Facsimile of 2013 Annual Social and Economic (ASEC) Supplement
Questionnaire
2013 Annual Social and Economic Supplement
Items Booklet - Feb/March/April 2013
2013 ANNUAL SOCIAL AND ECONOMIC SUPPLEMENT
CPS FIELD REPRESENTATIVE / CATI INTERVIEWER
ITEMS BOOKLET
U.S. DEPARTMENT OF
COMMERCE U.S. Census Bureau
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.
Did (you/name of reference person) live at this address during the week of November 19, 2012?
1 Yes
2 No
2 No
Did any of the following household members live here during the week of November 19, 2012?
1 Yes
2 No
2 No
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 9 30,000 to 34,999
2 5,000 to 7,499 10 35,000 to 39,999
3 7,500 to 9,999 11 40,000 to 49,999
4 10,000 to 12,499 12 50,000 to 59,999
5 12,500 to 14,999 13 60,000 to 74,999
6 15,000 to 19,999 14 75,000 to 99,999
7 20,000 to 24,999 15 100,000 to 149,000
8 25,000 to 29,999 16 150,000 to more
2 5,000 to 7,499 10 35,000 to 39,999
3 7,500 to 9,999 11 40,000 to 49,999
4 10,000 to 12,499 12 50,000 to 59,999
5 12,500 to 14,999 13 60,000 to 74,999
6 15,000 to 19,999 14 75,000 to 99,999
7 20,000 to 24,999 15 100,000 to 149,000
8 25,000 to 29,999 16 150,000 to more
Is the combined income of all members of this FAMILY during the past 12 months above or below $75,000?
1 Above
2 Below
2 Below
The questions you just answered were about your job and economic status last week. The next set of questions asks about your job and economic status last year.
1 Enter 1 to Continue
Did (name/you) work at a job or business at any time during 2012?
1 Yes
2 No
2 No
Did (you/he/she) do any temporary, part-time, or seasonal work even for a few days during 2012?
1 Yes
2 No
2 No
Even though (name/you) did not work in 2012, did (you/he/she) spend any time trying to find a job or on layoff?
1 Yes
2 No
2 No
How many different weeks (was/were) (name/you) looking for work or on layoff from a job?
(01-52) Number of weeks
What was the main reason (you/he/she) did not work in 2012? 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
2 Retired
3 Taking care of home or family
4 Going to school
5 Could not find work
6 Doing something else
During 2012 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
Enter 97 if respondent can only answer in months
Enter number of months worked
(1-12)
Then (name/you) worked about (number) weeks. Is that correct?
1 Yes
2 No - back to Q33 and obtain estimate
2 No - back to Q33 and obtain estimate
Did (name/you) lose any full weeks of work in 2012 because (you/he/she) (were/was) on layoff from a job or lost a job?
Number of weeks worked in 2012: (number)
1 Yes
2 No
7 Mistake made in number of weeks worked last year - Specify in Q35SP
1 Yes
2 No
7 Mistake made in number of weeks worked last year - Specify in Q35SP
Specify mistake made in number of weeks worked last year
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
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
2 No - two stretches
3 No - 3 or more stretches
What was the main reason (name/you) (was/were) not working or looking for work in the remaining weeks of 2012? 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)
2 Taking care of home or family
3 Going to school
4 Retired
5 No work available
6 Other (Specify - Q38sp)
Enter verbatim response
For how many employers did (name/you) work in 2012? If more than one at the same time, only count it as one employer.
1 One
2 Two
3 Three or more
2 Two
3 Three or more
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
During 2012, 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
2 No
In the weeks that (name/you) worked, how many weeks did (name/you) work less than 35 hours in 2012?
Number of weeks worked in 2012: (number)
(Number of weeks was reported in item Q33)
(1-52)
(Number of weeks was reported in item Q33)
(1-52)
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
2 Wanted to work part time or only able to work part time
3 Slack work or material shortage
4 Other reason
What was (name's/your) longest job during 2012?
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)
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
2 Different job
For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job during 2012?))
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 2012)
(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 2012)
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)
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)
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
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
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)
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)
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)
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)
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)
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)
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
2 Private for profit company
3 Non profit organization including tax exempt and charitable organizations
4 Self employed
5 Working in family business
Would that be the federal, state, or local government?
1 Federal
2 State
3 Local (county, city, township)
2 State
3 Local (county, city, township)
Was this business incorporated?
1 Yes
2 No
2 No
(Were/Was)(you/name) the owner of the business?
1 Yes
2 No
2 No
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+
2 10-49
3 50-99
4 100-499
5 500-999
6 1,000+
How much did (name/you) earn from this employer before taxes and other deductions during 2012?
Enter dollar amount
Enter 0 for none
Enter 0 for none
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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q48aa) from this employer in 2012?
(1-12/1-24/1-26/1-52)
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.
According to my calculations (name/you) earned (total) altogether from this employer in 2012 before deductions. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of (name's/your) correct total amount of earnings from this employer during 2012 before deductions?
PREVIOUS ENTRIES: Q48aa: (amount)
Q48aap: (periodicity)
Q48a1: (number of pay periods)
Enter dollar amount
Q48aap: (periodicity)
Q48a1: (number of pay periods)
Enter dollar amount
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this employer in 2012?
1 Yes
2 No
2 No
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from this employer in 2012?
Enter dollar amount
What were (name's/your) net earnings from this business/farm after expenses during 2012?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "L" for Lost Money
Enter amount of money lost in 2012
Enter annual amount only
Enter annual amount only
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
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
7 Yearly
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.
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.
What is your best estimate of (name's/your) ANNUAL net earnings from this business/farm after expenses in 2012?
PREVIOUS ENTRIES: Q48b: (amount)
Q48bp: (periodicity)
Enter dollar amount
Q48bp: (periodicity)
Enter dollar amount
What is your best estimate of (name's/your) ANNUAL net LOSS from this business/farm after expenses in 2012?
PREVIOUS ENTRIES: Q48bL: (amount)
Q48bp: (periodicity)
Enter dollar amount
Q48bp: (periodicity)
Enter dollar amount
What were (name's/your) net earnings from this business/farm during the FIRST quarter of 2012?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "L" for Lost Money
Enter amount of money lost in the first quarter of 2012.
What were (name's/your) net earnings from this business/farm during the SECOND quarter of 2012?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "L" for Lost Money
Enter amount of money lost in the second quarter of 2012.
What were (name's/your) net earnings from this business/farm during the THIRD quarter of 2012?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "L" for Lost Money
Enter amount of money lost in the third quarter of 2012.
What were (name's/your) net earnings from this business/farm during the FOURTH quarter of 2012?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Enter "L" for Lost Money
Enter amount of money lost in the fourth quarter of 2012.
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this business in 2012?
1 Yes
2 No
2 No
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions in 2012?
Enter dollar amount
Did (name/you) earn money from any other work (you/he/she) did during 2012?
1 Yes
2 No
2 No
How much did (name/you) earn from all other employers before taxes and other deductions during 2012?
Enter dollar amount
Enter "0" for None
Enter "0" for None
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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
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 2012?
(1-12/1-24/1-26/1-52)
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.
According to my calculations (name/you) earned (total) altogether from all other employers in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of (name's/your) correct total amount of earnings from all other employers during 2012?
PREVIOUS ENTRIES: Q49b1d: (amount)
Q49b1p: (periodicity)
Q49b11: (number of pay periods)
Enter dollar amount
Q49b1p: (periodicity)
Q49b11: (number of pay periods)
Enter dollar amount
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from all other employers in 2012?
1 Yes
2 No
2 No
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from all other employers in 2012?
Enter dollar amount
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
Enter "0" for None
If response is "Lost Money" press enter
Enter annual amount only
Enter "L" for Lost Money
Enter annual amount lost only
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
Enter "0" for None
If response is "Lost money" press enter
Enter annual amount only
Enter "L" for Lost Money
Enter annual amount lost only
At any time during 2012 did (name/you) receive any State or Federal unemployment compensation?
1 Yes
2 No
2 No
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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in State or Federal unemployment compensation during 2012?
Enter dollar amount
Do not read to the respondent. The annual rate appears out of range. The total State or Federal unemployment compensation received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive from State or Federal unemployment compensation during 2012?
(1-12/1-24/1-26/1-52)
According to my calculations (name/you) received (total) altogether from State or Federal unemployment compensation during 2012. Does that sound about right?
1 Yes
2 No
2 No
Q51A14
What is your best estimate of the correct total amount (name/you) received from State or Federal unemployment compensation during 2012?
PREVIOUS ENTRIES: Q51A11: (amount)
Q51A1p: (periodicity)
Q51A12: (number of pay periods)
Enter dollar amount
Q51A1p: (periodicity)
Q51A12: (number of pay periods)
Enter dollar amount
Q51A2
At any time during 2012 did (name/you) receive any Supplemental Unemployment Benefits (SUB)?
1 Yes
2 No
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
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 2012?
Enter dollar amount
Q51A2C
Do not read to the respondent. The annual rate appears out of range. The total Supplemental Unemployment Benefits received in 2012 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 2012?
(1-12/1-24/1-26/1-52)
Q51A23
According to my calculations (name/you) received (total) altogether from Supplemental Unemployment Benefits during 2012. Does that sound about right?
1 Yes
2 No
2 No
Q51A24
What is your best estimate of the correct total amount (name/you) received from Supplemental Unemployment Benefits during 2012?
PREVIOUS ENTRIES: Q51A21: (amount)
Q51A2p: (periodicity)
Q51A22: (number of pay periods)
Enter dollar amount
Q51A2p: (periodicity)
Q51A22: (number of pay periods)
Enter dollar amount
Q51A3
At any time during 2012 did (name/you) receive any Union Unemployment or Strike Benefits?
1 Yes
2 No
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
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 2012?
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 2012 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 2012?
(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 2012. Does that sound about right?
1 Yes
2 No
2 No
Q51A34
What is your best estimate of the correct total amount (name/you) received from Union Unemployment or Strike Benefits during 2012?
PREVIOUS ENTRIES: Q51A31: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)
Enter dollar amount
Q51A3p: (periodicity)
Q51A32: (number of pay periods)
Enter dollar amount
Q52a
During 2012 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
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
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
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 2012?
Enter dollar amount
Q52cC2
Do not read to the respondent. The annual rate appears out of range. The total worker's compensation received in 2012 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 2012?
(1-12/1-24/1-26/1-52)
Q52c3
Then (name/you) received (total) altogether from Worker's Compensation during 2012. Does that sound about right?
1 Yes
2 No
2 No
Q52c4
What is your best estimate of the correct total amount (name/you) received from Worker's Compensation during 2012?
PREVIOUS ENTRIES: Q52c1: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)
Enter dollar amount
Q52cp: (periodicity)
Q52c2: (number of pay periods)
Enter dollar amount
Q56a
During 2012 did (you/ anyone in this household) receive any Social Security payments from the U.S. Government?
1 Yes
2 No
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
5 Quarterly
7 Yearly
Q56d
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments in 2012?
Enter dollar amount
If already included in amount reported for another household member, press Enter
If already included in amount reported for another household member, press Enter
Q56dChar
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 2012?
(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
2 Before Deduction
Q56d4
Were there any changes since last year in your monthly payments?
1 Yes
2 No
2 No
Q56dC2
Do not read to the respondent. The annual rate appears out of range. The total Social Security received in 2012 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 2012. Does that sound about right?
1 Yes
2 No
2 No
Q56d6
What is your best estimate of the correct amount (name/you) received in Social Security during 2012?
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
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 2012? 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
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 2012? 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)
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 2012? 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
2 Surviving child/children
3 Dependent child/children
4 Other
Q56f
Did anyone in this household receive any Social Security income in 2012 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
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
5 Quarterly
7 Yearly
Q56i
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments for children in this household in 2012?
Enter dollar amount
If already included in amount reported for another household member, press Enter
If already included in amount reported for another household member, press Enter
Q56iChar
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 2012?
(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
2 No
Q56iC2
Do not read to the respondent. The annual rate appears out of range. The total Social Security received for children in 2012 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 2012. Does that sound about right?
1 Yes
2 No
2 No
Q56i5
What is your best estimate of the correct amount (name/you) received in Social Security for children in this household during 2012?
Previous entries: (amount)
Q56ip: (periodicity)
Q56i2: (number of pay periods)
Q56i3: (cost of living subtracted per month)
Enter dollar 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 2012? 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)
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 2012? 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
2 Surviving child/children
3 Dependent child/children
4 Other
Q57a
During 2012 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
2 No
Q57b
Read only if necessary. Who received SSI? 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
5 Quarterly
7 Yearly
Q57c
How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security Income payments in 2012?
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 2012?
(1-4; 1-12)
Q57c3
Was the cost of living increase the only change which occurred in monthly payments?
1 Yes
2 No
2 No
Q57cC2
Do not read to the respondent. The annual rate appears out of range. The total Supplemental Security Income received in 2012 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 2012. Does that sound about right?
1 Yes
2 No
2 No
Q57c5
What is your best estimate of the correct amount (name/you) received in Supplemental Security Income during 2012?
Previous entries: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)
Enter Dollar 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 2012? 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
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 2012? 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)
Enter 96 for All persons
Enter persons line number (1-16)
Q57d
Did anyone in this household receive any Supplemental Security Income in 2012 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
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
5 Quarterly
7 Yearly
Q57i
How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security Income on behalf of children in 2012?
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 2012?
(1-4; 1-12)
Q57i3
Was the cost of living increase the only change which occurred in monthly payments?
1 Yes
2 No
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 2012 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 2012. Does that sound about right?
1 Yes
2 No
2 No
Q57i5
What is your best estimate of the correct amount (name/you) received in Supplemental Security Income on behalf of children during 2012?
PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)
Enter dollar 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 2012? 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
2 On behalf of a blind child/children
3 Other
CSSI
Which children under age 18 were receiving Supplemental Security Income in 2012? 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)
Enter 96 for All persons
Enter persons line number (1-16)
Q59A88
At any time during 2012, 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
2 No
Q59A89
Just to be sure, in 2012, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?
1 Yes
2 No
2 No
Q59b88
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)
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
7 Yearly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q59e
During 2012, 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 2012?
(1-12; 1-52)
Q57eC2
Do not read to the respondent. The annual rate appears out of range. The total cash assistance received in 2012 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 2012. Does that sound about right?
1 Yes
2 No
2 No
Q59e4
What is your best estimate of the correct amount of cash assistance (name/you) received during 2012?
PREVIOUS ENTRIES: Q59e: (amount)
Q59ep: (periodicity)
Q59e2: (number of pay periods)
Enter dollar 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
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)
Enter 96 for All persons
Enter persons line number (1-16)
Q60A88
At any time during 2012 did (you/ anyone in this household) receive: Any Veterans' (VA) payments? Include assistance received by children of veterans.
1 Yes
2 No
2 No
Q60b88
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
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
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
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 2012?
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 2012?
(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 2012 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 2012. Does that sound about right?
1 Yes
2 No
2 No
Q60V14
What is your best estimate of the correct amount (name/you) received in Veteran's benefits during 2012?
PREVIOUS ENTRIES: Q60V1: (amount)
Q60V1P: (periodicity)
Q60V12: (number of pay periods)
Enter dollar 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
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 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q60c8) in 2012?
(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 2012 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 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received in (fill from second answer in Q60c8) during 2012?
PREVIOUS ENTRIES: Q60V2: (amount)
Q60V2P: (periodicity)
Q60V22: (number of pay periods)
Enter dollar amount
Q60V2P: (periodicity)
Q60V22: (number of pay periods)
Enter dollar amount
Did (you/ anyone in this household) receive any survivor benefits in 2012 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
2 No
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)
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
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
Specify other source of income as survivor or widow. Enter "Survivor Benefits" if the answer is "Don't Know"
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from first answer in Q58C or Q58Cs1) in 2012?
Enter dollar amount
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 2012?
(1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from (fill from first answer in Q58C or Q58Cs1) in 2012. Does that sound about right?
1 Yes
2 No
What is your best estimate of the correct amount (name/you) received from (fill from first answer in Q58C or Q58Cs1) during 2012?
PREVIOUS ENTRIES: Q58E1: (amount)
Q58E1P: (periodicity)
Q58E12: (number of pay periods)
Enter dollar amount
Q58E1P: (periodicity)
Q58E12: (number of pay periods)
Enter dollar amount
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from second answer in Q58C or Q58Cs1) in 2012?
Enter dollar amount
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 2012?
(1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from (fill from second answer in Q58C or Q58Cs1) in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from (fill from second answer in Q58C or Q58Cs1) during 2012?
PREVIOUS ENTRIES: Q58E2: (amount)
Q58E2P: (periodicity)
Q58E22: (number of pay periods)
Enter dollar amount
Q58E2P: (periodicity)
Q58E22: (number of pay periods)
Enter dollar amount
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from third answer in Q58C or Q58Cs1) in 2012?
Enter dollar amount
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 2012?
(1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from (fill from third answer in Q58C or Q58Cs1) in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from (fill from third answer in Q58C3 or Q58Cs1) during 2012?
PREVIOUS ENTRIES: Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)
Enter dollar amount
Q58E3P: (periodicity)
Q58E32: (number of pay periods)
Enter dollar amount
(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
2 No
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)
(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
2 No
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)
Did (name/you) receive any income in 2012 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
2 No
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
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
Specify other source from health problem or disability
Enter "Other Health Problem/Disability" if the answer is "Don't Know"
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
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 2012?
Enter dollar amount
How many (weekly/ every other week/ twice a month/ monthly) payments did (name/you) receive in (first answer from Q61c or Q61cs1) payments in 2012?
Disability income source #1 (1-12; 1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) dollars altogether from (first answer from Q61c or Q61cs1) payments in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from (first answer from Q61c or Q61cs1) payments during 2012?
PREVIOUS ENTRIES: Q61E1: (amount)
Q61E1P: (periodicity)
Q61E12: (number of pay periods)
Enter dollar amount
Q61E1P: (periodicity)
Q61E12: (number of pay periods)
Enter dollar amount
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
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 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer from Q61c or Q61cs1) payments in 2012?
Disability income payment source #2 (1-12; 1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) dollars altogether from (second answer from Q61c or Q61cs1) payments in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from (second fill from Q61c or Q61cs1) payments during 2012?
PREVIOUS ENTRIES: Q61E2: (amount)
Q61E2P: (periodicity)
Q61E22: (number of pay periods)
Enter dollar amount
Q61E2P: (periodicity)
Q61E22: (number of pay periods)
Enter dollar amount
During 2012 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
2 No
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)
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
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
Enter other source of pension or retirement income
Enter "Other Pension Or Retirement" if the answer is "Don't Know"
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in (first answer from Q62c or Q62cs1) in 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (first answer from Q62c or Q62cs1) in 2012?
Pension/Retirement #1 (1-12; 1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) dollars altogether from (first answer from Q62c or Q62cs1) in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received in (first answer from Q62c or Q62cs1) during 2012?
PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount
Q62E1P: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in (second answer from Q62c or Q62cs1) in 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer from Q62c or Q62cs1) in 2012?
Pension/Retirement #2 (1-12; 1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) dollars altogether from (second answer from Q62c or Q62cs1) in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received in (second answer from Q62c or Q62cs1) during 2012?
PREVIOUS ENTRIES: Q62E2: (amount)
Q62E2P: (periodicity)
Q62E22: (number of pay periods)
Enter dollar amount
Q62E2P: (periodicity)
Q62E22: (number of pay periods)
Enter dollar amount
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
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/) in (third answer from Q62c or Q62cs1) in 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (third answer from Q62c or Q62cs1) in 2012?
Pension/Retirement #3 (1-12; 1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) dollars altogether from (third answer fromQ62c or Q62cs1) in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received in (third answer from Q62c or Q62cs1) during 2012?
PREVIOUS ENTRIES: Q62E3: (amount)
Q62E3P: (periodicity)
Q62E32: (number of pay periods)
Enter dollar amount
Q62E3P: (periodicity)
Q62E32: (number of pay periods)
Enter dollar amount
At any time during 2012 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
2 No
At any time during 2012 did (you/ anyone in this household): Have any savings bonds?
1 Yes
2 No
2 No
At any time during 2012 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
2 No
Ask only if necessary. Which members of this household are aged 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)
How much did (name/you) receive in interest from these sources during 2012, including even small amounts reinvested or credited to accounts? Only include interest received from U.S. Savings Bonds cashed during 2012. Separate amounts for joint ownership. If already included in amount reported for another household member, press Enter
Enter dollar amount
Enter A for "Already Included"
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
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name/you) receive in interest income in 2012?
(1-2; 1-52)
Do not read to the respondent. The annual rate appears out of range. The total interest income received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) dollars altogether from interest income in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from interest payments during 2012?
PREVIOUS ENTRIES: Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
At any time during 2012 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
2 No
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)
How much did (name/you) receive in dividends from stocks (or mutual funds) during 2012, 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
Enter (A) for Already included
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
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly
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 2012?
(1-2; 1-52)
Do not read to the respondent. The annual rate appears out of range. The total dividend payments received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) dollars altogether from dividend payments in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from dividend payments during 2012?
PREVIOUS ENTRIES: Q64c: (amount)
Q64cp: (periodicity)
Q64c2: (number of pay periods)
Enter dollar amount
Q64cp: (periodicity)
Q64c2: (number of pay periods)
Enter dollar amount
During 2012 did (you/ anyone in this household): Own any land, business property, apartments, or houses which were rented to others?
1 Yes
2 No
2 No
At any time during 2012 did (you/ anyone in this household): Receive income from royalties or from roomers or boarders? (exclude amounts paid by relatives)
1 Yes
2 No
2 No
At any time during 2012 did (you/ anyone in this household): Receive income from estates or trusts? (exclude estates or trusts already reported)
1 Yes
2 No
2 No
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)
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 2012? 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
If already included in amount reported for another household member,
or if response is "None",
or if response is "Lost Money"
press (Enter) key
Enter "A" for Already included. Enter "L" for Lost Money. Enter "X" for None
Enter amount of money lost in 2012.
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
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 2012?
PREVIOUS ENTRIES: Q65c: (amount)
Q65cp: (periodicity)
Enter dollar amount
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 2012. Is this a correct entry?
If Yes, enter "S" to Suppress. If No, press enter and correct entry.
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 2012?
PREVIOUS ENTRIES: Q65cL: (amount)
Q65cp: (periodicity)
Enter dollar amount
Q65cp: (periodicity)
Enter dollar amount
During 2012 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
2 No
Did (you/ anyone in this household) receive any educational assistance for tuition, fees, books, or living expenses during 2012? Exclude loans, assistance from household members, and VA educational benefits.
1 Yes
2 No
2 No
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)
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.)
3 Assistance from a welfare or social service office
4 Some other government assistance
5 Scholarships, grants, etc.
6 Other assistance (employers, friends, etc.)
How much did (name/you) receive in Pell Grants during 2012?
Enter annual amount only
What is the easiest way for you to tell us (name's/your) (other/blank ) educational assistance during 2012; 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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
(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 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in educational assistance in 2012?
(1-12/1-24/1-26/1-52)
Do not read to the respondent. The annual rate appears out of range. The total educational assistance received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from educational assistance in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from educational assistance during 2012?
Previous entries: Q66h: (amount)
Q66hp: (periodicity)
Q66h2: (number of pay periods)
Enter dollar amount
Q66hp: (periodicity)
Q66h2: (number of pay periods)
Enter dollar amount
During 2012 did (you/ anyone in this household) receive: Any child support payments?
1 Yes
2 No
2 No
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)
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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly) in child support payments in 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/ monthly) child support payments did (name/you) receive in 2012?
(1-12/1-24/1-26/1-52)
Do not read to the respondent. The annual rate appears out of range. The total child support payments received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from child support payments in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from child support payments during 2012?
PREVIOUS ENTRIES: Q70c: (amount)
Q70cp: (periodicity)
Q70c2: (number of pay periods)
Enter dollar amount
Q70cp: (periodicity)
Q70c2: (number of pay periods)
Enter dollar amount
During 2012 did (you/ anyone in this household) receive: Any alimony payments?
1 Yes
2 No
2 No
Read only if necessary. Who received these payments during 2012? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)
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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) in alimony payments in 2012?
Enter dollar amount
How many (weekly/every other week/ twice a month/ monthly) alimony payments did (name/you) receive in 2012?
(1-12/1-24/1-26/1-52)
Do not read to the respondent. The annual rate appears out of range. The total alimony payments received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from alimony payments in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from alimony payments during 2012?
PREVIOUS ENTRIES: Q71c: (amount)
Q71cp: (periodicity)
Q71c2: (number of pay periods)
Enter dollar amount
Q71cp: (periodicity)
Q71c2: (number of pay periods)
Enter dollar amount
During 2012 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
2 No
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)
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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly) in regular financial assistance in 2012?
Enter dollar amount
How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in regular financial assistance in 2012?
(1-12/1-24/1-26/1-52)
Do not read to the respondent. The annual rate appears out of range. The total regular financial assistance payments received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from regular financial assistance in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount (name/you) received from regular financial assistance during 2012?
PREVIOUS ENTRIES: Q72c: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)
Q72cp: (periodicity)
Q72c2: (number of pay periods)
During 2012 did (you/ anyone in this household) receive income from: Hobbies, home businesses, farms, or business interests not already covered?
1 Yes
2 No
2 No
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)
What was the source of this income?
Asking about: (name/you) (name/name- -CURRENT RESPONDENT)
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 2012; 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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
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 2012?
Enter dollar amount
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 2012?
(1-12/1-24/1-26/1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (name/you) received (total) altogether from hobbies, home businesses, farms, or business interests not already covered in 2012. Does that sound about right?
1 Yes
2 No
2 No
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 2012?
PREVIOUS ENTRIES: Q731: (amount)
Q731P: (periodicity)
Q7312: (number of pay periods)
Enter dollar amount
Q731P: (periodicity)
Q7312: (number of pay periods)
Enter dollar amount
During 2012 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
2 No
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)
What was the source of this income?
Asking about: (name/you) (name/name- -CURRENT RESPONDENT)
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 2012; 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
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
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 2012?
Enter dollar amount
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 2012?
(1-12/1-24/1-26/1-52)
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 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
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 2012. Does that sound about right?
1 Yes
2 No
2 No
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 2012?
PREVIOUS ENTRIES: Q732: (amount)
Q732P: (periodicity)
Q7322: (number of pay periods)
Enter dollar amount
Q732P: (periodicity)
Q7322: (number of pay periods)
Enter dollar amount
These next questions are about health insurance coverage during the calendar year 2012. The questions apply to ALL persons of ALL ages.
Enter 1 to Continue
At any time in 2012, (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
2 No
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)
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
Enter persons line number (1-16)
Enter 96 for All persons
Enter persons line number (1-16)
Did (name's/your) plan cover anyone living outside this household?
1 Yes
2 No
2 No
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
2 Part
3 None
At any time during 2012, (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
2 No
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)
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)
Enter 96 for All persons
Probe: Anyone else?
Enter persons line number (1-16)
Did (name's/your) plan cover anyone living outside this household?
1 Yes
2 No
2 No
At any time in 2012, (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
2 No
Who was that? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)
At any time in 2012, (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
2 No
Who was that? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)
At any time in 2012, (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
2 No
Who was that? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)
How many months during 2012, (was/were) (name/you) covered by Medicaid/(fill state name)?
Enter number of months (1-12)
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
2 No
Who was that? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)
At any time in, 2012 (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 Veteran's Affairs.
1 Yes
2 No
2 No
Who was that? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)
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
2 CHAMPVA
3 VA
4 Indian Health Service
5 Other
Enter other type of plan
Other than the plans I have already talked about, during 2012, 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
2 No
Who has insurance? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)
What type of health insurance (was/were) (name/you) covered by in 2012? 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 VETERAN\'S 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
2 Medicaid
3 TRICARE
4 CHAMPVA (CHAMPVA IS THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERAN\'S 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
Enter other type of plan
I have recorded that (you/read list of names) (were/was) not covered by a health plan at any time during 2012. Is that correct?
1 Yes
2 No
2 No
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)
What type of health insurance (was/were) (name/you) covered by in 2012? 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 VETERAN\'S 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
2 Medicaid
3 TRICARE
4 CHAMPVA (CHAMPVA IS THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERAN\'S 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
Enter other type of health insurance covered by in 2012
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
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
2 Very good
3 Good
4 Fair
5 Poor
During 2012, 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
During 2012, about how much was paid for (name/you) 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
Aside from over-the-counter items, during 2012, 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
How about (name)?During 2012, about how much was paid for (name) for 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
Aside from over-the-counter items, during 2012, 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
Other than Social Security, did (ANY) employer or union that (name/you) worked for in 2012 have a pension or other type of retirement plan for any of its employees?
1 Yes
2 No
2 No
(Were/Was) (name/you) included in that plan?
1 Yes
2 No
2 No
During 2012 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)
Enter 0 for None
Enter persons line number (1-16)
During 2012 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)
Enter 0 for None
Enter persons line number (1-16)
Is this public housing, that is, is it owned by a local housing authority or other public agency?
1 Yes
2 No
2 No
Are you paying lower rent because the Federal, State, or local government is paying part of the cost?
1 Yes
2 No
2 No
Is this through Section 8 or through some other government program?
1 Section 8
2 Some other government program
3 Not sure
2 Some other government program
3 Not sure
Did (you/ anyone in this household) get SNAP (Supplemental Nutrition Assistance Program), food stamps or a food stamp benefit card at any time during 2012? Do not include WIC benefits.
1 Yes
2 No
2 No
At any time during 2012, 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 card name)? Do not include WIC benefits.
3 Yes
4 No
4 No
Which of the people now living here were covered by that food assistance during 2012? 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
Enter persons line number (1-16)
Enter 0 for None
Enter persons line number (1-16)
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
2 Yearly
3 Already included with TANF/AFDC payment
What is the (monthly/ ) value of the food assistance received in 2012?
Enter dollar amount
How many months was food assistance received in 2012?
(1-12)
Do not read to the respondent. The annual rate appears out of range. The total food assistance payments received in 2012 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
According to my calculations (total) was received altogether from food assistance in 2012. Does that sound about right?
1 Yes
2 No
2 No
What is your best estimate of the correct amount of food assistance received during 2012?
PREVIOUS ENTRIES: Q90: (amount)
Q90p: (periodicity)
Q902: (number of pay periods)
Enter dollar amount
Q90p: (periodicity)
Q902: (number of pay periods)
Enter dollar amount
At any time during 2012, (was/were) (you/ anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?
1 Yes
2 No
2 No
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)
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 2012, (have you/has this household) received assistance of this type from the federal, state, or local government?
1 Yes
2 No
2 No
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
2 No
Was it used to pay heating or cooling costs?
1 Yes
2 No
2 No
Q94
Altogether, how much energy assistance has been received in 2012?
Enter annual amount only
MIGSAM
(Were/Was) (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.
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
Current: (city)
Enter correct city/town/post office or press ENTER for SAME
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
Current: (state)
Enter W for person living on a ship at sea
Enter correct State or press ENTER for SAME
Where did (reference person's name/you) live one year ago?
Zip Code
Current: (zip)
Enter correct Zip Code or press ENTER for SAME
Current: (zip)
Enter correct Zip Code or press ENTER for SAME
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
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
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 foreclosure/eviction
14 other housing reason
15 to attend or leave college
16 change of climate
17 health reasons
18 natural disaster (hurricane, tornado, etc.)
19 other reason (specify)
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 foreclosure/eviction
14 other housing reason
15 to attend or leave college
16 change of climate
17 health reasons
18 natural disaster (hurricane, tornado, etc.)
19 other reason (specify)
MI1s
What was the reason for moving?
(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)
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.
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
Current: (city) Enter correct city/town/post office or
Press ENTER for SAME
Where did (name/you) live one year ago?
Name of State
Current: (state)
Enter correct State or press ENTER for SAME
Current: (state)
Enter correct State or press ENTER for SAME
Where did (name/you) live one year ago?
Zip Code Current: (zip)
Enter correct zip code or
Press ENTER for SAME
Enter correct zip code or
Press ENTER for SAME
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
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
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 foreclosure/eviction
14 other housing reason
15 to attend or leave college
16 change of climate
17 health reasons
18 natural disaster (hurricane, tornado, etc.)
19 other reason (specify)
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 foreclosure/eviction
14 other housing reason
15 to attend or leave college
16 change of climate
17 health reasons
18 natural disaster (hurricane, tornado, etc.)
19 other reason (specify)
NX1OTH
What was the reason for moving?
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
2 Two
3 Three or four
4 Five to nine
5 Ten or more
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
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
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
2 Yes, second mortgage.
3 Yes, second mortgage and home equity loan.
4 No
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 2012? 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
2 No
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)
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 2012: weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
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.
How many (weekly/every other week/twice a month/monthly) payments did (you/they) make during 2012?
Then (you/they) paid (total dollar amount) altogether in child care while (you/they) worked during 2012. Does that sound about right?
1 Yes
2 No
2 No
CCEST
What is your best estimate of the correct amount (you/they) paid for child care while (you/they) worked in 2012?
CSPCHILD
Does anyone in this household have any children who lived elsewhere with their other parent or guardian at any time during 2012?
1 Yes
2 No
2 No
CSPWHO
Who had children who lived elsewhere? Anyone else?
Enter line number
Enter all that apply, separate using the space bar or a comma.
Enter all that apply, separate using the space bar or a comma.
In 2012, (were/was) (name/you) required to pay child support?
1 Yes
2 No
2 No
CSPAMT
How much child support did (name/you) pay in 2012?
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
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
_________________________________