Income Instrument- all sections - Qs & Probes
Attachment 8 - Income Instrument- all sections - Qs & Probes.docx
Generic Clearance for Questionnaire Pretesting Research
Income Instrument- all sections - Qs & Probes
OMB: 0607-0725
Income with Employment and Poverty
Survey Questions with Probes
for Cognitive Interviewing, Round 1
Instructions:
For all questions, “Ask” or “Probe:” is something that should be asked when the R finishes the question.
“Observe” is something that doesn’t need to be asked, if the information requested is obvious through observation. If it is not observed, or the R is not thinking aloud, then these should be asked.
If a question and its probes are repeated, the instruction says “Probe if necessary”. If the probes were not asked before or the interviewer cannot remember if these probes were asked, ask the probe. If the person answered the probes previously, they do not need to answer them again (unless it seems like there are problems).
For all questions, note and /or probe any significant problems, comments, or behaviors that are not included in the probes, as would normally be done.
Necessary Household Questions from CPS, needed for fills (no probes)
ADDRESS: What is your current physical address?
Number and Street_____________
City___________ State___________
HOME: Are your living quarters…
Owned or being bought by you or someone in your household?
Rented for cash?
Occupied without payment of cash rent?
ROSTER1: Including yourself, what are the first names of each person who lives in your household?
ROSTER2_2: Enter the age and sex for each household member.
Age Sex
[Name] ____ _____
[Name] ____ _____
Main Questionnaire
Employment
Employment Questions
There are no select all that apply questions. Even though boxes are used, consider these radio buttons.
Q29a. Did you do any work for pay or profit at any time during 2023, even for one day?
Yes – 1
No – 2
[Do not probe on this question if answer = “No”. Probe on follow-up question instead.]
If yes
Probe: Would you answer the differently, or think of different kinds of work, if the first question asked about a “job or business” instead of “work”? E.g., Did you work at a job or business at any time in 2023?
Probe: Explain the work you did in 2023. (probe: Anything else? Short term? Military service?)
Probe: Did you include work that you did not get paid for, directly? E.g., manage a rental property or sell something online?
Q29b. Did you/^name do any temporary, part-time, or seasonal work, even for one day during 2023?
Yes – 1
No – 2
Probe: Would you answer the differently, or think of different kinds of work, if the first question asked about a “job or business” instead of “work”? E.g., Did you work at a job or business at any time in 2023?
Probe: Explain the work you did in 2023. (probe: Anything else? Short term? Military service?)
Probe: Did you include work that you did not get paid for, directly? E.g., manage a rental property or sell something online?
Q30. Did you/^name spend any time trying to find a job or on layoff during 2023?
Yes - 1
No – 2
Probe: How did you interpret ‘on layoff’? were you confused by this term? (Note to interviewer: on layoff is different than laid off. On layoff means they will be called back to work).
_____________________________________________________________________________
Q31. How many weeks in total were you/they looking for work or on layoff in 2023?
_______ weeks
[] all weeks in 2023
Probe: How did you count the number of weeks looking for work or on layoff? Probe if counted partial week(s).
Probe: We want to know if people know how many weeks are in a year, or if we need to remind them. Do you know how many weeks are in a year?
(If they used the check box) Probe: why did you select the check box rather than put in 52 weeks?
Q32. What was the main reason you/^name did not work in 2023?
Temporary injury, illness, or other health concern - 1
Chronic health condition or disability - 2
Retired - 3
Pregnancy or childbirth - 4
Taking care of children or others - 5
Going to school - 6
Unable to find work - 7
On layoff - 8
Not interested in working - 9
Some other reason - 10
Probe: How did you decide which response option to choose? How did you decide on the “main” reason if multiple reason applied?
Probe: Are any of the options unclear or confusing?
If choose temporary illness: probe for what this was (and if it lingered most of the year).
Q33. During 2023, how many weeks did you/^name do any work, even for a few hours? Include paid vacation and sick leave as work.
_______ weeks
[ ] all weeks in 2023
No probe. Probe after follow-up questions 35, 36.
(If Q33 equal to 50 or 51 weeks. Worked almost all weeks.)
Q35. Did you/^name lose any full weeks of work in 2023 because you/they were on layoff from a job or lost a job?
Yes
No
Observe/Probe: Did the respondent misreport weeks of work in the previous question because they missed the instruction about vacation, or some other reason?
Probe: We want to know if people know how many weeks are in a year, or if we need to remind them. Do you know how many weeks are in a year?
(If they used the check box in the previous question) Probe: why did you select the check box rather than put in 52 weeks ?
Probe: In the previous question, how did you remember/ count the number of weeks that you worked?
Probe: How did you interpret ‘on layoff’? were you confused by this term? Do you know that it’s different from laid off? (Note to interviewer: on layoff is different than laid off. On layoff means they will be called back to work).
Probe: Did you notice the instruction to report “full” weeks only? Did you report any partial weeks?
(If Q33 Less than 50 weeks. Worked less than 50 weeks)
Q36. Of the remaining [fill 52- minus previous answer] weeks, how many full weeks were you /^name on layoff or looking for a job?
_______ weeks
Observe/Probe: Did the respondent misreport weeks of work in the previous question because they missed the instruction about vacation, or some other reason?
Probe: We want to know if people know how many weeks are in a year, or if we need to remind them. Do you know how many weeks are in a year?
(If they used the check box in the previous question) Probe: why did you select the check box rather than put in 52 weeks ?
Probe: In the previous question, how did you remember/ count the number of weeks that you worked?
Probe: How did you interpret ‘on layoff’? were you confused by this term? Do you know it’s different than laid off? (Note to interviewer: on layoff is different than laid off. On layoff means they will be called back to work).
Probe (if answer>0): Did you notice the instruction to report “full” weeks only? Did you report any partial weeks?
If answer =0, Probe: Why did you answer zero? (What were they doing in those 3+ weeks while not working)?
(If Q36 greater than 1 week. On lay off or looking for 2+ weeks.)
Q37. Were the [number from Q36] weeks you/they were looking for work or on layoff all in one stretch?
Yes
No
Probe: Does “stretches” make sense? Does “all at once” work better?
(If yes) Probe: How many stretches?
Q36 is equal to 0 or 1 week. (This is for people who were mostly not looking for work.)
Q38. During the weeks you/they were not working, what was the main reason?
Temporary injury, illness, or other health concern - 1
Chronic health condition or disability - 2
Retired - 3
Pregnancy or childbirth - 4
Taking care of children or other persons - 5
Going to school - 6
Not interested in working - 7
Some other reason - 8
Probe: How did you decide which response option to choose? How did you decide on the “main” reason if multiple reason applied?
Probe: Are any of the options unclear or confusing?
If “Some other reason”: Probe on possible reasons.
If choose “temporary illness”: probe for what this was (and if it lingered most of the year).
Probe: Were there any periods when you were “in between jobs” in the sense that you had another job but it wasn’t starting yet? If yes, How did you answer this question for that situation? If no, thinking of this scenario, How would you answer this question?
Q39. For how many employers did you/^name work in 2023? If you worked for more than one employer at the same time, only count it as one employer.
One
Two
Three or more
Observe/Probe: Did they read the instruction? (2nd sentence) Did they have any weeks where this applied and did they count it correctly?
Q41. In the [fill # week/weeks form Q33] that you/^name worked, how many hours did you / they usually work per week?
______ hours
Probe: Do you work the same number of hours each week?
Probe: Do you work more than one job? If yes, How did you determine the usual number of hours to report?
_____________________________________________________________________________
Q43. Were there one or more weeks where you/^name worked less than 35 hours?
Do not count time off with pay like holidays, vacation, or sick leave.
Yes – 1
No – 2
(If no) Observe/Probe: Did they read the instruction? (2nd sentence) Did they have any weeks where this applied and did they count it correctly?
Q44. How many weeks did you/they work less than 35 hours?
_______ weeks
Observe/Probe: Did they remember the instruction about not counting time off with pay? Did they have any weeks where this applied and did they count it correctly?
_____________________________________________________________________________
Q45. What was the main reason you / ^name worked less than 35 hours per week?
Job was part-time - 1
Seasonal work - 2
Business was slow - 3
Weather conditions - 4
Physically unable to work full time -5
Caring for family or personal obligation -7
Some other reason - 8
Probe: How did you decide which response option to choose? How did you decide on the “main” reason if multiple reason applied?
Probe: Are any of the options unclear or confusing?
If “Some other reason”: Probe on possible reasons.
Q45a. Why were you/they physically unable to work full time?
Injury
Short-term illness
Chronic health condition or disability
Some other reason
If “Some other reason”: Probe on possible reasons
Probe: Where did/would you include mental or emotional health reasons?
_________________________________________________________________________
Q47a. What employer did (name/you) work for the longest in 2023?
Employer name: _________
Probe: If they work in more than one employer in 2023, how did the determine which one was the longest?
_____________________________________________________________________________
Randomize: Half of respondents get the Q47 series first (Q47e1 – Q47e1c) and half get Q48a first. Everyone should get all of the questions but we don’t want what they see first to influence their preference.
_____________________________________________________________________________
Q47e1. Which best describes {Employer Name from Q47a}?
Government - 1
Private for-profit company - 2
Non-profit organization including tax exempt and charitable organizations - 3
Self-employed - 4
Family business - 5
Probe: Did you read/need the additional text “including tax exempt and charitable organizations”? or is “non-profit org” enough?
Probe: Did more than one response options apply? Which ones and how did you choose the “best”?
_____________________________________________________________________________
(Q47e1 is Government)
Q47e1a. Which one of the following best describes {Employer Name from Q47a}?
Federal - (Federal government civilian employee) - 1
Active Duty (U.S. Armed Forces or Commissioned Corps) - 2
State (including state colleges/universities) - 3
Local (county, city, township) (city or county school district) - 4
Probe: do you need the extra information in the parentheses to find the right response?
(If they work for the government) Probe: do you automatically know if it’s federal, state, or local? Do you need the extra information?
_____________________________________________________________________________
Q47e1b. Was {employer name from Q47a } incorporated?
Yes
No
_______________________________________________________________________
Q47e1c. Were/Was you/ ^name the owner of {employer name from Q47a }?
Yes - 1
No - 2
_____________________________________________________________________________
Q48a. Which one of the following best describes {Employer Name from Q47a}?
Private Sector:
For-profit company or organization
Non-profit organization (including tax-exempt and charitable organizations
Government:
Local government (for example: city or county school district)
State government (including state colleges/universities)
Active Duty U.S. Armed Forces or Commissioned Corps service
Federal government civilian employee
Self-Employed or Other:
Own non-incorporated business, professional practice, or farm
Own incorporated business, professional practice, or farm
Worked without pay in a for-profit family business or farm for 15 hours or more per week
Observe: Do respondents try to pick one option under each heading?
Observe: How much of this list are the respondents reading?
Probe: Are the section headings helpful or confusing?
Probe: How easy/difficult is it to find the best response?
_____________________________________________________________________________
After both class of worker questions are asked:
Do respondents prefer the current sequential question for class of worker (Q47e1-Q47e1c), or a singular questions (Class of Worker Alternative).
_____________________________________________________________________
Q4788. Counting all locations where {employer name) operates, what was the total number of employees in 2023?
1- 9
10-49
50-99
100-499
500-999
1,000+ or more
_____________________________________________________________________________
Q47b. What kind of business or industry is {Employer Name from Q47a}?
Include the main activity, product, or service provided at the location where employed. (For example: elementary school, residential construction)
Kind of Business: _________
Observe/Probe: Do respondents understand that we are asking for a description of the industry?
Probe: Were multiple products or services provided by the business you work for? If yes, how did you decide what to respond?
_____________________________________________________________________________
Q47b1. Is this business or organization mainly manufacturing, retail trade, wholesale trade, or something else?
Manufacturing
Retail trade
Wholesale trade
Something else
_____________________________________________________________________________
Q47c. What kind of work were you/they doing at {employer name from Q47a}?
For example: 4th grade teacher, entry-level plumber
Main Occupation: _________
Observe: What do people report when they do not have an official job title? Do they know how to answer?
_____________________________________________________________________________
Q47d1. What were your/their most important activities or duties?
For example: instruct and evaluate students and create lesson plans, assemble and install pipe sections and review building plans for work details.
Job Duties: _________
Probe: Did you provide all of your duties/duties in general? Or the most important?
How did you decide what was most important?
Probe: Was there a reason for the order in which you listed the duties? E.g., the first activities were what you spend the most time on?
*** Proceed to Earned Income section as part of the same loop ****
If time permits, loop through a 2nd person in the household for both Employment and Earned Income.
Income
Note:
For loops asking about more than one person, only probe the additional people if R is having trouble fitting the scenario into a response. Do not ask probes that they’ve already answered.
Don’t probe if they simply don’t know the information for someone else but keep a rough track of the questions that were hardest to proxy report.
Earned Income
Continue loop from I&O’s section – everyone who said they worked and told us their main job
Q48a_source
Select all the types of income that (^name/you) received from [fill employer] during 2023.
1 Salary or wages
2 Tips
3 Bonuses
4 Overtime pay
5 Commissions
Probe: Did you have any trouble differentiating between these types of income? Was there anything missing?
(if selected tips or commissions) Probe: Do you consider Tips / Commissions as income from your employer?
_____________________________________________________________________________
Q48a_amount
Default screen:
Enter the total amount (^name/you) received, before taxes and other deductions, from this employer in 2023.
amount
(^earnings source
fill from Q48a_source) $____.00
[ ] I want to report monthly or in a different way.
This screen is next if respondent checked to report differently in the default screen.
Q48_per Enter the amount (^name/you) received, before taxes and other deductions, from this employer in 2023.
per Number of
amount payments
(^earnings source
fill from Q48a_source) $____.00 ___(drop down) ____________
Total earnings received in 2023:_______
If the total is not correct, please make corrections above.
Observe/probe as needed: Did respondents report amounts for the right periodicity (e.g. year)?
Observe/probe as needed: Where did respondents struggle with the data entry, especially the check box and follow-up question with the grid.
Probe: Were some of these hard to report separately? Would you prefer to report some of these together?
Probe: Would you have preferred to be asked how you want to report the amounts (bi-weekly, monthly, etc) first?
Probe: Was it clear what the checkbox was there for?
Probe: Did you find the format of this question(s) easy to understand? Would you change anything to make it easier?
Probe: Did seeing the total amount help you catch errors? Was this total meaningful to you (i.e. does the respondent have a sense of what the total is in order to judge if there is an error?)
(if respondent made corrections) Probe: Was it easy to make corrections to the amount and number of payments on the screen? or would you rather correct the total number?
_____________________________________________________________________________
Q48b_amount
Universe: respondents indicated being self-employed in I&O section
Default screen:
Enter (^name's/your) gross earnings (earnings before expenses) and expenses for {fill business name} in 2023.
Gross Earnings Expenses
$____.00 $____.00
[ ] I want to report quarterly or in a different way.
(If net earnings is positive, then display this)
(^Name/you) had a net earnings of $[fill total amount from previous questions] in 2023. If not, please verify amounts entered above and make any corrections needed.
(If net earnings is negative, then display this)
(^Name/you) had a loss of $[fill total amount from previous questions] in 2023. If not, please verify amounts entered above and make any corrections needed.
(If net earnings is 0)
(^Name/you) broke even in 2023, meaning earnings and expenses were the same. If the total is not correct, please make corrections above.
This screen is next if respondent checked to report differently in the default screen.
Enter (^name's/your) gross earnings (before expenses) and expenses for {fill business name} in 2023.
Gross Expenses per
Earnings
$____.00 $____.00 ___(drop down)
(If net earnings is positive or if both earnings and expenses entered is 0, then display this)
(^Name/you) had a net earnings of $[fill total amount from previous questions] in 2023. If not, please verify amounts entered above and make any corrections needed.
(If net earnings is negative, then display this)
(^Name/you) had a loss of $[fill total amount from previous questions] in 2023. If not, please verify amounts entered above and make any corrections needed.
(If net earnings and expenses entered are greater than 0 and are the same amount, then display this) (^Name/you) broke even in 2023, meaning earnings and expenses were the same. If not, please verify amounts entered above and make any corrections needed.
Observe/probe as needed: Did respondents report amounts for the right periodicity (e.g. year)?
Observe/probe as needed: Where did respondents struggle with the data entry, especially the check box and follow-up question with the grid.
Probe: Would you have preferred to be asked how you want to report the amounts (bi-weekly, monthly, etc) first?
Probe: Is reporting gross earnings and expenses easier than just reporting the net earnings?
Probe: Was it clear what the checkbox was there for?
Probe: Did you find the format of this question(s) easy to understand? Would you change anything to make it easier?
(if shown grid) Probe: Could you report both earnings and expenses with the same periodicity? Or did you want to select a different period for each?
Probe: Did seeing the total amount help you catch errors? Was this total meaningful to you (i.e. does the respondent have a sense of what the total is in order to judge if there is an error?)
(if respondent made corrections) Probe: Was it easy to make corrections to the amount and number of payments on the screen? or would you rather correct the total number?
END OF I&O + EARNED INCOME LOOP
Income Sources
Unemployment Compensation (Source)
Q51A1:
Which of these unemployment benefits, if any, did (^you/anyone in this household) receive in 2023?
Select all that apply.
State or Federal unemployment compensation
Supplemental Unemployment Benefits (SUB)
Union Unemployment or Strike Benefits
None of the above
Probe: How confident are you in your responses for yourself? For others?
_____________________________________________________________________________
Q51A1b:
Who received (^FILL FROM Q51A1)?
Select all that apply.
<List of household members who are ages 15 and over>
_____________________________________________________________________________
Workers Compensation (Source)
Q52A:
Which of these types of income, if any, did (^you/anyone in this household) receive as a result of a job-related injury or illness in 2023? Exclude sick pay and disability retirement.
Select all that apply.
State Worker's Compensation
Employer or employer's insurance worker’s compensation
Own insurance worker’s compensation
Other payments as a result of a job-related injury or illness
None of the above
Probe: Did you understand each of the response options? Was “own insurance” #3 clear to you?
(if select Other) Probe: Please explain
_____________________________________________________________________________
Q52Ab:
Who received (^FILL FROM Q52A)?
Select all that apply.
<List of household members who are ages 15 and over>
_____________________________________________________________________________
Social Security (Source)
Q56a:
In 2023, did (^you/anyone in this household) receive any Social Security payments from the U.S. Government?
Yes
No
_____________________________________________________________________________
Q56b:
Who received Social Security payments either for themselves or as combined payments with other family members?
Select all that apply.
<List of all household members>
Probe: The text is a little different for this question. Did you understand that this is a follow up to the previous question, still talk about the same thing?
Probe: How confident are you in your responses for yourself? For others?
_____________________________________________________________________________
SSR:
What were the reasons (^name/you) (^was/were) getting Social Security in 2023?
Select all that apply.
Retired
Disabled
Widowed
Spouse
Surviving child
Dependent child
7 Other
Probe: Did you have any trouble choosing a response?
(if other) Probe: Please explain.
_____________________________________________________________________________
SSCR:
What were the reasons (^Child’s name/the children) (^was/were) getting Social Security in 2023?
Select all that apply.
Disabled
Surviving child
Dependent child
4 Other
Probe: Did you have any trouble choosing a response?
(if other) Probe: Please explain.
_____________________________________________________________________________
Q56g:
Which parent or guardian received these Social Security benefits on behalf of a child?
<List of household members who are 19 years old and over>
Probe: Did you understand that we are talking about children already reported as receiving SS (in the previous questions)?
_____________________________________________________________________________
SSDIa1:
Did (^name/you) receive (^your/their) first Social Security Disability payment in 2023?
Yes
2 No
_____________________________________________________________________________
Q56f:
Is there anyone in this household, who we have not already counted, who received Social Security income in 2023 on behalf of any children in this household? Include all children under 19 years of age.
Yes
2 No
(If answered yes) Probe: Why didn’t you report this recipient earlier?
Probe: Did this question feel repetitive, like you’ve answered it before?
_____________________________________________________________________________
CSS:
Which children under age 19 were receiving Social Security in 2023?
Select all that apply.
<List of household members who are under age 19>
_____________________________________________________________________________
CRSS:
What was the reason (^Child's name) was getting Social Security in 2023?
Select all that apply.
Disabled child
Surviving child
Dependent child
4 Other
_____________________________________________________________________________
Q56g2:
Which parent or guardian received these Social Security benefits on behalf of a child?
Select all that apply.
<List of household members who are age 19 or older>
_____________________________________________________________________________
Supplemental Security Income (SSI) (Source)
Q57a:
In 2023, did (^you/ anyone in this household) receive any SSI payments (Supplemental Security Income)?
SSI payments are assistance payments to low-income aged, blind and disabled persons, and come from state or local welfare offices, the Federal government, or both.
Yes
2 No
Probe: Did you read the definition under the question? Was it helpful? Necessary?
_____________________________________________________________________________
Q57b:
Who received SSI (Supplemental Security Income)?
Select all that apply.
<List of household members who are ages 15 and over>
_____________________________________________________________________________
SSIR:
What were the reasons (^name/you) (^was/were) getting SSI (Supplemental Security Income) in 2023?
Select all that apply.
Disabled
Blind
On behalf of a disabled child
On behalf of a blind child
5 Other
_____________________________________________________________________________
Q57d:
Is there anyone in this household, who we have not already counted, who received Supplemental Security Income in 2023 on behalf of any children in this household?
Yes
2 No
(If answered yes) Probe: Why didn’t you report this recipient earlier?
Probe: Did this question feel repetitive, like you’ve answered it before?
_____________________________________________________________________________
Q57e:
Which parent or guardian received these Supplemental Security Income payments on behalf of a child?
Select all that apply.
<List of household members who are parent/guardian to a child in the household>
_____________________________________________________________________________
RSSI:
What were the reasons (^name/you) (^was/were) getting Supplemental Security Income on behalf of a child in 2023?
Select all that apply.
Disabled child/children
Blind child/children
3 Other
Feedback desired from respondents:
No specific feedback desired. Only change is formatting for ISR. Note any problems in general.
_____________________________________________________________________________
CSSI:
Which children under age 19 were receiving Supplemental Security Income in 2023?
Select all that apply.
<List of household members who are under age 19>
_____________________________________________________________________________
Disability Income (Source)
Q59AR:
During 2023, did (^you/anyone in the household) have a disability or health problem which prevented (^you/them) from working, even for a short time, or limited the work (^you/they) could do?
Yes
2 No
_____________________________________________________________________________
Q59b:
Who had a disability or health problem which prevented or limited their work in 2023?
Select all that apply.
<List of household members who are ages 15 and over>
_____________________________________________________________________________
Q60a:
(^Did you/Is there anyone in this household who) ever (^retire or leave/ retired or left) a job for health reasons?
Yes
2 No
_____________________________________________________________________________
Q60b:
Who retired or left a job for health reasons in 2023?
Select all that apply.
<List of household members who are ages 15 and over>
_____________________________________________________________________________
Q61C:
In 2023, which sources of income, if any, did (^you/name) receive due to a disability or health problem?
Select all that apply.
Worker’s compensation
Company or union disability
Federal government (Civil service) disability
U.S. Military retirement disability
State or local government employee disability
U.S. Railroad retirement disability
Accident or disability insurance
Black Lung miner’s disability
State temporary sickness
Other source
11 None of the above
Observe: Did respondents read all of the options? Or just the first few?
Observe: Did respondents who did not have any disability income find/use the “none” option?
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Veterans Payments (Source)
Q60A88:
Which sources of Veteran’s (VA) payments, if any, did (^you/anyone in this household) receive in 2023? Include assistance received by children of veterans.
Select all that apply.
Service-connected disability compensation
Survivor benefits
Veterans’ pension
Educational assistance (including assistance received by children of veterans)
Other Veterans’ payments
6 None of the above
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Q60b_88:
Who received the (^FILL FROM Q60A88) either for themselves or as combined payments with other family members?
Select all that apply.
<List of household members who are ages 15 and over>
Q60D88:
(^Are/Is) (^name/you) required to fill out an annual income questionnaire for the Department of Veterans’ Affairs?
Yes
2 No
Survivor Benefits (Source)
Q58a:
Which types of survivor benefits, if any, did (^anyone in this household/you) receive in 2023? Exclude Social Security and VA benefits.
Select all that apply.
Company or union survivor pension (include profit sharing)
Federal government survivor (Civil service) pension
U.S. Military retirement survivor pension
State or local government survivor pension
U.S. Railroad retirement survivor pension
Worker’s compensation survivor pension
Black Lung survivor pension
Regular payments from estates or trusts
Regular payments from annuities or paid-up insurance policies
Other type of survivor benefits
11 None of the above
Observe: Did respondents read all of the options? Or just the first few?
Observe: Did respondents who did not have any survivor income find/use the “none” option?
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Q58b:
Who received the (^FILL FROM Q58a)?
Select all that apply.
<List of household members who are ages 15 and over>
Public Assistance (Source)
Q59A88:
Which types of cash assistance, if any, did (^anyone in this household/you) receive in 2023?
Select all that apply.
(^State Program Name)/Temporary Assistance to Needy Families (TANF)/welfare/Aid to Families
General assistance
Emergency assistance/short-term cash assistance
Diversion payments
Refugee Cash and Medical Assistance program
General Assistance from Bureau of Indian Affairs, or Tribal Administered General Assistance
Some other program
8 None of the above
Observe: Did respondents read all of the options? Or just the first few?
Observe: Did respondents who did not have any assistance find/use the “none” option?
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Q59A89:
Which types of cash assistance, if any, did (^anyone in this household/you) receive on behalf of children in the household in 2023? Do not include Food Stamps (SNAP), SSI, Energy Assistance, WIC, School meals, Childcare, and Education Assistance.
Select all that apply.
(^State Program Name)/Temporary Assistance to Needy Families (TANF)/welfare/Aid to Families
General assistance
Emergency assistance/short-term cash assistance
Diversion payments
Refugee Cash and Medical Assistance program
General Assistance from Bureau of Indian Affairs, or Tribal Administered General Assistance
Some other program
None of the above
Probe: Was the “do not include” instruction helpful?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Q59b_88:
Who received this cash assistance: {fill type of cash assistance}?
Select all that apply.
<List of household members who are ages 15 and over>
Pensions (Source)
Q62Ar:
Which types of pension income, if any, did (^anyone in this household/you) receive in 2023?
Do not include distributions or withdrawals from IRAs, 401(k)s, or similar accounts.
Select all that apply.
1 Company
2 Union
3 Federal government
4 State government
5 Local government
6 U.S. Military
7 U.S. Railroad retirement
8 Other type of pension
9 None of the above
Observe: Did respondents read all of the options? Or just the first few?
Probe: Was the “do not include” instruction helpful?
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Q62b:
Who received income from a (^FILL FROM Q62Ar) pension?
Select all that apply.
<List of household members who are ages 15 and over>
Annuities (Source)
Q96Ar:
In 2023, did (^you/ anyone in this household) receive any income from an annuity?
1 Yes
2 No
Q96Br:
Who received annuity income?
Select all that apply.
<List of household members who are ages 15 and over>
Retirement Accounts (Source)
Q97Ar:
In 2023, which types of retirement accounts, if any, did (^you/anyone in this household) have that were designated specifically for retirement savings?
Select all that apply.
1- 401(k)
2- 403(b)
3- Roth IRA
4- Regular IRA
5- KEOGH plan
6- SEP plan (Simplified Employee Pension)
7- Other type of retirement account
8- None of the above
Probe: Was the end of the question, “designated specifically for retirement savings”, clear to you?
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Q97Br:
Who had a (^FILL FROM Q97Ar)?
Select all that apply.
<List of household members who are ages 15 and over>
Q98Ar:
Did (^you/NAME) withdraw any money or receive a distribution from (^your/their) (^FILL FROM Q97AR) in 2023, including any distributions (^you/they) may have been required to take?
1 Yes
2 No
Employers Pension Plan
Q74a:
Did (^the/any) employer or union that (^name/you) worked for in 2023 offer a pension plan for any of its employees?
1 Yes
2 No
Probe: Explain “pension plan”? (is the respondent including 401ks, etc.?)
(if no) Probe: Do you feel that you can answer this question for all types of employees at your workplace (union, non-union, contractual, permanent, etc.)?
Q74a2: Were/was you/name eligible to participate in the pension plan?
Yes
No
Probe: Is everyone eligible or just certain employees?
Q74b:
Did (^name/you) participate in the pension plan?
1 Yes
No
Income-Earnings Accounts Outside of Retirement (Source)
Q99Ara:
Besides retirement accounts, in 2023, which types of assets, if any, did (^you/anyone in this household) have that may have paid interest?
Select all that apply.
Interest-earning checking account
Savings account
CD (certificate of deposit)
Savings bond
Other savings or investments that pay interest
None of the above
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
(if selected None) Probe: Do you have any bank accounts? (if yes) Do any of them earn interest, even if it’s very low?
Q99Ba:
Who had the (^FILL FROM Q99Ara)? For joint accounts, include each person.
Select all that apply.
<List of household members who are ages 15 and over>
Probe: Is the instruction about joint accounts clear?
Probe: Were there other household members that you wanted to report who didn’t appear on the list?
Q99Arf:
In 2023, which types of assets did (^you/ anyone in this household) have that pay dividends?
Select all that apply.
Shares of stock in corporations
Mutual funds
Other savings or investments that pay dividends
None of the above
Probe: How confident are you in your understanding of dividends vs. interest?
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Q99Bf:
Who had (^FILL FROM Q99Arf)? For joint accounts, include each person.
Select all that apply.
<List of household members who are ages 15 and over>
Probe: Is the instruction about joint accounts clear?
CAPGDIS:
Did (^you/NAME) receive any capital gains from (^your/their) (^FILL FROM Q99Arf) in 2023?
1 Yes
2 No
Probe: How confident are you in your understanding of capital gains?
Probe: Is this something you knew (whether you had cap gains or not) for this account?
Property Income (Source)
Q65A2:
Which types of income, if any, did (^name/you) receive in 2023?
Select all that apply.
Royalties
Rent
3 Income from roomers or boarders (exclude amounts paid by relatives)
4 Income from estates or trusts (exclude estates or trusts already reported)
5 None of the above
Probe: Were any of the response options confusing or unclear?
Probe: Did you read the instructions in parentheses? Were they helpful?
Probe: How confident were you in your responses for others in the household?
Q65b:
Who received the (^FILL FROM Q65A2)? For joint ownership, include each person.
Select all that apply.
<List of household members who are ages 15 and over>
Probe: Is the instruction about joint ownership clear?
Probe: Did you want to report anyone not listed?
Education Assistance (Source)
Q66a:
In 2023, did (^you/anyone in this household) attend school beyond the high school level including a college, university, vocational, business, or trade school?
1 Yes
2 No
Probe: What type of schooling were you thinking about?
Probe: Was the language “beyond the high school level” clear to you?
NQ66bd:
Which types of educational assistance, if any, did (^anyone in this household/you) receive for tuition, fees, books, or living expenses in 2023?
Do not include VA educational benefits.
Select all that apply.
1 Pell Grant
2 Assistance from a welfare or social service office
3 Other government assistance
4 Scholarships, grants, etc.
5 Other assistance (employers, friends, etc.)
6 None of the above
Probe: Were any of the response options confusing or unclear?
Probe: How confident were you in your responses for others in the household?
(if selected Other govt or Other in general) Probe: Please explain.
Q66c:
Who received the (^FILL FROM Q66b)?
Select all that apply.
<List of household members who are ages 15 and over>
Child Support (Source)
Q70a:
In 2023, did (^you/anyone in this household) receive any child support payments?
1 Yes
2 No
Q70b:
Who received these child support payments?
Select all that apply.
<List of household members who are ages 15 and over>
Regular Financial Assistance (Source)
Q72a:
In 2023, did (^you/anyone in this household) receive (^any other/any) regular financial assistance from friends or relatives not living in this household?
Do not include amounts that must be paid back.
Yes
No
Observe/probe: Did the respondent read the instruction?
Who received this regular financial assistance?
Select all that apply.
<List of household members who are ages 15 and over>
Other Money Income (Source)
Which types of other income, if any, did (^anyone in the household/you) receive in 2023?
Select all that apply.
Alaska Permanent Fund
Foster child care
Alimony
Jury duty
Armed forces reserves
Severance pay
Hobbies
Other source
None
Probe: Were any of the response options confusing or unclear?
Probe: What does “hobbies” mean to you?
Probe: How confident were you in your responses for others in the household?
(if selected Other) Probe: Please explain.
Who received (^FILL FROM Q73A1R)?
Select all that apply.
<List of household members who are ages 15 and over>
Income Amounts
New unemployment amount question (Q59 series):
Universe: anyone selected in Q51A1b; loop through Q59 for each person selected in Q51A1b
Q59amt -- Default screen:
For {name fill}, enter the amount of unemployment received each month and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
(^unemployment
source fill from Q51A1 $____.00 _____________
[ ] I want to report yearly or in a different way.
Q59_alt -- Alternative periodicity screen:
Enter the amount of unemployment (^name/you) received in 2023.
Amount per Number of payments
(^unemployment
source fill from Q51A1) $____.00 ___(drop down) _________
Total unemployment in 2023: _______
If the total is not correct, please make corrections above.
Same probes for all income amount questions:
(These are more like usability probes. We probed on comprehension in the earlier section.)
Observe/probe as needed: Did respondents report amounts for the right periodicity (e.g. month)?
Observe/probe as needed: Where did respondents struggle with the data entry, especially the check box and follow-up question with the grid.
Probe: Would you have preferred to be asked how you want to report the amounts (bi-weekly, monthly, yearly) first?
Probe: Was it clear what the checkbox was there for?
Probe: Did you find the format of this question(s) easy to understand? Would you change anything to make it easier? [Ask this especially if they received the grid]
Probe: Was there some amount you wanted to include and then didn’t? What was it?
Probe: Did seeing the total amount help you catch errors? Was this total meaningful to you (i.e. does the respondent have a sense of what the total is in order to judge if there is an error?)
(if respondent made corrections) Probe: Was it easy to make corrections to the amount and number of payments on the screen? or would you rather correct the total number?
There are a few questions below that have additional probes unique to that question.
New workers compensation (Q52 series):
Universe: loop through this question for anyone selected in Q52Ab
Q52amt
Enter the amount of workers compensation (^name/you) received in 2023.
per Number of
amount payments
Worker’s compensation $____.00 ___(drop down) _________
Total worker’s compensation in 2023: _______
If the total is not correct, please make corrections above.
New Social Security (Q56 series):
Universe: loop for anyone selected in Q56b
Q56amt -- Default screen:
For {name fill}, enter the amount of Social Security received each month and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
Social Security $____.00 _____________
[ ] I want to report yearly or in a different way.
Q56amt_alt -- Alternative periodicity screen:
Enter the amount of Social Security (^name/you) received in 2023.
per Number of
amount payments
Social Security $____.00 ___(drop down) _________
Total Social Security in 2023: _______
If the total is not correct, please make corrections above.
New Social Security Disability (Q562 series):
Universe: SSR = 2
Q562 -- Default screen:
For {name fill}, enter the amount of Social Security Disability received each month and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
Social Security Disability $____.00 _____________
[ ] I want to report yearly or in a different way.
Q562_alt -- Alternative periodicity screen:
Enter the amount of Social Security Disability (^name/you) received in 2023.
per Number of
amount payments
Social Security Disability $____.00 ___(drop down) _________
Total Social Security Disability in 2023: _______
If the total is not correct, please make corrections above.
Universe: valid entry for either Q562 or Q562_alt
Q562d3
Is this $(total amount from Q562d) before or after any monthly Medicare deductions?
After deductions
Before deductions
Observe/Probe: Do they know if they have a deduction? What do they choose if they don’t know?
(If someone says they definitely don’t have a deduction)
Observe: What do they choose?
Probe: How long have you been on Soc Security Disability? Do you expect to get Medicare deductions in the future or have you had them in the past?
Universe: Q56d3 = 1 or 2
Q562md
How much were (name’s/your) monthly Medicare deductions?
Include Medicare Advantage, Part B, and Part D premiums.
$[text].00 per month
Probe: Do you know what your deduction is for (e.g., Medicare Part B)?
BACKPAY1
In 2023, did (name/you) receive an initial Social Security Disability payment that was larger than the usual payment that we haven’t accounted for yet?
Sometimes the initial payment is larger to make up for the delay in receiving the first payment.
Yes
No
BACKPAY2
How much was that initial disability payment?
$[text].00 per month
Probe: Did you already factor this into your previous answer, when reporting the monthly payments? If so, how? (By adding additional payments or by increasing the amount per month?)
Social Security for Children (Q56i series)
Universe: anyone indicated in Q56b AND age is less than 15
Q56i -- Default screen:
For {name fill}, enter the amount of Social Security payments received each month for all children in this household and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
Social Security
for children $____.00 _____________
[ ] I want to report yearly or in a different way.
Q56i_alt -- Alternative periodicity screen:
Enter the amount of Social Security payments for all children in this household (^name/you) received in 2023.
per Number of
amount payments
Social Security
for children $____.00 ___(drop down) _________
Total Social Security for children in 2023:_______
If the total is not correct, please make corrections above.
Supplemental Security Income (SSI) (Q57c series):
Universe: Anyone indicated in Q57b
Q57c -- Default screen:
For {name fill}, enter the amount of Supplemental Security Income received each month and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
Supplemental Security Income $____.00 _____________
[ ] I want to report yearly or in a different way.
Q57c_alt -- Alternative periodicity screen:
Enter the amount of Supplemental Security Income (^name/you) received in 2023.
per Number of
amount payments
Supplemental Security Income $____.00 ___(drop down) _________
Total Supplemental Security Income in 2023: _______
If the total is not correct, please make corrections above.
Supplemental Security Income for Children (Q57i series)
Universe: anyone listed in Q57e
Enter the amount of Supplemental Security Income (^name/you) received on behalf of children in 2023.
per Number of
amount payments
Supplemental Security Income $____.00 ___(drop down) _________
Total Supplemental Security Income on behalf of children in 2023: _______
If the total is not correct, please make corrections above.
Disability Income (Q61e series)
Universe: Q61c = 1-10
Q61e –Default screen:
For {name fill}, enter the amount of disability income each month and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
(^Disability Income
Source fill from Q61c) $____.00 _____________
[ ] I want to report yearly or in a different way.
Q61e_alt -- Alternative periodicity screen:
Enter the amount of disability income (^name/you) received in 2023.
per Number of
amount payments
(^Disability Income
source fill from Q61c) $____.00 ___(drop down) _________
Total Disability Income in 2023: _______
If the total is not correct, please make corrections above.
_____________________________________________________________________________
Veterans Payments (Q60V series)
Universe: anyone selected in Q60b_88
Q60V -- Default screen:
For {name fill}, enter the amount of veterans payments received and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
(^Veterans Payments
source fill from Q60A88) $____.00 _____________
[ ] I want to report yearly or in a different way.
Q60V_alt -- Alternative periodicity screen:
Enter the amount of Veterans Payments (^name/you) received in 2023.
per Number of
amount payments
(^Veterans Payments
source fill from NQ##) $____.00 ___(drop down) _________
Total Veterans Payments in 2023: _______
If the total is not correct, please make corrections above.
Survivor Benefits (Q58E1 series)
Universe: anyone selected in Q58b
Q58E1
For {name fill}, enter the amount of Survivor Benefits received in 2023.
per Number of
amount payments
(^Survivor Benefits
source fill from Q58A) $____.00 ___(drop down) _________
Total survivor benefits in 2023: _______
If the total is not correct, please make corrections above.
Public Assistance (Q59e series):
Universe: anyone selected in Q59b_88
Q59e -- Default screen:
For {name fill}, enter the amount of cash assistance received each month and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
(^Public Assistance
source fill from Q59A88) $____.00 _____________
[ ] I want to report yearly or in a different way.
Q59e_alt -- Alternative periodicity screen:
Enter the amount of cash assistance (^name/you) received in 2023.
per Number of
amount payments
(^Public Assistance
source fill from NQ##) $____.00 ___(drop down) _________
Total cash assistance in 2023: _______
If the total is not correct, please make corrections above.
Pensions (Q62E1 series)
Universe: anyone selected in Q62B
Q62E1 -- Default screen:
For {name fill}, enter the amount of pension income received each month and the number of payments in 2023.
Number of
amount payments
For: {fill name} each month
(^Pensions
source fill from NQ##) $____.00 _____________
[ ] I want to report yearly or in a different way.
Q62E1_alt -- Alternative periodicity screen:
Enter the amount of pension income (^name/you) received in 2023.
per Number of
amount payments
(^Pensions
source fill from NQ##) $____.00 ___(drop down) _________
Total from pensions in 2023: _______
If the total is not correct, please make corrections above.
Annuities (ANNNEW1 series)
Universe: anyone indicated in Q96Br
ANNNEW1
Enter the total amount of annuity income (^name/you) received in 2023.
per Number of
amount payments
$____.00 ___(drop down) _________
Total from annuities in 2023: _______
If the total is not correct, please make corrections above.
Withdrawals/Distributions from retirement plan (DISTNEW1 series)
Universe: Anyone indicated in Q97Br
DISTNEW -- Default screen:
Enter the total amount withdrawn or distributed from (^name’s/your) retirement account in 2023.
amount
(^retirement source
fill from Q97Ar) $____.00
[ ] I want to report monthly or in a different way.
DISTNEW_alt -- Alternative periodicity screen:
Enter the total amount withdrawn or distributed from (^name's/your) retirement account(s) in 2023.
per Number of
amount payments
(^retirement
source fill from Q97Ar) $____.00 ___(drop down) _________
Total from retirement plans in 2023: _______
If the total is not correct, please make corrections above.
Universe: Anyone indicated in Q97Br
ROLLA
Did (^you/name) re-invest or "roll over" any of the money into an IRA or some other kind of retirement plan?
1 Yes
Probe: Can you explain what roll over means?
Universe: ROLLA = 1
ROLLAMTA
How much did (^you/name) re-invest or “roll over” into an IRA or some other kind of retirement plan in 2023?
Enter dollar amount $_______________
Universe: ROLLAMTA = 2
ROLLB
(^Do/Does) (^you/name) plan to re-invest or roll over any of the money?
1 Yes
2 No
ROLLAMTB
How much (^do/does) (^you/name) plan to re-invest or “roll over” into an IRA or some other kind of retirement plan?
$________________
Interest/Dividends on retirement accounts (RETIRENEW series)
Universe: Anyone indicated in Q97Br
RETIRENEW1
Default screen:
For {name fill}, enter the total amount of interest or dividends received from retirement account(s) in 2023, including small amounts reinvested or credited to the account.
amount
(^retirement source
fill from Q97Ar) $____.00
[Note: Let the R skip. There are follow-ups]
If provide an answer:
Probe: Did this amount include general account growth / appreciation in value? (it shouldn’t)
Universe: RETIRENEW1 = SKIP
RETIRENEW2:
The Census Bureau can estimate the amount earned in this account based on the size of the account. How much money was in (name’s/your) (1st account type fill-in from Q97CR/Q97DR) account at the end of 2023?
$[text].00
Contributions to Retirement Accounts (CONTRIB series)
Universe: anyone indicated in Q97Br
CONTRIB1:
Earlier you said that (^you/name) (^have/has) a retirement account, such as a 401(k), 403(b), IRA, or other account designed specifically for retirement savings. Did (^you/they) contribute any money to (^your/their) plan(s), for example, through payroll deductions? Do not include amounts reinvested or “rolled over” from other retirement accounts.
Yes
No
Universe: CONTRIB1 = 1
CONTRIB2:
What is the easiest way for you to tell us (^your/ name's) contribution to (^your/their) retirement account in 2023?
Percent of earnings
Annual dollar amount
Universe: CONTRIB2 = 1
CONTRIB3a:
What percent of (^your/their) earnings did (^you/they) contribute to (^your/their) account(s) in 2023?
______%
Universe: CONTRIB2 = 2
CONTRIB3b:
How much did (you/they) contribute to (your/their) account(s) in 2023?
$_____.00
Interest/Dividends on non-retirement accounts (Q63/NONRETIRENEW series)
Universe: anyone indicated in Q99Ba
Q63cp -- Default screen:
Enter the amount (^name/you) received in interests and dividends in 2023, including small amounts reinvested or credited to the account.
amount
(^fill from Q99AR
or Q99BR) $____.00
[ ] I want to report monthly or in a different way.
[Let the R skip. There are follow-up questions]
If provide an answer:
Probe: Did this amount include general account growth / appreciation in value? (it shouldn’t)
Q63cp_alt -- Alternative periodicity screen:
Enter the amount (^name/you) received in interests and dividends in 2023, including small amounts reinvested or credited to the account.
per Number of
amount payments
(^fill from Q99AR or Q99BR) $____.00 ___(drop down) _________
Total interests or dividends from non-retirement accounts in 2023: _______
If the total is not correct, please make corrections above.
[Let the R skip. There are follow-up questions]
If provide an answer:
Probe: Did this amount include general account growth / appreciation in value? (it shouldn’t)
NONRETIRENEW12:
Universe: Q99Ara = 1 and Q63cp = SKIP OR Q63cp_alt = SKIP
The Census Bureau can estimate the amount earned in this account based on the size of the account. How much money did (you/name) have in checking accounts at the end of 2023?
$[text].00
Property Income (Q65 series)
Universe: Q65A2 = 1 AND anyone indicated in Q65b
Q65c -- Default screen:
Enter the total amount (^name/you) received for rental income during 2023, after expenses. If there was a loss, enter the amount of that loss and select “Loss.”
amount
Rental income $____.00 □ Loss
Q65d --Default screen:
Enter the total amount (^name/you) received in 2023.
amount
(^fill from
Q65A2) $____.00
[ ] I want to report monthly or in a different way.
Q65d_alt -- Alternative periodicity screen:
Enter) the amount (^name/you) received in 2023.
per Number of
amount payments
(^fill from Q65A2 ) $____.00 ___(drop down) _________
Total from (^fill from Q65A2 ) in 2023: _______
If the total is not correct, please make corrections above.
Educational Assistance
Universe: NQ66BD = 1-5
NQ669D:
Default screen:
Enter the total amount of educational assistance (^name/you) received in 2023.
amount
(^fill from NQ66bd) $____.00
[ ] I want to report monthly or in a different way.
Alternative periodicity screen:
NQ669G:
Enter the amount of educational assistance (^name/you) received in 2023.
per Number of
amount payments
(^Fill from NQ66bd) $____.00 ___(drop down) _________
Total educational assistance in 2023: _______
If the total is not correct, please make corrections above.
Child Support
Universe: anyone selected in Q70b
Q70cp:
Enter the amount of child support payments (^name/you) received in 2023.
per Number of
amount payments
$____.00 ___(drop down) _________
Total in 2023 for child support _______
If the total is not correct, please make corrections above.
Regular Financial Assistance:
Universe: anyone selected in Q72b
Q72cp:
Enter the amount of regular financial assistance (^name/you) received from friends or relatives during 2023.
per Number of
amount payments
$____.00 ___(drop down) _________
Total regular financial assistance in 2023: _______
If the total is not correct, please make corrections above.
Other Money Income
Universe: anyone selected in Q73A1b
Q731P:
Enter the amount of other income (^name/you) received in 2023.
per Number of
amount payments
(^source fill Q731Arc1) $____.00 ___(drop down) _________
Total other income received in 2023: _______
If the total is not correct, please make corrections above.
Poverty
Housing
Which of these loans do you have on this property?
Select all that apply.
1- Mortgage or similar
2- Second Mortgage
3- Home Equity Loan
4- None
Probe on any difficulty with terminology.
Ask R to explain difference between home equity loans and mortgages.
_____________________________________________________________________________
How many separate bedrooms do your living quarters contain?
Count as bedrooms those rooms you would list if these living quarters were for sale or rent. If this is an efficiency/studio apartment, enter 0.
[Text entry, whole digits]
Observe/ask if necessary: Did the R read the instructions and count rooms correctly?
Observe/ ask if necessary: Did the R struggle with the term “living quarters” or defining where they live?
_____________________________________________________________________________
Food Assistance
At any time during 2023, even for one month, did (you/anyone in this household) receive benefits from SNAP (the Supplemental Nutritional Assistance Program), the Food Stamp program, (state program fill,/blank) or use a SNAP or food stamp benefit card?
Do not include WIC.
1- Yes
2- No
Observe/ ask if necessary: Did they notice the “even for one month” instruction?
Observe only: Did they notice the WIC instruction and follow it?
Probe: Have you heard of all of these programs? Are some of these the same programs to you but with different names?
(if No) Probe: Did you receive any help buying food, that you can think of, in 2023?
[If R received any government benefit, ask them to change their answer so they receive the follow-up questions.]
[Do not draw extra attention to the WIC instruction because we want to know in the next question if they remember not to include it.]
_____________________________________________________________________________
Who received SNAP[, (state program fill) benefits,] or foods stamps at any time in 2023?
Select all that Apply
[Names from household roster]
Probe: The previous question noted an instruction not to include WIC. Did you remember that when answering?
Probe: Is there anyone in the household who you are not sure about?
_____________________________________________________________________________
What was the value of SNAP [,(state program fill) benefits,] or food stamps received in 2023 for the entire household?
$[text].00 per [periodicity dropdown—month, year]
[Allow Don’t know/Skip because there are follow-ups to be tested.]
Observe/Probe: Did you have any trouble with the periodicity/frequency of payment drop down?
(if more than one person on benefits) Probe: Did you add the benefits for all household members together?
Probe: You have a SNAP card, right? (should be yes) Do you know what benefits are loaded onto that card? Do you know the separate amounts for each? [Do not probe for specific amounts, just if they know them]
Probe: Do you get other benefits like P-EBT or Summer EBT or TANF? If yes, did you include these in the total?
How many monthly SNAP[, state program fill,] or food stamp payments were received in 2023?
(Amount fill from SNAP_AMT) for ____(text box 2 digits <13) months
Probe: Did you have any trouble figuring out how many months?
Probe: Does showing this question on the same screen help? Or is it confusing/cluttered?
_____________________________________________________________________________
Your total SNAP[, state program fill,] or food stamp payments was $[fill from SNAP_AMT * SNAP_FREQ]. Does that look right to you?
1 Yes
2 No, I need to correct something.
Probe: What did you think of this question? (looking for things like “redundant”, “unnecessary”, “annoying”, “insulting”, etc. Probe more if necessary.)
Probe: Does showing this question on the same screen help? Or is it confusing/cluttered?
Probe: Is seeing the amount for the whole year meaningful to you? Do you think of your benefits this way?
(if No) Probe: Do you know what went wrong in the previous questions that resulted in the amount being incorrect?
_____________________________________________________________________________
If you don't know the exact value, please estimate.
What was the value of SNAP[,(state program fill) benefits.,] or food stamps received in 2023 for the entire household?
1 $0 to $999
2 $1,000 to $2,999
3 $3,000 or more
Probe: Is seeing the amount for the whole year meaningful to you? Do you think of your benefits this way?
Probe: How confident were you in your response?
_____________________________________________________________________________
Was it…?
1 $0 to $99
2 $100 to $499
3 $500 or more
Probe: What did you think of this question? (looking for things like “redundant” or “too difficult to narrow down”, etc. Probe more if necessary.)
School Meals
During 2023, did any of the children in this household usually eat a complete breakfast and/or lunch provided by the school?
Yes
No
Probe: Think through each child and what food they eat school. Tell me, do they pack, buy something, or does the school provide free food?
Probe: Did you notice the word “complete” in the question? Did the inclusion of “complete” change your answer to the question?
Probe: What does provided mean to you? (Does provided mean the same as prepared? We want to understand if provided implies “free”.)
_____________________________________________________________________________
For each child, please indicate which school-provided meals they usually ate in 2023.
Select all that apply.
Observe: Did they use the None option or leave it blank?
Observe/Probe: Did the respondent have any difficulty with the grid format?
Probe, if not discussed in previous question: How did you determine which meals each child ate?
(if R selects nothing or all None) Probe: What went wrong in the previous question?
_____________________________________________________________________________
During 2023, did [any of these children/this child] receive free or reduced price school meals?
Yes
No
Probe: Did you have difficulty deciding what meals were free/reduced? Did you count meals where everyone gets free food, without having to apply for it (not need based)?
Probe: Were you thrown off by the phrase “reduced price”? Would “free or reduced school meals” make more sense?
Probe: Did you think of both breakfast and lunch? Do we need to specify both meals in the question? _____________________________________________________________________________
For each child, please indicate which school-provided meals were free or reduced price in 2023.
Select all that apply.
Observe: Did they use the None option or leave it blank?
Observe/Probe: Did the respondent have any difficulty with the grid format?
Observe/Probe: Did they realize that this is a different question from before? Or did they feel that they had already answered this?
(if R selects nothing or all None) Probe: What went wrong in the previous question?
_____________________________________________________________________________
Non-Cash Benefits
At any time during 2023, even for one month, did (you/anyone in this household) receive any of the following?
Observe/Probe: Did the respondent have any difficulty with the grid format?
Observe: Did they use the No option or leave it blank?
Probe: Could you answer this question? Do you know which programs you have?
Probe: Did you receive any other assistance that you don’t see in this list?
Observe: Did the R hover over the WIC help?
Probe: WIC has additional help. Did you know that WIC has a longer name? Is this extra information confusing or helpful?
_____________________________________________________________________________
Who were the WIC benefits for?
Select all that apply.
Roster names (children under 6, women between 15 and 45)
(if more than one person to choose from) Probe: How did you decide who counts as receiving the benefits? Was it the child who qualifies for the benefits? Or the adult who gets the money?
_____________________________________________________________________________
For how many months was WIC received in 2023?
Observe/Probe: Did the respondent have any difficulty with the grid format (if more than one name shown)?
Probe: Any trouble answering for other members of the household?
_____________________________________________________________________________
During 2023, how much [fill from NCREC--energy assistance/heating or cooling assistance/energy, heating, and cooling assistance] was received for the entire year?
$[text].00
Probe: Explain what energy benefits you receive.
Probe: This question asks you to add up your benefits for the entire year. Were you able to do that?
Probe: It be easier to enter this monthly or some other way?
_____________________________________________________________________________
If you don’t know the exact value, please estimate.
During 2023, how much energy assistance was received for the entire year?
1 $0 to $999
2 $1,000 to $2,999
3 $3,000 or more
Probe: Do you remember which energy benefits are being asked about? Or should “heating and cooling” be added to the question?
_____________________________________________________________________________
Was it…?
1 $0 to $99
2 $100 to $499
3 $500 or more
Probe: What did you think of this question? (looking for things like “redundant” or “too difficult to narrow down”, etc. Probe more if necessary.)
_____________________________________________________________________________
Child Care
Which type(s) of paid care were used for [CHILD] in 2023?
Select all that apply.
Child care center/preschool/nursery school
Home-based child care provider/paid care in provider’s home
Paid care inside of your home (e.g., nanny/babysitter)
Paid care with family, friends, or neighbors
Before and/or after-school care
Summer camps
Other
None, did not pay for child care
Observe: Did the R notice that this is only paid care? Are they trying to report unpaid care?
Probe: (If respondent answered “other”), ask them to explain.
Probe: Are we missing any other types of paid care?
Probe: Did you select one option for each type of care or did you select 2 options for the same care?
_____________________________________________________________________________
Which types of free child care were used for [CHILD] in 2023?
Select all that apply
Care by a parent/guardian at home
Head Start
Pre-Kindergarten
Free care with family, friends, or neighbors
Fully-subsidized child care through subsidy or voucher
Other
None
Observe/probe if necessary: Did the R notice that this is unpaid care? Did it feel like the same question?
Probe: Explain the first option about care by a parent or guardian. Did this make sense to you?
Probe: (If respondent answered “other”) ask them to explain.
Probe: (if selected “none”) ask them to explain.
Probe: (if select “Family, friends, neighbors”) ask if this was in the home or outside of the home? Did they include both places when selecting it?
Probe: Are we missing any other types of free care?
Probe: Is “free” the same as “unpaid” to you? Do you have a preference for which word should be used in this question?
Probe: Do you have any child care arrangements that don’t cost money but aren’t entirely free? In other words, you pay the care giver in some other way, like doing something for them or reducing their rent? If yes, did you include those when answering this question?
_____________________________________________________________________________
What was the main type of child care received by [CHILD] in 2023?
List of options (aside from None) selected on CHCARE_PAID and CHCARE_UNPAID
Probe: Did you have any trouble selecting one type of care? How did you decide on the “main” type of care? Were any of the types of care used equally?
_____________________________________________________________________________
Across all types of child care, how much was paid for each child in 2023?
Observe: Did the R have trouble with the drop downs or the grid?
Probe: Were these questions difficult to answer? If yes, why? (was it the time period of asking for a whole year? The breakdown per child? Variation in payments across the year? 2023 is too long ago?)
Probe: Would there be an easier way for you to report this?
(If answered $0) Probe: Why did you answer $0? Try to understand what went wrong in the previous question about paid care.
Probe: If we only asked you to think about care needed while at work, in training or school, or while looking for work, would that change the amounts you reported? If yes, what would the new amount be?
_____________________________________________________________________________
How many payments for child care were made in 2023?
Observe/ Probe: Did the R have trouble with the grid?
Probe: Was it helpful to see your previous response?
(If answered 12 months / 52 weeks) Probe: Did you pay for care every week, even during vacation time? Or is this an average for each month/week?
_____________________________________________________________________________
Does the total cost of child care for 2023 look correct to you?
Probe: What did you think of this question? (looking for things like “unnecessary”, “annoying”, “helpful”, “meaningless", etc. Probe more if necessary.)
Probe: Is seeing the total amount for the year meaningful to you? Are you able to double check this number?
Probe: Could you report a total amount of child care, for all children, for the year? So, just one number, not for each child? Would you prefer to do that rather than these separate steps?
_____________________________________________________________________________
Was/were the child's/children's care fully or partially covered by a voucher or child care subsidy?
Observe: Does the R mention that they were already asked about subsidy in the unpaid care question?
Observe/Probe: Did the R have any trouble with the grid? Or are they used to it by now?
Probe: Do you know what a voucher or subsidy is?
__________________________________________________________________________
Did [you / anyone in this household] have to work fewer hours in 2023 because of problems obtaining child care?
Yes
No
Probe: What situations did you think of when answering this question?
Probe: Did you think of infrequent situations (like your child or babysitter was sick), or chronic problems (like not being able to find after-school care), or both?
Probe: Did you count using paid time off (vacation or sick time) when answering this question?
__________________________________________________________________________
Considering all of your/the children, how much time did you/others in the household lose from work in 2023 because of trouble finding child care?
[text] [Periodicity dropdown—hours, days, weeks]
Observe/Probe: Did the R have any trouble with the drop down?
Probe: This question is just about you, not the household. Did you answer just for you?
Probe: If this question asked about other adults in the household, what would you answer?
__________________________________________________________________________
During 2023, did you [or anyone in the household] take any of the actions below in order to care for your [child/children] because child care was closed, unavailable, or unaffordable, or you were concerned for your [child’s/children’s] safety in care?
Select all that apply.
Took unpaid leave
Used vacation, sick days, or other paid leave
Cut your work hours
Quit a job
Were fired from a job
Did not look for a job
Supervised one or more children while working
Other (specify)
None of the above
Observe/Probe: Did the R read all of the responses?
Observe: The “fired from a job” option is not an action the respondent can take. It’s done to them. Does the R trip over this option?
Probe: Which of the child care problems listed after “because” (like child care was closed) happened to you in 2023?
Probe: Were you thinking of any other child care problems when you answered this question?
Probe: Did you select any of the answers even though it was not the result of a child care problem? (e.g., you supervised a child while working because you didn’t feel you needed child care).
__________________________________________________________________________
Child Support
Did (you/anyone in this household) have any children living elsewhere with their other parent or guardian during 2023?
Yes No
[Adult 1]
[Adult 2]
[Adult N]
Observe/Probe: Did the R have any trouble with the grid?
Probe: Are any children under 18 living outside the home with someone other than their parent or guardian?
_____________________________________________________________________________
In 2023, did (you/anyone in this household) pay any child support for children living elsewhere?
Probe: (if yes to any Adult) How is (adult) paying child support? E.g., garnished wages, sending a check to the other parent, pays for activities, etc.
_____________________________________________________________________________
How much child support was paid in 2023?
Probe: Did you think about informal child support like paying for activities, summer camp, school supplies, school tuition, etc.?
_____________________________________________________________________________
[End of instrument]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Jennifer Sinibaldi (CENSUS/CBSM FED) |
| File Modified | 0000-00-00 |
| File Created | 2025-08-12 |
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