Data Cart

Your data extract

0 variables
0 samples
View Cart



APPENDIX D
Facsimile of 2011 Annual Social and Economic (ASEC) Supplement Questionnaire
2011 Annual Social and Economic Supplement
Items Booklet - Feb/March/April 2011

2011 ANNUAL SOCIAL AND ECONOMIC SUPPLEMENT
CPS FIELD REPRESENTATIVE / CATI INTERVIEWER
ITEMS BOOKLET

U.S. DEPARTMENT OF COMMERCE

This document does not contain any Title 13 data or other personally identifiable information. All data are fictitious and any resemblance to actual data is coincidental. Consistent with Field Division Policy, any names referenced in practice interviews or other exercises are not meant to refer to any actual businesses, schools, group quarters, or persons, especially any current or former Census Bureau employees.
MOVER ITEMS
HH32b

Did (you/name of reference person) live at this address during the week of November 19, 2010?
(1) Yes
(2) No

HH32d
Did any of the following household members live here during the week of November 19, 2010?
(1) Yes
(2) No

FAMILY INCOME

S_FAMINC

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
(2) 5,000 to 7,499
(3) 7,500 to 9,999
(4) 10,000 to 12,499
(5) 12,500 to 14,999
(6) 15,000 to 19,999
(7) 20,000 to 24,999
(8) 25,000 to 29,999
(9) 30,000 to 34,999
(10) 35,000 to 39,999
(11) 40,000 to 49,999
(12) 50,000 to 59,999
(13) 60,000 to 74,999
(14) 75,000 to 99,999
(15) 100,000 to 149,000
(16) 150,000 to more

INCDKR
Is the combined income of all members of this FAMILY during the past 12 months above or below ($30,000/$50,000)?
(1) Above
(2) Below

INTRODUCTION

Pr_incom

?[F1] Importance of responding
Wording of introduction is optional.
The questions you just answered were about your job and economic status last week. The next set of questions ask about your job and economic status last year.
(1) Enter 1 to Continue

WORK EXPERIENCE

Q29a

Did (name/you) work at a job or business at any time during 2010?
(1) Yes
(2) No

Q29b
Did (you/he/she) do any temporary, part-time, or seasonal work even for a few days during 2010?
(1) Yes
(2) No

Q30
Even though (name/you) did not work in 2010, did (you/he/she) spend any time trying to find a job or on layoff?
(1) Yes
(2) No

Q31
How many different weeks (was/were) (name/you) looking for work or on layoff from a job?
(01-52) Number of weeks

Q32
What was the main reason (you/he/she) did not work in 2010?
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 2010 in how many weeks did (name/you) work even for a few hours? Include paid vacation and sick leave as work.
(01-52) Number of weeks
Enter 97 if respondent can only answer in months

Q33mon
Enter number of months worked
(1-12)

Q33ver
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 2010 because (you/he/she) (were/was) on layoff from a job or lost a job?
Number of weeks worked in 2010: (number)
(1) Yes
(2) No
(7) Mistake made in number of weeks worked last year - Specify in Q35SP

Q35SP
Specify mistake made in number of weeks worked last year

Q36
You said (name/you) worked about (number) (week/weeks). How many OF THE REMAINING (number) WEEKS (was/were) (you/he/she) looking for work or on layoff from a job?
Enter 0 for none

Q37
Were the (number) weeks (name/you) (was/were) 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) (was/were) not working or looking for work in the remaining weeks of 2010?
Read list only if respondent is having difficulty answering the question
(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 - Q38sp)

Q38sp
Enter verbatim response

Q39
For how many employers did (name/you) work in 2010? 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 2010, 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 2010?
Number of weeks worked in 2010: (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?
Read list only if respondent is having difficulty answering the question
(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 2010?
Was it:
(IO1NAM:) (name of employer)
(IO1IND:) (kind of business or industry)
(IO1OCC:) (occupation)
(IO1DT:) (duties)
CLASS OF WORKER: (PRIVATE/FEDERAL GOVERNMENT/STATE GOVERNMENT/LOCAL GOVERNMENT/WORKING WITHOUT PAY IN FAMILY BUS./SELF EMPLOYED--INCORPORATED/SELF EMPLOYED--UNINCORPORATED)
(1) Same as listed
(2) Different job

Q47a
For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job during 2010?))
Name of Company, business, organization or other employer
(blank/(IO1NAM:) (entry) The current employer is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/If longest job last year is military job, enter Armed Forces)
(blank/ Enter N for no work done at all during 2010)

Q47b
What kind of business or industry is this?
For example: TV and radio manufacturing, retail shoe store, farm
(blank/(IO1IND:) (entry) The current business or industry type is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/If longest job last year is military job, enter NA)

Q47b1
Is this business or organization mainly manufacturing, retail trade, wholesale trade, or something else?
(blank/(IO1MFG:) (entry) The current business or organization type is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/If longest job last year is military job, enter 4)
(1) Manufacturing
(2) Retail
(3) Wholesale trade
(4) Something else

Q47c
What kind of work (was/were) (you/he/she) doing?
For example: Electrical Engineer, Stock Clerk, Typist
(blank/(IO1OCC:) (entry) The current occupation is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/If longest job last year is military job, enter Armed Forces)

Q47d1
What were (your/his/her) most important activities or duties?
For example: Types, keeps account books, files, sells cars, operates printing press, finishes concrete.
(blank/(IO1DT:) (entry) The current job description is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/If longest job last year is military job, enter NA)

Q47d2
What were (your/his/her) most important activities or duties?
For example: Types, keeps account books, files, sells cars, operates printing press, finishes concrete.
(blank/(IO1DT:) (entry) The current job description is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/If longest job last year is military job, enter NA)

Q47E1
Ask Only If Necessary
(Were/Was) (you/he/she) employed by government, by a PRIVATE company, a nonprofit organization, or (was/were) ( you/he/she) 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
(Were/Was) (you/name) 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))?
Read categories if necessary
(1) under 10
(2) 10-49
(3) 50-99
(4) 100-499
(5) 500-999
(6) 1,000+

EARNED INCOME
Q48aa

How much did (name/you) earn from this employer before taxes and other deductions during 2010?
Enter dollar amount
Enter 0 for none

Q48aap
Read if necessary
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q48a1
For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q48aa) from this employer in 2010?
(1-12/1-24/1-26/1-52)

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? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48aV
According to my calculations (name/you) earned (total) altogether from this employer in 2010 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 2010 before deductions?
PREVIOUS ENTRIES:
Q48aa: (amount)
Q48aap: (periodicity)
Q48a1: (number of pay periods)

Enter dollar amount

Q48a3
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this employer in 2010?
(1) Yes
(2) No

Q48aad
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from this employer in 2010?
Enter dollar amount

Q48b
What were (name's/your) net earnings from this business/farm after expenses during 2010?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount

Q48b_char
Enter "L? for Lost Money

Q48BL
Enter amount of money lost in 2010
Enter annual amount only

Q48bp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(5) Quarterly
(7) Yearly

Q48B1A
Do not read to the respondent.
The annual rate appears out of range. The total annual business loss entered is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48B1B
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? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48b2
What is your best estimate of (name's/your) ANNUAL net earnings from this business/farm after expenses in 2010?
PREVIOUS ENTRIES:
Q48b: (amount)
Q48bp: (periodicity)

Enter dollar amount

Q48b2L
What is your best estimate of (name's/your) ANNUAL net LOSS from this business/farm after expenses in 2010?
PREVIOUS ENTRIES:
Q48bL: (amount)
Q48bp: (periodicity)

Enter dollar amount

Q48b3
What were (name's/your) net earnings from this business/farm during the FIRST quarter of 2010?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money? press enter
Enter dollar amount

Q48b3_char
Enter "L" for Lost Money

Q48B3L
Enter amount of money lost in the first quarter of 2010.

Q48b4
What were (name's/your) net earnings from this business/farm during the SECOND quarter of 2010?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount

Q48b4_char
Enter "L" for Lost Money

Q48B4L
Enter amount of money lost in the second quarter of 2010.

Q48b5
What were (name's/your) net earnings from this business/farm during the THIRD quarter of 2010?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount

Q48b5_char
Enter "L" for Lost Money

Q48B5L
Enter amount of money lost in the third quarter of 2010.

Q48b6
What were (name's/your) net earnings from this business/farm during the FOURTH quarter of 2010?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount

Q48b6_char
Enter "L" for Lost Money

Q48B6L
Enter amount of money lost in the fourth quarter of 2010.

Q48b7
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this business in 2010?
(1) Yes
(2) No

Q48bad
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions in 2010?
Enter dollar amount

Q49a
Did (name/you) earn money from any other work (you/he/she) did during 2010?
(1) Yes
(2) No

Q49b1d
How much did (name/you) earn from all other employers before taxes and other deductions during 2010?
Enter dollar amount
Enter "0? for None

Q49b1p
Read if necessary
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q49B11
For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q49b1d) from all other employers in 2010?
(1-12/1-24/1-26/1-52)

Q49B1C
Do not read to the respondent.
The total annual earnings entered from all other employers is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q49B1V
According to my calculations (name/you) earned (total) altogether from all other employers in 2010. 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 2010?
PREVIOUS ENTRIES:
Q49b1d: (amount)
Q49b1p: (periodicity)
Q49b11: (number of pay periods)

Enter dollar amount

Q49b13
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from all other employers in 2010?
(1) Yes
(2) No

Q49B1A
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from all other employers in 2010?
Enter dollar amount

Q49b2
How much did (name/you) earn from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter annual amount only

Q49b2_char
Enter "L" for Lost Money

Q49b3
Enter annual amount lost only

Q49b4
How much did (name/you) earn from (your/his/her) farm after expenses?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost money" press enter
Enter annual amount only

Q49b4_char
Enter "L" for Lost Money

Q49b5
Enter annual amount lost only

UNEMPLOYMENT AND WORKERS COMPENSATION
Q51A1

At any time during 2010 did (name/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 (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q51A11
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in State or Federal unemployment compensation during 2010?
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 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A12
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive from State or Federal unemployment compensation during 2010?
(1-12/1-24/1-26/1-52)

Q51A13
According to my calculations (name/you) received (total) altogether from State or Federal unemployment compensation during 2010. 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 2010?
PREVIOUS ENTRIES:
Q51A11: (amount)
Q51A1p: (periodicity)
Q51A12: (number of pay periods)

Enter dollar amount


Q51A2

At any time during 2010 did (name/you) receive any Supplemental Unemployment Benefits (SUB)?
(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 (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q51A21
How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in Supplemental Unemployment Benefits during 2010?
Enter dollar amount

Q51A2C
Do not read to the respondent.
The annual rate appears out of range. The total Supplemental Unemployment Benefits received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A22
How many (weekly/every other week/twice a month/ monthly) payments did (name/you) receive from Supplemental Unemployment Benefits during 2010?
(1-12/1-24/1-26/1-52)

Q51A23
According to my calculations (name/you) received (total) altogether from Supplemental Unemployment Benefits during 2010. 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 2010?
PREVIOUS ENTRIES:
Q51A21: (amount)
Q51A2p: (periodicity)
Q51A22: (number of pay periods)

Enter dollar amount

Q51A3
At any time during 2010 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 (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q51A31
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in Union Unemployment or Strike Benefits during 2010?
Enter dollar amount

C251A3
Do not read to the respondent.
The annual rate appears out of range. The total Union Unemployment or Strike Benefits received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A32
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive from Union Unemployment or Strike Benefits during 2010?
(1-12/1-24/1-26/1-52)

Q51A33
According to my calculations (name/you) received (total) altogether from Union Unemployment or Strike Benefits during 2010. 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 2010?
PREVIOUS ENTRIES:
Q51A31: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)

Enter dollar amount

Q52a
During 2010 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 (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q52c1
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in Worker?s Compensation during 2010?
Enter dollar amount

Q52cC2
Do not read to the respondent.
The annual rate appears out of range. The total worker's compensation received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q52c2
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive from Worker?s Compensation during 2010?
(1-12/1-24/1-26/1-52)

Q52c3
Then (name/you) received (total) altogether from Worker?s Compensation during 2010. 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 2010?
PREVIOUS ENTRIES:
Q52c1: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)

Enter dollar amount

SOCIAL SECURITY
Q56a

During 2010 did (you/ anyone in this household) receive any Social Security payments from the U.S. Government?
(1) Yes
(2) No

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
Enter all that apply, separate using the space bar or a comma.
Enter persons line number (1-16)

Q56dp
What is the easiest way for you to tell us (name's/your) Social Security payment; monthly, quarterly, or yearly?
(4) Monthly
(5) Quarterly
(7) Yearly

Q56d
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments in 2010?
Enter dollar amount
If already included in amount reported for another household member, press Enter

Q56d_Char
Enter (A) for Already included

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

Q56d2
For how many (months/quarters) did (name/you) receive Social Security in 2010?
(1-4; 1-12)

Q56d3
Is this $(amount from Q56d/amount from Q56d1) before or after the Medicare part B monthly deduction?
(1) After Deduction
(2) Before Deduction

Q56d4
Were there any changes since last year in your 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 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q56d5
According to my calculations (name/you) received $(total) altogether from Social Security in 2010. 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 2010?
PREVIOUS ENTRIES: (amount)
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)
Q56d4: (cost of living subtracted per month)

Enter dollar amount

SSR
What were the reasons (name/you) (was/were) getting Social Security in 2010?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
(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

SSRs
Specify other reason

SSC
Which children under age 15 were receiving Social Security in 2010?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

SSCR
What were the reasons (Child's name/the children) (was/were) getting Social Security in 2010?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
(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 2010 that we have not already counted on behalf of children in this household?
Includes all children under 19 years of age
Social Security Income previously reported will appear here
LN Name Amount reported in Q56d amount

(1) Yes
(2) No

Q56g
Read only if necessary
Who received these Social Security payments?
Enter line number of parent or guardian
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

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?
(4) Monthly
(5) Quarterly
(7) Yearly

Q56i
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments for children in this household in 2010?
Enter dollar amount
If already included in amount reported for another household member, press Enter

Q56i_Char
Enter A for Already included

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

Q56i2
For how many (months/quarters) did (name/you) receive Social Security in 2010?
(1-4; 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 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q56i4
According to my calculations (name/you) received $(total) altogether for children in this household from Social Security in 2010. 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 2010?
Previous entries: (amount)
Q56ip: (periodicity)
Q56i2: (number of pay periods)
Q56i3: (cost of living subtracted per month)

Enter dollar amount

CSS
Which children under age 19 were receiving Social Security in 2010?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

CRSS
What were the reasons (Child?s name/the children) (was/were) getting Social Security in 2010?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
(1) Disabled child/children
(2) Surviving child/children
(3) Dependent child/children
(4) Other

SUPPLEMENTAL SECURITY INCOME (SSI)
Q57a

During 2010 did (you/ anyone in this household) 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

Q57b
Read only if necessary
Who received SSI?
Supplemental Security Income
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q57cp
What is the easiest way for you to tell us (name's/your) Supplemental Security Income payment; monthly, quarterly, or yearly?
(4) Monthly
(5) Quarterly
(7) Yearly

Q57c
How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security Income payments in 2010?
Enter dollar amount

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

Q57c2
For how many (months/quarters) did (name/you) receive Supplemental Security Income in 2010?
(1-4; 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 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q57c4
According to my calculations (name/you) received $(total) altogether from Supplemental Security Income in 2010. 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 2010?
Previous entries: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)

Enter Dollar Amount

SSIR
What were the reasons (name/you) (was/were) getting Supplemental Security Income in 2010?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
(1) Disabled
(2) Blind
(3) On behalf of a disabled child
(4) On behalf of a blind child
(5) Other

SSIC
Which children under age 15 were receiving Supplemental Security Income in 2010?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed Enter 96 for All persons
Enter persons line number (1-16)

SUPPLEMENTAL SECURITY INCOME FOR CHILDREN
Q57d

Did anyone in this household receive any Supplemental Security Income in 2010 that we have not already counted on behalf of children in this household?
Includes all children under 18 years of age
SSI previously reported will appear here
LN Name Amount for Q57C amount

(1) Yes
(2) No

Q57e
Read only if necessary
Who received these Supplemental Security Income payments?
Enter line number of parent or guardian
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q57ip
What is the easiest way for you to tell us the Supplemental Security Income (name/you) received on behalf of children?
(4) Monthly
(5) Quarterly
(7) Yearly

Q57i
How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security Income on behalf of children in 2010?
Enter dollar amount

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

Q57i2
For how many (months/quarters) did (name/you) receive Supplemental Security Income on behalf of children in 2010?
(1-4;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 on behalf of children in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q57i4
According to my calculations (name/you) received $(total) altogether from Supplemental Security Income on behalf of children in 2010.
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 2010?
PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)

Enter dollar amount

RSSI
What were the reasons (name/you) (was/were) getting Supplemental Security Income on behalf of children in 2010?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
(1) On behalf of a disabled child/children
(2) On behalf of a blind child/children
(3) Other

CSSI
Which children under age 18 were receiving Supplemental Security Income in 2010?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

PUBLIC ASSISTANCE
Q59A88

At any time during 2010, even for one month, did (you/ anyone in this household) receive any CASH assistance from a state or county welfare program such as (State Program Name)?
Include cash payments from:
welfare or welfare-to-work programs, (State Program Name and/or acronyms), Temporary Assistance for Needy Families program (TANF), Aid to Families with Dependent Children (AFDC), General Assistance/Emergency Assistance program, Diversion Payments, Refugee Cash and Medical Assistance program, General Assistance from Bureau of Indian Affairs, or Tribal Administered General Assistance.
Do not include food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits, SSI, energy assistance, WIC, School meals, or transportation, childcare, rental, or education assistance.
(1) Yes
(2) No

Q59A89
Just to be sure, in 2010, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?
(1) Yes
(2) No

Q59b_88
Who received this CASH assistance?
Enter line number
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q59C8
From what type of program did (name/you) receive the CASH assistance? Was it a welfare or welfare-to-work program such as (State Program Name), General Assistance, Emergency Assistance, or some other program?
Enter all that apply, separate using the space bar or a comma.
Probe: Any other program?
(1) (State Program Name)/welfare/AFDC
(2) General Assistance
(3) Emergency Assistance/short-term cash assistance
(4) Some other program (specify)

Q59C8s
What type of program?

Q59ep
What is the easiest way for you to tell us (name's/your) CASH assistance payments; weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(5) Yearly

Q59e
During 2010, how much CASH assistance did (name/you) receive (per week/every other week/twice a month/ monthly/ )?
Enter dollar amount

Q59e2
How many (weekly/every other week/ twice a month/ monthly) cash assistance payments did (name/you) receive in 2010?
(1-12; 1-52)

Q57eC2
Do not read to the respondent.
The annual rate appears out of range. The total cash assistance received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q59e3
According to my calculations (name/you) received $(total) altogether in cash assistance from a state or county program in 2010. Does that sound about right?
(1) Yes
(2) No

Q59e4
What is your best estimate of the correct amount of cash assistance (name/you) received during 2010?
PREVIOUS ENTRIES:
Q59e: (amount)
Q59ep: (periodicity)
Q59e2: (number of pay periods)

Enter dollar amount

Q59f
Was the cash assistance for adults AND children, or JUST children?
(1) Both adults AND children
(2) Children only
(3) Adults only

Q59g
(Who/Which children) in your household was the cash assistance for?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

VETERANS PAYMENTS
Q60A88

At any time during 2010 did (you/ anyone in this household) receive: Any Veterans? (VA) payments?
Include assistance received by children of veterans
(1) Yes
(2) No

Q60b_88
Read only if necessary
Who received Veterans? (VA) payments either for themselves or as combined payments with other family members?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q60C8
What type of Veterans' payment did (name/you) receive?
Read list only if respondent is having difficulty answering the question.
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Payments?
(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

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 Q60c8); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q60V1
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) before deductions in (fill from first answer in Q60c8) in 2010?
Enter dollar amount

Q60V12
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from first answer in Q60c8) in 2010?
(1-52)

Q60V1C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q60c8) received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q60V13
According to my calculations (name/you) received (total) dollars altogether from (fill from first answer in Q60c8) in 2010. Does that sound about right?
(1) Yes
(2) No

Q60V14
What is your best estimate of the correct amount (name/you) received in Veteran's benefits during 2010?
PREVIOUS ENTRIES:
Q60V1: (amount)
Q60V1P: (periodicity)
Q60V12: (number of pay periods)

Enter dollar amount

Q60V2P
What is the easiest way for you to tell us (name's/your) (fill from second answer in Q60c8); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q60V2
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) before deductions in (fill from second answer in Q60c8) in 2010?
Enter dollar amount

Q60V22
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q60c8) in 2010?
(1-52)

Q60V2C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from second answer in Q60c8) received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q60V23
According to my calculations (name/you) received (total) dollars altogether from (fill from second answer in Q60c8) in 2010. Does that sound about right?
(1) Yes
(2) No

Q60V24
What is your best estimate of the correct amount (name/you) received in (fill from second answer in Q60c8) during 2010?
PREVIOUS ENTRIES:
Q60V2: (amount)
Q60V2P: (periodicity)
Q60V22: (number of pay periods)

Enter dollar amount

SURVIVOR BENEFITS
Q58A

Did (you/ anyone in this household) receive any survivor benefits in 2010 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

Q58b
Read only if necessary
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q58C
What was the source of this income?
Asking About: (name/name- -CURRENT RESPONDENT)
Read list if respondent is having difficulty answering the question
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Source?
(2) Company or union survivor pension (INCLUDE PROFIT SHARING)
(3) Federal Government survivor (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

Q58Cs1
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 Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q58E1
How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in (fill from first answer in Q58C or Q58Cs1) in 2010?
Enter dollar amount

Q58E12
How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from first answer in Q58C or Q58Cs1) in 2010?
(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 Q58Cs1) received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E13
According to my calculations (name/you) received (total) altogether from (fill from first answer in Q58C or Q58Cs1) in 2010. 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 Q58Cs1) during 2010?
PREVIOUS ENTRIES:
Q58E1: (amount)
Q58E1P: (periodicity)
Q58E12: (number of pay periods)

Enter dollar amount

Q58E2P
What is the easiest way for you to tell us (name's/your) (fill from second answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q58E2
How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from second answer in Q58C or Q58Cs1) in 2010?
Enter dollar amount

Q58E22
How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q58C or Q58Cs1) in 2010?
(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 Q58Cs1) received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E23
According to my calculations (name/you) received (total) altogether from (fill from second answer in Q58C or Q58Cs1) in 2010. 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 Q58Cs1) during 2010?
PREVIOUS ENTRIES:
Q58E2: (amount)
Q58E2P: (periodicity)
Q58E22: (number of pay periods)

Enter dollar amount

Q58E3P
What is the easiest way for you to tell us (name's/your) (fill from third answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q58E3
How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from third answer in Q58C or Q58Cs1) in 2010?
Enter dollar amount

Q58E32
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (fill from third answer in Q58C or Q58Cs1) in 2010?
(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 Q58Cs1) received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E33
According to my calculations (name/you) received (total) altogether from (fill from third answer in Q58C or Q58Cs1) in 2010. 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 Q58C3 or Q58Cs1) during 2010?
PREVIOUS ENTRIES:
Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)

Enter dollar amount

DISABILITY INCOME
Q59A

(Do you/Does anyone in the 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

Q59b
Read only if necessary
Who is that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

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

Q60b
Read only if necessary
Who is that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q61b
Did (name/you) receive any income in 2010 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 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)
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
(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

Q61Cs1
Specify other source 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 answer from Q61c or Q61cs1) payments; weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q61E1
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) before deductions in (first answer from Q61c or Q61cs1) payments in 2010?
Enter dollar amount

Q61E12
How many (weekly/ every other week/ twice a month/ monthly) payments did (name/you) receive in (first answer from Q61c or Q61cs1) payments in 2010?
Disability income source #1 (1-12; 1-52)

Q61E1C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q61c or Q61cs1) payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q61E13
According to my calculations (name/you) received (total) dollars altogether from (first answer from Q61c or Q61cs1) payments in 2010. Does that sound about right?
(1) Yes
(2) No

Q61E14
What is your best estimate of the correct amount (name/you) received from (first answer from Q61c or Q61cs1) payments during 2010?
PREVIOUS ENTRIES:
Q61E1: (amount)
Q61E1P: (periodicity)
Q61E12: (number of pay periods)

Enter dollar amount

Q61E2P
What is the easiest way for you to tell us (name's/your) (second fill from Q61c or Q61cs1) payments; weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q61E2
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) before deductions in (second answer from Q61c or Q61cs1) payments in 2010?
Enter dollar amount

Q61E22
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer from Q61c or Q61cs1) payments in 2010?
Disability income payment source #2 (1-12; 1-52)

Q61E2C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from second answer in Q61c or Q61cs1) payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q61E23
According to my calculations (name/you) received (total) dollars altogether from (second answer from Q61c or Q61cs1) payments in 2010. 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 Q61cs1) payments during 2010?
PREVIOUS ENTRIES:
Q61E2: (amount)
Q61E2P: (periodicity)
Q61E22: (number of pay periods)

Enter dollar amount

RETIREMENT AND PENSIONS
Q62A

During 2010 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

Q62b
Read only if necessary
Who received pension or retirement income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q62C
What was the source of (name's/your) income?
Enter all that apply, separate using the space bar or a comma.
Probe: Any other pension or retirement 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, 401(k), 403(b), and 457(b) and (f) accounts
(8) Other sources or don?t know - Specify - Enter last

Q62Cs1
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 answer from Q62c or Q62cs1); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q62E1
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in (first answer from Q62c or Q62cs1) in 2010?
Enter dollar amount

Q62E12
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (first answer from Q62c or Q62cs1) in 2010?
Pension/Retirement #1 (1-12; 1-52)

Q62E1C

Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q62c or Q62cs1) payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E13
According to my calculations (name/you) received (total) dollars altogether from (first answer from Q62c or Q62cs1) in 2010. Does that sound about right?
(1) Yes
(2) No

Q62E14
What is your best estimate of the correct amount (name/you) received in (first answer from Q62c or Q62cs1) during 2010?
PREVIOUS ENTRIES:
Q62E1: (amount)
Q62E1P: (periodicity)
Q62E12: (number of pay periods)

Enter dollar amount

Q62E2P
What is the easiest way for you to tell us (name's/your) (second answer from Q62c or Q62cs1); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q62E2
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in (second answer from Q62c or Q62cs1) in 2010?
Enter dollar amount

Q62E22
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer from Q62c or Q62cs1) in 2010?
Pension/Retirement #2 (1-12; 1-52)

Q62E2C

Do not read to the respondent.
The annual rate appears out of range. The total (fill from second answer in Q62c or Q62cs1) payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E23
According to my calculations (name/you) received (total) dollars altogether from (second answer from Q62c or Q62cs1) in 2010. Does that sound about right?
(1) Yes
(2) No

Q62E24
What is your best estimate of the correct amount (name/you) received in (second answer from Q62c or Q62cs1) during 2010?
PREVIOUS ENTRIES:
Q62E2: (amount)
Q62E2P: (periodicity)
Q62E22: (number of pay periods)

Enter dollar amount

Q62E3P
What is the easiest way for you to tell us (name's/your) (third answer from Q62c or Q62cs1); weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

Q62E3
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/) in (third answer from Q62c or Q62cs1) in 2010?
Enter dollar amount

Q62E32
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (third answer from Q62c or Q62cs1) in 2010?
Pension/Retirement #3 (1-12; 1-52)

Q62E3C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from third answer in Q62c or Q62cs1) payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E33
According to my calculations (name/you) received (total) dollars altogether from (third answer fromQ62c or Q62cs1) in 2010. Does that sound about right?
(1) Yes
(2) No

Q62E34
What is your best estimate of the correct amount (name/you) received in (third answer from Q62c or Q62cs1) during 2010?
PREVIOUS ENTRIES:
Q62E3: (amount)
Q62E3P: (periodicity)
Q62E32: (number of pay periods)
Enter dollar amount

INTEREST
Q63A1

At anytime during 2010 did (you/ anyone in this household): Have money in any kind of money market fund, interest earning checking account, or savings account?
(1) Yes
(2) No

Q63A2
At anytime during 2010 did (you/ anyone in this household): Have any savings bonds?
(1) Yes
(2) No

Q63A3
At anytime during 2010 did (you/ anyone in this household): Have any treasury notes, IRAs, certificates of deposit, or any other investments which pay interest?
(1) Yes
(2) No

Q63b
Ask only if necessary
Which members of this household ages 15 and over had (interest earning accounts or money market funds/savings bonds/treasury notes, IRAs, CDs, or any other investments which pay interest)?
Include each person in cases of joint accounts or ownership.
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q63c
How much did (name/you) receive in interest from these sources during 2010, including even small amounts reinvested or credited to accounts?
Only include interest received from U.S. Savings Bonds cashed during 2010
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount

Q63c_Char
Enter A for "Already Included"

Q63cp
Read if necessary
Is this a weekly, every other week, twice a month, monthly, quarterly, every 6 months, or yearly amount?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(5) Quarterly
(6) Every 6 months
(7) Yearly

Q63c2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name/you) receive in interest income in 2010?
(1-2; 1-52)

Q63cC2
Do not read to the respondent.
The annual rate appears out of range. The total interest income received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q63c3
According to my calculations (name/you) received (total) dollars altogether from interest income in 2010. 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 2010?
PREVIOUS ENTRIES:
Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)

Enter dollar amount

DIVIDENDS
Q64A

At anytime during 2010 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

Q64b
Ask only if necessary
Which members of this household?
Include each person in case of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma. Probe: Anyone else
Enter persons line number (1-16)

Q64c
How much did (name/you) receive in dividends from stocks (or mutual funds) during 2010, including dividends that were reinvested?
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter "0" for None
Enter dollar amount

Q64c_Char
Enter (A) for Already included

Q64cp
Read if necessary
Is this a weekly, every other week, twice a month, monthly, quarterly, every 6 months, or yearly amount?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(5) Quarterly
(6) Every 6 months
(7) Yearly

Q64c2
How many (weekly/every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name's/your) receive in dividends from stocks (or mutual funds) in 2010?
(1-2; 1-52)

Q64cC2
Do not read to the respondent.
The annual rate appears out of range. The total dividend payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q64c3
According to my calculations (name/you) received (total) dollars altogether from dividend payments in 2010. 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 2010?
PREVIOUS ENTRIES:
Q64c: (amount)
Q64cp: (periodicity)
Q64c2: (number of pay periods)

Enter dollar amount

PROPERTY INCOME
Q65A1

During 2010 did (you/ anyone in this household): Own any land, business property, apartments, or houses which were rented to others?
(1) Yes
(2) No

Q65A2
At anytime during 2010 did (you/ anyone in this household): Receive income from royalties or from roomers or boarders? (Exclude amounts paid by relatives)
(1) Yes
(2) No

Q65A3
At anytime during 2010 did (you/ anyone in this household): Receive income from estates or trusts? (Exclude estates or trusts already reported)
(1) Yes
(2) No

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
Enter all that apply, separate using the space bar or a comma. Probe: Anyone else?
Enter persons line number (1-16)

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 2010?
Separate amounts for joint ownership if response is "Broke Even" then enter 1.
Enter dollar amount
If already included in amount reported for another household member, or if response is "None", or if response is "Lost Money" press (Enter) key

Q65c_Char
Enter "A" for Already included
Enter "L" for Lost Money
Enter "X" for None

Q65cL
Enter amount of money lost in 2010.

Q65cp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(5) Quarterly
(7) Yearly

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 2010?
PREVIOUS ENTRIES:
Q65c: (amount)
Q65cp: (periodicity)

Enter dollar amount

Q65cC2
Do not read to the respondent.
The annual rate appears out of range. The total income received from rent ( /roomers or boarders, estates, trusts, or royalties) was (amount) in 2010. Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and 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 2010?
PREVIOUS ENTRIES:
Q65cL: (amount)
Q65cp: (periodicity)

Enter dollar amount

EDUCATION ASSISTANCE
Q66a

During 2010 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 2010? Exclude loans, assistance from household members, and VA educational benefits
(1) Yes
(2) No

Q66c
Ask only if necessary
Which member received assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q66d
What type of assistance did (name/you) receive?
Exclude assistance from household members
Enter all that apply, separate using the space bar or a comma.
Probe: Any other assistance?
(2) Pell Grant
(3) Assistance from a welfare or social service office
(4) Some other government assistance
(5) Scholarships, grants, etc.
(6) Other assistance (employers, friends, etc.)

Q69F88
How much did (name/you) receive in Pell Grants during 2010?
Enter annual amount only

Q66HP
What is the easiest way for you to tell us (name's/your) (other/blank ) educational assistance during 2010; weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(7) 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 2010?
Enter dollar amount

Q66H2
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in educational assistance in 2010?
(1-12/1-24/1-26/1-52)

Q66hC2
Do not read to the respondent.
The annual rate appears out of range. The total educational assistance received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q66H3
According to my calculations (name/you) received (total) altogether from educational assistance in 2010. 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 2010?
Previous entries:
Q66h: (amount)
Q66hp: (periodicity)
Q66h2: (number of pay periods)

Enter dollar amount

CHILD SUPPORT AND ALIMONY
Q70a

During 2010 did (you/ anyone in this household) receive: Any child support payments?
(1) Yes
(2) No

Q70b
Read only if necessary
Who received these payments?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

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 (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q70c
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in child support payments in 2010?
Enter dollar amount

Q70c2
How many (weekly/every other week/ twice a month/ monthly) child support payments did (name/you) receive in 2010?
(1-12/1-24/1-26/1-52)

Q70cC2
Do not read to the respondent.
The annual rate appears out of range. The total child support payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q70c3
According to my calculations (name/you) received (total) altogether from child support payments in 2010. 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 2010?
PREVIOUS ENTRIES:
Q70c: (amount)
Q70cp: (periodicity)
Q70c2: (number of pay periods)

Enter dollar amount

Q71a
During 2010 did (you/ anyone in this household) receive: Any alimony payments?
(1) Yes
(2) No

Q71b
Read only if necessary
Who received these payments during 2010?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

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 (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q71c
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in alimony payments in 2010?
Enter dollar amount

Q71c2
How many (weekly/every other week/ twice a month/ monthly) alimony payments did (name/you) receive in 2010?
(1-12/1-24/1-26/1-52)

Q71cC2
Do not read to the respondent.
The annual rate appears out of range. The total alimony payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q71c3
According to my calculations (name/you) received (total) altogether from alimony payments in 2010. 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 2010?
PREVIOUS ENTRIES:
Q71c: (amount)
Q71cp: (periodicity)
Q71c2: (number of pay periods)

Enter dollar amount

REGULAR FINANCIAL ASSISTANCE
Q72a

During 2010 did (you/ anyone in this household) receive: (Any other/Any) regular financial assistance from friends or relatives not living in this household? Do not include loans
(1) Yes
(2) No

Q72b
Read only if necessary
Who received this assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

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 (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q72c
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in regular financial assistance in 2010?
Enter dollar amount

Q72c2
How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in regular financial assistance in 2010?
(1-12/1-24/1-26/1-52)

Q72cC2
Do not read to the respondent.
The annual rate appears out of range. The total regular financial assistance payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q72c3
According to my calculations (name/you) received (total) altogether from regular financial assistance in 2010. 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 2010?
PREVIOUS ENTRIES:
Q72c: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)

OTHER MONEY INCOME
Q73A1

During 2010 did (you/ anyone in this household) receive income from: Hobbies, home businesses, farms, or business interests not already covered?
(1) Yes
(2) No

Q73A1b
Ask only if necessary
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q73A1c
What was the source of this income?
Asking about: (name/you) (name/name- -CURRENT RESPONDENT)

Q731P
What is the easiest way for you to tell us (name's/your) income from hobbies, home businesses, farms, or business interests not already covered during 2010; weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q731
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in income from hobbies, home businesses, farms, or business interests not already covered during 2010?
Enter dollar amount

Q7312
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in income from hobbies, home businesses, farms, or business interests not already covered in 2010?
(1-12/1-24/1-26/1-52)

Q731C2
Do not read to the respondent.
The annual rate appears out of range. The total income from hobbies, home businesses, farms, or business interests not already covered in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q7313
According to my calculations (name/you) received (total) altogether from hobbies, home businesses, farms, or business interests not already covered in 2010. Does that sound about right?
(1) Yes
(2) No

Q7314
What is your best estimate of the correct amount (name/you) received in income from hobbies, home businesses, farms, or business interests not already covered during 2010?
PREVIOUS ENTRIES:
Q731: (amount)
Q731P: (periodicity)
Q7312: (number of pay periods)

Enter dollar amount

Q73A2
During 2010 did (you/ anyone in this household) receive income from: Any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered?
(1) Yes
(2) No

Q73A2b
Ask only if necessary
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

Q73A2c
What was the source of this income?
Asking about: (name/you) (name/name- -CURRENT RESPONDENT)

Q732P
What is the easiest way for you to tell us (name's/your) income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2010; weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week (bi-weekly)
(3) Twice a month
(4) Monthly
(7) Yearly

Q732
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money I income not already covered during 2010?
Enter dollar amount

Q7322
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2010?
(1-12/1-24/1-26/1-52)

Q732C2
Do not read to the respondent.
The annual rate appears out of range. The total income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money not already covered in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q7323
According to my calculations (name/you) received (total) altogether from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2010. Does that sound about right?
(1) Yes
(2) No

Q7324
What is your best estimate of the correct amount (name/you) received in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2010?
PREVIOUS ENTRIES:
Q732: (amount)
Q732P: (periodicity)
Q7322: (number of pay periods)

Enter dollar amount

HEALTH INSURANCE
SHI1

These next questions are about health insurance coverage during the calendar year 2010. The questions apply to ALL persons of ALL ages.
Enter 1 to Continue

SHI2
At any time in 2010, (was/were) (you/ anyone in this household) covered by a health insurance 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

SHI3
Who in this household were policyholders?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHI4
In addition to (name/you) who else in this household was covered by (name?s/your) plan?
Enter all that apply, separate using the space bar or a comma. Enter 0 if no one listed Enter 96 for All persons
Probe: Anyone else?
Enter persons line number (1-16)

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 any time during 2010, (was/were) (you/ anyone in this household) covered by a health insurance plan that (you/they) PURCHASED DIRECTLY FROM AN INSURANCE COMPANY, that is, not related to current or past employment?
(1) Yes
(2) No

SHI8
Who in this household were policyholders?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHI9
In addition to (name/you) who else in this household was covered by (name?s/your) plan?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if None listed
Enter 96 for All persons
Probe: Anyone else?
Enter persons line number (1-16)

SHI10
Did (name?s/your) plan cover anyone living outside this household?
(1) Yes
(2) No

SHI11
At any time in 2010, (was/were) (you/ anyone in this household) covered by the health insurance plan of someone who does not live in this household?
(1) Yes
(2) No

SHI12
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHI13
At any time in 2010, (was/were) (you/ 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

SHI14
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHI15
At any time in 2010, (was/were) (you/ 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

SHI16
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHI17
How many months during 2010, (was/were) (name/you) covered by Medicaid/(fill state name)?
Enter number of months (1-12)

SHI21
In (state), the (fill state CHIP program name) helps families get health insurance for CHILDREN. (Just to be sure,) Were any of the children in this household covered by that program?
Read if necessary: (fill state CHIP program name) is the name of your state's CHIP program. It is the same as the Children's Health Insurance Program, which helps pay for children's health care.
(1) Yes
(2) No

SHI22
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHI18
At any time in, 2010 (was/were) (you/ anyone in this household) covered by TRICARE, CHAMPVA, VA, military health care, or Indian Health Service?
NOTE: CHAMPVA is the Civilian Health and Medical Program of the Department of Veterans Affairs.
(1) Yes
(2) No

SHI19
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHI20
What plan (was/were) (name/you) covered by?
Enter all that apply, separate using the space bar or a comma.
Probe: Any other plan?
(1) TRICARE
(2) CHAMPVA
(3) VA
(4) Indian Health Service
(5) Other

SHI20s
Enter other type of plan

SHIC1
Other than the plans I have already talked about, during 2010, was anyone in this household covered by a health insurance plan [such as the (state-specific name plan) or any other type of plan/of any other type]?
(1) Yes
(2) No

SHIC2
Who has insurance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHIC3
What type of health insurance (was/were) (name/you) covered by in 2010?
Up to six entries allowed
Probe: Any other type of plan?
(1) Medicare
(2) Medicaid
(3) TRICARE
(4) CHAMPVA (CHAMPVA is the Civilian Health and Medical Program of the Department of Veterans Affairs)
(5) VA
(6) Military Health Care
(7) Children\'s Health Insurance Program (CHIP)
(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

SHIC3s
Enter other type of plan

SHIC4
I have recorded that (you/read list of names) (were/was) not covered by a health plan at any time during 2010. Is that correct?
(1) Yes
(2) No

SHIC4A
Who should be marked as covered?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

SHIC6
What type of health insurance (was/were) (name/you) covered by in 2010?
Up to six entries allowed
Probe: Any other type of plan?
(1) Medicare
(2) Medicaid
(3) TRICARE
(4) CHAMPVA (CHAMPVA is the Civilian Health and Medical Program of the Department of Veterans Affairs)
(5) VA
(6) Military Health Care
(7) Children\'s Health Insurance Program (CHIP)
(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

SHIC6s
Enter other type of health insurance covered by in 2010

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 1 to Continue

SHI25
Would you say (name's/your) health in general is excellent, very good, good, fair, or poor?
(1) Excellent
(2) Very good
(3) Good
(4) Fair
(5) Poor

MEDICAL EXPENDITURES
HIPREM

During 2010, about how much did (name/you) pay for health insurance premiums for yourself/himself/herself) or others in the household, after any reimbursements? Please include premiums paid for HMOs, Fee for Service Plans, Commercial Medicare Supplements, or other special purpose plans, such as vision or dental plans. Include prescription drug insurance such as Medicare Part D premiums, and Medicare Advantage premiums. DO NOT include Medicare Part B premiums.
Enter dollar amount

OTCMEDAMT
During 2010, about how much was paid for (name?s/your) for over-the-counter health related products such as aspirin, cold remedies, bandages, first aid supplies, and other items? Include any amount paid on (your/his/her) behalf by anyone in this household, that was not reimbursed.
Enter dollar amount

MEDAMT
Aside from over-the-counter items, during 2010, about how much was paid for (name?s/your) own medical care, including payments and co-payments for hospital visits, medical providers, dental services, prescription medicine, vision aids, and medical supplies? Include any amount paid on (your/his/her) behalf by anyone in this household, that was not reimbursed.
Enter dollar amount

COTCAMT
How about (name)? During 2010, about how much was paid for (name?s) over-the-counter health related products such as aspirin, cold remedies, bandages, first aid supplies, and other items? Include only amounts paid that were not reimbursed.
Enter dollar amount

CMEDAMT
Aside from over-the-counter items, during 2010, about how much was paid for (name's) own medical care, including payments and co-payments for hospital visits, medical providers, dental services, prescription medicine, vision aids, and medical supplies?
Include only amounts paid that were not reimbursed.
Enter dollar amount

EMPLOYER?S PENSION PLAN
Q74a

Other than Social Security did (ANY) employer or union that (name/you) worked for in 2010 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 2010 which of the children ages 5 to 18 in this household usually ate a complete lunch offered at school?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Enter persons line number (1-16)

Q83
During 2010 which of the children in this household received free or reduced priced lunches because they qualified for the Federal School Lunch Program?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Enter persons line number (1-16)

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

SPHS8
Is this through Section 8 or through some other government program?
(1) Section 8
(2) Some other government program
(3) Not sure

FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
Q87

At any time during 2010, even for one month, did (you/ anyone in this household) receive any food assistance from (State Program name) or a food assistance benefit card (such as State EBT car name)?
Do not include WIC benefits.
(1) Yes
(2) No

Q88
Which of the people now living here were covered by that food assistance during 2010?
List all household members covered by food assistance regardless of age
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Probe: Anyone else?
Enter persons line number (1-16)

Q90p
What is the easiest way for you to tell us the value of the food assistance: monthly or yearly?
(1) Monthly
(2) Yearly
(3) Already included with TANF/AFDC payment

Q90
What is the (monthly)/ value of the food assistance received in 2010?
Enter dollar amount

Q902
How many months was food assistance received in 2010?
(1-12)

Q90C2
Do not read to the respondent.
The annual rate appears out of range. The total food assistance payments received in 2010 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q903
According to my calculations (total) was received altogether from food assistance in 2010. Does that sound about right?
(1) Yes
(2) No

Q904
What is your best estimate of the correct amount of food assistance received during 2010?
PREVIOUS ENTRIES:
Q90: (amount)
Q90p: (periodicity)
Q902: (number of pay periods)

Enter dollar amount

SWRWIC
At any time during 2010, (was/were) (you/ anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?
(1) Yes
(2) No

SWRW
Who received WIC for themselves or on behalf of a child?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

ENERGY ASSISTANCE
Q93

The government has an energy assistance program which helps pay heating and cooling 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. In 2010, (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 year to help pay heating or cooling costs?
(1) Yes
(2) No

Q93pr2
Was it used to pay heating or cooling costs?
(1) Yes
(2) No

Q94
Altogether, how much energy assistance has been received in 2010?
Enter annual amount only

MIGRATION
MIGSAM

(Was/Were) (reference person's name/you) living in this house (or apartment) one year ago?
(1) Yes, this house (apt)
(2) No, different house in U.S.
(3) No, outside the U.S.

MIGPLC
Where did (reference person's name/you) live one year ago?
Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME

MIGSTA
?[F1]
Where did (reference person's name/you) live one year ago?
Name of State
Current: (state)
Enter W for person living on a ship at sea
Enter correct State or press ENTER for SAME

MIGZIP
Where did (reference person's name/you) live one year ago?
Zip Code
Current: (zip)
Enter correct Zip Code or press ENTER for SAME

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?
Enter "IND CITY" if an independent city, not a county

S_MIGCN1
What country did (reference person's name/you) live in one year ago?

MI1RES
What was [your/name?s] main reason for moving to this house (apartment)?
The answer categories are separated into the following groups:
FAMILY-RELATED REASONS 1-3
EMPLOYMENT-RELATED REASONS 4-8
HOUSING-RELATED REASONS 9-13
OTHER REASONS 14-18
(1) change in marital status
(2) to establish own household
(3) other family reason
(4) new job or job transfer
(5) to look for work or lost job
(6) to be closer to work/easier commute
(7) retired
(8) other job-related reason
(9) wanted to own home, not rent
(10) wanted new or better house/ apartment
(11) wanted better neighborhood/less crime
(12) wanted cheaper housing
(13) other housing reason
(14) to attend or leave college
(15) change of climate
(16) health reasons
(17) natural disaster (hurricane, tornado, etc.)
(18) other reason (specify)

MI1s
What was the reason for moving?

MIGALL
(There are (number) other persons in this household ages 1 year or over/ ) Did (all of these persons/this person) live with (reference person's name/you) (in this house/in City, State/outside the U.S.) one year ago?
(1) Yes, all lived with (reference person's name/you)
(2) No, some or all did not live with (reference person's name/you)

MIGM
Which of the other members of this household did NOT live with (reference person's name/you) one year ago?
PROBE: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter persons line number (1-16)

NXTSAM
Did (name/you) live in this house (apartment) one year ago?
(1) Yes , this house
(2) No, different house in U.S.
(3) No, outside the U.S.

NXTPLC
Where did (name/you) live one year ago?
Name of city/town/post office
Current: (city) Enter correct city/town/post office or
Press ENTER for SAME

NXTSTA
?[F1]
Where did (name/you) live one year ago?
Name of State
Current: (state)
Enter correct State or press ENTER for SAME

NXTZIP
Where did (name/you) live one year ago?
Zip Code Current: (zip)
Enter correct zip code or
Press ENTER for SAME

NXTCLM
Did (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?
Enter "IND CITY" if an independent city, not a county

S_NXTCN1
What country did (name/you) live in one year ago?

NX1RES
What was (name?s/your) main reason for moving to this house (apartment)?
The answer categories are separated into the following groups:
FAMILY-RELATED REASONS 1-3
EMPLOYMENT-RELATED REASONS 4-8
HOUSING-RELATED REASONS 9-13
OTHER REASONS 14-18
(1) change in marital status
(2) to establish own household
(3) other family reason
(4) new job or job transfer
(5) to look for work or lost job
(6) to be closer to work/easier commute
(7) retired
(8) other job-related reason
(9) wanted to own home, not rent
(10) wanted new or better house/ apartment
(11) wanted better neighborhood/less crime
(12) wanted cheaper housing
(13) other housing reason
(14) to attend or leave college
(15) change of climate
(16) health reasons
(17) natural disaster (hurricane, tornado, etc.)
(18) other reason (specify)

NX1OTH
What was the reason for moving?

SUNITS
Ask if necessary
How many housing units are in your building?
(1) Only one
(2) Two
(3) Three or four
(4) Five to nine
(5) Ten or more

PROPERTY VALUE/PRESENCE OF MORTGAGE
VALPROP

About how much do you think this (house and lot/apartment/mobile home) would sell for if it were for sale? Enter dollar amount

MORTYN
Not counting home equity loans, do you or any other member of this household have a mortgage, deed of trust, contract to purchase, or similar debt on THIS property?
(1) Yes
(2) No

SMORTYN
Do you or any member of this household have a second mortgage or a home equity loan on THIS property?
(1) Yes, home equity loan.
(2) Yes, second mortgage.
(3) Yes, second mortgage and home equity loan.
(4) No

CHILD CARE
Q95

Now we want to ask about some of your expenses for children. Did (you/anyone in this household) PAY for the care of (your/their) (child/children) while (you/they) worked in 2010?
Include: All child care expenses including preschool and nursery school expenses, before and after school care, and summer care. Do not include: cost of kindergarten or grade/elementary school.
(1) Yes
(2) No
Enter persons line number (1-16)

Q95A
Which children needed care while their parents worked?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter 96 for All persons
Enter persons line number (1-16)

CCFREQ
What is the easiest way for you to tell us how much (you/you and others in this household) paid for child care while (you/they) worked in 2010: weekly, every other week, twice a month, monthly, or yearly?
(1) Weekly
(2) Every other week
(3) Twice a month
(4) Monthly
(7) Yearly

CCAMT
How much did (you/they) pay for child care?
Include child care payments made for all children in the household.
For example, if there are two adults in the household with childcare expenses use the total paid by both adults. Do not try to separate the payments. Record one total for the entire household.

CCNUMPAY
How many (weekly/every other week/twice a month/monthly) payments did (you/they) make during 2010?

CCTOT
Then (you/they) paid (total dollar amount) altogether in child care while (you/they) worked during 20109. Does that sound about right?
(1) Yes
(2) No

CCEST
What is your best estimate of the correct amount (you/they) paid for child care while (you/they) worked in 2010?

CHILD SUPPORT PAID
CSPCHILD

Does anyone in this household have any children who lived elsewhere with their other parent or guardian at anytime during 2010?
(1) Yes
(2) No

CSPWHO
Who had children who lived elswhere? Anyone else?
Enter line number
Enter all that apply, separate using the space bar or a comma.

CSPREQ
In 2010, (was/were) (name/you) required to pay child support?
(1) Yes
(2) No

CSPAMT
How much child support did (name/you) pay in 2010?
Enter dollar amount
COUNT ALL FORMS OF CHILD SUPPORTS PAYMENTS, INCLUDING: ...PAYMETNS MADE DIRECTLY TO THE OTHER PARENT/GUARDIAN; ...PAYMENTS MADE THROUGH A COURT OR AGENCY; AND ...PAYMENTS WITHHELD FROM THIS PERSON'S PAYCHECK

Q96_INTRO
Now, for the last few questions, we would like to get some CURRENT information.
Enter 1 to continue

Q96
You said earlier that (no one in your household/someone in your household/you) received cash assistance from a state or county welfare program in 2010. WITHIN THE LAST 30 DAYS, did (you/ anyone in this household) receive any CASH assistance from a state or county welfare program such as (State Program Name)?
Include cash payments from: welfare or welfare-to-work programs, (State Program Name) Temporary Assistance for Needy Families program (TANF), Aid to Families with Dependent Children (AFDC), General Assistance/Emergency Assistance program, Diversion Payments, Refugee Cash and Medical Assistance program, General Assistance from Bureau of Indian Affairs, or Tribal Administered General Assistance.
Do not include food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits, SSI, energy assistance, WIC, school meals, or transportation, child care, rental, or education assistance.
(1) Yes
(2) No

Q97
Just to be sure, WITHIN THE LAST 30 DAYS, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?
(1) Yes
(2) No

Q96A
Who received this CASH assistance?
Enter line number
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)