o
preocuparse por la pérdida de otros beneficios?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
176
01
00
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_BP13c=01)
C_BP13.c1.What was it about {your/NAME’s} personal circumstances that caused {you/him/her} to stop working?
¿Qué es de {su/NAME} circunstancias personales que podrían causado {usted/él/ella} a dejar de trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿Algo más?
NEED HELP CARING FOR CHILDREN OR
OTHERS .........................................................................
NEED PERSONAL ASSISTANCE ..................................
GET INJURED ................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL
SECURITY, SNAP, MEDICAID/MEDICARE ...................
PERSONALITY CONFLICTS WITH OTHERS AT
THE JOB .........................................................................
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB .......
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK .........................................................
DRUG/ALCOHOL RELAPSE ..........................................
WOULD RATHER DO OTHER THINGS THAN
WORK .............................................................................
DO NOT LIKE WORKING ...............................................
WORK IS TOO TIRING OR STRESSFUL ......................
MOVED TO ANOTHER AREA (NEW) ............................
LOSS OR POTENTIAL LOSS OF GOVERNMENT
BENEFITS (NEW) ...........................................................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP13.C1=12)
C_BP13.c1_oth.
01
02
03
04
05
06
07
08
09
10
11
19
21
12 (C_BP13.c1_oth.)
d
r
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW .................................................................
REFUSED .......................................................................
177
d
r
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B1=>1)
C_B39a2.Sometimes people work fewer hours or earn less money than they could in order to care for family members,
keep the cash benefits they need, or just to have more free time. In (your/NAME’s) [main] job, did you/he/she}
work fewer hours or earn less money than (you/he/she) could for any reason?
Algunas personas a veces trabajan menos horas o ganan menos dinero de lo que pudieran, para poder cuidar
o atender a miembros de su familia, o para recibir beneficios en efectivo que necesitan, o simplemente para
tener más tiempo libre. En su trabajo o empleo (principal), ¿trabajaba {usted/NAME} menos horas o gana
menos dinero de lo que {usted/(él/ella)} pudiera, por cualquier razón?
PROGRAMMER: USE “MAIN” IF C_B1>01.
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B39_1)
DON’T KNOW ............................................................................ d (C_B39_1)
REFUSED .................................................................................. r (C_B39_1)
(C_B39a2=01)
C_B39b. Did (you/NAME) work fewer hours or earn less money than (you/he/she) could because (you/he/she)…
¿Trabajaba {usted/NAME} menos horas o gana menos dinero de lo que [usted/él/ella] pudiera, porque . . .
PROBE: I need to ask everyone in our study the same questions, even if they don’t seem to apply to
(you/NAME).
Necesito hacer las mismas preguntas a todos los participantes en nuestro estudio, aún si no parece
que se aplican a {usted/NAME}.
a.
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
{Were/Was } enrolled in school or a training program?
estuvo (matriculado/matriculada) en un programa de estudio
o entretenimiento?
c.
NO
{Were/Was} taking care of children or others?
estuvo cuidando a niños o a otras personas?
b.
YES
Wanted to keep Medicare or Medicaid coverage?
queria continuar teniendo su cobertura de Medicare o
Medicaid?
d1. Wanted to keep Social Security disability cash benefits?
Quería conservar los beneficios en efectivo por incapacidad
del Seguro Social?
d2. Wanted to keep other benefits like food stamps, housing
assistance, or workers’ compensation?
quería continuar recibiendo beneficios tales como estampillas
de comida o cupones de alimentos, asistencia para vivienda
o compensación de trabajadores?
e.
Just did not want to work more?
simplemente porque no quería trabajar más?
g.
{Were/was} in poor health or had health concerns?
estaba en mal estado de salud o tenía preocupaciones en
relación a su salud?
178
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
f.
Are there any reasons I didn’t mention why (you were/NAME
was) working or earning less than (you/he/she) could?
¿Hay alguna otra razón que no he mencionado, y por la cual
{usted/NAME} ha trabajado menos o ha ganado menos de lo
que {usted/(él/ella)} pudiera?
01
00
d
r
PROGRAMMER: IF C_B39b_f=01 GO TO C_B39f_Other, ELSE SKIP TO C_B39_1
(C_B39b_f=01)
C_B39f_Other What other reason?
¿Qué otra razón?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C_B1=>1)
C_B39_1 Were any of {your/NAME’s} disability-related benefits reduced or ended because of {your/his/her} [main]
job?
¿Alguno de los beneficios que {usted/NAME} recibe relacionados a incapacidad, han sido reducidos o
terminados por causa de su empleo o trabajo (principal)?
PROGRAMMER: USE “MAIN” IF C_B1>01
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B39_3)
DON’T KNOW ............................................................................ d (C_B39_3)
REFUSED .................................................................................. r (C_B39_3)
179
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B39_1=01)
C_B39_2
What benefits were reduced or ended as a result of {your/NAME’s} [main] job?
¿Qué beneficios han sido reducidos o terminados como resultado del empleo o trabajo (principal)
que {usted/NAME} tiene
INTERVIEWER: CODE ALL THAT APPLY.
PROGRAMMER: USE “MAIN” IF C_B1>01
PRIVATE DISABILITY INSURANCE..........................................
WORKERS’ COMPENSATION ..................................................
VETERANS’ BENEFITS.............................................................
MEDICARE ................................................................................
MEDICAID..................................................................................
SOCIAL SECURITY DISABILITY BENEFITS (SSI OR SSDI) ...
PUBLIC ASSISTANCE OR WELFARE ......................................
FOOD STAMPS .........................................................................
PERSONAL ASSISTANCE SERVICES (PAS) ..........................
UNEMPLOYMENT BENEFITS ..................................................
OTHER STATE DISABILITY BENEFITS ...................................
OTHER GOVERNMENT PROGRAMS ......................................
OTHER.......................................................................................
01
02
03
04
05
06
07
08
09
10
11
12
13
(C_B39_2 = 13)
C_B39_2_Other: What other benefits?
Que otros beneficios?
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(C_B1=>1)
C_B39_3. Now, I am going to read you a list of things that sometimes help people keep their jobs. Do you think that
[you/she/he] would have kept working if (you/he/she) had…
Ahora le voy a leer una lista de cosas que a veces ayudan a gente a mantener su trabajo. ¿Cree usted que
(NAME) hubiera seguido trabajando si {usted/(él/ella)} tuviera . . .
a.
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
Reliable transportation to and from work?
transporte en el que puede confiar, para ir y regresar del
trabajo?
d.
DON’T
KNOW
Help with {your/his/her} own personal care such as bathing,
dressing, preparing meals, and doing housework?
ayuda para su atención o cuidado personal, tal como para
bañarse, vestirse, preparar comidas, y hacer quehaceres
domésticos?
c.
NO
Help caring for {your/his/her} children or others in the
household?
ayuda para cuidar a niños o a otros miembros de su hogar?
b.
YES
Better job skills?
mejores destrezas de empleo?
180
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
e.
A job with a flexible work schedule?
un empleo o trabajo con un horario flexible de trabajo?
f.
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
Help with finding and getting a better job?
ayuda para encontrar y obtener un mejor empleo o trabajo?
g.
01
Any special equipment or medical devices?
algún equipo especial o aparato médico?
PROGRAMMER: IF C_B39_3g=01, GO TO
C_B39_3g_Other, ELSE GO TO C_B39_3h.
h.
Is there anything else that I didn’t mention that would help
[you/NAME] work or earn more?
¿Hay alguna otra cosa que no he mencionado que le
ayudaría a {usted/NAME} trabajar o ganar más?
181
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
PROGRAMMER: IF C3_B9_3h=01, GO TO C_B39_3h_Other, ELSE GO TO C_B39_4.
(C39_3g=01)
C_B39_3g_Other. What other special equipment or medical devices?
¿Qué otro equipo especial o aparato médico?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C39_3h=01)
C_B39_3h_Other What else?
¿Qué más?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(C_B1=>1)
C_B39_4. One last question about (your / NAME’s) [main] job. Because of {your/his/her} work, did Social Security
need to make any changes to the amount of {your/his/her} disability benefits?
Una última pregunta acerca del empleo o trabajo (principal) que {usted/NAME} tiene. Por causa de su
trabajo, ¿el Seguro Social o Social Security ha necesitado hacer algún cambio en la suma que recibe por
sus beneficios por incapacidad?
PROBE: Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?
¿La suma del beneficio que {usted/NAME} recibe fue reducida o perdió {usted/ (él/ella)} todos sus
beneficios?
PROGRAMMER: USE “MAIN” IF C_B1>01
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
00
d
r
(C_B39_5)
(C_B39_5)
(C_B39_5) (C_B39_4=01)
(C_B39_4=01)
C_B39_4a.Because of these changes did the Social Security Administration pay {you/NAME} the wrong benefit
amount?
Por causa de estos cambios, la Administración del Seguro Social o Social Security Administration le pagó
a {usted/NAME} la suma equivocada en beneficios?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
00
d
r
(C_B1=>1)
C_B39_5. {Were you/Was NAME} asked to re-pay benefits because the Social Security Administration overpaid
{you/him/her}?
¿Le pidieron que {usted/NAME} pague de vuelta los beneficios que le fueron sobre-pagados por la
Administración del Seguro Social o Social Security Administration?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
182
01
00
d
(C_B40CHECK)
(C_B40CHECK)
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
REFUSED ....................................................................... r
(C_B40CHECK)
(C_B39_5=01)
C_B39_6. {Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/he was/she
was} working while receiving benefits?
¿Le pidieron a {usted/NAME} que pague de vuelta a la Administración del Seguro Social o Social Security
Administration, porque {usted/(él/ella)} estaba trabajando mientras recibía beneficios?
YES ................................................................................. 01 (C_B39_7)
NO ................................................................................... 00 (C_B40CHECK)
DON’T KNOW ................................................................. d
(C_B40CHECK)
REFUSED ....................................................................... r
(C_B40CHECK)
183
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
(C_B39_6=01)
C_B39_7. Did {you/NAME} try to appeal or challenge the request to re-pay benefits to the Social Security
Administration?
¿{Usted/NAME} intentó apelar u objetar cuando le pidieron que pagara de vuelta los beneficios a la
Administración del Seguro Social o Social Security Administration?
YES ............................................................................................ 01 (C_B39_8)
NO .............................................................................................. 00 (C_BP16)
DON’T KNOW ............................................................................ d (C_BP16)
REFUSED .................................................................................. r (C_BP16)
(C_B39_7=01)
C_B39_8. Did {you/NAME} end up repaying the full benefit amount, repaying some of the benefit amount, or did you
not repay any amount?
¿Terminó {you/NAME} pagando de vuelta la cantidad total de los beneficios, pagando de vuelta parte de
la cantidad total de los beneficios, o no pagó nada de vuelta?
REPAY FULL BENEFIT AMOUNT ............................................. 01
REPAY SOME BENEFIT AMOUNT ........................................... 02
DID NOT REPAY AND BENEFIT AMOUNT............................... 03
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B39_6=01)
C_BP16. Did {you/NAME} change the way {you/he/she} worked because {you were/he was/she was} asked to re-pay
the Social Security Administration?
Usted/NAME cambio la forma que usted/él/ella trabajo, por que le pidió que devolver pagos la
Administración del Seguro Social?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
00
d
r
(C_B40CHECK)
(C_B40CHECK)
(C_B40CHECK)
(C_BP16=01)
C_BP16a. What did {you/NAME} change about the way {you/he/she} worked? Did {you/he/she}….
En que manera ha cambiado como {usted/NAME} trabaja. Fue…
Reduce {your/his/her} work hours by a little,
Reducir {sus} horas de trabajo por un poco, ...................
Reduce {your/his/her} work hours by a lot,
Reducir {sus} horas de trabajo por mucho, .....................
Increase {your/his/her} work hours by a little,
Aumentar sus horas de trabajo por un poco, ..................
Increase {your/his/her} work hours by a lot or
(C_BP16a=05)
C_BP16a_oth.
(C_B1=>1)
Aumentar sus horas de trabajo por mucho .....................
Something else? (SPECIFY)
Otra cosa.........................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
02
03
04
05
d
r
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
184
d
r
(C_BP16a_oth.)
SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
C_B40. CHECK: WAS {NAME} WORKING IN 2022 (B30 = 01)?
YES .................................................................................
NO ...................................................................................
185
01
00
(D1)
(SC1CHECK)
SECTION D: JOBS/OTHER JOBS DURING 2022
SECTION D: JOBS/OTHER JOBS DURING 2022
(B30=01)
D1.
Now, I will ask you about jobs {you/NAME} had during 2022. When answering these questions, please include
both part-time and full-time jobs, but only include jobs {you/NAME} held for pay or profit for one month or
longer.
Ahora le voy a hacer algunas preguntas acerca de los trabajos o empleos que [usted/NAME] tenía durante el
año 2022. Cuando contesta a estas preguntas, por favor incluya ambos a trabajos o empleos a tiempo parcial
y a tiempo completo, pero solamente incluya los empleos (o trabajos) en los que [usted/NAME] trabajó por
pago o para tener ganancias, por un mes o más.
PROGRAMMER: IF (C1=01 AND C4 YEAR <2022) or (C_B1=01 and C_B4a_yr=2022 or C_B4b_yr=2022)
or (C_B1=01 and C_B4a_yr < 2022 and C_B4b_yr>2022) ASK:
Other than (your/NAME’s) job that you already told me about, in 2022 did {you/NAME} work for pay at any
other jobs for longer than a month?
Además del trabajo de (usted/NAME) que ya me contó, ¿en 2018 trabajó {usted/NAME} por pago en cualquier
otro trabajo por más de un mes?
PROGRAMMER: IF (C1>01 AND C4 YEAR < 2022) or (C_B1>1 and C_B4a_yr=2022 or C_B4b_yr=2022)
or (C_B1>01 and C_B4a_yr < 2022 and C_B4b_yr>2022) FOR ONE OR MORE CURRENT JOBS IN
SECTION C or C_B, ASK:
Other than (your/NAME’s) jobs that you already told me about in 2022, did {you/NAME} work for pay at any
other jobs for longer than a month?
Además del trabajo de (usted/NAME) que ya me contó, ¿en 2022 trabajó {usted/NAME} por pago en cualquier
otro trabajo por más de un mes?
ELSE:
In 2022, did {you/NAME} work for pay at any jobs for longer than a month?
En 2022, ¿trabajó {usted/NAME} por pago en cualquier otro trabajo por más de un mes?
YES ............................................................................................ 01 (D3)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D1=00, d, or r)
D2.
SOFT EDIT: IF {NAME} WORKED IN 2022 (B30=01) AND {NAME} DID NOT WORK IN 2022 (D1=0, d, r)
INTERVIEWER READ: “Earlier you said that {you/NAME} worked for pay in 2022. Let me repeat the question
I just read and verify your response.”
Antes dijo que {usted/NAME} trabajó por pago en 2022. Déjeme repetir la pregunta que acabo de leer y
verificar su respuesta
PROGRAMMER: IF (C1=01 AND C4 YEAR < 2022) or (C_B1=01 and C_B4a_yr=2022 or C_B4b_yr=2022)
ASK:
Other than (your/NAME’s) jobs that you already told me about, in 2022 did {you/NAME} work for pay at any
other jobs for longer than a month?
Además del trabajo de (usted/NAME) que ya me contó, ¿en 2022 trabajó {usted/NAME} por pago en cualquier
otro trabajo por más de un mes?
PROGRAMMER: IF (C1>01 AND C4 YEAR < 2022) or (C_B1>1 and C_B4a_yr=2022 or C_B4b_yr=2022)
FOR ONE OR MORE CURRENT JOBS IN SECTION C or C_B, ASK:
Other than (your/NAME’s) jobs that you already told me about, in 2022 did {you/NAME} work for pay at any
other jobs for longer than a month?
186
SECTION D: JOBS/OTHER JOBS DURING 2022
Además del trabajo de (usted/NAME) que ya me contó, ¿en 2022 trabajó {usted/NAME} por pago en cualquier
otro trabajo por más de un mes?
ELSE:
In 2022, did {you/NAME} work for pay at any jobs for longer than a month?
En 2022, ¿trabajó {usted/NAME} por pago en cualquier otro trabajo por más de un mes?
YES ............................................................................................ 01
NO .............................................................................................. 00 (SC1CHECK)
DON’T KNOW ............................................................................ d (SC1CHECK)
REFUSED .................................................................................. r (SC1CHECK)
187
SECTION D: JOBS/OTHER JOBS DURING 2022
(D1=01 or D2=01)
D3.
PROGRAMMER: IF (C1=01 AND C4 YEAR < 2022) or (C_B1=01 and C_B4a_yr=2022 or C_B4b_yr=2022)
or (C_B1=01 and C_B4a_yr < 2022 and C_B4b_yr>2022) ASK::
Other than (your/NAME’s) the job that you already told me about, how many other jobs did {you/NAME} hold
for at least one month in 2022?
Aparte de los trabajo que ya me habló, cuántos otros trabajos hiciste {usted / NAME} durante 2022 y por lo
menos un mes?
PROGRAMMER: IF (C1>01 AND C4 YEAR < 2022) or (C_B1>1 and C_B4a_yr=2022 or C_B4b_yr=2022) or
(C_B1>01 and C_B4a_yr < 2022 and C_B4b_yr>2022) FOR ONE OR MORE CURRENT JOBS IN SECTION
C or C_B, ASK:
Other than (your/NAME’s) jobs that you already told me about, how many other jobs did {you/NAME} hold for
at least one month in 2022?
Aparte de los trabajos que ya me habló, cuántos otros trabajos hiciste {usted / NAME} durante 2022 y por lo
menos un mes?
ELSE:
How many jobs did {you/NAME} hold for at least one month in 2022?
¿Cuántos empleos {usted / NAME} mantiene durante al menos un mes en 2022?
|__|__| NUMBER OF JOBS (1-5)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
PROGRAMMER: D4 THROUGH D23 ASKED FOR MAIN JOB WHEN D3>01. D5, D14, DP4, DP5, DP1a, DP1b,
DP1c, and DP2 SKIPPED FOR JOBS TWO THROUGH FIVE.
(D1=01 or D2=01)
D4.
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:
Now thinking only about these jobs, let us start with {your/NAME’s} main job in 2022 – that is, the job at which
{you worked/(he/she) worked} the most hours.
Ahora pensando sólo en estos puestos de trabajo, comencemos con {su/el} trabajo principal {de NAME} en
2022 - es decir, el trabajo en el que {usted/él/ella} trabaja más horas.
What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
Now I would like to ask about {your/NAME’S} {second/third/fourth} job in 2022.
Ahora me gustaría preguntar acerca de su {NAME} {segundo/ tercer/ cuarto} trabajo en 2022.
What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}?
ELSE (D3=01):
What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?
¿Qué tipo de trabajo {hace/ hace NAME}, es deci, cuál es su ocupación {de NAME}?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high
school; sales clerk in a women’s shoe store.
188
SECTION D: JOBS/OTHER JOBS DURING 2022
Por ejemplo: proveedora de 'child-care' o cuidado de niños en un programa preescolar de una
escuela privada, maestro(a) de geometría en un 'public high school' o escuela secundaria
pública; vendedor(a) en una tienda de zapatos de mujeres.
PROBE 2: What are {your/NAME’S} main activities or duties? What else do you do? What else? Do you
supervise anyone?
¿Cuáles son su/sus actividades u obligaciones principales?¿Qué más hace? ¿Algo más? ¿Es
supervisor(a) de alguien?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
189
d
r
SECTION D: JOBS/OTHER JOBS DURING 2022
(D1=01 or D2=01)
D5.
PROGRAMMER: SKIP D5 FOR JOB TWO THROUGH FIVE.
What kind of business was this?
¿Qué tipo de negocio es este?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For what type of organization or industry did you work? For example: accounting firm, daycare
center, educational facility, food services.
¿Para qué tipo de organización o industria trabaja [usted/NAME]?
Por ejemplo: una firma de contabilidad, un centro de 'daycare' o cuidado de niños, una institución
educacional, servicios de comida.
PROBE 2: What do they make, sell, or do where {you/NAME} worked?
Qué es lo que producen, venden, o hacen donde [usted/NAME] trabajaba?
PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses) or
retail trade (selling to customers) or something else?
Es este un negocio de manufactura (fabrican un producto), negocio de venta al por mayor
(venden a otros negocios), o venta al por menor (venta a clientes) o alguna otra cosa?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(D1=01 or D2=01)
D6mth. In what month and year did {you/NAME} start working there?
¿En qué mes y año empezó [usted/NAME] a trabajar allí?
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(D1=01 or D2=01)
D6yr.
PROBE 1: In what month and year did {you/NAME} start working there?
¿En qué mes y año empezó [usted/NAME] a trabajar allí?
PROBE 2: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: ENTER YEAR
|__|__|__|__|
YEAR
(1956-2022)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(D1=01 or D2=01)
D7.
SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (D6 YEAR) SHOULD BE GREATER
THAN OR EQUAL TO YEAR OF BIRTH (A04d) PLUS 14 YEARS. IF RESPONDENT FAILS EDIT,
190
SECTION D: JOBS/OTHER JOBS DURING 2022
INTERVIEWER READ: I must have recorded an incorrect answer. I show that {you were/NAME was} born
in (A04d) and {you/NAME} started working at this job in (D6 YEAR), which means {you/NAME} started
working at this job when {you were/he was/she was} (PROGRAMMER CALCULATE AND FILL AGE: D6
YEAR – YEAR OF BIRTH) years old. Is that correct?
Debo haber anotado una respuesta incorrecta. Anoté que {usted/NAME} nació en (A04d) y {usted/NAME}
empezó a trabajar en este trabajo en (D6 YEAR), lo que significa que {usted/NAME} empezó a trabajar en
este trabajo cuando {usted/él/ella} tenía (PROGRAMMER CALCULATE AND FILL AGE: D6 YEAR – YEAR
OF BIRTH)) años. ¿Es eso correcto?
YES ............................................................................................ 01
NO .............................................................................................. 02 (CHANGE D6 YEAR)
SUPPRESS ................................................................................ 03
191
SECTION D: JOBS/OTHER JOBS DURING 2022
(D1=01 or D2=01)
D8mth. In what month and year did {you/NAME} stop working there?
¿En qué mes y año dejó [usted/NAME] de trabajar allí?
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(D1=01 or D2=01)
D8yr.
PROBE 1: In what month and year did {you/NAME} stop working there?
¿En qué mes y año dejó [usted/NAME] de trabajar allí?
d
r
PROBE 2: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER: ENTER YEAR
|__|__|__|__|
YEAR
(1956-2023)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(D1=01 or D2=01)
D9.
SOFT EDIT: DATE {NAME} STOPPED WORKING AT THIS JOB (D8 MONTH, D8 YEAR) SHOULD BE
LATER THAN DATE {NAME} STARTED WORKING AT THIS JOB (D6 MONTH, D6 YEAR). IF
RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I show that
{you/NAME} started working at this job in (D6 MONTH, D6 YEAR) and that (you/NAME) stopped working at
this job in (D8 MONTH, D8 YEAR). Is that correct?
Debo haber anotado una respuesta incorrecta. Anoté que {usted/NAME} empezó a trabajar en este trabajo
en (D6 MONTH, D6 YEAR) y que (usted/NAME) dejó de trabajar en este trabajo en (D8 MONTH, D8
YEAR). ¿Es eso correcto?
YES ............................................................................................
NO, CHANGE ANSWER TO D6.................................................
NO, CHANGE ANSWER TO D8.................................................
NO, CHANGE ANSWERS FOR BOTH D6 AND D8 ...................
SUPPRESS ................................................................................
01
02 (CHANGE D6)
03 (CHANGE D8)
04 (CHANGE D6 AND D8)
05
(D1=01 or D2=01)
D10.
SOFT EDIT: IF DATE {NAME} STOPPED WORKING AT THIS JOB (D8 MONTH, D8 YEAR ) AND DATE
{NAME} STARTED WORKING AT THIS JOB (D6 MONTH, D6 YEAR) ARE THE SAME (D8 MONTH, D8
YEAR – D6 MONTH, D6 YEAR = 0), INTERVIEWER READ: You said that {you/NAME} started and stopped
working at this job in (D8 MONTH, D8 YEAR). I’d like to verify that {you/NAME} worked at this job for less
than one month. Is this correct?
Usted dijo que {NAME} empezó y dejó de trabajar en este trabajo en (D8 MONTH, D8 YEAR). Me gustaría
verificar que {usted/NAME} trabajó en este trabajo por menos de un mes. ¿Es eso correcto?
YES, WORKED AT JOB FOR LESS THAN ONE MONTH ........ 01
NO, WORKED AT JOB FOR MORE THAN ONE MONTH ......... 02
SUPPRESS ................................................................................ 03
(D1=01 or D2=01)
D11.
SOFT EDIT: IF YEAR {NAME} STOPPED WORKING AT THIS JOB (D8 YEAR) IS BEFORE 2022,
INTERVIEWER READ: You said that {you/NAME} stopped working at this job in (D8 YEAR). I’d like to verify
that this job ended before 2022. Is this correct?
192
SECTION D: JOBS/OTHER JOBS DURING 2022
Dijo que {usted/NAME} dejó de trabajar en este trabajo en (D8 YEAR). Me gustaría verificar que este
trabajó terminó antes de 2022. ¿Es eso correcto?
YES, JOB ENDED BEFORE 2022 ............................................. 01
NO, JOB DID NOT END BEFORE 2022 .................................... 02
SUPPRESS ................................................................................ 03
193
SECTION D: JOBS/OTHER JOBS DURING 2022
(D1=01 or D2=01)
D12.
CHECK: DID {NAME} WORK AT THIS JOB FOR LESS THAN ONE MONTH (D10=01)?
YES ............................................................................................ 01 (DP1a)
NO .............................................................................................. 00
(D12=00)
D13.
CHECK: DID THIS JOB END BEFORE 2022 (D11=01)?
YES ............................................................................................ 01 (DP1a)
NO .............................................................................................. 00
((D1=01 or D2=01) and D12=00 and D13=00)
D14.
PROGRAMMER: SKIP D14 FOR JOB TWO THROUGH FIVE.
{Were you/Was NAME} self-employed at this job? Self-employed means that {you work/NAME works} for
{yourself/themselves} or {own your /owns their} own business.
¿Estaba {usted/NAME} autoempleado/autoempleada en este trabajo? Autoempleado/ Autoempleada, o
Self-employed en inglés, significa que {usted/NAME} trabaja para {usted/él mismo/ella misma} o es {dueño/
dueña} de su propio negocio.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D1=01 or D2=01) and D12=00 and D13=00)
D16.
How many hours per week did {you/NAME} usually work at this job?
¿Cuántas horas por semana generalmente trabajaba [usted/NAME] en este empleo?
PROBE:
Include overtime if {you/he/she} usually worked overtime.
Incluya 'overtime' o sobretiempo si [usted/él/ella] generalmente trabajaba horas extra.
|__|__|__| HOURS PER WEEK (1-60)
(1-168)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
((D1=01 or D2=01) and, D12=00 and D13=00)
D17.
How many weeks per year did {you/NAME} usually work at this job, including paid vacation and holidays?
¿Cuántas semanas por año generalmente trabajaba [usted/NAME] en este empleo, incluyendo vacaciones
pagadas y feriados? Por favor incluya tiempo libre por vacaciones y feriados si [usted/NAME] recibe pago
por ese tiempo.
PROBE 1: Please include time off for vacations and holidays if {you were/NAME was} paid for that time.
Por favor incluya tiempo libre por vacaciones y feriados si [usted/NAME] recibe pago por ese
tiempo.
PROBE 2: There are 52 weeks in a year.
Hay 52 (cincuentaidos) semanas en un año.
|__|__| WEEKS PER YEAR (1-52)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
194
d
r
SECTION D: JOBS/OTHER JOBS DURING 2022
((D1=01 or D2=01) and D12=00 and D13=00)
D18.
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME was}
paid on {your/(his/her)} main job in 2022. On {your/NAME’s} main job {were you/was (he/she} paid by the
hour?
Para el propósito de este estudio, es importante para obtener información sobre cuánto le paga {Name} en {
su / del NAME} trabajo principal en 2022. En { su / del NAME} trabajo principal está {usted / es (él / ella}
pagado por hora?
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME was}
paid on {your/(his/her)} {second/third/fourth} job in 2022. On {your/NAME’s} {second/third/fourth} job {were
you/was (he/she} paid by the hour?
Para el propósito de este estudio, es importante para obtener información sobre cuánto le paga {Name} en {
su / del NAME} {segundo/ tercer/ cuarto } trabajo en 2022. En { su / del NAME} {segundo/ tercer/ cuarto }
trabajo está {usted / es (él / ella} pagado por hora?
ELSE (D3=01): For the purpose of this survey, it is important to obtain some information on how much {you
were/NAME was} paid on {your/(his/her)} job in 2022. On {your/NAME’s} job {were you/was (he/she} paid by
the hour?
Para el propósito de este estudio, es importante para obtener información sobre cuánto {eres / NAME} pagado
en su trabajo en 2022. En {su {trabajo en 2022 está usted / es (él / ella} pagado por hora?
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:
PROBE:
{Your/NAME’s} main job in 2022 was the job at which {you worked/(he/she) worked} the most
hours.
{Su trabajo principal/El trabajo principal de NAME} en 2022 es el trabajo en el que {usted/él/ella}
trabaja la mayor cantidad de horas.
YES ............................................................................................ 01
NO .............................................................................................. 00 (D20amt)
DON’T KNOW ............................................................................ d (D20amt)
REFUSED .................................................................................. r (D20amt)
((D1=01or D2=01) and D12=00 and D13=00 and D18=01)
D19.
What was {your/NAME’s} regular hourly pay, including tips and commissions?
¿Cuál era el sueldo regular por hora que [usted/NAME]) recibía, incluyendo propinas y comisiones?
PROBE: IF LESS THAN $5.00 AN HOUR: Does this include tips and commissions?
¿Esto incluye propinas y comisiones?
$ |___|___|___| . |___|___| PER HOUR
(1 - 25.00)
(1 - 300.00)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
GO TO DP1a
((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r)
D20amt. Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips and
commissions?
Antes de impuestos y otras deducciones, ¿cuánto le pagaban a [usted/NAME] en este empleo, incluyendo
propinas y comisiones?
195
SECTION D: JOBS/OTHER JOBS DURING 2022
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
¿Le pagaban a [usted/NAME] cada día, cada semana, cada dos semanas, dos veces cada mes,
cada mes, o cada año?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$|___|___|___| , |___|___|___| . 00
DON’T KNOW ............................................................................
REFUSED ..................................................................................
196
d
r
SECTION D: JOBS/OTHER JOBS DURING 2022
((D1=01 or D2=01) and, D12=00 and D13=00 and D18=00, d, r)
D20hop. Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips and
commissions?
Antes de impuestos y otras deducciones, ¿cuánto le pagaban a [usted/NAME] en este empleo, incluyendo
propinas y comisiones?
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
¿Le pagaban a [usted/NAME] cada día, cada semana, cada dos semanas, dos veces cada mes, cada mes,
o cada año?
INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY (EVERY TWO WEEKS) ...................
TWICE A MONTH ................................................
MONTHLY............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................
01
02
03
04
05
06
d
r
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)
PROGRAMMER, CALCULATE MONTHLY PRE-TAX PAY BASED ON D20AMT AND D20HOP FOR EACH JOB:
If D18=01, and D19 and D16≠d or r, C_2022Job2022MnthPay(1)=D19*D16*4.35.
If D18=01 and D19 or D16=d, C_2022JobMnthPay(1)=d.
If D18=01 and D19 or D16=r and neither are d, C_2022JobMnthPay(1)=r.
If D18=00, d, OR r AND D20AMT OR D20HOP=d, C_2022JobMnthPay(1)=d.
If D18=00, d, OR r AND D20AMT OR D20HOP=r AND NEITHER ARE d, C_2022JobMnthPay(1)=r.
If D18=00, d, or r and D20hop=1, C_2022JobMnthPay(1)=D20amt*21.74.
If D18=00, d, or r and D20hop=2, C_2022JobMnthPay(1)=D20amt*4.35.
If D18=00, d, or r and D20hop=3, C_2022JobMnthPay(1)=D20amt*2.17.
If D18=00, d, or r and D20hop=4, C_2022JobMnthPay(1)=D20amt*2.
If D18=00, d, or r and D20hop=5, C_2022JobMnthPay(1)=D20amt.
If D18=00, d, or r and D20hop=6, C_2022JobMnthPay(1)=D20amt/12.
If D18=00, d, or r and D20hop or D20amt=d, then C_2022JobMnthPay(1)=d.
If D18=00, d, or r and D20hop or D20amt=r and none=d, then C_2022JobMnthPay(1)=r.
197
SECTION D: JOBS/OTHER JOBS DURING 2022
((D12=00 or D2=01) and D13=00 and D18=00, d, r)
D21amt. For this job, about how much was left as take-home pay after taxes and other deductions?
En este empleo, ¿más o menos cuánto de su pago le quedaba para llevar a casa, después de impuestos y
otras deducciones?
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
¿Le pagaban a [usted/NAME] por día, por semana, por cada dos semanas, dos veces por mes, por mes, o
por año?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$|___|___|___| , |___|___|___| . 00
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r)
D21hop. For this job, about how much was left as take-home pay after taxes and other deductions?
En este empleo, ¿más o menos cuánto de su pago le quedaba para llevar a casa, después de impuestos y
otras deducciones?
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
¿Le pagaban a [usted/NAME] por día, por semana, por cada dos semanas, dos veces por mes, por mes, o
por año
INTERVIEWER: ENTER HOW OFTEN PAID.
DAILY...................................................................
WEEKLY ..............................................................
BI-WEEKLY (EVERY TWO WEEKS) ...................
TWICE A MONTH ................................................
MONTHLY ...........................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................
01
02
03
04
05
06
d
r
(1-346)
(1-1,730)
(1-3,750)
(1-3,750)
(1-7,500)
(1-90,000)
(1-1,730)
(1-8,653)
(1-18,750)
(1-18,750)
(1-37,500)
(1-450,000)
PROGRAMMER, CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON D21AMT AND D21HOP:
If D18=01 and D19 and D16≠d or r, C_2022JobMnthPayTH(1)=D19*D16*4.35.
If D18=01 and D19 or D16=d, C_2022JobMnthPayTH(1)=d.
If D18=01 and D19 or D16=r and neither are d, C_2022JobMnthPayTH(1)=r.
If D18_1=00, d, or r and D21amt or D21hop=d, C_2022JobMnthPayTH(1)=d.
If D18_1=00, d, or r and D21amt or D21hop=r, and neither are d, C_2022JobMnthPayTH(1)=r.
If D18=00, d, or r and D21hop=1, C_2022Job2MnthPayTH(1)=D21amt*21.74.
If D18=00, d, or r and D21hop=2, C_2022JobMnthPayTH(1) =D21amt*4.35.
If D18=00, d, or r and D21hop=3, C_2022JobMnthPayTH(1)=D21amt*2.17.
If D18=00, d, or r and D21hop=4, C_2022JobMnthPayTH(1)=D21amt*2.
If D18=00, d, or r and D21hop=5, C_2022JobMnthPayTH(1)=D21amt.
If D18=00, d, or r and D21hop=6, C_2022JobMnthPayTH(1)=D21amt/12.
If D18=00, d, or r and D21hop or D21amt=d, then C_2022JobMnthPayTH(1)=d.
If D18=00, d, or r and D21hop or D21amt=r and none=d, then C_2022JobMnthPayTH(1)=r.
198
SECTION D: JOBS/OTHER JOBS DURING 2022
((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r) and (D20hop=01, 02, 03, 04, 05, or 06) and
(D21hop=01, 02, 03, 04, 05, or 06)
D22.
SOFT EDIT: AMOUNT OF CALCULATED MONTHLY TAKE-HOME PAY MUST BE LESS THAN OR EQUAL
T0 CALCULATED MONTHLY PRE-TAX PAY.
IF AMOUNT OF MONTHLY TAKE HOME PAY
(C_2022JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF PRE-TAX MONTHLY PAY
(C_2022JobMnthPay(1)) NE D OR R, AND C_2022JobMnthPayTH(1) > C_2022JobMnthPay(1), TRIGGER
EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER, AMOUNT OF CALCULATED MONTHLY TAKE
HOME PAY IS GREATER THAN AMOUNT OF CALCULATED MONTHLY PRE-TAX PAY. CHECK ENTRY.
IF NECESSARY READ: I must have recorded an incorrect answer. You said that {you were/NAME was} paid
(D20) per (D20 AMOUNT), which would be about (C_2022JobMnthPay(1) before taxes and other deductions
and that (D21) per (D21 AMOUNT), or about (C_2022JobMnthPayTH(1) was left as take-home pay after taxes
and other deductions. Based on what I recorded, your take home pay was more than your pre-tax pay. Should
I change the amount {you were/NAME was} paid before taxes and other deductions or the amount {you
took/NAME took} home after taxes and other deductions?
Debo haber anotado una respuesta incorrecta. Dijo que a {usted/NAME} se le pagan (D20) por (D20
AMOUNT) antes de impuestos y otras deducciones, lo que sería aproximadamente (C_2022JobMnthPay(1)
por mes y que (D21) por (D21 AMOUNT), o aproximadamente (C_2022JobMnthPayTH(1) por mes, sobra
como sueldo neto después de impuestos y otras deducciones. Basado en lo que anoté, su sueldo neto es
más que su sueldo antes de impuestos. ¿Debo cambiar la cantidad que se le pagan a {usted/NAME] antes
de los impuestos y otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras
deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND
OTHER DEDUCTIONS ..................................................... 01
CHANGE AMOUNT OF TAKE-HOME PAY ...................... 02
SUPPRESS ....................................................................... 03
(CHANGE D20amt)
(CHANGE D21amt)
((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r) and (D20hop=01, 02, 03, 04, 05, or 06) and
(D21hop=01, 02, 03, 04, 05, or 06)
D22a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND
CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF MONTHLY TAKE
HOME PAY (C_2022JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY
(C_2022JobMnthPay(1)) NE D OR R, AND (C_2022JobMnthPay(1) - C_2022JobMnthPayTH(1) /
C_2022JobMnthPayTH(1) > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER,
DIFFERENCE IN AMOUNT OF TAKE HOME PAY AND PRE-TAX PAY IS GREATER THAN 30%. CHECK
ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said that {you were/NAME
was} paid (D20) per (D20 AMOUNT), which would be about (C_2022JobMnthPay(1) before taxes and other
deductions and that (D21) per (D21 AMOUNT) , or about (C_2022JobMnthPayTH(1) was left as take-home
pay after taxes and other deductions. Is this correct or should I change the amount {you were/NAME was}
paid before taxes and other deductions or the amount {you took/NAME took} home after taxes and other
deductions?
Debo haber anotado una respuesta incorrecta. Dijo que a {usted/NAME} se le pagan (D20) por (D20
AMOUNT) antes de impuestos y otras deducciones, lo que sería aproximadamente (C_2022JobMnthPay(1)
por mes y que (D21) por (D21 AMOUNT), o aproximadamente (C_2022JobMnthPayTH(1) por mes, sobra
como sueldo neto después de impuestos y otras deducciones. Basado en lo que anoté, su sueldo neto es
más que su sueldo antes de impuestos. ¿Debo cambiar la cantidad que se le pagan a {usted/NAME] antes
de los impuestos y otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras
deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS .................................................................... 01 (CHANGE D20amt)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE D21amt)
SUPPRESS ................................................................................ 03
199
SECTION D: JOBS/OTHER JOBS DURING 2022
(D1=01 or D2=01)
DP4.
PROGRAMMER: SKIP DP4 FOR JOB TWO THROUGH FIVE.
At this job, did most of the other workers have disabilities?
En este trabajo, ¿la mayoría de los demás trabajadores tenían discapacidades?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D1=01 or D2=01)
DP5.
PROGRAMMER: SKIP DP5 FOR JOB TWO THROUGH FIVE.
Could this job have been taken by anybody who applied for it and was qualified, including someone who
did not have a disability?
¿Podría haber tomado este trabajo cualquier persona que lo solicitara y estuviera calificada, incluso
alguien que no tuviera una discapacidad?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D1=01 or D2=01)
DP1a. PROGRAMMER: SKIP DP1A FOR JOB TWO THROUGH FIVE.
I’m going to ask you about reasons {you/NAME} might have left this job. Did {you/NAME} leave this job
because of {your/NAME’s} health, for example, because of worsening illness or the need to go to medical
appointments?
Voy a preguntarle sobre razones {usted / NAME} podría haber dejado este trabajo. Ha dejado este trabajo
debido a su salud, por ejemplo a causa de agravamiento de la enfermedad o de la necesidad de ir a las citas
médicas?
YES ...................................................................... 01
NO........................................................................ 00
DON’T KNOW ...................................................... d
REFUSED ............................................................
r
200
SECTION D: JOBS/OTHER JOBS DURING 2022
(DP1a=01)
DP1a_1. What was it about {your/NAME’s} health that made {you/him/her} leave this job?
¿Qué de su salud que hizo {usted / él / ella} dejar este trabajo?
CODE ALL THAT APPLY.
PROBE:
Anything else?
¿ Algo más?
EXISTING HEALTH PROBLEM GOT WORSE ................
NEW HEALTH PROBLEM STARTED ..............................
GOT INJURED ..................................................................
JOB HAD A NEGATIVE IMPACT ON HEALTH ................
NEEDED TO BE HOSPITALIZED ....................................
NEEDED TIME TO GO TO MEDICAL APPOINTMENTS .
GOT FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION.......................
HEALTH INTERFERED WITH JOB PERFORMANCE .....
DID NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK ..............................
PAIN INTERFERED WITH WORKING A SET
SCHEDULE ......................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TOOK TOO LONG ................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY .....
DID NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ......................
WORK WAS TOO TIRING OR STRESSFUL ...................
OTHER .............................................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................
(DP1a_1=15)
DP1a_1_oth.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
d
r
(DP1a_1_oth.)
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
(D1=1 or D2=01)
DP1b. PROGRAMMER: SKIP DP1B FOR JOB TWO THROUGH FIVE.
d
r
I’m going to ask you about reasons {you/NAME} might have left this job. Did {you/he/she} leave this job
because of {your/NAME’s} job, for example because of the need for accommodations or problems with
{your/his/her} co-workers?
Voy a preguntarle sobre razones {usted / NAME} podría haber dejado este trabajo. {Usted/NAME} dejo este
trabajo por el trabajo, por ejemplo por la necesidad de arreglos o por problemas con compañeros de trabajo?
YES ...................................................................... 01
NO........................................................................ 00
DON’T KNOW ...................................................... d
REFUSED ............................................................
r
201
SECTION D: JOBS/OTHER JOBS DURING 2022
(DP1b=01)
DP1b_1. What was it about {your/NAME’s} job that made {you/him/her} leave it?
Qué es de este trabajo que ha causado que {usted/NAME} dejar de trabajar?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿ Algo más?
JOB DID NOT PAY ENOUGH .........................................
JOB DID NOT OFFER HEALTH INSURANCE
BENEFITS.......................................................................
NEEDED A DIFFERENT SCHEDULE OR SHIFT ...........
NEEDED TIME TO GO TO MEDICAL APPOINTMENTS
GOT FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION .....................
HEALTH INTERFERED WITH JOB PERFORMANCE ...
DID NOT HAVE THE STRENGTH, PHYSICAL
ENERGY OR STAMINA REQUIRED TO WORK ............
PAIN INTERFERED WITH WORKING A SET
SCHEDULE .....................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TOOK TOO LONG ..............................................
DID NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ....................
PERSONALITY CONFLICTED WITH OTHERS AT
THE JOB .........................................................................
GOT FIRED FOR BEHAVIOR AT THE JOB ...................
FOUND ANOTHER JOB (NEW) .....................................
WORK SCHEDULE (NEW) .............................................
SEASONAL/TEMPORARY JOB (NEW)..........................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(DP1b_1=13)
DP1b_1_oth.
01
02
03
04
05
06
07
08
09
10
11
12
20
22
23
13
d
r
(DP1b_1_oth.)
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
(D1=01 or D2=01)
DP1c. PROGRAMMER: SKIP FOR JOB TWO THROUGH FIVE.
d
r
I’m going to ask you about reasons {you/NAME} might have left this job. Did {you/he/she} leave this job
because of {your/NAME’s} personal circumstances, for example because {you/he/she} need(s) childcare,
{don’t/doesn’t} have reliable transportation, or {worry/worries} about losing other benefits?
Voy a preguntarle sobre razones {usted / NAME} podría haber dejado este trabajo. (Usted/NAMe} dejo este
trabajo por circunstancias personales, por ejemplo la necesidad de cuidado de los hijos, no tener transporte
confiable, o preocuparse por la pérdida de otros beneficios?
YES ...................................................................... 01
NO........................................................................ 00
DON’T KNOW ...................................................... d
REFUSED ............................................................
r
202
SECTION D: JOBS/OTHER JOBS DURING 2022
203
SECTION D: JOBS/OTHER JOBS DURING 2022
(DP1c=01)
DP1c_1. What was it about {your/NAME’s} personal circumstances that made {you/him/her} leave the job?
¿Qué de {sus/las} circunstancias personales {de NAME} hizo {usted / él / ella} dejar el trabajo?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿ Algo más?
(DP1c_1=10)
DP1c_1_oth.
NEED HELP CARING FOR CHILDREN OR OTHERS .
NEED PERSONAL ASSISTANCE TO GET READY
FOR WORK EACH DAY ...............................................
GET INJURED ..............................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL
SECURITY, SNAP, MEDICAID/MEDICARE .................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK .......................................................
DRUG/ALCOHOL RELAPSE ........................................
WOULD RATHER DO OTHER THINGS THAN WORK
DO NOT LIKE WORKING .............................................
INCREASE IN INCOME FROM ANOTHER SOURCE ..
MOVED TO ANOTHER AREA (NEW) ..........................
LOSS OR POTENTIAL LOSS OF GOVERNMENT
BENEFITS (NEW) .........................................................
OTHER..........................................................................
DON’T KNOW ...............................................................
REFUSED .....................................................................
01
02
03
04
05
06
07
08
09
19
21
10
d
r
(DP1c_1_oth.)
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(D1=01 or D2=01)
DP2.
PROGRAMMER: SKIP FOR JOB TWO THROUGH FIVE.
Are there any other reasons that we haven’t talked about why {you/NAME} left this job?
¿Hay otras razones por las que no hemos hablado de por {usted/NAME} qué dejó este trabajo
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(DP2=01)
DP2a_oth.
01
00
d
r
What other things made {you/NAME} leave this job?
¿Qué otras cosas le hizo a {usted/NAME} dejar este trabajo?
Other (SPECIFY)
DON’T KNOW .................................................................
d
REFUSED .......................................................................
r
(D1=01 or D2=01)
D24.
CHECK: DID {NAME} HOLD MORE THAN ONE JOB DURING 2022 (D3 > 01)?
YES .................................................................................
01
204
(DP2a_oth)
(D24)
(D24)
(D24)
SECTION D: JOBS/OTHER JOBS DURING 2022
(REPEAT D4 THROUGH D23 FOR EACH JOB. SKIP D5, D14, DP4, DP5, DP1a, DP1b,
DP1c, AND DP2 FOR JOBS 2 TO 5.)
NO ...................................................................................
00
205
SECTION D: JOBS/OTHER JOBS DURING 2022
(D1=01 or D2=01)
D25.
Sometimes people work fewer hours or earn less money than they could in order to care for family
members, keep the cash benefits they need, or just to have more free time. In 2022, did (you/NAME) work
fewer hours or earn less money than (you/he/she) could have for any reason?
A veces, gente trabaja menos horas, o ganan menos dinero de lo que podrían ganar, para poder atender o
cuidar a miembros de su familia, mantener o continuar recibiendo beneficios de dinero (cash benefits), o
simplemente para tener más tiempo libre. En 2022, ¿trabajó [usted/NAME] menos horas, o ganó menos
dinero de lo que pudiera haber ganado, por cualquier razón?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
00
d
r
(D26)
(D26)
(D26)
((D1=01 or D2=01) and D25=01)
D25a. Did (you/NAME) work fewer hours or earn less money than (you/he/she) could have because (you/he/she)…
¿Trabajó [usted/NAME] menos horas, o ganó menos dinero de lo que pudiera haber ganado, porque
[usted/él/ella]. …
PROBE: I need to ask everyone in our study the same questions, even if they don’t seem to apply to (you/NAME).
Necesitamos preguntar la misma pregunta a todas las personas tomando parte en el estudio,
aún si parece que no aplican a [usted/NAME].
a.
YES
NO
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
estaba en mal estado de salud o tenía preocupaciones en
relación a su salud?
01
00
d
r
Are there any reasons I didn’t mention why {you/NAME}
might have worked or earned less than {you/he/she} could
have during 2022?
01
00
d
r
{Were/Was} taking care of children or others?
estaba cuidando a niños o a otras personas?
b.
{Were/Was} enrolled in school or a training program?
estaba matriculad[o/a] en estudios o en un programa de
entretenimiento o capacitación?
c.
Wanted to keep Medicare or Medicaid coverage?
quería mantener cobertura de Medicare o Medicaid?
d1. Wanted to keep Social Security disability cash benefits?
Quería conservar los beneficios en efectivo por incapacidad
del Seguro Social?
d2. Wanted to keep other benefits like food stamps, housing
assistance, or workers’ compensation?
quería continuar recibiendo beneficios tales como estampillas
de comida o cupones de alimentos, asistencia para vivienda
o compensación de trabajadores?
e.
Just did not want to work more?
simplemente no quería trabajar más?
g.
f.
{Were/was} in poor health or had health concerns?
206
SECTION D: JOBS/OTHER JOBS DURING 2022
hay alguna otra razón que no he mencionado por la cual
durante 2022 [usted/NAME] quizás trabajó o ganó menos de
lo que [usted/él/ella] pudiera haber hecho o ganado?
PROGRAMMER: IF D25f=01 GO TO D25f_Other, ELSE SKIP TO D25_1
((D1=01 or D2=01) and D25=01 and D25f=01)
D25f_Other What other reason?
¿Qué otra razón?
DON’T KNOW ...............................................................
REFUSED .....................................................................
d
r
((D1=01 or D2=01) and D25=01)
D25_1. Were any of (your/NAME’s) disability-related benefits reduced or ended as a result of {your/his/her} working
in 2022?
¿Alguno de los beneficios relacionados a incapacidad que [usted/NAME] recibía fue reducido o terminado,
como resultado de que [usted/él/ella] trabajó en 2022?
YES ...............................................................................
NO .................................................................................
DON’T KNOW ...............................................................
REFUSED .....................................................................
207
01
00
d
r
(D26)
(D26)
(D26)
SECTION D: JOBS/OTHER JOBS DURING 2022
(D25_1=01)
D25_2. What benefits were reduced or ended as a result of {your/NAME’s} job in 2022?
¿Qué beneficios fueron reducidos o terminados, como resultado del empleo o trabajo de [usted/NAME] en
2022?
INTERVIEWER: CODE ALL THAT APPLY.
PRIVATE DISABILITY INSURANCE............................. 01
WORKERS’ COMPENSATION ..................................... 02
VETERANS’ BENEFITS................................................ 03
MEDICARE ................................................................... 04
MEDICAID..................................................................... 05
SOCIAL SECURITY DISABILITY BENEFITS (SSI OR SSDI)
PUBLIC ASSISTANCE OR WELFARE ......................... 07
FOOD STAMPS ............................................................ 08
PERSONAL ASSISTANCE SERVICES (PAS) ............. 09
UNEMPLOYMENT BENEFITS ..................................... 10
OTHER STATE DISABILITY BENEFITS ...................... 11
OTHER GOVERNMENT PROGRAMS ......................... 12
OTHER.......................................................................... 13
(D25_2=13)
D25_2_Other: What other benefits?
¿Qué otra beneficios?
06
(D25_2_Other)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(D1=01 or D2=01)
D26.
Now, I am going to read you a list of things that sometimes help people to work more hours or earn more
money. If any of these do not apply to {you/NAME}, please just say so.
In 2022, do you think {you/NAME} could have worked or earned more if {you/he/she} had…
Ahora le voy a leer una lista de cosas que a veces ayudan para que gente trabaje más horas o ganen más
dinero. Si cualquiera de estas no aplica a [usted/NAME], por favor dígamelo. ¿Piensa usted que en 2022,
[usted/NAME] podría haber trabajado o ganado más si [usted/él/ella]
a.
YES
NO
NA
DON’T
KNOW
REFUSED
01
00
02
d
r
01
00
02
d
r
hubiera tenido transporte en el que podía confiar para
ir y volver del trabajo?
01
00
02
d
r
Better job skills?
01
00
02
d
r
Help caring for {your/his/her} children or others in the
household?
hubiera tenido ayuda en atender o cuidar a sus hijos y
a otras personas en su hogar?
b.
Help with {your/his/her} own personal care such as
bathing, dressing, preparing meals, and doing
housework?
hubiera tenido ayuda con su propia atención o cuidado
personal, tal como ayuda para bañarse, vestirse,
preparar comidas, y hacer las tareas o quehaceres
domésticos?
c.
d.
Reliable transportation to and from work?
208
SECTION D: JOBS/OTHER JOBS DURING 2022
hubiera tenido mejores destrezas o capacidades de
trabajo (job skills)?
e.
A job with a flexible work schedule?
hubiera tenido un horario de trabajo flexible (work
schedule)?
f.
02
d
r
01
00
02
d
r
01
00
02
d
r
01
00
02
d
r
Any special equipment or medical devices?
PROGRAMMER: IF D26g=01, GO TO D26g_Other,
ELSE GO TO D26h.
hubiera tenido algún equipo o aparato médico
especial?
h.
00
Help with finding and getting a better job?
hubiera tenido ayuda en encontrar y conseguir un
mejor empleo (o trabajo)?
g.
01
Is there anything else that I didn’t mention that would
have helped {you/NAME} to work or earn more during
2022?
¿Hay algo más que no mencioné que le hubiera
ayudado a {usted]NAME} a trabajar o ganar más
dinero en 2022?
PROGRAMMER: IF D26h=01, GO TO D26h_Other,
ELSE GO TO D27
209
SECTION D: JOBS/OTHER JOBS DURING 2022
((D1=01 or D2=01) and D26g=01)
D26g_Other What other special equipment or medical devices?
¿Qué otro equipo o aparato médico especial?
(D26h)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (D26h)
r (D26h)
((D1=01 or D2=01) and D26h=01)
D26h_Other What else?
¿ Qué más?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(D1=01 or D2=01)
D27.
One last question about when {you were/NAME was} working in 2022. Because of {your/his/her} work, did
Social Security need to make any changes to the amount of {your/his/her} disability benefits?
Una última pregunta acerca de cuando [usted/NAME] estaba trabajando en el año 2022. Por causa de su
trabajo, ¿tuvo el Social Security o Seguro Social que hacer algún cambio en la suma (de dinero) que
[usted/NAME] recibía en pagos de beneficios por incapacidad (disability benefits)?
PROBE:
Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?
¿La suma total de sus beneficios fue reducida, o perdió [usted/NAME] todos sus beneficios?
YES ............................................................................................ 01
NO .............................................................................................. 00 (D29)
DON’T KNOW ............................................................................ d (D29)
REFUSED .................................................................................. r (D29)
((D1=01 or D2=01) and D27=01)
D28.
Because of these changes did the Social Security Administration pay {you/NAME} the wrong benefit amount
at any time during 2022?
Por causa de estos cambios, ¿el Social Security Administration (Administración del Seguro Social) le pagó
a [usted/NAME] la suma equivocada de beneficios en cualquier momento durante 2022?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D1=01 or D2=01)
D29.
In 2022, {were you/was NAME} ever asked to re-pay benefits because the Social Security Administration
overpaid {you/him/her}?
En 2022, ¿alguna vez le pidieron a [usted/NAME] que pague de vuelta por beneficios que el Social Security
Administration (Administración del Seguro Social) le sobre-pagó?
YES ............................................................................................ 01
NO .............................................................................................. 00 (SC1CHECK)
DON’T KNOW ............................................................................ d (SC1CHECK)
REFUSED .................................................................................. r (SC1CHECK)
((D1=01 or D2=01) and D29=01)
D30.
{Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/(he/she) was}
working while receiving benefits?
¿Le pidieron a [usted/NAME] que pague de vuelta al Social Security Administration (Administración del Seguro
Social) porque [usted/él/ella] estaba trabajando mientras recibía beneficios?
210
SECTION D: JOBS/OTHER JOBS DURING 2022
YES ............................................................................................
NO ..............................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01 (D31)
00 (SC1CHECK)
d (SC1CHECK)
r (SC1CHECK)
(D30=01)
D31.
Did {you/NAME} try to appeal or challenge the request to re-pay benefits to the Social Security
Administration?
¿{Usted/NAME} intentó apelar u objetar cuando le pidieron que pagara de vuelta los beneficios a la
Administración del Seguro Social o Social Security Administration?
YES ............................................................................................ 01 (D32)
NO .............................................................................................. 00 (DP3)
DON’T KNOW ............................................................................ d (DP3)
REFUSED .................................................................................. r (DP3)
211
SECTION D: JOBS/OTHER JOBS DURING 2022
(D31=01)
D32.
Did {you/NAME} end up repaying the full benefit amount, repaying some of the benefit amount, or did you
not repay any amount?
¿Terminó {you/NAME} pagando de vuelta la cantidad total de los beneficios, pagando de vuelta parte de
la cantidad total de los beneficios, o no pagó nada de vuelta?
REPAY FULL BENEFIT AMOUNT ............................................. 01
REPAY SOME BENEFIT AMOUNT ........................................... 02
DID NOT REPAY AND BENEFIT AMOUNT............................... 03
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D30=01)
DP3.
Did {you/NAME} change how much {you/he/she} worked because {you were/he was/she was} asked to repay the Social Security Administration?
¿Cambió {Usted/NAME} cuánto {usted/él/ella} trabajó, porque se le pidió a {usted/él/ella} que devolviera
pagos a la Administración del Seguro Social?
YES ............................................................................................
NO...............................................................................................
DON’T’ KNOW............................................................................
REFUSED ..................................................................................
01
00 (SC1CHECK)
d (SC1CHECK)
r (SC1CHECK)
(DP3=01)
DP3a. What did {you/NAME} change about how much {you/he/she} worked? Did {you/he/she}….
¿Qué cambió {usted/NAME} acerca de las horas que trabajó? (Usted/Él/Ella)…
Reduce your work hours by a little
Reducir {sus} horas de trabajo por un poco, ..............................
Reduce your work hours by a lot
Reducir {sus} horas de trabajo por mucho, ................................
Increase your work hours by a little, or
Aumentar sus horas de trabajo por un poco ...............................
Increase your work hours by a lot?
Aumentar sus horas de trabajo por mucho? ...............................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
GO TO SC1CHECK1
212
01
02
03
04
d
r
SECTION SC: BENEFIT SUSPENSE
SECTION SC: BENEFIT SUSPENSE
SC1CHECK:
IS {NAME} CURRENTLY WORKING, WORKED IN PAST 6 MONTHS, WORKED IN 2022 (B24=01 OR B24b=01 OR
B30=01)
YES ............................................................................................ 01 (SC1a)
NO .............................................................................................. 00 (EP1)
(C39_2=06 or CB39_2=06 or D25_2=06)
SC1a. Earlier you told me that {your/NAME’S} Social Security disability benefits were reduced or ended because of
a recent job. During the past year, did {you/NAME} ever completely stop receiving cash disability benefits for
a time because {you were/NAME was} working?
Anteriormente usted me dijo que {sus} beneficios {de NAME} por discapacidad del Seguro Social se han
reducido o terminado debido a un trabajo reciente. Durante el pasado año, ¿alguna vez {usted/NAME}
completamente dejó de recibir beneficios por incapacidad por un tiempo porque {usted/NAME} estaba
trabajando?
PROBE:
This includes stopping cash disability benefits because {you were//NAME was} earning too
much or working too many hours.
Esto incluye dejar de recibir beneficios por incapacidad en efectivo porque {usted/NAME}
estaba ganando demasiado o trabajar demasiadas horas.
YES. ........................................................................................... 01 (SC2)
NO............................................................................................... 00 (EP1)
DON’T’ KNOW............................................................................ d (EP1)
REFUSED................................................................................ ... r (EP1)
(SC1CHECK=01 and C39_2 NE 06 and CB39_2 NE 06 and D25_2 NE 06)
SC1.
Now I would like to ask you about {your/NAME’s} experiences working and how working has affected
{your/NAME’s} cash disability benefits. During the past year, did {you/NAME} ever stop receiving cash
disability benefits for a time because {you were/he was/she was} working?
Ahora me gustaría preguntarle acerca de {sus/las} experiencias {de NAME} en el trabajo y la forma que
trabajando ha afectado a sus beneficios por incapacidad efectivo. Durante el pasado año, ¿alguna vez
{usted//NAME} dejó de recibir beneficios por incapacidad en efectivo por un tiempo, por que estaba
trabajando?
PROBE:
This includes stopping cash benefits because {you were/he was/she was} earning too much or
working too many hours.
Esto incluye dejar de recibir beneficios por incapacidad en efectivo porque {usted/NAME}
estaba ganando demasiado o trabajar demasiadas horas.
YES. ........................................................................................... 01 (SC2)
NO............................................................................................... 00 (EP1)
DON’T’ KNOW............................................................................ d (EP1)
REFUSED................................................................................ ... r (EP1)
(SC1=01 OR SC1a=01)
SC2. {Are you/Is NAME} currently receiving cash disability benefits?
¿Está {usted/NAME} actualmente recibiendo beneficios por incapacidad en efectivo?
YES. ........................................................................................... 01 (SA7)
NO............................................................................................... 00 (SC3)
DON’T’ KNOW............................................................................ d (SC3)
REFUSED................................................................................ ... r (SC3)
(SC2 =00, d, r)
213
SECTION SC: BENEFIT SUSPENSE
SC3.
{Are you/Is NAME} in the process of getting back on cash disability benefits?
¿Está {usted/NAME} en el proceso de conseguir de nuevo beneficios por discapacidad en efectivo?
INTERVIEWER NOTE:
If respondent indicates that they are planning on getting back on benefits but have
not yet started the process, code as ‘01’.
YES. ........................................................................................... 01 (SA7)
NO............................................................................................... 00 (SA7)
DON’T’ KNOW............................................................................ d (SA7)
REFUSED................................................................................ ... r (SA7)
214
SECTION SA: QUESTIONS APPLICABLE TO ALL EXPERIENCING RECENT SUSPENSE
SECTION SA: QUESTIONS APPLICABLE TO ALL EXPERIENCING RECENT SUSPENSE
(SC1a=01 or SC1=01)
Now I would like to ask you about the work that led to {you /his/her} cash benefits ending.
Ahora me gustaría preguntarle acerca del trabajo que dio lugar a que sus beneficios en efectivo terminen.
SA7.
Did {you/NAME} know when {you/he/she} started working or earning more that {you/he/she} would stop
receiving cash disability benefits from Social Security?
¿Sabía que cuando {usted / NAME} comenzó a trabajar o ganar más que {usted / él / ella} dejaria de recibir
beneficios por incapacidad en efectivo de la Seguridad Social?
YES. ........................................................................................... 01 (SA8CHECK)
NO............................................................................................... 00 (SA8)
DON’T’ KNOW............................................................................ d (SA8CHECK))
REFUSED .................................................................................. r (SA8CHECK))
(SA7=00)
SA8.
If {you/NAME} had known that {you were/ he was / she was} going to stop receiving cash benefits, would
{you/he/she} still have started working or earning more?
Si {usted / NAME} hubiera(s) sabido que hiba a dejar de recibir beneficios en efectivo, todavía habrías
empezado a trabajar o ganar más?
YES. ........................................................................................... 01
NO............................................................................................... 00
DON’T’ KNOW............................................................................ d
REFUSED .................................................................................. r
SA8CHECK:
IS {NAME} STILL IN SUSPENSE AND NOT IN PROCESS OF GETTING BACK ON BENEFITS: SC2=00 AND
SC3=00?
YES ............................................................................................ 01 (SS2)
NO .............................................................................................. 00
IS {NAME} STILL RECEIVING BENEFITS SC2=01 OR IN PROCESS OF GETTING BACK ON BENEFITS
(SC3=01)?
YES ............................................................................................ 01 (SB1)
NO .............................................................................................. 00 (EP1)
215
SECTION SS: QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT INTERVIEW
SECTION SS: QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT INTERVIEW
(SC2=00 AND SC3=00)
SS2.
I’m going to ask you about things that might make {you/NAME} have to go back on cash disability benefits in
the future. {Are you/Is NAME} likely to go back on cash disability benefits because of…
Voy a preguntarle acerca de las cosas que podrían hacer que {usted / NAME} que volver a los beneficios por
incapacidad en efectivo en el futuro. {Es usted / es el NAME} probable a volver a los beneficios por
incapacidad en efectivo debido a…
YES
NO
DON’T
KNOW
REFUSED
a. {Your/his/her} health, for example because of
worsening illness or the need to go to medical
appointments?
su salud, por ejemplo a causa de agravamiento de la
enfermedad o de la necesidad de ir a las citas
médicas.
01
00
d
r
b. {Your/His/Her} job, for example because of a need for
accommodations or problems with {your/his/her} coworkers?
su trabajo, ejemplo por la necesidad de arreglos o por
problemas con compañeros de trabajo?
01
00
d
r
c. {Your/His/Her}personal circumstances, for example
because {you need/he needs/she needs} child care,
{do/does} not have reliable transportation, or
{worry/worries} about losing other benefits?
su circunstancias personales, por ejemplo, porque
necesita cuidado de los niños, no tienen transporte
confiable, o preocuparse de perder otros beneficios?
01
00
d
r
PROGRAMMER NOTE: IF SS2a= 0,D,R and SS2b=00,D,R and SS2c=00, D, R, GO TO SS3.
IF SS2a= 1, GO TO SS2a_1.
IF SS2b= 1, GO TO SS2b_1.
IF SS2c= 1, GO TO SS2c_1.
PROGRAMMER NOTE: SS2a_1 SHOULD BE ASKED IMMEDIATELY AFTER SS2a IF =YES. THEN CYCLE
BACK TO SS2b.
(SS2a=01)
SS2a_1. What about {your/NAME’s} health makes {you/NAME} think {you/he/she} might go back on benefits?
¿Qué pasa con {su/el} salud {de NAME} hace que usted piensa que {usted/él/ella} podría volver en los beneficios?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿ Algo más?
EXISTING HEALTH PROBLEM GETS WORSE ........................
NEW HEALTH PROBLEM STARTS ..........................................
GET INJURED............................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH ..........................
NEED TO BE HOSPITALIZED ...................................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE ...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
216
01
02
03
04
05
06
07
08
09
SECTION SS: QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT INTERVIEW
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR WORK
TAKES TOO LONG ....................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY ...............
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK. ..............................
WORK IS TOO TIRING OR STRESSFUL ..................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED................... ...............................................................
217
10
11
12
13
14
15 (SS2a_1_oth)
d
r
SECTION SS: QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT INTERVIEW
(SS2a_1=15)
SS2a_1_oth.
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
PROGRAMMER NOTE: SS2b_1SHOULD BE ASKED IMMEDIATELY AFTER SS2b IF =YES. THEN CYCLE
BACK TO SS2c.
(SS2b=01)
SS 2b_1. What is it about {your/NAME’s} job that makes {you/NAME} think {you/he/she} might go back on benefits?
Qué es de {su/el} trabajo {de NAME} que le hace pensar que {usted/él/ella} podría volver a los beneficios?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿ Algo más?
JOB DOES NOT PAY ENOUGH ................................................ 01
JOB DOES NOT OFFER HEALTH INSURANCE BENEFITS .... 02
NEED A DIFFERENT SCHEDULE OR SHIFT ........................... 03
NEED TIME TO GO TO MEDICAL APPOINTMENTS ............... 04
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................ 05
HEALTH INTERFERES WITH JOB PERFORMANCE ............... 06
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK ....................................... 07
PAIN INTERFERES WITH WORKING A SET SCHEDULE ....... 08
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ...................................................................... 09
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ............................... 10
FOUND ANOTHER JOB (NEW)................................................. 20
WORK SCHEDULE (NEW) ........................................................ 22
DID NOT LIKE/GET ALONG WITH CO-WORKERS (NEW) ...... 23
DID NOT LIKE/GET ALONG WITH MANAGER, SUPERVISOR,
OR BOSS (NEW) ....................................................................... 24
DID NOT LIKE/GET ALONG WITH OTHER STAFF
RESPONSIBLE FOR HIRING OR PROVIDING
ACCOMMODATIONS (SUCH AS HUMAN RESOURCES) (NEW) 25
OTHER ....................................................................................... 11 (SS2b_1_oth)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(SS2b_1=11)
SS2b_1_oth.
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
PROGRAMMER NOTE: SS2c_1 SHOULD BE ASKED IMMEDIATELY AFTER SS2c IF =YES.
218
SECTION SS: QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT INTERVIEW
(SS2c=01)
SS 2c_1. What is it about {your/NAME’s} personal circumstances that makes {you/NAME} think {you/he/she} might
go back on benefits?
¿Qué de {sus/las} circunstancias personales {de NAME} que le hacen pensar que {usted/él/ella} podría volver
a los beneficios?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿Algo más?
NEED HELP CARING FOR CHILDREN OR OTHERS ..............
NEED PERSONAL ASSISTANCE TO GET READY FOR
WORK EACH DAY .....................................................................
GET INJURED............................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL
SECURITY, SNAP, MEDICAID/MEDICARE ..............................
PERSONALITY CONFLICTS WITH OTHERS AT THE JOB......
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB ..................
DO NOT HAVE RELIABLE TRANSPORTATION TO AND
FROM WORK .............................................................................
DRUG/ALCOHOL RELAPSE .....................................................
WOULD RATHER DO OTHER THINGS THAN WORK .............
DO NOT LIKE WORKING... .......................................................
WORK IS TOO TIRING OR STRESSFUL ..................................
MOVED TO ANOTHER AREA (NEW) .......................................
LOSS OR POTENTIAL LOSS OF GOVERNMENT
BENEFITS (NEW) ......................................................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED. .................................................................................
(SS2c_1=12)
SS2c_1_oth.
01
02
03
04
05
06
07
08
09
10
11
19
21
12 (SS2c_1_oth)
d
r
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(SC2=00 AND SC3=00)
SS3.
Are there any other things we haven’t talked about that might make {you/NAME} go back on benefits?
¿Hay otras cosas que no hemos hablado que podrían hacer que {usted/NAME} vaya de nuevo a los
beneficios?
YES. ........................................................................................... 01 (SS3a)
NO............................................................................................... 00 (Section E)
DON’T’ KNOW............................................................................ d (Section E)
REFUSED................................................................................ ... r (Section E)
(SS3=01)
SS3a. What other things might make {you/NAME} go back on benefits?
¿Qué otras cosas puede hacer que {usted/NAME} vuelve a los beneficios?
Other (SPECIFY)
DON’T KNOW .................................................................
219
d
SECTION SS: QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT INTERVIEW
REFUSED .......................................................................
GO TO SECTION E.
220
r
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING
BENEFITS AT INTERVIEW
Earlier you told me that {you are/NAME is} {back on benefits/in the process of getting back} on benefits].
Anteriormente me dijiste que {usted / NAME} {está de nuevo en los beneficios /en el proceso de volver a estar con
beneficios}.
(SC2=01) or (SC3=01)
SB1.
{Did you go/are you going/Did NAME go/Is NAME going} back on benefits because of . . .
{¿Fuiste / ¿Vas/NAME se fue/NAME se va} de nuevo en beneficios debido a…
YES
NO
DON’T
KNOW
REFUSED
a. {Your/His/Her} health, for example because of
worsening illness or the need to go to medical
appointments?
su salud, por ejemplo a causa de agravamiento de
la enfermedad o de la necesidad de ir a las citas
médicas?
01
00
d
r
b. {Your/His/Her} job, for example because of the need
for accommodations or problems with {your/his/her}
co-workers?
su trabajo, ejemplo por la necesidad de arreglos o
por problemas con compañeros de trabajo?
01
00
d
r
c. {Your/His/Her} personal circumstances, for example
because {you need/he needs/she needs} child care,
{do/does} not have reliable transportation, or
{worry/worries} about losing other benefits?
circunstancias personales, por ejemplo, porque
necesita cuidado de los niños, no tienen transporte
confiable, o preocuparse de perder otros beneficios?
01
00
d
r
PROGRAMMER NOTE: IF SB1a= 0,D,R and SB1b=00,D,R and SB1c=00, D, R, GO TO SB2a_other.
IF SB1a= 1, GO TO SB1a_1.
IF SB1b= 1, GO TO SB1b_1.
IF SB1c= 1, GO TO SB1c_1.
PROGRAMMER NOTE: SB1a_1 SHOULD BE ASKED IMMEDIATELY AFTER SB1a IF =YES. THEN CYCLE
BACK TO SB1b.
(SB1a=01)
SB1a_1.
What was it about {your/NAME’s} health that made {you/him/her} have to go back on benefits?
Qué es de {su/la} salud {de NAME} hace que {usted/él/ella} vuela a los beneficios?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
¿ Algo más?
EXISTING HEALTH PROBLEM GETS WORSE ........................
NEW HEALTH PROBLEM STARTS ..........................................
GET INJURED............................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH ..........................
NEED TO BE HOSPITALIZED ...................................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
221
01
02
03
04
05
06
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE ...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR WORK
TAKES TOO LONG ....................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY ...............
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK. ..............................
WORK IS TOO TIRING OR STRESSFUL ..................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED................... ...............................................................
222
07
08
09
10
11
12
13
14
15 (SB1a_1_oth)
d
r
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
(SB1a_1=15)
SB1a_1_oth.
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
PROGRAMMER NOTE: SB1b_1 SHOULD BE ASKED IMMEDIATELY AFTER SB1b IF =YES. THEN CYCLE BACK
TO SB1c.
(SB1b=01)
SB1b_1. What was it about {your/NAME’s} job that made {you/him/her} have to go back on benefits?
Qué es de {su/el} trabajo {de NAME} que le hizo tener que volver a los beneficios?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿ Algo más?
JOB DOES NOT PAY ENOUGH ................................................ 01
JOB DOES NOT OFFER HEALTH INSURANCE BENEFITS .... 02
NEED A DIFFERENT SCHEDULE OR SHIFT ........................... 03
NEED TIME TO GO TO MEDICAL APPOINTMENTS ............... 04
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................ 05
HEALTH INTERFERES WITH JOB PERFORMANCE ............... 06
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK ....................................... 07
PAIN INTERFERES WITH WORKING A SET SCHEDULE ....... 08
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ...................................................................... 09
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ............................... 10
FOUND ANOTHER JOB (NEW) ................................................ 20
WORK SCHEDULE (NEW) ........................................................ 22
DID NOT LIKE/GET ALONG WITH CO-WORKERS (NEW) ...... 23
DID NOT LIKE/GET ALONG WITH MANAGER, SUPERVISOR,
OR BOSS (NEW) ....................................................................... 24
DID NOT LIKE/GET ALONG WITH OTHER STAFF
RESPONSIBLE FOR HIRING OR PROVIDING
ACCOMMODATIONS (SUCH AS HUMAN RESOURCES) (NEW) 25
OTHER ....................................................................................... 11 (SB1b _1_oth)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(SB1b_1=11)
SB1b_1_oth.
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
PROGRAMMER NOTE: SB1c_1 SHOULD BE ASKED IMMEDIATELY AFTER SB1c IF =YES.
223
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
(SB1c=01)
SB1c_1. What was it about {your/NAME’s} personal circumstances that made {you/him/her} have to go back on
benefits?
Qué es de sus circunstancias personales que hizo que {usted / él / ella} a volver a los beneficios?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:
Anything else?
¿ Algo más?
NEED HELP CARING FOR CHILDREN OR OTHERS .......... 01
NEED PERSONAL ASSISTANCE TO GET READY
FOR WORK EACH DAY ........................................................ 02
GET INJURED....................................................................... 03
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE .............................................. 04
PERSONALITY CONFLICTS WITH OTHERS AT THE JOB.. 05
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB .............. 06
DO NOT HAVE RELIABLE TRANSPORTATION TO AND
FROM WORK ........................................................................ 07
DRUG/ALCOHOL RELAPSE ................................................ 08
WOULD RATHER DO OTHER THINGS THAN WORK ......... 09
DO NOT LIKE WORKING... ................................................... 10
WORK IS TOO TIRING OR STRESSFUL .............................. 11
MOVED TO ANOTHER AREA (NEW) ................................... 19
LOSS OR POTENTIAL LOSS OF GOVERNMENT
BENEFITS (NEW) .................................................................. 21
OTHER ................................................................................... 12 (SB1c_1_oth)
DON’T KNOW .......................................................................... d
REFUSED. ................................................................................ r
(SB1c_1=12)
SB1c_1_oth.
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
d
r
(SC2=01) or (SC3=01)
SB2.
Are there any other things that we haven’t talked about that explain why {you went/you are going/NAME
went/NAME is going} back on benefits?
¿Hay otras razones por las que no hemos hablado de que explicar por qué {usted/NAME} se fue de vuelta
en los beneficios?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
01
00
d
r
(SB2=01)
SB2a_other. What (things/ SB1a, Sb1b, Sb1c=1: other things) made {you/NAME} go back on benefits?
Que otras cosas hecho que {usted/NAME} volver a los beneficios?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
224
d
r
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
(SC2=01) or (SC3=01)
SB3.
Is there anything that could have helped {you/NAME} to keep working and earning enough to stay off
benefits?
¿Hay algo que podría haber ayudado {usted / NAME} para seguir trabajando y ganar lo suficiente para
mantenerse fuera de los beneficios?
YES .................................................................................
NO ...................................................................................
DON’T’ KNOW ................................................................
REFUSED .......................................................................
01
00
d
r
(SB4)
(SB4)
(SB4)
(SB3=01)
SB3a. What might have helped {you/NAME} keep working and earning enough to stay off benefits?
INTERVIEWER: CODE ALL THAT APPLY.
Que podría haber ayudado a {usted/NAME} a mantener trabajar y ganar lo suficiente para mantenerse fuera
de los beneficios?
PROBE:
Anything else?
¿ Algo más?
WORKING FEWER HOURS A DAY ..........................................
WORKING FEWER DAYS A WEEK ..........................................
WORKING A DIFFERENT SHIFT ..............................................
HAVING A MORE FLEXIBLE SCHEDULE.................................
BEING ABLE TO START LATER IN THE DAY ..........................
HAVING/HAVING MORE SICK OR OTHER LEAVE..................
PERSONAL CARE ATTENDANT/PERSONAL
ASSISTANT TO HELP WITH GETTING READY
AND/OR DO HOUSEHOLD TASKS ...........................................
ASSISTANCE WITH WORK TASKS ..........................................
MORE UNDERSTANDING EMPLOYER ....................................
MORE UNDERSTANDING CO-WORKERS...............................
ASSISTIVE DEVICE AT WORK .................................................
PHYSICAL MODIFICATIONS OF WORKSPACE ......................
JOB COACH...............................................................................
SIGN LANGUAGE INTERPRETER............................................
READER/INTERPRETER FOR THE BLIND ..............................
ON THE JOB TRAINING ............................................................
BEHAVIORAL COACHING ........................................................
BENEFITS COUNSELING .........................................................
TRANSPORTATION ASSISTANCE. ..........................................
CHILD/FAMILY CARE ASSISTANCE ........................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED. .................................................................................
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21 (SB3a_oth)
d
r
(SB3a=21)
SB3a_oth. What other things might have helped {you/NAME} keep working and earning enough to stay off benefits?
¿Qué otras cosas podrían haber ayudado {usted / NAME} seguir trabajando y ganar lo suficiente para
mantenerse fuera de los beneficios?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
(SC2=01) or (SC3=01)
IF B24=01 (currently working), fill “work and earn enough to stay off benefits”
ELSE, fill “go back to work”
225
d
r
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
SB4.
{Do you/Does NAME} think {you/he/she} will {go back to work / work and earn enough to stay off benefits} in
the future?
¿Piensa que {usted / NAME} {volverá a trabajar/trabajará suficiente para no recibir beneficios} en el futuro?
YES ........................................................................................ 01 (EP1)
NO .......................................................................................... 00 (SB4a)
DON’T KNOW .......................................................................... d (SB4b)
REFUSED ................................................................................. r (EP1)
226
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
(SB4=00)
IF B24=01 (currently working), fill “work and earn enough to stay off benefits in the future”
ELSE, fill “go back to work”
SB4a.
Why {don’t you/doesn’t NAME} think {you/he/she} will {go back to work / work and earn enough to stay off
benefits in the future}?
¿Por qué no piensa {usted / NAME} {volver a trabajar/ trabajará suficiente para no recibir beneficios en el
futuro}?
INTERVIEWER: CODE ALL THAT APPLY.
(SB4a=08)
SB4a_oth.
HEALTH GOES UP AND DOWN ...............................................
HEALTH WILL NOT IMPROVE ENOUGH TO WORK ...............
NOT GETTING MEDICAL TREATMENT, EQUIPMENT, OR
PERSONAL CARE NEED ..........................................................
NOT FINDING RIGHT JOB ........................................................
GETTING HELP CARING FOR
NOT GETTING HELP CARING FOR CHILDREN OR
OTHERS ....................................................................................
NOT GETTING HEALTH INSURANCE ......................................
NOT GETTING TRANSPORTATION .........................................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
08 (SB4a_oth)
d
r
INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
(EP1)
d (EP1)
r (EP1)
(SB4 = d)
IF B24=01 (currently working), fill “work and earn enough to stay off benefits in the future”
ELSE, fill “go back to work”
SB4b.
Why {are you/is NAME} unsure about whether {you/he/she} will {go back to work / work and earn enough to
stay off benefits in the future}?
Por que no esta seguro que va ha {regresar a trabajar/trabajar suficiente para no recibir beneficios en el
futuro}?
INTERVIEWER: CODE ALL THAT APPLY.
HEALTH GOES UP AND DOWN ............................................... 01
HEALTH MAY NOT IMPROVE ENOUGH TO WORK ................ 02
MAY NOT GET MEDICAL TREATMENT, EQUIPMENT, OR
PERSONAL CARE NEED .......................................................... 03
MAY NOT FIND RIGHT JOB ...................................................... 04
MAY NOT GET HELP CARING FOR
CHILDREN OR OTHERS ...............................................................05
MAY NOT GET HEALTH INSURANCE ...................................... 06
MAY NOT GET TRANSPORTATION ......................................... 07
OTHER (SPECIFY) .................................................................... 08 (SB4b_oth)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(SB4b=08)
SB4b_oth. INTERVIEWER: PLEASE SPECIFY
227
SECTION SB: QUESTIONS APPLICABLE TO SAMPLE MEMBERS WITH RECENT SUSPENSE RECEIVING BENEFITS AT
INTERVIEW
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................
228
(EP1)
d (EP1)
r (EP1)
SECTION E: AWARENESS OF SSA PROGRAMS
SECTION E: AWARENESS OF SSA PROGRAMS
(All)
EP1.
Now I will ask you some questions about disability benefit programs.
If {you/NAME} needed information about {your/his/her} disability benefits or how work affects {your/his/her}
benefits who would {you/NAME or (his/her) representative} contact to get that information? (adapted from
NBS10 QF1)
Ahora voy a hacerle algunas preguntas acerca de los programas de prestaciones de incapacidad.
Si {usted / NOMBRE} necesitaba información sobre {sus} beneficios por incapacidad o cómo el trabajo afecta
{ su } beneficios, ¿a quién contactaría {usted / NOMBRE / su representante} para conseguir la información?
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anyone or anyplace else?
Alguien mas o cualquier otro lugar?
SOCIAL SECURITY ADMINISTRATION (PHONE
OR IN PERSON) .............................................................
STATE VOCATIONAL REHABILITATION AGENCY OR
{VR NAME} ....................................................................
BENEFIT SPECIALIST OR WORK INCENTIVES
PLANNING AND ASSISTANCE (WIPA) PROGRAM ......
EMPLOYMENT SERVICE PROVIDER OR
EMPLOYMENT NETWORK (EN)....................................
PROTECTION AND ADVOCACY FOR
BENEFICIARIES OF SOCIAL SECURITY (PABSS) OR
OTHER ADVOCACY ORGANIZATION ..........................
FRIEND OR FAMILY MEMBER ......................................
INDEPENDENT LIVING CENTER OR OTHER
DISABILITY SERVICE/SUPPORT ORGANIZATION ......
MEDICAL DOCTOR OR PROFESSIONAL .....................
SEARCH ON THE INTERNET (E.G., SSA WEBSITE) ...
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(All)
EP1a.
01
02
03
04
05
06
07
08
09
10
d
r
In 2022, did {you/NAME or (his/her) representative} do any of the following to contact the Social Security
Administration (SSA) for information about {your/his/her} disability benefits or how work affects {your/his/her}
benefits? The first is…
En 2022, ¿hizo {usted /NOMBRE o su representante} alguna de las siguientes para contactar a la
Administración del Seguro Social (SSA por sus siglas en inglés) para obtener información sobre sus
beneficios por incapacidad o cómo afecta el trabajo sus beneficios? La primera es…
YES
NO
DON’T
KNOW
REFUSED
a. use a telephone to call the Social Security
Administration?
¿Usó un teléfono para llamar a la Administración del
Seguro Social?
01
00
d
r
b. visit a Social Security Administration office in person?
¿Visitó una oficina de Administración del Seguro
Social en persona?
01
00
d
r
c. go online to the Social Security Administration’s
website or contact them by email?
01
00
d
r
229
SECTION E: AWARENESS OF SSA PROGRAMS
¿Visitó la página web de la Administración del Seguro
Social o les contactó por correo electrónico?
PROGRAMMER NOTE: IF all responses in EP1aa – EP1ac =00, D, R, GO TO B23_3.
(EP1aa=01 OR EP1ab=01 OR EP1ac=01)
EP1b. In general, how easy was it for {you/NAME or (his/her) representative} to get the information {you/they} wanted
about {your/his/her} disability benefits or how work affects {your/his/her} benefits from the Social Security
Administration (SSA)? Was it:
En general, que tan fácil fue para {usted / NOMBRE o (su) representante} para obtener la información que
{usted/NAME} quería sobre sus beneficios por incapacidad o cómo el trabajo afecta sus beneficios de la
Administración del Seguro Social (SSA)? Era:
Very easy,
Muy fácil ..........................................................................
Somewhat easy,
algo fácil, .........................................................................
Not very easy, or
no muy fácil, o .................................................................
Not at all easy?
para nada fácil? ...............................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
230
01
02
03
04
d
r
SECTION E: AWARENESS OF SSA PROGRAMS
(EP1aa=01 OR EP1ab=01 OR EP1ac=01)
EP1d. Overall, how helpful was the information {you/NAME} got about {your/his/her} disability benefits or how work
affects {your/his/her} benefits from the Social Security Administration (SSA)? Would you say:
En general, que útil fue la información {usted / NOMBRE} {consiguió sobre sus /} beneficios por incapacidad
o cómo el trabajo afecta sus beneficios de la Administración del Seguro Social (SSA)? Dirías:
Very helpful,
Muy útil .......................................................................................
Somewhat helpful,
algo útil, ......................................................................................
Not very helpful, or
no muy útil, o ..............................................................................
Not at all helpful?
para nada útil? ............................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
d
r
NEW ITEM
(All)
B23_3. {Have you/Has name} ever used the Internet to access information about {your/his/her} disability, services,
or work from websites other than the SSA’s website?
¿Alguna vez [usted/NAME] usó una computadora para tener acceso a información sobre su incapacidad,
servicios o información relacionada a trabajo por medio del Internet?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
B23_2. How often {do you/does NAME} access the Internet?
¿Con qué frecuencia [usted/NAME] usa una computadora para tener acceso al Internet?
Probe: This includes accessing the Internet by computer, smart phone, tablet, or any other means.
Esto incluye ingresar al Internet por medio de computadora, telefono celular, tableta, u otro medio.
Never
Nunca .........................................................................................
Daily
Diariamente ................................................................................
A few times a week
Algunas veces a la semana ........................................................
Once a week
Una vez a la semana, o ..............................................................
Less than once a week
Menos de una vez a la semana ..................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
EP2a.
01
02
03
04
05
d
r
Next, I’m going to read you two statements. Please tell me if {you think/NAME thinks} they are true or not
true. Here is the first. People who get disability benefits are allowed to work at a job for pay.
A continuación, voy a leerle dos afirmaciones. Por favor dígame si {usted/NAME} piensa que éstas son
ciertas o no son ciertas. La primera es: A las personas que reciben beneficios por discapacidad se les
permite trabajar por pago.
Probe: Is this statement true or not true?
¿Esta afirmación es cierta o no es cierta?
Probe: If you are not sure, that’s okay. You can tell me that as well.
No hay problema si usted no está seguro(a). También me puede contestar eso.
231
SECTION E: AWARENESS OF SSA PROGRAMS
TRUE .......................................................................................... 01
NOT TRUE ................................................................................. 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
EP2b.
Here is the second statement. People who get disability benefits must report any changes in their work to
the Social Security Administration. By changes in work, we mean starting a new job for pay, changing work
duties, changing work hours, or changing work pay.
La segunda afirmación es: Las personas que reciben beneficios por discapacidad deben reportar cualquier
cambio en el trabajo a la Administración del Seguro Social o Social Security Administration. Por cambios en
el trabajo queremos decir iniciar un nuevo empleo por pago, cambios en las responsabilidades de trabajo,
cambios en el horario de trabajo o cambios en el pago por su trabajo.
Probe: Is this statement true or not true?
¿Esta afirmación es cierta o no es cierta?
Probe: If you are not sure, that’s okay. You can tell me that as well.
No hay problema si usted no está seguro(a). También me puede contestar eso.
TRUE .......................................................................................... 01
NOT TRUE ................................................................................. 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
E1.
Next, I’m going to read you a list of things that Social Security offers to people getting disability benefits, to
encourage them to work. Please tell me if {you have/NAME has} ever {heard of these things.
A continuación, voy a leerle una lista de cosas que el Seguro Social ofrece a personas que están recibiendo
beneficios por incapacidad, para animarles a trabajar. Por favor dígame si ^Fills.aName ha oído hablar alguna
vez de estas cosas.
(All)
E2.
PRESS 1 TO CONTINUE ........................................................... 01
CHECK: IS {NAME} AN SSI BENEFICIARY (BSTATUS = 01,03)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (E14)
(E2=01)
E3.
{Have you/Has NAME} ever heard of a Plan for Achieving Self-Support or a PASS Plan? This is a Social
Security support that lets {you/beneficiaries} set aside money to be used to help {you/them} reach a work goal.
The money set aside does not affect {your/their} benefits.
¿Alguna vez oyó ^Fills.aName de un Plan para Lograr la Auto-Suficiencia o Independencia Económica, lo
que en inglés llaman el Plan for Achieving Self-Support o PASS Plan? Esto es un una ayuda del Seguro
Social, que le permite a guardar y ahorrar dinero que se va a usar para ayudarle a llegar a una meta de
trabajo. El dinero ahorrado no afecta a sus beneficios.
PROBE 1: {Have you/Has NAME} ever heard of this plan?
¿Alguna vez oyó [usted/NAME] de este plan?
PROBE 2: If you’re not sure, please just say so.
Si no está segur[o/a], puede decir que no sabe.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
232
SECTION E: AWARENESS OF SSA PROGRAMS
DON’T KNOW ............................................................................
REFUSED ..................................................................................
233
d
r
SECTION E: AWARENESS OF SSA PROGRAMS
(E2=01)
E5.
{Have you/Has NAME} ever heard of the earned income exclusion or the 1 for 2 earnings exclusion? This is
a Social Security rule where one-half of {your/a beneficiary’s} earnings over $85 are not counted when Social
Security figures {your/the} benefit.
¿Alguna vez oyó o escuchó ^Fills.aName de la exclusión por ingresos ganados lo que en inglés llaman earned
income exclusion o de la exclusión de 1 por 2 (UNA por DOS) ganancias? Esto es una regla del Seguro
Social, por la cual la mitad de sus ganancias sobre $85 (ochentaicinco dólares) no son contadas cuando el
Seguro Social calcula sus beneficios?
PROBE 1: {Have you/Has NAME} ever heard of this exclusion?
¿Alguna vez oyó [usted/NAME] de esta exclusión?
PROBE 2: If you’re not sure, please just say so.
Si no está [o/a], puede decir que no sabe
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E2=01)
E7.
{Have you/Has NAME} ever heard of Property Essential to Self-Support, or PESS? This is a Social Security
support where the dollar value of tools, equipment, or other property needed for {your/a beneficiary’s} work is
excluded when Social Security figures {your/the} benefit.
¿Alguna vez oyó o escuchó [usted/NAME] de Propiedad Esencial para la Auto-Suficiencia o Indepencia
Económica, lo que en inglés llaman Property Essential to Self-Support, o PESS? Esto es una ayuda del
Seguro Social por la cual el valor de las herramientas, equipo, u otra propiedad que necesita para su trabajo
no es incluido cuando el Seguro Social calcula su beneficio.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E2=01)
E9.
{Have you/Has NAME} ever heard of Continued Medicaid Eligibility or 1619(b) coverage? This is a Social
Security rule that lets {you/beneficiaries} keep {your/their} Medicaid insurance after {you/they} go to work,
even if {your/their} benefits have stopped.
¿Alguna vez oyó o escuchó [usted/NAME] de Elegibilidad Continuada de Medicaid, lo que en inglés llaman
Continued Medicaid Eligibility o cobertura 1619(b)? Esto es una regla del Seguro Social que le permite a la
gente mantener su seguro de Medicaid después de que empiezan a trabajar, aún si sus beneficios han parado
o terminado.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E2=01)
E11. CHECK: IS {NAME} 25 OR YOUNGER {C_Intage < or = 25} AND DID {NAME} RECEIVE SSI BENEFITS
BEFORE AGE 22 {SSIAGE < 22}?
YES ............................................................................................ 01
NO .............................................................................................. 00 (E14)
234
SECTION E: AWARENESS OF SSA PROGRAMS
(E2=01 and E11=01)
E12.
{Have you/Has NAME} ever heard of the student earned-income exclusion? This is a Social Security rule
where if {you are/a beneficiary is} in school, up to $1,870 of earnings per month are not counted when Social
Security figures {your/the} benefit.
¿Alguna vez oyó o escuchó [usted/NAME] de la exclusión de ingresos ganados por estudiantes, lo que en
inglés llaman student earned-income exclusion? Esto es una regla del Social Security o Seguro Social según
la cual si alguien está matriculado en estudios, hasta $1,870 (mil trescientos cuarenta dólares) de sus
ganacias por mes no son contados cuando el Social Security calcula su beneficio.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
235
SECTION E: AWARENESS OF SSA PROGRAMS
(All)
E14.
CHECK: IS {NAME} A SSDI BENEFICIARY (BSTATUS=02,03)?
(E14=01)
E15a.
YES ............................................................................................ 01
NO .............................................................................................. 00 (E19)
Most people receiving Social Security disability benefits will lose their cash benefits if they work and earn more
than $1,220 in a month for more than nine months. Is this something {you/NAME} knew before today?
La mayoría de las personas que reciben beneficios de Seguro Social por incapacidad perderán todos sus
beneficios si trabajan y ganan más de $1,220 en un mes durante más de nueve meses. ¿Es esto algo que
{usted/NAME} sabía antes de hoy?
KNEW BEFORE TODAY ............................................................ 01
DID NOT KNOW BEFORE TODAY............................................ 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E14=01)
E15.
{Have you/Has NAME} ever heard of a Trial Work Period? This is a Social Security rule that lets
{you/beneficiaries} earn above $880 per month for nine months without losing {your/their} benefits.
¿Alguna vez oyó o escuchó [usted/NAME] de un Periodo de Prueba de Trabajo, lo que en inglés llaman Trial
Work Period? Esto es una regla del Seguro Social que le permite a alguien ganar más de $880 por mes por
nueve meses, sin perder sus beneficios.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E14=01)
E17.
{Have you/Has NAME} ever heard of an Extended Period of Eligibility for Medicare? This is a Social Security
rule that lets {you/beneficiaries} keep Medicare coverage when {you/they} go to work, even if {your/their}
benefits have stopped.
¿Alguna vez oyó o escuchó [usted/NAME] de un Periodo Extendido de Elegibilidad para Medicare, lo que en
inglés llaman Extended Period of Eligibility for Medicare? Esto es una regla del Seguro Social que permite
retener cobertura de Medicare cuando van a trabajar, también si sus beneficios han parado o terminado.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01 (E19)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E9=00, d, r OR E17=00, d, r)
EP3.
Most people who start working and lose their disability benefits are able to keep their health insurance. Is this
something {you/NAME} knew before today?
La mayoría de las personas que comienzan a trabajar y pierden sus beneficios por incapacidad son capaces
de mantener su seguro de salud. ¿Es esto algo que {usted/NAME} sabía antes de hoy?
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
236
SECTION E: AWARENESS OF SSA PROGRAMS
(All)
E19.
{Have you/Has NAME} ever heard of exclusions for Impairment-Related Work Expenses or Blind Work
Expenses? This is a Social Security rule where the value of certain impairment-related items is not counted
when figuring {your/a person’s} benefits and eligibility.
¿Alguna vez oyó o escuchó [usted/NAME] de exclusiones por Gastos de Trabajo Relacionados a
Incapacidad, lo que en inglés llaman Impairment-Related Work Expenses, o Gastos de Trabajo para Ciegos?
Esto es una regla del Seguro Social por la cual no se cuenta el valor de ciertos artículos relacionados a
incapacidad cuando se calculan sus beneficios y elegibilidad.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
237
SECTION E: AWARENESS OF SSA PROGRAMS
(All)
E20a.
{Have you/Has NAME} ever heard of Expedited Reinstatement? This is a Social Security rule that lets
beneficiaries restart their benefits without having to complete a new application if their attempts at work are
not successful.
¿Alguna vez oyó o escuchó {usted/NAME} de Reincorporación Acelerada, lo que en inglés llaman Expedited
Reinstatement? Este es un incentivo del Seguro Social que permite a beneficiarios empezar sus beneficios
de nuevo, sin tener que llenar una nueva aplicación o solicitud, si sus intenciones de trabajar no tienen éxito.
INTERVIEWER: IF ‘NOT SURE’ ANSWER ‘DON’T KNOW’.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
E20c.
Before today, {have you/has NAME} ever heard of Work Incentive and Planning Assistance programs? These
are local organizations that give beneficiaries information about Ticket to Work and other programs and help
them understand how their Social Security benefits are affected by work.
Antes del día de hoy, ¿ha oído hablar {usted/NAME} alguna vez de programas de Incentivos de Trabajo y
Asistencia con Planificacion? Éstas son organizaciones locales que proporcionan información a beneficiarios
sobre Boleto para Trabajar (TTW, por sus siglas en inglés) y otros programas y les ayudan a entender cómo
el trabajo afecta sus beneficios de Seguro Social.
INTERVIEWER: IF ‘NOT SURE’, ANSWER ‘DON’T KNOW’
PROBE: These are sometimes called WIPAs.
A veces estos se llaman WIPAs.
YES ............................................................................................ 01
NO .............................................................................................. 00 (E20e)
DON’T KNOW ............................................................................ d (E20e)
REFUSED .................................................................................. r (E20e)
(E20c=01)
E20d. {Have you/Has NAME} ever used a Work Incentive and Planning Assistance program?
¿Alguna vez usó [usted/NAME] un programa de Asistencia de Incentivas y Planificación de Trabajo?
INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW
YES ........................................................................................... 01
NO ............................................................................................. 00
DON’T KNOW ........................................................................... d
REFUSED ................................................................................. r
(All)
E20e.
{Have you/Has NAME} ever heard of Protection and Advocacy for Beneficiaries of Social Security or PABSS?
This program is focused on protecting beneficiaries’ rights to obtain services.
¿Alguna vez oyó o escuchó [usted/NAME] de Protección y Abogacía para Beneficiarios del Seguro Social Protection and Advocacy for Beneficiaries of Social Security o PABSS? Este programa se enfoca en proteger
los derechos de beneficiarios para obtener servicios.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00 (E21)
DON’T KNOW ............................................................................ d (E21)
REFUSED .................................................................................. r (E21)
238
SECTION E: AWARENESS OF SSA PROGRAMS
(E20e=01)
E20f.
{Have you/Has NAME} ever used Protection and Advocacy for Beneficiaries of Social Security or PABSS?
¿Alguna vez usó [usted/NAME] a la Protección y Abogacía para Beneficiarios del Seguro Social - Protection
and Advocacy for Beneficiaries of Social Security o PABSS?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
239
SECTION E: AWARENESS OF SSA PROGRAMS
(All)
E21.
{Have you/Has NAME} ever heard of the Ticket to Work program?
¿Alguna vez oyó o escuchó [usted/NAME] del programa llamado Ticket to Work o Boleto a Trabajar?
PROBE:
The Ticket to Work program provides services to help disability beneficiaries achieve steady,
long-term employment by providing them greater choices and opportunities to go to work if they
want to.
El programa de Ticket to Work o Boleto a Trabajar proporciona servicios para ayudar a
beneficiarios con incapacidades a alcanzar un empleo fijo y de largo plazo, proporcionando más
opciones y oportunidades para trabajar, si es lo que desean.
YES ............................................................................................ 01 (E22)
NO .............................................................................................. 00 (G1)
DON’T KNOW ............................................................................ d (G1)
REFUSED .................................................................................. r (G1)
(E21=01)
E22.
In general, how useful {do you / does NAME} think that the Ticket to Work program is? Would {you/they} say
the Ticket to Work program is…
En general, ¿qué tan útil cree {usted / NAME} que es el programa Ticket to Work o Boleto a Trabajar? ¿Diría
{usted/él/élla} que el programa Boleto a Trabajar es…
PROBE:
The Ticket to Work program provides services to help disability beneficiaries achieve steady,
long-term employment by providing them greater choices and opportunities to go to work if they
want to.
El programa de Ticket to Work o Boleto a Trabajar proporciona servicios para ayudar a
beneficiarios con incapacidades a alcanzar un empleo fijo y de largo plazo, proporcionando más
opciones y oportunidades para trabajar, si es lo que desean.
Extremely useful, .......................................................................
Extremadamente útil..................................................................
Very useful, ...............................................................................
Muy útil ......................................................................................
Useful, .......................................................................................
Útil, ............................................................................................
A little useful, or .........................................................................
Un poco útil, o ...........................................................................
Not useful at all? ........................................................................
Nada útil? ..................................................................................
DON’T KNOW ...........................................................................
REFUSED .................................................................................
240
01
02
03
04
05
d
r
SECTION F: REMOVED FROM THE NBS
241
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
SERVICE PROVIDERS
(All)
G1.
Next, I will ask about different types of services that people with disabilities sometimes get in order to improve
their ability to work or live independently. Please think only about services {you/NAME} received in 2022.
First, I will ask about employment services {you/NAME} may have received.
Ahora le voy a preguntar acerca de distintos tipos de servicios que personas con incapacidades a veces
reciben para poder mejorar su habilidad para trabajar o vivir en forma independiente. Por favor solo piense
en los servicios recibidos durante el año 2022.
Primero, le voy a preguntar acerca de servicios de empleo que [usted/NAME] quizás recibió.
(All)
G2.
In 2022, did {you/he/she} receive:
Por favor dígame si en el año 2022, [usted/NAME] recibió…
YES
NO
NA
DON’T
KNOW
REF
a work or job assessment to determine if a
job is a good fit for {you/him/her}?
una obra o trabajo de evaluación para
determinar si un trabajo es una buena
opción para usted?
01
00
02
d
r
b.
help to find a job?
ayudar a encontrar un trabajo?
01
00
02
d
r
c.
advice about modifying {your/his/her} job or
work place?
consejos acerca de cómo modificar [su}
trabajo o lugar de trabajo?
01
00
02
d
r
01
00
02
d
r
01
00
02
d
r
a.
d.
job coaching or support services?
servicios de entrenamiento o de apoyo?
e.
any other employment support services to
help {you/NAME} get a job or live
independently?
cualquier otro servicio de apoyo para
ayudar a conseguir un trabajo o vivir de
forma independiente?
(G2_e=01)
G2_oth.
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
242
d
r
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
(All)
G10. Sometimes people get training to help them learn new skills so they can get a new job or change careers.
A veces, gente recibe entrenamiento para ayudarles a aprender nuevas destrezas para que puedan obtener
un nuevo empleo (o trabajo), o para cambiar carreras.
PRESS 1 TO CONTINUE.............................................
(All)
G11. In 2022, did {you/he/she} receive:
Por favor dígame si en el año 2022, [usted/NAME] recibió…
a.
YES
NO
NA
DON’T
KNOW
REF
01
00
02
d
r
01
00
02
d
r
01
00
02
d
r
training to learn a new job or skill?
capacitación para aprender un nuevo
trabajo o habilidad?
b.
on-the-job training?
entrenamiento en el trabajo?
c.
any other training or certification to help
{you/NAME} learn new skills or get a job
that I didn’t mention?
1
cualquier otro tipo de capacitación o
certificación para ayudarle a aprender
nuevas habilidades o conseguir un trabajo
que no he mencionado?
243
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
(G11c = 01)
G11_oth.
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
G15.
d
r
Sometimes people with disabilities receive medical services to improve their ability to work or help them live
independently. Some examples of these services are physical therapy, surgery, and help getting special
equipment or devices.
A veces, personas con incapacidades reciben servicios médicos para mejorar su habilidad para trabajar, o
para ayudarles a vivir en forma independiente. Algunos ejemplos de estos servicios son terapia física, cirugía,
y ayuda en recibir equipo o aparatos especiales
PRESS 1 TO CONTINUE.............................................
244
1
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
(All)
G16. In 2022, did {you/he/she} receive:
Por favor dígame si en el año 2022, [usted/NAME] recibió alguno de los siguientes servicios de. ¿Recibió
[usted/él/ella] servicios
a.
b.
c.
d.
YES
NO
NA
DON’T
KNOW
REF
physical therapy?
Terapia física?
01
00
02
d
r
occupational therapy? PROBE: Occupation therapy is
treatment that helps people achieve independence in all
areas of their lives and can include home and job site
evaluations, skills assessments, equipment
recommendations, and other treatment to help improve a
person’s ability to perform daily activities
Terapia ocupacional? Terapia ocupacional es tratamiento
que ayuda a la gente a lograr independencia en todos los
aspectos de la vida, y puede incluir evaluaciones del
hogar y del lugar de trabajo, evaluación o análisis de
destrezas, recomendaciones para equipo o aparatos, y
otros tratamientos para ayudar a mejorar la habiliadad o
capacidad de alguien para realizar actividades cotidianas
(o diarias)?
01
00
02
d
r
speech therapy?
Terapia del habla?
01
00
02
d
r
special equipment or devices?
Equipo o aparatos especiales?
01
00
02
d
r
01
00
02
d
r
01
00
02
d
r
e. prescription medications?
Medicamentos?
PROBE: Prescription medications are medications
prescribed by a doctor and do not include over-thecounter medications.
Medicamentos recetados son remedios recetados por un
médico y no incluyen medicamentos sin receta.
f. any other medical services to improve {your/NAME’s}
ability to work or live independently that I didn’t mention?
cualesquiera otros servicios médicos para mejorar su
capacidad para trabajar o vivir independientemente que
no mencionara?
(G16f=01)
G16_oth.
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
G20.
d
r
Sometimes people go to a mental health professional to get therapy or counseling to improve their ability to
work or live independently. In 2022, did {you/he/she} receive:
245
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
A veces, hay personas que van a un profesional de salud mental para recibir terapia o servicios de consejería
(counseling) para mejorar sus capacidades para trabajar, o para ayudarles a vivir en forma independiente.
En 2022, {usted / él / ella} recibó…
YES
NO
NA
DON’T
KNOW
REF
a. personal counseling or therapy?
asesoramiento personal o terapia?
01
00
02
d
r
b. group therapy?
Terapia de grupo?
01
00
02
d
r
01
00
02
d
r
c.
(G20c=01)
G20_oth.
any other mental health services to help
{you/NAME} work or live independently that
I didn’t mention?
cualquier otro servicio de salud mental para
ayudarle a trabajar o vivir
independientemente que no he
mencionado?
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
246
d
r
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
(All)
G23.
At any time in 2022, did {you/ NAME} enroll in school or take any classes to help {you/him/her} get a new job
or change careers? Please do not include any training you have already told me about.
En cualquier momento en 2022, se inscribio {usted/NAME} en una escuela o ha tomado alguna clase para
ayudarle a obtener un nuevo empleo (o trabajo), o para cambiar carreras? Por favor no incluya cualquier
entrenamiento del cual ya me ha dicho.
PROBE 1: This could include vocational training in high school, college classes, or other instructional
programs.
Esto puede incluir entrenamiento vocacional en la escuela secundaria o high school, cursos o
clases en la universidad o college, u otros programas de instrucción.
YES ............................................................................... 01
NO ................................................................................. 00
DON’T KNOW ............................................................... d
REFUSED .....................................................................
r
(G23=01)
G26.
{Are you/Is NAME} currently enrolled in school or taking any classes?
¿Está [usted/NAME] actualmente matriculad[o/a] en estudios en alguna escuela, o tomando clases?
YES ............................................................................................ 01 (G27)
NO .............................................................................................. 00 (G58)
DON’T KNOW ............................................................................ d (G58)
REFUSED .................................................................................. r (G58)
(G26=01)
G27.
{Are you/Is NAME} working toward a degree, a certificate or license, or {are you/is (he/she)} just taking
classes?
¿Está [usted/NAME] estudiando para recibir un título (degree), certificado, o licencia; o [usted/él/ella]
solamente está tomando clases?
WORKING TOWARD DEGREE ................................................. 01 (G28)
WORKING TOWARD CERTIFICATE/LICENSE ........................ 02 (G28)
ONLY TAKING CLASSES .......................................................... 03 (G58)
DON’T KNOW ............................................................................ d (G58)
REFUSED .................................................................................. r (G58)
(G27=01,02)
G28.
PROGRAMMER: IF G27=01 USE “DEGREE” AND IF G27=02 USE “CERTIFICATE OR LICENSE”
Toward what type of {degree/certificate or license} {are you/is NAME} working?
¿Para qué tipo de aG28_fill está [usted/NAME] estudiando?
INTERVIEWER: CODE ONE ONLY.
GED OR HIGH SCHOOL EQUIVALENCE
PROGRAM/COURSES ..............................................................
VOCATIONAL PROGRAM .........................................................
ASSOCIATE DEGREE PROGRAM (AA DEGREE) ...................
UNDERGRADUATE DEGREE PROGRAM (BA, BS DEGREE)
GRADUATE DEGREE PROGRAM (e.g., MA, MS, MD, EdD)....
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(G28=02)
G28b_oth. INTERVIEWER: PLEASE SPECIFY
247
01
02
03
04
05
06
d
r
(G29)
(G28b_oth)
(G29)
(G29)
(G29)
(G28f_oth)
(G29)
(G29)
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
(G29)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
248
d (G29)
r (G29)
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
(G28=06)
G28f_oth.
INTERVIEWER: PLEASE SPECIFY
(G29)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (G29)
r (G29)
(G27=01, 02)
G29.
{Are you/Is NAME} a full-time or part-time student?
¿Es [usted/NAME] un(a) estudiante a tiempo completo (full-time) o a tiempo parcial?
FULL-TIME ................................................................................. 01 (G58)
PART-TIME ................................................................................ 02 (G58)
DON’T KNOW ............................................................................ d (G58)
REFUSED .................................................................................. r (G58)
G43. DELETED
G44. DELETED
G45. DELETED
G45_oth. DELETED
G46. DELETED
G47. DELETED
G47_week.DELETED
G47_month.DELETED
G47_year. DELETED
INFORMATION ABOUT SERVICES IN 2022
(All)
G58.
Now I want to ask you about how easy it is to get information about services. This includes both services
{you/NAME} used and did not use.
Thinking only about 2022, did {you/NAME} or {your/his/her} representative contact anyone to try to get
information about services to help {you/NAME} work or live independently?
Ahora quiero preguntarle acerca de cuán fácil es obtener información sobre los servicios. Esto incluye tanto
a los servicios que [usted/NAME] usó, y los que no usó. Pensando solamente en relación al año 2022, ¿se
comunicó [usted/NAME] o su representante con alguien para tratar de obtener información acerca de servicios
para ayudarl[o/a] a [usted/NAME] a trabajar o para vivir en forma independiente?
YES ............................................................................................ 01 (G59)
NO .............................................................................................. 00 (G60)
DON’T KNOW ............................................................................ d (G60)
REFUSED .................................................................................. r (G60)
(G58=01)
G59.
In general, how easy or difficult was it for {you/NAME} or {your/his/her} representative to get the information
{you/they} wanted about these services? Was it…
En general, ¿qué tan fácil o difícil fue para {usted/NAME} o su representante obtener la información acerca
de estos servicios que {usted/él/ella} quería? ¿Fue…
Very easy,
Muy fácil, .................................................................................... 01
Easy,
249
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
Fácil ............................................................................................
Neither easy nor difficult,
Ni fácil ni difícil, ...........................................................................
Difficult, or
Difícil, o .......................................................................................
Very difficult?
Muy difícil?..................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
02
03
04
05
d
r
(G58=01)
G59a. Who did {you or your representative/NAME or his/her representative} get information from about these
services?
¿Quién le dio a {usted o a su representante/NAME o a su representante} la información sobre estos servicios?
STATE UNEMPLOYMENT OFFICE ..........................................
AMERICAN JOB CENTER / A STATE OR LOCAL
WORKFORCE CENTER ............................................................
FRIENDS OR RELATIVES ........................................................
STATE VOCATIONAL REHABILITATION
AGENCY OR {VRSTATE FROM {NAME’S} CURRENT
STATE} ......................................................................................
AN EMPLOYMENT AGENCY, PROGRAM, OR
EMPLOYMENT NETWORK (EN)...............................................
THE TICKET TO WORK (TTW) PROGRAM ..............................
A FORMER EMPLOYER ...........................................................
ANY OTHER EMPLOYERS .......................................................
GENERAL INTERNET SEARCH ...............................................
OTHER (SPECIFY) ....................................................................
(G59a=10)
G59a_Oth.
01
02
03
04
05
06
07
08
09
10 (G59a_oth)
Who else provided information {you/NAME} wanted about services?
¿Quién más le dio la información que {usted/NAME} quería acerca de los servicios?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
SERVICES NEEDED BUT NOT RECEIVED IN 2022
(All)
G60.
In 2022, were there any services, equipment, or other supports that {you/NAME} needed but did not receive
that would have improved {your/his/her} ability to work or live independently?
En el año 2022, ¿había algún servicio, equipo o aparato, u otros apoyos que [usted/NAME] necesitaba pero
que no recibió, que habrían mejorado su habilidad para trabajar o vivir en forma independiente?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I1)
DON’T KNOW ............................................................................ d (I1)
REFUSED .................................................................................. r (I1)
(G60=01)
G61.
Why {were you/was NAME} unable to get these services?
¿Por qué no podía [usted/NAME] obtener o recibir estos servicios?
250
SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2022
(I1)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
251
d (I1)
r (I1)
SECTION H: REMOVED FROM THE NBS
252
SECTION I: HEALTH AND FUNCTIONAL STATUS
SECTION I: HEALTH AND FUNCTIONAL STATUS
GENERAL HEALTH STATUS
(ITEMS I1 through I8 constitute the SF-8)
(All)
I1.
The next questions are about {your/NAME’s} health.
Overall, how would you rate {your/NAME’s} health during the past 4 weeks?
Las próximas preguntas son acerca de {su salud/la salud de NAME}.
En general, ¿cómo clasificaría a {su salud/la salud de NAME} durante las últimas cuatro semanas?
(All)
I2.
Excellent,
Excelente, ...................................................................................
Very good,
Muy buena ..................................................................................
Good,
Buena, ........................................................................................
Fair,
Normal, .......................................................................................
Poor, or
Mal, o ..........................................................................................
Very poor
Muy Mal ......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
d
r
During the past 4 weeks, how much did physical health problems limit {your/NAME’s} usual physical activities
(such as walking or climbing stairs?)
Durante las últimas cuatro semanas, ¿cuánto [lo/la] limitaron problemas de salud física a [usted/NAME] en
sus actividades físicas normales tales como caminar o subir escaleras?
(All)
I3.
Not at all,
Nada, ..........................................................................................
Very little,
muy poco, ...................................................................................
Somewhat,
Algo, ...........................................................................................
Quite a lot, or
Bastante, o .................................................................................
Could {you/he/she} not do physical activities?
{Usted/Él/Ella} no podía hacer actividades físicas? ....................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
d
r
During the past 4 weeks, how much difficulty did {you/NAME} have doing {your/his/her} daily work, both at
home and away from home, because of {your/his/her} physical health?
Durante las últimas cuatro semanas, ¿cuánta dificultad tuvo [usted/NAME] en su trabajo diario, ambos en su
hogar y fuera del hogar, por causa de su salud física?
None at all,
Para nada, .................................................................................. 01
A little bit,
muy poco, ................................................................................... 02
Some,
Algo, ........................................................................................... 03
253
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
I4.
Quite a lot, or
Bastante, o ................................................................................. 04
Could {you/he/she} not do daily work?
{Usted/Él/Ella} no podía hacer trabajo diario? ............................ 05
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
How much bodily pain {have you/has NAME} had in the past 4 weeks?
¿Cuánto dolor en su cuerpo ha tenido [usted/NAME] en las últimas cuatro semanas?
None,
Ningun dolor ...............................................................................
Very mild,
Dolor muy leve (o muy ligero), ....................................................
Mild,
Dolor leve (o ligero), ...................................................................
Moderate,
Dolor moderado, .........................................................................
Severe, or
Dolor severo o fuerte, o ..............................................................
Very severe?
Dolor muy severo o muy fuerte?.................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
254
01
02
03
04
05
06
d
r
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
I5.
During the past 4 weeks, how much energy did {you/NAME} have?
Durante las últimas cuatro semanas, ¿cuánta energía tenía [usted/NAME]?
(All)
I6.
Very much,
Mucha,........................................................................................
Quite a lot,
Bastante, ....................................................................................
Some,
Algo, ...........................................................................................
A little, or
Un Poco, o ..................................................................................
None?
Nada de energia? .......................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
d
r
During the past 4 weeks, how much did {your/NAME’s} physical health or emotional problems limit
{your/his/her} usual social activities with family or friends?
Durante las últimas cuatro semanas, ¿cuánto [lo/la] limitaron sus problemas físicos o emocionales a
[usted/NAME] en sus actividades sociales normales con familia o amistades?
(All)
I7.
Not at all,
Para nada, ..................................................................................
Very little,
muy poco, ...................................................................................
Somewhat,
Algo, ...........................................................................................
Quite a lot, or
Bastante, o .................................................................................
Could {you/he/she} not do social activities?
{Usted/Él/Ella} no podía tomar parte en actividades sociales? ...
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
d
r
During the past 4 weeks, how much {have you/has NAME} been bothered by emotional problems (such as
feeling anxious, depressed or irritable?)
Durante las últimas cuatro semanas, ¿cuánto le han molestado a [usted/NAME] problemas emocionales tal
como sentirse ansios[o/a], deprimid[o/a] o irritad[o/a] ?
(All)
I8.
Not at all,
Para nada, ..................................................................................
Slightly,
Ligeramente,...............................................................................
Moderately
Moderadamente, ......................................................................
Quite a lot, or
Bastante, o .................................................................................
Extremely?
En extremo? ...............................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
d
r
During the past 4 weeks, how much did personal or emotional problems keep {you/NAME} from doing
{your/his/her} usual work, school or other daily activities?
255
SECTION I: HEALTH AND FUNCTIONAL STATUS
Durante las últimas cuatro semanas, ¿cuánto le impedieron a [usted/NAME] problemas personales o
emocionales en hacer su trabajo normal, o en tomar parte en sus actividades diarias o de estudio?
Not at all,
Para nada, ..................................................................................
Very little,
muy poco, ...................................................................................
Somewhat,
Algo, ...........................................................................................
Quite a lot, or
Bastante, o .................................................................................
Could {you/he/she} not do daily activities?
{Usted/Él/Ella} no podía tomar parte en actividades diarias? .....
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
d
r
(All)
IP1. {Do you/Does NAME} have a physical or mental health condition that gets worse every now and then that requires
more than a few days to recover from?
{/NOMBRE} tiene una condición de salud física o mental que empeora de vez en cuando y requiere más de unos
pocos días para recuperarse?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
256
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
I9.
Compared to {THIS MONTH, LAST YEAR}, how would you rate {your/NAME’s} health in general now?
En comparación al mes de aMonthName I9_Year, ¿cómo clasificaría usted en general a {su salud/la salud
de NAME} ahora?
Much better now,
Mucho mejor ahora,....................................................................
Somewhat better now,
Algo mejor ahora, .......................................................................
About the same,
Más o menos igual, ....................................................................
Somewhat worse now, or
Algo peor ahora, o ......................................................................
Much worse now?
Mucho peor ahora? ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
d
r
Unmet Health Needs
(All)
IP2. Sometimes people delay or skip getting the health care they need for different reasons. Please tell me if any time
in the past 12 months {you/NAME} delayed or skipped getting . . . (NHIS 2011 AAU section and NHIS 1996 access
questions modified)
A veces las personas posponen o pasan por alto el cuidado médico que necesitan por varias razones. Por favor
dígame si hubo algún momento en los últimos 12 meses en que {usted/NAME} si se retrasó en obtener o saltó…
a.
b.
c.
YES
NO
DON’T
KNOW
REFUSED
prescription medicines
medicamentos con receta
01
00
d
r
special equipment or medical devices
equipo especial o dispositivos médicos
01
00
d
r
mental health care or counseling
atención de salud mental o consejería
01
00
d
r
01
00
d
r
d. any other type of medical care I didn’t mention
cualquier otro tipo de atención médica que no
mencioné
(All)
IP5.
During the past 12 months, about how many days did illness or injury keep {you/NAME} in bed more than half
of the day (include days while an overnight patient in a hospital)? (NHIS 2011 item AHS 050)
Durante los últimos 12 meses, ¿aproximadamente cuántos días tuvo que quedarse en la cama {usted/NAME}
más de la mitad del día por enfermedad o lesión (incluya días como paciente hospitalizado de noche)?
INTERVIEWER: ENTER THE NUMBER OF DAYS
INTERVIEWER: IF ‘0’ DAYS, ENTER 0.
PROBE: Half a day means more than half of the time you are awake.
La mitad del día significa más de la mitad del tiempo que está despierto(a).
|
|
|
(0-365)
257
SECTION I: HEALTH AND FUNCTIONAL STATUS
258
SECTION I: HEALTH AND FUNCTIONAL STATUS
Informal Supports
(All)
IP7.
People sometimes look to others for support. For each of the following kinds of support, please tell me how
often {you are/NAME is} able to get it when {you need/he needs/she needs} it. Would you say . . . none of the
time, a little of the time, some of the time, most of the time, or all of the time?
A veces las personas se ven a los demás como apoyo. Para cada uno de los siguientes tipos de apoyo, por
favor dígame con qué frecuencia {eres / NOMBRE} es capaz de conseguirlo cuando {necesita}. Dirías . . .
ninguna vez, una Pocas veces, algunas de las veces, la mayoría del tiempo, o todo el tiempo?
a.
b.
c.
d.
e.
NONE
OF
THE
TIME
A
LITTLE
OF
THE
TIME
SOME
OF
THE
TIME
MOST
OF THE
TIME
ALL
OF
THE
TIME
NA
DON’T
KNOW
REFUSED
Someone to help
{you/NAME} with bathing,
dressing, or preparing meals
if {you/NAME} needed it
Alguien para ayudar {usted /
NOMBRE} para bañarse,
vestirse, o la preparación de
comidas si {usted /
NOMBRE} necesitabas?
01
02
03
04
05
06
d
r
Someone to give
{you/NAME} good advice
about a crisis or a personal
problem if {you/NAME}
needed it
Alguien para dar {usted /
NOMBRE} buenos consejos
acerca de una crisis o un
problema personal si {usted /
NOMBRE} necesitabas?
01
02
03
04
05
06
d
r
Someone to take
{you/NAME} to the doctor if
{you/he/she} needed it
Alguien que tome {usted /
NOMBRE} con el médico si
{usted / él / ella}
necesitabas?
01
02
03
04
05
06
d
r
Someone to help
{you/NAME} with
{your/his/her} daily chores if
{you/NAME} needed it
Alguien para ayudar {usted /
NOMBRE} con {sus tareas
diarias} {si usted / NOMBRE}
necesitabas?
01
02
03
04
05
06
d
r
Someone to help
{you/NAME} with
{your/his/her} expenses if
{you/NAME} needed it
Alguien para ayudar {usted /
NOMBRE} con {sus / sus /
sus gastos si} {usted /
NOMBRE} necesitaban?
01
02
03
04
05
06
d
r
259
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
IP8a.
In a typical week, how many times {do you/does NAME} talk on the telephone with family, friends, or
neighbors?
En una semana típica, ¿cuántas veces {usted/NAME} habla por teléfono con familiares, amigos o vecinos?
INTERVIEWER: ENTER THE NUMBER OF CONTACTS
INTERVIEWER: IF ‘0’ CONTACTS, ENTER 0.
(All)
IP8b.
|
|
|
(0-99)
In a typical week, how often {do you/does NAME} get together with friends or relatives?
En una semana típica, ¿con qué frecuencia {usted/NAME} se junta con amigos o familiares?
PROBE: I mean things like going out together or visiting in each other’s homes.
Me refiero a cosas como salir juntos o visitar en las casas de los demás.
INTERVIEWER: ENTER THE NUMBER OF CONTACTS
INTERVIEWER: IF ‘0’ TIMES, ENTER 0.
|
(All)
IP8c.
|
|
(0-99)
In a typical week, how often {do you/does NAME} attend church or religious services?
En una semana típica, ¿con qué frecuencia {usted/NAME} asiste a la iglesia o servicios religiosos?
INTERVIEWER: ENTER THE NUMBER OF TIMES
INTERVIEWER: IF ‘0’ TIMES, ENTER 0.
|
|
|
(0-99)
260
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
IP8d.
In a typical week, how often {do you/does NAME} attend meetings of clubs or organizations {you belong/he
belongs/she belongs} to?
En una semana típica, ¿con qué frecuencia {usted/NAME} asiste a las reuniones de los clubes u
organizaciones que pertenecen?
PROBE: These include church groups, unions, fraternal or athletic groups or school groups.
Estos incluyen grupos de iglesias, sindicatos, grupos fraternales o atléticos o grupos escolares.
INTERVIEWER: ENTER THE NUMBER OF TIMES
INTERVIEWER: IF ‘0’ TIMES, ENTER 0.
|
(All)
IP9.
|
|
(0-99)
Can {you/NAME} drive {yourself/himself/herself} when {you need/he needs/she needs} to go places?
Puedes {usted / NOMBRE} conducer a sí mismo / a sí misma cuando} {usted necesita / necesita / ella
necesita} para ir a lugares?
YES ............................................................................................ 01 (IP10)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d (IP10)
REFUSED .................................................................................. r (IP10)
(IP9=00)
IP9.a. {Do you/Does NAME} have some way of getting to places when {you need/he needs/she needs} to go such
as having someone else drive or using public transportation?
¿Usted / NOMBRE} tiene alguna forma de llegar a lugares cuando {necesita} ir como tener a alguien en coche
o en transporte público?
(All)
IP10.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
Overall, how reliable {is your/is NAME’s} transportation when {you need/he needs/she needs} it? By reliable,
we mean your transportation gets you to where you need to go on time. Would you say {your/NAME’s}
transportation is. . .
En general, ¿qué tan fiable es el transporte {suyo/de NAME} cuando lo necesita? Diría . . .
Very reliable,
Muy fiable ................................................................................... 01
Somewhat reliable, or
Algo fiable .................................................................................. 02
Not reliable at all?
Nada fiable ................................................................................. 03
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I10.
{Do you/Does NAME} take any prescription medications for any ongoing physical health conditions?
PROBE: Please do not include over the counter medication such as cold or headache medication, vitamins,
or herbal supplements.
¿Toma [usted/NAME] cualquier medicina recetada para tratar alguna condición corriente de su salud física?
Por favor no incluya medicamentos de venta libre, tales como medicamentos para el resfriado o dolor de
cabeza, vitaminas o suplementos a base de hierbas.
261
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
I11.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
{Do you/Does NAME} take any prescription medications for any ongoing mental or emotional conditions?
{NAME} Toma algún medicamento con receta para cualquier condición mental o emocional en curso?
PROBE: Please do not include over the counter medication such as cold or headache
medication, vitamins, or herbal supplements.
Por favor no incluya medicamentos de venta libre, tales como medicamentos para el
resfriado o dolor de cabeza, vitaminas o suplementos a base de hierbas.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
262
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
I12.
Since {THIS MONTH, LAST YEAR}, {have you/has NAME} received any treatment for a mental or emotional
condition at a hospital, clinic, or doctor’s office?
¿Deste {THIS MONTH, LAST YEAR} ha recibido {usted/NAME} cualquier medicina recetada para tratar
alguna condición mental o emocional en un hospital, una clínica o consultorio medico?
PROBE: Do not include medications.
No incluya medicamentos.
YES ............................................................................................ 01 (I17a)
NO .............................................................................................. 00 (I17a)
DON’T KNOW ............................................................................ d (I17a)
REFUSED .................................................................................. r (I17a)
ADL, IADL, AND FUNCTIONAL LIMITATIONS
(All)
I17a.
Now I’d like to ask you some questions about everyday activities and how much difficulty {you have/NAME
has} doing these activities. Our study requires that all beneficiaries be asked these questions. Please give
me your best answer even if the questions don’t seem to apply to {you/NAME}.
Ahora quisiera hacerle algunas preguntas acerca de actividades cotidianas, y cuánta dificultad tiene
[usted/NAME] en hacer estas actividades. Nuestro estudio requiere que les preguntemos a todos los
beneficiarios estas preguntas. Por favor déme su mejor respuesta, aunque es posible que le parezca que la
pregunta no aplica a [usted/NAME].
PRESS 1 TO CONTINUE ...........................................................
1
(All)
I17b.
{Are you/Is NAME} blind or do {you/ does he/she} have serious difficulty seeing even when wearing
glasses?
¿Es [usted/NAME] ciego(a) o tiene [usted/él/ella] dificultad seria para ver aun cuando lleva anteojos?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I21)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I17b=01,d, r)
I19.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
seeing, such as telescopic lenses, adapted computer equipment, Braille, a guide dog, or a white cane?
¿Usa [usted/NAME] algún aparato o equipo especial o cualquier otra asistencia especial por tener dificultad
en ver, tal como lentes telescópicos, aparatos de computadoras adaptados, Braille, un perro de guía, o un
bastón blanco?
PROBE: Do not include glasses or contact lenses.
No incluya anteojos o lentes de contacto.
YES ............................................................................................ 01
NO .............................................................................................. 00 (I21)
DON’T KNOW ............................................................................ d (I21)
REFUSED .................................................................................. r (I21)
(I19=01)
I20.
What devices, equipment, or other types of assistance {do you/does NAME} use?
¿Qué aparato, equipo u otros tipos de asistencia usa [usted/NAME]?
263
SECTION I: HEALTH AND FUNCTIONAL STATUS
PROBE:
Anything else?
¿ Algo más?
INTERVIEWER: CODE ALL THAT APPLY.
TELESCOPIC LENSES .............................................................. 01
ADAPTED COMPUTER EQUIPMENT ....................................... 02
BRAILLE ..................................................................................... 03
READERS .................................................................................. 04
GUIDE DOG ............................................................................... 05
WHITE CANE ............................................................................. 06
OTHER SEEING ASSISTANCE ................................................. 07
MAGNIFYING GLASS ................................................................ 08
SCREEN READERS ................................................................... 09
TEXT-TO-VOICE DEVICES ........................................................ 10
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
264
(I21)
(I21)
(I21)
(I21)
(I21)
(I21)
(I20_Other)
(I21)
(I21)
(I21)
(I21)
(I21)
SECTION I: HEALTH AND FUNCTIONAL STATUS
(I20=07)
I20_Other.
What other seeing assistance?
¿Qué otra asistencia para ver?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
I21.
d
r
{Are you/is NAME} deaf or do {you/he/she} have serious difficulty hearing?
¿Es [usted/NAME] sordo(a) o tiene [usted/él/ella] dificultad seria de oído?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I25)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I21=01,d, r)
I22.
{Are you/Is NAME} able to hear what is said in normal conversation at all?
¿Puede [usted/NAME] oir lo que se dice en una conversación normal en alguna forma?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I21=01,d, r)
I23.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
hearing? This includes a hearing aide, a phone amplifier, TTY or teletype Relay, an assistive listening or
signaling device, or an interpreter.
¿Usa [usted/NAME] cualquier dispositivo, equipo especial, u otro asistencia especial por dificultad para oír.
Esto incluye un audífono, un amplificador de teléfono, TTY o equipo de Retransmisión, un dispositivo para
escuchar o señalar, o un intérprete.
INTERVIEWER NOTE: If person reports cochlear implant, code ‘01’.
YES ............................................................................................ 01
NO .............................................................................................. 00 (I25)
DON’T KNOW ............................................................................ d (I25)
REFUSED .................................................................................. r (I25)
(I21=01,d, r and I23=01)
I24.
What devices, equipment, or other types of assistance {do you/does NAME} use?
¿Qué aparatos, equipo u otros tipos de asistencia usa [usted/NAME]?
PROBE:
Anything else?
¿ Algo más?
INTERVIEWER: CODE ALL THAT APPLY.
HEARING AID ............................................................................
PHONE AMPLIFIER ...................................................................
TYY OR TELETYPE / TTD .........................................................
CLOSED CAPTION TV ..............................................................
ASSISTIVE LISTENING/SIGNALING DEVICE ..........................
INTERPRETER ..........................................................................
OTHER HEARING ASSISTANCE ..............................................
INSTANT MESSAGING .............................................................
SKYPE OR OTHER VIDEO MESSAGING .................................
265
01
02
04
05
06
07
08
09
10
(I25)
(I25)
(I25)
(I25)
(I25)
(I25)
(I24_Other)
(I25)
(I25)
SECTION I: HEALTH AND FUNCTIONAL STATUS
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (I25)
r (I25)
(I21=01,d, r and I23=01 and I24=08)
I24_Other. What other hearing assistance?
¿Qué otra asistencia para oir?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
I25.
d
r
{Do you/Does NAME} have any difficulty having {your/his/her} speech understood because of a health
condition or problem?
¿Tiene [usted/NAME] alguna dificultad en que gente pueda entender lo que dice cuando habla, por causa de
un problema o condición de salud?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I29)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I25=01,d, r)
I26.
{Are you/Is NAME} able to have {your/his/her} speech understood at all?
¿Es posible entender por lo menos algo de lo que [usted/NAME] dice cuando habla?
PROBE:
This applies only to spoken speech and does not include sign language ‘speech’.
Esto es en relación solamente a hablar con la voz, y no incluye lenguaje de señas.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I25=01,d, r)
I27.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
speaking or having {your/his/her} speech understood, such as a voice synthesizer or voice amplifier?
¿Usa [usted/NAME] algún aparato o equipo especial, o cualquier otra asistencia especial, por dificultades en
hablar o en que se entienda lo que dice cuando habla, tal como un sintetizador o amplificador de voz?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I29)
DON’T KNOW ............................................................................ d (I29)
REFUSED .................................................................................. r (I29)
(I25=01,d, r and I27=01)
I28.
What devices, equipment, or other types of assistance {do you/does NAME} use?
¿Qué aparatos, equipo u otros tipos de asistencia usa [usted/NAME]?
PROBE: Anything else?
¿ Algo más?
INTERVIEWER: CODE ALL THAT APPLY.
VOICE SYNTHESIZER ..............................................................
VOICE AMPLIFIER ....................................................................
SIGN LANGUAGE INTERPRETER............................................
OTHER SPEECH ASSISTANCE................................................
266
01
02
03
04
(I29)
(I29)
(I29)
(I28_Other)
SECTION I: HEALTH AND FUNCTIONAL STATUS
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d (I29)
r (I29)
(I25=01,d, r and I27=01 and I28=04)
I28_Other. What other speech assistance?
¿Qué otra asistencia para el habla?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
I29.
d
r
{Do you/Does NAME} have serious difficulty walking or climbing stairs?
¿Tiene [usted/NAME] dificultad seria para caminar o subir escaleras?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I35)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
267
SECTION I: HEALTH AND FUNCTIONAL STATUS
(I29=01,d, r)
I30.
{Are you/Is NAME} able to walk without assistance at all?
¿Puede [usted/NAME] caminar sin ninguna ayuda?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I29=01,d, r)
I34.
{Are you/Is NAME} able to climb stairs at all?
¿Puede [usted/NAME] subir escaleras?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I29=01,d, r)
I31.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
walking, such as a cane, walker, wheelchair, scooter, prosthetic device, or a personal care attendant?
¿Usa [usted/NAME] algún aparato o equipo especial o cualquier otra asistencia especial por tener dificultad
en caminar, tal como un bastón, un andador o 'walker', una silla de ruedas, una motoneta o 'scooter', un
aparato prostético, o un asistente personal?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I35)
DON’T KNOW ............................................................................ d (I35)
REFUSED .................................................................................. r (I35)
(I29=01,d, r and I31=01)
I32.
What devices, equipment, or other types of assistance {do you/does NAME} use?
¿Qué aparatos, equipo u otros tipos de asistencia usa [usted/NAME]?
PROBE:
Anything else?
¿ Algo más?
INTERVIEWER: CODE ALL THAT APPLY.
BRACES, CRUTCHES, CANE, OR WALKER............................
WHEELCHAIR OR SCOOTER...................................................
PROSTHETIC DEVICE ..............................................................
SPECIAL CHAIR (NOT WHEELCHAIR) ....................................
PERSONAL CARE ASSISTANT ................................................
VEHICLE HAND CONTROLS ....................................................
LIFT (HOME OR VEHICLE) .......................................................
SPECIAL SHOES OR INSERTS ................................................
BREATHING DEVICES ..............................................................
OTHER MOBILITY ASSISTANCE..............................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
09
10
08
d
r
(I29=01,d, r and I31=01 and I32=08)
I32_Other. What other mobility assistance?
¿Qué otra asistencia de movilidad?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
268
d
r
(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I32_Other)
(I35)
(I35)
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
I35.
{Do you/Does NAME} have any difficulty lifting and carrying something as heavy as 10 pounds, such as a full
bag of groceries?
¿Tiene [usted/NAME] cualquier dificultad en levantar y cargar algo que pesa hasta unas 10 libras (5 kilos), tal
como una bolsa de compras del mercado?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I37)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
269
SECTION I: HEALTH AND FUNCTIONAL STATUS
(I35=01,d, r)
I36.
{Are you/Is NAME} able to lift and carry 10 pounds at all?
¿Puede [usted/NAME] levantar y cargar 10 libras (5 kilos) de cualquier manera?
(All)
I37.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
{Do you/Does NAME} have any difficulty using {your/his/her} hands and fingers to do things such as picking
up a glass or grasping a pencil?
¿Tiene [usted/NAME] alguna dificultad en usar sus manos y dedos para hacer cosas tales como alzar un
vaso o agarrar un lápiz?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I39)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I37=01,d, r)
I38.
{Are you/Is NAME} able to use {your/his/her} hands and fingers to grasp and handle at all?
¿Puede [usted/NAME] usar sus manos y dedos para agarrar, y sostener o manipulear cosas en cualquier
manera?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I39.
{Do you/Does NAME} have any difficulty reaching over {your/his/her} head?
¿Tiene [usted/NAME] alguna dificultad en alzar o estrechar sus brazos sobre su cabeza?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I41)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I39=01,d, r)
I40.
{Are you/Is NAME} able to reach over {your/his/her} head at all?
¿Puede [usted/NAME] alzar o estrechar sus brazos sobre su cabeza en cualquier manera?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I41.
{Do you/Does NAME} have any difficulty standing or being on {your/his/her} feet for one hour?
¿Tiene [usted/NAME] alguna dificultad en estar de pie o estar parad[o/a] por una hora?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I43)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I41=01,d, r)
I42.
{Are you/Is NAME} able to stand on {your/his/her} feet at all?
270
SECTION I: HEALTH AND FUNCTIONAL STATUS
¿Puede [usted/NAME] estar de pie en cualquier manera?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I43.
{Do you/Does NAME} have any difficulty stooping, crouching or kneeling?
¿Tiene [usted/NAME] alguna dificultad en agacharse o arodillarse?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I45)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
271
SECTION I: HEALTH AND FUNCTIONAL STATUS
(I43=01,d, r)
I44.
{Are you/Is NAME} able to stoop, crouch, or kneel at all?
¿Puede [usted/NAME] agacharse o arodillarse en cualquier manera?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I45.
{Do you/Does NAME} have any difficulty getting around inside {your/his/her} home?
¿Tiene [usted/NAME] alguna dificultad en moverse dentro de su hogar?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I47)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I45=01,d, r)
I46.
{Do you/Does NAME} need the help of another person in order to get around inside {your/his/her} home?
¿Necesita [usted/NAME] la ayuda de otra persona para poder moverse dentro de su hogar?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I47.
Because of a physical, mental, or emotional condition, {do you/does NAME} have difficulty doing errands alone
such as visiting a doctor’s office or shopping?
¿Tiene [usted/NAME] dificultad haciendo recados a solas, como visitar la oficina de un médico o ir de compras
por una condición física, mental, o emocional?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I49)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I47=01,d, r)
I48.
{Do you/Does NAME} need the help of another person in order to get around outside {your/his/her} home?
¿Necesita [usted/NAME] la ayuda de otra persona para poder moverse fuera de su hogar?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I49.
{Do you/Does NAME} have any difficulty getting into and out of bed or a chair?
¿Tiene [usted/NAME] alguna dificultad en sentarse, acostarse, o levantarse de la cama o de una silla?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I51)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I49=01,d, r)
I50.
{Do you/Does NAME} need the help of another person in order to get into and out of bed or a chair?
272
SECTION I: HEALTH AND FUNCTIONAL STATUS
¿Necesita [usted/NAME] la ayuda de otra persona para sentarse, acostarse, o levantarse de la cama o de
una silla?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
273
SECTION I: HEALTH AND FUNCTIONAL STATUS
(All)
I51.
{Do you/Does NAME} have difficulty dressing or bathing?
¿Tiene [usted/NAME] alguna dificultad en vestirse o bañarse?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I53)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I51=01,d, r)
I52.
{Do you/Does NAME} need the help of another person in order to bathe or dress?
¿Necesita [usted/NAME] la ayuda de otra persona para bañarse o vestirse?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I53.
{Do you/Does NAME} have any difficulty shopping for personal items, such as toilet items or medicine?
¿Tiene [usted/NAME] alguna dificultad en hacer compras de artículos personales, tal como artículos de
tocador, o medicinas?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I55)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I53=01,d, r)
I54.
{Do you/Does NAME} need the help of another person in order to shop for personal items?
¿Necesita [usted/NAME] la ayuda de otra persona para hacer compras de artículos personales?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I55.
{Do you/Does NAME} have any difficulty preparing {your/his/her} own meals?
PROBE: IF {NAME} DOES NOT PREPARE MEALS: If you do not prepare meals, is this because you have
difficulty with this task?
¿Tiene [usted/NAME] alguna dificultad en preparar sus propias comidas?
IF RESPONDENT/ DOES NOT PREPARE OWN MEALS: Si [usted/NAME] no prepara sus propias comidas,
¿es esto porque [usted/NAME] tiene dificultad con esta tarea?
INTERVIEWER: IF RESPONDENT SAYS NO, CODE AS NO.
YES ............................................................................................ 01
NO .............................................................................................. 00 (I57)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I55=01,d, r)
I56.
{Do you/Does NAME} need the help of another person in order to prepare {your/his/her} meals?
¿Necesita [usted/NAME] la ayuda de otra persona para preparar sus comidas?
YES ............................................................................................ 01
NO .............................................................................................. 00
274
SECTION I: HEALTH AND FUNCTIONAL STATUS
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
I57.
d
r
{Do you/Does NAME} have any difficulty eating?
PROBE: This includes difficulty chewing, swallowing, or using utensils.
¿Tiene [usted/NAME] alguna dificultad en comer?
Esto es incluyendo dificultades para masticar o tragar comida, o con el uso de utensilios?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I59)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
275
SECTION I: HEALTH AND FUNCTIONAL STATUS
(I57=01,d, r)
I58.
{Do you/Does NAME} need the help of another person in order to eat?
¿Necesita [usted/NAME] la ayuda de otra persona para poder comer?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I59.
Because of a physical, mental, or emotional condition, {do you/does NAME} have serious difficulty
concentrating, remembering, or making decisions?
¿Tiene [usted/NAME] dificultad seria para concentrarse, recordar, o tomar decisiones, por una condición física,
mental, o emocional?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I60.
{Do you/Does NAME} have a lot of trouble coping with day-to-day stresses?
¿Tiene [usted/NAME] mucha dificultad en confrontar las tensiones o el estrés de día a día?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I61.
{Do you/Does NAME} have a lot of trouble getting along with other people and making or keeping friendships?
¿Tiene [usted/NAME] mucha difficultad en llevarse bien con otras personas, y en hacer o mantener amistades?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
ALCOHOL ABUSE
(All)
I62.
These next questions are about {your/NAME’s} use of alcohol. Please remember that your answers are
confidential. If {you do/NAME does} not drink alcohol at all, just say so.
In the past 12 months, have {you/ friends or family} ever felt {you/NAME} ought to cut down on {your/his/her}
drinking?
Estas siguientes preguntas son acerca {su uso o consumo de alcohol/ el uso o consumo del alcohol de
NAME}. Por favor recuerde que sus respuestas son confidenciales. Si [usted/NAME] nunca toma bebidas
alcohólicas, por favor diga.
¿En los últimos 12 (doce) meses, alguna de sus amistades ha pensado que [usted/NAME] debería de reducir
la cantidad que toma?
YES ............................................................................................ 01
NO .............................................................................................. 00
IF VOLUNTEERED: I DON’T DRINK ......................................... 02 (I72)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I62=01,00,d, r)
276
SECTION I: HEALTH AND FUNCTIONAL STATUS
I63.
In the past 12 months, have people annoyed {you/NAME} by criticizing {your/his/her} drinking?
¿En los últimos 12 (doce) meses hubo gente que le causaron a [usted/NAME] alguna molestia por criticar su
tomar?
YES ............................................................................................ 01
NO .............................................................................................. 00
IF VOLUNTEERED: I DON’T DRINK ......................................... 02 (I72)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
277
SECTION I: HEALTH AND FUNCTIONAL STATUS
(I62=01,00,d, r and I63=01,00,d, r)
I64.
In the past 12 months, {have you/has NAME} ever felt bad or guilty about {your/his/her} drinking?
¿En los últimos 12 (doce) meses alguna vez se ha sentido [usted/NAME] mal o culpable por causa de su
tomar?
YES ............................................................................................ 01
NO .............................................................................................. 00
IF VOLUNTEERED: I DON’T DRINK ......................................... 03 (I72)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I62=01,00,d, r and I63=01,00,d, r and I64=01,00,d, r)
I65.
In the past 12 months, {have you/has NAME} ever had a drink first thing in the morning to steady {your/his/her}
nerves, get rid of a hangover, or get the day started?
¿En los últimos 12 (doce) meses alguna vez ha tomado [usted/NAME] un trago la primera cosa en la mañana
para calmar sus nervios, librarse de los efectos de una borrachera, o para empezar el día?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I62=01,00,d, r and I63=01,00,d, r and I64=01,00,d, r)
I66.
During the past 12 months, has {your/NAME’s} doctor or another health professional advised {you/NAME} to
stop using alcohol or recommended that {you/he/she} participate in a program to help {you/him/her} stop using
alcohol?
Durante los últimos 12 (doce) meses, ¿su doctor u otro profesional médico o de salud le aconsejó a
[usted/NAME] que deje de usar alcohol, o recomendó que [usted/él/ella] participe en un programa que le
ayudaría a dejar de usar alcohol?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I62=01,00,d, r and I63=01,00,d, r and I64=01,00,d, r)
I67.
During the past 12 months, {have you/has NAME} received treatment or counseling for {your/his/her} use of
alcohol?
Durante los últimos 12 (doce) meses, ¿ha recibido [usted/NAME] tratamiento o consejo (counseling) por su
uso de alcohol?
YES ............................................................................................ 01 (I72)
NO .............................................................................................. 00 (I72)
DON’T KNOW ............................................................................ d (I72)
REFUSED .................................................................................. r (I72)
DRUG ABUSE
(All)
I72.
The next questions are about the use of prescription and non-prescription drugs. I will be asking if {you
have/NAME has} ever used these drugs on {your/his/her} own. By ‘on {your/his/her} own’ I mean using nonprescription drugs or using prescription drugs in a non-prescribed manner, such as using larger quantities
than prescribed or for longer periods than prescribed. Examples of non-prescription drugs are marijuana or
pot, speed, crack or cocaine, LSD, or Ecstasy.
278
SECTION I: HEALTH AND FUNCTIONAL STATUS
During the past 12 months, {have you/has NAME} used drugs on {your/his/her} own more than 5 times?
Las siguientes preguntas son acerca del uso de drogas (o medicinas) recetadas y no-recetadas. Voy a estar
preguntando si alguna vez [usted/NAME] ha usado estas drogas por sí {mismo/misma}. En decir 'por sí
{mismo/misma}, quiero decir usar drogas o medicinas sin ser recetadas, o usar drogas o medicinas recetadas
en una manera no-recetada, por ejemplo usando cantidades más grandes de lo recetado, o por periodos más
largos de lo recetado. Ejemplos de drogas no-recetadas son la marihuana, 'speed', crack o cocaína, el LSD,
o Ecstasy.
Durante los últimos 12 (doce) meses, ¿usó [usted/NAME] drogas por sí mism[o/a] más de 5 (cinco) veces?
PROBE:
Have you used drugs to get high or used drugs without a prescription or in larger amounts than
prescribed?
Ha usted usado drogas para ponerse 'high', o usado drogas sin receta médica o en cantidades
más grandes de lo recetado?
YES ............................................................................................ 01
NO .............................................................................................. 00 (J1)
DON’T KNOW ............................................................................ d (J1)
REFUSED .................................................................................. r (J1)
279
SECTION I: HEALTH AND FUNCTIONAL STATUS
(I72=01)
I73.
During the past 12 months, did {you/NAME} find {you/he/she} needed larger amounts of these drugs to get an
effect or that {you/he/she} could no longer get high on the amount {you/he/she} had used before?
Durante los últimos 12 (doce) meses, ¿encontró [usted/NAME] que necesitaba cantidades más grandes de
estas drogas para que tengan efecto, o que [usted/él/ella] ya no se ponía 'high' usando la misma cantidad
que usaba antes?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I72=01)
I74.
During the past 12 months, did {you/NAME} have emotional or physical problems from using drugs – such as
withdrawal symptoms, inability to work, feeling crazy, paranoid, depressed or uninterested in things, craving,
or wanting to stop and being unable to?
Durante los últimos 12 (doce) meses, ¿tuvo [usted/NAME] problemas emocionales o físicos por usar drogas
- tal como síntomas de reajuste o withdrawal, incapacidad de trabajar, sentir que se volvía loc[o/a],
paranoic[o/a], deprimid[o/a], o indiferente o desinteresad[o/a] en las cosas, tenía antojos, o quería parar y no
podía?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I72=01)
I75.
During the past 12 months has {your/NAME’s} doctor or another health professional advised {you/NAME} to
stop using non-prescription drugs or recommended that {you/he/she} participate in a program to help
{you/him/her} stop using non-prescription drugs or prescription drugs in a non-prescribed manner?
Durante los últimos 12 (doce) meses, ¿su doctor u otro profesional médico o de salud le aconsejó a
[usted/NAME] que deje de usar drogas o medicinas no-recetadas, o recomendó que [usted/él/ella] participe
en un programa que le ayudaría a dejar de usar drogas o medicinas no-recetadas o dejar de usar drogas o
medicinas recetadas en una manera no-recetada?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I72=01)
I76.
During the past 12 months, {have you/has NAME} received treatment or counseling for {your/his/her} use of
non-prescription drugs or of prescription drugs in a non-prescribed manner?
Durante los últimos 12 (doce) meses, ¿ha recibido [usted/NAME] tratamiento o consejo (counseling) por su
uso de drogas o medicinas no-recetadas o su uso de drogas o medicinas recetadas en una manera norecetada?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
280
SECTION J: HEALTH INSURANCE
SECTION J: HEALTH INSURANCE
(All)
J1.
Now, I’m going to ask you about different types of health insurance coverage {you/NAME} might have.
{Are you/Is NAME} currently covered by Medicare?
PROBE: Medicare is health insurance coverage provided nationally to certain disabled people under age 65,
including Social Security Disability Insurance beneficiaries that have been receiving benefits for more than 24
months.
Ahora le voy a preguntar acerca de los distintos tipos de cobertura de seguro médico o seguro de salud que
[usted/NAME] quizás tiene.
¿Está [usted/NAME] actualmente cubiert[o/a] por Medicare?
Medicare es la cobertura de seguro médico o de seguro de salud proporcionado en todo el país a ciertas
personas con incapacidades que tienen menos de los 65 (sesentaicinco) años de edad, incluyendo
beneficiarios de Social Security Disability Insurance o Seguro por Incapacidad del Seguro Social, que han
estado recibiendo beneficios por más de 24 (veinticuatro) meses
(All)
J2.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
PROGRAMMER: IF STATEMED IS BLANK USE FOLLOWING TEXT:
There is a program called Medicaid that pays for health care for persons in need. {Are you/Is NAME} currently
covered by Medicaid?
Hay un programa llamado Medicaid que paga por servicios de salud para personas necesitadas. ¿Está
{usted/NAME} actualmente cubierto(a) por Medicaid?
OTHERWISE USE:
There is a program called Medicaid that pays for health care for persons in need. In {your/NAME’S} state, you
may also hear it called {STATE MED FROM {NAME’S} CURRENT STATE}. {Are you/Is NAME} currently
covered by Medicaid?
Hay un programa llamado Medicaid que paga por servicios de salud para personas necesitadas. En el estado
de {usted/NAME}, también se le puede llamar {STATE MED FROM {NAME’S CURRENT STATE}. ¿Está
{usted/NAME} actualmente cubierto(a) por Medicaid?
PROBE:
Medicaid is a state medical assistance program that serves low-income people and Social
Security Income recipients with disabilities.
Medicaid es programa estatal de asistencia médica que sirve a personas con ingresos limitados,
y recipientes de Ingresos del Seguro Social (Social Security Income) con incapacidades.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
J4.
{Are you/Is NAME} currently covered by military health care, through Armed Forces retirement benefits, the
VA, or TRICARE?
¿Está [usted/NAME] actualmente cubiert[o/a] por servicios militares de salud, a través de beneficios de
jubilación de las Fuerzas Armadas (Armed Forces retirement benefits), de la Administración de Veteranos o
VA, TRICARE, CHAMPUS, o CHAMP-VA?
PROBE:
TRICARE is a managed health care program for active duty and retired members of the uniformed
services, their families and survivors’
281
SECTION J: HEALTH INSURANCE
TRICARE es un programa de cuidado de salud administrado para miembros activos o retirados
de servicios uniformados, sus familias, y sobrevivientes.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
J5.
{Are you/Is NAME} currently covered by private health insurance, for example, private insurance that {you
get/(he/she) gets} through an employer, a family member, or that {you purchase/(he/she) purchases} on
{your/his/her} own including private insurance through the Affordable Care Act, sometimes called
HealthCare.gov or ObamaCare?
¿Está [usted/NAME] cubierto(a) actualmente por seguro privado de salud, por ejemplo seguro privado que
[usted/él/ella] obtiene por un empleador, un miembro de la familia, o que [usted/él/ella] compra por su cuenta
incluyendo seguro privado por La Ley de Cuidado de Salud a Bajo Precio a veces llamado
cuidadodesalud.gov u ObamaCare?
YES ............................................................................................ 01
NO .............................................................................................. 00 (J7)
DON’T KNOW ............................................................................ d (J7)
REFUSED .................................................................................. r (J7)
282
SECTION J: HEALTH INSURANCE
(J5=01)
J6.
{Do you/Does NAME} currently receive {your/his/her} private health insurance through a present or former
employer of {yours/his/hers}, through a present or former employer of {your/his/her} spouse, partner or parent,
or some other source?
¿Recibe [usted/NAME] actualmente su seguro médico privado por medio de uno de sus empleadores actuales
o anteriores, por medio de uno de los empleadores actuales o anteriores de su pareja, su pareja o de su
padre o madre, o de alguna otra fuente?
INTERVIEWER: IF THE RESPONDENT SAYS THAT THEY OR SOMEONE IN THEIR FAMILY PAYS FOR
THEIR HEALTH INSURANCE, CODE ‘PAID BY SELF/FAMILY’.
OWN EMPLOYER ......................................................................
SPOUSE’S/PARTNER’S/PARENT’S EMPLOYER.....................
PAID BY SELF/FAMILY .............................................................
OTHER SOURCE (SPECIFY) ...................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
d
r
(J7)
(J7)
(J7)
(J6_Other)
(J7)
(J7)
(J5=01 and H6=04)
J6_Other. What is the Other Source?
¿Cuál es la otra fuente?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
J7.
d
r
CHECK: DOES {NAME} HAVE ANY TYPE OF INSURANCE (J1=01 OR J2=01 OR J4=01 OR J5=01)?
YES ............................................................................................ 01 (J10)
NO .............................................................................................. 00
(J7=00)
J8.
It appears that {you do/NAME does} not currently have any health insurance coverage to help pay for services
from hospitals, doctors, and other health professionals. Is that correct?
Parece que [usted/NAME] no tiene actualmente cualquier cobertura de seguro médico para ayudar a pagar
por servicios de hospital, de doctores, y de otros profesionales de salud. ¿Es eso correcto?
YES ............................................................................................ 01 (J10)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d (J10)
REFUSED .................................................................................. r (J10)
PROGRAMMER NOTE: IF STATEMED IS BLANK, PLEASE DISPLAY “MEDICAID” FOR RESPONSE OPTION 1
283
SECTION J: HEALTH INSURANCE
(J7=00 and J8=00)
J9.
What kinds of health insurance coverage {do you/does NAME} have?
¿Qué tipos de cobertura de seguro médico tiene [usted/NAME]?
PROBE:
Any other kind?
¿Algún otro tipo?
INTERVIEWER: IF RESPONDENT SAYS “OBAMACARE” OR “AFFORDABLE CARE ACT”
PROBE:
“Is this a plan you pay for on your own? (IF YES, CODE AS PRIVATE INSURANCE PAID
BY SELF/FAMILY). (IF NO), “Is this provided through Medicaid?” (IF YES, CODE AS
MEDICAID)
¿Es esto un plan que usted paga por su cuenta? (IF YES, CODE AS PRIVATE INSURANCE
PAID BY SELF/FAMILY). (IF NO), ¿Se provee esto por medio de Medicaid?
INTERVIEWER: CODE ALL THAT APPLY.
MEDICAID/{STATEMED} .........................................................................
MEDICARE ..............................................................................................
TRICARE, VA, OTHER MILITARY ...........................................................
INDIAN HEALTH SERVICE .....................................................................
MEDI-GAP................................................................................................
STATE PROGRAM ..................................................................................
PRIVATE INSURANCE THROUGH OWN EMPLOYER ..........................
PRIVATE INSURANCE THROUGH SPOUSE/PARTNER/PARENT........
PRIVATE INSURANCE PAID BY SELF/FAMILY .....................................
OTHER PLAN (SPECIFY) .........................................................
DON’T KNOW ..........................................................................................
REFUSED ................................................................................................
01
02
03
04
05
06
07
08
09
10
d
r
(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J9_Other)
(J10)
(J10)
(J7=00 and J8=00 and J9=10)
J9_Other. What is the Other Plan?
¿Que otro plan?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
J10.
d
r
Now, I’d like you to think back to 2022. In 2022, {were you/was NAME} covered by any type of health
insurance?
Ahora, quisiera que piense atrás, al año 2022. En el año 2022 ¿estaba [usted/NAME] cubiert[o/a] por cualquier
tipo de seguro médico?
PROBE:
Answer ‘yes’ if {you were/NAME was} covered for any part of the year.
Responda 'sí' si [usted/NAME] estaba cubiert[o/a] por cualquier parte del año.
YES ............................................................................................ 01
NO .............................................................................................. 00 (K1)
DON’T KNOW ............................................................................ d (K1)
REFUSED .................................................................................. r (K1)
PROGRAMMER NOTE: IF STATEMED IS BLANK, PLEASE DISPLAY “MEDICAID” FOR RESPONSE OPTION 1
284
SECTION J: HEALTH INSURANCE
(J10=01)
J11.
What kinds of health coverage did {you/NAME} have?
¿Qué tipos de cobertura de salud tenía {usted/NAME}
PROBE:
Any other kind?
Algún otro tipo?
INTERVIEWER: IF RESPONDENT SAYS “OBAMACARE” OR “AFFORDABLE CARE ACT”
PROBE:
“Is this a plan you pay for on your own? (IF YES, CODE AS PRIVATE INSURANCE PAID
BY SELF/FAMILY). (IF NO), “Is this provided through Medicaid?” (IF YES, CODE AS
MEDICAID)
¿Es esto un plan que usted paga por su cuenta? (IF YES, CODE AS PRIVATE INSURANCE
PAID BY SELF/FAMILY). (IF NO), ¿Se provee esto por medio de Medicaid?
INTERVIEWER: CODE ALL THAT APPLY.
MEDICAID/{STATMED} ...........................................................................
MEDICARE ..............................................................................................
TRICARE, VA, OTHER MILITARY ...........................................................
INDIAN HEALTH SERVICE .....................................................................
MEDI-GAP................................................................................................
STATE PROGRAM ..................................................................................
PRIVATE INSURANCE THROUGH OWN EMPLOYER ..........................
PRIVATE INSURANCE THROUGH SPOUSE/PARTNER/PARENT........
PRIVATE INSURANCE PAID BY SELF/FAMILY .....................................
PRIVATE INSURANCE, NOT SPECIFIED WHO THROUGH ..................
OTHER PLAN (SPECIFY) .........................................................
DON’T KNOW ..........................................................................................
REFUSED ................................................................................................
01
02
03
04
05
06
07
08
09
11
10
d
r
(J10=01 and J11=10)
J11_Other. What is the other plan?
¿Cuál es el otro Plan?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
285
d
r
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(J11_Other)
(K1)
(K1)
SECTION K: INCOME AND OTHER ASSISTANCE
SECTION K: INCOME AND OTHER ASSISTANCE
(All)
K1.
The next set of questions is about income {you/NAME} received last month, that is, in [INSERT LAST MONTH,
THIS YEAR]. This includes earnings from work and benefits from different programs. When answering these
questions, please think only about {your/NAME’s} own earnings and benefits, and don’t include earnings or
benefits that other family members may have received.
La siguiente serie de preguntas es acerca de los ingresos que [usted/NAME] recibió el mes pasado, o sea en
aMonthName, de KNew_Year. Esto incluye su sueldo y ganancias de trabajo y beneficios que recibió de
distintos programas. Cuando conteste a estas preguntas, por favor piense solamente en las ganacias y
beneficios de [usted/NAME], y no incluya a las ganancias o beneficios que otros miembros de su familia
pueden haber recibido.
(All)
K2.
PRESS 1 TO CONTINUE ........................................................... 01
CHECK 1: IS {NAME} CURRENTLY WORKING (B24a=01)?
YES ............................................................................................ 01 (K2CHECK2)
NO .............................................................................................. 00 (K2CHECK3)
(K2=01)
K2CHECK2.
CHECK 2: DID {NAME} START AT LEAST ONE JOB PRIOR TO OR DURING LAST MONTH ((C4MTH
< OR = LAST MONTH THIS YEAR AND C4YR = 2022) OR (C4YR < 2022))?
YES ............................................................................................ 01 (K3)
NO .............................................................................................. 00 (K2A)
PROGRAMMER: IF {NAME} IS CURRENTLY WORKING (B24=01) AND STARTED JOB AFTER LAST MONTH
THIS YEAR - (C4MTH > LAST MONTH THIS YEAR AND C4YR =2022), GO TO K2A
(K2=00 and K2CHECK2=01)
K2CHECK 3. HAS {NAME} EVER WORKED (B36=01, D, OR R) OR (B22=01, D, OR R) OR (B30=01, D, OR R) OR
IS EVER WORKED MISSING (B36=.)?
YES ............................................................................................ 01 (K2A)
NO .............................................................................................. 00 (K4)
(K2CHECK2=00 and K2CHECK3=01)
K2A.
Did {you/NAME} work last month?
¿[usted/NAME] trabajó el mes pasado?
YES ............................................................................................ 01 (K3)
NO .............................................................................................. 00 (K4)
(K2CHECK3=01 and K2A=01)
K3.
First thinking about the jobs {you/NAME} had last month, including all jobs {you/he/she} had, how much did
{you/he/she} earn last month, that is, in [INSERT LAST MONTH, THIS YEAR] before taxes and deductions?
Pensando primero acerca de los empleos que [usted/NAME] tuvo el mes pasado, incluyendo todos los
empleos (o trabajos) que [usted/él/ella] tuvo, ¿ cuánto ganó [usted/él/ella]Eel mes pasado, o sea en
aMonthName de KNew_Year, antes de impuestos y deducciones?
INTERVIEWER:
ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(0 – 12,500)
(0 – 40,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
286
d
r
SECTION K: INCOME AND OTHER ASSISTANCE
(K2CHECK3=01 and K2A=01 and K3 > or = 0)
K3b.
SOFT EDIT: LAST MONTH INCOME SHOULD BE WITHIN 30% OF TOTAL CURRENT MONTHLY PAY AS
REPORTED IN SECTION C. IF K3 NE D OR R AND C_CURMNTHPAY NE D OR R, AND THE ABSOLUTE
VALUE OF (K3 - C_CurMnthPay/ K3 >.30) AND THE ABSOLUTE VALUE OF (C_CurMnthPay - K3/
C_CurMnthPay >.30), TRIGGER EDIT, AND DISPLAY FOLLOWING TEXT: INTERVIEWER, LAST MONTH
INCOME IS AT LEAST 30% HIGHER OR LOWER THAN AMOUNT REPORTED AS TOTAL MONTHLY PAY
IN SECTION C. CHECK ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. Earlier
we calculated that {you are/NAME is} currently paid about (C_CurMnthPay) on all jobs combined. Is this
correct or should I change the amount {you/NAME} earned last month before taxes and other deductions?
Puede que anoté una respuesta incorrecta. Antes calculamos que actualmente se le pagan a {usted/NAME}
(C_CurMnthPay) en todos los trabajos combinados. ¿Es correcto eso o debo cambiar la cantidad que
{usted/NAME] ganó el mes pasado antes de impuestos y otras deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
SUPPRESS ................................................................................ 03
(K2CHECK3=01 and K2A=01 and (K3 > 0 or d or r)
K3a.
Including all jobs {you/NAME} had, how much was left last month,that is in [INSERT LAST MONTH, THIS
YEAR], as take-home pay after taxes and other deductions?
Incluyendo todos los empleos/trabajos que [usted/NAME] tuvo, ¿cuánto le quedó de su sueldo para llevar a
casa el mes pasado, o sea en [INSERT LAST MONTH, THIS YEAR], después de impuestos y deducciones?
INTERVIEWER:
ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(1 – 11,250)
(1 – 36,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(K2CHECK3=01 and K2A=01 and K3 > or = 0 and K3a > 0)
K3b1. SOFT EDIT: AMOUNT OF TAKE-HOME PAY (K3a) MUST BE LESS THAN OR EQUAL TO AMOUNT PAID
BEFORE TAXES AND OTHER DEDUCTIONS (K3). IF K3A NE D OR R AND K3 NE D OR R, AND K3A >
K3, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER, TAKE HOME PAY IS GREATER
THAN PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an incorrect answer.
You said that {you are/NAME is} paid (K3) before taxes and other deductions and that (K3a) is left as takehome pay after taxes and other deductions. Based on what I recorded, your take home pay is more than your
pre-tax pay. Should I change the amount {you are/NAME is} paid before taxes and other deductions or the
amount {you take/NAME takes} home after taxes and other deductions?
Dijo que se le pagan (K3) a {usted/NAME} antes de impuestos y otras deducciones y que sobra (K3A) como
sueldo neto después de los impuestos y otras deducciones. Basado en lo que anoté, su sueldo neto es más
que su sueldo antes de impuestos. ¿Debo cambiar la cantidad que se le pagan a {usted/NAME] antes de los
impuestos y otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE K3a)
SUPPRESS ................................................................................ 03
(K2CHECK3=01 and K2A=01 and K3> or = 0 and K3a > 0)
K3b2. SOFT EDIT: IF K3 GREATER THAN 0, K3A SHOULD BE GREATER THAN 0. IF K3 >0 AND K3A =0,
TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER: AMOUNT OF TAKE HOME PAY=0,
CHECK ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. I have recorded that
you are paid (K3) before taxes and deductions but that your take home pay is 0. Should I change the amount
287
SECTION K: INCOME AND OTHER ASSISTANCE
{you are/NAME is} paid before taxes and other deductions or the amount {you take/NAME takes} home after
taxes and other deductions?
Puede que anoté una respuesta incorrecta. Anoté que se le pagan (K3) antes de los impuestos y otras
deducciones pero que su sueldo neto es 0. ¿Debo cambiar la cantidad que se le pagó a {usted/NAME] antes
de impuestos y otras deducciones o el sueldo neto de {usted/NAME} después de impuestos y otras
deducciones?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE K3a)
SUPPRESS ................................................................................ 03
288
SECTION K: INCOME AND OTHER ASSISTANCE
(K2CHECK3=01 and K2A=01 and K3> 0 and K3a > 0)
K3b3. SOFT EDIT: DIFFERENCE IN AMOUNT OF TAKE HOME PAY AND PRE-TAX PAY IS GREATER THAN
30%. IF AMOUNT OF TAKE HOME PAY (K3A) NE D OR R, AND AMOUNT OF PRE-TAX PAY (K3) NE D
OR R, AND (K3 – K3A) / K3A > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER,
DIFFERENCE IN AMOUNT OF TAKE HOME PAY AND PRE-TAX PAY IS GREATER THAN 30%. CHECK
ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said that {you are/NAME is}
paid (K3) before taxes and other deductions and that (K3A) is left as take-home pay after taxes and other
deductions. Is this correct or should I change the amount {you are/NAME is} paid before taxes and other
deductions or the amount {you take/NAME takes} home after taxes and other deductions
Debo haber anotado una respuesta incorrecta. Dijo que se le pagan (K3) a {usted/NAME} antes de impuestos
y otras deducciones y que sobra (K3A) como sueldo neto después de los impuestos y otras deducciones.
¿Es correcto eso o debo cambiar la cantidad que se le pagan a {usted/NAME] antes de los impuestos y otras
deducciones o el sueldo neto después de los impuestos y otras deducciones?
(All)
K4.
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE K3a)
SUPPRESS ................................................................................ 03
Thinking about the benefits {you/NAME} received last month, did {you/he/she} receive any income from Social
Security?
Pensando acerca de los beneficios que [usted/NAME] recibió el mes pasado, ¿ recibió [usted/él/ella] algún
ingreso del Social Security/Seguro Social?
INTERVIEWER:
(All)
K5.
SHOULD INCLUDE ANY SSI AND SSDI PAYMENTS
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
PROGRAMMER: IF {NAME} RECEIVED INCOME FROM ANY SOURCE BELOW (K6a-h=01), ASK K7
THROUGH K10 IMMEDIATELY AFTER EACH ‘YES’. OTHERWISE, ASK ABOUT NEXT SOURCE OF
INCOME IN K6.
289
SECTION K: INCOME AND OTHER ASSISTANCE
(All)
K6.
Last month did {you/NAME} receive any income from…
¿ El mes pasado recibió [usted/NAME] algún ingreso de ...
PROBE:
IF RESPONDENT MENTIONS FOOD STAMPS: I will ask you about food stamps in a
separate question. Do {you/he/she} receive any other income on a regular basis that does
not come from jobs or social security?
Le voy a preguntar acerca de cupones de alimentos o 'food stamps' en una pregunta por
separado. ¿Recibe [usted/NAME] regularmente cualquier otro ingreso que no proviene de
trabajo o del Seguro Social o Social Security?
PROBE:
Examples include child support, interest from savings or checking accounts, or dividends?
Ejemplos incluyen pagos de mantenimiento de niños o child support, pagos de interés de
cuentas de ahorro o cheques, o pago de dividend.
a.
YES
NO
DON’T
KNOW
REFUSED
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
01
00
d
r
Ingreso de pensiones o jubilaciones o?
01
00
d
r
Other sources on a regular basis but not from jobs
or Social Security?
01
d
r
Private disability insurance (sometimes called longterm disability insurance)?
Seguro privado por incapacidad (Private disability
insurance) (a veces también llaman a esto: seguro
por incapacidad de largo plazo o en inglés: longterm disability insurance)?
b.
Workers’ compensation?
Workers' compensation o Compensación de
Trabajadores?
c.
Veterans’ benefits?
Veterans' benefits o Beneficios de Veteranos?
d.
Public assistance or welfare payments?
Asistencia pública o pagos de 'welfare' o bienestar
social?
PROBE: Please include any payments from the
Temporary Assistance for Needy Families, or TANF,
program or any public assistance payments from
your state.
PROBE: Por favor incluya cualquier pago del
programa de Ayuda Temporal para Familias
Necesitadas o TANF o cualquier pago de asistencia
pública estatal.
e.
Unemployment benefits?
Beneficios de Desempleo?
f.
g.
Pensions or retirement income?
Cualquier otra fuente en forma regular, pero no de
empleos/trabajos o del Social Security/Seguro
Social?
290
00
(K6_g_oth)
SECTION K: INCOME AND OTHER ASSISTANCE
PROBE: IF RESPONDENT MENTIONS FOOD
STAMPS: I will ask you about food stamps in a
separate question. Do you receive any other
income on a regular basis that does not come from
jobs or Social Security?
Le voy a preguntar acerca de cupones de alimentos
o 'food stamps' en una pregunta por separado.
¿Recibe ^Fills.aName regularmente cualquier otro
ingreso que no proviene de trabajo o del Seguro
Social o Social Security?
PROBE: Examples include child support, interest
from savings or checking accounts, or dividends?
Ejemplos incluyen pagos de mantenimiento de niños
o child support, pagos de interés de cuentas de
ahorro o cheques, o pago de dividendo
h.
Other sources not on a regular basis?
(K6_h_oth)
Otras fuentes, pero no en forma regular?
01
00
d
r
(K6_g=01)
K6_g_oth What were they?
¿ Qué eran?
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(K6_h=01)
K6_h_oth What were they?
d
r
¿ Qué eran?
INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
291
d
r
SECTION K: INCOME AND OTHER ASSISTANCE
(K6=01)
K7.
How much income did {you/NAME} receive last month from {SOURCE FROM K6}?
¿ Cuánto recibió [usted/NAME] el mes pasado como ingresos de… {SOURCE FROM K6}?
INTERVIEWER:
ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(1 – 1,000)
(1 – 15,000)
(GO TO K6 FOR NEXT SOURCE OR K11)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(K6=01 and K7=d, r)
K8.
Was it more than or less than $300?
¿ Fue más de $300 (trescientos dólares) o menos de $300?
$300 OR MORE ......................................................................... 01 (K9)
LESS THAN $300 ...................................................................... 02 (K10)
DON’T KNOW ............................................................................ d (K6 FOR NEXT SOURCE
OR K11)
REFUSED .................................................................................. r (K6 FOR NEXT SOURCE
OR K11)
(K6=01 and K7=d, r and K8=01)
K9.
Was it more than or less than $500?
¿ Fue más de $500 (quinientos dólares) o menos de $500?
$500 OR MORE ......................................................................... 01
LESS THAN $500....................................................................... 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
GO TO K6 FOR NEXT SOURCE OR K11.
(K6=01 and K7=d, r and K8=02)
K10.
Was it more than or less than $150?
¿ Fue más de $150 (cientocincuenta dólares) o menos de $150?
$150 OR MORE ......................................................................... 01
LESS THAN $150....................................................................... 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
GO TO K6 FOR NEXT SOURCE OR K11.
(All)
K11.
Did {you/NAME} receive any food stamps last month? You may know this as SNAP benefits. Please include
only food stamps {you/NAME} received for {you/NAME} and {your/NAME’s} family. Do not include food
stamps received separately by other members of [your/NAME’s} household.
¿Recibió [usted/NAME] cupones de alimento el mes pasado? Quizás conoce esto como beneficios de SNAP.
Por favor incluya sólo cupones de alimento que [usted/NAME] recibió para [usted/NAME] y la familia de
[usted/NAME]. No incluya cupones que otros miembros aK11 recibieron por separado.
YES ............................................................................................ 01
NO .............................................................................................. 00 (K13)
DON’T KNOW ............................................................................ d (K13)
REFUSED .................................................................................. r (K13)
292
SECTION K: INCOME AND OTHER ASSISTANCE
(K11=01)
K12.
What was the dollar value of the food stamps {you/NAME} received last month? Please include only food
stamps {you/NAME} received by {you/NAME} for {your/NAME’s} family.
¿ Cuánto es el valor en dólares de los cupones de alimentos o food stamps que [usted/NAME] recibió el mes
pasado? Por favor incluya solamente cupones de alimentos o 'food stamps' que [usted/NAME] recibe para
[usted/NAME] mism[o/a] y para su familia. No incluya cupones de alimentos o 'food stamps' que otros
miembros de su hogar reciben por separado.
INTERVIEWER:
ROUND TO NEAREST DOLLAR
$|___| , |___|___|___| . 00
(0 – 400)
(0 – 950)
(All)
K13.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
Did {you/NAME} receive assistance from any other government program last month? For example, housing
or energy assistance.
¿ Recibió [usted/NAME] asistencia o ayuda de cualquier otro programa del gobierno en el mes pasado? Por
ejemplo, asistencia de vivienda, o de energía (electricidad, gas, etc.).
YES ............................................................................................ 01
NO .............................................................................................. 00 (KP1)
DON’T KNOW ............................................................................ d (KP1)
REFUSED .................................................................................. r (KP1)
(K13=01)
K14.
What other assistance did {you/NAME} receive?
¿ Qué otra asistencia o ayuda recibió [usted/NAME]?
INTERVIEWER:
PROGRAM:
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(K13=01)
K15.
How much income did {you/NAME} receive last month from the assistance you just told me about?
¿ Cuánto fue el ingreso que [usted/NAME] recibió el mes pasado de la asistencia de la cual me acaba de
decir?
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
INTERVIEWER:
ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(0 – 500)
(0 – 10,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
KP1.
d
r
Which of the following best describes {your/NAME’s} current financial situation? (NOD Harris 2010 item
Q1430)
¿Cuál de las siguientes opciones describe mejor la situación financiera actual de {usted/NOMBRE}?
293
SECTION K: INCOME AND OTHER ASSISTANCE
INTERVIEWER: CODE ONE ONLY.
Struggling to meet {your/his/her} basic needs
Luchando para satisfacer sus necesidades básicas .......
Meeting {your/his/her} basic needs, but not able
to save or improve {your/his/her} standard of
living
La satisfacción de sus necesidades básicas, pero
no puede salvar o mejorar su nivel de vida .....................
Able to save a little, but not completely
financially comfortable
Capaz de ahorrar un poco, pero no del todo
financieramente cómodo .................................................
Financially comfortable with few worries about money
Financieramente cómodo con pocas preocupaciones
sobre el dinero ................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
294
01
02
03
04
d
r
SECTION K: INCOME AND OTHER ASSISTANCE
(All)
KP2.
If {you/NAME} had to support {yourself/himself/herself} for three months without any income or gifts from
others, would {you/he/she} have enough money in savings to get by? (NOD Harris 2010 item Q1435 modified)
Si {usted / NOMBRE} tenía que mantenerse a sí mismo durante tres meses sin ningún ingreso o los regalos
de los demás, {usted / él / ella} tener suficiente dinero en ahorros para salir adelante?
PROBE: By income I mean money from earnings, disability benefits, or from any other source except savings.
Por ingreso me refiero a dinero de las ganancias, beneficios por incapacidad, o de cualquier otra
fuente, excepto ahorros.
PROBE: Your best estimate is fine.
La mejor estimación que me puede dar está bien.
YES ................................................................................. 01
NO ................................................................................... 00
DON’T KNOW ................................................................. d
REFUSED ....................................................................... r
295
SECTION L: SOCIODEMOGRAPHIC INFORMATION
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(All)
L1.
I have a few more questions about {you/NAME}.
What is {your/NAME’s} ethnic background? {Are you/Is (he/she)}:
Tengo unas pocas preguntas más acerca de [usted/NAME].
¿Cuál es su origen étnico? ¿Es [usted/NAME] de origen:
(All)
L2.
Hispanic or Latino, or
Hispano o latino o ....................................................................... 01
Not Hispanic or Latino?
Ni hispano ni latino? ................................................................... 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
What is {your/NAME’s} race? {Are you/Is (he/she)}:
¿De qué raza es [usted/NAME]? ¿Es [usted/NAME]:
PROBE: IF RESPONDENT STATES HIS OR HER RACE IS HISPANIC OR PROVIDES A SPECIFIC ETHNICITY LIKE
CUBAN OR ITALIAN: I understand. However, for the purposes of this survey, race is different from origin or
ethnicity. This question is only asking about race. REREAD QUESTION.
PROBE: IF RESPONDENT STATES HIS OR HER RACE IS HISPANIC OR PROVIDES A SPECIFIC ETHNICITY LIKE
CUBAN OR ITALIAN: Ya entiendo. Pero para los propósitos de esta encuesta, la raza y el origen o grupo
étnico son dos cosas diferentes. En esta pregunta solo se pregunta por la raza. REREAD QUESTION.
INTERVIEWER: IF RESPONDENT DOES NOT SELECT ONE OR MORE RACES OR INSISTS ON “OTHER RACE”
AFTER USING ABOVE PROBE, ENTER REFUSED.
INTERVIEWER:
CODE ALL THAT APPLY.
Alaska Native or American Indian,
(All)
L3.
Nativo/a de Alaska, India-Americano/a o de raza indígena ........
Asian,
Asiático/a ....................................................................................
Black or African American,
Negro/a of Africana-Americana ..................................................
Native Hawaiian or Other Pacific Islander, or
Nativo/a de Hawái o de otra Isla del Pacifico, o..........................
White
Blanco/a .....................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
d
r
What is the highest year or grade {you/NAME} finished in school?
¿Cuál es el grado o año de estudios más alto que [usted/NAME] completó?
INTERVIEWER:
READ LIST IF NECESSARY. CODE ONE ANSWER.
INTERVIEWER:
IF ATTENDED SCHOOL BUT COMPLETED LESS THAN HIGH SCHOOL, CODE AS
1. IF NEVER ATTENDED SCHOOL, CODE AS 10.
INTERVIEWER:
IF RESPONDENT SAYS THEY WERE HOME SCHOOLED, PROBE FOR HIGHEST
YEAR, GRADE, DEGREE, OR CERTIFICATE COMPLETED.
DID NOT COMPLETE HIGH SCHOOL OR GED
296
SECTION L: SOCIODEMOGRAPHIC INFORMATION
NO COMPLETÓ HIGH SCHOOL O GED ....................................................
HIGH SCHOOL: GED
OBTUVO EL GED .......................................................................................
HIGH SCHOOL: DIPLOMA
OBTUVO DIPLOMA DE HIGH SCHOOL .....................................................
HIGH SCHOOL: CERTIFICATE OF COMPLETION
OBTUVO CERTIFICADO DE HABER COMPLETADO HIGH SCHOOL......
SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL
COURSES
ALGO DE UNIVERSIDAD O COLLEGE/ALGUNOS CURSOS
VOCACIONALES DESPUÉS DE HIGH SCHOOL .......................................
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE)
OR VOCATIONAL SCHOOL DIPLOMA
GRADO DE COLLEGE DE 2 o DE 3 AÑOS (GRADO ASOCIADO) O
DIPLOMA DE ESCUELA VOCACIONAL .....................................................
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE)
GRADO DE UNIVERSIDAD O COLLEGE DE 4 AÑOS (GRADO DE
BACHELOR o LICENCIATURA) ..................................................................
SOME GRADUATE WORK/NO GRADUATE DEGREE
ALGO DE ESTUDIOS DE POSGRADO PERO SIN TÍTULO DE
POSGRADO ................................................................................................
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D.,
J.D., M.D.)
TÍTULO DE POSGRADO O TÍTULO PROFESIONAL (por ej.,
MAESTRÍA O DOCTORADO, MA, MBA, Ph.D., J.D., M.D.) ........................
NEVER ATTENDED SCHOOL
NUNCA ASISTIÓ A LA ESCUELA ...............................................................
SPECIAL EDUCATION WITH NO CERTIFICATE OF COMPLETION
EDUCACIÓN ESPECIAL SIN CERTIFICADO DE HABER
COMPLETADO ............................................................................................
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................
297
01
02
03
04
05
06
07
08
09
10
11
d
r
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(All)
L4.
What is the highest year or grade {your/NAME’s} father finished in school?
¿Cuál es el grado o año de estudios más alto que {su padre/el padre de NAME} completó?
(All)
L5.
INTERVIEWER:
READ LIST IF NECESSARY. CODE ONE ANSWER.
INTERVIEWER:
IF ATTENDED SCHOOL BUT COMPLETED LESS THAN HIGH SCHOOL, CODE AS 1.
IF NEVER ATTENDED SCHOOL, CODE AS 10.
INTERVIEWER:
IF RESPONDENT SAYS THEY WERE HOME SCHOOLED, PROBE FOR HIGHEST
YEAR, GRADE, DEGREE, OR CERTIFICATE COMPLETED.
DID NOT COMPLETE HIGH SCHOOL OR GED .........................................
HIGH SCHOOL: GED ..................................................................................
HIGH SCHOOL: DIPLOMA ..........................................................................
HIGH SCHOOL: CERTIFICATE OF COMPLETION ....................................
SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL
COURSES ...................................................................................................
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE)
OR VOCATIONAL SCHOOL DIPLOMA.......................................................
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) ............................
SOME GRADUATE WORK/NO GRADUATE DEGREE ..............................
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D.,
J.D., M.D.) ....................................................................................................
NEVER ATTENDED SCHOOL ....................................................................
SPECIAL EDUCATION WITH NO CERTIFICATE OF COMPLETION.........
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................
01
02
03
04
05
06
07
08
09
10
11
d
r
What is the highest year or grade {your/NAME’s} mother finished in school?
¿Cuál es el grado o año de estudios más alto que {su madre/la madre de NAME} completó?
INTERVIEWER:
READ LIST IF NECESSARY. CODE ONE ANSWER.
INTERVIEWER:
IF ATTENDED SCHOOL BUT COMPLETED LESS THAN HIGH SCHOOL, CODE AS 1.
IF NEVER ATTENDED SCHOOL, CODE AS 10.
INTERVIEWER:
IF RESPONDENT SAYS THEY WERE HOME SCHOOLED, PROBE FOR HIGHEST
YEAR, GRADE, DEGREE, OR CERTIFICATE COMPLETED.
DID NOT COMPLETE HIGH SCHOOL OR GED .........................................
HIGH SCHOOL: GED ..................................................................................
HIGH SCHOOL: DIPLOMA ..........................................................................
HIGH SCHOOL: CERTIFICATE OF COMPLETION ....................................
SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL
COURSES ...................................................................................................
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE)
OR VOCATIONAL SCHOOL DIPLOMA.......................................................
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) ............................
SOME GRADUATE WORK/NO GRADUATE DEGREE ..............................
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D.,
J.D., M.D.) ....................................................................................................
NEVER ATTENDED SCHOOL ....................................................................
SPECIAL EDUCATION WITH NO CERTIFICATE OF COMPLETION.........
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................
298
01
02
03
04
05
06
07
08
09
10
11
d
r
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(All)
L6ft.
How tall {are you/is NAME}?
¿Cuánto (de altura) mide [usted/NAME]?
INTERVIEWER:
ENTER FEET
|__| FEET
(3-8)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
L6in.
d
r
(How tall {are you/is NAME}?)
(¿Cuánto (de altura) mide [usted/NAME]? )
PROBE: ROUND TO NEAREST WHOLE NUMBER (E.G., ENTER 6 FOR 5 ½ INCHES)
INTERVIEWER:
ENTER INCHES.
|__|__| INCHES
(0-12)
(All)
L7.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
How much {do you/does NAME} weigh?
¿Cuánto pesa [usted/NAME]?
|__|__|__| POUNDS (50-300)
(50-600)
(All)
L8.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
{Are you/Is NAME} now married, partnered (but not married), widowed, divorced, separated, or {have you/has
(he/she)} never been married?
¿Está [usted/NAME] actualmente casad[o/a], en pareja pero no casado, es viud[o/a], divorciad[o/a],
separad[o/a], o [usted/NAME] nunca ha estado casad[o/a]?
INTERVIEWER: UNMARRIED PARTNER MEANS A MARRIAGE-LIKE RELATIONSHIP.
MARRIED ...................................................................................
UNMARRIED PARTNER ............................................................
WIDOWED .................................................................................
DIVORCED.................................................................................
SEPARATED ..............................................................................
NEVER MARRIED......................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
06
02
03
04
05
d
r
(L10)
(L10)
(L10)
(L10)
(L10)
(L10)
(L8=01, 06)
L9.
Do {you/NAME} and {your/his/her} {spouse/unmarried partner} live in the same household?
¿Viven {usted/NAME} y su {esposo(a)/pareja} en el mismo hogar?
INTERVIEWER: IF UNMARRIED PARTNERS (MEANING, A MARRIAGE-LIKE RELATIONSHIP) LIVE IN
THE SAME HOUSEHOLD, CODE AS YES.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
299
SECTION L: SOCIODEMOGRAPHIC INFORMATION
REFUSED ..................................................................................
GO TO L11
300
r
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(L8=02, 03, 04, 05, d, r)
L10.
{Do you/Does NAME} have a long-term partner who lives in the same household with {you/him/her} in a
marriage-like relationship?
¿Tiene [usted/NAME] una pareja de largo-tiempo con quien [usted/NAME] vive en el mismo hogar como si
fueran casados?
(All)
L11.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
Which of the following best describes {your/NAME’s} living situation?
¿Cuál de estos mejor describe a la situación de vivienda o domicilio de [usted/NAME]
INTERVIEWER:
READ LIST. CODE ONE ANSWER. ‘LIVE WITH CHILDREN’ SHOULD BE CODED AS ‘2’
PROGRAMMER DISPLAY ONLY IF L9≠01 {You live/NAME lives} alone
{Vives / NOMBRE vive} solo. .......................................................................
{You live/NAME lives} with {your/his/her} parents, guardians, a
spouse/partner, or other relative
{Vives / NOMBRE vive} {con su} los padres, tutores, un cónyuge /
pareja, u otro pariente ..................................................................................
{You live/NAME lives} with friends or roommates
{Vives / vidas NOMBRE} con amigos o compañeros de habitación .............
{You live/NAME lives} in another group setting with people not related to
{you/him/her}
{Vives / vidas nombre} en otro ambiente de grupo con personas no
relacionadas con {usted / él / ella}................................................................
{You live/NAME lives} in some other living situation
{Vives / vidas nombre} en alguna otra situación de vida ..............................
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................
(L11=05)
L11_Other. What is the other living situation?
01 (L11a)
02 (L11a)
03 (L11a)
04 (L11a)
05 (L11_Other)
d (L11a)
r (L11a)
¿Cuál es la otra situación de vivienda?
(All)
L11a.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
SOFT EDIT: RESPONDENT CANNOT LIVE IN SAME HOUSEHOLD WITH SPOUSE (L9=01) OR LIVE IN
SAME HOUSEHOLD WITH LONG-TERM PARTNER (L10=01) AND LIVE ALONE (L11=01).
IF
RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I show that
{you live/NAME lives} in the same household with {your/his/her} spouse or partner and {you live/NAME lives}
alone? Could you verify which is correct?
Puede que anoté una respuesta incorrecta. Anoté que {usted/NAME} vive en el mismo hogar que su
esposo(a) o pareja y que {usted/NAME} vive solo(a). ¿Podría verificar cuál es correcto?
LIVE WITH SPOUSE OR PARTNER ......................................... 01 (CHANGE L9 OR L10)
LIVE ALONE............................................................................... 02 (CHANGE L11)
SUPPRESS ................................................................................ 03
301
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(All)
L12.
The next question is about the place {you live/NAME lives}. Is this place a…
La próxima pregunta es acerca del lugar donde [usted/NAME] vive. ¿Es este lugar una . . .
INTERVIEWER:
CODE ONE ANSWER.
INTERVIEWER:
IF RESPONDENT SAYS TOWNHOUSE OR CONDO, CODE AS 1.
Single family home
Casa unifamiliar ..........................................................................
Mobile home
Casa móvil ..................................................................................
Regular apartment
Apartamento regular ...................................................................
Supervised apartment
Apartamento vigilado ..................................................................
Group home
Hogar grupal ...............................................................................
Halfway house
Hogar de transición ....................................................................
Personal care or board and care home
Hogar de cuidado personal o alojo y cuidado .............................
Assisted living facility
Centro de vida asistida ...............................................................
Nursing or convalescent home
Asilo de cuidado o para convalecientes .....................................
Center for Independent Living
Centro para la vida independiente ..............................................
Some other type of supervised group residence or facility
Algún otro tipo de residencia o instalación grupal vigilada .........
HOMELESS (NEW)
SIN HOGAR ...............................................................................
Something else
otra cosa .....................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(L12=12)
L12_Other. What is the other type of place?
01 (L12a)
02 (L12a)
03 (L12a)
04 (L12a)
05 (L12a)
06 (L12a)
07 (L12a)
08 (L12a)
09 (L12a)
10 (L12a)
11 (L12a)
13 (L12a)
12 (L12_Other)
d (L12a)
r (L12a)
¿Qué es el otro tipo de lugar?
(All)
L12a.
(All)
L13.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
SOFT EDIT: RESPONDENT CANNOT LIVE ALONE (L11=01) AND LIVE IN A GROUP SETTING
(L12=04-11). IF RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect
answer. I show that {you/NAME} live alone in a {FILL ANSWER FROM L12}? Which is correct?
Anoté que {usted/NAME} vive solo(a) en un(a) {FILL ANSWER FROM L12}. ¿Cuál es correcto?
LIVE ALONE............................................................................... 01 (CHANGE L12)
LIVE IN GROUP SETTING......................................................... 02 (CHANGE L11)
SUPPRESS ................................................................................ 03
CHECK: DOES {NAME} LIVE IN A GROUP SETTING (L12 = 04 – 12)?
(L13=01)
YES ............................................................................................ 01
NO .............................................................................................. 00 (L14)
302
SECTION L: SOCIODEMOGRAPHIC INFORMATION
L15.
Is this place primarily for people with hearing or vision impairments, mental illness, intellectual disabilities, or
developmental disabilities?
¿Es este lugar principalmente para personas con incapacidades auditivas o de visión, enfermedades mentales,
incapacidades intelectuales o de desarrollo?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
303
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(L12=01, 02, 03, 04, 12, d, r)
L21b. {Do you/Does NAME} own or rent {your/his/her} home?
{¿Tienes / Tiene NOMBRE} {propia o alquiler de su/su propia o alquiler de su } casa?
Interviewer note: If respondent says they pay a mortgage, code as ‘01’.
(All)
L14.
OWN ........................................................................................... 01
RENT .......................................................................................... 02
LIVE WITH OTHERS RENT FREE ............................................ 03
Don’t know .................................................................................. d
Refused ...................................................................................... r
CHECK: DOES {NAME} LIVE ALONE (L11 = 01) OR LIVE IN GROUP SETTING (L12=4-12)?
YES ............................................................................................ 01 (L20)
NO .............................................................................................. 00
(L14=00)
L16.
How many adults 18 years of age or older live in {your/NAME’s} household, including {yourself/NAME}?
¿Cuántos adultos de la edad de 18 (dieciocho) años o más viven en el mismo hogar que [usted/NAME],
incluyendo a [usted/NAME]?
PROBE: This includes all adults who usually live there, even if they are temporarily away on business,
vacation, in a hospital, away at school or on military duty.
Esto incluye a todos los adultos que generalmente viven allí, también si temporariamente no están
por viaje de negocios, vacaciones, por estar en el hospital, por estudiar lejos del hogar, o por
servicio militar.
|__|__| ADULTS
(1-4)
(1-20)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(L14=00)
L17.
How many children under 18 years of age live in {your/NAME’s} household?
d
r
¿Cuántos niños y niñas de menos de los 18 (dieciocho) años de edad viven en el mismo hogar que
[usted/NAME]?
PROBE: This includes all children who usually live there, even if they are temporarily away on vacation, in a
hospital, or away at school.
Esto incluye a todos los menores de edad que generalmente viven allí, también si temporariamente
están de vacaciones, en el hospital, o en una escuela lejos del hogar.
|__|__| CHILDREN
(0-6)
(0-20)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(L14=00)
L18.
CHECK: DO NO CHILDREN LIVE IN THE HOUSEHOLD (L17=0)?
d
r
YES ............................................................................................ 01 (L20)
NO .............................................................................................. 00
(L14=00 and L18=00)
L19.
How many of these children are {your/NAME’s} own? Please include biological, adopted, step, and foster
children.
¿Cuántos de estos niños son de [usted/NAME] mism[o/a]? Por favor incluya hijos e hijas biológicos (de
sangre), adoptados, hijastros, e hijos de crianza o foster children.
304
SECTION L: SOCIODEMOGRAPHIC INFORMATION
|__|__| CHILDREN
(0-6)
(0-20)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
305
d
r
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(All)
L20.
{Do you/Does NAME} have children of {your/his/her} own under the age of 18 living outside of {your/his/her}
household?
¿Tiene [usted/NAME] hijos o hijas de menos de los 18 (dieciocho) años de edad que no viven en el mismo
hogar que [usted/NAME]?
PROBE: Please include biological, adopted, step, and foster children.
Por favor incluya hijos e hijas biológicos (de sangre), adoptados, hijastros, e hijos de crianza o
foster children
YES ............................................................................................ 01
NO .............................................................................................. 00 (L22a)
DON’T KNOW ............................................................................ d (L22a)
REFUSED .................................................................................. r (L22a)
(L20=01)
L21.
How many children under 18 not living in {your/NAME’s} household {do you/does (he/she)} have?
¿Cuántos de sus hijos o hijas de menos de los 18 (dieciocho) años de edad no viven en el mismo hogar que
[usted/NAME]?
|__|__| CHILDREN (1-20)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(All)
L21_CHECK
SOFT EDIT: IF L21 CHILDREN > 6, INTERVIEWER READ: Let me make sure I did not make a mistake. You
just indicated that you have [FILL] children under 18 not living in your household. Is this correct?
Déjeme confirmar que no cometí un error. Acaba de indicar que tiene [FILL] hijos menores de 18 años que
no viven en su hogar. ¿Es esto correcto?
(All)
L22a.
NO ..............................................................................................
SUPPRESS ................................................................................
(CHANGE L21)
CHECK: DOES {NAME} HAVE ANY CHILDREN (L17>=1 AND L19>=1) OR (L21>=1)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (LP23)
(L22a=01)
L22.
Are any of {your/NAME’s} children, either living with {you/him/her} or not, under the age of six?
¿Cualquiera de sus hijos e hijas, sea los que viven con [usted/NAME] o no, tienen menos de la edad de seis
años?
(All)
LP23.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
{Have you/Has NAME} ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard?
(ACS)
{¿Alguna vez ha estado en servicio activo en las Fuerzas Armadas de Estados Unidos, las Reservas o la
Guardia Nacional?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
306
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(All)
L23Aamt. PROGRAMMER: IF L11=01, 03, or 04, ASK:
What was {your/NAME’s} total income in 2022, before taxes or other deductions? Please include money
{you/NAME} received from all sources.
¿Cuál fue el ingreso total {de su / de NAME} en 2022, antes de impuestos u otras deducciones? Por favor,
incluya el dinero {usted / NOMBRE} recibido de todas las fuentes.
PROGRAMMER: IF L11=02, or 05, d, r, ASK:
What was the total combined income of all members of {your/NAME’s} household in 2022, before taxes or
other deductions? Please include money all members of {your/NAME’s} household received from all
sources.
¿Cuál fue el ingreso total combinado de todos los miembros del hogar de {usted/NAME} en 2022, antes de
impuestos y otras deducciones? Por favor incluya dinero que recibe el hogar de {usted/NAME} de todas las
fuentes.
PROBE: IF RESPONDENT CANNOT PROVIDE AN ANNUAL AMOUNT: If it is hard to calculate an annual
amount can you tell me what your income was per day, week, bi-weekly, twice a month or monthly
in 2022.
Si le resulta difícil calcular una cantidad anual, ¿me puede decir su ingreso por día, semana,
cada dos semanas, dos veces al mes o mes en 2022?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$|___|___|___| , |___|___|___| . 00 AMOUNT
(10,000-75,000)
(0-500,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(L23Aamt = numeric response)
L23Ahop. PROBE: PROGRAMMER: IF L11=01, 03, or 04, DISPLAY:
d (L24)
r (L24)
What was {your/NAME’s} total income in 2022, before taxes or other deductions? Please include money
{you/NAME} received from all sources.
¿Cuál fue el ingreso total de su {/ de NAME} en 2022, antes de impuestos u otras deducciones? Por favor,
incluya el dinero {usted / NOMBRE} recibido de todas las fuentes.
PROBE: PROGRAMMER: IF L11=02, or 05, d, r, DISPLAY:
What was the total combined income of all members of {your/NAME’s} household in 2022, before taxes or
other deductions? Please include money all members of {your/NAME’s} household received from all
sources.
¿Cuál fue el ingreso total combinado de todos los miembros del hogar de {usted/NAME} en 2022, antes de
impuestos y otras deducciones? Por favor incluya dinero que recibe el hogar de {usted/NAME} de todas las
fuentes.
PROBE: IF RESPONDENT CANNOT PROVIDE AN ANNUAL AMOUNT: If it is hard to calculate an annual
amount can you tell me what your household income was per day, week, bi-weekly, twice a month
or monthly in 2022.
Si le resulta difícil calcular una cantidad anual, ¿me puede decir su ingreso por día, semana,
cada dos semanas, dos veces al mes o mes en 2022?
PROBE: Is that daily, weekly, bi-weekly, twice a month, or annually?
¿Es diariamente, semanalmente, cada dos semanas, dos veces al mes, o anualmente?
INTERVIEWER: ENTER HOW OFTEN PAID
ANNUALLY................................................................................. 01 (L25)
307
SECTION L: SOCIODEMOGRAPHIC INFORMATION
MONTHLY ..................................................................................
TWICE A MONTH ......................................................................
WEEKLY ....................................................................................
BI-WEEKLY (EVERY TWO WEEKS) .........................................
DAILY .........................................................................................
OTHER .......................................................................................
308
02
03
04
05
06
07
(L23b)
(L23b)
(L23b)
(L23b)
(L23b)
SECTION L: SOCIODEMOGRAPHIC INFORMATION
(L23Aamt = numeric response and L23Ahop =07)
L23Ahop_Other.
INTERVIEWER: ENTER OTHER
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
GO TO L24
(L23Aamt = numeric response and L23Ahop = 02, 03, 04, 05, 06)
L23b. PROGRAMMER: USE “{YOUR/NAME’S} HOUSEHOLD” IF L11=02 OR 05, OTHERWISE USE
“{YOUR/NAME}”
How many {days/weeks/months} did {{you/NAME}/{your household/NAME’s household}} receive this income
in 2022?
¿{{Cuántos días/meses}/{Cuántas semanas}} recibió {{usted/NAME}/{su hogar/el hogar de NAME}} este
ingreso en 2022?
|__|__|__| DAYS/WEEKS/MONTHS
(1-365) (1-52) (1/12)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
GO TO L25
(L23Aamt =d, r or L23Ahop=07)
L24.
PROGRAMMER: USE “HOUSEHOLD” IF L11=02 OR 05
Could you please tell me if {your/NAME’S} annual (household) income before taxes and other deductions in
2022 was...
¿Podría decirme si los ingresos anuales de su en 2022, antes de impuestos y otras deducciones fueron...
L25.
L26.
$2,500 or less, ............................................................................
$2, 501 to $5,000,.......................................................................
$5,001 to $10,000,......................................................................
$10,001 to $20,000,....................................................................
$20,001 to $30,000,....................................................................
$30,001 to $40,000,....................................................................
$40,001 to $50,000,....................................................................
$50,001 to $75,000,....................................................................
$75,001 to $100,000, or .............................................................
More than $100,000? .................................................................
DON’T KNOW ............................................................................
01
02
03
04
05
06
07
08
09
10
d
REFUSED ..................................................................................
r
DELETED
DELETED
GO TO M1
309
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(All)
M1.
PROGRAMMER:
IF WE HAVE NAME, ADDRESS, AND PHONE NUMBER FROM EITHER THE
SCREENER OR FROM THE OTHER PRELOADED INFORMATION DISPLAY THAT
NAME, ADDRESS, AND PHONE NUMBER.
That concludes this interview. Can you please verify (your/NAME’S) current contact information?
Eso concluye esta entrevista. ¿puede usted verificar la información de contacto que tenemos actualmente
para {usted/NAME}?
NAME: {FULL NAME FROM SCREENER OR PRELOADED INFORMATION}
STREET ADDRESS 1: {FIRST LINE OF ADDRESS FROM SCREENER OR PRELOADED INFORMATION}
STREET ADDRESS 2: {SECOND LINE OF ADDRESS FROM SCREENER OR PRELOADED
INFORMATION}
STREET ADDRESS 3: {THIRD LINE OF ADDRESS FROM SCREENER OR PRELOADED
INFORMATION}
CITY OR TOWN: {CITY OR TOWN FROM SCREENER OR PRELOADED INFORMATION}
STATE: {STATE FROM SCREENER OR PRELOADED INFORMATION}
ZIP CODE: {ZIP CODE FROM SCREENER OR PRELOADED INFORMATION}
TELEPHONE NUMBER: {TELEPHONE NUMBER FROM SCREENER OR PRELOADED INFORMATION}
SAME AS PROVIDED................................................................ 00 (M1a)
INCORRECT INFORMATION ABOVE, NEED TO ENTER
NEW INFORMATION ......................................................... 01 (M1_Firstname)
DON’T KNOW ............................................................................ d (M1a)
REFUSED .................................................................................. r (M1a)
M1 {PROVIDE BOX FOR DATA ENTRY. 1, 0, d, r ARE THE ONLY POSSIBLE RESPONSES; IF M1=01,
THEN GO TO QUESTIONS BELOW, OTHERWISE SKIP TO M1a}
(M1=01)
M1_FirstName.
NAME: {DISPLAY FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH FIRST NAME
BOLDED}
First name?
¿Primer nombre?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M1=01)
M1_MiddleName.
NAME: {DISPLAY FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH MIDDLE
INITIAL BOLDED}
Middle initial?
¿Inicial del segundo nombre?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
310
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M1=01)
M1_LastName.
NAME: {DISPLAY FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH LAST NAME
BOLDED}
Last name?
¿Apellido?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M1=01)
M1_Confirm.
NAME: {DISPLAY FULL NAME}
INTERVIEWER: PRESS 1 TO CONTINUE
(M1=01)
M1_Address1.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
LINE 1 BOLD}
Street and number?
¿Calle y número?
INTERVIEWER:
REFUSED AND DON’T KNOW ALLOWED, WILL SKIP REST OF ADDRESS
QUESTIONS.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M1=01)
M1_Address2.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
LINE 2 BOLD}
PROBE: READ IF NECESSARY: Second part of the address.
¿Segunda parte de la dirección?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M1=01)
M1_Address3.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
LINE 3 BOLD}
PROBE: READ IF NECESSARY: Third part of the address.
¿Tercera parte de la dirección?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
311
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M1=01)
M1_City.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
CITY BOLD}
Town or city?
¿Pueblo o ciudad?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M1=01)
M1_State.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
STATE BOLD}
State?
¿Estado?
INTERVIEWER:
USE TWO CHARACTER ABBREVIATION.
INTERVIEWER:
ENTER ZZ TO ENTER INTERNATIONAL CITY AND COUNTRY BELOW.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M1=01)
M1_ZipCode.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH ZIP
CODE BOLD}
Zip code?
¿Código postal?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M1=01)
M1_Confirm.
ADDRESS: {DISPLAY FULL ADDRESS}
INTERVIEWER:
(M1=01)
M1_PhoneNumber.
PRESS 1 TO CONTINUE
TELEPHONE: {TELEPHONE NUMBER FROM SCREENER OR PRELOADED INFORMATION}
Please give me the telephone number, area code first?
¿Por favor dígame el número de teléfono con el código de área primero?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
312
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(All)
M2A.
CHECK: IS INTERVIEWER SPEAKING WITH {NAME} OR A PROXY?
{NAME} ....................................................................................... 01 (M2CHECK)
PROXY ....................................................................................... 02
(M2A=02)
Confirm. What is your first name?
¿Cuál es su primer nombre?
INTERVIEWER:
PRESS 1 TO CONTINUE
(M2A=02)
M2a_FirstName.
NAME: {DISPLAY PROXY’S FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH
FIRST NAME BOLD}
First name?
¿Primer nombre?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
313
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M2A=02)
M2a_MiddleName.
NAME: {DISPLAY PROXY’S FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH
MIDDLE INITIAL BOLD}
Middle initial?
¿Inicial del segundo nombre?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M2A=02)
M2a_LastName.
NAME: {DISPLAY PROXY’S FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH LAST
NAME BOLD}
Last name?
¿Apellido?
(M2A=02)
Confirm. NAME: {DISPLAY PROXY’S FULL NAME}
INTERVIEWER:
PRESS 1 TO CONTINUE
(M2A=02)
M2a_Address1.
ADDRESS:
Street and number?
¿Calle y número?
INTERVIEWER:
REFUSED OR DON’T KNOW ALLOWED. WILL SKIP REST OF ADDRESS QUESTIONS.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M2A=02)
M2a_Address2.
ADDRESS: {DISPLAY ADDRESS1 FROM PREVIOUS QUESTION}
PROBE: READ IF NECESSARY: Second part of the address.
¿Segunda parte de la dirección?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M2A=02)
M2a_Address3.
ADDRESS: {DISPLAY ADDRESS1 AND ADDRESS2 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Third part of the address.
¿Tercera parte de la dirección?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
314
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
315
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M2A=02)
M2a_Address4.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, AND ADDRESS3 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Fourth part of the address.
¿Cuarta parte de la dirección?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M2A=02)
M2a_City.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, AND ADDRESS4 FROM PREVIOUS
QUESTIONS}
Town or City?
¿Pueblo o ciudad?
(M2A=02)
M2a_State.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, ADDRESS4, AND TOWN/CITY FROM
PREVIOUS QUESTIONS}
State?
¿Estado?
INTERVIEWER:
USE TWO CHARACTER ABBREVIATION.
INTERVIEWER:
ENTER ZZ TO ENTER INTERNATIONAL CITY AND COUNTRY BELOW.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M2A=02)
M2a_ZipCode.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, ADDRESS4, TOWN/CITY, AND STATE
FROM PREVIOUS QUESTIONS}
Zip code?
¿Código postal?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(M2A=02)
Confirm.
NAME: {DISPLAY PROXY’S FULL ADDRESS}
INTERVIEWER:
PRESS 1 TO CONTINUE
(M2A=02)
M2a_PhoneNumber.
TELEPHONE NUMBER:
Please give me the telephone number, area code first?
¿Por favor dígame el número de teléfono con el código de área primero?
316
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
DON’T KNOW ............................................................................
REFUSED ..................................................................................
317
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M2A=02)
M2a_Rlshp. How are you related to {NAME}?
¿Cual es su relación con {NAME}?
{NAME’S} SPOUSE....................................................................
{NAME’S} MOTHER ...................................................................
{NAME’S} FATHER ....................................................................
{NAME’S} CHILD ........................................................................
GRANDPARENT OF {NAME} ....................................................
BROTHER/SISTER (NATURAL/STEP) OF {NAME} ..................
AUNT/UNCLE OF {NAME} .........................................................
FRIEND ......................................................................................
CASEWORKER/CAREGIVER/PAYEE .......................................
GIRLFRIEND/BOYFRIEND/PARTNER ......................................
GUARDIAN/FOSTER/STEP PARENT .......................................
IN-LAW .......................................................................................
OTHER RELATIVE OF {NAME} .................................................
NOT RELATED ..........................................................................
STAFF AT RESIDENCE .............................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
11
12
13
14
15
08
09
10
d
r
(M2A=02 and M2a_Rlshp=08)
M2a_oth1. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M2A=02 and M2a_Rlshp=09)
M2a_oth2. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
318
d
r
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_Rlshp_oth2)
(M2a_email)
(M2a_email)
(M2a_email)
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M2A=02)
M2a_email. Do you have an email address?
¿Tiene {usted/NAME} una dirección de correo electrónico o e-mail?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M2CHECK)
DON’T KNOW ............................................................................ d (M2CHECK)
REFUSED .................................................................................. r (M2CHECK)
(M2A=02 and M2a_email=01)
M2b.
What is your email address?
Cuál es {su/el} dirección de correo electrónico o e-mail {de NAME}?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(All)
M2CHECK. PROGRAMMER: If makedialphone=8 , go to M2field_callin.
ELSE GO TO M3.
PROGRAMMER NOTE: IF FIELD LOCATOR CALL-IN (MAKEDIALPHONE=8):
M2field_callin.
The field locator will now give you a $30 gift card. Please read me the last four digits listed on the
front of your gift card.
El localizador de campo le dará ahora una tarjeta de regalo de $30 ahora. Por favor léame los últimos
cuatro dígitos que aparecen en el frente de su tarjeta de regalo
|__|__||__|__|
PROGRAMMER NOTE: IF CAPI FIELD COMPLETE, CASE, THEN DISPLAY TEXT BELOW INSTEAD
M2_INC_FIELD:. ELSE, M3
M2_INC_FIELD: ARE YOU GIVING THE GIFT CARD TO THE RESPONDENT?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M3)
(M2_INC_FIELD=00)
M3.
Would you like us to send the $30 gift card to {you/NAME} or someone else?
¿Le gustaría que le enviemos una tarjeta de regarlo de 30 a {usted/NAME} o a otra persona?
{YOU/NAME} .............................................................................. 01
SEND GIFT CARD TO SOMEONE ELSE ................................. 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(M3a)
(M3a)
(M3a)
(M3a)
(M3 = ANSWER OR d OR r)
M3_a. PROGRAMMER:
IF SWIFT FLAG = 0 ............................................................ 01 (M3a)
IF SWIFT FLAG = 1 ............................................................ 02 SET M3a = 03 (M10a)
319
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M2CHECK=01,00 ) AND NOT A FIELD COMPLETE
M3a. **DO NOT READ THIS QUESTION. SELECT WALMART GIFT CARD**
WALMART GIFT CARD ............................................................. 01 (M10a)
(IF M3 = 1)
Confirm1: I would like to confirm the name and address where we should send the payment. Is it:
Me gustaría confirmar el nombre y la dirección adonde deberíamos enviar el pago. ¿Es…?
Yes ............................................................................................. 01
No .............................................................................................. 02
Fix this name/address ................................................................ d
New name/address..................................................................... r
PROGRAMMER: IF M3=2, THEN M4. ELSE, M10a.
(M3=02,d,r)
M4.
PROGRAMMER: WE WOULD LIKE THE FOLLOWING FORMAT TO BE USED FOR THE DISPLAY ON TOP
HALF OF SCREEN (IF POSSIBLE, THIS DISPLAY SHOULD CHANGE AS THE INTERVIEWER ENTERS
NEW INFORMATION):
What is the name and address of the person to whom we should send the gift card?
¿Cuál es el nombre y dirección de la persona a quien debemos enviar la tarjeta de regalo?
NAME: {FULL NAME FROM M1}
STREET ADDRESS 1: {FIRST LINE OF ADDRESS FROM M1}
STREET ADDRESS 2: {SECOND LINE OF ADDRESS FROM M1}
STREET ADDRESS 3: {THIRD LINE OF ADDRESS FROM M1}
CITY OR TOWN: {CITY OR TOWN FROM M1}
STATE: {STATE FROM M1}
ZIP CODE: {ZIP CODE FROM M1}
TELEPHONE NUMBER: {TELEPHONE NUMBER FROM M1}
SAME AS PROVIDED................................................................ 00 (M6)
INCORRECT INFORMATION ABOVE, NEED TO ENTER
NEW INFORMATION ......................................................... 01 (M4Fname)
DON’T KNOW ............................................................................ d (M6)
REFUSED .................................................................................. r (M6)
PROGRAMMER: SEE M1 FOR FORMATTING TO USE FOR BOTTOM OF SCREEN
(M3=02,d,r and M4=01)
M4_Firstname.
NAME:
First name?
¿Primer nombre?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
320
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M3=02,d,r and M4=01)
M4_Middlename.
NAME: {DISPLAY FIRST NAME FROM QUESTION M4_FIRSTNAME}
Middle initial?
¿Inicial del segundo nombre?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M3=02,d,r and M4=01)
M4_Lastname.
NAME: {DISPLAY FIRST NAME FROM QUESTION M4_FIRSTNAME AND MIDDLE NAME FROM
M4_MIDDLENAME}
Last name?
¿Apellido?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M3=02,d,r and M4=01)
Confirm.
NAME: {DISPLAY NAME FROM PREVIOUS QUESTIONS}
INTERVIEWER:
PRESS 1 TO CONTINUE
(M3=02,d,r and M4=01)
M4_Address1.
ADDRESS:
Street and number?
Calle y número?
INTERVIEWER:
REFUSED OR DON’T KNOW ALLOWED. WILL SKIP REST OF ADDRESS QUESTIONS.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M3=02,d,r and M4=01)
M4_Address2.
ADDRESS: {DISPLAY ADDRESS1 FROM PREVIOUS QUESTION}
PROBE: READ IF NECESSARY: Second part of the address.
¿Segunda parte de la dirección?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M3=02,d,r and M4=01)
M4_Address3.
ADDRESS: {DISPLAY ADDRESS1 AND ADDRESS2 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Third part of the address.
¿Tercera parte de la dirección?
DON’T KNOW ............................................................................
321
d
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
REFUSED ..................................................................................
322
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M3=02,d,r and M4=01)
M4_Address4.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, AND ADDRESS3 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Fourth part of the address.
¿Cuarta parte de la dirección?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M3=02,d,r and M4=01)
M4_City.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, AND ADDRESS4 FROM PREVIOUS
QUESTIONS}
Town or city?
¿Pueblo o ciudad?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M3=02,d,r and M4=01)
M4_State. ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3 ADDRESS4, AND TOWN/CITY FROM
PREVIOUS QUESTIONS}
State?
¿Estado?
INTERVIEWER:
USE TWO CHARACTER ABBREVIATION.
INTERVIEWER:
ENTER ZZ TO ENTER INTERNATIONAL CITY AND COUNTRY BELOW.
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M3=02,d,r and M4=01)
M4_Zip. ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, ADDRESS4, TOWN/CITY, AND STATE
FROM PREVIOUS QUESTIONS}
Zip code?
¿Código postal?
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(M3=02,d,r and M4=01)
Confirm. ADDRESS: {DISPLAY FULL ADDRESS}
INTERVIEWER: PRESS 1 TO CONTINUE
(M3=02,d,r and M4=01)
M4_Telephone.
TELEPHONE NUMBER:
Please give me the telephone number, area code first?
¿Por favor dígame el número de teléfono con el código de área primero?
323
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
DON’T KNOW ............................................................................
REFUSED ..................................................................................
324
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
M7.
(All)
M10a.
DELETED
Thank you very much for taking part in this survey. Because people like you are such a valued part of what
we do, I’d like you to think about the survey you just participated in. On a scale from 1 to 10 where one means
'it was not a good use of time' and ten means “it was a good use of time,” which number between 1 and 10
best describes how you feel about your experience today?
Muchas gracias por haber tomado parte en esta encuesta. Gente como usted son una parte muy apreciada
de lo que hacemos, quisiera saber qué piensa usted acerca de la encuesta en la que acaba de participar.
Usando una escala de 1 (uno) a 10 (diez), en la cual 'uno' significa 'no fue’ un buen uso de tiempo', y diez
significa 'sí fue’ un buen uso de tiempo', ¿qué número entre 1 y diez mejor describe lo que usted piensa
acerca de su experiencia hoy día?
|___|___|
(01-10)
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(All)
M11_Thanks.
Thank you for your cooperation. This completes the survey! Thank you again.
Le agradezco por su cooperación. ¡ Esto completa la encuesta! Otra vez, muchas gracias.
PRESS 1 TO CONTINUE ..........................................................
01
INTERVIEWER OBSERVATIONS
NEW ITEM
(All)
M11a. How was this interview conducted?
Over the telephone .....................................................................
In person ....................................................................................
Using TTY...................................................................................
Other: Specify .............................................................................
(M11a=04)
M11a_Other.
INTERVIEWER:
PLEASE SPECIFY
325
01
02
03
04
(M11)
(M11)
(M11)
(M11a_Other)
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
M11.
INTERVIEWER: INTERVIEWER OBSERVATIONS:
Who was the respondent to this interview?
INTERVIEWER:
PLEASE CODE THE PERSON WITH WHOM YOU CONDUCTED MOST OF THE
INTERVIEW.
{NAME} HIMSELF/HERSELF ..................................................... 01
PROXY FOR {NAME} ................................................................. 02 (M13)
(M11=01)
M12.
Was {NAME} assisted by anyone during this interview? That is, did anyone help {NAME} in interpreting the
questions or giving answers?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M15)
(M11=02 or M12=01)
M13.
PROGRAMMER: IFM12=01 FILL “ASSISTANT” AND IF M11=02 FILL “PROXY”
How is the {assistant/proxy} related to (NAME)?
INTERVIEWER:
IF MORE THAN ONE ASSISTANT OR PROXY, INDICATE THE RELATIONSHIP OF THE
ONE YOU CONSIDER TO BE THE MAIN ASSISTANT OR PROXY.
{NAME’S} SPOUSE....................................................................
{NAME’S} MOTHER ...................................................................
{NAME’S} FATHER ....................................................................
{NAME’S} CHILD ........................................................................
GRANDPARENT OF {NAME} ....................................................
BROTHER/SISTER (NATURAL/STEP) OF {NAME} ..................
AUNT/UNCLE OF {NAME} .........................................................
FRIEND ......................................................................................
CASEWORKER/CAREGIVER/PAYEE .......................................
GIRLFRIEND/BOYFRIEND/PARTNER ......................................
GUARDIAN/FOSTER/STEP PARENT .......................................
IN-LAW .......................................................................................
OTHER RELATIVE OF {NAME} .................................................
NOT RELATED ..........................................................................
STAFF AT RESIDENCE .............................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
*Note:
01
02
03
04
05
06
07
11
12
13
14
15
08
09
10
d
r
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M13_h_oth)
(M13_i_oth)
(M14)
(M14)
(M14)
M14=11 is a category added at R2; value of “other” category (M14=10) maintained for comparability across
rounds.
(M11=02 or M12=01 and M13=08)
M13_h_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
(M11=02 or M12=01 and M13=09)
M13_i_oth. INTERVIEWER: PLEASE SPECIFY
DON’T KNOW ............................................................................
REFUSED ..................................................................................
326
d
r
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(M11=02 or M12=01)
M14.
PROGRAMMER: IFM12=01 FILL “ASSISTANT” AND IF M11=02 FILL “PROXY”
PROGRAMMER: ONLY DISPLAY RESPONSE OPTION 10, IF M11=02
Why was an {assistant/proxy} needed?
INTERVIEWER:
*Note:
CODE ONLY ONE.
{NAME} DIDN’T KNOW HOW TO ANSWER..............................
{NAME} HOSPITALIZED ............................................................
{NAME} INSTITUTIONALIZED ...................................................
{NAME} HAS HEARING PROBLEM...........................................
{NAME} HAS SPEECH PROBLEM ............................................
{NAME} HAS LANGUAGE PROBLEM .......................................
{NAME} HAS POOR MEMORY OR CONFUSION .....................
{NAME} HAS OTHER MENTAL CONDITION ............................
{NAME} HAS PHYSICAL ILLNESS OR DISABILITY .................
{NAME} FAILED COGNITIVE TEST ..........................................
OTHER NON-HEALTH RELATED REASON .............................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
01
02
03
04
05
06
07
08
09
11
10
d
r
DON’T KNOW ............................................................................
REFUSED ..................................................................................
d
r
In general, do you feel the respondent was intellectually capable of responding?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
(All)
M16.
In general, do you feel the respondent’s answers were reasonably accurate?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
(All)
M17.
In general, do you feel the respondent understood the questions?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
(All)
M18.
(M15)
(M15)
M14=11 is a new category added at R2 and R3; value of “other” category (M14=10) maintained for
comparability across rounds.
(M11=02 or M12=01 and M14=10)
M14_j_oth. INTERVIEWER: PLEASE SPECIFY
(All)
M15.
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)*
In general, how tiring did the interview seem to be for the respondent?
VERY TIRING............................................................................. 01
A LITTLE TIRING ....................................................................... 02
NOT TIRING ............................................................................... 03
DON’T KNOW ............................................................................ d
327
SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(All)
M19.
In general, did the respondent have difficulty hearing you during the interview?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M21)
DON’T KNOW ............................................................................ d (M21)
(M19=01)
M20.
In general, do you feel the respondent’s hearing difficulty affected the interview?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
(All)
M21.
INTERVIEWER: Record any special circumstances encountered while interviewing respondent.
328
| File Type | application/pdf |
| File Title | National Beneficiary Survey R4 Instrument |
| Subject | CATI |
| Author | MATHEMATICA STAFF |
| File Modified | 2022-08-17 |
| File Created | 2022-08-17 |