OMB Number: 0970-0033
Expiration Date: [XX/XX/XXXX]
ANNUAL SURVEY OF REFUGEES
SURVEY QUESTIONNAIRE
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to learn how refugees adapt to life in the U.S. Public reporting burden for this collection of information is estimated to average 48 minutes per respondent, including any time you needed to collect information to be able to answer our questions. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact Office of Refugee Resettlement at asr@acf.hhs.gov.
ANNUAL SURVEY OF REFUGEES
SURVEY QUESTIONNAIRE
S1. Hi. I’m ________, calling from SSRS, a research company, about a study sponsored by the Office of Refugee Resettlement. How are you today? We are doing a study about refugees’ adjustment to life in the United States.
Is this (INSERT NAME FROM SAMPLE)?
(INTERVIEWER: If respondent not on phone, ask “May I speak with him/her?”. Repeat intro if respondent comes to phone.)
1 Respondent is on the phone [CONTINUE TO S2]
2 Respondent is not available right now [SET UP CALLBACK]
3 Respondent no longer lives here [CONTINUE TO S1a]
9 (DO NOT READ) Refused [THANK & TERM]
(ASK IF S1=3)
S1A. Do you have a phone number where I can reach (INSERT NAME FROM SAMPLE)?
___________ [Enter new telephone number]
9 (DO NOT READ) Don’t know/Refused
(ASK IF S1=1 AND CELL SAMPLE)
'CELL1' [CELL2]. Have I reached you on a cell phone?
1 Yes
2 No
9 REFUSED
(ASK IF CELL1=1, 9)
'CELL2' [CELL2]. Are you driving right now?
1 Yes
2 No
9 REFUSED
(ASK IF CELL2=1, 9 CELL SAMPLE AND DRIVING OR REFUSED)
'CELL3' [CELL3]. When would be a better time to call you?
[IF RESPONDENT INDICATES THAT THEY ARE WILLING TO TALK NOW: “I’m sorry, but for your safety we’re not able to do the interview while you’re driving. When would be a better time to call you?”] [SET CALLBACK]
(ASK IF S1=1)
S2. Yes, good (morning/afternoon/evening)!
(INTERVIEWER -- If necessary, confirm the person’s full name and verify age or date of birth)
Great! Hopefully you recently received a letter from us telling you about the survey. And just to confirm, did you enter the US since [CURRENT FY-5] as a refugee?
1 Respondent is a refugee [CONTINUE TO S3]
2 Respondent not a refugee [THANK & TERM]
9 (DO NOT READ) Don’t know/Refused [THANK & TERM]
(ASK IF S2=1)
S3. Ok, thank you. And to confirm, is your date of birth (INSERT DATE OF BIRTH FROM SAMPLE).
1 Confirmed date of birth [CONTINUE TO INTRO]
2 Confirmed year but not month [CONTINUE TO INTRO]
3 Confirmed month but not year [CONTINUE TO S3a]
4 Incorrect month and year [CONTINUE TO S3b]
9 (DO NOT READ) Refused [INTERVIEWER: IF RESPONDENT REFUSES ONCE, READ PROBE FROM Q*Q. IF STILL REFUSED CONTINUE WITH THE SURVEY]
(ASK IF S3=3)
S3A. What is your age?
INTERVIEWER: PLEASE ENTER AGE AS A 3 DIGIT CODE. FOR INSTANCE 003, 016, 078..ETC.)
1 [ENTER AGE]
9 (DO NOT READ) Refused [INTERVIEWER: IF RESPONDENT REFUSES ONCE, READ PROBE FROM Q*Q. IF STILL REFUSED CONTINUE WITH THE SURVEY]
[PN: IF AGE GIVEN AT S3A IS WITHIN 5 YEARS OF SAMPLE AGE, CONTINUE TO INTRO. IF OUTSIDE OF 5 YEARS, ASK S3B.]
[PN: TO CALCULATE SAMPLE AGE, USE: (Current date – Arrival date) + Age at arrival]
(ASK IF S3=4 OR S3A= MORE THAN 5 YEARS FROM SAMPLE AGE)
S3B. What year did you arrive in the U.S.?
(DO NOT READ: Year of arrival: [INSERT YEAR OF ARRIVAL FROM SAMPLE])
1 Confirmed year of arrival [CONTINUE TO INTRO]
2 Unable to confirm year of arrival [THANK & TERM]
9 (DO NOT READ) Refused [INTERVIEWER: IF RESPONDENT REFUSES ONCE, READ PROBE FROM Q*Q. IF STILL REFUSED CONTINUE WITH THE SURVEY]
IF S3A<18 OR ‘AGE’ FROM SAMPLE <18 PLEASE ASK MINOR
MINOR. May I speak with your parent or guardian?
Yes
No [END INTERVIEW AND DISPO AS INITIAL REFUSAL]
Parent/Guardian is not available right now [SET UP CALLBACK]
9 (DO NOT READ) Refused [THANK & TERM]
IF MINOR=1
WHEN PARENT/GUARDIAN COME TO THE PHONE PLEASE READ
PARENT. Hi. I’m ________ calling on behalf of the Office of Refugee Resettlement, how are you today? We are doing a study about refugees’ adjustment to life in the United States.
Can you answer questions on behalf of (INSERT NAME FORM SAMPLE)?
Yes
No [DISPO AS INITIAL REFUSAL]
9 (DO NOT READ) Refused [DISPO AS INITIAL REFUSAL]
CREATE ‘PROXY’ VARIABLE AND ASSIGN CODE 1 IF PARENT =1.
PROGRAMMER: IF PROXY =1 PLEASE DISPAY ‘PROXY’ ON THE TOP OF THE SCREEN
INTERVIEWER: PLEASE EDIT INTRODUCTION TEXT AS NECESSARY
INTRO. We would like you to be in a voluntary study about how refugees adapt to life in the U.S. It is funded by the Office of Refugee Resettlement and being conducted by two research organizations, the Urban Institute and SSRS.
We would like to ask some questions about your education and work and any help you are getting from the government. It takes up to 48 minutes, but it’s sometimes shorter and we will send you a $25 gift card to thank you for participating.
Before we start we just need to tell you a few things. You don’t have to answer any questions you don’t want to answer and you can stop the interview at any time. The answers you give will be private and will not have your name on them. Federal law keeps your answers private. You will continue to receive social services and benefits regardless of your decision to participate in the study.
Your responses will be combined with others and used in a report to the U.S. Congress. The data without your name will be stored for future research.
Finally, there is little risk associated with your participation because of the care we are taking to keep your name and your answers safe. There are no direct benefits to you, but you will be helping the Office of Refugee Resettlement understand what refugees like you are going through.
Also, a federal 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 number for this information collection is 0970-0033 and the expiration date is [TBD].
If you have any comments about how long this survey took or any other aspect of this survey, including suggestions for how to reduce the time needed, you can send comments to the Office of Refugee Resettlement at asr@acf.hhs.gov.
Do you have any questions about the study or the interview?
Do you agree to be interviewed?
01 YES [INTERVIEWER: IF YES, THANK AND CONTINUE]
02 NO [INTERVIEWER: IF NO, SAY “Ok, thank you for considering.” AND
TERMINATE]
INTRO1a. Next, we would like to ask your permission to record this interview. This is also voluntary. It will help us to get all the information and feedback you provide. We will destroy the recording after this study is completed.
Do we have your permission to record the interview?
01 YES [INTERVIEWER: IF YES, THANK AND CONTINUE]
02 NO [INTERVIEWER: IF NO, SAY “Ok, we will not record this interview.” AND CONTINUE. (DO NOT RECORD)
[PN: IF INTRO1a=01 TURN ON RECORDING FOR INTERVIEW, IF INTRO1a=02, DO NOT RECORD]
Now let’s begin.
BEGIN: We would like to start by asking you a few questions about each person who lives in your home, or who is staying or visiting there and has no other home.
(ASK ALL)
[PN: ALLOW UP TO 15 NAMES TO BE ENTERED.]
Q1. Including yourself, how many people are living or staying at this address? Please include family members as well as others not related to you who live in your home.
Enter Number: ________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q1>1, 98, 99)
Q1A. Not counting you, start with your oldest family members and tell me the names of each person who lives there. PROBE: Are there other family members? Who else?
AFTER FAMILY MEMBERS ARE LISTED, PROBE: Who are the people that live here who are not your family members? (Who else?)
(INTERVIEWER: If respondent does not want to provide names of household members, tell them we are only using the name to refer to the correct person in later questions. Just a first name or initials are fine.)
(PROBE: ARE THERE OTHER PERSONS WHO USUALLY LIVE HERE BUT ARE TEMPORARILY ABSENT?)
01 [AUTO-POPULATE RESPONDENT NAME]
02 [RECORD HH MEMBER #2 IF APPLICABLE]
03 [RECORD HH MEMBER #3 IF APPLICABLE]
04 [RECORD HH MEMBER #4 IF APPLICABLE]
05 [RECORD HH MEMBER #5 IF APPLICABLE]
06 [RECORD HH MEMBER #6 IF APPLICABLE]
07 [RECORD HH MEMBER #7 IF APPLICABLE]
08 [RECORD HH MEMBER #8 IF APPLICABLE]
09 [RECORD HH MEMBER #9 IF APPLICABLE]
10 [RECORD HH MEMBER #10 IF APPLICABLE]
11 [RECORD HH MEMBER #11 IF APPLICABLE]
12 [RECORD HH MEMBER #12 IF APPLICABLE]
13 [RECORD HH MEMBER #13 IF APPLICABLE]
14 [RECORD HH MEMBER #14 IF APPLICABLE]
15 [RECORD HH MEMBER #15 IF APPLICABLE]
99 (DO NOT READ) NO OTHER HH MEMBERS
[PN: ASK Q2 for each member named in Q1a, including the respondent. COLLECT Q2 FOR ALL HH MEMBERS BEFORE MOVING TO Q3]
[PN: AUTOPOPULATE Q2(a) WITH CODE 01 – SELF]
Q2(a-o). What is (INSERT NAME)’s relationship to you?
(DO NOT READ LIST)
01 Self
02 Husband or wife
03 Unmarried partner
04 Biological son or daughter
05 Adopted son or daughter
06 Stepson or stepdaughter
07 Brother or sister
08 Father or mother
09 Grandchild
10 Parent-in-law
11 Son-in-law or daughter-in-law
12 Foster child
13 Other relative
14 Roomer or boarder
15 Housemate or roommate
16 Other non-relative
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(FOR ONLY THOSE WITH Q2(a-o)=01-13, I.E., FAMILY MEMBERS, ASK Q3 TO Q4B BEFORE MOVING TO Q5)
Q3(a-o). Now we’d like to get some information on your family living with you. [Are you/Is (INSERT NAME)] male or female?
(INTERVIEWER: CONFIRM BASED ON NAME; PROBE AS APPROPRIATE AND EXPLAIN NEED FOR ASKING THIS QUESTION]
01 Male
02 Female
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q4A(a-o). What is (your/INSERT NAME)’s age?
(INTERVIEWER: Please report babies as age 0 when the child is less than 1 year old)
___________ [RANGE 1-110]
000 Less than one year
998 (DO NOT READ) Don’t know
999 (DO NOT READ) Refused
(ASK ALL)
Q4B(a-o). What is (your/INSERT NAME)’s date of birth?
1 ENTER 2-DIGIT MONTH
2 ENTER 2-DIGIT DAY
3 ENTER 4-DIGIT YEAR
8 (DO NOT READ) Don’t know
9 (DO NOT READ) Refused
[PN: STARTING WITH RESPONDENT, ASK Q5 THROUGH Q14 FOR EACH FAMILY MEMBER in Q2 (if Q2a-o<14).]
(IF Q4 = AGE 15 OR OLDER AND NOT ALREADY COMMUNICATED ABOVE IN RELATIONSHIP) IFQ2=2 AUTOPOPULATE AS CODE 1
Q5(a-o). What is (your/INSERT NAME)’s current marital status?
(DO NOT READ LIST)
[INTERVIEWER: CONSIDER CULTURAL KNOWLEDGE TO DETERMINE WHETHER THIS IS AN APPROPRIATE QUESTION ABOUT EACH HOUSEHOLD MEMBER]
01 Now married, spouse living in household
02 Now married, spouse not living in household
03 Divorced or separated
04 Never married
05 Widowed
97 Other (SPECIFY) _______________
96 (DO NOT READ) Culturally inappropriate to ask of household member
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
[PN: START WITH RESPONDENT, ASK Q6 TO Q11; THEN AUTO-POPULATE AS APPROPRIATE FOR FAMILY MEMBERS Q2(a-o)<14 USING RESPONDENT’S RESPONSES]
Q6(a-o). What is (YOUR/INSERT NAME)’s country of birth?
[INTERVIEWER: CODE 1 CANNOT BE USED FOR THE PA RESPONDENT (BECAUSE THEN THEY WOULD NOT BE A REFUGEE)]
(DO NOT READ LIST)
01 United States
02 Afghanistan
03 Bhutan
04 Burma
05 Burundi
06 Cuba
07 Democratic Republic of the Congo
08 Eritrea
09 Ethiopia
10 Iran
11 Iraq
12 Jordan
13 Kenya
14 Malaysia
15 Nepal
16 Rwanda
17 Somalia
18 Sudan
19 Syria
20 Tanzania
21 Thailand
22 Uganda
23 Ukraine
97 Other (SPECIFY) _______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q6=2-24)
[PN: IF Q6_1=1 DO NOT ASK Q6(B-O). IF Q6_1=2-99 ASK Q6(B-O) FOR REMAINING FAMILY MEMBERS]
Q6_1. Were all family members of this household born in [INSERT COUNTRY NAME FROM Q6]?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[PN: IF YES TO Q6_1 (Q6_1=1), THEN AUTOPOPULATE Q6 FOR ALL FAMILY MEMBERS AND DO NOT ASK Q6 FOR THE FAMILY MEMBERS]
(ASK IF Q6=02-99)
[PN: AUTO-POPULATE FOR FAMILY MEMBERS Q2(a-0)<14 WITH RESPONDENT RESPONSE IF Q7_1 =1]
Q7(a-o). Did [you/insert name] enter as a refugee?
[PROBE: either as a Principal Applicant or as part of a refugee family]
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q7=1)
[PN: IF Q7_1=1 DO NOT ASK Q7(B-O) FOR THE FAMILY MEMBERS Q2(a-o)<14. IF Q7_1=2-99 ASK Q7(B-O) FOR REMAINING FAMILY MEMBERS]
Q7_1. Did all members of this household arrive in the U.S. as a refugee?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER HH MEMBERS)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q6=02-99)
[PN: AUTO-POPULATE FOR FAMILY MEMBERS B-O IE, Q2(A-O)<14 USING RESPONDENT’S Q8a RESPONSE IF Q8_1=1]
Q8(a-o). In what month and year did (YOU/INSERT NAME) arrive in the U.S.?
01 [ENTER 2-DIGIT MONTH]
02 [ENTER 4-DIGIT YEAR]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF YEAR PROVIDED IN Q8)
[PN: IF Q8_1=1 DO NOT ASK Q8(B-O). IF Q8_1=2-99 ASK Q8(B-O) FOR REMAINING FAMILY MEMBERS Q2(a-o)<14]
Q8_1. Did all members of this household arrive in the U.S. in [INSERT YEAR FROM Q8]?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER HH MEMBERS)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q6=02-99)
[PN: AUTO-POPULATE Q9 FOR FAMILY MEMBERS B-O WITH Q2(A-O)<14 USING RESPONDENT’S Q9a RESPONSE if Q9_1=1]
Q9(a-o). In what state and city did [YOU/insert name] originally resettle?
State, Specify_____________ [PN: SHOW STATE LIST]
Q9A(a-o). City, Specify_______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q9 IS NOT DK/REF (RESPONDENT GIVES STATE)
[PN: IF Q9_1=1 DO NOT ASK Q9(B-O) TO THE FAMILY MEMBERS. IF Q9_1=2-99 ASK Q9(B-O) FOR REMAINING FAMILY MEMBERS WITH Q2(A-O)<14]
Q9_1. When first arriving in the U.S., did all family members of this household originally resettle in [INSERT STATE NAME FROM Q9]?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER FAMILY MEMBERS)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
[PN: AUTO-POPULATE FOR PERSONS B-O USING RESPONDENT’S Q10A RESPONSE IF Q10_1=1]
Q10(a-o). What is (YOUR/INSERT NAME)’s ethnic origin?
(DO NOT READ LIST)
01 ARAB
02 ARMENIAN
03 ASHARAF
04 BANTU
05 BANYAMULENGE, BANYAMULENGUE
06 BEMBE, BEMBA, MBEMBE
07 BURMESE
08 CHALDEAN
09 CHIN
10 CUBAN
11 DAROD
12 FARS
13 FUR
14 GREAT RUSSIAN
15 HAWIYE
16 HAZARA
17 HUTU
18 JEWISH
19 KACHIN
20 KAREN
21 KAREN NI (KAYAR)
22 KUNAMA
23 KURD
24 LHOTSAMPA
25 MASSALIT
26 OROMO
27 PASHTOON
28 PERSIAN
29 ROHINGYA
30 SAHO
31 SIRYAC
32 TAJIK
33 TIGRINYA
34 TUTSI
35 UKRAINIAN
36 ZAGAWA
97 OTHER (SPECIFY) _______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q10=1-97)
[PN: IF Q10_1=1 DO NOT ASK Q10(B-O). IF Q10_1=2-99 ASK Q10(B-O) FOR REMAINING FAMILY MEMBERS WITH Q2(A-O)<14]
Q10_1. Are all family members of this household of [INSERT ETHNIC ORIGIN FROM Q10a] origin?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER FAMILY MEMBERS)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
[PN: AUTO-POPULATE Q11 FOR FAMILY MEMBERS B-O FOR WHOM Q2(A-O)<14 USING RESPONDENT’S Q11a RESPONSE IF Q11_1=1]
Q11(a-o). What is [YOUR/insert name]'s race or ethnicity?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
01 White,
02 Black or African American,
03 Asian,
04 Middle Eastern or North African,
05 Latino/Hispanic, or
97 Other (Specify) _______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK OF RESPONDENT ONLY AND IF Q11=1-97)
[PN: IF Q11_1=1 DO NOT ASK Q11(B-O). IF Q11_1=2-99 ASK Q11(B-O) FOR REMAINING FAMILY MEMBERS]
Q11_1. Are all family members of this household [INSERT RACE FROM Q11a]?
(INTERVIEWER: IF YES, DO NOT ASK ABOUT OTHER FAMILY MEMBERS)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
[PN: AUTO-POPULATE FOR FAMILY MEMBERS B-O FOR WHOM Q2(A-O)<14 WITH RESPONDENT RESPONSE]
Q12(a-o). In what state and city (are you/is [INSERT NAME]) currently residing…
State, Specify_____________ [PN: SHOW STATE LIST]
Q12A: City, Specify______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[PN: Q13 AND 14 ARE ONLY ASKED OF THE RESPONDENT]
(ASK OF RESPONDENT ONLY)
Q13. How many other states have you lived in since you arrived in the U.S.?
00 No other states
________ [PN: RANGE 1-97]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[ASK IF Q13>0]
Q14. What was the main reason for your first move from the initial state where you were resettled? Was it for:
Economic opportunity, such as employment,
A social connection such as for family, friends, or an ethnic community,
97 Or was it for some other reason? SPECIFY:____________
(DO NOT READ) Don’t know
(DO NOT READ) Refused
(ASK ALL)
Q15. Who if anyone in the household is responsible for most of the daily caregiving for any children, disabled, or elderly who live in this house or apartment?
[MARK ALL THAT APPLY] [PROBE: Who else?]
___________ [LIST ROSTER FROM Q1a]
97 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY: ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Now I want to ask you some questions about your experience before your arrival in the U.S. These questions are about your experience only. First, I’ll ask about when you lived in your home country.
(ASK ALL)
Q16. What was your work status before you left your home country? Were you…
(READ LIST)
Not working,
Working for paid jobs, SPECIFY occupation:__________
Self-employed (DO NOT READ: business, profession, or farming),
97 Or something else? Other, SPECIFY______________
(DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Next let’s talk about your experience after leaving your home country and while you were displaced: the time before your arrival in the U.S.
(ASK ALL)
Q17. Just before coming to the U.S., while you were displaced, were you living…
(READ LIST)
01 In a refugee camp,
02 In a city, town, village, or countryside, or
03 In another type of location, SPECIFY ___________
97 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY: ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q18. How long were you displaced from your home country? By this I mean, how many years went by after leaving your home country and before coming to the US?
00 LESS THAN A YEAR
________ (RECORD NUMBER OF YEARS) [PN: RANGE 0-96]
97 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q19. What was your work status just before you came to the U.S. (IF NEEDED: while you were displaced)? Were you…
(READ LIST)
01 Not working,
02 Working for paid jobs, SPECIFY occupation:__________
03 Self-employed (DO NOT READ: business, profession, or own farm),
04 Or something else? SPECIFY______________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[ASK IF Q19=1]
Q20. What is the main reason you were not working while you were displaced?
(READ LIST)
Too young to work,
02 Taking care of children or family,
03 Safety concerns,
04 Disabled and unable to work,
05 Lack of work authorization,
06 Or was there some other reason? SPECIFY ___________
97 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY: ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Next I want to ask about your ability in your native language and in English.
(ASK ALL)
Q21A. How well can you read in your native language:
(READ LIST)
01 Very well.
02 Well.
03 Not well.
04 Not at all?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q21B. And how well can you write in your native language:
(READ LIST)
01 Very well,
02 Well,
03 Not well,
04 Not at all?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q22. Before coming to the U.S. did you study English or take ESL or English classes?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q23. When you arrived in the U.S., how well did you speak English:
(READ LIST)
01 Very well,
02 Well,
03 Not well,
04 Not at all?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q24. How well do you speak English now:
(READ LIST)
01 Very well,
02 Well,
03 Not well,
04 Not at all?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q25. Since arriving in the US, have you ever taken any ESL or English classes?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q25=01)
Q26. Where have you taken ESL or English classes in the U.S.?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
01 At work,
02 At a local school or college,
03 At a library,
04 At a church or other religious organization,
97 or somewhere else? OTHER (SPECIFY) __
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q25=1)
Q27. What challenges, if any, have you had taking ESL or English classes in the US?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
Cost of classes,
Too busy with work responsibilities,
Too busy with child care or family responsibilities,
Lack of knowledge on classes available,
Lack of transportation,
or was there some other reason? SPECIFY ___________
11 (DO NOT READ) NO CHALLENGES
97 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY: ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Next I would like to ask some questions about any programs or classes you may have taken here in the U.S. other than studying English.
(ASK ALL)
Q28. Since arriving in the US, have you participated in a program to prepare you for a job?
(INTERVIEWER: IF NEEDED: JOB TRAINING CLASSES OR PROGRAMS OR JOB SEARCH TRAINING (INTERVIEW AND RESUME PREPARATION, JOB SEARCH TRAINING))
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q28=01)
Q29. Where did you take this job preparation program?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
01 At work,
02 At a local school or college,
03 At a library,
04 At a church or other religious organization,
97 or somewhere else? OTHER (SPECIFY) __
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Next I would like to ask about education that you and your adult family members received before coming to the U.S.
(ASK ALL)
[PN: BEGIN WITH Q30a to Q34 FOR RESPONDENT, AND THEN ASK Q30B-O to Q33B-O FOR FAMILY MEMBERS FOR WHOM Q2(a-o)<14 IF Q4=16-110,998,999 AND Q7=1,98,99;)]
Q30(a-o). What was the highest degree or level of school that [YOU/INSERT NAME] completed before coming to the U.S.?
(DO NOT READ LIST)
01 No schooling
02 Primary or elementary school
03 Lower secondary school (or middle school)
04 Upper secondary school (or high school)
05 Some technical or vocational training
06 Some university classes but did not attain degree
07 University (bachelor's degree)
08 Advanced degree (master's, PhD, or professional degree)
09 Religious school
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q30(a-o) > 01)
Q31(a-e). Has [YOUR/INSERT NAME’s] education, degree, or certificate earned outside the U.S. been:
(READ LIST)
01 Fully recognized in the U.S,
02 Partially recognized, or
03 Not at all recognized in the U.S.?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
Q32(a-o). Since arriving in the U.S., (have you/has [INSERT NAME]) pursued a degree or certificate by attending school, community college, or college, with classes either online or in a classroom?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q32 (a-o)=01)
Q33(a-o). At what level was/is (your/[INSERT NAME]’s) degree or certificate program. Was it:
(READ LIST)
01 GED or high school equivalency,
02 Professional certificate,
03 Associate's degree,
04 Bachelor's degree,
05 An advanced degree (DO NOT READ: master's, PhD, or professional),
97 Or some other degree? OTHER (SPECIFY) ________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL) PN: ASK ONLY OF THE RESPONDENT; SKIP TO Q35 FOR FAMILY MEMBERS
Q34. Not counting ESL or English classes, which of the following challenges, if any, have you had getting training or education?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
Cost of classes,
Too busy with work responsibilities,
Too busy with child care or family responsibilities,
Lack of knowledge on classes available,
Lack of transportation,
or was there some other reason? SPECIFY ___________
11 DO NOT READ: No challenges
97 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY: ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[Note the work questions Q35-56 will be asked about all eligible refugee family members aged 16 and over, not just the respondent – with the exception of Q49. Interviewer will go through all questions for the respondent, then cycle through for each of the remaining adult household members. If there was uncertainty about the age, refugee status, or entrance year for any household members, err on including all adult household members in this section.]
[PN: ASK Q35-48 AND Q50-56 FOR FAMILY MEMBERS A-O FOR WHOM Q2(A-O)<14 IF Q4=16-110,998,999 AND Q7=1,98,99; START WITH RESPONDENT, THEN CYCLE THROUGH Q35-48 AND Q50-56 FOR EACH FAMILY MEMBER 16+ YRS OLD. IF THERE ARE MORE THAN 4 FAMILY MEMBERS WHO ARE 16+ AND ELIGIBLE, Q35-48 AND Q50-56 SHOULD BE ASKED OF 4 RANDOMLY SELECTED FAMILY MEMBERS WHO ARE 16+ AND ELIGIBLE. QUESTIONS SHOULD BE ASKED OF THE SAME 4 MEMBERS]
READ TO ALL: In this next part of the survey, I’d like to ask about you (and other family members of your household): [fill in the names of those eligible based on the screening/HH roster]. First we will talk about your employment.
(ASK ALL)
Q35(a-o). Last week, did [you/INSERT NAME] work for pay at a job or business?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01)
Q36(a-o). Last week, at how many jobs did [YOU/INSERT NAME] work for pay?
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01)
Q37(a-o). How many hours did YOU/[INSERT NAME] work for pay at all jobs last week?
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK Q38(a-o) IF Q35(a-o)=02; ELSE SKIP TO Q40)
Q38(a-o). During the last 4 weeks, (have you/has [INSERT NAME]) been actively looking for work?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q38(a-o)=02)
Q39(a-o). Why (have you/has [INSERT NAME]) not been looking for work?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
Has a job but was temporarily absent for any reason (e.g., illness, bad weather, vacation, labor-management disputes)
Poor health
Disability
Insufficient English ability
Attending school or training
Providing child care or family caregiving
Is elderly (past retirement age)
Lack of transportation
OTHER (SPECIFY) ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=02 AND Q39(a-o) NOT EQUAL 01)
Q39A(a-o). Although [you/INSERT NAME] did not work last week, did [you/INSERT NAME] have a job or business at any time in the past year?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01OR Q39(a-o)=1 OR Q39A(a-o)=1)
Q40(a-o). What was (your/[INSERT NAME]'s) hourly wage at your/his/her primary job?
________ (RANGE: 0-96)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01; OR Q39(a-o)=1)
Q41(a-o). About how much did you/[INSERT NAME] earn last month from all job(s)?
________ [RANGE: 0-99,997]
99998 (DO NOT READ) Don’t know
99999 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01or Q39(a-o)=01 or Q39A(a-o)=01)
Q42(a-o). In the past year, how many weeks did [you/INSERT NAME] work, even for a few hours, including paid vacation, paid sick leave, and military service?
(INTERVIEWER: If they’re having difficulty giving you a number of weeks, probe for dates and calculate the number of weeks)
________ (RANGE: 0-52)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01or Q39(a-o)=01 or Q39A(a-o)=01)
Q43(a-o). How many hours per week did [you/INSERT NAME] usually work in the past year (across all jobs)?
________ (RANGE: 0-168)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01 or Q39(a-o)=01 or Q39A(a-o)=01)
Q43A(a-o). In the last year, what is the greatest number of hours [you’ve/[INSERT NAME] has] worked in a week at your main job? Please consider all hours, including any extra hours, overtime, or work you did at home.
_________ (RANGE: 0-168)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01 or Q39(a-o)=01 or Q39A(a-o)=01)
Q43B(a-o). In the last year, what is the fewest number of hours [you’ve/[INSERT NAME] has] worked in a week at your main job? Please do not include weeks in which you missed work because of illness or vacation.
________ (RANGE: 0-168)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01or Q39(a-o)=01 or Q39A(a-o)=01)
Q44(a-o). In the past year, including all jobs worked for pay, who did [you/INSERT NAME] work for?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
01 Government,
02 Private for-profit,
Private not-for-profit,
04 Self-employed (DO NOT READ: business, profession, or own farm)
05 or something else? (SPECIFY) ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=01or Q39(a-o)=01 or Q39A(a-o)=01)
Q45(a-o). What kind of work do /does [you/INSERT NAME] do, that is, what is [your/INSERT NAME]’S occupation? For example: plumber, typist, or farmer.
(INTERVIEWER: IF NEEDED: what is the work you/[INSERT NAME] are/is doing?)
________ (record occupation)
98 (DO NOT READ) Don’t know
99 (DO
NOT READ) Refused
(ASK IF Q39A(a-0)=02)
Q46(a-o). Have you/Has [INSERT NAME] ever worked for pay since coming to the U.S.?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q46(a-o)=02AND Q38(a-o) NOT EQUAL 01)
Q47(a-o). Since arriving in the U.S., (have you/has [INSERT NAME]) ever actively looked for work?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q48(a-o). Have you/Has [INSERT NAME] faced any of the following challenges in finding a job in the US?
(READ LIST)
(INTERVIEWER: PAUSE AND CAPTURE EACH ONE)
Yes
No
11 DO NOT READ: No challenges
97 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY_______________
98 (DO NOT READ) Don’t Know
99 (DO NOT READ) Refused
a Limited English ability?
b Low literacy in own language?
c Not knowing how to find a job?
d Employers not recognizing qualifications or work experience from outside the US?
e Not having family or friends who could help?
f Child care or family responsibilities?
g Sickness or disability?
h Lack of transportation?
i Some other challenge (SPECIFY) ___________
[NEXT SECTION ONLY IF HAS EVER WORKED IN THE US (IF Q35(a-o)=1 OR Q39(a-o)=1 OR Q39A(a-o)=1 OR Q46(a-o)=1)] Now let’s talk about (your/INSERT NAME’s) first job that (you/he/she) got in the U.S.
(ASK Q49 ONLY OF THE RESPONDENT)
Q49(a-o). Who was the most helpful to you in getting your first job in the U.S.?
(DO NOT READ LIST)
01 Got it myself/himself/herself
02 Friends or relatives
03 Case worker/Refugee resettlement organization
04 Government agency
05 Private employment agency
06 Church or religious organization
97 OTHER (SPECIFY) ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=1 OR Q39(a-o)=1 OR Q39A(a-o)=1 OR Q46(a-o)=1)
Q50(a-o). What kind of work did [you/INSERT NAME] do in that first job, that is, what was [your/INSERT NAME]’s occupation? (IF NEEDED: For example: plumber, typist, or farmer.)
_______ (RECORD RESPONSE)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=1 OR Q39(a-o)=1 OR Q39A(a-o)=1 OR Q46=1)
Q51(a-o). Did that first job come with health insurance benefits?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=1 OR Q39(a-o)=1 OR Q39A(a-o)=1 OR Q46(a-o)=1)
Q52(a-o). Is (your/[INSERT NAME]’s) current or most recent job the same as that first job in the U.S.?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
ASK IF Q35(a-o)=1 OR Q39(a-o)=1 OR Q39A(a-o)=1 OR Q46(a-o)=1)
Q53(a-o): Does your/[INSERT NAME]’s current or most recent job correspond to your/[INSERT NAME]’s level of education?
01 Your/his/her level of education is higher than what is required by you/his/her job.
02 Your/his/her level of education is matched to what is required by your/his/her job.
03 Your/his/her job requires a higher level of education.
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
ASK IF Q35(a-o)=1 OR Q39(a-o)=1 OR Q39A(a-o)=1 OR Q46(a-o)=1)
Q54(a-o): Overall, how would you describe your/[INSERT NAME]’s skills in relation to what is required to do in your/[INSERT NAME]’s current (or most recent) job?
01 Your/his/her skills are higher than what is required by your/his/her job
02 Your/his/her skills are matched to what is required by your/his/her job
03 Some of your/his/her skills need to be further developed for your/his/her job
98 Don’t know
99 Refused
ASK IF Q35(a-o)=1 OR Q39(a-o)=1 OR Q39A(a-o)=1 OR Q46(a-o)=1)
Q55(a-o): Does your/[INSERT NAME]’s current or most recent job come with health insurance benefits?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q35(a-o)=1 OR Q39A(a-o)=1 OR Q39A(a-o)=1 OR Q46(a-o)=1)
Q56(a-o). Does your/[INSERT NAME]'s current or most recent job provide a higher hourly wage than your/his/her first job in the US?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[PN: SHIFT BACK HERE TO ASKING ONLY ABOUT THE RESPONDENT, NOT ALL ELIGIBLE FAMILY ADULTS]
READ TO ALL: Now I would like to ask you some questions about your family and how you support yourselves.
(ASK ALL)
Q57. Approximately, what was your family's average monthly net household income in the past year, that is, the money left over after taxes are removed?
________ [RANGE: 0-99997]
99998 (DO NOT READ) Don’t know
99999 (DO NOT READ) Refused
(ASK IF Q57=98 OR Q57=99)
Q57A.
(IF Q57=99998: Yes, I understand it is hard to estimate this, but)
(IF Q57=99999: I understand that this can be a sensitive
question, but)
Would you be able to tell me if your average
monthly net household income was:
(READ LIST)
01 less than $2300,
02 more than $2300,
03 or about that amount?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q57A=01)
Q57B. And would you say it was
(READ LIST)
01 less than $1200
02 more than $1200
03 or about that amount?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q57B=01)
Q57C. And would you say it was
(READ LIST)
01 less than $300
02 more than $300
03 or about that amount?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q57B=02)
Q57D. And would you say it was
(READ LIST)
01 less than $1800
02 more than $1800
03 or about that amount?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q57A=02)
Q57E. And would you say it was
(READ LIST)
01 less than $3300
02 more than $3300
03 or about that amount?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q57E=01)
Q57F. And would you say it was
(READ LIST)
01 less than $2700
02 more than $2700
03 or about that amount?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q57E=02)
Q57G. And would you say it was
(READ LIST)
01 less than $4500
02 more than $4500
03 or about that amount?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q58. Was your family able to pay its monthly living expenses last month?
(INTERVIEWERS: if necessary: To pay for your housing, utilities, transportation, and other bills)
Yes
No
(DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q59. Which of the following did your family use to pay for last month’s living expenses? Did they use:
[EACH STATE HAS A DIFFERENT NAME FOR TANF, SEE LIST PROVIDED TO MATCH TO RESPONDENT’S CURRENT STATE]
Yes
No
98 (DO NOT READ) Don’t Know
99 (DO NOT READ) Refused
(READ LIST)
(INTERVIEWER: PAUSE AND CAPTURE EACH ONE)
a Employment/jobs income?
b Family members or friends living in another household?
c Credit card?
d Savings?
e Case worker/Refugee resettlement organization?
h Government housing programs?
i Any other government benefits, like SSI, food stamps, or TANF? SPECIFY______
j Anything else? SPECIFY______
READ TO ALL: Next I would like to ask about your family’s receipt of different government benefits.
(ASK ALL)
Q60. In the past year, have one or more persons in your family received food stamps? This is when the government gives you vouchers that you exchange for food, also known as “SNAP”.
(INTERVIEWER: Food stamps, now known the Supplemental Nutrition Assistance Program (SNAP), are vouchers issued by the government for low income families or individuals that can be exchanged for food.)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF THERE ARE CHILDREN <18 in the Household; IF ANY Q4a (B-O)=0-17)
Q61. In the past year, have one or more persons in your family received TANF, also known in your state as [INSERT PROGRAM NAME BASED ON SAMPLE STATE] This is when the government provides cash assistance to families with children to help pay for food, shelter, utilities, and non-medical expenses.
(INTERVIEWER: TANF is a federally-funded program run by states that provides limited cash assistance to extremely low-income parents and their children. TANF provides financial assistance to help pay for food, shelter, utilities, and expenses other than medical. Each state in the U.S. has a different name for its TANF program, see list provided to match to respondent’s current state.]
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q62. In the past year, have one or more persons in your family received “SSI” or Supplemental Security Income? This is when the government provides cash assistance to the elderly and disabled.
(INTERVIEWER: Supplemental Security Income (SSI) is a United States government program that provides stipends to low income people who are either aged 65 or older, blind, or disabled.)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q63. In the past year, have one or more persons in your family received income from General Assistance or other welfare? This is when the government assists adults in meeting their basic needs for housing, utilities, personal needs, and transportation.
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q64. In the past year, have you or anyone in your family received any other government supports, from federal, state, or local government?
01 Yes, (SPECIFY) ___________
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Next I would like to ask you some questions about your neighborhood and connections to the community.
(ASK ALL)
Q65. To what extent do people in your community share your cultural background? Is it:
(READ LIST)
(INTERVIEWERS: if necessary: They share the same culture, ethnic group, language, or religion)
01 All or most,
02 About half,
03 Only a few, or
04 None?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q66. Have you visited the home of any friends or neighbors of your same cultural background, or have any visited your home?
(INTERVIEWERS: if necessary: They share the same culture, ethnic group, language, or religion)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q67. Have you visited the home of any friends or neighbors of a different cultural background, or have any visited your home?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q67=01)
Q68. How did you meet this person (or these people) (IF NEEDED: of a different cultural background)?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE] (READ LIST)
01 Through work,
02 Through children's school,
03 In the neighborhood,
04 Through friends or relatives,
97 or some other way? SPECIFY ____________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q69. Which, if any, kinds of groups or organizations have you participated in? Have you participated in:
(INTERVIEWER: IF NEEDED ON GROUP RELATED TO CHILDREN'S SCHOOL: like the PTA or parents' volunteering groups)
(READ LIST)
(INTERVIEWER: PAUSE AND CAPTURE EACH ONE)
Yes
No
98 (DO NOT READ) Don’t Know
99 (DO NOT READ) Refused
a Group related to children's school?
b Church or other religious organization or group?
c Community or ethnic organization or club?
d Sports club or team?
e Any other group? (SPECIFY) _________
(ASK ALL)
Q70. How welcome do you currently feel in the U.S.? We want to know how welcome you feel in your community today, and not when you first arrived in the
US. Today, do you feel:
(READ LIST)
01 Very welcome,
02 Somewhat welcome,
03 Somewhat unwelcome, or
04 Very unwelcome?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q71. After your first year in the U.S., did you apply for a green card? (IF NEEDED: to become a permanent resident)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q72: What challenges, if any, have you had when applying for a green card?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE] (READ LIST)
Lack of information
Limited English ability
Cost of applying
Medical requirements
Lack of transportation
97 OTHER (SPECIFY) ___________
(DO NOT READ) No challenges
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q73. Are you planning to become a U.S. citizen?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q74. Do you have a U.S. driver's license?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: I am now going to ask you about assets that you own in the U.S.
(ASK ALL)
Q75. In the U.S., do you currently own:
[PN: ALLOW MULTIPLE RESPONSES – CODES 8-9 MUTUALLY EXCLUSIVE]
(READ LIST)
01 A car or truck
02 A house or apartment
03 A mobile home
04 A business or farm
05 A plot of land
06 Something else? SPECIFY:____________
07 None
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q76. Which, if any, do you plan to buy in the future?
[PN: ALLOW MULTIPLE RESPONSES – CODES 8-9 MUTUALLY EXCLUSIVE]
(READ LIST)
01 A car or truck
02 A house or apartment
03 A mobile home
04 A business or farm
05 A plot of land
06 Something else? SPECIFY:____________
07 None
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Now I will ask you some questions about where you currently live.
(ASK ALL)
Q77. Is your house or apartment where you currently live…
(READ LIST)
01 Owned or being bought by someone in the household
02 Rented
97 OTHER (SPECIFY) ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q78. How many bedrooms are there in your current apartment or house?
____________(RANGE 0-97)
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q79. What is the total monthly rent or housing payment for your home?
(INTERVIEWER: HERE YOU WANT TO KNOW WHAT THE MONTHLY RENT IS, NOT JUST WHAT THE INDIVIDUAL RESPONDENT CONTRIBUTES EACH MONTH]
________ [RANGE: 0-9997]
9998 (DO NOT READ) Don’t know
9999 (DO NOT READ) Refused
(ASK ALL)
Q80. Do you feel safe at night walking alone at night in the city or area where you live?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q81. How much do you trust your local police?
01 Not at all
02 Somewhat
03 A lot
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q82. Discrimination may happen when people are perceived as being different than others. Since coming to the U.S., have you experienced discrimination or been treated unfairly by others because of your ethnicity, race, skin color, culture, language or accent, gender, or religion?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q82=01, 98, OR 99)
Q83. In which places or situations do you feel you experienced discrimination or were treated unfairly? Did you experience discrimination:
[INTERVIEWER: PAUSE AND CAPTURE EACH ONE]
(READ LIST)
01 Yes
02 No
98 (DO NOT READ) Don’t Know
99 (DO NOT READ) Refused
a On the street?
b In local businesses?
c At work or when applying for a job or promotion?
d When dealing with police or courts?
e In school or class?
f When looking for a place to live or when renting or buying a home?
g When dealing with health care providers?
h In any other place or situation? OTHER (SPECIFY) _______
READ TO ALL: Next I’d like to talk about your health and your access to health care services.
(ASK ALL)
Q84. Have you visited the doctor for a routine physical exam within the past year?
IF NEEDED: (A routine physical exam includes “well visit” or preventive care. This can include screenings and checkups; to help prevent health problems before you have any symptoms. They do not include tests or services to monitor or manage a condition or disease once it has been diagnosed.)
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q85. If you received any healthcare in the past year, what kind of place was it? Was it from....?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
01 A doctor’s office or private clinic,
02 A community health center or other public clinic,
03 A hospital outpatient department,
04 A hospital emergency room,
05 An urgent care center,
06 A traditional healer from your community such as a dhami, jakhri, or curandero,
07 Or, some other place? (SPECIFY: ______)
08 (DO NOT READ) Did not receive any healthcare in the past year
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q86. Which of the following challenges, if any, did you or family members face in receiving medical care in the past year?
[INTERVIEWER: PAUSE AND CAPTURE EACH ONE]
(READ LIST)
Yes
No
98 (DO NOT READ) Don’t Know
99 (DO NOT READ) Refused
a Finding a medical provider?
b Limited English ability?
c Lack of transportation?
d Cost of care?
e No insurance coverage?
f Any other? (SPECIFY) _____________
(ASK ALL)
Q87. In the past year, have you or family members delayed seeking medical care because of worry about the costs?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q88. Would you say that in general your physical health is:
(READ LIST)
01 Excellent,
02 Very Good,
03 Good,
04 Fair, or
05 Poor?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q89. During the past 30 days, how often did you feel so sad that nothing could cheer you up:
(READ LIST)
01 All of the time,
02 Most of the time,
03 Some of the time,
04 A little of the time, or
05 None of the time?
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q90. What kind of health insurance or health care coverage do you currently have?
(INTERVIEWER: Medicaid and CHIP are federally-funded programs run by states, that provide health care coverage to low-income adults, children, pregnant women, elderly, and people with disabilities. Each state in the U.S. has a different name for its Medicaid and CHIP programs, see list provided to match to respondent’s current state. CHIP is the Children’s Health Insurance Program, which provides health coverage to children]
(READ LIST)
01 (DO NOT READ; USE IF R STATES THEY HAVE NO INSURANCE: No insurance)
02 Insurance through your job,
03 Insurance through a family member’s job,
04 Medicaid, CHIP or Refugee Medical Assistance (RMA) from the government, (INTERVIEWER IF NEEDED: also known in your state as [INSERT PROGRAM NAME BASED ON SAMPLE STATE])
97 or another type? (SPECIFY) _______
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK ALL)
Q91. About how many months in the past year did you have health insurance or health care coverage ?
________ [RANGE: 0-12]
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[PN: Q92-Q98 should be asked if household roster included any children under age of 20 and respondent is their parent or guardian (IF ANY Q2(a-o)=4,5,6,12 AND ANY Q4a(a-o)=0-19)]
READ TO ALL: I’d like to ask a few questions now about your children.
[PN: ASK QUESTIONS 92-97 ABOUT THE OLDEST CHILD IN THE HOUSEHOLD UNDER AGE OF 20 AND OVER AGE 5]
Q92. Was [INSERT CHILD’S NAME] enrolled in school last year?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q92=02)
Q93. Why was [INSERT CHILD’S NAME] not enrolled in school?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
01 Was not able to enroll, (INTERVIEWER: problems registering, accessing school, etc.)
02 Is being home schooled, (INTERVIEWER: parents have chosen to provide formal education at home rather than sending child to school)
03 Is pursuing other education such as a GED preparation program,
04 Is working full-time, or
97 some other reason? SPECIFY_______
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
ASK Q94 ABOUT THE OLDEST CHILD IN THE HOUSEHOLD UNDER AGE OF 20 AND OVER AGE 5]
Q94. Has [INSERT CHILD’S NAME] ever experienced any of the following problems in school in the U.S.:
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
01 Child’s limited English ability,
02 Inadequate school resources to assist child in achieving English proficiency,
03 Teachers not well prepared for children from your culture,
04 Discrimination
05 Bullying
97 Or some other problem? SPECIFY _________
06 (DO NOT READ) NOT APPLICABLE, SPECIFY WHY: ___________
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
[PN: IF ANY Q2(B-O)=2 INSERT “and your spouse’s”]
READ TO ALL: Next I will ask you some questions about your [if applicable: and your spouse's] interaction with your children’s school and how you engaged during the last school year.
(ASK IF Q92=01, 98, OR 99)
[PN: IF ANY Q2(B-O)=2 INSERT “or your spouse”]
Q95. Did you [or your spouse] attend a school event? (INTERVIEWER: social, sporting, cultural, or educational activity or event)?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q92=01, 98, OR 99)
[PN: IF ANY Q2(B-O)=2 INSERT “or your spouse”]
Q96. Did you [or your spouse] contact a teacher or counselor about your children’s performance in school?
01 Yes
02 No
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
(ASK IF Q92=01, 98, OR 99)
[PN: IF ANY Q2(B-O)=2 INSERT “or your spouse”]
Q97. Which of the following challenges, if any, did you [or your spouse] face in participating at your children’s school?
[PN: ALLOW MULTIPLE RESPONSES – CODES 98-99 MUTUALLY EXCLUSIVE]
(READ LIST)
Lack of information or don’t know how to participate,
Limited English ability,
Too busy with work responsibilities,
Too busy with child care or family responsibilities,
Lack of transportation,
or any other challenges? SPECIFY:___
(DO NOT READ) No challenges
98 (DO NOT READ) Don’t know
99 (DO NOT READ) Refused
READ TO ALL: Thank you for your time participating today.
(ASK ALL)
Q98. In the future, would you be willing to take this survey by:
(READ LIST)
(INTERVIEWER: PAUSE AND CAPTURE EACH ONE)
Yes
No
98 (DO NOT READ) Don’t Know
(DO NOT READ) Refused
a Having an interviewer ask you the questions on the phone?
b Filling out the survey yourself on your cell phone
c Filling out the survey yourself on a computer
d Filling out the survey yourself through a mobile application or “app” on your cell phone that you would have to download to your phone
e Some other way? SPECIFY:__ PN: STOP RECORDING
(ASK ALL)
IN1. We would you like to send you $25 for your contribution to this important research. You would receive a gift card in approximately 4 to 6 weeks. Can you confirm we have the correct mailing address?
[PN: INSERT SAMPLE MAILING ADDRESS – FULL NAME, STREET, CITY, STATE, ZIP]
1 Correct name/address
2 Incorrect name/address
3 Respondent does not wish to receive gift card
9 (DO NOT READ) Don’t know/Refused
(ASK IF IN1=2)
IN2. May I please have your name?
(VERIFY SPELLING)
1 Answer given (SPECIFY) _________________
R (DO NOT READ) Refused
May I please have your address?
(VERIFY SPELLING)
1 Street: ______________________________
2 City: _______________________________
3 State: _______________________________
4 Zip code:____________________________
R (DO NOT READ) Don’t know
CLOSE: That was our final question. Thank you very much for your participation in this survey.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Linda Lomelino |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |