First follow-up survey

Attachment C

First follow-up survey

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Evaluation of Employment Coaching for TANF and Related Populations

First Follow-up Survey

Revised March 2020

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time required to complete this information collection is estimated to average 45 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

B6: Reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc. (PAR), 16204 North Florida Avenue, Lutz, Florida 33549, from the Behavior Rating Inventory of Executive Function Adult Version by Robert M. Roth, PhD, Peter K. Isquith, PhD and Gerard A. Gioia, PhD, Copyright 1996, 1998, 2001, 2003, 2004, 2005 by PAR. Further reproduction is prohibited without permission from PAR.
For Review Only, Do NOT Copy

PUBLIC VERSION

CONTENTS

Section Page

i. introduction 1

A. economic stability 12

B. employment Challenges and skills 21

C. sERVICE RECEIPT 26

D. Demographics 33

E. contact information 36

PROGRAMMER:

PRELOAD program NAMES.

PROGRAMMER BOX IN0.

IF DIAL OUT, GO TO IN1;

IF FIELD CALL IN, GO TO IN2;

IF RESPONDENT CALL IN, GO TO IN3.

CALL OUT

IN1. May I please speak with [NAME]? My name is [FILL INTERVIEWER NAME] and I’m calling from Mathematica Policy Research, a research company in Princeton, New Jersey.

SPEAKING TO [NAME] 1 GO TO IN13

[NAME] COMES TO PHONE 2 GO TO IN13

PERSON ASKS WHAT CALL IS ABOUT 3 GO TO IN4

[NAME] IS NOT AVAILABLE 4 GO TO IN6

[NAME] IS INCARCERATED 5 GO TO IN8

[NAME] HAS MOVED/HAS A DIFFERENT NUMBER 6 GO TO IN9

NEVER HEARD OF [NAME] / WRONG NUMBER 7 IN22, STATUS 1530

[NAME] IS DECEASED 8 GO TO IN12

[NAME] DOES NOT SPEAK ENGLISH 9 IN22, STATUS 1401

HUNG UP 10 STATUS 1240

REFUSED r STATUS 1220

FIELD CALL IN

IN2. May I have your first name?

(STRING 20)

FIELD INTERVIEWER FIRST NAME

IN2 = ANSWERED (FIELD CALL IN)

IN2a. And your last name?

(STRING 30)

FIELD INTERVIEWER LAST NAME

IN2a = ANSWERED (FIELD CALL IN)

IN2b. May I have your field interviewer ID number?

| | | | | |

(0000 - 99999)

IN2b = ANSWERED (FIELD CALL IN)

IN2c. CODE PURPOSE OF FIELD CALL IN

CALLED TO COMPLETE INTERVIEW 1 GO TO IN13

CALLED TO SAY [NAME] IS DECEASED 2 GO TO IN12

CALLED TO SAY [NAME] IS INCARCERATED 3 GO TO IN8

RESPONDENT CALL IN

IN3. Thank you for calling. My name is [FILL INTERVIEWER NAME] from Mathematica Policy Research. May I have your name?

SPEAKING TO RESPONDENT ([NAME]) 1 GO TO IN13

SOMEONE ELSE CALLED TO COMPLETE INTERVIEW 2 GO TO IN5

CALLED TO ASK WHY WE CALLED 3 GO TO IN4

CALLED TO SET APPOINTMENT 4 GO TO IN6

CALLED TO REFUSE 5 GO TO IN22

STATUS 1240

CALLED TO SAY [NAME] MOVED/HAS A DIFFERENT NUMBER 6 GO TO IN9

CALLED TO SAY [NAME] IS DECEASED 7 GO TO IN12

CALLED TO SAY [NAME] IS INCARCERATED 8 GO TO IN8

CALLED TO SAY NEVER HEARD OF [NAME] / WRONG NUMBER 9 GO TO IN22

STATUS 1530

HUNG UP 10 STATUS 1240

IN1 = 3 OR IN3 = 3 (WHAT IS CALL ABOUT)

FILL $35 UP TO FOUR WEEKS AFTER RELEASE DATE OTHERWISE FILL $25

FILL $50 IF PROGRAM = FADSS, JEFFCO, LIFT, WORK SUCCESS

IF BL A1C=1 FILL HE/HIM

IF BL A1C=2 FILL SHE/HER

FILL RESPONDENT NAME

IN4. I would like to speak with [NAME] about a research study [he/she] joined about [FILL MONTHS] months ago. I want to ask [NAME] some questions about how [he/she] has been doing since then. [NAME] will be given a [$35/$25/50] gift card as a token of appreciation for [his/her] time.

May I please speak with [NAME]?

SPEAKING TO [NAME] 1 GO TO IN13

[NAME] COMES TO PHONE 2 GO TO IN13

[NAME] IS NOT AVAILABLE 3 GO TO IN6

[NAME] IS INCARCERATED 4 GO TO IN8

[NAME] HAS MOVED/HAS A DIFFERENT NUMBER 5 GO TO IN9

NEVER HEARD OF [NAME] / WRONG NUMBER 6 GO TO IN22

STATUS 1530

[NAME] IS DECEASED 7 GO TO IN12

[NAME] DOES NOT SPEAK ENGLISH 8 GO TO IN22

STATUS 1401

HUNG UP 9 STATUS 1240

REFUSED r STATUS 1220

PROGRAMMER SKIP BOX IN4 =6 or in4=8

Interviewer: Thank you for taking time to speak with me. Goodbye.

If in4=6 STATUS CASE 1530

if in4=8 status case 1401

IN3 = 2 (SOMEONE ELSE CALLED IN TO COMPLETE INTERVIEW)

IN5. I’m sorry, but I need to speak to [NAME]. May I please speak with [NAME]?

[NAME] COMES TO PHONE 1 GO TO IN13

[NAME] IS NOT AVAILABLE 2 GO TO IN6

[NAME] IS INCARCERATED 3 GO TO IN8

[NAME] HAS MOVED/HAS A DIFFERENT NUMBER 4 GO TO IN9

NEVER HEARD OF [NAME] / WRONG NUMBER 5 GO TO IN22

STATUS 1530

[NAME] IS DECEASED 6 GO TO IN12

[NAME] DOES NOT SPEAK ENGLISH 7 GO TO IN22

STATUS 1401

HUNG UP 8 STATUS 1240

REFUSED r STATUS 1220

PROGRAMMER SKIP BOX IN5 =5 or in5=7

Interviewer: Thank you for taking time to speak with me. Goodbye.

If in5=5 STATUS CASE 1530

if in5=7 status case 1401

IN1 = 4 OR IN3 = 4 OR IN4 = 3 OR IN5 = 2 (NOT AVAILABLE; SET APPOINTMENT)

IN6. When would be a good time to call back?

[NAME] COMES TO PHONE 1 GO TO IN13

SET APPOINTMENT 2 GO TO IN7

IN6 = 2 (SET APPOINTMENT)

IN7. When would be a good time to reach [NAME]?

INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.

INSTRUCTION: MAKE AN APPOINTMENT USING THE PARALLEL BLOCK.

INSTRUCTION: USE THE ‘APPOINTMENT’ TAB OR PRESS <CTRL-S> TO INVOKE THE APPOINTMENT MAKING DIALOG.

(STRING 20)

IN1 = 5 OR IN2c = 3 OR IN3 = 8 OR IN4 = 4 OR IN5 = 3 (INCARCERATED)

IN8. What is the name of the place where [NAME] is being held?

(STRING 200)

NAME OF PRISON

DON’T KNOW d

REFUSED r GO TO BOX IN8d.1

IN8 = ANSWERED, d

IN8a. In what city or town is that located?

(STRING 50)

NAME OF CITY/TOWN

DON’T KNOW d

REFUSED r

IN8 = ANSWERED, d

IN8b. In what state is that located?

(STRING 20)

NAME OF STATE

DON’T KNOW d

REFUSED r

IN8 = ANSWERED, d

IN8c. When is [NAME] expected to be released?

PROBE: I just need a month and year. Your best estimate is fine.

INTERVIEWER: ENTER MONTH ON NEXT SCREEN OR CODE DON’T KNOW

programmer:

ENTER DATE ON NEXT SCREEN 1

SERVING A LIFE SENTENCE 2 GO TO IN8d

IN8c_month & IN8c_year When is [NAME] expected to be released?

PROBE: I just need a month and year. Your best estimate is fine.

| | | / | | | | |

(1-12) (2018- 2099)

DON’T KNOW d

REFUSED r

IN8 = ANSWERED, d

IN8d. And do you know [NAME]’s inmate number?

INTERVIEWER: ENTER NUMBER OR CODE DON’T KNOW

(STRING 20)

INMATE NUMBER

DON’T KNOW d

REFUSED r

PROGRAMMER Box

IF IN5=3 OR IN3=8 OR IN4=4 GO TO IN22 & STATUS CASE 1541 (PRISON).

Else go to in9 or in13

IN1 = 6 OR IN3 = 6 OR IN4 = 5 OR IN5 = 4 (MOVED; HAS DIFFERENT PHONE)

IN9. Do you or does anyone there know how we can reach [NAME]?

YES 1 GO TO IN10

NO 0 STATUS 1530

if in9=0

Interviewer: Thank you for taking time to speak with me. Goodbye.

IN9 = 1

IN10. May I please have [his/her] telephone number?

INTERVIEWER: ENTER NUMBER ON NEXT SCREEN OR CODE DON’T KNOW

ENTER NUMBER 1

DON’T KNOW d GO TO IN11

REFUSED r GO TO IN11

IN10 = 1

IN10_phone. Please give me the phone number, area code first.

| | | | - | | | | - | | | | |

SOFT CHECK: IF IN10_phone IS NOT 10 NUM DIGITS; THE PHONE NUMBER SHOULD BE 10 NUMERIC DIGITS, NO SPACES, DASHES, PARENTHESES OR OTHER PUNCTUATION. THE FIELD SHOULD ALSO NOT BE EMPTY.

SOFT CHECK: USE STANDARD PHONE NUMBER CHECKS.

IN9 = 1 AND IN10=DK OR R

IN11. May I have [his/her] address?

INTERVIEWER: ENTER ADDRESS ON NEXT SCREEN OR CODE DON’T KNOW

ENTER ADDRESS 1

DON’T KNOW d GO TO IN22

REFUSED r GO TO IN22

IN11 = 1

IN11_address. What is [NAME]’s address?

STREET 1

STREET 2

STREET 3

CITY

STATE

ZIP

if in11=1 GO TO IN22.

IF IN10 = 1 (NEW NUMBER), STATUS CASE 1899

IN1=8 AND IN2c = 2 OR IN3 = 7 OR IN4 = 7 OR IN5 = 6 (RESPONDENT IS DECEASED)

I was calling about… IF IN1 = 8 (CALL OUT)

IN12. I am very sorry to hear that. [I was calling about a research study on behalf of the U.S. Department of Health and Human Services.] When did [NAME] pass away?

Thank you. Please accept my condolences. Goodbye.

programmer:

ENTER DATE ON NEXT SCREEN 1

DON’T KNOW d

REFUSED r

IN12_month & IN12_day & IN12_year

Thank you. Please accept my condolences. Goodbye.

| | | / | | | / | | | | |

(1-12) (1 - 31) (2012- 2099)

DON’T KNOW d

REFUSED r

STATUS CASE 1440 (DECEASED).

IF IN1= 1 Or 2; IN3=1; IN4=1 OR 2; IN5=1; IN6=1

IF BL INTRO1 = 1, fill PROGRAM NAME

IF BL INTRO1 = 2, fill PROGRAM NAME

IF BL INTRO1 = 3, fill PROGRAM NAME

IF IN4 = 1 OR 2; IF IN5=1; IF IN6 =1, fill “Hello, my name is [FILL INTERVIEWER NAME] and I’m calling from Mathematica Policy Research, a research company in Princeton, New Jersey.”

IF IN2c=1, fill “Today, we are going to talk”

IF IN1 =1 OR 2; IN4 = 1 OR 2; IF IN5=1; IF IN6 =1, fill “I’m calling you”

IN13. [Hello, my name is [FILL INTERVIEWER NAME] and I’m calling from Mathematica Policy Research, a research company in Princeton, New Jersey. [I’m calling you/Today, we are going to talk] about a study you joined when you applied to [PROGRAM NAME] about [FILL MONTHS] months ago. Before we get started I would like to make sure we have your name recorded correctly.

Can you verify your first name?

PROBE: Can you spell that for me please?

INTERVIEWER: IF THE NAME DOES NOT MATCH THEN TELL YOUR SUPERVISOR AND IF NECESSARY DISCONTINUE THE INTERVIEW

(STRING 20)

FIRST NAME

ALL

IN14. And your middle name please?

PROBE: Can you spell that for me please?

INTERVIEWER: IF THE NAME DOES NOT MATCH THEN TELL YOUR SUPERVISOR AND IF NECESSARY DISCONTINUE THE INTERVIEW

(STRING 20)

MIDDLE NAME

ALL

IN15. And your last name please?

PROBE: Can you spell that for me please?

INTERVIEWER: IF THE NAME DOES NOT MATCH THEN TELL YOUR SUPERVISOR AND IF NECESSARY DISCONTINUE THE INTERVIEW

(STRING 20)

LAST NAME

ALL

Fill [RESP FIRST name] from IN15.

IN16. Are you usually called [RESP FIRST NAME] or do you go by another name?

INSTRUCTION: IF SAME JUST HIT ENTER.

PROBE: Can you spell that for me please?

(STRING 20)

FIRST NAME

[IN1=1 OR 2] OR IN2C=1 OR [IN4=1 OR 2] OR IN5=1 OR IN6=1

FILL $35 UP TO FOUR WEEKS AFTER RELEASE DATE OTHERWISE FILL $25

FILL $50 IF PROGRAM = FADSS, JEFFCO, LIFT, WORK SUCCESS

IN17. You may have received a letter recently to let you know that we would be calling you for a follow-up interview for our study. I’d like to interview you today.

The interview will take about 45 minutes and you will receive a [$35/$25/$50] gift card as a token of our appreciation for completing the interview. Your participation in the survey is voluntary. You do not have to answer any questions that make you uncomfortable. All your responses will be kept strictly private and will only be used for research purposes, except if you say something that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you. Nobody will ever publish your name in connection with the information you provide. Instead, information about you will be combined with information about other people in the study. This interview may be recorded so my supervisor can monitor the interview and make sure that the questions are asked correctly. These recordings will be destroyed when the study is completed.

Is now a good time to start?

YES 1 GO TO IN19

NO 0

IN17=0

IN18. When would be a good time to do the interview?

INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.

INSTRUCTION: MAKE AN APPOINTMENT USING THE PARALLEL BLOCK.

INSTRUCTION: USE THE ‘APPOINTMENT’ TAB OR PRESS <CTRL-S> TO INVOKE THE APPOINTMENT MAKING DIALOG.

(STRING 20)

First we are going to ask you some questions to check that we are speaking with the correct person.

IN17=1

IN19. What is your date of birth?

| | | / | | | / | | | | |

MONTH DAY YEAR

(1-12) (1-31) (1918-2001)

DON’T KNOW d

REFUSED r

BL INTRO1 = 2 OR 3

IN20. And what are the last 4-digits of your Social Security number?

| | | | | LAST FOUR

(0000-9999)

DON’T KNOW d GO TO IN21

REFUSED r GO TO IN21

PROGRAMMER:

IF EITHER IN19 = EXACT MATCH ON BL A2 (DOB) OR IN20 = EXACT MATCH ON A3 GO A1

IF IN19 AND I20 IS NOT A MATCH GO TO IN21

IN19 AND IN20 = MISMATCH

IN21. I’m sorry. I need to check my records before I can interview you. Is this the best time and number to reach you in the future?

YES 1

NO, CALL BACK INFO 0

(STRING 20)

INSTRUCTION: RECORD DATE, TIME, and best number FOR CALL BACK.

IN11=D OR R OR IN18=answer

IN22. Thank you for taking time to speak with me. Goodbye.

INSTRUCTION: STATUS THIS CASE 1380 FOR SUPERVISOR REVIEW.

IF IN11=D OR R STATUS CASE 1530.

all

A1. The first questions are about sources of income and other support that you and other members of your household may have received in the past month.

In the past month, have you or anyone in your household received any income from [fill statements a-j]?

	CODE ONE RESPONSE PER ROW
	YES	NO	DK	REF
a. Temporary Assistance for Needy Families, or TANF (this is also known as welfare)	1	0	d	r
b. Supplemental Security Income, or SSI	1	0	d	r
c. Social Security Disability Insurance, or SSDI	1	0	d	r
d. Food stamps or SNAP	1	0	d	r
e. Women, Infants, and Children, or WIC	1	0	d	r
f. Unemployment Insurance	1	0	d	r
g. Housing choice vouchers, Section 8, project-based rental assistance, public housing, housing where an agency helps you pay the rent, or other housing assistance	1	0	d	r

A1a = 1

A1h. How much money have you or anyone in your household received from TANF in the past month? If both you and someone else in your household received money from TANF, please add those amounts together.

PROBE: Your best guess is fine.

$| | | , | | | |

(0-99,999)

DON’T KNOW d

REFUSED r

Now I would like to ask some questions about work.

ALL

A2. Are you currently working for pay?

Working for pay can include regular paid jobs, odd jobs, temporary jobs, work done in your own business, “under the table” work, or any other types of work you have done for pay.

YES 1 GO TO A3

NO 0 GO TO A2a

DON’T KNOW d GO TO A2a

REFUSED r GO TO A2a

A2 NE 1

A2a. Have you worked for pay at any time since [RA MONTH YEAR]?

YES 1 GO TO A4b

NO 0 GO TO A15

DON’T KNOW d GO TO A15

REFUSED r GO TO A15

	JOB 1	JOB 2
A2 =1 A3. First I am going to ask about your current job or jobs. Please tell me who you work for. This could be the name of a job, organization, person, or you could work for yourself or have your own business. If you currently work at more than one job, please start with the job where you usually work the most hours.	JOB NAME (SPECIFY) 99 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r PROGRAMMER: IF A3 = d, r, make [Company Name] be “Job 1” for Job 1, “Job 2” for Job 2, etc. INTERVIEWER: IF A3=d, r, THEN SAY: That’s okay, we’ll just refer to this job as “Job 1” in the next few questions.	JOB NAME (SPECIFY) 99 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r
A2=1 (CURRENTLY EMPLOYED) A4. Including all types of jobs, do you currently have any other paid jobs?	YES 1 GO TO A4a, JOB 2 NO 0 GO TO A4c DON’T KNOW d GO TO A4c REFUSED r GO TO A4c	YES 1 GO TO A4a, JOB 3 NO 0 GO TO A4c DON’T KNOW d GO TO A4c REFUSED r GO TO A4c
A2=1 (CURRENTLY EMPLOYED) A4a. Please tell me who you work for on that job?		COMPANY NAME (SPECIFY) 99 (STRING 50) SELF EMPLOYED………..2 DON’T KNOW d REFUSED r IF A2=1 LOOP A4 AND A4a JOBS UNTIL A4=(0,d, r). WHEN A4= 0,d,or r GO TO A4c.
A2a=1 (NOT CURRENTLY EMPLOYED) A4b. Since [RA MONTH YEAR], please tell me who you worked for? This could be the name of a company, organization, person, or you could work for yourself or have your own business. If you had more than one job, please start with the job where you worked the most hours.	JOB NAME (SPECIFY) 99 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r	JOB NAME (SPECIFY) 99 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r
If A4=(0, d, r) [TOLD INTERVIEWER THAT NO MORE CURRENT JOBS] or A2=1 [NOT CURRENTLY EMPLOYED BUT EMPLOYED SINCE RA MONTH YEAR] A4c. Have you had any other paid jobs since [RA MONTH YEAR] that you haven’t told me about?	YES 1 GO TO A4b, JOB 2 NO 0 GO TO A5 DON’T KNOW d GO TO A5 REFUSED r GO TO A5 IF A4c=1 LOOP A4b AND A4c UNTIL A4C=0,d, or r . WHEN A4C=0, d, or r GO TO A5.	YES 1 GO TO A4b, JOB 3 NO 0 GO TO A5 DON’T KNOW d GO TO A5 REFUSED r GO TO A5 IF A4c=1 LOOP A4b AND A4c UNTIL A4C=0,d, or r . WHEN A4C=0, d, or r GO TO A5.
A2=1 OR A2a=1 IF A3 or A4b=2 FILL “to become” ELSE FILL “to help get” IF A3 or A4b = 2, FILL “SELF EMPLOYED” ELSE FILL “NOW THINKING OF THE JOB YOU [DO/DID] AT [JOB NAME 1].” A5. [Now thinking of the job you [do/did] [at JOB NAME 1].] Did you receive assistance from an organization or an agency [to help get/to become] [JOB NAME 1/self-employed]. Please do not include temp agencies.	ORGANIZATION 1 AGENCY 2 DID NOT RECEIVE ANY ASSISTANCE 3 DON’T KNOW d REFUSED r	ORGANIZATION 1 AGENCY 2 DID NOT RECEIVE ANY ASSISTANCE 3 DON’T KNOW d REFUSED r

	JOB 1	JOB 2
A2=1 OR A2a=1 IF A3 or A4b = 2, FILL “YOURSELF;” ELSE FILL “NOW THINKING OF THE JOB YOU [DO/DID] AT [JOB NAME 1].” A6. When did you start working for [JOB NAME 1/yourself]? INTERVIEWER: RECORD MONTH AND YEAR. NOTE: ALLOW SKIP ON MONTH.	| | | / | | | | | MONTH YEAR (1-12) (1990-2017) DON’T KNOW d REFUSED r	| | | / | | | | | MONTH YEAR (1-12) (1990-2017) DON’T KNOW d REFUSED r
A2=1 OR A2a=1 If A3 = 2 or A3b = 2 FILL “YOURSELF,” ELSE FILL JOB NAME A7. Are you still working for [JOB NAME/yourself]?	YES 1 GO TO A8 NO 0 GO TO A7a DON’T KNOW d REFUSED r	YES 1 GO TO A8 NO 0 GO TO A7a DON’T KNOW d REFUSED r
A2=0 A7a. When did you stop working at this job? INTERVIEWER: RECORD MONTH AND YEAR.	| | | / | | | | | MONTH YEAR (1-12) (2013-2018) STILL AT JOB 98 DON’T KNOW d REFUSED r	| | | / | | | | | MONTH YEAR (1-12) (2013-2018) STILL AT JOB 98 DON’T KNOW d REFUSED r
A2a=1 FILL “ARE” IF A7=1, ELSE FILL “WERE” SKIP IF A3 = 2 or a3b = 2 A8. Which of the following best describes your employment at that job? [Were/Are] you working . . . PROBE: A temporary help agency supplies workers to other companies on an as needed basis. PROBE: Some companies provide employees or their services to others under contract. A few examples of services that can be contracted out include security, landscaping, or computer programming. PROBE: Independent contractors, independent consultants, and free-lance workers obtain customers on their own to provide a product or service and can have other employees working for them. PROBE: Day laborers are people who work as needed. For example, day laborers may get work by waiting at a place where employers pick up people to work for a day or by posting paper or electronic job wanted ads and responding on a day-by-day basis. PROBE: On-call workers are in a pool of workers who are ONLY called to work as needed, although they can be scheduled to work for several days or weeks in a row, for example, substitute teachers, and construction workers supplied by a union hiring hall.	CODE ONE ONLY as a regular full-time employee, 1 as a regular part-time employee, 2 for a temporary help agency, 3 for a company that contracts out you or your services, 4 as an independent contractor, independent consultant, or freelance worker, 5 as a day laborer, 6 as an on call employee, 7 for friends, family, or other people doing part-time tasks or odd jobs, 8 or something else (PLEASE specify)? 99 (STRING (100)) DON’T KNOW d REFUSED r	CODE ONE ONLY as a regular full-time employee, 1 as a regular part-time employee, 2 for a temporary help agency, 3 for a company that contracts out you or your services, 4 as an independent contractor, independent consultant, or freelance worker, 5 as a day laborer, 6 as an on call employee, 7 for friends, family, or other people doing part-time tasks or odd jobs, 8 or something else (PLEASE specify)? 99 (STRING (100)) DON’T KNOW d REFUSED r

	JOB 1	JOB 2
A2=1 OR A2a=1 IF A7=1 FILL DO; ELSE, FILL DID A8a. [Do/Did] you have taxes taken out of your paycheck for the work you [do/did] at this job?	YES 1 NO 0 R VOLUNTEERS: WAS PAID IN CASH 9 DON’T KNOW d REFUSED r	YES 1 NO 0 R VOLUNTEERS: WAS PAID IN CASH 9 DON’T KNOW d REFUSED r
A2=1 OR A2a=1 IF A7=1 FILL DO ELSE FILL DID A9. How many hours [do/did] you usually work in a week at this job? Your best estimate is fine.	| | | HOURS PER WEEK (0-98) 99 OR MORE HOURS PER WEEK 99 DON’T KNOW d REFUSED r IF A4=1 OR A4c=1 GO TO A5 [JOB 2-6] WHEN (=A4 NE 1 AND A4c NE 1) GO TO A10	| | | HOURS PER WEEK (0-98) 99 OR MORE HOURS PER WEEK 99 DON’T KNOW d REFUSED r IF A4=1 OR A4c=1 GO TO A5 [JOB 2-6] WHEN A4 NE 1 AND A4c NE 1 GO TO A10
A2=1 OR A2a=1 FILL ”DO” IF A7=1, ELSE FILL ”DID” A10. Now thinking about your job at [JOB NAME], how much [do/did] you get paid before taxes and deductions, at this job? PROBE: If your pay [varies/varied], please provide an average amount. If you are paid per job or for completing a particular task, please tell us the total amount you usually made per week or per month while doing this type of work. IF THE RESPONDENT DOES NOT PROVIDE A PAY PERIOD THEN PROBE: And, is that per hour, per week, per month, once every two weeks, twice a month, per year, day/daily, or something else? ACCEPT MOST CONVENIENT PAY PERIOD. SOFT CHECK: IF ANSWER IS GREATER THAN $50 PER HOUR, $2000 PER WEEK, $4000 ONCE EVERY 2 WEEKS, $4000 TWICE A MONTH, $100,000 PER YEAR, $400 DAY/DAILY, OR $8000 MONTH, SAY: “I recorded [A10 and A10 amount answer]. Is that correct?”	$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r	$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r
FILL WAGE FROM A10 A11. Did you always earn {A10 WAGE} per [HOUR/UNIT FROM A10] at this job?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r
If A11= no A11a. How much were you paid when you started working at this job before taxes and deductions? PROBE: If your pay [varies/varied], please provide an average amount. ACCEPT MOST CONVENIENT PAY PERIOD. SOFT CHECK: IF ANSWER IS GREATER THAN $50 PER HOUR, $2000 PER WEEK, $4000 ONCE EVERY 2 WEEKS, $4000 TWICE A MONTH, $100,000 PER YEAR, $400 DAY/DAILY, OR $8000 MONTH, SAY: “I recorded [A11a and A11a amount answer]. Is that correct?”	$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r	$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r
SKIP IF A3=2 OR A4a=2 FILL “ARE” IF A7=1 ELSE FILL “WERE” A12. Which of the following benefits [are/were] available to you at your job? (READ EACH ITEM) . . . SELECT IF AVAILABLE, BUT NOT USED.	CODE ALL THAT APPLY Paid leave for holidays, vacation or illness? 1 Health insurance or membership in an HMO or PPO plan? 2 Retirement benefits? 3 DON’T KNOW d REFUSED r	CODE ALL THAT APPLY Paid leave for holidays, vacation or illness? 1 Health insurance or membership in an HMO or PPO plan? 2 Retirement benefits? 3 DON’T KNOW d REFUSED r
SKIP IF A3=2 OR A4a=2 Have” IF A7=1 ELSE FILL “ Had” A13. [Have/Had] you been promoted to a higher position with greater responsibility while working at this job?	YES 1 NO 0 DON’T KNOW d REFUSED r	YES 1 NO 0 DON’T KNOW d REFUSED r
A7=1 SKIP IF A3=2 OR A4a=2 A14. How likely do you think it is that you will be promoted by [employer] in the next 12 months?	very likely, 01 somewhat likely, 02 not very likely, or 03 not likely at all? 04 DON'T KNOW d REFUSED r IF A4=1 OR A4c=1 GO TO A10 [JOB 2-6] WHEN (=A4 NE 1 AND A4c NE 1) GO TO A15	very likely, 01 somewhat likely, 02 not very likely, or 03 not likely at all? 04 DON'T KNOW d REFUSED r IF A4=1 OR A4c=1 GO TO A10 [JOB 2-6] WHEN (=A4 NE 1 AND A4c NE 1) GO TO A15

all

A15. Since [RA MONTH YEAR], was there anything else you did for pay, such as odd jobs, “under the table” jobs, or any other type of work, that we haven’t already talked about?

YES 1

NO 0 GO TO A18

DON’T KNOW d GO TO A18

REFUSED r GO TO A18

A15=1

A16. What is your best guess of how much money you received from these activities in a typical month since [RA MONTH YEAR]? Please do not include money you made from jobs we talked about earlier.

PROBE: Your best guess is fine.

$| | | , | | | |

(0-99,999)

DON’T KNOW d

REFUSED r

A2 = 1

If number of CURRENT JOBS equals 1 fill “job”

If number of CURRENT JOBS IS greater than 1 fill “jobs”

A17. How satisfied are you with your current [job/jobs]? Would you say very satisfied, somewhat satisfied, or not satisfied?

VERY SATISFIED 1

SOMEWHAT SATISFIED 2

NOT SATISFIED 3

DON’T KNOW d

REFUSED r

ALL

A18. Are you currently looking for a job?

YES 1

NO 0

DON’T KNOW d

REFUSED r

A18=0, d, r; A2 NE 1

A18a. How would you describe your current status. Are you . . .

CODE ALL THAT APPLY

Temporarily laid off, 1

Retired, 2

In school or training, 3

Unable to work because of caring for another family member, 4

Unable to work because of pregnancy 5

Sick or disabled, 6

Gave up looking for work, or 7

Something else? (SPECIFY) 99

(STRING (NUM))

DON’T KNOW d

REFUSED r

all

Now we would like to ask you some questions about the things you may have done to look for a job since [RA MONTH YEAR].

A19. Since [RA MONTH YEAR], have you [FILL WITH A-G]?

	CODE ONE RESPONSE PER ROW
	YES	NO	DK	REF
a. Updated your resume	1	0	d	r
b. Looked into the requirements needed to get a job you wanted	1	0	d	r
c. Been able to get stable and reliable childcare that would allow you to work, go to school, or go to job interviews	1	0	d	r
d. Looked into how to get new skills or credentials to get a job or advance your career	1	0	d	r
e. Figured out how to get transportation to school or a job you wanted	1	0	d	r

all

A20. Since [RA MONTH YEAR] have you received a job offer?

YES 1 GO TO A20a

NO 0 GO TO A22a

DON’T KNOW d

REFUSED r

A20=1

A20a. How many times did that happen?

| | | NUMBER OF OFFERS

(0-25)

DON’T KNOW d

REFUSED r

all

A21. Did you receive any of these job offers when you were working in another job?

YES 1

NO 0 GO TO A22a

DON’T KNOW d

REFUSED r

RESPONDENT HAS NOT HAD A JOB SINCE RA GO TO A22a

A21=1

A21a. How many times did you receive a job offer when working?

| | | NUMBER OF OFFERS

(0-25)

DON’T KNOW d

REFUSED r

ALL

A22a. Thinking about a typical month since [RA MONTH YEAR] when you were not working, how often did you [FILL WITH A-D]? Was it almost every day, a few times a week, a few times during the month, once or never?

INSTRUCTION: IF RESPONDENT SAYS THAT THEY WERE ALWAYS WORKING SINCE RANDOM ASSIGNMENT THEN CODE AS “I NEVER HAD A MONTH WHERE I DIDN’T WORK.”

I NEVER HAD A MONTH IN WHICH I DID NOT WORK 0 GO TO A22b

	CODE ONE RESPONSE PER ROW
	ALMOST EVERY DAY	A FEW TIMES A WEEK	A FEW TIMES DURING THE MONTH	ONCE	NEVER	DK	REF
a. Look for job openings	1	2	3	4	5	d	r
b. Submit a job application	1	2	3	4	5	d	r
c. Attend an interview	1	2	3	4	5	d	r

IF A2 OR A2a = 1

A22b. Thinking about a typical month since [RA MONTH YEAR] when you were working, how often did you [ FILL WITH A-D]? Was it almost every day, a few times a week, a few times during the month, once or never?

INSTRUCTION: IF RESPONDENT SAYS THAT THEY NEVER WORKED SINCE RANDOM ASSIGNMENT THEN CODE AS “I DIDN’T WORK AT ALL SINCE [RA MONTH YEAR].”

I DIDN’T WORK AT ALL SINCE [RA MONTH YEAR] 0 GO TO A22b

	CODE ONE RESPONSE PER ROW
	ALMOST EVERY DAY	A FEW TIMES A WEEK	A FEW TIMES DURING THE MONTH	ONCE	NEVER	DK	REF
a. Look for job openings	1	2	3	4	5	d	r
b. Submit a job application	1	2	3	4	5	d	r
c. Attend an interview	1	2	3	4	5	d	r

Now we are going to talk about some of things you might do because there wasn’t enough money.

ALL

A23. Since [RA MONTH YEAR], did you do any of the following because there wasn’t enough money?

	CODE ONE RESPONSE PER ROW
	YES	NO	DON’T KNOW	REFUSED
a. Cut the size of your meals or skip meals because you couldn’t afford enough food?	1	0	d	r
b. Move in with other people, even for a little while, because of financial problems?	1	0	d	r
c. Ask to borrow money from friends or family?	1	0	d	r
d. Go without a phone because you could not afford to pay the bill or buy extra cell phone minutes?	1	0	d	r
e. Took a payday loan or auto-title loan, or sold or pawned your belongings?	1	0	d	r
f. Thought about going to the doctor, dentist or hospital, but decided not to because of the cost?	1	0	d	r

all

The next question is about where you live.

A24. Do you currently own your home or apartment or have a mortgage, rent it, pay some amount toward rent, live rent free with a friend or relative, or do you have some other arrangement?

OWN OR HAVE MORTGAGE 1

RENT 2

PAY SOME OF THE RENT 3

LIVE RENT FREE (SOMEONE ELSE RENTS/OWNS HOUSE OR APARTMENT) 4

LIVE IN SHELTER 5

LIVE ON STREETS 6

LIVE IN ABANDONED BUILDING/CAR 7

OTHER (SPECIFY) 99

(STRING 250)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): What is the other arrangement?

ALL

B1. Now I am going to read you a list of things that some people find challenging in finding and keeping a good job.

Please tell me if the following has made it not at all hard, a little hard, somewhat hard, very hard, or extremely hard for you to find or keep a good job since [RA MONTH YEAR].

Would you say that [FILL a-g] made it not at all hard, a little hard, somewhat hard, very hard, or extremely hard for you to find or keep a good job in the past year?

INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-J

PROGRAMMER: CODE ONE PER ROW

CODE ONE RESPONSE PER ROW

	NOT AT ALL	A LITTLE	SOMEWHAT	VERY	EXTREMELY	DK	REF
a. Not having reliable transportation	1	2	3	4	5	d	r
b. Not having good enough childcare or family help	1	2	3	4	5	d	r
c. Not having the right clothes or tools for work	1	2	3	4	5	d	r
d. Not having the right skills or education	1	2	3	4	5	d	r
e. Having a criminal record	1	2	3	4	5	d	r
f. A lack of good jobs available in your area	1	2	3	4	5	d	r
g. Not being able to do certain kinds or amounts of work, training, or school work because of your health	1	2	3	4	5	d	r

ALL

B2a. Do you have a regular child care arrangement you can use so that you can go to a job, a job interview, school, or other appointment?

YES 1

NO 0

RESPONDENT SAYS THAT THEY DON’T NEED CHILD CARE 2 GO TO B3

DON’T KNOW d

REFUSED r

B2a=1

B2b. Now I would like to talk about backup child care arrangements. If your child care falls through would you say that you always, very often, sometimes, rarely or never have a backup child care arrangement?

ALWAYS 1

VERY OFTEN 2

SOMETIMES 3

RARELY 4

NEVER 5 GO TO B3

DON’T KNOW d

REFUSED r

B2b=1

B2c. How many backup child care arrangements do you have?

| | | NUMBER

(0-50)

DON’T KNOW d

REFUSED r

ALL

B3. Are you unable to do certain kinds or amounts of work, training, or school work because of [FILL A-C]?

	CODE ONE RESPONSE PER ROW
	YES	NO	DK	REF
a. A physical disability or illness	1	0	d	r
b. An emotional or mental health problem	1	0	d	r
c. A learning disability	1	0	d	r

ALL

B4. Do you currently have a valid driver’s license? By valid we mean that it not expired, and has not been suspended or taken away.

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

B4a. Since [RA MONTH YEAR], have you ever not been able to apply to a job because you didn’t have a valid driver’s license?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL; IF A2=1 THEN DO NOT ASK B

B5. Please tell me if you strongly disagree, disagree, agree, or strongly agree with the following statements or if you never had an employment goal.

CODE ONE RESPONSE PER ROW

	STRONGLY DISAGREE	DISAGREE	AGREE	STRONGLY AGREE	NEVER HAD EMPLOYMENT GOAL	DK	REF
a. I know I need to get a job or a better job and really think I should work on finding one.	1	2	3	4		d	r
b. I guess being out of work is not good, but there is nothing I can do about it right now.	1	2	3	4		d	r
c. I set employment goals based on what is important to me or my family .	1	2	3	4	5	d	r
d. I set long-term employment goals that I hope to achieve (such as finding a job, finding a better job, getting promoted, or enrolling in further education).	1	2	3	4	5	d	r
e. I set specific short-term goals that will allow me to achieve my long-term employment goals.	1	2	3	4	5	d	r
f. Based on everything I know about myself, I believe I can achieve my employment goals.	1	2	3	4	5	d	r
g. When I set employment goals, I think about barriers that might get in my way and make specific plans for overcoming those barriers.	1	2	3	4	5	d	r
h. Even when I face challenges, I continue to pursue my employment goals.	1	2	3	4	5	d	r
i. I keep track of my overall progress toward my long-term employment goals and adjust my plans if needed.	1	2	3	4	5	d	r

B5c-g: Noonan, P.M., & Gaumer Erickson, A.S. (2017). The skills that matter: Teaching intrapersonal and interpersonal competencies in any classroom. Thousand Oaks, CA: Corwin.

ALL

B6.1. During the past month, how often has each of the following behaviors been a problem? Would you say that the following behaviors have been a problem never, sometimes, or often?

**NOTE: The specific wording of items B6.1a-l and B6.2a-h are not shown on this copy of the survey because the items are adapted and reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549. Further reproduction is prohibited without permission by PAR, Inc.

CODE ONE RESPONSE PER ROW

For Review Only, Do NOT Copy	NEVER	SOMETIMES	OFTEN	DK	REF
a. Item 25 **SEE NOTE ABOVE	0	1	2	d	r
b. Item 49	0	1	2	d	r
c. Item 52	0	1	2	d	r
d. Item 6	0	1	2	d	r
e. Item 71	0	1	2	d	r
f. Item 75	0	1	2	d	r
g. Item 24	0	1	2	d	r
h. Item 53	0	1	2	d	r
i. Item 9	0	1	2	d	r
j. Item 15 -edited	0	1	2	d	r
k. Item 63 - edited	0	1	2	d	r
l. Item 2	0	1	2	d	r

B6.2. During the past month, how often has each of the following behaviors been a problem? Would you say that the following behaviors have been a problem never, sometimes, or often?

CODE ONE RESPONSE PER ROW

For Review Only, Do NOT Copy	NEVER	SOMETIMES	OFTEN	DK	REF
a. Item 28	0	1	2	d	r
b. Item 69	0	1	2	d	r
c. Item 1	0	1	2	d	r
d. Item 72	0	1	2	d	r
e. Item 23.	0	1	2	d	r
f. Item 50	0	1	2	d	r
g. Item 64	0	1	2	d	r
h. Item 70 -edited	0	1	2	d	r

Reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc. (PAR), 16204 North Florida Avenue, Lutz, Florida 33549, from the Behavior Rating Inventory of Executive Function-Adult Version by Robert M. Roth, PhD, Peter K. Isquith, PhD and Gerard A. Gioia, PhD, Copyright 1996, 1998, 2001, 2003, 2004, 2005 by PAR. Further reproduction is prohibited without permission from PAR.
For Review Only, Do NOT Copy

ALL

B7. Since [RA MONTH YEAR], how often have you [FILL A-F] ? Would you say every day or almost every day, a few times a week, a few times a month, about once a month, only a few times, or hardly ever or never?

CODE ONE RESPONSE PER ROW

		A FEW TIMES A WEEK	A FEW TIMES A MONTH	ABOUT ONCE A MONTH	HARDLY EVER OR NEVER		DK	REF
a. Lost your temper with someone other than friends or family.		1	2	3	4		d	r
b. Said something that you later regretted to someone other than friends or family.		1	2	3	4		d	r
c. Decided not to apply for a job because you didn’t think you would get an interview.		1	2	3	4		d	r
d. Overcame a barrier that could have prevented you from finding or keeping a job.		1	2	3	4		d	r
e. Been late for a job, interview, program meeting, class, or training session.		1	2	3	4		d	r
f. Missed an appointment related to work, looking for a job, a program, school, or training for a reason other than you were sick or ill.		1	2	3	4		d	r

ALL

B8. Next, I’m going to read a list of opinions people have about themselves. After I read each one, I want you to tell me whether you strongly disagree, disagree, agree, or strongly agree.

CODE ONE RESPONSE PER ROW

	STRONGLY DISAGREE	DISAGREE	AGREE	STRONGLY AGREE	DK	REF
a. I am able to do things as well as most people.	1	2	3	4	d	r
b. I certainly feel useless at times.	1	2	3	4	d	r
c. All in all, I tend to feel that I am a failure.	1	2	3	4	d	r

Now we are going to ask you about services you may have received to help you find a job or advance in your career.

ALL

C1a. Since [RA MONTH YEAR], have you attended any workshops or classes that provided instruction on how to find a job? These may have provided help with things such as resume writing, interviewing, and networking.

YES 1

NO 2 GO TO C2

DON’T KNOW d GO TO C2

REFUSED r GO TO C2

C1a=1

C1b. Since [RA MONTH YEAR], about how many times did you attend workshops or classes that focused on finding a job? Did you attend a workshop or class once, twice, 3 to 5 times, 6 to 10 times, 11 to 20 times, or more than 20 times?

Your best estimate is fine.

Once 1

Twice 2

3 to 5 times 3

6 to 10 times 4

11 to 20 times 5

More than 20 times 6

DON’T KNOW d

REFUSED r

ALL

C2. We are interested in learning if you met one-on-one with someone to receive assistance in finding a job or advancing your career. By one-on-one assistance, we mean meeting with someone whose job it is to help you find a job. This assistance may have been provided by a coach, case manager, counselor, or some other type of worker. It could have been in-person or by phone.

Since [RA MONTH YEAR] have you met one-on-one with someone to receive job assistance?

YES 1

NO 2 GO TO C5

DON’T KNOW d GO TO C5

REFUSED r GO TO C5

C2=1

C3a. When did you start receiving one-on-one job assistance? Your best guess is fine.

| | | / | | | | |

MONTH YEAR

(1-12) (2000-2021)

DON’T KNOW d

REFUSED r

C2=1

C3b. When did you stop receiving the one-on-one job assistance? Your best guess is fine.

| | | / | | | | |

MONTH YEAR

(1-12) (2018-2021)

Currently receive job assistance 1

DON’T KNOW d

REFUSED r

C2=1

IF C3b=1, fill “do”

if C3b ne 1, fill “did”

C3c. How regularly [did/do] you receive one-one-one job assistance since [RA MONTH YEAR]? Was it weekly, every two weeks, twice a month, monthly, quarterly, annually, or something else?

WEEKLY 1

EVERY 2 WEEKS (BI-WEEKLY) 2

TWICE A MONTH 3

MONTHLY 4

QUARTERLY 5

ANNUALLY 6

OTHER (SPECIFY) 7

___________________________________________ (STRING (100))

DON’T KNOW d

REFUSED r

C2=1

C3d. How many times did you receive the one-on-one job assistance since [RA MONTH YEAR]? Your best guess is fine.

| | | | TIMES

(0-500)

DON’T KNOW d

REFUSED r

C2=1IF C2b=1, fill “are”

if C3b ne 1, fill “were”

C3e. On average, how long [are/were] each of these one-on-one meetings? Your best estimate is fine.

LESS THAN 15 MINUTES 1

15 MINUTES TO 30 MINUTES 2

30 MINUTES TO AN HOUR 3

MORE THAN ONE HOUR 4

DON’T KNOW d

REFUSED r

DO NOT ASK IF C3d = DK/REF

C3f. Now thinking about the [FILL FROM C3d] times when you received one-on-one job assistance, how many different coaches, case managers, counselors, or other type of workers did you work with?

| | | | Coaches/Case Managers/Counselors/Other type of workers

(0-500)

DON’T KNOW d

REFUSED r

C3f > 1

C3g. How many different organizations provided this one-on-one job assistance to you?

| | | | Organizations

(0-500)

DON’T KNOW d

REFUSED r

C2=1

C4. What type of one-on-one job assistance did you receive? Did someone help you…

	CODE ONE RESPONSE PER ROW
	YES	NO	DK	REF
a. Set a short-term goal	1	0	d	r
b. Set a long-term goal	1	0	d	r
c. Make a plan to achieve your goal	1	0	d	r
d. Be on time for appointments	1	0	d	r
e. Be more organized	1	0	d	r
f. Be calmer in stressful situations	1	0	d	r
g. Get along with others	1	0	d	r
h. Any other type of assistance? (SPECIFY)	1	0	d	r
______________________________ STRING (100)

ALL

C5. Since [RA MONTH YEAR], did any coach, case manager, counselor, or other type of worker provide you with names of employers who were interviewing, or set up interviews with employers for you?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

C6. Since [RA MONTH YEAR], did you complete any career assessments to find out what types of jobs would be good for you? A career assessment may be used to help identify a career that is right for you based on your interests and skills.

YES 1

NO 0

DON’T KNOW d

REFUSED r

The next questions ask you about your participation in education and training programs.

ALL

C7. Since [RA MONTH YEAR], did you participate in any education programs? This includes adult basic education or GED courses, English as a Second Language classes, online courses, and college or other types of school. Do not include training programs to develop skills for a particular job or occupation or any other work experience in which all or part of your wages were paid for by a program.

YES 1

NO 0 GO TO C8

DON’T KNOW d GO TO C8

REFUSED r GO TO C8

C7 = 1

C7a. Are you participating in the program now?

YES 1 GO TO C8

NO 0 GO TO C7B

DON’T KNOW d GO TO C7B

REFUSED r GO TO C7B

C7A ne 1

C7b. Did you complete the program?

YES 1 GO TO C7C

NO 0 GO TO C8

DON’T KNOW d GO TO C7C

REFUSED r GO TO C7C

C7A ne 1 AND C7B NE 2

C7c. Did you receive a diploma or degree from the program?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

C8. Since [RA MONTH YEAR], did you participate in any training programs to develop skills for a particular job or occupation? These are sometimes called vocational training programs. Do not include training programs provided by your employer.

YES 1 GO TO C8A

NO 0 GO TO C9

DON’T KNOW d GO TO C9

REFUSED r GO TO C9

C8 = 1

C8a. Are you participating in the program now?

YES 1 GO TO C9

NO 0 GO TO C8B

DON’T KNOW d GO TO C8B

REFUSED r GO TO C8B

C8a= NE 1

C8b. Did you complete the program?

YES 1 GO TO C8C

NO 0 GO TO C9

DON’T KNOW d GO TO C8C

REFUSED r GO TO C8C

C8A ne 1 AND C8B NE 2

C8c. Did you receive a certificate, license, or diploma from the program?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

FILL WITH LOCAL PROGRAM NAME

C9. Since [RA MONTH YEAR], did you participate in a work experience program in which all or part of your wages were paid for by a program like TANF or [other local program]? This type of work experience program is usually temporary. Its goal is to help the workers develop skills so that they can obtain a job in which the employer pays all the wages. Sometimes this work experience is called subsidized employment, supported work, or transitional employment.

YES 1 GO TO C9A

NO 2 GO TO C10

DON’T KNOW d GO TO C10

REFUSED r GO TO C10

C9=1

C9a. Are you currently participating in this work experience?

YES 1 GO TO C9B

NO 2 GO TO C9B

DON’T KNOW d GO TO C10

REFUSED r GO TO C10

IF C9A=1 OR 2

IF c9a=1, fill “have you participated”

if c9a=0, fill “did you participate”

C9b. How many weeks [did you participate/have you participated] in this work experience?

INSTRUCTION: IF THE RESPONDENT PROVIDES THE NUMBER OF MONTHS THEN PROBE FOR THE NUMBER OF WEEKS.

| | | NUMBER OF WEEKS

(0 – 99)

DON’T KNOW/DON’T REMEMBER d

REFUSED r

ALL

C10. The next questions are about other services you may have received. Since [RA MONTH YEAR] did you receive…

CODE ONE RESPONSE PER ROW
	YES	NO	DON’T KNOW	REFUSED
a. Childcare assistance including vouchers or funds	1	0	d	r
b. Transportation assistance (such as gas cards or bus passes)	1	0	d	r
c. Clothes, uniforms, tools or other supplies and equipment	1	0	d	r
d. Tuition assistance	1	0	d	r
e. Assistance finding stable housing	1	0	d	r
f. Assistance with budgeting, credit, banking, or other financial matters	1	0	d	r
g. Assistance expunging a criminal record or other legal assistance	1	0	d	r
h. Help related to domestic violence	1	0	d	r
i. Help with marital and other family relationships	1	0	d	r
j. Help with child behavioral issues	1	0	d	r
k. Cash or a gift card	1	0	d	r

ALL

C11. Since [RA MONTH YEAR], did you receive alcohol, drug, or other substance abuse counseling?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

C12. Since [RA MONTH YEAR], did you receive mental health treatment?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

C13. Since [RA MONTH YEAR], did you receive any services to help with stress reduction or other approaches to improve your emotional well-being?

YES 1

NO 0

DON’T KNOW d

REFUSED r

I would like to ask you a few questions about your experience with the criminal justice system. As a reminder, nothing you tell us will be shared or affect the services you receive.

ALL

D1. Have you ever been convicted of a crime?

YES 1 GO TO D2a

NO 0 GO TO D4

DON’T KNOW d GO TO D4

REFUSED r GO TO D4

D1=1

D2a. Were you ever convicted of a crime before [RA MONTH YEAR]?

YES 1 GO TO D2b

NO 0 GO TO D3a

DON’T KNOW d GO TO D3a

REFUSED r GO TO D3a

D2a=1

D2b. Were you convicted of a felony before [RA MONTH YEAR]?

YES 1

NO 0

DON’T KNOW d

REFUSED r

D1=1

D3a. Were you ever convicted of a crime after [RA MONTH YEAR]?

YES 1 GO TO D3b

NO 0 GO TO D4

DON’T KNOW d GO TO D4

REFUSED r GO TO D4

D3a=1

D3b. Were you convicted of a felony after [RA MONTH YEAR]?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

D4. What is the highest level of education you have completed?

INTERVIEWER: IF RESPONDENT SAYS “HIGH SCHOOL,” PROBE: Did you receive a diploma or GED?

CODE ONE ONLY

DID NOT COMPLETE HIGH SCHOOL OR GED 1

HIGH SCHOOL: DIPLOMA (NOT GENERAL EDUCATION DEVELOPMENT OR GED) 2

GENERAL EDUCATION DEVELOPMENT OR GED 3

SOME COLLEGE BUT NO DEGREE 4

2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE) 5

4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) 6

GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D., JD, MD) 7

NEVER ATTENDED SCHOOL 8

DON’T KNOW d

REFUSED r

All

D5. What is your current marital status—are you now married, separated, divorced, widowed, or have you never been married?

CODE ONE ONLY

MARRIED 1

SEPARATED 2

DIVORCED 3

WIDOWED 4

NEVER MARRIED 5

DON’T KNOW d

REFUSED r

Now I would like to ask you some questions about people who live with you.

All

D6. How many adults age 18 or older, currently live in your household at least half the time? Please include yourself.

| | | ADULTS

(1-99)

INTERVIEWER: IF THE RESPONDENT SAYS “0” THEN REMIND THEM THAT THEY SHOULD INCLUDE THEMSELVES IN THIS TOTAL.

DON’T KNOW d

REFUSED r

All

D7. How many children under age 18 live with you at least half the time? This includes biological, adopted, foster, step, and any other children.

| | | CHILDREN

(0-99)

DON’T KNOW d

REFUSED r

All

D8. Were you born in the…

United States, 1

Or some other country? 2

DON’T KNOW d

REFUSED r

We are almost finished. I just have a few more questions. These will help us contact you if we need to reach you in the future. We will only use this information if we cannot reach you with the other information you provided us.

all

E1. What is your current address?

PROBE: Is there an apartment number?

PROBE: This is where we will mail your gift card.

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

all

E2. Do you have a current home telephone number?

YES 1

NO 0 GO TO E4

DON’T KNOW d GO TO E4

REFUSED r GO TO E4

E2=1

E3. What is your current home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

DON’T KNOW d

REFUSED r

all

E4. Do you have a cell phone?

YES 1

NO 0 GO TO E7

DON’T KNOW d GO TO E7

REFUSED r GO TO E7

E4=1

E4a. What is your cell phone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

DON’T KNOW d

REFUSED r

E4a=NE d or r

E5. Is it okay for us to text you at this number? Message and data rates may apply.

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

E6. What is another phone number where you can be reached?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

NO OTHER NUMBER 1

DON’T KNOW d

REFUSED r

E6 HAS COMPLETE PHONE NUMBER ENTERED

E6a. Is this number, [E6], for a cell phone?

YES 1

NO 0

DON’T KNOW d

REFUSED r

E6a=1

E6b. Is it okay for us to text you at this number? Message and data rates may apply.

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

E7. What is your email address?

INTERVIEWER: ENTER E-MAIL ON NEXT SCREEN

(STRING 50)

DON’T HAVE ONE 0

DON’T KNOW d

REFUSED r

ALL

E8a. We would like to contact you in about a year to see how you are doing. In case we have trouble reaching you, we would like to have the names of three people who would most likely know where you are or who you keep in close contact with, such as a grandmother or grandfather, other relative, or friend. We will not contact these people for any other reason.

What is the full name of the first person we should contact?

(STRING 50)

FIRST NAME

(STRING 50)

MIDDLE INITIAL/NAME

(STRING 50)

LAST NAME

DON’T KNOW d GO TO END1

REFUSED r GO TO END1

E8a NE d OR r

E8b. What is (his/her) address?

PROBE: Is there an apartment number?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

E8a NE d OR r

E8c. What is (his/her) relationship to you?

SPOUSE/PARTNER 1

MOTHER 2

FATHER 3

SISTER/BROTHER 4

GRANDMOTHER/GRANDFATHER 5

SON/DAUGHTER 6

FRIEND 7

OTHER (SPECIFY) 99

_____________________________ (STRING 50)

DON’T KNOW d

REFUSED r

E8a NE d OR r

E8d. What is (his/her) home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

NO LANDLINE 0

DON’T KNOW d

REFUSED r

E8a NE d OR r

E8e. Does (he/she) have a cell phone?

YES 1

NO 0 GO TO E8g

DON’T KNOW d GO TO E8g

REFUSED r GO TO E8g

E8e=1

E8f. Can I have that number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

DON’T KNOW d

REFUSED r

E8 NE d OR r

E8g. What is (his/her) work telephone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

NO WORK NUMBER 0

DON’T KNOW d

REFUSED r

E8a NE d OR r

E8h. What is (his/her) email address?

INTERVIEWER: ENTER E-MAIL ON NEXT SCREEN

(STRING 50)

EMAIL ADDRESS

DOESN’T HAVE ONE 0 GO TO E8j

DON’T KNOW d GO TO E8j

REFUSED r GO TO E8j

E8H NE 0, d, OR r

E8i. Does (he/she) have another email address?

INTERVIEWER: ENTER E-MAIL ON NEXT SCREEN

(STRING 50)

EMAIL ADDRESS

DON’T KNOW d

REFUSED r

SECOND CONTACT

E8a NE d OR r

E9a. What is the full name of the second person we should contact?

(STRING 50)

FIRST NAME

(STRING 50)

MIDDLE INITIAL/NAME

(STRING 50)

LAST NAME

DON’T KNOW d GO TO END1

REFUSED r GO TO END1

E9a NE d OR r

E9b. What is (his/her) address?

PROBE: Is there an apartment number?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

E9a NE d OR r

E9c. What is (his/her) relationship to you?

SPOUSE/PARTNER 1

MOTHER 2

FATHER 3

SISTER/BROTHER 4

GRANDMOTHER/GRANDFATHER 5

SON/DAUGHTER 6

FRIEND 7

OTHER (SPECIFY) 99

_____________________________ (STRING 50)

DON’T KNOW d

REFUSED r

E9a NE d OR r

E9d. What is (his/her) home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

NO LANDLINE 0

DON’T KNOW d

REFUSED r

e9a NE d OR r

E9e. Does (he/she) have a cell phone?

YES 1

NO 0 GO TO E9g

DON’T KNOW d GO TO E9g

REFUSED r GO TO E9g

E9E=1

E9f. Can I have that number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

DON’T KNOW d

REFUSED r

E9a NE d OR r

E9g. What is (his/her) work telephone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

NO WORK NUMBER 0

DON’T KNOW d

REFUSED r

E9a NE d OR r

E9h. What is (his/her) email address?

(STRING 50)

EMAIL ADDRESS

DOESN’T HAVE ONE 0 GO TO E9j

DON’T KNOW d GO TO E9j

REFUSED r GO TO E9j

E9h NE 0, d, or R

E9i. Does (he/she) have another email address?

(STRING 50)

EMAIL ADDRESS

DON’T KNOW d

REFUSED r

THIRD CONTACT

E9a NE d OR r

E10a. What is the full name of the third person we should contact?

(STRING 50)

FIRST NAME

(STRING 50)

MIDDLE INITIAL/NAME

(STRING 50)

LAST NAME

DON’T KNOW d GO TO END1

REFUSED r GO TO END1

E10a NE d OR r

E10b. What is (his/her) address?

PROBE: Is there an apartment number?

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP

DON’T KNOW d

REFUSED r

E10a NE d OR r

E10c. What is (his/her) relationship to you?

SPOUSE/PARTNER 1

MOTHER 2

FATHER 3

SISTER/BROTHER 4

GRANDMOTHER/GRANDFATHER 5

SON/DAUGHTER 6

FRIEND 7

OTHER (SPECIFY) 99

_____________________________ (STRING 50)

DON’T KNOW d

REFUSED r

E10a NE d OR r

E10d. What is (his/her) home telephone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

NO LANDLINE 0

DON’T KNOW d

REFUSED r

E10a NE d OR r

E10e. Does (he/she) have a cell phone?

YES 1

NO 0 GO TO E10g

DON’T KNOW d GO TO E10g

REFUSED r GO TO E10g

E10e=1

E10f. Can I have that number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

DON’T KNOW d

REFUSED r

E10a NE d OR r

E10g. What is (his/her) work telephone number?

| | | | - | | | | -| | | | | TELEPHONE

(201-989) (200-999) (0000-9999)

NO WORK NUMBER 0

DON’T KNOW d

REFUSED r

E10a NE d OR r

E10h. What is (his/her) email address?

INTERVIEWER: ENTER E-MAIL ON NEXT SCREEN

(STRING 50)

EMAIL ADDRESS

DOESN’T HAVE ONE 0 GO TO E10j

DON’T KNOW d GO TO E10j

REFUSED r GO TO E10j

E10h NE 0, d, OR r

E10i. Does (he/she) have another email address?

INTERVIEWER: ENTER E-MAIL ON NEXT SCREEN

(STRING 50)

EMAIL ADDRESS

DON’T KNOW d

REFUSED r

interview completed

FILL $35 UP TO FOUR WEEKS AFTER RELEASE DATE OTHERWISE FILL $25

FILL $50 IF PROGRAM = FADSS, JEFFCO, LIFT, WORK SUCCESS

END1. Thank you very much for your time. Those are all the questions I have right now. You will receive a [$35/$25/$50] gift card as a token of our appreciation. Thank you for your participation in the study.

If MakeDialphone=5

END2. Please hand the phone back to our field locator.