Appendix U
30-Month Follow-Up Survey
Appendix U
30-Month Follow-Up Survey
Introduction and Sample Member Identity Verification 3
C. Living Conditions and Well-being 31
F. Social Support and Networks 65
QLANG
CHOOSE LANGUAGE
1 ENGLISH
2 SPANISH
ADMINTYPE (SRBI CAPI ONLY)
CHOOSE SURVEY ADMINISTRATION TYPE
1 PHONE (GO TO QINTRO)
2 IN-PERSON (GO TO QINTRO)
3 INCARCERATED RESPONDENT
INCARCERATED (SRBI ONLY)
CHOOSE DATA COLLECTION METHOD
1 CELLPHONE CALL TO PHONE CENTER
2 CAPI SURVEY
3 PAPER SURVEY
GO TO QINTRO
QTYPE (DIR ONLY)
IS THIS A FIELD LOCATOR-BASED INTERVIEW?
1 YES, FIELD LOCATOR-BASED (GO TO QINTID)
2 NO, RESPONDENT CALLED IN (GO TO QREC)
3 NO, CALL INIATED BY PHONE CENTER (GO TO QINTRO)
4 NO, ANSWERING MACHINE
QANSW
Hello, my name is [INTERVIEWER NAME] and I am calling from [SURVEY FIRM] for the [CBONAME] program. I am trying to reach [FLNAME] for a short paid interview.
Please have [FLNAME] call us at [TELEPHONE]. Thank you.
RECORD CALL DISPOSITION AND EXIT SURVEY.
QINTID
ENTER THE FIELD LOCATOR’S 4-DIGIT ID NUMBER (GO TO Q1)
QREC
Hello, my name is [INTERVIEWER NAME].
Are you …
1 Responding to a “Sorry I Missed You” card that was left at your door? OR
2 Responding to a letter or postcard that you received in the mail or a voicemail message?
7 DON’T KNOW
8 REFUSED
GO TO Q1
Q1INTRO
Hello, this is [INTERVIEWER NAME]. I’m calling from [SURVEY FIRM] about a program at [CBONAME]. May I please speak to [FLNAME]?
IF NECESSARY: [FLNAME] has agreed to help us with a study about work assistance.
1 RESPONDENT AVAILABLE (GO TO Q1)
2 RESPONDENT NOT AVAILABLE – ARRANGE CALLBACK
8 REFUSED (GO TO END INTERVIEW)
RCONU
IF R IS CONFIRMED BUT UNAVAILABLE:
Could you tell me a good time to reach him/her?
RECORD CALLBACK TIME.
Thank you, I will call back then.
IF SPEAKING WITH R:
What is the best time for us to call you back to complete the survey?
RECORD CALLBACK TIME.
Thank you, I will call back then.
IF R NO LONGER LIVES THERE:
Is there a number where [FLNAME] can be reached? May I have it please?
RECORD NEW NUMBER.
Thank you for your assistance.
Q1 (12MFUP Introduction) [TIMESTAMP]
Thank you for taking the time to speak with me today.
I am conducting interviews with people who agreed to be in a study about a program offered at [CBONAME] called [ETJDPRO/STEDPRO]. The study is called the [Enhanced Transitional Jobs Demonstration or ETJD/Subsidized and Transitional Employment Demonstration or STED] for short. It is funded by the U.S. Department of Labor and the U.S. Department of Health and Human Services and my company, [SURVEY FIRM], is conducting this survey. You may have received a letter recently about the [ETJD/STED] study.
We need to talk with people who got into the program and those who did not. Your participation in this study will help policy-makers better understand how to help people find and keep jobs. This interview will include questions on your employment situation, your use of services, and your overall well-being.
This interview should only take about 30 minutes.
IF CATI, NON-INCARCERATED RESPONDENT:
We will mail you a [$50/$40] gift card as a “thank you” for completing the interview.
IF CAPI, NON-INCARCERATED RESPONDENT:
We will give you a [$50/$40] money order as a “thank you” for completing the interview.
S1 (12MFUP S1)
Before we begin, I’d like to confirm that I am speaking with the correct person. In order to do so, could you please give me your date of birth?
___________________ MONTH (RANGE 1-12)
___________________ DAY (RANGE 1-31)
___________________ YEAR (RANGE 1930-1995)
DON’T KNOW 97/97/9997
REFUSED 98/98/9998
VALIDATE AGAINST DOB FROM SAMPLE. IF DOB CONFIRMED, GO TO INFORMED CONSENT.
S2 (12MFUP S2)
Again, to confirm that I am speaking to the correct person, could you please give me the last four digits of your social security number?
9997 DON’T KNOW
9998 REFUSED
VALIDATE LAST 4 SSN FROM SAMPLE. IF SSN4 CONFIRMED, GO TO INFORMED CONSENT.
FAIL_SCREENER
IF DOB AND SSN4 NOT CONFIRMED, GO TO CALLBACK.
IF DOB AND SSN4 BOTH DK AND/OR REFUSED, GO TO REFSCREEN.
CALLBACK
Thank you for taking the time to answer these questions. The information you provided does not match our records. I will need to check with my supervisor to determine how to resolve this issue. If we are able to do so, I will give you a call back.
Is this the best number to reach you at?
1 YES (GO TO THANKYOU)
2 NO
RPHONE1
What number should we call?
RECORD AREA CODE AND PHONE NUMBER.
THANKYOU
Thank you for your time and patience. We will contact you as soon as we resolve this problem. Your information is important to us and to the success of this study. Have a nice [day/evening].
RECORD CALL DISPOSITION AND EXIT SURVEY.
REFSCREEN
It is important to verify that you are a participant in this research study. To do this, it is important for you to tell me your date of birth OR the last four digits of your social security number. Your information is private. It will only be used for research purposes. The interview will take about 30 minutes and you can choose to answer or not answer any question.
IF CATI, NON-INCARCERATED RESPONDENT:
We will mail you a $XX [check/gift card] as a “thank you” for completing the interview.
IF CAPI, NON-INCARCERATED RESPONDENT:
We will give you a $XX money order as a “thank you” for completing the interview.
ALL RESPONDENTS:
Do you wish to complete this survey?
1 YES (GO TO S1)
2 NO (GO TO ENDINTERVIEW)
3 NOT NOW (GO TO RCONU)
INFORMED CONSENT (12MFUP Introduction)
Thank you for confirming this information with me.
Before we begin the survey, I would like to assure that all of your responses on this survey will be kept private; the research staff has been trained in protecting private information and your name will not appear in any written reports we produce. All of the study results will be reported for groups of individuals; no results will be analyzed or reported for individuals.
Your responses to these questions are also completely voluntary. That means you may choose not to answer any question, or you may stop the interview if you wish, but we hope you don’t. Your responses to these questions will in no way affect your participation in the [ETJDPRO/STEDPRO] program or affect your receipt of any kinds of public benefits or services.
According to the Paperwork Reduction Act (PRA), an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0413 and it expires October 31, 2015.
And finally, this interview might be monitored or recorded for quality control purposes. May we begin?
1 YES
2 NOT NOW (GO TO RCONU)
7 DON’T KNOW (GO TO RCONU)
8 REFUSED (GO TO ENDINTERVIEW)
WORKREL
IF R IS NOT EX-OFFENDER (FROM SAMPLE FILE), GO TO A1.
Before we start with the survey, I want to make sure we properly protect the confidentiality of your responses.
Are you currently living in a work release center or a half-way house?
1 YES
2 NO (GO TO A1)
7 DON’T KNOW (GO TO A1)
8 REFUSED (GO TO A1)
WORKREL2
We want to make sure that you are in a place where you can answer questions without concern of risk and that no one with authority over you is influencing your decisions to participate in this survey. We also want to make sure your conversation is not being monitored by anybody with authority over you. If at any point you feel uncomfortable telling me information, just let me know and we will stop the interview.
INTERVIEWER: STOP INTERVIEW AND SCHEDULE CALLBACK IF APPROPRIATE.
1 CONTINUE (GO TO A1)
2 STOP INTERVIEW
END INTERVIEW
Thank you for taking the time to speak with me today. I’m sorry that you aren’t able to participate in our study. If you change your mind and decide you would like to participate, please call [TELEPHONE].
A1 [TIMESTAMP]
First, I’d like to talk about your current education and training.
Do you have a GED certificate or high school diploma?
1 YES (GO TO A3)
2 NO
7 DON’T KNOW
8 REFUSED
A2 (12MFUP A21)
Are you currently taking GED classes, or classes to prepare for a regular high school diploma?
IF NECESSARY: A GED or “General Education Development” certificate is similar to a high school diploma. GED classes help prepare for the GED test.
IF NECESSARY: By currently, I mean within the past month.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
GO TO A4
A3
What is the highest degree or level of school you have completed?
1 HIGH SCHOOL OR GED
2 SOME POSTSECONDARY (NO DEGREE)
3 ASSOCIATE (2-YEAR COLLEGE) DEGREE
4 BACHELOR (4-YEAR COLLEGE) DEGREE
5 ADVANCED DEGREE (MASTER, PROFESSIONAL, DOCTORATE)
7 DON’T KNOW
8 REFUSED
A4 (12MFUP A23)
Are you currently taking any courses at a community, two-year, or four-year college?
IF (A2=1) ADD: This would be courses in addition to those you are taking for your GED or high school diploma.
IF NECESSARY: By currently, I mean within the past month.
1 YES
2 NO (GO TO A6)
7 DON’T KNOW (GO TO A6)
8 REFUSED (GO TO A6)
A5 (12MFUP A24)
Were any of these courses taken to receive credit towards an associate, bachelor’s, or other degree, that is, college credit?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
A6 (12MFUP A26)
Are you currently getting training for a specific job, trade, or occupation?
IF NECESSARY: This is sometimes called vocational training. Sometimes these classes are offered at a community college or by a private training provider, but they don’t lead to a degree. Sometimes they lead to a certificate or license.
1 YES
2 NO (GO TO A8)
7 DON’T KNOW (GO TO A8)
8 REFUSED (GO TO A8)
A7 (12MFUP A27)
What kind of job, trade, or occupation are you training for?
VERBATIM
97 DON’T KNOW
98 REFUSED
A8 (12MFUP A30)
Do you have any professional certifications or state or industry licenses?
IF NECESSARY: A professional certification or license shows you are qualified to perform a specific job and includes things like Licensed Realtor, Certified Medical Assistant, Certified Construction Manager, a Project Management Profession or PMP certification, or an IT certification.
1 YES
2 NO (GO TO B1)
7 DON’T KNOW (GO TO B1)
8 REFUSED (GO TO B1)
A9 (12MFUP A31)
What type of license or certification is it?
IF NECESSARY: What type of trade or work does it qualify you to do?
VERBATIM
97 DON’T KNOW
98 REFUSED
A10
Do you have a driver’s license?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B1 (12MFUP B1) [TIMESTAMP]
Are you currently working for pay? This includes any work where you get paid including self-employment, temporary work, work as a day laborer, and paid work at an employment program.
1 YES (GO TO B2)
2 NO
7 DON’T KNOW
8 REFUSED
B1A
Just to be sure, are you doing any work at all including work at irregular, odd, or side jobs or at any work program that is not a typical job but is designed to give you work experience?
Do you currently have any work like that?
1 YES
2 NO (GO TO B24)
7 DON’T KNOW (GO TO B24)
8 REFUSED (GO TO B24)
B2 (12MFUP B2)
How many jobs do you currently have?
INTERVIEWER: SELF-EMPLOYMENT OR TEMPORARY OR “TEMP” WORK IN THE SAME FIELD COUNTS AS ONE JOB.
NUMBER OF JOBS (RANGE: 1- 10)
10 10 OR MORE
97 DON’T KNOW
98 REFUSED
B3 (12MFUP B4)
These next few questions are about your current job.
IF B2-2-10: Since you currently work at several jobs, please answer these questions about the job where you work the most hours.
IF HOURS ARE THE SAME: OK, then please answer the questions about the job you’ve worked at the longest.
When did this job start?
INTERVIEWER: PROBE FOR SEASON IF DON’T KNOW MONTH.
MM/YYYY
1-12 JANUARY-DECEMBER
13 WINTER
14 SPRING
15 SUMMER
16 FALL
01/2005 BEFORE OR ON JANUARY 2005
97/9997 DON’T KNOW
98/9998 REFUSED
B4 (12MFUP B8)
On this job, what kind of work do you do – what is your occupation? IF NEEDED: Occupation means the type of tasks that you do on your job, for example doctor, stock clerk, farmer, forklift operator, etc.
VERBATIM
97 DON’T KNOW
98 REFUSED
B5 (12MFUP B7)
What kind of business or industry is that in?
IF NECESSARY: What is the main product or service provided at the company you work for?
VERBATIM
97 DON’T KNOW
98 REFUSED
B6 (12MFUP B5)
What type of company or organization (are/were) you working for?
INTERVIEWER PROBE: Who did the paycheck come from?
Is it …
1 self-employment, (GO TO B8)
2 a temporary agency,
3 an employment program or transitional job program
4 a government employer,
5 a company, that is a private employer, or
6 something else? (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B7 (12MFUP B9)
Is this job…
1 permanent employment, including part-time work,
2 seasonal work, temporary work through a temp agency, day labor, an odd job, or
3 something else? (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B8 (12MFUP B10)
Which of the following best describes your usual weekly work schedule at this job? Do/did you work a…
1 daytime shift,
2 an evening shift,
3 a night shift,
4 a rotating shift, that is one that changes regularly from days to evenings to nights,
5 a split shift, that is one consisting of two distinct periods each day,
6 an irregular schedule, that is one that changes from day to day or week to week, or
7 something else? (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B9 (12MFUP B11)
Including overtime, how many hours per week do you usually work on this job?
IF SCHEDULE IS IRREGULAR OR VARIES: How many hours did you work in the last week you worked at this job?
NUMBER OF HOURS (RANGE 1-80)
96 OVER 80 HOURS PER WEEK
97 DON’T KNOW
98 REFUSED
B10
What is your wage now before taxes? Please include tips, commissions, and regular overtime pay.
IF JOB IS IRREGULAR SCHEDULE OR COMMISSION BASIS, PROBE FOR HOW MUCH R MAKED IN THE LAST WEEK THEY WORKED AT JOB.
AMOUNT (RANGE: .01 -to 50,000.00)
99999.96 MORE THAN $50,000
99999.97 DON’T KNOW (GO TO B13)
99999.98 REFUSED (GO TO B13)
B11
Is that:
INTERVIEWER: READ CATEGORIES UNTIL RESPONENT INDICATES THE CORRECT SELECTION
1 …per hour?
2 …per week?
3 …every 2 weeks?
4 …twice monthly?
5 …monthly?
6 …annually?
7 …per day or per task?
8 OTHER (SPECIFY: ________________)
97 DON’T KNOW (GO TO B13)
98 REFUSED (GO TO B13)
B12 (12MFUP B17)
Is that …
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
B13 (12MFUP B25)
What was the most important resource you used to find this job?
Was it …
1 a friend, relative, or acquaintance,
2 a job posting or help-wanted ad found in the newspaper, on the computer, or somewhere else,
3 an employment placement service at school or training provider,
4 a church or community center,
5 an employer that decided to retain you permanently after you were placed in a temporary, transitional, or subsidized job,
6 an employment program or a transitional job program,
7 or something else? (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B14 (12MFUP B27)
IF B2=1, GO TO B24
Thinking now about the other jobs that you’re currently working, tell me all of the other places that you currently work.
IF NECESSARY: What are your employers’ names?
RECORD UP TO THREE OTHER CURRENT JOBS AS B14A, B14B, and B14C.
VERBATIM
96 SELF EMPLOYED (SPECIFY: TYPE OF WORK OR R’S BUSINESS NAME)
97 DON’T KNOW
98 REFUSED
99 NO OTHER JOBS
ITEMS B15-B23 WILL BE ASKED FOR UP TO THREE ADDITIONAL JOBS R IS CURRENTLY WORKING. SKIP LOOP IF B14=97, 98, 99
B15 (A/B/C) (12MFUP B28)
IF NAME PROVIDED IN B14:
Thinking of your job with [B14], when did this job start?
IF B14 = 96:
When did you start [B14 SPECIFY]?
INTERVIEWER: PROBE FOR SEASON IF DON’T KNOW MONTH.
MM/YYYYY
1-12 JANUARY-DECEMBER
13 WINTER
14 SPRING
15 SUMMER
16 FALL
01/2005 BEFORE OR ON JANUARY 2005
97/9997 DON’T KNOW
98/9998 REFUSED
B16 (A/B/C) (12MFUP B31)
On this job, what kind of work do you do - what is your occupation?
IF NECESSARY: Occupation means the type of tasks that you do on your job, for example doctor, stock clerk, farmer, forklift operator, etc.
VERBATIM
97 DON’T KNOW
98 REFUSED
B17(A/B/C) (12MFUP B30)
What kind of business or industry is that in?
IF NECESSARY: What is the main product or service provided at the company you work for?
VERBATIM
97 DON’T KNOW
98 REFUSED
B18(A/B/C) (12MFUP B29)
IF B14=96 GO TO B19
What type of company or organization are you working for at [B14]? Is it…
INTERVIEWER PROBE: Who did the paycheck come from?
1 self-employment,
2 a temporary agency,
3 an employment program or a transitional job program,
4 a government employer,
5 a company, that is a private employer, or
6 something else? (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B19 (A/B/C) (12MFUP B34)
Including overtime, how many hours per week do you usually work on this job?
IF SCHEDULE IS IRREGULAR OR VARIES: How many hours did you work in the last week you worked at this job?
NUMBER OF HOURS (RANGE 1-80)
96 OVER 80 HOURS PER WEEK
97 DON’T KNOW
98 REFUSED
B20 (A/B/C)
For this job, what is your wage before taxes? Please include tips, commissions, and regular overtime pay.
IF JOB IS IRREGULAR SCHEDULE OR COMMISSION BASIS, PROBE FOR HOW MUCH R MAKES IN A TYPICAL WEEK.
AMOUNT (RANGE: .01 -to 50,000.00)
99999.96 MORE THAN $50,000
99999.97 DON’T KNOW (GO TO B23)
99999.98 REFUSED (GO TO B23)
B21(A/B/C)
Is that:
READ CATEGORIES UNTIL R INDICATES THE CORRECT SELECTION
1 …per hour?
2 …per week?
3 …every 2 weeks?
4 …twice monthly?
5 …monthly
6 …annually?
7 …per day or per task?
8 OTHER (SPECIFY ____)
97 DON’T KNOW (GO TO B23)
98 REFUSED (GO TO B23)
B22 (A/B/C) (12MFUP B40)
Is that …
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
B23 (A/B/C) (12MFUP B45)
What was the most important resource you used to find this job?
Was it…
1 a friend, relative, or acquaintance,
2 a job posting or help-wanted ad found in the newspaper, on the computer, or somewhere else,
3 an employment placement service at school or training provider,
4 a church or community center,
5 an employer that decided to retain you permanently after you were placed in a temporary, transitional, or subsidized job,
6 an employment program or transition job, or
7 something else? (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
IF THERE ARE ADDITIONAL OTHER CURRENT JOBS TO BE PROFILED, LOOP BACK TO B15.
B24 (12MFUP B48B)
IF B1=1:
Thinking about the job you had before your current [job/jobs], when did that job end?
ELSE:
Thinking about the last job you worked at, when did that job end?
INTERVIEWER PROBE FOR SEASON IF DON’T KNOW MONTH.
MM/YYYYY
1-12 JANUARY-DECEMBER
13 WINTER
14 SPRING
15 SUMMER
16 FALL
01/2005 BEFORE OR ON JANUARY 2005
96/9996 NO JOBS BEFORE CURRENT JOB/JOBS; NEVER WORKED
97/9997 DON’T KNOW
98/9998 REFUSED
IF JOB ENDED BEFORE [RAMY] GO TO B37
ITEMS B25-B35 WILL BE ASKED FOR UP TO 7 ADDITIONAL JOBS WORKED BY R SINCE [RAMY].
B25 (A/B/C/D/E/F/G) (12MFUP B51)
What kind of employer were you working for? Was it …
IF NECESSARY: Who did the paycheck come from?
1 self-employment,
2 a temporary agency,
3 an employment program or transitional job program,
4 a government employer,
5 a company, that is a private employer, or
6 something else? (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B26 (A/B/C/D/E/F/G) (12MFUP B52)
On this job, what kind of work did you do - what was your occupation?
IF NECESSARY: Occupation means the type of tasks that you do on your job, for example doctor, stock clerk, farmer, forklift operator, etc.
VERBATIM
97 DON’T KNOW
98 REFUSED
B27 (A/B/C/D/E/F/G)
What kind of business or industry was that in?
IF NECESSARY: What is the main product or service produced at the company you work for?
VERBATIM
97 DON’T KNOW
98 REFUSED
B28 (A/B/C/D/E/F/G) (12MFUP B53)
Including overtime, how many hours per week did you work on this job when you left?
IF SCHEDULE WAS IRREGULAR OR VARIED: How many hours did you work in the last week you worked at this job?
NUMBER OF HOURS (RANGE 1-80)
96 OVER 80 HOURS PER WEEK
97 DON’T KNOW
98 REFUSED
B29 (A/B/C/D/E/F/G)
What was your wage just before you left, before taxes? Please include tips, commissions, and regular overtime pay.
IF JOB IS IRREGULAR SCHEDULE OR COMMISSION BASIS, PROBE FOR HOW MUCH R MADE IN THE LAST WEEK THEY WORKED THE JOB.
AMOUNT (RANGE: .01 -to 50,000.00)
99999.96 MORE THAN $50,000
99999.97 DON’T KNOW (GO TO B32)
99999.98 REFUSED (GO TO B32)
B30 (A/B/C/D/E/F/G)
Was that:
READ CATEGORIES UNTIL R INDICATES THE CORRECT SELECTION
1 …per hour?
2 …per week?
3 …every 2 weeks?
4 …twice monthly?
5 …monthly
6 …annually?
7 …per day or per task?
8 OTHER (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B31 (A/B/C/D/E/F/G) (12MFUP B55)
Is that …
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
B32 (A/B/C/D/E/F/G)
Did you lose or quit that job, or was it a temporary job that ended?
1 LOST JOB (GO TO B34)
2 QUIT JOB
3 TEMPORARY JOB ENDED (GO TO B34)
7 DON’T KNOW (GO TO B34)
8 REFUSED (GO TO B34)
B33 (A/B/C/D/E/F/G)
Why did you quit working at this job?
IF MORE THAN ONE RESPONSE GIVEN: What was the primary reason you stopped working at this job?
1 GOT A NEW/DIFFERENT JOB
2 NOT INTERESTED IN WORKING
3 UNABLE TO WORK BECAUSE OF INJURY, ILLNESS, OR DISABILITY
4 INCARCERATED
5 PREGNANCY/CHILDBIRTH
6 FAMILY RESPONSIBILITIES
7 GOING TO SCHOOL
8 OTHER. (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
B34 (A/B/C/D/E/F/G) (12MFUP B50)
When did that job start?
INTERVIEWER PROBE FOR SEASON IF DON’T KNOW MONTH.
MM/YYYYY
1-12 JANUARY-DECEMBER
13 WINTER
14 SPRING
15 SUMMER
16 FALL
01/2005 BEFORE OR ON JANUARY 2005
97/9997 DON’T KNOW
98/9998 REFUSED
B35 (A/B/C/D/E/F/G) (12MFUP B61)
Did you have any other jobs that we haven’t talked about?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
FOR B35A-F: IF B35=1, GO TO B24
B36 (12MFUP B62)
IF B1=1 OR B1A=1, GO TO B37
What is the main reason you are not currently working?
IF MORE THAN ONE RESPONSE GIVEN: What is the primary reason you’re not working?
1 UNABLE TO WORK BECAUSE OF INJURY, ILLNESS, OR DISABILITY
2 INCARCERATED
3 PREGNANCY/CHILDBIRTH
4 FAMILY RESPONSIBILITIES
5 GOING TO SCHOOL
6 UNABLE TO FIND WORK
7 NOT INTERESTED IN WORKING
8 OTHER (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
IF B24 MORE THAN THREE MONTHS AGO OR 96/9996 GO TO B52
B37
IF B1=1 OR B1A=1 (currently employed):
Now I want to ask some more questions about your current job.
IF B2 > 1 (more than one current job):
This would be about the job where you work the most hours or have worked the longest.
ELSE (not currently employed; worked in the last three months):
Now I’d like to ask you some more questions about the last job you worked at.
ALL [currently employed/recently employed]:
Some employers offer different kinds of paid time off for their employees. This can include paid sick days, vacation time, or holiday pay. At your [current/last] job, did your employer offer any type of paid time off?
IF NECESSARY: We want to know if any paid time off was available to you, regardless of whether or not you used this benefit.
1 YES
2 NO (GO TO B39)
8 DON’T KNOW (GO TO B39)
9 REFUSED (GO TO B39)
B38
What types of paid time off [are/were] available to you, even if you did not participate or use it?
a. Paid sick time?
b. Vacation time?
c. Paid holidays?
1 YES
2 NO
8 DON’T KNOW
9 REFUSED
B39
Some employers offer different kinds of health insurance to their employees – this includes coverage for medical and mental health care, vision care, and dental care. Sometimes the employer pays all or some of the cost and sometimes the employee pays for the coverage. [Is/Was] there any type of health insurance available to you?
IF NECESSARY: We want to know if any insurance was available to you, regardless of whether or not you used these benefits.
1 YES
2 NO (GO TO B41)
8 DON’T KNOW (GO TO B41)
9 REFUSED (GO TO B41)
B40
What types of health insurance [does/did] your employer offer?
a. Medical care?
b. Vision care?
c. Dental care?
1 YES
2 NO
8 DON’T KNOW
9 REFUSED
B41
[Does/Did] your employer offer a pension or retirement savings plan?
IF NECESSARY: We want to know if any type of pension or savings plan was available to you, regardless of whether or not you used this benefit.
1 YES
2 NO
8 DON’T KNOW
9 REFUSED
B42 (12MFUP B20/B42/B57)
[Are/Were] you a member of a labor union or an employee association like a union at [this/that] job?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B43
Now I want to talk about strenuous or difficult activities that you [do/did] on your job. How often [do/did] your work tasks require you to …
a. work in tiring or painful positions?
b. lift or move people?
c. carry or move heavy loads?
d. stand for long periods?
e. repetitive hand or arm motions?
f. dealing with customers, suppliers, or the public?
g. be exposed to hot or cold temperatures – that is, work in a place that is not climate-controlled?
h. work in a noisy environment where it is so loud that you would have to raise your voice to talk to someone?
1 All of the time
2 Some of the time
3 Rarely
4 Never
7 DON’T KNOW
8 REFUSED
B44
For each of the following statements, I want you to tell me how much it [applies/applied] to your job.
a. Your co-workers help[s/ed] and support[s/ed] you.
b. Your supervisor help[s/ed] and support[s/ed] you.
c. You [can/could] take a break when you wish[ed].
d. You [have/had] enough time to get your work tasks completed.
e. Your job [gives/gave] you a feeling of work well done.
f. You [have/had] the feeling of doing useful work.
g. You [know/knew] what was expected of you.
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
7 DON’T KNOW
8 REFUSED
B45
[Have/Did] you receive any training to improve your performance at [this/that] job?
IF NECESSARY: I am interested in any kind of job-related training you may have had. For example, training on how to use equipment, software, or other tools or training related to customer service or teamwork.
1 YES
2 NO (GO TO B47)
7 DON’T KNOW (GO TO B47)
8 REFUSED (GO TO B47)
B46
What kinds of training did you have? Was it …
a. on-the-job training provided by your supervisor or co-workers?
b. Training classes or courses arranged by your employer?
c. Training classes or courses you took on your own?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B47
[Did/do] you receive assistance from a program or community organization to help you keep working? This would be for things like help with making transportation arrangements or paying for transportation, assistance paying for work tools or uniforms, or assistance making child care arrangements.
1 YES
2 NO (GO TO B49)
7 DON’T KNOW (GO TO B49)
8 REFUSED (GO TO B49)
B48
What types of assistance are you currently receiving? Do you get help with …
a. making transportation arrangements?
b. paying for transportation?
c. paying for work tools or uniforms?
d. finding or making child care arrangements?
e. paying for child care?
f. something else (specify)?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B49a
IF NOT CURRENTLY EMPLOYED, GO TO B51
While you’ve been working for this employer, have you changed jobs or moved to a different position?
1 YES
2 NO (GO TO B50)
7 DON’T KNOW (GO TO B50)
8 REFUSED (GO TO B50)
B49b
Was this job change a promotion – did you get a higher position or job title?
INTERVIEWER: IF R HAD MULTIPLE JOB CHANGES, ASK IF ANY WERE A PROMOTION.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B50
Do you think you are likely to move up or be promoted in the future?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B51
Now I’d like you to think about your (current/most recent) job and compare it to other jobs you’ve had. Thinking about [ITEM], would you say your (current/most recent) job is better, about the same, or worse than those other jobs?
ITEMS
a. Number of hours of work
b. Start and end times of workday or shift
c. Money earned in a typical week
d. Travel to and from home and work
e. Job security
f. Opportunity to advance on the job
1 BETTER
2 ABOUT THE SAME
3 WORSE
7 DON’T KNOW
8 REFUSED
B52 (6MFUP_YA C3)
Now I’d like to talk about your career goals. How much do you agree or disagree with the following statements?
a. I have specific goals for my future career. Do you ….
b. I have a plan for achieving my career goals. Do you …
c. Planning for a career is not worth the effort. Do you …
d. I haven’t thought much about my future career. Do you …
e. If I have a career, I won’t be able to enjoy other things in life. Do you …
1 strongly agree
2 agree
3 disagree, or
4 strongly disagree
7 DON’T KNOW
8 REFUSED
C1 (12MFUP_YA C1) [TIMESTAMP]
Now I’d like to talk about your living arrangements. Where are you living right now?
IF NECESSARY: Where do you stay most often?
1 PARENT’S HOME
2 OTHER RELATIVE’S OR FRIENDS’ HOME
3 OWN HOME (GO TO C4)
4 SHARE WITH ROOMATES/FRIENDS/PARTNER
5 GROUP QUARTERS (DORMITORY, GROUP HOME, SHELTER, HOSPITAL, RESIDENTIAL FACILITY, ETC.)
(GO TO C3)
6 HOMELESS (NO REGULAR PLACE TO STAY) (GO TO C7)
7 OTHER (SPECIFY: ___________________________) (GO TO C7)
8 INCARCERATED (GO TO C11)
97 DON’T KNOW (GO TO C7)
98 REFUSED (GO TO C7)
C2
Do you pay rent or contribute to the food or utility bills?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
GO TO C7
C3 (12MFUP_YA C2)
What type of group quarters do you live in?
1 DORMITORY
2 GROUP HOME
3 HOSPITAL/TREATMENT FACILITY
4 SHELTER
5 PRISON/JAIL
6 OTHER (SPECIFY: _________________________)
7 DON’T KNOW
8 REFUSED
GO TO C6
C4 (12MFUP_YA C3)
Do you live alone or with others?
1 ALONE (GO TO C6)
2 WITH OTHERS
7 DON’T KNOW
8 REFUSED
C5 (12MFUP_YA C4)
Including you, how many people live there? By live there, we mean that they spend at least two nights per week there.
INTERVIEWER WAIT FOR ANSWER THEN SAY: And that includes you, correct?
__________________
NUMBER IN HOUSEHOLD (MUST BE 2 OR MORE)
97 DON’T KNOW
98 REFUSED
C6 (12MFUP_YA C5)
Are any of those that you live with …
a. your parents or grandparents?
b. your spouse, partner, or boyfriend/girlfriend?
c. your child?
d. your brother or sister?
e. your cousin, aunt or uncle, or other relation?
f. your friend or other non-relative?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
C7 (12MFUP_YA C6)
IF C1=1/2/3/4/5/7: How long have you lived there?
IF C1=6: How long have you been without a regular place to stay?
IF C1=97/98: Thinking of the place you live right now, how long have you lived there?
1 LESS THAN ONE YEAR
2 ONE YEAR OR LONGER (GO TO C9)
7 DON’T KNOW (GO TO C9)
8 REFUSED (GO TO C9)
C8 (12MFUP_YA C7)
Where were you living before?
1 PARENT’S HOME
2 OTHER RELATIVE’S OR FRIENDS’ HOME
3 OWN HOME
4 SHARE WITH ROOMATES/FRIENDS/PARTNER
5 GROUP QUARTERS (DORMITORY, GROUP HOME, SHELTER, HOSPITAL, RESIDENTIAL FACILITY, PRISON, ETC.)
6 HOMELESS (NO REGULAR PLACE TO STAY)
7 OTHER (SPECIFY: ___________________________)
97 DON’T KNOW
98 REFUSED
C9 (A-O) (12MFUP C5)
IF C6c=2, 7, or 8 GO TO C11
Now I want to talk about your children - this would be any biological, adoptive, foster, step, or other children for whom you’re responsible that live with you at least half the time. I am interested in your minor children – that would be children that are under age 19.
[FIRST CHILD] How old is the oldest child that lives with you?
[OTHER CHILDREN] What about the next oldest – how old is he or she?
_____ ____
AGE IN YEARS AGE IN MONTHS IF LESS THAN 1 YEAR
96 NONE OF MY CHILDREN IN HOUSEHOLD ARE MINORS
97 DON’T KNOW
98 REFUSED
C10 (A-O) (12MFUP C8)
Are there any more children under age 19 who live with you in your household?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
IF C10=1 AND LESS THAN 15 CHILDREN HAVE BEEN RECORDED, LOOP BACK TO C9
C11 (12MFUP C9)
IF C6c=1:
Do you have any minor children – aged under 19 - that don’t live with you?
ELSE:
Do you have any minor children? This would be children aged under 19.
1 YES
2 NO (GO TO C14)
7 DON’T KNOW (GO TO C14)
8 REFUSED (GO TO C14)
C12(A-O) (12MFUP C10a)
[FIRST CHILD] How old is your oldest minor child that does not live with you?
[OTHER CHILDREN] What about the next oldest – how old is he or she?
_____ ____
AGE IN YEARS AGE IN MONTHS IF LESS THAN 1 YEAR
97 DON’T KNOW
98 REFUSED
C13(A-O) (12MFUP C10b)
Do you have any more children under age 19 who don’t live with you?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
IF C13=1 AND LESS THAN 15 CHILDREN HAVE BEEN RECORDED, LOOP BACK TO C12
C14 (C12MFUP C11)
Which of the following is your current marital status? Are you:
1 never married,
2 married,
3 in a civil union or domestic partnership,
4 separated,
5 divorced, or
6 widowed?
7 DON’T KNOW
8 REFUSED
C14b
What is your spouse’s or partner’s gender?
1 MALE
2 FEMALE
7 DON’T KNOW
8 REFUSED
C15 (12MFUP_YA C20)
IF FEMALE: Are you pregnant?
IF MALE: Is someone currently pregnant with your child?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
C16 (12MFUP_YA D1)
Now, I am going to ask you some questions about the income you received last month. Again, I want to assure you that none of your answers will be discussed with anyone.
In [PRIOR MONTH], did you… |
YES |
NO |
DON’T KNOW |
REFUSED |
a. have income from working? |
1 |
2 |
7 |
8 |
b. receive SSI or Supplemental Security Income? |
1 |
2 |
7 |
8 |
c. receive public assistance or welfare, not including WIC or food stamps? |
1 |
2 |
7 |
8 |
d. receive retirement or Social Security? |
1 |
2 |
7 |
8 |
e. receive a pension from the Veteran’s Administration? |
1 |
2 |
7 |
8 |
f. receive Unemployment insurance? |
1 |
2 |
7 |
8 |
g. receive Worker’s Compensation or disability payments? |
1 |
2 |
7 |
8 |
h. receive child support ? |
1 |
2 |
7 |
8 |
i. receive cash from family and friends who live outside of your household? |
1 |
2 |
7 |
8 |
j. receive energy assistance subsidies or vouchers? |
1 |
2 |
7 |
8 |
k. receive a child care subsidy or voucher? |
1 |
2 |
7 |
8 |
l. receive benefits from Section 8 or other housing assistance program? |
1 |
2 |
7 |
8 |
m. receive food stamps - also known as Supplemental Nutrition Assistance Program or SNAP? |
1 |
2 |
7 |
8 |
n. receive WIC? |
1 |
2 |
7 |
8 |
|
|
|
|
|
C17 (12MFUP C14)
Was there any other source of income you received last month that we haven’t talked about?
1 YES
2 NO (GO TO C19)
7 DON’T KNOW (GO TO C19)
8 REFUSED (GO TO C19)
C18 (12MFUP C15)
What was that other income?
IF NEEDED: Was it from a government program we haven’t talked about, a loan, or what?
_____________________
SOURCE
97 DON’T KNOW
98 REFUSED
C19 (12MFUP_YA D4)
Thinking of all of the income received by you last month, what was your total income in (PRIOR MONTH)? Please don’t include tax returns in your answer.
INTERVIEWER PROBE: Your best estimate is fine.
INTERVIEWER: ROUND TO NEAREST WHOLE DOLLAR.
$ _, _ _ _
AMOUNT (RANGE 1-9995) (GO TO C21)
9996 GREATER THAN $9995 (GO TO C21)
9997 DON’T KNOW
9998 REFUSED
C21 (12MFUP_YA D5)
Would you say it was…
1 None ($0)
2 $500 or less,
3 $501-$1000,
4 $1001-$1500,
5 $1501-$2000,
6 $2000-$2500, or
7 $2500 or more?
97 DON’T KNOW
98 REFUSED
C22 (12MFUP C25)
The federal government has a special rule that allows working people who make less than about $49,000 a year to take advantage of something called the Earned Income Tax Credit, or EITC. They can claim the Earned Income Tax Credit by filling out a special form called Schedule EIC when they fill out their income taxes, or they can fill out a special form with their employer.
Did you or will you claim the Earned Income Tax Credit for your earnings next year?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
C23
Do you have a …
a. checking account?
b. savings account?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
C24 (12MFUP C27)
Now I have some questions about your financial situation. Sometimes due to circumstances beyond your control, it can be difficult to meet all of your financial obligations. As I read each question, please let me know if you have faced any of the following situations.
In the past year, has there been a time when…
|
YES |
NO |
DON’T KNOW |
REF |
a. …you did not pay the full amount of the rent or mortgage because you could not afford it? |
1 |
2 |
7 |
8 |
|
|
|
|
|
b. …you were evicted from your home or apartment for not paying the rent or mortgage? |
1 |
2 |
7 |
8 |
c. …you filed in court for bankruptcy? |
1 |
2 |
7 |
8 |
d. …you did not pay the full amount of the gas, oil, or electricity bills? |
1 |
2 |
7 |
8 |
e. …you had service turned off by the gas or electric company, or oil company would not deliver oil? |
1 |
2 |
7 |
8 |
f. …you had cellular or land telephone service disconnected because payments were not made? |
1 |
2 |
7 |
8 |
g…you ever needed to go to the doctor or dentist but didn’t because you didn’t think you could afford to pay for it? |
1 |
2 |
7 |
8 |
h. ...you could not fill or postponed filling a prescription for drugs when they were needed because you could not afford it? |
1 |
2 |
7 |
8 |
C25 (12MFUP C28)
In general, how do your family finances usually work out at the end of the month? Is there…
1 some money left over,
2 just enough to make ends meet, or
3 not enough money to make ends meet?
7 DON’T KNOW
8 REFUSED
C26 (12MFUP C26)
How much do you agree or disagree with the following statement? My financial situation is better than it was last year at this time. Would you say you…
1 strongly disagree,
2 somewhat disagree,
3 slightly disagree,
4 slightly agree,
5 somewhat agree, or
6 strongly agree?
7 DON’T KNOW
8 REFUSED
C27 (12MFUP C30)
On a scale of 0 to 10, where 0 means “never” and 10 means “all the time,” how often do you worry about being able to meet normal monthly living expenses?
______
NUMBER
(RANGE: 0-10)
97 DON’T KNOW
98 REFUSED
C28 (12MFUP C31)
Getting enough food can be a problem for some people. Which of these statements best describes the food eaten in your household in the prior month? Would you say there is…
1 enough of the kind of foods you want,
2 enough, but not always the kinds of food you want,
3 sometimes not enough to eat, or
4 often not enough to eat?
7 DON’T KNOW
8 REFUSED
C29 (6MFUP H5)
Sometimes not having enough money or other financial problems can cause problems in relationships. These next few questions are about relationship issues that might arise concerning money or finance. Please tell me how often the following statements apply to you.
There are disagreements about money in my home. Would you say this happens…
1 never,
2 rarely,
3 sometimes,
4 often, or
5 always?
7 DON’T KNOW
8 REFUSED
C30 (6MFUP H6)
I tend to argue with others about money. Would you say this happens…
1 never,
2 rarely,
3 sometimes,
4 often, or
5 always?
7 DON’T KNOW
8 REFUSED
C31 (6MFUP H7)
Financial problems hurt my relationships. Would you say this happens…
1 never,
2 rarely,
3 sometimes,
4 often, or
5 always?
7 DON’T KNOW
8 REFUSED
C32 (12MFUP D1)
In [PRIOR MONTH], were you covered by any form of health insurance?
1 YES
2 NO (GO TO C35)
7 DON’T KNOW (GO TO C35)
8 REFUSED (GO TO C35)
C33 (12MFUP D2)
What types of health insurance were you covered by?
INTERVIEWER: MARK ALL THAT APPLY.
1 MEDICAID OR OTHER PUBLIC SYSTEM
2 EMPLOYER BASED OR COBRA
3 [INSERT NAME OF STATE’S CHILD HEALTH INSURANCE PROGRAM]
4 SELF PAID PRIVATE INSURANCE
5 PARENT’S INSURANCE
6 INSURANCE PAID BY SOMEONE ELSE
7 OTHER, SPECIFY_________
97 DON’T KNOW
98 REFUSED
C35 (12MFUP D3)
IF C6b = 2/7/8 GO TO C37
In [PRIOR MONTH], was your spouse or partner covered by any form of health insurance?
1 YES
2 NO (GO TO C37)
7 DON’T KNOW (GO TO C37)
8 REFUSED (GO TO C37)
C36 (12MFUP D4)
What type of health insurance were they covered by?
INTERVIEWER: MARK ALL THAT APPLY.
1 MEDICAID OR OTHER PUBLIC SYSTEM
2 EMPLOYER BASED OR COBRA
3 [INSERT NAME OF STATE’S CHILD HEALTH INSURANCE PROGRAM]
4 SELF PAID PRIVATE INSURANCE
5 PARENT’S INSURANCE
6 INSURANCE PAID BY SOMEONE ELSE
7 OTHER, SPECIFY_________
97 DON’T KNOW
98 REFUSED
C37 (12MFUP D5)
IF C9A OR C12ANOT ANSWERED (i.e., has no minor children) GO TO C39
Which of the following best describes your children’s health insurance coverage?
1 All my children are covered,
2 some of my children are covered, or
3 none of my children are covered? (GO TO C39)
7 DON’T KNOW (GO TO C39)
8 REFUSED (GO TO C39)
C38 (C12MFUP D6)
What types of health insurance were they covered by?
INTERVIEWER: MARK ALL THAT APPLY.
1 MEDICAID OR OTHER PUBLIC SYSTEM
2 EMPLOYER BASED OR COBRA
3 [INSERT NAME OF STATE’S CHILD HEALTH INSURANCE PROGRAM]
4 SELF PAID PRIVATE INSURANCE
5 PARENT’S INSURANCE
6 INSURANCE PAID BY SOMEONE ELSE
7 OTHER, SPECIFY_________
97 DON’T KNOW
98 REFUSED
C39 (12MFUP E1)
Now I have some questions about your health and well-being. In general, would you say your health is…
1 excellent,
2 very good,
3 good,
4 fair, or
5 poor?
7 DON’T KNOW
8 REFUSED
C40 (12MFUP E2)
Compared to one year ago, how would you rate your health now? Would you say it is…
1 much better.
2 somewhat better now,
3 about the same,
4 somewhat worse now, or
5 much worse now?
7 DON’T KNOW
8 REFUSED
C41 (12MFUP E3)
These next questions are about feelings you may have experienced over the past month.
During the month, how often did you feel…
INTERVIEWER: READ ITEM THEN READ RESPONSE CATEGORIES.
|
Would you say you felt this way… |
|||||
|
often, |
sometimes, |
hardly ever, or |
never? |
DK |
REF |
a. …so sad that nothing could cheer you up? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …nervous? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …restless or fidgety? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …hopeless? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …that everything was an effort? |
1 |
2 |
3 |
4 |
7 |
8 |
f. …worthless? |
1 |
2 |
3 |
4 |
7 |
8 |
C42 (12MFUP E6)
Taken all together, how would you say things were these days – would you say that you are…
1 very happy,
2 pretty happy,
3 not too happy?
7 DON’T KNOW
8 REFUSED
C43 (6MFUP_YA B3)
I’m going to read you a list of statements dealing with your general feelings about yourself. Please tell me how much you agree or disagree with each one.
a. I feel that I’m a person of worth, at least on an equal plane with others. Do you …
b. I feel that I have a number of good qualities. Do you …
c. All in all, I am inclined to feel that I am a failure. Do you …
d. I am able to do things as well as most other people. Do you …
e. I feel that I do not have much to be proud of. Do you …
f. I take a positive attitude towards myself. Do you …
g. On the whole, I am satisfied with myself. Do you …
h. I wish I could have more respect for myself. Do you …
i. I certainly feel useless at times. Do you …
j. At times I think I am no good at all. Do you …
1 strongly agree,
2 agree,
3 disagree, or
4 strongly disagree?
7 DON’T KNOW
8 REFUSED
C44 (6MFUP E1)
The next questions are about how you handle problems in life and work. Please rate your agreement with the following statements.
|
Do you … |
|||||||
Strongly Disagree |
Somewhat Disagree |
Slightly Disagree |
Slightly Agree |
Somewhat Agree |
Strongly Agree |
DK |
REF |
|
a. I can do just about anything that I really set my mind to. |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
b. When I really want to do something, I usually find a way to succeed at it. |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
c. Whether or not I am able to get what I want is in my own hands. |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
d. What happens to me in the future mostly depends on me. |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
e. I can do the things that I want to do. |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
NOTE: EX-OFFENDER RESPONDENTS ONLY.
D1 [TIMESTAMP]
How old were you the first time you were arrested?
VERBATIM (AGE; RANGE 10-65) (GO TO D3)
9 LESS THAN 10 YEARS OLD (GO TO D3)
66 OLDER THAN 65 (GO TO D3)
97 DON’T KNOW
98 REFUSED
D2
Were you under age 16 the first time you were arrested?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
D3 (12MFUP F7)
At any time since [RAMY], have you been on parole or probation?
1 YES
2 NO (GO TO D11)
7 DON’T KNOW (GO TO D11)
8 REFUSED (GO TO D11)
D4 (12MFUP F8)
Since [RAMY], have you been sanctioned or have you violated the conditions of your supervision? By sanction or violation, we mean that your parole or probation officer determined that you broke the rules of your parole/probation.
1 YES
2 NO (GO TO D10)
7 DON’T KNOW (GO TO D10)
8 REFUSED (GO TO D10)
UP TO 15 VIOLATIONS WILL BE PROFILED IN QUESTION BLOCK D5 THROUGH D9.
D5 (A-O) (12MFUP F9)
[FOR FIRST VIOLATION, SAY:] When was the LAST TIME your parole/probation officer issued a technical violation?
[FOR VIOLATIONS 2-15, SAY:] What was the date of your PREVIOUS violation?
_________________
MM/YYYY (GO TO D6)
01/2005 BEFORE OR ON JANUARY 2005 (GO TO D6)
97/9997 DON’T KNOW
98/9998 REFUSED
IF D3 BEFORE [RAMY], GO TO D8
D5a (A-O) (12MFUP F9a)
Was this technical violation issued after [RAMY]?
1 YES
2 NO (GO TO D10)
7 DON’T KNOW (GO TO D10)
8 REFUSED (GO TO D10)
D6 (A-O) (12MFUP F10)
What was the reason you received the technical violation?
1 Missed Curfew
2 Failure to Report for Scheduled Appointment with Parole/Probation Officer
3 Drug Use
4 Failure to Seek or Maintain Employment
5 Associated with Restricted People
6 HOUSING
7 Failure to Pay Parole/Probation Fees
8 Did Not Notify Parole/Probation Officer of Address Change
9 Contact with Victim
10 Arrested for a New Crime
11 Failed to Attend Treatment or a Program as Directed
12 OTHER (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
D7 (A-O) (12MFUP F11)
Were you sanctioned for the technical violation?
1 YES
2 NO (GO TO D9)
7 DON’T KNOW (GO TO D9)
8 REFUSED (GO TO D9)
D8 (A-O) (12MFUP F12)
What type of sanction did your parole/probation officer impose?
1 TREATMENT
2 CURFEW
3 REPRIMAND
4 ELECTRONIC MONITORING
5 HOUSE ARREST
6 DAY REPORTING
7 INCARCERATION
8 OTHER (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
D9 (A-O) (12MFUP F13)
Were you sanctioned or did you violate the conditions of your supervision another time since [RAMY]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
IF D9=1, AND FEWER THAN 15 VIOLATIONS ARE REPORTED, LOOP BACK TO D5
D10 (12MFUP F14)
Was your parole or probation ever revoked since [RAMY]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
D11 (12MFUP F15)
IF C1=8, GO TO D12
At any point since [RAMY], have you spent time in jail or prison?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
D12 (12MFUP F6)
What was the total amount of time that you spent in jail or prison since [RAMY]?
IF NEEDED: In total for all sentences.
__________________
AMOUNT OF TIME
(RANGE: 1-996)
997 DON’T KNOW
998 REFUSED
Time unit:
1 DAYS
2 WEEKS
3 MONTHS
4 YEARS
7 DON’T KNOW
8 REFUSED
D13 (12MFUP F17)
Please rate your agreement with the following statements.
IF C1=8 or C3=5, USE PRESENT TENSE; OTHERWISE USE PAST TENSE
|
Would you say you… |
||||||
strongly disagree, |
disagree, |
neither agree nor disagree, |
agree, or |
strongly agree? |
DON’T KNOW |
REF |
|
a. You (were/are) locked up because you had a run of bad luck. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
b. The real reason you (were/are) locked up is because of your race. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
c. Nothing you do is going to make a difference in the way you are treated. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
d. You are not to blame for everything you have done. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
e. Laws are just a way to keep poor people down. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
f. You may have committed crimes, but your environment is to blame. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
NOTE: FOR NCP RESPONDENTS ONLY
E1 [TIMESTAMP]
IF NO MINOR CHILDREN, GO TO E21
I have a few questions about one of your children.
IF C11=1 (has minor child not living with):
The child I want to talk about is [C12 YOUNGEST] [years/months] old.
ELSE IF C9 < 96 (has minor child in household):
The child I want to talk about is [C9 YOUNGEST] [years/months] old.
Do you know the child who I am referring to?
1 YES
[SET AGE IN QUESTION TEXT TO FCAGE; IF FROM C11, FCLOCATE=NO, IF FROM C9, FCLOCATE=YES]
2 NO (GO TO E2)
7 DON’T KNOW (GO TO E2)
8 REF (GO TO E2)
E1a
What is that child’s name?
IF NEEDED: We can use an initial if you don’t want to name the child. I just need to have something to call him or her as I ask questions.
IF NO NAME OR INITIAL OFFERED SAY: I’ll call the child “Jesse” for this interview.
__________________ [SET AS FCNAME]
FOCAL CHILD NAME
E1b
What is that child’s birthday?
MM/DD/YYYY Child’s date of birth
97/97/9997 DON’T KNOW
98/98/9998 REFUSED
GO TO E4
E2
IF C11 > 1, GO TO E3
Earlier, you told me that you had children under age 19 who did not live with you.
I would like to ask you some questions about your youngest child that does NOT live with you. What is that child’s name?
IF NEEDED: We can use an initial if you don’t want to name the child. I just need to have something to call him or her as I ask questions.
IF NO NAME OR INITIAL OFFERED SAY: I’ll call the child “Jesse” for this interview.
__________________ [SET AS FCNAME; FCLOCATE=NO]
FOCAL CHILD NAME
0 NO FOCAL CHILD ACKNOWLEDGED BY R (GO TO E3)
7 DON’T KNOW (GO TO E3)
8 REFUSED (GO TO E3)
E2a
What is that child’s birthday?
MM/DD/YYYY Child’s date of birth [CALCULATE FCAGE] (GO TO E4)
97/97/9997 DON’T KNOW
98/98/9998 REFUSED
E2b
How old is she or he?
_____ ____ [SET AS FCAGE] (GO TO E4)
AGE IN YEARS AGE IN MONTHS IF LESS THAN 1 YEAR
97 DON’T KNOW
98 REFUSED
E3
IF C9 = 96/97/98, GO TO E21
Earlier, you told me that you had children that you were responsible for who lived with you.
I would like to ask you some questions about (your youngest/your) child that lives with you. What is that child’s name?
IF NO NAME OR INITIAL OFFERED SAY: I’ll call the child “Jesse” for this interview.
__________________ [SET AS FCNAME; FCLOCATE=YES]
FOCAL CHILD NAME
0 NO FOCAL CHILD ACKNOWLEDGED BY R (GO TO E21)
7 DON’T KNOW (GO TO E21)
8 REFUSED (GO TO E21)
E3a
What is that child’s birthday?
MM/DD/YYYY Child’s date of birth [CALCULATE FCAGE] (GO TO E4)
97/97/9997 DON’T KNOW
98/98/9998 REFUSED
E3b
How old is she or he?
_____ ____ [SET AS FCAGE]
AGE IN YEARS AGE IN MONTHS IF LESS THAN 1 YEAR
97 DON’T KNOW
98 REFUSED
E4 (12MFUP HSCREEN4)
How many months have you lived with [FCNAME] during the last 12 months?
INTERVIEWER: ROUND TO WHOLE NUMBER.
________ (RANGE 1-12)
MONTHS
00 NONE
96 LESS THAN ONE MONTH
97 DON’T KNOW
98 REFUSED
E5 (12MFUP H1)
IF FCLOCATE =YES (child lives with R), GO TO E7
Some people have an agreement about how much time a parent can spend with children they don’t live with. Do you currently have a legal agreement about your visits with [FCNAME]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
E6 (12MFUP H2)
In what month and year did you last see [FCNAME]?
_ _/ _ _ _ _
MM/YYYY
96/9996 HAVE NOT MET CHILD
97/9997 DON’T KNOW
98/9998 REFUSED
E7 (12MFUP H3)
IF E6 IS MORE THAN THREE MONTHS AGO OR DK/REF, GO TO E13.
During the past three months, about how often did you spend one or more hours a day with [FCNAME]? Would you say it was…
1 everyday or nearly every day,
2 a few times a week,
3 a few times per month,
4 only once or twice, or
5 not at all?
7 DON’T KNOW
8 REFUSED
E8 (12MFUP H4)
IF FCAGE IS UNKNOWN GO TO E12
IF FCAGE > 11 MONTHS, GO TO E9
In the past 3 months, how often did you help with caring for the baby by feeding, bathing, providing transportation, helping with chores, or other things to help care for the baby? Would you say…
1 every day or almost every day,
2 a few times a week,
3 a few times a month,
4 less often than that, or
5 never?
7 DON’T KNOW
8 REFUSED
GO TO E12
E9 (12MFUP H5)
IF FCAGE > 59 MONTHS, GO TO E10
About how often in the past three months have you…
|
Would you say it was… |
|||||
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
|
a. …played inside with games or toys with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …taken [FCNAME] for a walk or to play outside? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …sung songs or nursery rhymes with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …read books or told stories to [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …dealt with [FCNAME] when he/she did something wrong? |
1 |
2 |
3 |
4 |
7 |
8 |
GO TO E12
E10 (12MFUP H6)
IF FCAGE > 107 MONTHS, GO TO E11
About how often in the past three months have you…
|
Would you say it was… |
|||||
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
|
a. …talked with [FCNAME] about school, grades, homework, or other things that he/she does at school? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …spent time with [FCNAME] doing one of his/her favorite activities like shopping, playing a sport, going to a movie, watching TV, or playing video games? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …talked with [FCNAME] about his/her friends? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …read a book with [FCNAME] or talked about a book he/she was reading? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …dealt with [FCNAME] when he/she did something wrong? |
1 |
2 |
3 |
4 |
7 |
8 |
GO TO E12
E11 (12MFUP H7)
IF FCAGE > 227 MONTHS, GO TO E12
|
Would you say it was… |
|||||
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
|
a. …talked with [FCNAME] about school grades, homework, or other things that he/she does at school? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …spent time with [FCNAME] doing one of his/her favorite activities like shopping, playing a sport, going to a movie, watching TV, or playing video games? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …talked with [FCNAME] about his/her friends or dating relationships? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …talked about a book [FCNAME] was reading? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …dealt with child when [FCNAME] did something wrong? |
1 |
2 |
3 |
4 |
7 |
8 |
E12 (12MFUP H8)
About how often in the past three months have you…
|
Would you say it was… |
|||||
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
|
a. …told [FCNAME] that you love him/her? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …hugged or kissed [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …praised [FCNAME] or told him/her that you appreciated something that he/she did? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …laughed with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …argued with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
f. …lost your temper with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
g. …yelled or shouted at [FCNAME] because you were angry at him/her? |
1 |
2 |
3 |
4 |
7 |
8 |
h. …hit, spanked, grabbed or used physical punishment with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
E13 (12MFUP H9)
How close do you feel to [FCNAME]? Would you say…
1 very close,
2 quite close,
3 fairly close,
4 not very close?
7 DON’T KNOW
8 REFUSED
E14 (12MFUP H10)
What is your relation to [FCNAME]’s (mother/father)? Are you married, divorced, never married, or in another arrangement?
1 MARRIED, CIVIL UNION, REGISTERED DOMESTIC PARTNERSHIP
2 DIVORCED
3 SEPARATED
4 NEVER MARRIED TO EACH OTHER
5 MARRIAGE ANNULED
6 WIDOWED (OTHER PARENT IS DECEASED) (GO TO E16)
7 OTHER (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
E15 (12MFUP H11)
Which of the following statements best describes your current relationship with that person?
1 We are romantically involved on a steady basis, or
2 we are involved in an on again and off again relationship, or
3 we are not in a romantic relationship?
7 DON’T KNOW
8 REFUSED
E16
IF FCLOCATE=YES, GO TO E21
With whom does [FCNAME] live?
01 MOTHER
02 FATHER
03 GRANDMOTHER
04 GRANDFATHER
05 AUNT
06 UNCLE
07 OTHER (SPECIFY: ________________)
97 DON’T KNOW
98 REFUSED
E17 (12MFUP H12)
My next few questions are about your relationship with the person [FCNAME] lives with, who I will call his or her caregiver. Overall, would you describe your current relationship with [FCNAME]’s caregiver as…
1 very friendly,
2 somewhat friendly,
3 neither friendly nor unfriendly,
4 somewhat unfriendly,
5 very unfriendly, or
6 no relationship at all?
7 DON’T KNOW
8 REFUSED
E18 (12MFUP H13)
In the last month, how often did you talk with [FCNAME]’s caregiver about him or her, such as how things are going in school or day care, how the child spends their time, problems with the child, or anything to do with child? Would you say it was…
1 often,
2 sometimes,
3 hardly ever, or
4 never?
7 DON’T KNOW
8 REFUSED
E19 (12MFUP H14)
How much involvement do you currently have in making major decisions about such things as [FCNAME]’s education, religion, and health care? Would you say…
1 none,
2 some, or
3 a great deal?
7 DON’T KNOW
8 REFUSED
E20 (12MFUP H15)
Now I would like to read you a list of issues that people raising a child may have disagreements about. For each one, please tell me how often you and [FCNAME]’s caregiver disagree.
|
Would you say you disagree… |
|||||
|
often, |
sometimes, |
hardly ever, or |
never? |
DON’T KNOW |
REF |
a. Setting rules for disciplining child. |
1 |
2 |
3 |
4 |
7 |
8 |
b. The activities that the child participates in. |
1 |
2 |
3 |
4 |
7 |
8 |
c. How money is spent on the child. |
1 |
2 |
3 |
4 |
7 |
8 |
d. Who does childcare tasks. |
1 |
2 |
3 |
4 |
7 |
8 |
e. The amount of time you spend with child. |
1 |
2 |
3 |
4 |
7 |
8 |
E21 (12MFUP H16)
Are you required by a court or state agency to pay child support for any children?
IF FOCAL CHILD QUESTIONS ASKED:
This would be for any of your children, not only [FCNAME].
1 YES
2 NO (GO TO E27)
7 DON’T KNOW (GO TO E27)
8 REFUSED (GO TO E27)
E22 (12MFUP H17)
Now I want to ask you a few questions about that child support.
IF FOCAL CHILD QUESTIONS ASKED:
These questions are about [FCNAME] and any other children you may have.
For how many children are you required to pay child support? Include any children for which you are required to pay arrears or make back payments.
_______________________
NUMBER OF CHILDREN (RANGE = 1-15)
96 MORE THAN 15
97 DON’T KNOW
98 REFUSED
E23 (12MFUP H18/H19)
What is the total amount you are required to pay through the child support system?
IF NEEDED: This is the total for all of your children.
INTERVIEWER: ROUND TO NEAREST DOLLAR
$_____ , _____ _____ _____
AMOUNT PAID (RANGE 1 to 9995)
9996 $9,996 or more
9997 DON’T KNOW
9998 REFUSED
Time Unit
1 per week
2 every other week
3 per month
4 some other time period
7 DON’T KNOW
8 REFUSED
E24 (12MFUP H20)
Last month, did you pay the full amount of the payment ordered by the court or state agency?
1 YES (GO TO E26)
2 NO
7 DON’T KNOW
8 REFUSED
E25 (12MFUP H21)
How much child support did you actually pay through the child support system last month?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$_____ , _____ _____ _____
AMOUNT PAID (RANGE 1 to 9995)
0000 $0 or None (GO TO E27)
9996 $9.996 or more
9997 DON’T KNOW (GO TO E27)
9998 REFUSED (GO TO E27)
E26 (12MFUP H22)
How many children did this cover?
_______________________
NUMBER OF CHILDREN (RANGE 1-15)
96 MORE THAN 15
97 DON’T KNOW
98 REFUSED
E27 (12MFUP H23)
IF C11 > 1, GO TO E31
IF E24=1 OR E25 HAS AMOUNT:
Not counting child support you already told me about, in the past 30 days did you provide cash for (your child that does/any of your children that do) not live with you?
ELSE:
In the past 30 days did you provide cash for any of your children that do not live with you?
1 YES
2 NO (GO TO E30)
7 DON’T KNOW (GO TO E30)
8 REFUSED (GO TO E30)
E28 (12MFUP H24)
Approximately how much cash did you provide?
$ ____ , ____ ____ ____
AMOUNT (1 to 9995)
9996 $9,996 or more
9997 DON’T KNOW
9998 REFUSED
E29 (12MFUP H25)
How many children did this cover?
______________________
NUMBER OF CHILDREN (RANGE =1-30)
97 DON’T KNOW
98 REFUSED
E30 (12MFUP H26)
During the past month did you provide help with any of the following your children that do not live with you?
|
YES |
NO |
DON’T KNOW |
REFUSED |
a. Food? |
1 |
2 |
7 |
8 |
b. Clothing or diapers? |
1 |
2 |
7 |
8 |
c. Child care or babysitting? |
1 |
2 |
7 |
8 |
d. Medicine/health care? |
1 |
2 |
7 |
8 |
e. Bills or payments? |
1 |
2 |
7 |
8 |
f. Toys, books, school supplies? |
1 |
2 |
7 |
8 |
g. Transportation to school, appointments, or other activities? |
1 |
2 |
7 |
8 |
E31 (12MFUP H27)
IF E24=1 OR E25 HAS AMOUNT OR E27=1 OR ANY E30A-G=1, GO TOE32
There are many reasons why someone may not provide financial support for their children. I’m going to read a list of reasons, please tell me whether the reason applied to you for any of your children.
Would you say that you haven’t paid child support because…
|
YES |
NO |
DON’T KNOW |
REF |
a. You don’t have the money. |
1 |
2 |
7 |
8 |
b. [IF H16=1:]Your child support order is set too high. |
1 |
2 |
7 |
8 |
c. You have another family to support. |
1 |
2 |
7 |
8 |
d. You have some disagreements about visitation. |
1 |
2 |
7 |
8 |
e. [IF H16=1:]The child support money goes to the state, not the children. |
1 |
2 |
7 |
8 |
f. Custodial parent doesn’t need the money or help. |
1 |
2 |
7 |
8 |
g. Custodial parent has a new partner. |
1 |
2 |
7 |
8 |
h. Custodial parent does not want you involved. |
1 |
2 |
7 |
8 |
i. You don’t believe that child is really yours. |
1 |
2 |
7 |
8 |
j. Child is not your responsibility. |
1 |
2 |
7 |
8 |
k. Some other reason. |
1 |
2 |
7 |
8 |
E32 (12MFUP H28)
IF E21 > 1, GO TO E33
Does owing child support affect your willingness to accept jobs that are offered to you?
1 YES
2 NO
7 DON’TKNOW
8 REFUSED
E33 (12MFUP H29)
Since [RAMY], have you been arrested for not paying child support?
1 YES
2 NO (GO TO NEXT SECTION)
7 DON’T KNOW (GO TO NEXT SECTION)
8 REFUSED (GO TO NEXT SECTION)
E34 (12MFUP H30)
Since [RAMY], how many times have you been arrested for not paying child support?
_______________________
TIMES ARRESTED (Range: 1 to 95)
96 96 or more
97 DON’T KNOW (GO TO NEXT SECTION)
98 REFUSED (GO TO NEXT SECTION)
E35 (12MFUP H31/H32)
How much time have you been incarcerated for not paying child support since [RAMY]?
_________
NUMBER
0 HAVE NOT BEEN INCARCERATED
996 996 or more
997 DON’T KNOW
998 REFUSED
Time Unit:
1 days
2 weeks
3 months
7 DON’T KNOW
8 REFUSED
F1 (6MFUP H1)
The next set of questions is about support systems. People sometimes look to others for companionship, assistance, or other types of support. How often is each of the following kinds of support available to you if you need it?
|
Would you say this kind of support is available to you … |
||||||
none of the time, |
a little of the time, |
some of the time, |
most of the time, or |
all of the time? |
DK |
REF |
|
a. Someone you can count on to listen to you when you need to talk. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
b. Someone to give you information to help you understand a situation |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
c. Someone to give you good advice about a crisis, |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
d. Someone to confide in or talk to about yourself or your problems. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
e. Someone whose advice you really want. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
f. Someone to share your most private worries and fears with. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
g. Someone to turn to for suggestions about how to deal with a personal problem. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
h. Someone who understands your problems. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
F2 (6MFUP H1)
From time to time, most people discuss things that are important to them with others. These may include good or bad things that happen to you, problems you are having, or important concerns you may have. I’d like to ask you about the people with whom you often discuss things that are important to you. You may refer to these people in any way you want; for example you may use just their first names or nicknames or initials. I am not interested in the identities of these people. I just need to have some way to refer to them so that when I ask you a follow-up question we both know who we are talking about.
Over the last 6 months, who are the people with whom you most often discussed things that were important to you?
IF NEEDED: This could be a person you tend to talk to about things that are important to you.
INTERVIEWER: AFTER EACH NAME, PROMPT: Who else?
1 NAME GIVEN, SPECIFY_________________
[RECORD UP TO 10 NAMES]
96 NO ONE ELSE
97 DON’T KNOW
98 REFUSED
F3 (6MFUP H2)
People can have many different connections to others. For example, a woman can be your co-worker and also be your neighbor. Or a man could be your brother and also a member of your church. Now, I would like to go through the names you just gave me. Please list all the ways that person is connected to you. How is [NAME FROM LIST] connected to you?
INTERVIEWER: RECORD UP TO FOUR CONNECTIONS FOR EACH NAME.
INTERVIEWER: AFTER EACH CONNECTION, PROBE:
What other ways is [NAME FROM LIST] connected to you?......What else?
FAMILY OR SEXUAL PARTNER
1 SPOUSE
2 EX-SPOUSE
3 ROMANTIC/SEXUAL PARTNER
4 PARENT
5 PARENT IN-LAW
6 OTHER IN-LAW
7 CHILD
8 STEP-CHILD
9 BROTHER OR SISTER
10 OTHER RELATIVE
FRIEND/NEIGHBOR
11 FRIEND
12 NEIGHBOR
OTHER CONNECTION
13 CO-WORKER OR BOSS
14 MINISTER, PRIEST, OR OTHER CLERGY
15 MEMBER OF THE SAME CONGREGATION
16 MEMBER OF THE SAME CLUB OR ACTIVITY GROUP
17 PSYCHIATRIST, PSYCHOLOGIST, COUNSELOR, OR THERAPIST
18 CASEWORKER/SOCIAL WORKER
19 JOB PLACEMENT/TRAINING PROGRAM STAFF
20 OTHER, SPECIFY
97 DON’T KNOW
98 REFUSED
Close
That is the last question I have for you today/tonight. I want to thank you again for your time.
U-
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |