APPENDIX D

Facsimile of March Supplement Questionnaire

CPS FIELD REPRESENTATIVES/INTERVIEWER MEMORANDUM NO. 97-03

Items Booklet - March 1997

MARCH 1997

CPS FIELD REPRESENTATIVE / CATI INTERVIEWER

ITEMS BOOKLET

U.S. DEPARTMENT OF COMMERCE

Bureau of the Census

HISPANIC

HH32b< Did (name of reference person)live at this address during the week and >SNAD1< of

November 19, 1996?

<1> Yes

<2> No

===>_

>HH32d< Did any of the following household members live here during the and >SNAD2< week of November 19, 1996?

NAME NAME

(Person 1) (person 9)

(Person 2) (person 10)

(Person 3) (person 11)

(Person 4) (person 12)

(Person 5) (person 13)

(Person 6) (person 14)

(Person 7) (person 15)

(Person 8) (person 16)

<1> Yes

<2> No

===>_

ASIAN PACIFIC ISLANDER

>API-intro< This month, we are asking Asian and Pacific Islanders to indicate the specific Asian or Pacific Islander group from which they originate.

ENTER TO PROCEED

===>_

>API34< What is (name's/your)specific Asian or Pacific Islander group?

<A> API help

<1> Chinese

<2> Filipino

<3> Japanese

<4> Asian Indian

<5> Korean

<6> Vietnamese

<7> Laotian, Cambodian, Hmong

<8> Other Asian (For example, Thai, Pakistani, Sri Lankan, Burmese)

<9> Hawaiian

<10> Other Pacific Islander (For example, Samoan, Guamanian, Tongan)

===>__

`>API-help<

ASIAN GROUPS PACIFIC ISLANDER GROUPS
Asian Indian Japanese Carolinian Polynesian

Bangladeshi Korean Chuukese Saipanese

Bhutanese Laotian Fijian Samoan

Borneo Malayan Guamanian Tahitian

Burmese Maldivian Hawaiian Tongan

Cambodian Nepali Kosraean Yapese

Celebesian Okinawan Mariana Islander

Cernan Pakistani Marshallese

Chinese Sikkim Melanesian

Filipino Singaporean Micronesian

Hmong Sri Lankan (Ceylonese)Palauan

Indochinese Thai Papua New Guinean

Indonesian Vietnamese

Iwo-Jiman

ENTER TO PROCEED

SOCIAL SECURITY NUMBER

>SSN-scrn< What is (name's/your)Social Security or Railroad Retirement number?

===>__

FAMILY INCOME

>FAMIN-scrn< I am going to read a list of income categories. Which category represents the total combined income of all members of this FAMILY during the past 12 months)? This includes money from jobs, net income from business, farm or rent, pensions, dividends, interest, social security payments and any other money income received by members of this FAMILY who are 15 years of age or older.

<1> Less than $5,000 <8> 25,000 to 29,999

<2> 5,000 to 7,499 <9> 30,000 to 34,999

<3> 7,500 to 9,999 <10> 35,000 to 39,999

<4> 10,000 to 12,499 <11> 40,000 to 49,999

<5> 12,500 to 14,999 <12> 50,000 to 59,999

<6> 15,000 to 19,999 <13> 60,000 to 74,999

<7> 20,000 to 24,999 <14> $75,000 or more

===>__

INTRODUCTION TO MARCH

>Pr-incom< **WORDING OF INTRODUCTION IS OPTIONAL**

We have just completed the questions about employment and unemployment. Each March, the Census Bureau also collects information about the economic situation of Americans and their families for the previous year.

I am going to ask these questions now. We don't expect all answers to be perfect, but please think about each question and answer it the best you can.

ENTER TO PROCEED

ENTER FOR IMPORTANCE OF RESPONDING

===>_

WORK EXPERIENCE

>Q29a< Did (name/you)work at a job or business at any time during 1996?

<1> Yes

<2> No

===>_

>Q29b< Did (you/he/she)do any temporary, part-time, or seasonal work even for a few days during 1996?

<1> Yes

<2> No

===>_

>Q30< Even though (name/you)did not work in 1996, did (you/he/she)spend any time trying to find a job or on layoff?
<1> Yes

<2> No
===>_

>Q31< How many different weeks (were/was) (name/you)looking for work or on layoff from a job?

<1-52>

===>__

>Q32< What was the main reason (you/he/she)did not work in 1996?

READ CATEGORIES IF NECESSARY.

<1> Ill, or disabled and unable to work

<2> Retired

<3> Taking care of home or family

<4> Going to school

<5> Could not find work

<6> Doing something else

===>_

>Q33< During 1996 in how many weeks did (name/you)work even for a few hours? Include paid vacation and sick leave as work.

ENTER NUMBER OF WEEKS<1-52> OR<M> IF RESPONDENT CAN ONLY ANSWER IN MONTHS

===>__

>Q33-mon< ENTER NUMBER OF MONTHS WORKED

===>__

<1-12>

>Q33-ver< Then (name/you)worked about (number)weeks. Is that correct?

<1> Yes

<2> No -- back to Q33 and obtain estimate

===>_

>Q35< Did (name/you)lose any full weeks of work in 1996 because (you/he/she) (were/was)on layoff from a job or lost a job?

NUMBER OF WEEKS WORKED IN 1996: (number)
<1> Yes

<2> No

<M> Mistake made in number of weeks worked in 1996--Specify
===>_

>Q36< You said (name/you)worked about (number) (week/weeks)in 1996. How many OF THE REMAINING (number)WEEKS (were/was) (you/he/she)looking for work or on layoff from a job?

<X> None
===>__

>Q37< Were the (number)weeks (name/you) (were/was)looking for work or on layoff all in one stretch?
<1> Yes -- one stretch

<2> No -- two stretches

<3> No -- 3 or more stretches

===>_

>Q38< What was the main reason (name/you) (were/was)not working or looking for work in the remaining weeks of 1996?

<1> Ill, or disabled and unable to work

<2> Taking care of home or family

<3> Going to school

<4> Retired

<5> No work available

<6> Other (SPECIFY)

===>_

>Q39< For how many employers did (name/you)work in 1996? If more than one at the same time, only count it as one employer.
<1> One

<2> Two

<3> Three or more
===>_

>Q41< In the (one week/weeks)that (name/you)worked, how many hours did (you/he/she) (work that week?/usually work per week?)

ENTER NUMBER OF HOURS

===>__

>Q43< During 1996, were there one or more weeks in which (name/you)worked less than 35 hours? Exclude time off with pay because of holidays, vacation, days off, or sickness.

<1> Yes

<2> No

===>_

>Q44< In the weeks that (name/you)worked, how many weeks did (name/you)work less than 35 hours in 1996?

NUMBER OF WEEKS WORKED IN 1996: (number)

(NUMBER OF WEEKS WAS REPORTED IN ITEM Q33)

<1-52>

===>__

>Q45< What was the main reason (name/you)worked less than 35 hours per week?

<1> Could not find a full time job

<2> Wanted to work part time or only able to work part time

<3> Slack work or material shortage

<4> Other reason

===>_

>Q46< What was (name's/your)longest job during 1996?

Was it:

(IO1NAM:) (name of employer)

(IO1IND:) (kind of business or industry)

(IO1OCC:) (occupation)

(IO1DT:) (duties)

(duties)

CLASS OF WORKER: (PRIVATE/FEDERAL GOVERNMENT/STATE GOVERNMENT/LOCAL GOVERNMENT/WORKING WITHOUT PAY IN FAMILY BUS./SELF EMPLOYED--INCORPORATED/SELF EMPLOYED--UNINCORPORATED)

<S> Same as listed

<N> Not the same job

===>_

>Q47a< For whom did (name/you)work(?/at) (blank/(your/his/her) (blank/longest job during 1996?)

NAME OF COMPANY, BUSINESS, ORGANIZATION OR OTHER EMPLOYER

(blank/<J> REFER TO CURRENT AND LONGEST JOBS)

(((IO1NAM:) (entry))/If longest job last year is military job, enter Armed Forces)

(blank/<S> Same as IO1NAM /<N> No work done at all during 1996)

===>__________________________________________________________

>Q47b< What kind of business or industry is this?

FOR EXAMPLE: TV AND RADIO MFG., RETAIL SHOE STORE, FARM

(blank/<J> REFER TO CURRENT AND LONGEST JOBS)

(((IO1IND:) (entry))/If longest job last year is military job, enter NA)

(blank/<S> Same as IO1IND/blank)

===>__________________________________________________________

>Q47c< What kind of work (were/was) (you/he/she)doing?

FOR EXAMPLE: ELECTRICAL ENGINEER, STOCK CLERK, TYPIST

(<J> REFER TO CURRENT AND LONGEST JOBS/blank)

(((IO1OCC): entry)/If longest job last year is military job, enter Armed Forces)

(<S> Same as IO1OCC/Blank)

===>__________________________________________________________

>Q47d< What were (your/his/her)most important activities or duties?

FOR EXAMPLE: TYPES, KEEPS ACCOUNT BOOKS, FILES, SELLS CARS, OPERATES PRINTING PRESS, FINISHES CONCRETE.

(<J> REFER TO CURRENT AND LONGEST JOBS/blank)

(((IO1DT): entry)/If longest job last year is military job, enter NA) (entry 2/blank)

(<S> Same as IO1DT/Blank)

===>__________________________________________________________

>Q47E1< (ASK ONLY IF NECESSARY) (Were/Was) (you/name)employed by government, by a PRIVATE company, a non-profit organization, or (were/was) (you/name)self employed or working in a family business?

<1> Government

<2> private for profit company

<3> Non-profit organization including tax exempt and charitable organizations

<4> Self employed

<5> Working in family business

>Q47E1a< Would that be the federal, state, or local government?

<1> Federal

<2> State

<3> Local (county, city, township)

>Q47E1b< Was this business incorporated?
<1> Yes

<2> No

>Q47E1c< Are you the owner of the business?

<1> Yes

<2> No

>Q4788< Counting all locations where (this employer/(name/you)) (operates/operate), what is the total number of persons who work for ((name's/your)employer)/(name/you))?
<1> under 10

<2> 10-24

<3> 25-99

<4> 100-499

<5> 500-999

<6> 1,000+

EARNED INCOME

>Q48a< How much did (name/you)earn from this employer before taxes and other deductions during 1996?
Enter dollar amount $ .00 Enter<X> for None

READ IF NECESSARY: Is this a weekly, every other week, twice a month, monthly or yearly amount?

Per <1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

Q48ap ==>___

>Q48a1< For how many (weekly/every other week/twice a month/monthly)pay periods did (name/you)earn (fill from Q48a)from this employer in 1996?

>Q48aC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL ANNUAL EARNINGS ENTERED IS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q48aV< According to my calculations (name/you)earned (total)dollars altogether from this employer in 1996 before deductions. Does that sound about right?

<1> Yes

<2> No

>Q48a2< What is your best estimate of (name's/your)correct total amount of earnings from this employer during 1996 before deductions?

Enter dollar amount $___.00

>Q48a3< Does this amount include all tips, bonuses, overtime pay or commissions (name/you)may have received from this employer in 1996?

<1> Yes

<2> No

Q48aad How much did (name/you)earn in tips, bonuses, overtime pay or commissions from this employer in 1996?

Enter dollar amount $ .00

>Q48b< What were (name's/your)net earnings from this (business/farm)after expenses during 1996?

IF RESPONSE IS "BROKE EVEN" THEN ENTER 1.

<X> None

<L> Lost Money

Enter dollar amount $__.00

>Q48BL< ENTER AMOUNT OF MONEY LOST IN 1996.

===>$___,___ .00

>Q48bp< Is this an annual, quarterly, monthly, weekly, or other amount?
Per<1> Annual

<2> Quarterly

<3> Monthly

<4> Weekly

<5> Other

Q48bp ==>___

>Q48b1 *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL ANNUAL BUSINESS INCOME ENTERED IS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No goto 48b (TO CORRECT ENTRY)

>Q48b2< What is your best estimate of (name's/your)ANNUAL net earnings from this business/farm after expenses in 1996?

PREVIOUS ENTRIES: Q48b: (amount)

Q48b1: (periodicity)

Enter dollar amount $__.00

>Q48b2L< What is your best estimate of (name's/your)ANNUAL net LOSS from this business/farm after expenses in 1996?

PREVIOUS ENTRIES: Q48b: (amount)

Q48b1: (periodicity)

Enter dollar amount $__.00

>Q48b3< What were (name's/your)net earnings from this (business/farm)during the FIRST quarter of 1996?

IF RESPONSE IS "BROKE EVEN," ENTER 1.

<X> None

<L> Lost Money

Enter dollar amount $__.00

>Q48b3L< ENTER AMOUNT OF MONEY LOST IN THE FIRST QUARTER OF 1996.

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

>Q48b4< What were (name's/your)net earnings from this (business/farm)during the SECOND quarter of 1996?

IF RESPONSE IS "BROKE EVEN," ENTER 1.

<X> None

<L> Lost Money

Enter dollar amount $__.00

>Q48b4L< ENTER AMOUNT OF MONEY LOST IN THE SECOND QUARTER OF 1996.

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

>Q48b5< What were (name's/your)net earnings from this (business/farm)during the THIRD quarter of 1996?

IF RESPONSE IS "BROKE EVEN," ENTER 1.

<X> None

<L> Lost Money

Enter dollar amount $__.00

>Q48b5L< ENTER AMOUNT OF MONEY LOST IN THE THIRD QUARTER OF 1996.

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

>Q48b6< What were (name's/your)net earnings from this (business/farm)during the FOURTH quarter of 1996?

IF RESPONSE IS "BROKE EVEN," ENTER 1.

<X> None

<L> Lost Money
Enter dollar amount $ .00

>Q48b6L< ENTER AMOUNT OF MONEY LOST IN THE FOURTH QUARTER OF 1996.

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

>Q48b7< Does this amount include all tips, bonuses, overtime pay or commissions (name/you)may have received in 1996?

<1> Yes

<2> No

>Q48bad< How much did (name/you)earn in tips, bonuses, overtime pay or commissions in 1996?

Enter dollar amount $ __.00

>Q49a< Did (name/you)earn money from any other work (you/he/she)did during 1996?

<1> Yes

<2> No
===>_

>Q49a1< Did (name/you)earn this money from other employers, (his/her/your)own business, or from (his/her/your)own farm ?

PROBE: Any other source?<N> no more

<1> Other employers

<2> Own business

<3> Own farm

===>_ ===>_ ===>_

>Q49B1< How much did (name/you)earn from all other employers before taxes and other deductions during 1996?

Enter dollar amount $ __.00

<X> none

READ IF NECESSARY: Is this a weekly, every other week, twice a month, monthly or yearly amount?

Per<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

>Q49B1p< ==>___

>Q49B11< For how many (weekly/every other week/twice a month/monthly)pay periods did (name/you)earn (fill from Q49B1)from all other employers in 1996?

>Q49B1C< *** DO NOT READ TO THE RESPONDENT ***

THE TOTAL ANNUAL EARNINGS ENTERED FROM ALL OTHER EMPLOYERS IS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q49B1V< According to my calculations (name/you)earned (total)dollars altogether from all other employers in 1996. Does that sound about right?

<1> Yes

<2> No

>Q49B12< What is your best estimate of (name's/your)correct total amount of earnings from all other employers during 1996?

PREVIOUS ENTRIES: Q48a: (amount)

Q48ap: (periodicity)

Q48a1: (number of pay periods)

Enter dollar amount $_.00

>Q49B13< Does this amount include all tips, bonuses, overtime pay or commissions (name/you)may have received from all other employers in 1996?

<1> Yes

<2> No

>Q49B1A< How much did (name/you)earn in tips, bonuses, overtime pay or commissions from all other employers in 1996?

Enter dollar amount $__.00

>Q49B2< How much did (name/you)earn from (his/her/your)own business after expenses?

(IF RESPONSE IS "BROKE EVEN" THEN ENTER 1.)

FOR AMOUNTS $1,000,000 AND OVER, ENTER $999,999

<X> None<L> Lost money

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

FOR AMOUNTS $10,000 AND OVER, ENTER $9,999

===>$___,___ .00 ENTER ANNUAL AMOUNT LOST ONLY

>Q49B3< How much did (name/you)earn from (his/her/your)farm after expenses?

(IF RESPONSE IS "BROKE EVEN" THEN ENTER 1.)

FOR AMOUNTS $1,000,000 AND OVER, ENTER $999,999

<X> None<L> Lost money

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

FOR AMOUNTS $10,000 AND OVER, ENTER $9,999
===>$___,___ .00 ENTER ANNUAL AMOUNT LOST ONLY

UNEMPLOYMENT AND WORKERS COMPENSATION

>Q51A1< At any time during 1996 did (names/you)receive any State or Federal unemployment compensation?

<1> Yes

<2> No

>Q51A1p< What is the easiest way for you to tell us (name's/your)State or Federal unemployment compensation; weekly, every other week, twice a month, monthly, or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q51A11< How much did (name\you)receive (weekly/ every other week/twice a month/monthly/ )in State or Federal unemployment compensation during 1996?

Enter dollar amount $___

>Q51A1C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL STATE OR FEDERAL UNEMPLOYMENT COMPENSATION RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes

<2> No

>Q51A12< How many (weekly/ every other week/twice a month/monthly)payments did (name/you)receive from State or Federal unemployment compensation during 1996?
<1-52>

>Q51A13< According to my calculations (name/you)received (total)dollars altogether from State or Federal unemployment compensation during 1996. Does that sound about right?
<1> Yes

<2> No

>Q51A14< What is your best estimate of the correct total amount (name/you)received from State or Federal unemployment compensation during 1996?

PREVIOUS ENTRIES: Q51A11: (amount)

Q51A1p: (periodicity)

Q51A12: (number of pay periods)

Enter dollar amount $ __.00

>Q51A2< At any time during 1996 did (name/you)receive any Supplemental Unemployment Benefits?
<1> Yes

<2> No

===>_

>Q51A2p< What is the easiest way for you to tell us (name's/your)Supplemental Unemployment Benefits; weekly, every other week, twice a month, monthly, or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q51A21< How much did (name\you)receive (weekly/ every other week/twice a month/monthly/ )in Supplemental Unemployment Benefits during 1996?

Enter dollar amount $.__.00

>Q51A2C2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL UNEMPLOYMENT BENEFITS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q51A22< How many (weekly/ every other week/twice a month/monthly)payments did (name/you)receive from Supplemental Unemployment Benefits during 1996?
<1-52>

>Q51A23< According to my calculations (name/you)received (total)dollars altogether from Supplemental Unemployment Benefits during 1996. Does that sound about right?

<1> Yes

<2> No

>Q51A24< What is your best estimate of the correct total amount (name/you)received from Supplemental Unemployment Benefits during 1996?

PREVIOUS ENTRIES: Q51A21: (amount)

Q51A2p: (periodicity)

Q51A22: (number of pay periods)

Enter dollar amount $ __.00

>Q51A3< At any time during 1996 did (name/you)receive any Union Unemployment or Strike Benefits?

<1> Yes

<2> No
===>_

>Q51A3p< What is the easiest way for you to tell us (name's/your)Union Unemployment or Strike Benefits; weekly, every other week, twice a month, monthly, or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q51A31< How much did (name\you)receive (weekly/every other week/twice a month/monthly/ )in Union Unemployment or Strike Benefits during 1996?

Enter dollar amount $ __.00

>C251A3< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL UNION UNEMPLOYMENT OR STRIKE BENEFITS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q51A32< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive from Union Unemployment or Strike Benefits during 1996?

<1-52>

>Q51A33< According to my calculations (name/you)received (total)dollars altogether from Union Unemployment or Strike Benefits during 1996. Does that sound about right?

<1> Yes

<2> No

>Q51A34< What is your best estimate of the correct total amount (name/you)received from Union Unemployment or Strike Benefits during 1996?

PREVIOUS ENTRIES: Q51A31: (amount)

Q51A3p: (periodicity)

Q51A32: (number of pay periods)

Enter dollar amount $ __.00

>Q52a< During 1996 did (name/you)receive any Worker's Compensation payments or other payments as a result of a job related injury or illness?

EXCLUDE SICK PAY AND DISABILITY RETIREMENT.

<1> Yes

<2> No

>Q52b< What was the source of these payments?

<1> State Worker's Compensation

<2> Employer or employer's insurance

<3> Own insurance

<4> Other

===>_

>Q52cp< What is the easiest way for you to tell us (name's/your)Worker's Compensation; weekly, every other week, twice a month, monthly, or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

>Q52c1< How much did (name\you)receive (weekly/every other week/twice a month/monthly/ )in Worker's Compensation during 1996?

Enter dollar amount $ ___.00

>Q52cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL WORKER'S COMPENSATION RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q52c2< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive from Worker's Compensation during 1996?

<1-52>

>Q52c3< Then (name/you)received (total)dollars altogether from Worker's Compensation during 1996. Does that sound about right?

<1> Yes

<2> No

Q52c4 What is your best estimate of the correct total amount (name/you)received from Worker's Compensation during 1996?

PREVIOUS ENTRIES: Q52c1: (amount)

Q52cp: (periodicity)

Q52c2: (number of pay periods)

Enter dollar amount $__.00

SOCIAL SECURITY

>Q56a< During 1996 did (anyone in this household/you)receive any Social Security payments from the U.S. Government?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q56b< **READ ONLY IF NECESSARY**

Who received Social Security payments either for themselves or as combined payments with other family members?

ENTER LINE NUMBER OF PARENT OR GUARDIAN FOR PAYMENTS MADE TO CHILDREN UNDER AGE 15.

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q56dp< What is the easiest way for you to tell us (name's/your)Social Security payment; monthly, quarterly or yearly?

<1> monthly

<2> quarterly

<3> yearly

==>___

>Q56d< How much did (name/you)receive (monthly/quarterly/ )in Social Security payments in 1996?

( \<A> already included)

Enter dollar amount $ __.00

>Q56d1< What is the amount of the Social Security payment (name/you)received last month?

Enter dollar amount $ __.00

>Q56d2< For how many (months/quarters)did (name/you)receive Social Security in 1996?
<1-12>

>Q56d3< Is this (amount from Q56d/amount from Q56d1)before or after the (42.50/43.80)per month Medicare deduction?

<1> after

<2> before

>Q56d4< Was the cost of living increase the only change which occurred in monthly payments?
<1> Yes

<2> No

>Q56dC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SOCIAL SECURITY RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q56d5< According to my calculations (name/you)received (total)dollars altogether from Social Security in 1996. Does that sound about right?

<1> Yes

<2> No

>Q56d6< What is your best estimate of the correct amount (name\you)received in Social Security during 1996?

PREVIOUS ENTRIES: Q56d1: (amount)

Q56dp: (periodicity)

Q56d2: (number of pay periods)

Q56d3: (amount added per month)

Q56d4: (cost of living subtracted per month)

Enter dollar amount $__.00

>SSR< What were the reasons (name/you)(was/were)getting Social Security in 1996?

PROBE: Any other reason?<N> No more

<1> Retired

<2> Disabled

<3> Widowed

<4> Spouse

<5> Surviving child

<6> Dependent child

<7> On behalf of surviving, dependent or disabled children

<8> Other

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD

>SSC< Which children under age 15 were receiving Social Security in 1996?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SSCR< What were the reasons (Child's name/the children) (was/were)getting Social Security in 1996?

PROBE: Any other reason?<N> No more

<1> Disabled child/children

<2> Surviving child/children

<3> Dependent child/children

<4> Other

===>__ ===>__ ===>__ ===>__

SOCIAL SECURITY FOR CHILDREN

>Q56f< Did anyone in this household receive any Social Security income in 1996 that we have not already counted on behalf of children in this household?

INCLUDES ALL CHILDREN UNDER 23 YEARS OF AGE

<1> Yes

<2> No

<H> (Help)Social Security income previously reported

===>_

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q56g< **READ ONLY IF NECESSARY**

Who received these Social Security payments?

ENTER LINE NUMBER OF PARENT OR GUARDIAN

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

<H> (Help)Social Security income previously reported

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q56ip< What is the easiest way for you to tell us( name's/your)Social Security payment for children in this household; monthly, quarterly or yearly?

<1> monthly

<2> quarterly

<3> yearly

==>___

>Q56i< How much did (name/you)receive (monthly/quarterly/ )in Social Security payments for children in this household in 1996?
( \<A> already included)
Enter dollar amount $ .00

>Q56i1< What is the amount of the Social Security payment (name/you)received for children in this household last month?

Enter dollar amount $ __.00

>Q56i2< For how many (months/quarters)did (name/you)receive Social Security in 1996?

<1-12>

>Q56i3< Was the cost of living increase the only change which occurred in monthly payments for children in this household?

<1> Yes

<2> No

>Q56iC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SOCIAL SECURITY RECEIVED FOR CHILDREN IN THIS HOUSEHOLD IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q56i4< According to my calculations (name/you)received (total)dollars altogether for children in this household from Social Security in 1996. Does that sound about right?

<1> Yes

<2> No

>Q56i5< What is your best estimate of the correct amount (name\you)received in Social Security for children in this household during 1996?

PREVIOUS ENTRIES: Q56i1: (amount)

Q56ip: (periodicity)

Q56i2: (number of pay periods)

Q56i3: (cost of living subtracted per month)

Enter dollar amount $ __.00

>RSS< What were the reasons (name/you) (was/were)getting Social Security for children in this household in 1996?
PROBE: Any other reason?<N> No more
<1> Surviving child

<2> Dependent child

<3> On behalf of children

<4> Other

===>__ ===>__ ===>__ ===>__

NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD

>CSS< Which children under age 23 were receiving Social Security in 1996?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>CRSS< What were the reasons (Child's name/the children) (was/were)getting Social Security in 1996?

PROBE: Any other reason?

<N> No more

<1> Disabled child/children

<2> Surviving child/children

<3> Dependent child/children

<4> Other

===>__ ===>__ ===>__ ===>__

SUPPLEMENTAL SECURITY INCOME (SSI)

>Q57a< During 1996 did (anyone in this household receive:/you receive:)

Any SSI payments, that is, Supplemental Security Income?

NOTE: SSI ARE ASSISTANCE PAYMENTS TO LOW-INCOME AGED, BLIND AND DISABLED PERSONS AND COME FROM STATE OR LOCAL WELFARE OFFICES, THE FEDERAL GOVERNMENT, OR BOTH.
<1> Yes

<2> No

===>_

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q57b< **READ ONLY IF NECESSARY**

Who received SSI? SUPPLEMENTAL SECURITY INCOME

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q57cp< What is the easiest way for you to tell us (name's/your)Supplemental Security Income payment; monthly, quarterly or yearly?

<1> monthly

<2> quarterly

<3> yearly

>Q57c< How much did (name/you)receive (monthly/quarterly/ )in Supplemental Security Income payments in 1996?
Enter dollar amount $ __.00

>Q57c1< What is the amount of the Supplemental Security Income payment (name/you)received last month?

Enter dollar amount $ __.00

>Q57c2< For how many (months/quarters)did (name/you)receive Supplemental Security Income in 1996?

<1-12>

>Q57c3< Was the cost of living increase the only change which occurred in monthly payments?

<1> Yes

<2> No

>Q57cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL SECURITY INCOME RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q57c4< According to my calculations (name/you)received (total)dollars altogether from Supplemental Security Income in 1996. Does that sound about right?

<1> Yes

<2> No

>Q57c5< What is your best estimate of the correct amount (name\you)received in Supplemental Security Income during 1996?

PREVIOUS ENTRIES: Q57c1: (amount)

Q57cp: (periodicity)

Q57c2: (number of pay periods)

Q57c3: (amount subtracted per month)

Enter dollar amount $ __.00

>SSIR< What were the reasons (name/you) (was/were)getting Supplemental Security Income in 1996?

PROBE: Any other reason?<N> No more

<1> Disabled

<2> Blind

<3> On behalf of a disabled child

<4> On behalf of a blind child

<5> Other

===>__ ===>__ ===>__ ===>__ ===>__

NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD

>SSIC< Which children under age 15 were receiving Supplemental Security Income in 1996?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

SUPPLIMENTAL SECURITY INCOME FOR CHILDREN

>Q57d< Did anyone in this household receive any Supplemental Security Income in 1996 that we have not already counted on behalf of children in this household?

INCLUDES ALL CHILDREN UNDER 18 YEARS OF AGE

<1> Yes

<2> No

<H> (Help)Supplemental Security Income previously reported

===>_

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q57e< **READ ONLY IF NECESSARY**

Who received these Supplemental Security Income payments?

ENTER LINE NUMBER OF PARENT OR GUARDIAN

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

<H> (Help)Supplemental Security Income previously reported

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q57ip< What is the easiest way for you to the Supplemental Security Income (name/you)received on behalf of children?

<1> monthly

<2> quarterly

<3> yearly

==>___

>Q57i< How much did (name/you)receive (monthly/quarterly/ )in Supplemental Security Income on behalf of children in 1996?

Enter dollar amount $__ .00

>Q57i1< What is the amount of the Supplemental Security Income payment (name/you)received on behalf of children last month?

Enter dollar amount $ __.00

>Q57i2< For how many (months/quarters)did (name/you)receive Supplemental Security Income on behalf of children in 1996?

<1-12>

>Q57i3< Was the cost of living increase the only change which occurred in monthly payments?

<1> Yes

<2> No

>Q57iC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL SECURITY INCOME RECEIVED IN 1996 ON BEHALF OF CHILDREN WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q57i4< According to my calculations (name/you)received (total)dollars altogether from Supplemental Security Income on behalf of children in 1996. Does that sound about right?

<1> Yes

<2> No

>Q57i5< What is your best estimate of the correct amount (name\you)received in Supplemental Security Income on behalf of children during 1996?

PREVIOUS ENTRIES: Q57i1: (amount)

Q57cp: (periodicity)

Q57c2: (number of pay periods)

Q57c3: (amount subtracted per month)

Enter dollar amount $ __.00

>RSSI< What were the reasons (name/you) (was/were)getting Supplemental Security Income on behalf of children in 1996?

PROBE: Any other reason?<N> No more

<1> On behalf of a disabled child/children

<2> On behalf of a blind child/children

<3> Other

===>__ ===>__ ===>__

NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD

>CSSI< Which children under age 18 were receiving Supplemental Security Income in 1996?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

PUBLIC ASSISTANCE

>Q59A88< At any time during 1996, even for one month, did (anyone in this household/you)receive any public assistance or welfare payments from the state or local welfare office?

INCLUDE SUCH PAYMENTS AS AID TO FAMILIES WITH DEPENDENT CHILDREN, AID TO DEPENDENT CHILDREN, TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM (TANF), GENERAL ASSISTANCE PROGRAM, EMERGENCY ASSISTANCE, CUBAN/HAITIAN REFUGEE, OR INDIAN ASSISTANCE.

DO NOT INCLUDE FOOD STAMPS OR SSI PAYMENTS.

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q59b-88< Who received these payments?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q59C88< Did (name/you)receive Aid to Families With Dependent Children (AFDC)/Aid to Dependent Children (ADC)/Temporary Assistance for Needy Families (TANF)or some other type of assistance payments?

<1> Aid to Families With Dependent Children (AFDC)/Aid to Dependent Children (ADC)/Temporary Assistance for Needy Families (TANF)

<2> Other Assistance

<3> Both

===>_

>Q59ep< What is the easiest way for you to tell us (name's/your)Public Assistance or Welfare Payments; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q59e< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in Public Assistance or Welfare Payments in 1996?

Enter dollar amount $ __.00

>Q59e2< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive from Public Assistance or Welfare Payments in 1996?

<1-52>

>Q59eC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL PUBLIC ASSISTANCE OR WELFARE PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q59e3< According to my calculations (name/you)received (total)dollars altogether from Public Assistance or Welfare Payments in 1996. Does that sound about right?

<1> Yes

<2> No

>Q59e4< What is your best estimate of the correct amount (name\you)received in Public Assistance or Welfare Payments during 1996?

PREVIOUS ENTRIES: Q59e: (amount)

Q59ep: (periodicity)

Q59e2: (number of pay periods)

Enter dollar amount $ __.00

NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD

>Q59C< Which children in the household were covered by (name's/your)Aid to Families With Dependent Children (AFDC)/Aid to Dependent Children (ADC)/Temporary Assistance for Needy Families (TANF)in 1996?

NOTE: INCLUDE CHILDREN UNDER 19 YEARS OLD ONLY

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

<A> All

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

VETERANS PAYMENTS

>Q60A88< At any time during 1996 did (anyone in this household receive:/you receive:)Any Veterans' (VA)payments?

INCLUDE ASSISTANCE RECEIVED BY CHILDREN OF VETERANS

<1> Yes

<2> No

===>_

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q60b-88< **READ ONLY IF NECESSARY**

Who received Veterans' (VA)payments?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q60c-88< What type of Veterans' payments did (name/you)receive?

<1> Service-connected disability compensation

<2> Survivor Benefits

<3> Veterans' pension

<4> Educational assistance (including assistance received by children of veterans)

<5> Other Veterans' payments

<N> No more

PROBE: Anything else?

===>__ ===>__ ===>__ ===>__ ===>__

>Q60D88< (Are/Is) (name/you)required to fill out an annual income questionnaire for the Department of Veterans' Affairs?

<1> Yes

<2> No

===>_

>Q60V1p< What is the easiest way for you to tell us (name's/your) (fill from first answer in Q60c-88); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q60V1< How much did (name/you)receive (weekly/every other week/twice a month/monthly /)before deductions in (fill from first answer in Q60c-88)in 1996?

Enter dollar amount $__ .00

>Q60V12< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (fill from first answer in Q60c-88)in 1996?

<1-52>

>Q60V1C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM FIRST ANSWER IN Q60c-88)RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q60V13< According to my calculations (name/you)received (total)dollars altogether from (fill from first answer in Q60c-88)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q60V14< What is your best estimate of the correct amount (name\you)received from (fill from first answer in Q60c-88)during 1996?

PREVIOUS ENTRIES: Q60V1: (amount)

Q60V1p: (periodicity)

Q60V12: (number of pay periods)

Enter dollar amount $ __.00

>Q60V2p< What is the easiest way for you to tell us (name's/your) (fill from second answer in Q60c-88); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q60V2< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in (fill from second answer in Q60c-88)in 1996?

Enter dollar amount $ __.00

>Q60V22< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (fill from second answer in Q60c-88)in 1996?

<1-52>

>Q60V2C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM SECOND ANSWER IN Q60c-88)RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q60V23< According to my calculations (name/you)received (total)dollars altogether from (fill from second answer in Q60c-88)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q60V24< What is your best estimate of the correct amount (name\you)received from (fill from second answer in Q60c-88)during 1996?

PREVIOUS ENTRIES: Q60V2: (amount)

Q60V2p: (periodicity)

Q60V22: (number of pay periods)

Enter dollar amount $ __.00

SURVIVOR BENEFITS

>Q58a< Did (you/anyone in this household)receive any survivor benefits in 1996 such as widow's pensions, estates, trusts, insurance annuities, or any other survivor benefits, (other than Social Security/other than VA benefits/other than Social Security or VA benefits)?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q58b< **ASK ONLY IF NECESSARY**

Who received this income?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q58c< What was the source of this income?

ASKING ABOUT: (name) (blank/--CURRENT RESPONDENT)

<2> Company or union survivor pension (INCLUDE PROFIT SHARING)

<3> Federal Government (CIVIL SERVICE)pension

<4> U.S. Military retirement survivor pension

<5> State or Local government survivor pension

<6> U.S. Railroad retirement survivor pension

<7> Worker's compensation survivor pension

<8> Black Lung survivor pension

<9> Regular payments from estates or trusts

<10> Regular payments from annuities or paid-up insurance policies

<11> Other or don't know (SPECIFY)--ENTER LAST

PROBE: Any other source?

<N> No more

===>__ ===>__ ===>__ ===>__ ===>__

>Q58Coth< SPECIFY OTHER SOURCE OF INCOME AS SURVIVOR OR WIDOW

ENTER "SURVIVOR BENEFITS" IF THE ANSWER IS "DON'T KNOW"

===>_____________________________________________________________

>Q58E1p< What is the easiest way for you to tell us (name's/your) (fill from first answer in Q58c or Q58Coth); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q58E1< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in (fill from first answer in Q58c or Q58Coth)in 1996?

Enter dollar amount $ __.00

>Q58E12< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (fill from first answer in Q58c or Q58Coth)in 1996?

<1-52>

>Q58E1C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM FIRST ANSWER IN Q58c or Q58Coth)PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q58E13< According to my calculations (name/you)received (total)dollars altogether from (fill from first answer in Q58c or Q58Coth)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q58E14< What is your best estimate of the correct amount (name\you)received from (fill from first answer in Q58c or Q58Coth)during 1996?

PREVIOUS ENTRIES: Q58E1: (amount)

Q58E1p: (periodicity)

Q58E12: (number of pay periods)

Enter dollar amount $__.00

>Q58E2p< What is the easiest way for you to tell us (name's/your) (fill from second answer in Q58c or Q58Coth); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q58E2< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in (fill from second answer in Q58c or Q58Coth)in 1996?

Enter dollar amount $__.00

>Q58E22< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (fill from second answer in Q58c or Q58Coth)in 1996?

<1-52>

>Q58E2C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM SECOND ANSWER IN Q58c or Q58Coth)RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q58E23< According to my calculations (name/you)received (total)dollars altogether from (fill from second answer in Q58c or Q58Coth)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q58E24< What is your best estimate of the correct amount (name\you)received from (fill from second answer in Q58c or Q58Coth)during 1996?

PREVIOUS ENTRIES: Q58E2: (amount)

Q58E2p: (periodicity)

Q58E22: (number of pay periods)

Enter dollar amount $ __.00

>Q58E3p< What is the easiest way for you to tell us (name's/your) (fill from third answer in Q58c or Q58Coth); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q58E3< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in (fill from third answer in Q58c or Q58Coth)in 1996?

Enter dollar amount $ __.00

>Q58E32< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (fill from third answer in Q58c or Q58Coth)in 1996?

<1-52>

>Q58E3C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM THIRD ANSWER IN Q58c or Q58Coth)RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q58E33< According to my calculations (name/you)received (total)dollars altogether from (fill from third answer in Q58c or Q58Coth)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q58E34< What is your best estimate of the correct amount (name\you)received from (fill from third answer in Q58c or Q58Coth)during 1996?

PREVIOUS ENTRIES: Q58E2: (amount)

Q58E2p: (periodicity)

Q58E22: (number of pay periods)

Enter dollar amount $__.00

DISABILITY INCOME

>Q59a< (Do you/Does anyone in this household)have a health problem or disability which prevents (you/them)from working or which limits the kind or amount of work (you/they)can do?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q59b< **ASK ONLY IF NECESSARY**

Who is that?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q60a< (Did you/Is there anyone in this household who)ever (retire or leave/retired or left)a job for health reasons?

<1> Yes

<2> No

===>_

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q60b< **ASK ONLY IF NECESSARY**

Who is that?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

`===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q61b< Did (name/you)receive any income in 1996 as a result of (your/his/her)health problem, (other than Social Security/other than VA benefits/other than Social Security or VA benefits)?

(blank/IF AMOUNT WAS REPORTED PREVIOUSLY AS COMPENSATION FROM A JOB)

(blank/RELATED INJURY OR ILLNESS, THEN ENTER PRECODE 2.)

(blank/AMOUNT PREVIOUSLY REPORTED IN (Q52cT)WAS: $(amount))

<1> Yes

<2> No

>Q61c< What was the source of this income?

ASKING ABOUT: (name) (blank/--CURRENT RESPONDENT)

PROBE: Any other income related to this health condition or disability?

(blank/<2> Worker's compensation)

<3> Company or union disability

<4> Federal Government (CIVIL SERVICE)disability

<5> U.S. Military retirement disability

<6> State or Local government employee disability

<7> U.S. Railroad retirement disability

<8> Accident or disability insurance

<9> Black Lung miner's disability

<10> State temporary sickness

<11> Other or don't know - SPECIFY - ENTER LAST

<N> NO OTHER SOURCES OF INCOME

===>__ ===>__ ===>__ ===>__ ===>__

>Q61c-oth< SPECIFY OTHER SOURCE OF INCOME FROM HEALTH PROBLEM OR DISABILITY

ENTER "OTHER HEALTH PROBLEM/DISABILITY" IF THE ANSWER IS "DON'T KNOW"

===>______________________________________________________

>Q61E1p< What is the easiest way for you to tell us (name's/your) (first fill from Q61c or Q61c-oth)payments; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q61E1< How much did (name/you)receive (weekly/every other week/twice a month/

monthly/ )before deductions in (first fill from Q61c or Q61c-oth)payments in 1996?

Enter dollar amount $ .00

>Q61E12< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (first fill from Q61c or Q61c-oth)payments in 1996?

<1-52>

>Q61E1C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FIRST FILL FROM Q61c OR Q61c-oth)PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q61E13< According to my calculations (name/you)received (total)dollars altogether from (first fill from Q61c or Q61c-oth)payments in 1996. Does that sound about right?

<1> Yes

<2> No

>Q61E14< What is your best estimate of the correct amount (name\you)received from (first fill from Q61c or Q61c-oth)payments during 1996?

PREVIOUS ENTRIES: Q61E1: (amount)

Q61E1p: (periodicity)

Q61E12: (number of pay periods)

Enter dollar amount $ .00

>Q61E2p< What is the easiest way for you to tell us (name's/your) (second fill from Q61c or Q61c-oth)payments; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q61E2< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in (second fill from Q61c or Q61c-oth)payments in 1996?

Enter dollar amount $ .00

>Q61E22< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (second fill from Q61c or Q61c-oth)payments in 1996?

<1-52>

>Q61E2C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (SECOND FILL FROM Q61c OR Q61c-oth)PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q61E23< According to my calculations (name/you)received (total)dollars altogether from (second fill from Q61c or Q61c-oth)payments in 1996. Does that sound about right?

<1> Yes

<2> No

>Q61E24< What is your best estimate of the correct amount (name\you)received from (second fill from Q61c or Q61c-oth)payments during 1996?

PREVIOUS ENTRIES: Q61E2: (amount)

Q61E2p: (periodicity)

Q61E22: (number of pay periods)

Enter dollar amount $ .00

RETIREMENT AND PENSIONS

>Q62a< During 1996, did (you/anyone in this household)receive any pension or retirement income from a previous employer or union, or any other type of retirement income (other than Social Security/other than VA benefits/ other than Social Security or VA benefits)?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q62b< **ASK ONLY IF NECESSARY**

Who received pension or retirement income?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q62c< What was the source of (name's/your)income?

<1> Company or union pension (INCLUDE PROFIT SHARING)

<2> Federal Government (CIVIL SERVICE)retirement

<3> U.S. Military retirement

<4> State or Local government pension

<5> U.S. Railroad Retirement

<6> Regular payments from annuities or paid up insurance policies

<7> Regular payments from IRA, KEOGH or 401(k)accounts

<8> Other sources or don't know -- SPECIFY -- ENTER LAST

PROBE: Any other pension or retirement income?

<N> NO OTHER SOURCES OF INCOME

===>_ ===>_ ===>_ ===>_

>Q62c-oth< ENTER OTHER SOURCE OF PENSION OR RETIREMENT INCOME

ENTER "OTHER PENSION OR RETIREMENT" IF THE ANSWER IS "DON'T KNOW"

===>__________________________________________________________

>Q62E1p< What is the easiest way for you to tell us (name's/your) (first fill from 62c or 62c-oth); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q62E1< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in (first fill from 62c or 62c-oth)in 1996?

Enter dollar amount $ .00

>Q62E12< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (first fill from 62c or 62c-oth)in 1996?

<1-52>

>Q62E1C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FIRST FILL FROM 62c OR 62c-oth)PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q62E13< According to my calculations (name/you)received (total)dollars altogether from (first fill from 62c or 62c-oth)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q62E14< What is your best estimate of the correct amount (name\you)received from (first fill from 62c or 62c-oth)during 1996?

PREVIOUS ENTRIES: Q62E1: (amount)

Q62E1p: (periodicity)

Q62E12: (number of pay periods)

Enter dollar amount $ .00

>Q62E2p< What is the easiest way for you to tell us (name's/your) (second fill from 62c or 62c-oth); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q62E2< How much did (name/you)receive (weekly/every other week/twice a month/

monthly/ )in (second fill from 62c or 62c-oth)in 1996?

Enter dollar amount $ .00

>Q62E22< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (second fill from 62c or 62c-oth)in 1996?

<1-52>

>Q62E2C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (SECOND FILL FROM 62c OR 62c-oth)RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q62E23< According to my calculations (name/you)received (total)dollars altogether from (second fill from 62c or 62c-oth)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q62E24< What is your best estimate of the correct amount (name\you)received from (second fill from 62c or 62c-oth)during 1996?

PREVIOUS ENTRIES: Q62E2: (amount)

Q62E2p: (periodicity)

Q62E22: (number of pay periods)

Enter dollar amount $ .00

>Q62E3p< What is the easiest way for you to tell us (name's/your) (third fill from 62c or 62c-oth); weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q62E3< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in (third fill from 62c or 62c-oth)in 1996?

Enter dollar amount $ .00

>Q62E32< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in (third fill from 62c or 62c-oth)in 1996?

<1-52>

>Q62E3C< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (THIRD FILL FROM 62c OR 62c-oth)RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q62E33< According to my calculations (name/you)received (total)dollars altogether from (third fill from 62c or 62c-oth)in 1996. Does that sound about right?

<1> Yes

<2> No

>Q62E34< What is your best estimate of the correct amount (name\you)received from (third fill from 62c or 62c-oth)during 1996?

PREVIOUS ENTRIES: Q62E1: (amount)

Q62E1p: (periodicity)

Q62E12: (number of pay periods)

Enter dollar amount $ .00

INTEREST

>Q63A1< At anytime during 1996, did (you/anyone in this household):

Have money in any kind of money market fund or savings account?

<1> Yes

<2> No

===>_

>Q63A2< Have any bonds, treasury notes, IRA's, or certificates of deposit?

<1> Yes

<2> No

===>_

>Q63A3< Have an interest earning checking account or any other investments which pay interest?

<1> Yes

<2> No

===>_

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q63b< **ASK ONLY IF NECESSARY**

Which members of this household ages 15 and over had (savings accounts or money market funds/bonds, treasury notes, or certificates of deposit/investments which pay interest)?

INCLUDE EACH IN CASES OF JOINT ACCOUNTS OR OWNERSHIP

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q63cp< What is the easiest way for you to tell us how much (name/you)received in interest income; monthly, quarterly, or yearly?

ONLY INCLUDE INTEREST RECEIVED FROM U. S. SAVINGS BONDS CASHED DURING 1996

SEPARATE AMOUNTS FOR JOINT OWNERSHIP

(blank/<A> Already included)

<X> None

<1> Monthly

<2> Quarterly

<3> Yearly

==>___

>Q63c< How much did (name/you)receive (monthly/quarterly/ )in interest from these sources during 1996, including even small amounts reinvested or credited to accounts?

SEPARATE AMOUNTS FOR JOINT OWNERSHIP

(blank/<A> Already included)

<X> None

Enter dollar amount $ .00

>Q63c2< How many (monthly/quarterly)payments did (name/you)receive in interest income in 1996?

<1-52>

>Q63cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL INTEREST INCOME RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q63c3< According to my calculations (name/you)received (total)dollars altogether from interest income in 1996. Does that sound about right?

<1> Yes

<2> No

>Q63c4< What is your best estimate of the correct amount (name\you)received from interest payments during 1996?

PREVIOUS ENTRIES: Q63c: (amount)

Q63cp: (periodicity)

Q63c2: (number of pay periods)

Enter dollar amount $ .00

DIVIDENDS

>Q64a< (blank/At any time during 1996 did (anyone in this household ages 15 and over/you))

Own any shares of stock in corporations (PAUSE)or any mutual fund shares?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q64b< **ASK ONLY IF NECESSARY**

Which members of this household?

INCLUDE EACH PERSON IN CASE OF JOINT OWNERSHIP

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q64cp< What is the easiest way for you to tell us (name's/your)dividend income; monthly, quarterly or yearly?

SEPARATE AMOUNTS FOR JOINT OWNERSHIP

(blank/<A> Already included)

<1> Monthly

<2> Quarterly

<3> Yearly

==>___

>Q64c< How much did (name/you)receive (monthly/quarterly/ )in dividends from stocks (mutual funds)during 1996, including dividends that were reinvested?

SEPARATE AMOUNTS FOR JOINT OWNERSHIP

(blank/<A> Already included)

<X> None

Enter dollar amount $ .00

>Q64c2< How many (monthly/quarterly)payments did (name/you)receive in dividends from stocks (mutual funds)in 1996?

<1-52>

>Q64cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL DIVIDEND PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q64c3< According to my calculations (name/you)received (total)dollars altogether from dividend payments in 1996. Does that sound about right?

<1> Yes

<2> No

>Q64c4< What is your best estimate of the correct amount (name\you)received from dividend payments during 1996?

PREVIOUS ENTRIES: Q64c: (amount)

Q64cp: (periodicity)

Q64c2: (number of pay periods)

Enter dollar amount $ .00

PROPERTY INCOME

>Q65A1< During 1996 did (you/anyone in this household):

Own any land, business property, apartments, or houses which were rented to others?

<1> Yes

<2> No

>Q65A2< Receive income from royalties or from roomers or boarders? (exclude amounts paid by relatives)

<1> Yes

<2> No

>Q65A3< Receive income from estates or trusts? (exclude estates or trusts already reported)

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q65b< **ASK ONLY IF NECESSARY**

Who received this (income/rent)?

INCLUDE EACH IN CASES OF JOINT OWNERSHIP FOR SELF-EMPLOYED PERSONS, DETERMINE IF INCOME WAS ALREADY INCLUDED

SE LN NAME SE LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

<H> (Help)Self-employed income previously reported

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q65c< How much did (name/you)receive in income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts)AFTER EXPENSES during 1996?

SEPARATE AMOUNTS FOR JOINT OWNERSHIP

IF RESPONSE IS "BROKE EVEN" THEN ENTER 1.

(blank/<A> Already included)

<X> None

<L> Lost

Enter dollar amount $ .00

>Q65cL< ENTER AMOUNT OF MONEY LOST IN 1996.

===>$___,___ .00

>Q65cp< Is this an annual, quarterly, monthly, weekly, or other amount?

Per <1> Annual

<2> Quarterly

<3> Monthly

<4> Weekly

<5> Other

Q65cp ==>___

>Q65c2< What is your best estimate of (name's/your)ANNUAL net income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts)AFTER EXPENSES in 1996?

PREVIOUS ENTRIES: Q65c: (amount)

Q65cp: (periodicity)

Enter dollar amount $ .00

>Q65cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL SECURITY INCOME RECEIVED IN 1996 ON BEHALF OF CHILDREN WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No goto 65c (TO CORRECT ENTRY)

>Q65c2L< What is your best estimate of (name's/your)ANNUAL LOSS from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts)AFTER EXPENSES in 1996?

PREVIOUS ENTRIES: Q65cL: (amount)

Q65c1: (periodicity)

Enter dollar amount $ .00

EDUCATION ASSISTANCE

>Q66a< During 1996 did (you/anyone in this household)attend school beyond the high school level including a college, university, or other schools? (include vocational, business, or trade schools)

<1> Yes

<2> No

>Q66b< Did (you/anyone in this household)receive any educational assistance for tuition, fees, books, or living expenses during 1996?

EXCLUDE LOANS, ASSISTANCE FROM HOUSEHOLD MEMBERS, AND VA EDUCATIONAL BENEFITS

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q66c< **ASK ONLY IF NECESSARY**

Which member received assistance?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q66d< What type of assistance did (name/you)receive?

EXCLUDE ASSISTANCE FROM HOUSEHOLD MEMBERS

<2> Pell Grant

<3> Some other government assistance

<4> Scholarships, grants, etc.

<5> Other assistance (employers, friends, etc.)

PROBE: Any other assistance?

<N> No other assistance

===>_ ===>_ ===>_ ===>_

>Q69F88< How much did (name/you)receive in Pell Grants during 1996?

FOR AMOUNTS $50,000 AND OVER, ENTER $49,999

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

>Q66hp< What is the easiest way for you to tell us (name's/your)educational assistance during 1996; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q66h< (blank/Aside from the Pell Grant assistance,) (How/how)much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in educational assistance during 1996?

Enter dollar amount $ .00

>Q66h2< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in educational assistance in 1996?

<1-52>

>Q66hC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL EDUCATIONAL ASSISTANCE RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q66h3< According to my calculations (name/you)received (total)dollars altogether from educational assistance in 1996. Does that sound about right?

<1> Yes

<2> No

>Q66h4< What is your best estimate of the correct amount (name\you)received from educational assistance during 1996?

PREVIOUS ENTRIES: Q66h: (amount)

Q66hp: (periodicity)

Q66h2: (number of pay periods)

Enter dollar amount

CHILD SUPPORT AND ALIMONY

>Q70a< During 1996 did (anyone in this household/you)receive:

Any child support payments?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q70b< **ASK ONLY IF NECESSARY**

Who received these payments?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q70cp< What is the easiest way for you to tell us (name's/your)child support payments; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

>Q70c< How much did (name/you)receive

(weekly/every other week/twice a month/monthly/ )

in child support payments in 1996?

Enter dollar amount $ .00

>Q70c2< How many (weekly/every other week/twice a month/monthly)child support payments did (name/you)receive in 1996?

<1-52>

>Q70cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL CHILD SUPPORT PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q70c3< According to my calculations (name/you)received (total)dollars altogether from child support payments in 1996. Does that sound about right?

<1> Yes

<2> No

>Q70c4< What is your best estimate of the correct amount (name\you)received from child support payments during 1996?

PREVIOUS ENTRIES: Q70c: (amount)

Q70cp: (periodicity)

Q70c2: (number of pay periods)

Enter dollar amount $ .00

>Q71a< (blank/During 1996 did (anyone in this household receive:/you receive:)

Any alimony payments?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q71b< **ASK ONLY IF NECESSARY**

Who received these payments during 1996?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q71cp< What is the easiest way for you to tell us (name's/your)alimony payments; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q71c< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ ) in alimony payments in 1996?

Enter dollar amount $ .00

>Q71c2< How many (weekly/every other week/twice a month/monthly)alimony payments did (name/you)receive in 1996?

<1-52>

>Q71cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL ALIMONY PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q71c3< According to my calculations (name/you)received (total)dollars altogether from alimony payments in 1996. Does that sound about right?

<1> Yes

<2> No

>Q71c4< What is your best estimate of the correct amount (name\you)received from alimony payments during 1996?

PREVIOUS ENTRIES: Q71c: (amount)

Q71cp: (periodicity)

Q71c2: (number of pay periods)

Enter dollar amount $ .00

REGULAR FINANCIAL ASSISTANCE

>Q72a< (blank/During 1996 did (anyone in this household receive:/you receive:) (Any other/ Any)regular financial assistance from friends or relatives not living in this household?

DO NOT INCLUDE LOANS

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q72b< **ASK ONLY IF NECESSARY**

Who received this assistance?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q72cp< What is the easiest way for you to tell us (name's/your)regular financial assistance; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q72c< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ ) in regular financial assistance in 1996?

Enter dollar amount $ .00

>Q72c2< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in regular financial assistance in 1996?

<1-52>

>Q72cC2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL REGULAR FINANCIAL ASSISTANCE PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q72c3< According to my calculations (name/you)received (total)dollars altogether from regular financial assistance in 1996. Does that sound about right?

<1> Yes

<2> No

>Q72c4< What is your best estimate of the correct amount (name\you)received from regular financial assistance during 1996?

PREVIOUS ENTRIES: Q72c: (amount)

Q72cp: (periodicity)

Q72c2: (number of pay periods)

Enter dollar amount $ .00

OTHER MONEY INCOME

>Q73A1< During 1996, did (anyone in this household/you)receive income from:

Hobbies, home businesses, farms, or business interests not already covered?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q73A1b< **ASK ONLY IF NECESSARY**

Who received this income?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q73A1c< What was the source of this income?

SPECIFY ASKING ABOUT: (name/name--CURRENT RESPONDENT)

===>______________________________________________________

>Q731p< What is the easiest way for you to tell us (name's/your)income from hobbies, home business, farms, or business interest not already covered during 1996; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q731< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in income from hobbies, home business, farms, or business interest not already covered during 1996?

Enter dollar amount $ .00

>Q7312< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in income from hobbies, home business, farms, or business interest not already covered in 1996?

<1-52>

>Q731C2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL INCOME FROM HOBBIES, HOME BUSINESS, FARMS, OR BUSINESS INTEREST NOT ALREADY COVERED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q7313< According to my calculations (name/you)received (total)dollars altogether from hobbies, home business, farms, or business interest not already covered in 1996. Does that sound about right?

<1> Yes

<2> No

>Q7314< What is your best estimate of the correct amount (name\you)received from hobbies, home business, farms, or business interest not already covered during 1996?

PREVIOUS ENTRIES: Q731: (amount)

Q731p: (periodicity)

Q7312: (number of pay periods)

Enter dollar amount $ .00

>Q73A2< During 1996, did (anyone in this household/you)receive income from:

Any severance pay, welfare, foster child care payments, or any other money income not already covered?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>Q73A2b< **ASK ONLY IF NECESSARY**

Who received this income?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q73A2c< What was the source of this income?

SPECIFY ASKING ABOUT: (name/name--CURRENT RESPONDENT)

===>______________________________________________________

>Q732p< What is the easiest way for you to tell us (name's/your)income from any unemployment compensation, severance pay, welfare, foster child care payments, or any other money not already covered during 1996; weekly, every other week, twice a month, monthly or yearly?

<1> Weekly

<2> Every other week

<3> Twice a month

<4> Monthly

<5> Yearly

==>___

>Q732< How much did (name/you)receive (weekly/every other week/twice a month/monthly/ )in income from any unemployment compensation, severance pay, welfare, foster child care payments, or any other money not already covered during 1996?

Enter dollar amount $ .00

>Q7322< How many (weekly/every other week/twice a month/monthly)payments did (name/you)receive in income from any unemployment compensation, severance pay, welfare, foster child care payments, or any other money not already covered in 1996?

<1-52>

>Q732C2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL INCOME FROM ANY UNEMPLOYMENT COMPENSATION, SEVERANCE PAY, WELFARE, FOSTER CHILD CARE PAYMENTS, OR ANY OTHER MONEY NOT ALREADY COVERED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q7323< According to my calculations (name/you)received (total)dollars altogether from any unemployment compensation, severance pay, welfare, foster child care payments, or any other money not already covered in 1996. Does that sound about right?

<1> Yes

<2> No

>Q7324< What is your best estimate of the correct amount (name\you)received from any unemployment compensation, severance pay, welfare, foster child care payments, or any other money not already covered during 1996?

PREVIOUS ENTRIES: Q732: (amount)

Q732p: (periodicity)

Q7322: (number of pay periods)

Enter dollar amount $ .00

HEALTH INSURANCE

>SHI1< These next questions are about health insurance coverage during the calendar year 1996. The questions apply to ALL persons of ALL ages.

ENTER TO PROCEED

===>_

>SHI2< At any time in 1996, (were you/was anyone in this household)covered by a health plan provided through (their/your)current or former employer or union? (MILITARY HEALTH INSURANCE WILL BE COVERED LATER IN ANOTHER QUESTION.)

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI3< Who in this household were policyholders?

PROBE: Anyone else? ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI4< In addition to (you/name), who else in this household was covered by (name's/your)plan?

PROBE: Anyone else? ENTER<X> FOR NONE

ENTER<A> FOR ALL

ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SHI5< Did (name's/your)plan cover anyone living outside this household?

<1> Yes

<2> No

>SHI6< Did (name's/your)former or current employer or union pay for all, part, or none of the health insurance premium?

(NOTE: REPORT HERE EMPLOYER'S CONTRIBUTION TO EMPLOYEE'S HEALTH INSURANCE PREMIUMS, NOT THE EMPLOYEE'S MEDICAL BILLS.)

<1> All

<2> Part

<3> None

===>_

>SHI7< At anytime during 1996, (were you/was anyone in this household)covered by a plan that (you/they)PURCHASED DIRECTLY, that is, not related to current or past employment?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI8< Who in this household were policyholders?

PROBE: Anyone else? ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI9< In addition to (you/name), who else in this household was covered by (name's/your)plan?

PROBE: Anyone else? ENTER<X> FOR NONE

ENTER<A> FOR ALL

ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SHI10< Did (name/your)plan cover anyone living outside this household?

<1> Yes

<2> No

>SHI11< At any time in 1996, (were you/was anyone in this household)covered by the health plan of someone who does not live in this household?

<1> Yes

<2> No

OTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI12< Who was that?

PROBE: Anyone else? ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SHI13< At any time in 1996, (were you/was anyone in this household)covered by Medicare?

READ IF NECESSARY: Medicare is the health insurance for persons 65 years old and over or persons with disabilities

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI14< Who was that?

PROBE: Anyone else? ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SHI15< At any time in 1996, (were you/was anyone in this household)covered by Medicaid/(fill state name)?

READ IF NECESSARY: Medicaid/ (fill state name)is the government assistance program that pays for health care.

<1> Yes

<2> No

State fills for item SHI15:

Alaska Medical Assistance Program

Arizona AHCCCS, Acute Care Program or Long Term Care System (ALTCS)

California Medi-Cal

Connecticut Connecticut Access (CONNECT CARD)

D.C. Medical Assistance

Florida MediPass

Georgia Better Health Care Program or Medical Assistance

Hawaii Med-QUEST, Maluhia or Medical Assistance

Idaho Healthy Connections or Medical Assistance

Illinois MediPlan

Indiana Hoosier Healthwise

Iowa MediPAS (Medical Assistance)

Kansas PrimeCare, Community Care Kansas (CCK)or HealthConnect

Kentucky Kentucky Patient Access and Care System (KenPAC)or Medical Assistance

Louisiana CommunityCARE Program

Maine PrimeCare

Maryland Maryland Access to Care (MAC)or Medical Assistance

Massachusetts MassHealth

Minnesota Prepaid Medical Assistance Program (PMAP)or Health Care Programs

Mississippi HealthMACS

Missouri MC Plus

Montana Passport to Health

Nebraska Primary Care Plus (+)or Health Connection

Nevada MAPnet

New Jersey New Jersey Care 2000

New Mexico Primary Care Network

New York MAX

North Carolina Carolina Access

North Dakota North Dakota Access to Care (No DAC)

Ohio Accessing Better Care (ABC)Program

Oklahoma SoonerCare

Oregon Oregon Health Plan (OHP), Kaiser-S/HMO or Medical Assistance

Pennsylvania HealthPASS, Family Care Network (FCN), Lancaster Community Health Plan, Blue Card or Green Card or ACCESS

Rhode Island Rite Care or Medical Assistance

South Carolina South Carolina Health Access Plan (SCHAP)

South Dakota Primary Care Provider Program

Tennessee TennCare

Texas LoneSTAR (State of Texas Access Reform)

Vermont Dr. Dynosaur, Vermont Health Access Program (VHAP)or AIM

Virginia Medallion, Options or Medical Assistance

Washington Health Access Spokane, Kaiser-S/HMO or Healthy Options

West Virginia West Virginia Physician Assured Access System (PAAS)

Wisconsin Medical Assistance Program

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI16< Who was that?

PROBE: Anyone else? ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SHI17< How many months during 1996, (were/was) (name/you)covered by Medicaid/(local name)?

ENTER NUMBER OR MONTHS

===>__

(1-12)

>SHI18< At any time in 1996, (were you/was anyone in this household)covered by CHAMPUS, CHAMPVA, VA, military health care, or Indian Health Service?

NOTE: "CHAMPVA" IS THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERAN'S AFFAIRS.

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI19< Who was that?

PROBE: Anyone else? ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SHI20a< What plan (were/was) (name/you)covered by?

<1> CHAMPUS or military health care

<2> CHAMPVA

<3> VA

<4> Indian Health Service

<5> Other

===>_

>SHIC1< Other than the plans I have already talked about, during 1996, was anyone in this household covered by a health insurance plan (such as the [use fill specified for particular state shown below] plan or any other type of plan/of any other type)?

<1> Yes

<2> No

Fills for State-specific health insurance programs for low-income uninsured individuals (to be used in SHIC1).

Alaska General Relief Medical (GRM)

California County Medical Services Program (CMSP), Children's Services (CCS)

Colorado Child Health Plan

Connecticut Healthy Steps, General Assistance Program (GA)

Florida Healthy Kids

Illinois General Assistance Program (State Child and Family Assistance, SCFA or Transitional Assistance, TA)

Iowa Caring Program for Children

Kansas MediKan, Caring Program for Kids

Massachusetts CommonHealth Program, Medical Security Plan (MSO), CenterCare Program, Children's Medical Security Plan

Michigan Wayne County Plus Care Program, Medical Assistance Program, Care Program for Children

Minnesota MinnesotaCare, Minnesota General Assistance Medical Care Program (GAMC)

Missouri General Relief Medical Assistance

Nebraska State Disability Program

New Jersey Health Access New Jersey

New York Home Relief, Child Health Plus (CHP)

North Carolina Caring Program for Children

Ohio Ohio Disability Assistance Medical Program

Pennsylvania Children's Health Insurance Programs (CHIP), General Assistance Medical Program

Rhode Island General Public Assistance (GPA)Medical Program

Utah Utah Medical Assistance Program (UMAP)

Virginia State and Local Hospitalizations (SLH)Program, Caring Program for Children

Washington Basic Health Plan, Children's Health Program, General Assistance Unemployable Program (GA-U)

Wisconsin General Relief Medical

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHIC2< Who has insurance?

ENTER LINE NUMBER OF INSURED PERSON.

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

(Ask SHIC3 for each person listed in SHIC2)

>SHIC3< What type of insurance did (you/name)have in 1996?

<1> Medicare

<2> Medicaid

<3> CHAMPUS

<4> CHAMPVA ("CHAMPVA" Is the civilian health and medical

program of the Department of Veteran's Affairs.)

<5> VA health care

<6> Military health care

<7> Indian Health Service

<8> Other government health care

<9> Employer/union-provided (policyholder)

<10> Employer/union-provided (as dependent)

<11> Privately purchased (policyholder)

<12> Privately purchased (as dependent)

<13> Plan of someone outside the household

<14> Other

===>__

>SHI21< (You reported that you or someone in this household was covered by health insurance last year.)These next questions are about CURRENT health insurance coverage, that is, health coverage last week. (Were you/Was anyone in this household)covered by ANY type of health insurance plan last week?

<1> Yes

<2> No

NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS

>SHI22< Who was that?

PROBE: Who else was covered? ENTER<N> FOR NO MORE

R LN NAME R LN NAME

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>SHI221< (Were/Was) (you/all of these persons/name)covered by the same type(s)of health insurance last week that covered (you/them/him/her)last year?

<1> Yes

<2> No

>SHI23< What type of plan (were/was) (name/you)covered by last week?

PROBE: Any other plan? ENTER<N> FOR NO MORE

<1> Same as last year

<2> Medicare

<3> Medicaid/(state fill name)

<4> CHAMPUS

<5> CHAMPVA ("CHAMPVA" Is the civilian health and medical

program of the Department of Veteran's Affairs.)

<6> VA health care

<7> Military health care

<8> Indian Health Service

<9> Other government health care

<10> Employer/union-provided (policyholder)

<11> Employer/union-provided (as dependent)

<12> Privately purchased (policyholder)

<13> Privately purchased (as dependent)

<14> Plan of someone outside the household

<15> Other (Specify)

===>

>SHI24< An important factor in evaluating a person's or family's health insurance situation is their current health status and/or the current health status of other family members.

ENTER TO PROCEED

===>_

>SHI25< Would you say (name's/your)health in general is:

<1> Excellent

<2> Very good

<3> Good

<4> Fair

<5> Poor

===>_

EMPLOYER'S PENSION PLAN

>Q74a< Other than Social Security did the (ANY)employer or union that (name/you)worked for in 1996 have a pension or other type of retirement plan for any of its employees?

<1> Yes

<2> No

>Q74b< (Were/Was) (name/you)included in that plan?

<1> Yes

<2> No

SCHOOL LUNCHES

>Q80< During 1996 how many of the children ages 5 to 18 in this household usually ate a complete lunch offered at school?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

<A> All<1-8>

<X> None<9> Nine or more

===>__ TOTAL NUMBER OF CHILDREN COVERED

>Q83< During 1996 how many of the children in this household received free or reduced price lunches because they qualified for the Federal School Lunch program?

Number of children who ate hot lunch offered at school: (entry in Q80)

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

<A> All<1-8>

<X> None<9> Nine or more

===>__ TOTAL NUMBER OF CHILDREN COVERED

PUBLIC HOUSING

>Q85< Is this public housing, that is, is it owned by a local housing authority or other public agency?

<1> Yes

<2> No

>Q86< Are you paying lower rent because the Federal, State, or local government is paying part of the cost?

<1> Yes

<2> No

FOOD STAMPS

>Q87< Did (you/anyone in this household)get food stamps at any time during 1996?

<1> Yes

<2> No

>Q88< Which of the people now living here were covered by food stamps during 1996?

LIST ALL HOUSEHOLD MEMBERS COVERED BY FOOD STAMPS REGARDLESS OF AGE

PROBE: Anyone else? ENTER<N> FOR NO MORE

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

<A> All

<X> None

ENTER LINE NUMBER

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>Q90p< What is the easiest way for you to tell us the value of the food stamps; monthly or yearly?

<1> Monthly

<2> Yearly

==>___

>Q90< What is the (monthly/ )value of food stamps received in 1996?

Enter dollar amount $ .00

>Q902< How many months were food stamps received in 1996?

<1-12>

>Q90C2< *** DO NOT READ TO THE RESPONDENT ***

THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL FOOD STAMPS PAYMENTS RECEIVED IN 1996 WAS (AMOUNT). IS THIS A CORRECT ENTRY?

<1> Yes

<2> No

>Q903< According to my calculations (total)dollars was received altogether from food stamps in 1996. Does that sound about right?

<1> Yes

<2> No

>Q904< What is your best estimate of the correct amount received from food stamps during 1996?

PREVIOUS ENTRIES: Q90: (amount)

Q90p: (periodicity)

Q902: (number of pay periods)

Enter dollar amount

ENERGY ASSISTANCE

>Q93< The government has an energy assistance program which helps pay heating costs. This assistance can be received directly by the household or it can be paid directly to the electric company, gas company, or fuel dealer.

Since October 1, 1996, (have you/has this household)received assistance of this type from the federal, state, or local government?

<1> Yes

<2> No

>Q93PR1< Do you remember receiving an additional or unexpected check that was sent during the winter to help pay heating costs?

<1> Yes

<2> No

>Q93PR2< Was it used to pay heating costs?

<1> Yes

<2> No

>Q94< Altogether, how much energy assistance has been received since October 1, 1996?

FOR AMOUNTS $25,000 AND OVER, ENTER $24,999

===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY

MIGRATION

>MIGSAM< (Was (reference person's name)/Were you)living in this house (or apartment)one year ago; that is, on March 1, 1996?

<1> Yes, this house (apt)

<2> No, different house in U.S.

<3> No, outside the U.S.

>MIGLIV< Where did (reference person's name/you)live on March 1, 1996?

>MIGPLC< Name of city/town/post office <S> Same city, town, post office

_______________________ CURRENT: (city)

>MIGSTA< Name of State

` <W> For persons living on a ship at sea

<S> Same state

<H> Help, State codes

_______________________ CURRENT: (state)

>MIGZIP< ZIP Code

_____ CURRENT: (zip code)

>MIGCLM< Did (reference person's name/you)live inside the city limits of (place name)?

<1> Yes, inside city limits

<2> No, outside city limits or post office name only

>MIGCOU< What (county/parish)is (place name)in?

________________________ (goto MIGCKA)

Note: Enter "IND CITY" if an independent city, not in a county.

>MIGCN1< What country did (reference person's name/you)live in 1 year ago?

301 Canada 383 Guyana 315 Mexico

206 Cambodia 342 Haiti 316 Nicaragua

207 China 314 Honduras 385 Peru

379 Colombia 209 Hong Kong 231 Philippines

337 Cuba 117 Hungary 128 Poland

339 Dominican Republic 210 India 129 Portugal

380 Ecuador 212 Iran 72 Puerto Rico

312 El Salvador 119 Ireland/Eire 192 Russia

139 England 120 Italy 140 Scotland

109 France 343 Jamaica 238 Taiwan

110 Germany 215 Japan 239 Thailand

116 Greece 218 Korea/South Korea 351 Trinidad & Tobago

313 Guatemala 221 Laos 242 Vietnam

===>___ Other country ===><M>

Note: More countries on additional screens (MIGCN2-MIGCN4).

>MIGCN2< Other Countries

200 Afghanistan 103 Belgium 415 Egypt

60 American Samoa 300 Bermuda 417 Ethiopia

375 Argentina 376 Bolivia 507 Fiji

185 Armenia 377 Brazil 108 Finland

102 Austria 205 Burma 421 Ghana

501 Australia 378 Chile 138 Great Britain

130 Azores 311 Costa Rica 340 Grenada

333 Bahamas 155 Czech Republic 66 Guam

202 Bangladesh 105 Czechoslovakia 126 Holland

334 Barbados 106 Denmark 211 Indonesia

310 Belize 338 Dominica

===>___ Other country ===><M>

Note: More countries on additional screens (MIGCN3-MIGCN4).

>MIGCN3< Other Countries

213 Iraq 440 Nigeria 134 Spain

214 Israel 142 Northern Ireland 136 Sweden

216 Jordan 127 Norway 137 Switzerland

427 Kenya 229 Pakistan 237 Syria

183 Latvia 253 Palestine 240 Turkey

222 Lebanon 317 Panama 78 U.S. Virgin Islands

184 Lithuania 132 Romania 195 Ukraine

224 Malaysia 233 Saudi Arabia 387 Uruguay

436 Morocco 234 Singapore 180 USSR

126 Netherlands 156 Slovakia/Slovak Rep. 388 Venezuela

514 New Zealand 449 South Africa 147 Yugoslavia

===>___ Other country ===><M>

Note: More areas/continents on additional screen (MIGCN4).

>MIGCN4< PROBE: The country you have named is not on my list. Can you tell me what part of the world that country is in?

353 Caribbean 148 Europe 245 Asia

318 Central America 252 Middle East 527 Pacific Islands

389 South America 468 North Africa

304 North America 462 Other Africa

===>___

>MIGALL1< (There are (number)other persons in this household ages 1 year or over/ ). Did (all of these persons/person name)live with (reference person's name/you)in (this house/name of country/name of city, State)1 year ago?

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

<1> Yes, all lived with reference person/you

<2> No, some or all did not live with reference person/you

>MIGM< Which of the other members of this household did NOT live with (reference person's name/you)1 year ago? (Enter all that apply.)

LN NAME RELATION LN NAME RELATION

(person 1) (person 9)

(person 2) (person 10)

(person 3) (person 11)

(person 4) (person 12)

(person 5) (person 13)

(person 6) (person 14)

(person 7) (person 15)

(person 8) (person 16)

ENTER LINE NUMBER<N> No more

PROBE: Anyone else?

===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__ ===>__

>NXTSAM< Did (NEXTMOVER's name/you)live in this house 1 year ago; that is, on March 1, 1996?

<1> Yes, this house (apt)

<2> No, different house in U.S.

<3> No, outside the U.S.

>NXTLIV< Where did (NEXTMOVER's name/you)live on March 1, 1996?

>NXTPLC< Name of city/town/post office <S> Same city, town, post office

_______________________ CURRENT: (city)

>NXTSTA< Name of State

<W> For persons living on a ship at sea

<S> Same state

<H> Help, State codes

_______________________ CURRENT: (state)

>NXTZIP< ZIP Code

_____ CURRENT: (zip code)

>NXTCLM< Did (NEXTMOVER's name/you)live inside the city limits of (place name)?

<1> Yes, inside city limits

<2> No, outside city limits or post office name only

>NXTCOU< What (county/parish)is (place name)in?

________________________

>NXTCN1< What country did (NEXTMOVER's name/you)live in 1 year ago?

301 Canada 383 Guyana 315 Mexico

206 Cambodia 342 Haiti 316 Nicaragua

207 China 314 Honduras 385 Peru

379 Colombia 209 Hong Kong 231 Philippines

337 Cuba 117 Hungary 128 Poland

339 Dominican Republic 210 India 129 Portugal

380 Ecuador 212 Iran 72 Puerto Rico

312 El Salvador 119 Ireland/Eire 192 Russia

139 England 120 Italy 140 Scotland

109 France 343 Jamaica 238 Taiwan

110 Germany 215 Japan 239 Thailand

116 Greece 218 Korea/South Korea 351 Trinidad & Tobago

313 Guatemala 221 Laos 242 Vietnam

===>___ Other country ===><M>

Note: More countries on additional screens (NXTCN2-NXTCN4).

>NXTCN2< Other Countries

200 Afghanistan 103 Belgium 415 Egypt

60 American Samoa 300 Bermuda 417 Ethiopia

375 Argentina 376 Bolivia 507 Fiji

185 Armenia 377 Brazil 108 Finland

102 Austria 205 Burma 421 Ghana

501 Australia 378 Chile 138 Great Britain

130 Azores 311 Costa Rica 340 Grenada

333 Bahamas 155 Czech Republic 66 Guam

202 Bangladesh 105 Czechoslovakia 126 Holland

334 Barbados 106 Denmark 211 Indonesia

310 Belize 338 Dominica

===>___ Other country ===><M>

Note: More countries on additional screens (NXTCN3-NXTCN4).

>NXTCN3< Other Countries

213 Iraq 440 Nigeria 134 Spain

214 Israel 142 Northern Ireland 136 Sweden

216 Jordan 27 Norway 137 Switzerland

427 Kenya 229 Pakistan 237 Syria

183 Latvia 253 Palestine 240 Turkey

222 Lebanon 317 Panama 78 U.S. Virgin Islands

184 Lithuania 132 Romania 195 Ukraine

224 Malaysia 233 Saudi Arabia 387 Uruguay

436 Morocco 234 Singapore 180 USSR

126 Netherlands 156 Slovakia/Slovak Rep. 388 Venezuela

514 New Zealand 449 South Africa 147 Yugoslavia

===>___ Other country ===><M>

Note: More areas/continents on additional screen (NXTCN4).

>NXTCN4< PROBE: The country you have named is not on my list. Can you tell me what part of the world that country is in?

353 Caribbean 148 Europe 245 Asia

318 Central America 252 Middle East 527 Pacific Islands

389 South America 468 North Africa

304 North America 462 Other Africa

===>___

>SUNITS< *** ASK IF NECESSARY ***

How many housing units are in this structure?

<1> Only one

<2> Two

<3> Three or four

<4> Five to nine

<5> Ten or more

===>___

Contacts - -Table of Contents

Source: U.S. Census Bureau

Skip this navigation

Census Bureau Links: Home · Search · Subjects A-Z · FAQs · Data Tools · Catalog · Census 2000 · Quality · Privacy Policy · Contact Us

Page Last Modified: March 07, 2008