CPS Supplement
Income survey
March 2015

MOVER ITEMS

HH32b

Did (you/name of reference person) live at this address during the week of November 19, 2014?

1 Yes
2 No

HH32d

Did any of the following household members live here during the week of November 19, 2014?

1 Yes
2 No

FAMILY INCOME

S_FAMINC

Which category represents the total combined income of all members of this FAMILY during the past 12 months? This includes money from jobs, net income from business, farm or rent, pensions, dividends, interest, social security payments and any other money income received by members of this family who are 15 years of age or older?

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

INCDKR

Is the combined income of all members of this FAMILY during the past 12 months above or below $75,000?

1 Above
2 Below

INTRODUCTION

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

WORK EXPERIENCE

Q29a

Did (name/you) work at a job or business at any time during 2014?

1 Yes
2 No

Q29b

Did (you/he/she) do any temporary, part-time, or seasonal work even for a few days during 2014?

1 Yes
2 No

Q30

Even though (name/you) did not work in 2014, did (you/he/she) spend any time trying to find a job or on layoff?

1 Yes
2 No

Q31

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

(01-52) Number of weeks
________________

Q32

What was the main reason (you/he/she) did not work in 2014?

Read categories if necessary

1 Ill, or disabled and unable to work
2 Retired
3 Taking care of home or family
4 Going to school
5 Could not find work
6 Doing something else

Q33

During 2014 in how many weeks did (name/you) work even for a few hours?

Include paid vacation and sick leave as work.

(01-52) Number of weeks
Enter 97 if respondent can only answer in months
________________

Q33mon

Enter number of months worked.

(1-12)
________________

Q33ver

Then (name/you) worked about (number) weeks. Is that correct?

1 Yes
2 No -- back to Q33 and obtain estimate

Q35

Did (name/you) lose any full weeks of work in 2014 because (you/he/she) (were/was) on layoff from a job or lost a job?

Number of weeks worked in 2014: (number)

1 Yes
2 No
7 Mistake made in number of weeks worked last year - Specify in Q35SP

Q35SP

Specify mistake made in number of weeks worked last year.

_________________________________________________

Q36

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

Enter 0 for none
________________

Q37

Were the (number) weeks (name/you) (was/were) looking for work or on layoff all in one stretch?

1 Yes -- one stretch
2 No -- two stretches
3 No -- 3 or more stretches

Q38

What was the main reason (name/you) (was/were) not working or looking for work in the remaining weeks of 2014?

Read list only if respondent is having difficulty answering the question

1 Ill, or disabled and unable to work
2 Taking care of home or family
3 Going to school
4 Retired
5 No work available
6 Other (Specify - Q38sp)

Q38sp

Enter verbatim response

_________________________________________________

Q39

For how many employers did (name/you) work in 2014?

If more than one at the same time, only count it as one employer.

1 One
2 Two
3 Three or more

Q41

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

)

Enter number of hours
________________

Q43

During 2014, were there one or more weeks in which (name/you) worked less than 35 hours?

Exclude time off with pay because of holidays, vacation, days off, or sickness.

1 Yes
2 No

Q44

In the weeks that (name/you) worked, how many weeks did (name/you) work less than 35 hours in 2014?

Number of weeks worked in 2014: (number) (Number of weeks was reported in item Q33)

(1-52)
________________

Q45

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

Read list only if respondent is having difficulty answering the question

1 Could not find a full time job
2 Wanted to work part time or only able to work part time
3 Slack work or material shortage
4 Other reason

Q46

What was (name's/your) longest job during 2014? Was it:

(IO1NAM:) (name of employer)
(IO1IND:) (kind of business or industry)
(IO1OCC:) (occupation)
(IO1DT:) (duties)
CLASS OF WORKER: (PRIVATE/FEDERAL GOVERNMENT/STATE GOVERNMENT/LOCAL GOVERNMENT/WORKING WITHOUT PAY IN FAMILY BUS./SELF EMPLOYED--INCORPORATED/SELF EMPLOYED--UNINCORPORATED)

1 Same as listed
2 Different job

Q47a

For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job during 2014?))

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 2013)

_________________________________________________

Q47b

What kind of business or industry is this?

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

_________________________________________________

Q47b1

Is this business or organization mainly manufacturing, retail trade, wholesale trade, or something else?

(blank/( IO1MFG:) (entry) The current business or organization type is pre-filled in the Form Pane below. Press ENTER if Same) (blank/ If longest job last year is military job, enter 4)

1 Manufacturing
2 Retail trade
3 Wholesale trade
4 Something else

Q47c

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

For example: Electrical Engineer, Stock Clerk, Typist (blank/( IO1OCC:) (entry) The current occupation is pre-filled in the Form Pane below. Press ENTER if Same) (blank/ If longest job last year is military job, enter Armed Forces)

_________________________________________________

Q47d1

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

For example: Types, keeps account books, files, sells cars, operates printing press, finishes concrete. (blank/( IO1DT:) (entry) The current job description is pre-filled in the Form Pane below. Press ENTER if Same) (blank/ If longest job last year is military job, enter NA)

_________________________________________________

Q47d2

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

_________________________________________________

Q47E1

Ask Only If Necessary (Were/Was) (you/he/she) employed by government, by a PRIVATE company, a nonprofit organization, or (was/were) ( you/he/she) self-employed or working in a family business?

1 Government
2 Private for profit company
3 Non profit organization including tax exempt and charitable organizations
4 Self employed
5 Working in family business

Q47E1a

Would that be the federal, state, or local government?

1 Federal
2 State
3 Local (county, city, township)

Q47E1b

Was this business incorporated?

1 Yes
2 No

Q47E1c

(Were/Was) (you/name) the owner of the business?

1 Yes
2 No

Q4788

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

Read categories if necessary

1 under 10
2 10-49
3 50-99
4 100-499
5 500-999
6 1,000+

EARNED INCOME

Beginning with the 2015 CPS ASEC, the Earnings and Income question series include range follow-up questions presented anytime a respondent doesn't know or refuses to provide an exact dollar amount for a source they (or someone in the household) indicates as having received. Follow-up questions allow respondents that do not feel comfortable giving exact dollar values to report an income range. There are three sets of categories used for the income range follow-up questions: high-range, mid-range, and low-range. The income range used in the follow-up range questions depends on the source of the income. See Attachment A to this items booklet for the three levels of income range follow up questions. See Attachment B for a table that displays the income source and the range level used for the follow-up questions.

Q48aa

How much did (name/you) earn from this employer before taxes and other deductions during 2014?

Enter dollar amount

Enter 0 for none

________________

Q48

Ask only if the respondent "Doesn't know" or 'Refused" Q48aa. Could you tell me if (name/you) earned less than $45,000, between $45,000 and $60,000, or over $60,000 for the TOTAL yearly amount from this employer before taxes and other deductions during 2014?

1 Less than $45,000
2 Between $45,000 and $60,000
3 Over $60,000

Q48aarn2

Did (name/you) earn less than $15,000, between $15,000 and $30,000, or over $30,000 from this employer during 2014?

1 Less than $15,000
2 Between $15,000 and $30,000
3 Over $30,000

Q48aap

Read if necessary. Is this a weekly, every other week, twice a month, monthly, or yearly amount?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q48a1

For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q48aa) from this employer in 2014?

(1-12/1-24/1-26/1-52)
________________

Q48aC2

Do not read to the respondent. The annual rate appears out of range. The total annual earnings entered is (amount). Is this a correct entry?

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

Q48aV

According to my calculations (name/you) earned (total) altogether from this employer in 2014 before deductions. Does that sound about right?

1 Yes
2 No

Q48a2

What is your best estimate of (name's/your) correct total amount of earnings from this employer during 2014 before deductions?

PREVIOUS ENTRIES: Q48aa: (amount)
Q48aap: (periodicity)
Q48a1: (number of pay periods)

Enter dollar amount

________________

Q48a3

Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this employer in 2014?

1 Yes
2 No

Q48aad

How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from this employer in 2014?

Enter dollar amount

________________

Q48aadrn1

Ask only if the respondent "Doesn't know" or "Refused" Q48aad. Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over $3,000 in tips, bonuses, overtime pay, or commissions from this employer during 2013?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

Q48aadrn2

Did (name/you) earn less than $100, between $100 and $500, or over $500 in tips, bonuses, overtime pay, or commissions from this employer during 2013?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q48b

What were (name's/your) net earnings from this business/farm after expenses during 2014?

If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b_char

Enter "L" for Lost Money

________________

Q48BL

Enter amount of money lost in 2014. Enter annual amount only

________________

Q48brn1

Ask only if the respondent "Doesn't know" or refused Q48b. Could you tell me if (name/you) earned less than $45,000, between $45,000 and $60,000, or over $60,000 for the TOTAL yearly amount from this business/farm after expenses during 2014?

1 Less than $45,000
2 Between $45,000 and $60,000
3 Over $60,000

Q48brn2

Did (name/you) earn less than $15,000, between $15,000 and $30,000, or over $30,000 from this business/farm after expenses during 2014?

1 Less than $15,000
2 Between $15,000 and $30,000
3 Over $30,000

Q48bp

Is this a weekly, every other week, twice a month, monthly, Quarterly, or yearly amount?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
7 Yearly

Q48B1A

Do not read to the respondent.

The annual rate appears out of range. The total annual business loss entered is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48B1B

Do not read to the respondent.

The annual rate appears out of range. The total annual business income entered is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48b2

What is your best estimate of (name's/your) ANNUAL net earnings from this business/farm after expenses in 2014?

PREVIOUS ENTRIES:
Q48b: (amount)
Q48bp: (periodicity)

Enter dollar amount

________________

Q48b2L

What is your best estimate of (name's/your) ANNUAL net LOSS from this business/farm after expenses in 2014?

PREVIOUS ENTRIES:
Q48bL: (amount)
Q48bp: (periodicity)

Enter dollar amount

________________

Q48b3

What were (name's/your) net earnings from this business/farm during the FIRST Quarter of 2014?

If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b3_char

Enter "L" for Lost Money
________________

Q48B3L

Enter amount of money lost in the first Quarter of 2014.
________________

Q48b4

What were (name's/your) net earnings from this business/farm during the SECOND quarter of 2014?

If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b4_char

Enter "L" for Lost Money

________________

Q48B4L

Enter amount of money lost in the second Quarter of 2014.

________________

Q48b5

What were (name's/your) net earnings from this business/farm during the THIRD quarter of 2014?

If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b5_char

Enter "L" for Lost Money

________________

Q48B5L

Enter amount of money lost in the third quarter of 2014.

________________

Q48b6

What were (name's/your) net earnings from this business/farm during the FOURTH quarter of 2014?

If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b6_char

Enter "L" for Lost Money

________________

Q48B6L

Enter amount of money lost in the fourth Quarter of 2014.

________________

Q48b7

Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this business in 2014?

1 Yes
2 No

Q48bad

How much did (name/you) earn in tips, bonuses, overtime pay, or commissions in 2014?

Enter dollar amount

________________

Q48badrn1

Ask only if the respondent "Doesn't know" or "Refused" Q48bad. Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over $3,000 in tips, bonuses, overtime pay, or commissions from this business during 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

Q48badrn2

Did (name/you) earn less than $100, between $100 and $500, or over $500 in tips, bonuses, overtime pay, or commissions during 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q49a

Did (name/you) earn money from any other work (you/he/she) did during 2014?

1 Yes
2 No

Q49b1d

How much did (name/you) earn from all other employers before taxes and other deductions during 2014?

Enter dollar amount

Enter "0" for None

________________

Q49b1drn1

Ask only if the respondent "Doesn't know" or "Refused" Q48b1d. Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over $20,000 from all other employers before taxes and other deductions during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q49b1drn2

Redesigned income path only Did (name/you) earn less than $1,000, between $1,000 and $5,000, or over $5,000 from all other employers before taxes and other deductions during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q49b1p

Read if necessary. Is this a weekly, every other week, twice a month, monthly, or yearly amount?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q49B11

For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q49b1d) from all other employers in 2014?

(1-12/1-24/1-26/1-52)
________________

Q49B1C

Do not read to the respondent. The total annual earnings entered from all other employers is (amount). Is this a correct entry?

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

Q49B1V

According to my calculations (name/you) earned (total) altogether from all other employers in 2014. Does that sound about right?

1 Yes
2 No

Q49B12

What is your best estimate of (name's/your) correct total amount of earnings from all other employers during 2014?

PREVIOUS ENTRIES:
Q49b1d: (amount)
Q49b1p: (periodicity)
Q49b11: (number of pay periods)

Enter dollar amount

________________

Q49b13

Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from all other employers in 2014?

1 Yes
2 No

Q49B1A

How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from all other employers in 2014?

Enter dollar amount

________________

Q49B1ARN1

Ask only if the respondent "Doesn't know" or "Refused" Q49B1A. Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over $3,000 in tips, bonuses, overtime pay, or commissions from all other employers in 2013?

1 Less than $1,000 (proceed to Q49B1ARN2)
2 Between $1,000 and $3,000
3 Over $3,000

Q49B1ARN2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in tips, bonuses, overtime pay, or commissions from all other employers in 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q49b2

How much did (name/you) earn from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter annual amount only

________________

Q49b2rn1

Ask only if the respondent "Doesn't know" or 'Refused" Q49b2. Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over $20,000 from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

1 Less than $10,000 (proceed to Q49b2rn2)
2 Between $10,000 and $20,000
3 Over $20,000

Q49b2rn2

Could you tell me if (name/you) earned less than $1,000, between $1,000 and $5,000, or over $5,000 from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q49b2_char

Enter "L" for Lost Money

________________

Q49b3

Enter annual amount lost only

____________

Q49b4

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

If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost money" press enter
Enter annual amount only

_______________

Q49b4rn1

Ask only if the respondent "Doesn't know" or "Refused" Q49b4. Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over $20,000 from (your/his/her) farm after expenses?

1 Less than $10,000 (proceed to Q49b4rn2)
2 Between $10,000 and $20,000
3 Over $20,000

Q49b4rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q49b4_char

Enter "L" for Lost Money

________________

Q49b5

Enter annual amount lost only

________________

INCOME SOURCES

In the ASEC income section the order of the questions changes based on the household composition (Low-income, Householder or Spouse Aged 62 or Older, or Default); see chart on the following page. All low-income transfer program questions are asked in each interview regardless of household family income.

UNEMPLOYMENT AND WORKERS COMPENSATION (Source)

Q51A1

At any time during 2014 did (name/you) receive any State or Federal unemployment compensation?

1 Yes
2 No

Q51A1b

Read only if necessary. Who received State or Federal unemployment compensation?

Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?

Enter persons line number (1-16)

Q51A2

At any time during 2014 did (you/anyone in the household) receive any Supplemental Unemployment Benefits (SUB)?

1 Yes
2 No

Q51A2b

Read only if necessary. Who received Supplemental Unemployment Benefits?

Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?

Enter persons line number (1-16)

Q51A3

At any time during 2014 did (you/anyone in the household) receive any Union Unemployment or Strike Benefits?

1 Yes
2 No

Q51A3b

Read only if necessary. Who received Union Unemployment or Strike Benefits? Enter all that apply, separate using the space bar or comma. Probe: Anyone Else?

Enter persons line number (1-16)

Q52A

During 2014 did (you/anyone in the household receive any Worker's Compensation payments or other payments as a result of a job related injury or illness?

Exclude sick pay and/or disability retirement.

1 Yes
2 No

Q52Ab

Read only if necessary. Who received Worker's Compensation or payments as a result of a job related injury or illness?

Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?

Exclude those who received sick pay and/or disability retirement.

Enter persons line number (1-16)

Q52b

What was the source of (your/name's Fill Q52Ab) payments?

Read Categories if necessary

1 State Worker's Compensation
2 Employer or employer's insurance
3 Own insurance
4 Other

Q52Cs1

Specify other source from workers compensation/insurance. Enter "Worker's Compensation" if the answer is "Don't Know"

1.1 SOCIAL SECURITY (Source)

Q56a

During 2014 did (you/ anyone in this household) receive any Social Security payments from the U.S. Government?

1 Yes
2 No

Q56b

Read only if necessary. Who received Social Security payments either for themselves or as combined payments with other family members?

Enter Line Number Of Parent Or Guardian For Payments Made To
Children Under Age 15
Enter all that apply, separate using the space bar or a comma.
Enter persons line number (1-16)

SSR

What were the reasons (name/you) (was/were) getting Social Security in 2014?

Mark all that apply
Probe: Any Other Reason?

1 Retired
2 Disabled
3 Widowed
4 Spouse
5 Surviving child
6 Dependent child
7 On behalf of surviving, dependent, or disabled children
8 Other

SSRs_T

Specify other reason

________________________________________________

SSC

Which children under age 15 were receiving Social Security in 2013?

Probe: Anyone Else?
Enter all that apply, separate by commas.
Enter 0 if none listed
Enter persons line number (1-16)

SSCR

What were the reasons (Child's name/the children) (was/were) getting Social Security in 2014?

Mark all that apply. Probe: Any Other Reason?

1 Disabled child
2 Surviving child
3 Dependent child
4 Other

SSDIa1

Did (name/you) receive (your/his/her) first Social Security Disability payment in 2014?

1 Yes
2 No

SOCIAL SECURITY FOR CHILDREN (Source)

Q56f_T

Did anyone in this household receive any Social Security income in 2014 that we have not already counted on behalf of children in this household?

Includes all children under 19 years of age
Social Security Income previously reported will appear here
LN Name Amount reported in Q56d amount

1 Yes
2 No

Q56g

Read only if necessary Who received these Social Security payments?

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

SSC-R

Which children under age 19 were receiving Social Security in 2014?

Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

SSCR

What were the reasons (Child's name/the children) (was/were) getting Social
Security in 2014?

Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?

1 Disabled child/children
2 Surviving child/children
3 Dependent child/children
4 Other

SUPPLEMENTAL SECURITY INCOME (SSI)

Q57a

During 2014 did (you/ anyone in this household) receive: any SSI payments, that is, Supplemental Security Income?

Note: SSI are assistance payments to low-income aged, blind and disabled persons,
and come from state or local welfare offices, the Federal government, or both.

1 Yes
2 No

Q57b

Read only if necessary Who received SSI?

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

SSIR

What were the reasons (name/you) (was/were) getting Supplemental Security Income in 2014?

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 ___________________

SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (SSI) (Source)

Q57d

Did anyone in this household receive any Supplemental Security Income in 2014 that we have not already counted on behalf of children in this household?

Includes all children under 18 years of age
SSI previously reported will appear here
LN Name Amount for Q57C amount

1 Yes
2 No

Q57e

Read only if necessary. Who received these Supplemental Security Income payments?

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

RSSI

What were the reasons (name/you) (was/were) getting Supplemental Security Income on behalf of children in 2014?

Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?

1 On behalf of a disabled child/children
2 On behalf of a blind child/children
3 Other ____________________

CSSI

Which children under age 18 were receiving Supplemental Security Income in 2014?

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)

DISABILITY INCOME

Q59AR

At any time in 2014 (did you/did anyone in the household) have a disability or health problem which prevented (you/them) from working, even for a short time, or which limited the work (you/they) could do?

1 Yes
2 No

Q59b

Read only if necessary Who is that?

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

Q60a

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

1 Yes
2 No

61b

Did (you/name) receive any disability income in 2014 as a result of (your/his/her) disability or health problem (other than Social Security Disability)

1 Yes
2 No

Q61C

What was the source of this income?

Asking About: (name) (blank/- -CURRENT RESPONDENT)
Enter all that apply, separate using the space bar or a comma.
Probe: Any other reason?

2 Worker's compensation
3 Company or union disability
4 Federal Government (CIVIL SERVICE) disability
5 U.S. Military retirement disability
6 State or Local government employee disability
7 U.S. Railroad retirement disability
8 Accident or disability insurance
9 Black Lung miner's disability
10 State temporary sickness
11 Other or don't know -- Specify -- Enter last

Q61Cs1

Specify other source of income from health problem or disability Enter "Other Health Problem/Disability" if the answer is "Don't Know"

_____________________________________________

VETERANS PAYMENTS (Source)

Q60A88

At any time during 2014 did (you/ anyone in this household) receive: Any Veterans' (VA) payments?

Include assistance received by children of veterans

1 Yes
2 No

Q60b_88

Read only if necessary Who received Veterans' (VA) payments either for themselves or as combined payments with other family members?

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

Q60C8

What type of Veterans' payment did (name/you) receive?

Read list only if respondent is having difficulty answering the question.
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Payments?

1 Service-connected disability compensation
2 Survivor Benefits
3 Veterans' Pension
4 Educational assistance (including assistance received by children of veterans)
5 Other Veterans' payments _________________

Q60D88

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

1 Yes
2 No

SURVIVOR BENEFITS (Source)

Q58A

Did (you/ anyone in this household) receive any survivor benefits in 2014 such as widow's pensions, estates, trusts, insurance annuities, or any other survivor benefits (other than Social Security/ other than VA benefits/ other than Social Security or VA benefits)?

1 Yes
2 No

Q58b

Read only if necessary Who received this income?

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

Q58C

What was the source of this income?

Asking About: (name/name- -CURRENT RESPONDENT)
Read list if respondent is having difficulty answering the Question
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Source?

2 Company or union survivor pension (INCLUDE PROFIT SHARING)
3 Federal Government survivor (CIVIL SERVICE) pension
4 U.S. Military retirement survivor pension
5 State or Local government survivor pension
6 U.S. Railroad retirement survivor pension
7 Worker's compensation survivor pension
8 Black Lung survivor pension
9 Regular payments from estates or trusts
10 Regular payments from annuities or paid-up insurance policies
11 Other or don't know (SPECIFY) - ENTER LAST

Q58Cs1

Specify other source of income as survivor or widow
Enter "Survivor Benefits" if the answer is "Don't Know"

________________________________________________

PUBLIC ASSISTANCE (Source)

Q59A88

At any time during 2014, 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 from:
Welfare or Welfare to Work
TANF
General Assistance
Diversion Payments
Refugee Cash
Gen Assist Indian Affairs

Don't include:
Food Stamps (SNAP)
AFDC /Aid to Families SSI
Energy Assistance
WIC
School Meals
Childcare
Education Assistance

1 Yes
2 No

Q59A89

Just to be sure, in 2014, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?

1 Yes
2 No

Q59b_88

Who received this CASH assistance?

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

Q59C8r

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 Diversion Payments
5 Refugee cash and medical assistance program
6 General assistance from Bureau of Indian Affairs, or Tribal administered general assistance
7 Some other program (specify)

(If respondent mentions any of the following categories 7 through 12, note this, but explain: "Right now we are interested in CASH assistance" and seek answers using the accepted categories:

Food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits
SSI
Energy assistance
WIC
School meals
Transportation, childcare, rental or education assistance

Q59C8s

What was the name of the other program?

Specify other source of cash assistance
Enter "Cash" if the answer is "Don't Know"

_________________________________________________

Food Stamps/Supplemental Nutrition Assistance Program (SNAP) (Source)

Q87r

Did (you/ anyone in this household) get food stamps or use a food stamp benefit card at any time during 2014?

Do not include WIC benefits

1 Yes
2 No

Q87ar

At any time during 2014, even for one month, did (you/ anyone in this household) receive any food assistance from (State Program name)?

Do not include WIC benefits.

1 Yes
2 No

Q88

Which of the people now living here were covered by that food assistance during 2014?

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

PENSIONS (Source)

Q62Ar

During 2014 did (you/ anyone in this household) receive any pension income from a previous employer or union (other than Social Security/ other than VA benefits/ other than Social Security or VA benefits)?

PLEASE DO NOT INCLUDE DISTRIBUTIONS OR WITHDRAWALS FROM IRAs, 401(k)s, OR SIMILAR ACCOUNTS!

1 Yes
2 No

Q62b

Read only if necessary
Who received pension or retirement income?

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

Q62Cra

Was (name's/your) pension income from a:
Company or union pension (include profit sharing)?

Enter all that apply, separate using the space bar or a comma.
Probe: Any Other pension or retirement income?

1 Company Pension
2 Union Pension
3 Neither

Q62Crb

Was (name's/your) pension income from a: Federal, State or Local Government pension?

Enter all that apply, separate using the space bar or a comma.
If "Yes," probe to identify which source

1 Federal Government Pension
2 State Government Pension
3 Local Government Pension
4 None of the above

Q62Crc

Was (name's/your) pension income from: a U.S Military pension?

1 Yes
2 No

Q62Crd

Did (you/name) receive pension income from some other source?

1 Yes
2 No

Q62Dr

What was the source of (name's/your) pension income?

Enter all that apply
Probe as needed: Who received this source?
Probe: Any Other pension income?

1 U.S. Railroad Retirement
2 Other sources or don't know -- Specify --

Enter other source of pension income

_____________________________________________

Q62Cs1

Specify other source of pension income
Enter "Other Pension" if the answer is "Don't Know"

_________________________________________________

ANNUITIES (Source)

Q96Ar

During 2014 did (you/ anyone in this household) receive any income from an annuity?

1 Yes
2 No

Q96Br

Read only if necessary. Who received annuity income?

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

RETIREMENT ACCOUNTS (Source)

Q97Ar

At any time during 2014 did (you/ anyone in this household) have any retirement accounts such as a 401(k), 403(b), IRA, or other account designed specifically for retirement savings?

1 Yes
2 No

Q97Br

Read only if necessary
Who had such a retirement account?

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

Q97Cr

What type of retirement account (did you/ NAME) have? Did (you/he/she) have. . .

READ EACH CATEGORY! Enter all that apply, separate using the space bar or a comma.

1. 401(k) 5. KEOGH plan ("KEE-OH")
2. 403(b) 6. SEP plan (Simplified Employee Pension)
3. Roth IRA 7. another type of retirement account
4. Regular IRA

Q97Dr

What was the source of (name's/your) retirement income?

Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Probe: Any Other retirement income?

Enter other source of retirement income
_____________________________________________

Q98Ar

Did (you/NAME) withdraw any money or receive a distribution from (your/his/her)

[ACCOUNT TYPE_ FILL IN FROM Q97CR or Q97DR] account in 2014? (IF AGE 70+ ADD: including distributions you may have been required to take?)

1 Yes
2 No

INCOME-EARNING ACCOUNTS OUTSIDE OF RETIREMENT (Source)

Q99ArA

IF ANY RETIREMENT ACCOUNTS IN HH, READ TRANSITION:
(Now I will ask about assets that may have paid interest or dividends in 2014 outside of the retirement account(s).) At anytime during 2014, did (you/anyone in this household): Have money in an interest-earning checking account?

1 Yes ( Probe as needed: Who received this source?)
2 No

Q99ArB

At anytime during 2014, did (you/anyone in this household): Have a savings account?

1 Yes ( Probe as needed: Who received this source?)
2 No

Q99ArC

At anytime during 2014, did (you/anyone in this household): Have a money-market fund?

1 Yes ( Probe as needed: Who received this source?)
2 No

Q99ArD

At anytime during 2014, did (you/anyone in this household): Have CDs (certificates of deposit)?

1 Yes ( Probe as needed: Who received this source?)
2 No

Q99ArE

At anytime during 2014, did (you/anyone in this household): Have Savings bonds?

1 Yes ( Probe as needed: Who received this source?)
2 No

Q99ArF

At anytime during 2014, did (you/anyone in this household): Have shares of stock in corporations or mutual funds?

1 Yes ( Probe as needed: Who received this source?)
2 No

Q99ArG

Any other savings or investments that pay interest or dividends?

1 Yes
2 No

CAPGDIS

Did (you/NAME) receive any capital gains from (your/his/her) shares of stocks or mutual funds in 2014?

1 Yes
2 No

Q99Br

What was the other source of (name's/your) the savings or investments that pay interest or dividends?

Enter all that apply
Probe as needed: Who received this source?

Enter other source of retirement income
_____________________________________________

PROPERTY INCOME (Source)

Q65A1

During 2014 did (you/ anyone in this household): Own any land, business property, apartments, or houses which were rented to others?

1 Yes
2 No

Q65A2

At anytime during 2014 did (you/ anyone in this household): Receive income from royalties or from roomers or boarders? (exclude amounts paid by relatives)

1 Yes
2 No

Q65A3

At anytime during 2014 did (you/ anyone in this household): Receive income from estates or trusts? (exclude estates or trusts already reported)

1 Yes
2 No

Q65b

Ask only if necessary Who received this (income/rent)?

Include each in cases of joint ownership. For self-employed persons, determine if income was already included
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)

EDUCATION ASSISTANCE (Source)

Q66a

During 2014 did (you/ anyone in this household) attend school beyond the high school level including a college, university, or other schools? (include vocational, business, or trade schools)

1 Yes
2 No

Q66b

Did (you/ anyone in this household) receive any educational assistance for tuition, fees, books, or living expenses during 2014?

Exclude loans, assistance from household members, and VA educational benefits

1 Yes
2 No

Q66c

Ask only if necessary Which member received assistance?

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

Q66d

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

Exclude assistance from household members
Enter all that apply, separate using the space bar or a comma.
Probe: Any other assistance?

2 Pell Grant
3 Assistance from a welfare or social service office
4 Some other government assistance
5 Scholarships, grants, etc.
6 Other assistance (employers, friends, etc.)

CHILD SUPPORT (Source)

Q70a

During 2014 did (you/ anyone in this household) receive: Any child support payments?

1 Yes
2 No

Q70b

Read only if necessary Who received these payments?

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

REGULAR FINANCIAL ASSISTANCE (Source)

Q72a

Any regular financial assistance from friends or relatives not living in this household?

Do not include loans

1 Yes
2 No

Q72b

Read only if necessary Who received this assistance?

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

OTHER MONEY INCOME (Source)

Q73A1R

During 2014 did (you/ anyone in this household) receive cash income not already covered such as: income from foster child care, alimony, jury duty, armed forces reserves, severance pay, hobbies, or any other source?

1 Yes
2 No

Q73A1b

Ask only if necessary Who received this income?

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

Q73A1Rc

What was the source of this income?

Asking about: (fill from Q73A1b)

Enter other source of income
_________________________________________________

INCOME AMOUNTS

AMTINTRO

Now I will ask you about the amount of income you and others in this household received from various sources in 2014.

UNEMPLOYMENT AND WORKER'S COMPENSATION (Amounts)

Q51A1p

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

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q51A11

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in State or Federal unemployment compensation during 2014?

Enter dollar amount

________________

Q51A11r1

Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in State or Federal unemployment compensation during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q51A11r2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in State or Federal unemployment compensation during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q51A1C

Do not read to the respondent. The annual rate appears out of range. The total State or Federal unemployment compensation received in 2014 was (amount). Is this a correct entry?

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

Q51A12

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive from State or Federal unemployment compensation during 2014?

(1-12/1-24/1-26/1-52)
________________

Q51A13

According to my calculations (name/you) received (total) altogether from State or Federal unemployment compensation during 2014. Does that sound about right?

1 Yes
2 No

Q51A14

What is your best estimate of the correct total amount (name/you) received from State or Federal unemployment compensation during 2014?

PREVIOUS ENTRIES: Q51A11: (amount)
Q51A1p: (periodicity)
Q51A12: (number of pay periods)

Enter dollar amount

________________

Q51A2p

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

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q51A21

How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in Supplemental Unemployment Benefits during 2014?

Enter dollar amount

_____________

Q51A21r1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Supplemental Unemployment Benefits during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q51A21r2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Supplemental Unemployment Benefits during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q51A2C

Do not read to the respondent. The annual rate appears out of range. The total Supplemental Unemployment Benefits received in 2014 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 2014?

(1-12/1-24/1-26/1-52)
________________

Q51A23

According to my calculations (name/you Fill) received (total) altogether from Supplemental Unemployment Benefits during 2014. Does that sound about right?

1 Yes
2 No

Q51A24

What is your best estimate of the correct total amount (name/you) received from Supplemental Unemployment Benefits during 2014?

PREVIOUS ENTRIES:
Q51A21: (amount)
Q51A2p: (periodicity)
Q51A22: (number of pay periods)

Enter dollar amount

________________

Q51A3p

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

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q51A31

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in Union Unemployment or Strike Benefits during 2014?

Enter dollar amount

________________

Q51A31r1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Union Unemployment or Strike Benefits during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q51A31r2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Union Unemployment or Strike Benefits during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

C251A3

Do not read to the respondent.
The annual rate appears out of range. The total Union Unemployment or Strike Benefits received in 2014 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 2014?

(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 2014. Does that sound about right?

1 Yes
2 No

Q51A34

What is your best estimate of the correct total amount (name/you) received from Union Unemployment or Strike Benefits during 2014?

PREVIOUS ENTRIES:
Q51A31: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)

Enter dollar amount

________________

Q52cp

What is the easiest way for you to tell us (your/name's) (Fill Q52b or Q52Cs1); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q52c1

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in (Fill Q52b or Q52Cs1) during 2014?

Enter dollar amount

________________

Q52cr1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (Fill Q52b or Q52Cs1) during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q52cr2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (Fill Q52b or Q52Cs1) during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q52cC2

Do not read to the respondent.
The annual rate appears out of range. The total worker's compensation received in 2014 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 (Fill Q52b or Q52Cs1) during 2014?

(1-12/1-24/1-26/1-52)
________________

Q52c3

Then (name/you) received (total) altogether from (Fill Q52b or Q52Cs1) during 2014. Does that sound about right?

1 Yes
2 No

Q52c4

What is your best estimate of the correct total amount (name/you) received from (Fill Q52b or Q52Cs1) during 2014?

PREVIOUS ENTRIES:
Q52c1: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)

Enter dollar amount

________________

SOCIAL SECURITY (Amounts)

Q56dp

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

4 Monthly
5 Quarterly
7 Yearly

Q56d

How much did (name/you) receive (monthly/quarterly) in Social Security payments in 2014?

Enter dollar amount

If already included in amount reported for another household member, press Enter

________________

Q56d_Char

Enter (A) for Already included

________________

Q56drn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Social Security payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q56drn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social Security payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q56d2

For how many (months/ Quarters) did (name/you) receive Social Security in 2014?

(1-4; 1-12)
________________

Q56d3

Is this $(amount from Q56d/amount from Q56d1) before or after the monthly Medicare deduction?

1 After Deduction
2 Before Deduction

Q56md

How much was your monthly Medicare deduction?

Enter dollar amount

________________

Q56dC2

Do not read to the respondent.
The annual rate appears out of range. The total Social Security received in 2014 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 2014. Does that sound about right?

1 Yes
2 No

Q56d6

What is your best estimate of the correct amount (name/you) received in Social Security during 2014?

PREVIOUS ENTRIES: (amount)
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)

Enter dollar amount

________________

SOCIAL SECURITY DISABILITY (Amounts)

Q562dp

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

4 Monthly
5 Quarterly
7 Yearly

Q562d

How much did (name/you) receive (monthly/quarterly) in Social Security Disability payments in 2014?

Enter dollar amount

If already included in amount reported for another household member, press Enter

________________

Q562d_Char

Enter A for Already included

________________

Q562d2

For how many (months/quarters) did (name/you) receive Social Security Disability in 2014?

(1-4; 1-12)
________________

Q562drn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Social Security Disability payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q562drn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social Security Disability payments in 2014?

4 Less than $1,000
5 Between $1,000 and $5,000
6 Over $5,000

Q562d3

Is this $(amount from Q562d/amount from Q562d1) before or after the monthly Medicare deduction?

1 After Deduction
2 Before Deduction

Q562md

How much was your monthly Medicare deduction?

Enter dollar amount

________________

Q562dC2

Do not read to the respondent.
The annual rate appears out of range. The total Social Security received in 2014 was (amount). Is this a correct entry?

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

BACKPAY1

During 2014, did (name/you) receive an initial Social Security Disability payment that was larger than the usual payment that we haven't accounted for yet? (This is sometimes done to make up for a delay in the start of payments)

1 Yes
2 No

BACKPAY2

How much was that initial disability payment?

Enter dollar amount

______________

Q562d5

According to my calculations (name/you) received $(total) altogether from Social Security Disability in 2014. Does that sound about right?

1 Yes
2 No

Q562d6

What is your best estimate of the correct amount (name/you) received in Social Security Disability during 2014?

PREVIOUS ENTRIES: (amount)
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)

Enter dollar amount

________________

SOCIAL SECURITY FOR CHILDREN (Amounts)

Q56r

Now we're going to ask you to report the amount of Social Security received on behalf of children in the household.

Q56ip

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

4 Monthly
5 Quarterly
7 Yearly

Q56i

How much did (name/you) receive (monthly/ quarterly/ ) in Social Security payments for children in this household in 2014?

Enter dollar amount

If already included in amount reported for another household member, press Enter

________________

Q56i_Char

Enter A for Already included

________________

Q56irn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Social Security payments for children in this household in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q56irn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social Security payments for children in this household in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q56i2

For how many (months/ Quarters) did (name/you receive Social Security in 2014?

(1-4; 1-12)
________________

Q56iC2

Do not read to the respondent.
The annual rate appears out of range. The total Social Security received for children in 2014 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 2014. Does that sound about right?

1 Yes
2 No

Q56i5

What is your best estimate of the correct amount (name/you) received in Social Security for children in this household during 2014?

Previous entries: (amount)
Q56ip: (periodicity)
Q56i2: (number of pay periods)

Enter dollar amount

________________

SUPPLEMENTAL SECURITY INCOME (SSI) (Amounts)

Q57cp

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

4 Monthly
5 Quarterly
7 Yearly

Q57c

How much did (name/you fill) receive (monthly/quarterly) in Supplemental Security Income payments in 2014?

Enter dollar amount

________________

Q57crn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Supplemental Security Income payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q57crn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Supplemental Security Income payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q57c2

For how many (months/quarters) did (name/you) receive Supplemental Security Income in 2014?

(1-4; 1-12)
________________

Q57cC2

Do not read to the respondent. The annual rate appears out of range. The total Supplemental Security Income received in 2014 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 2014. Does that sound about right?

1 Yes
2 No

Q57c5

What is your best estimate of the correct amount (name/you) received in Supplemental Security Income during 2014?

Previous entries: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)

Enter dollar amount

________________

SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (Amounts)

Q57R

Now we're going to ask you to report the amount of Supplemental Security Income received on behalf of children in the household. What would be the easiest way for you to report the amount (name/you) received for [fill in from Q57d] -- Is it easiest to report for them combined, or separately?

1 Separately
2 Combined

Q57ip

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

4 Monthly
5 Quarterly
7 Yearly

Q57i

How much did (name/you) receive (monthly/ Quarterly) in Supplemental Security Income on behalf of children in 2014?

Enter dollar amount

________________

Q57irn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Supplemental Security Income on behalf of children in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q57irn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Supplemental Security Income on behalf of children in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q57i2

For how many (months/quarters) did (name/you) receive Supplemental Security Income on behalf of children in 2014?

(1-4; 1-12)
________________

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 2014 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 2014. Does that sound about right?

1 Yes
2 No

Q57i5

What is your best estimate of the correct amount (name/you fill Q57e) received in Supplemental Security Income on behalf of children during 2014?

PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)

Enter dollar amount

________________

DISABILITY INCOME (Amounts)

Q61E1P

What is the easiest way for you to tell us (name's/your) (fill first answer from Q61C or Q61Cs1) payments; weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q61E1

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly) before deductions in (fill first answer from Q61C or Q61Cs1) payments in 2014?

Enter dollar amount

_______________

Q61e1rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 for the TOTAL amount (name/you) received in (fill first answer from Q61Cr or Q61Cs1) during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q61e1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill first answer from Q61C or Q61Cs1) during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q61E12

How many (weekly/ every other week/ twice a month/ monthly) payments did (name/you) receive in (fill first answer from Q61C or Q61Cs1) payments in 2014?

Disability income source #1 (1-12; 1-52)

______________

Q61E1C

Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q61c or Q61cs1) payments received in 2014 was (amount). Is this a correct entry?

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

Q61E13

According to my calculations (name/you) received $(total) altogether from ( first answer from Q61C or Q61Cs1) payments in 2014. Does that sound about right?

1 Yes
2 No

Q61E14

What is your best estimate of the correct amount (name/you) received from (fill first answer from Q61C or Q61Cs1) payments during 2014?

PREVIOUS ENTRIES:
Q61E1: (amount)
Q61E1P: (periodicity)
Q61E12: (number of pay periods)

Enter dollar amount

_______________

Q61E2P

What is the easiest way for you to tell us (name's/your) (fill second 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

Q61E2

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) before deductions in (fill second answer from Q61C or Q61Cs1) payments in 2014?

Enter dollar amount

_______________

Q61e2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 for the TOTAL amount (name/you) received in (fill SECOND answer from Q61C or Q61Cs1) during 2014?

1 Less than $10,000 (proceed to next question)
2 Between $10,000 and $20,000
3 Over $20,000

Q61e2rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill SECOND answer from Q61C or Q61Cs1) during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q61E22

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (fill second answer from Q61C or Q61Cs1) payments in 2014?

Disability income payment source #2 (1-12; 1-52)

_______________

Q61E2C

Do not read to the respondent. The annual rate appears out of range. The total (fill from second answer in Q61c or Q61cs1) payments received in 2014 was (amount). Is this a correct entry?

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

Q61E23

According to my calculations (name/you) received $(total) altogether from (fill second answer from Q61C or Q61Cs1) payments in 2014. Does that sound about right?

1 Yes
2 No

Q61E24

What is your best estimate of the correct amount (name/you) received from (fill second answer from Q61C or Q61Cs1) payments during 2014?

PREVIOUS ENTRIES:
Q61E2: (amount)
Q61E2P: (periodicity)
Q61E22: (number of pay periods)

Enter dollar amount

_______________

VETERANS PAYMENTS (Amounts)

Q60V1P

What is the easiest way for you to tell us (name's/your) (fill from first answer in Q60c8); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q60V1

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/) before deductions in (fill from first answer in Q60c8) in 2014?

Enter dollar amount

________________

Q60v1rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from first answer in Q60c8) payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q60v1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from first answer in Q60c8) payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q60V12

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from first answer in Q60c8) in 2014?

(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 2013 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 fill) received $(total) altogether from (fill from first answer in Q60c8) in 2014. Does that sound about right?

1 Yes
2 No

Q60V14

What is your best estimate of the correct amount (name/you) received in Veteran's benefits during 2014?

PREVIOUS ENTRIES:
Q60V1: (amount)
Q60V1P: (periodicity)
Q60V12: (number of pay periods)

Enter dollar amount

________________

Q60V2P

What is the easiest way for you to tell us (name's/your) (fill from second answer in Q60c8); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
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 Q60c8) in 2014?

Enter dollar amount

________________

Q60v2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from second answer in Q60c8) payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q60v2rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from second answer in Q60c8) payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q60V22

How many (weekly/every other week/ twice a month/monthly) payments did
(name/you) receive in (fill from second answer in Q60c8) in 2014?

(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 2014 was (amount). Is this a correct entry?

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

Q60V23

According to my calculations (name/you) received $(total) altogether from (fill from second answer in Q60c8) in 2014. Does that sound about right?

1 Yes
2 No

Q60V24

What is your best estimate of the correct amount (name/you) received in (fill from second answer in Q60c8) during 2014?

PREVIOUS ENTRIES:
Q60V2: (amount)
Q60V2P: (periodicity)
Q60V22: (number of pay periods)

Enter dollar amount

________________

SURVIVOR BENEFITS -- Amounts

Q58E1P

What is the easiest way for you to tell us (name's/your) (fill from first answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q58E1

How much did (name/you) receive (weekly/every other week/twice a month/ monthly) in (fill from first answer in Q58C or Q58Cs1) in 2014?

Enter dollar amount

________________

Q58e1rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from first answer in Q58C or Q58Cs1) payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q58e1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from first answer in Q58C or Q58Cs1) payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q58E12

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from first answer in Q58C or Q58Cs1) in 2014?

(1-52)
________________

Q58E1C

Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q58C or Q58Cs1) received in 2014 was (amount). Is this a correct entry?

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

Q58E13

According to my calculations (name/you) received (total) altogether from (fill from first answer in Q58C or Q58Cs1) in 2014. Does that sound about right?

1 Yes
2 No

Q58E14

What is your best estimate of the correct amount (name/you) received from (fill from first answer in Q58C or Q58Cs1) during 2014?

PREVIOUS ENTRIES:
Q58E1: (amount)
Q58E1P: (periodicity)
Q58E12: (number of pay periods)

Enter dollar amount

________________

Q58E2P

What is the easiest way for you to tell us (name's/your) (fill from second answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q58E2

How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from second answer in Q58C or Q58Cs1) in 2014?

Enter dollar amount

________________

Q58e2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from second answer in Q58C or Q58Cs1) payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q58e2rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from second answer in Q58C or Q58Cs1) payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q58E22

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q58C or Q58Cs1) in 2014?

(1-52)

________________

Q58E2C

Do not read to the respondent The annual rate appears out of range. The total (fill from second answer in Q58C o Q58Cs1) received in 2014 was (amount). Is this a correct entry?

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

Q58E23

According to my calculations (name/you) received (total) altogether from (fill from second answer in Q58C or Q58Cs1) in 2014. Does that sound about right?

1 Yes
2 No

Q58E24

What is your best estimate of the correct amount (name/you) received from (fill from second answer in Q58C or Q58Cs1) during 2014?

PREVIOUS ENTRIES:
Q58E2: (amount)
Q58E2P: (periodicity)
Q58E22: (number of pay periods)

Enter dollar amount

________________

Q58E3P

What is the easiest way for you to tell us (name's/your) (fill from third answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q58E3

How much did (name/you) receive (weekly/every other week/twice a month/ monthly) in (fill from third answer in Q58C or Q58Cs1) in 2014?

Enter dollar amount

________________

Q58e3rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from third answer in Q58C or Q58Cs1) payments in 2014?

1 Less than $10,000 (proceed to Q58e3rn2)
2 Between $10,000 and $20,000
3 Over $20,000

Q58e3rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from third answer in Q58C-R or Q58D-R) payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q58E32

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (fill from third answer in Q58C or Q58Cs1) in 2014?

(1-52)
________________

Q58E3C

Do not read to the respondent. The annual rate appears out of range. The total (fill from third answer in Q58C or Q58Cs1) received in 2014 was (amount). Is this a correct entry?

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

Q58E33

According to my calculations (name/you) received (total) altogether from (fill from third answer in Q58C or Q58Cs1) in 2014. Does that sound about right?

1 Yes
2 No

Q58E34

What is your best estimate of the correct amount (name/you) received from (fill from third answer in Q58C or Q58Cs1) during 2014?

PREVIOUS ENTRIES:
Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)
Enter dollar amount
_______________

PUBLIC ASSISTANCE (Amounts)

Q59ep

What is the easiest way for you to tell us [name's/your fill from Q59b 88] CASH assistance payments from [fill from Q59C8-R]; weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q59e

During 2014, how much CASH assistance did [name's/your] receive (per week/every other week/twice a month/ monthly)?

Enter dollar amount

___________

Q59ern1

Could you tell me if (name's/your fill) received less than $1,000, between $1,000 and $3,000, or over $3,000 in TOTAL CASH assistance payments in 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3000

Q59ern2

Did (name's/your) receive less than $100, between $100 and $500, or over $500 in TOTAL CASH assistance payments in 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q59e2

How many (weekly/every other week/ twice a month/ monthly) cash assistance payments did (name's/your) receive in 2014?

(1-12/1-24/1-26/1-52)
________________

Q59eC2

Do not read to the respondent.
The annual rate appears out of range. The total cash assistance received in 2013 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's/your) received $(total) altogether in cash assistance from a state or county program in 2014. Does that sound about right?

1 Yes
2 No

Q59e4

What is your best estimate of the correct amount of cash assistance (name's/your) received during 2014?

PREVIOUS ENTRIES:

Q59e: (amount)
Q59ep: (periodicity)
Q59e2: (number of pay periods)

Enter dollar amount

________________

Q59f

Was the cash assistance for adults AND children, or JUST children?

1 Both adults AND children
2 Children only
3 Adults only

Q59g

(Who/Which children) in your household was the cash assistance for?

Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (Amounts)

Q90p

What is the easiest way for you to tell us the value of the food assistance: monthly or yearly?

1 Monthly
2 Yearly
3 Already included with TANF/AFDC payment

Q90

What is the (monthly) value of the food assistance received in 2014?

Enter dollar amount

________________

Q90rn1

Could you tell me if the value of food assistance received in 2014 was less than $1,000, between $1,000 and $3,000, or over $3,000 in food assistance in 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3000

Q90rn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in food assistance in 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q902

How many months was food assistance received in 2014?

(1-12)
________________

Q90C2

Do not read to the respondent. The annual rate appears out of range. The total food assistance payments received in 2014 was (amount). Is this a correct entry?

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

Q903

According to my calculations (total) was received altogether from food assistance in 2014. Does that sound about right?

1 Yes
2 No

Q904

What is your best estimate of the correct amount of food assistance received during 2014?

PREVIOUS ENTRIES:
Q90: (amount)
Q90p: (periodicity)
Q902: (number of pay periods)

Enter dollar amount

________________

PENSIONS (Amounts)

Q62E1PR

What is the easiest way for you to tell us (name's/your) (first answer FILL IN FROM Q62C-R or Q62DR); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q62E1R

How much did (name's/your) receive (weekly/every other week/ twice a month/monthly/ ) in (first answer FILL IN FROM Q62C-R or Q62DR) in 2014?

Enter dollar amount

_______________

Q62E1rn1

Could you tell me if (you/name) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (first answer FILL IN FROM Q62CR or Q62DR)
payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q62E1rn2

Did (you/name) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (first answer FILL IN FROM Q62CR or Q62DR) payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q62E12R

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (first answer FILL IN FROM Q62CR or Q62DR) in 2014?

Pension/Retirement #1 (1-12; 1-52)

_______________

Q62E1CR

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 2014 was (amount). Is this a correct entry?

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

Q62E13R

According to my calculations (name/you) received (total) dollars altogether from (first answer FILL IN FROM Q62C-R or Q62DR) in 2014. Does that sound about right?

1 Yes
2 No

Q62E14R

What is your best estimate of the correct amount (name/you) received in (first answer FILL IN FROM Q62C-R or Q62DR) during 2014?

PREVIOUS ENTRIES:
Q62E1: (amount)
Q62E1P: (periodicity)
Q62E12: (number of pay periods)

Enter dollar amount

_______________

Q62E2PR

What is the easiest way for you to tell us (name's/your) (second answer FILL IN FROM Q62C-R or Q62DR); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

Q62E2R

How much did (name's/your) receive (weekly/every other week/ twice a month/ monthly) in (second answer FILL IN FROM Q62C-R or Q62D-R) in 2014?

Enter dollar amount

_______________

Q62E2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (second answer FILL IN FROM Q62CR or Q62DR) payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q62E2rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (second answer FILL IN FROM Q62CR or Q62DR) payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q62E22R

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer FILL IN FROM Q62C-R or Q62DR) in 2014?

Pension/Retirement #1 (1-12; 1-52)

_______________

Q62E2CR

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 2014 was (amount). Is this a correct entry?

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

Q62E23R

According to my calculations (name/you) received $(total) altogether from (second answer FILL IN FROM Q62CR or Q62DR) in 2014. Does that sound about right?

1 Yes
2 No

Q62E24R

What is your best estimate of the correct amount (name/you) received in (second answer FILL IN FROM Q62C-R or Q62DR) during 2014?

PREVIOUS ENTRIES:
Q62E1: (amount)
Q62E1P: (periodicity)
Q62E12: (number of pay periods)

Enter dollar amount

_______________

ANNUITIES (Amounts)

ANNNEW1

What is the easiest way for you to tell us (name/your) annuity income; weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

ANNNEW2

How much did (name/you) receive (weekly/every other week/ twice a month/monthly) in annuities in 2014?

Enter dollar amount

_______________

ANNNEWrn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in annuity payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

ANNNEWrn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in annuity payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

ANNNEW3

How many (weekly/every other week/ twice a month/ monthly) annuity payments did (name/you) receive in 2014?

(1-12; 1-52)
_______________

ANNNEW4

According to my calculations (name/you) received $(total) altogether from annuities in 2014. Does that sound about right?

PREVIOUS ENTRIES: ANNNEW2: (amount)
ANNNEW3: (periodicity)

1 Yes
2 No

ANNNEW5

What is your best estimate of the correct amount (name/you) received in annuities in 2014?

Enter dollar amount

_______________

WITHDRAWALS/DISTRIBUTIONS FROM RETIREMENT PLAN (Amounts)

DISTNEW1

What is the easiest way for you to tell us the amount of money withdrawn or distributed from (name's/your) [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014: monthly, Quarterly, every 6 months, or yearly?

4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly

DISTNEW2

How much was (name's/your) withdraw or distribution (weekly/every other week/ twice a month/ monthly/ ) from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014?

Enter dollar amount

_______________

DISTNEWrn1

Could you tell me if (name's/your) withdraw or distribution was less than $10,000, between $10,000 and $20,000, or over $20,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

DISTNEWrn2

Did (name's/your) withdraw or distribution was less than $1,000, between $1,000 and $5,000, or over $5,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

DISTNEW4

According to my calculations (name/you) withdrew or was distributed (total) dollars altogether from the [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014. Does that sound about right?

1 Yes
2 No

DISTNEW5

What is your best estimate of the correct amount (name/you) withdrew or the distribution received from the [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] during 2014?

Enter dollar amount

_______________

ROLLA

Did [you/NAME] re-invest or "roll over" any of the money into an IRA or some other kind of retirement plan?

1 Yes
2 No

ROLLAMTA

How much did (you/NAME) re-invest or "roll over" into an IRA or some other kind of retirement plan in 2014?

Enter dollar amount

_______________

ROLLB

Does (you/NAME) plan to re-invest or roll over any of the money?

1 Yes
2 No

ROLLAMTB

How much does (you/NAME) plan to re-invest or "roll over" into an IRA or some other kind of retirement plan?

Enter dollar amount

_______________

DISTNEW6

What is the easiest way for you to tell us the amount of money withdrawn or distributed from (name's/your) [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014: monthly, Quarterly, every 6 months, or yearly?

4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly

DISTNEW7

How much was (name's/your) withdraw or distribution (weekly/every other week/ twice a month/ monthly) from [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014?

Enter dollar amount

_______________

DISTNEW8

How many (monthly/quarterly) withdrawals did (name/you) make or distributions did (name/you) receive in 2014 from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)]?

Enter dollar amount
_______________

DISTNEWrn3

Could you tell me if (name's/your) withdraw or distribution was less than $10,000, between $10,000 and $20,000, or over $20,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

DISTNEWrn4

Did (name's/your) withdraw or distribution was less than $1,000, between $1,000 and $5,000, or over $5,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

DISTNEW9

According to my calculations (name/you) withdrew or was distributed $(total) altogether from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2014. Does that sound about right?

1 Yes
2 No

DISTNEWE10

What is your best estimate of the correct amount (name/you) withdrew or the distribution received from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] during 2014?

Enter dollar amount

_______________

ROLLC

Did [you/NAME] re-invest or "roll over" any of the money into an IRA or some other kind of retirement plan?

1 Yes
2 No

ROLLAMTC

How much did (you/name) re-invest or "roll over" into an IRA or some other kind of retirement plan in 2014?

Enter dollar amount

_______________

ROLLD

Does (you/name) plan to re-invest or roll over any of the money?

1 Yes (If 'yes', go to ROLLAMTD)
2 No

ROLLAMTD

How much does (you/name) plan to re-invest or "roll over" into an IRA or some other kind of retirement plan?

Enter dollar amount

_______________

INTEREST/DIVIDENDS OR RETIREMENT ACCOUNTS (Amounts)

RETIRENEW1

Within [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] account, how much did (name/you) earn in interest or dividends during 2014?

Please include small amounts reinvested or credited to the account.
Enter dollar amount

_____________

RETIRENEWrn1

Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over $3,000 in interest or dividends from [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] during 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

RETIRENEWrn2

Did (name/you) earn less than $100, between $100 and $500, or over $500 in interest or dividends from [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] during 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

RETIRENEW2

The Census Bureau can estimate the amount earned in this account based on the size of the account. So can you tell me how much money was in (name's/your) [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] at the end of 2014?

Enter dollar amount

_____________

INTEREST/DIVIDENDS ON NON- RETIREMENT ACCOUNTS (Amounts)

NONRETIRENEW(1-7)1

How much did (you/NAME) receive in (interest/dividends) from [FILL IN Q99AR or Q99BR] during 2014, including even small amounts reinvested or credited to accounts?

If a joint account please split interest income in half for each person.

Enter dollar amount

_____________

NONRETIRENEW(1-7)rn1

Could you tell me if (you/NAME) received less than $1,000, between $1,000 and $3,000, or over $3,000 in interest or dividends from [FILL IN Q99A-R or Q99B-R] during 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

NONRETIRENEW(1-7)rn2

Did (you/NAME) receive less than $100, between $100 and $500, or over $500 in interest or dividends from [FILL IN Q99AR or Q99BR] during 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

NONRETIRENEW(1-7)2

The Census Bureau can estimate the amount earned in this account based on the size of the account. How much money did (you/NAME) have in [FILL IN Q99AR or Q99BR] at the end of 2014?

Enter dollar amount

_____________

Q63cp

Is this a weekly, every other week, twice a month, monthly, Quarterly, every 6 months, or yearly amount?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly

Q63c2

How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (you/name) receive in interest/dividend income in 2014 from [FILL IN Q99A-R or Q99B-R]?

_______________

Q63c3

According to my calculations (you/name) received $(total) from interest/dividend income from [FILL IN Q99A-R or Q99B-R] in 2014. Does that sound about right?

1 Yes
2 No

Q63c4

What is your best estimate of the correct amount (you/NAME) received from interest payments during 2014?

PREVIOUS ENTRIES:
Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)

Enter dollar amount

_______________

CAPGDAMT

How much did (you/name) receive in capital gains in 2014?

Enter dollar amount

_______________

CAPGDAMTrn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 for the TOTAL yearly amount in capital gains during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

CAPGDAMTrn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in capital gains during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

PROPERTY INCOME (Amounts)

Q65c

How much did (name/you) receive in income from rent (roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES during 2014?

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

_______________

Q65c_Char

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

______________

Q65cL

Enter amount of money lost in 2014.

_______________

Q65crn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in income from rent (roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES during 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q65crn2

Did (name/you)receive less than $1,000, between $1,000 and $5,000, or over $5,000 in income from rent (roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES during 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q65cp

Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
7 Yearly

Q65c2

What is your best estimate of (name's/your) ANNUAL net income from rent (roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2014?

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

Enter dollar amount

_______________

Q65cC2

Do not read to the respondent.
The annual rate appears out of range. The total income received from rent (roomers or boarders, estates, trusts, or royalties) was (amount) in 2014. Is this a correct entry?

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

Q65c2L

What is your best estimate of (name/you) ANNUAL LOSS from rent (roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES in 2014?

PREVIOUS ENTRIES:
Q65cL: (amount)
Q65cp: (periodicity)

Enter dollar amount

_______________

EDUCATIONAL ASSISTANCE (Amounts)

Q69F88

How much did (name/you) receive in Pell Grants during 2014?

Enter annual amount only

________________

Q69Frn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in Pell Grants during 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

Q69Frn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in Pell Grants during 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q66HP

What is the easiest way for you to tell us (name's/your) (other/blank) educational assistance during 2014; weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q66H

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in educational assistance during 2014?

Enter dollar amount

________________

Q66H2

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you fill Q66c) receive in educational assistance in 2013?

(1-12/1-24/1-26/1-52)
________________

Q66Hrn1

Could you tell me if (name/you received less than $1,000, between $1,000 and $3,000, or over $3,000 in educational assistance during 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

Q66Hrn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in Pell Grants during 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q66HC2

Do not read to the respondent.
The annual rate appears out of range. The total educational assistance received in 2013 was (amount). Is this a correct entry?
If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q66H3

According to my calculations (name/you) received (total) altogether from educational assistance in 2014. Does that sound about right?

1 Yes
2 No

Q66H4

What is your best estimate of the correct amount (name/you) received from educational assistance during 2014?

Previous entries:
Q66h: (amount)
Q66hp: (periodicity)
Q66h2: (number of pay periods)

Enter dollar amount

________________

CHILD SUPPORT (Amounts)

Q70cp

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

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q70c

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in child support payments in 2014?

Enter dollar amount

________________

Q70c1rn1

Could you tell me if (name/you fill Q70b) received less than $10,000, between $10,000 and $20,000, or over $20,000 in child support payments in 2014?

1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000

Q70c1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in child support payments in 2014?

1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000

Q70cC2

Do not read to the respondent. The annual rate appears out of range. The total child support payments received in 2014 was (amount). Is this a correct entry?

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

Q70c3

According to my calculations (name/you) received (total) altogether from child support payments in 2014. Does that sound about right?

1 Yes
2 No

Q70c4

What is your best estimate of the correct amount (name/you) received from child support payments during 2014?

PREVIOUS ENTRIES:
Q70c: (amount)
Q70cp: (periodicity)
Q70c2: (number of pay periods)

Enter dollar amount

________________

REGULAR FINANCIAL ASSISTANCE (AMOUNTS)

Q72cp

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

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q72c

How much did (name/you) receive (weekly/every other week/twice a month/monthly) in regular financial assistance in 2014?

Enter dollar amount

________________

Q72c2

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in regular financial assistance in 2014?

(1-12/1-24/1-26/1-52)

_______________

Q72crn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in regular financial assistance in 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

Q72crn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in regular financial assistance in 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q72cC2

Do not read to the respondent.
The annual rate appears out of range. The total regular financial assistance payments received in 2014 was (amount). Is this a correct entry?
If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q72c3

According to my calculations (name/you) received (total) altogether from regular financial assistance in 2014. Does that sound about right?

1 Yes
2 No

Q72c4

What is your best estimate of the correct amount (name/you fill) received from regular financial assistance during 2014?

PREVIOUS ENTRIES:
Q72c: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)

________________

OTHER MONEY INCOME (Amounts)

Q731P

What is the easiest way for you to tell us (name's/your) income from (fill from Q73A1Rc); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly

Q731

How much did (name/you) receive (weekly/every other week/twice a month/ monthly) in income from (fill from Q73AIRc) during 2014?

Enter dollar amount

________________

Q7312

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in income from (fill from Q73A1Rc) during 2014?

(1-12/1-24/1-26/1-52)

________________

Q73rn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in income not already covered?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000

Q73rn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in income not already covered?

1 Less than $100
2 Between $100 and $500
3 Over $500

Q731C2

Do not read to the respondent.
The annual rate appears out of range. The total income from (fill from Q73A1Rc) in 2014 was (amount). Is this a correct entry?

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

Q7313

According to my calculations (name/you) received (total) altogether from (fill from Q73A1Rc) in 2014. Does that sound about right?

1 Yes
2 No

Q7314

What is your best estimate of the correct amount (name/you) received in income from (fill from Q73A1Rc) in 2014?

PREVIOUS ENTRIES:
Q731: (amount)
Q731P: (periodicity)
Q7312: (number of pay periods)

Enter dollar amount

________________

HEALTH INSURANCE
INTRODUCTION TO HEALTH INSURANCE SECTION

HINTRO

These next Questions are about health coverage between January 1, 2014 and now.

Press 1 to Continue
1 Enter 1 to Continue

PINTRO

First I'm going to ask about (name's/your) health coverage.

Press 1 to Continue
1 Enter 1 to Continue

CURRENT COVERAGE

MCARE1

?[F1] Medicare is health insurance for people 65 years and older and people under 65 with disabilities. (Are/Is) (name/you) NOW covered by Medicare?

Code Medicare Parts A, B, and C and Medicare Advantage as "Yes"

1 Yes
2 No

ANYCOV

(Do/Does) (name/you) NOW have any type of health plan or health coverage?

1 Yes
2 No

MEDI

?[F1] (Are/Is/Was/Were) (name/you) covered by Medicaid, Medical Assistance, or (CHIP/Medicare)?

1 Yes
2 No

OTHGOVT

(Are/Is) (name/you) NOW covered by a state or government assistance program that helps pay for healthcare, such as: State Medicaid, CHIP, Exchange/Portal, or other State Health program?

Stop reading list if respondent says "YES"

1 Yes
2 No

VET

(Are/Is) (name/you) NOW covered by Veteran's Administration (VA) care?

1 Yes
2 No

VERIFY

I recorded that (name/you) (are/is) not currently covered by a health plan. Is that correct?

1 Yes, is NOT covered
2 No, is covered

TYPE OF COVERAGE

SRCEGEN

? [F1]

ASK OR VERIFY
For the coverage (name/you) (have/has/had) NOW, (do/does/did) (you/he/she) get it through a job, the government or state, or some other way?

JOB GOVERNMENT OR STATE OTHER WAY
Former job/Retiree Medical Assistance Privately purchased
Union Medicaid Parent or spouse
Spouse/parent's job Medicare (Parts A+B; Part C) Medicare Supplements
Job with the government Medicare Advantage Exchange plan/Marketplace
COBRA State-provided health coverage Group or association
TRICARE/TRICARE For Life VA Care/CHAMPVA/other military School
IF RESPONDENT CHOOSES MORE THAN ONE: Let's talk about one plan at a time. Which would you like to tell me about first?
[ If respondent is not covered, go back to VERIFY and select "Yes"]

1 Job (current or former)
2 Government or State
3 Some other way

SRCEDEPDIR

ASK OR VERIFY
(Do/Does/Did) (name/you) get that coverage through a parent or spouse, (do/does/did) ( you/he/she) buy it (yourself/himself/herself), or (do/does/did) (you/he/she) get it some other way?

PARENT OR SPOUSE BUY IT DIRECTLY SOME OTHER WAY
Parent Buy it Former employer
Spouse Parent or spouse buys it Group or association
Medicare Supplement Indian Health Service
School

1 Parent or spouse
2 Buy it
3 Some other way

SRCEOTH

ASK OR VERIFY
(Do/Does/Did) (name/you) get it through a former employer, a union, a group or association, the Indian Health Service, a school, or some other way?

1 Former employer
2 Union
3 Group or association
4 Indian Health Service
5 School
6 Some other way

JOBCOV

(Is/Was) that coverage related to a JOB with the government or state?

READ IF NECESSARY: Include coverage through FORMER employers and unions, and COBRA plans.

1 Yes
2 No

MILPLAN

ASK OR VERIFY
(Is/Was) that plan related to military service in any way?

Examples of military plans include:
- VA Care
- TRICARE
- TRICARE for Life
- CHAMPVA
- Other military care

1 Yes
2 No

GOVTYPE

?[F1]

ASK OR VERIFY
(Is/Was) that coverage Medicaid, CHIP, Medicare, a plan through the military, or some other program?

Code Medicare Parts A, B, and C and Medicare Advantage as "Medicare"
IF RESPONDENT CHOOSES MORE THAN ONE: Let's talk about one plan at a time. Which would you like to tell me about first?

1 Medicaid or Medical Assistance
2 CHIP
3 Medicare
4 Military
5 Other

MILTYPE

ASK OR VERIFY
(Is/Was) that plan through TRICARE, TRICARE for Life, CHAMPVA, VA Care, military health care, or something else?

1 TRICARE
2 TRICARE for Life
3 CHAMPVA
4 Veterans Administration (VA) care
5 Military health care
6 Other

POLHOLDER

ASK OR VERIFY
Whose name (is/was) the policy in? (Who (is/was) the policyholder?)

1-16 Name on roster
17 Someone living outside the household
Enter persons line number (1-16), or 17 for person not in the household

SRCEPTSP

ASK OR VERIFY
(Do/Did) they get that coverage through their job, (do/did) they buy it themselves, or (do/did) they get it some other way?

1 Job (current or former)
2 Buy it
3 Some other way

GOVPLAN

ASK OR VERIFY
What do you call the program?

IF RESPONDENT ANSWERS WITH INSURANCE COMPANY NAME: OK, so that would be the plan name. What do you call the program? Some examples of programs in (state) are [read full list below].

1 Medicaid
2 Medical Assistance
3 Indian Health Service (IHS)
4-12 State Medicaid Programs Names
13-15 State Exchange Programs Names
16 Plan through State Exchange Portal
17 Other government plan
18 Other (please specify)

MISCSPEC

Please Specify

Write in plan name

_______________

PORTAL

ASK OR VERIFY
(Is/Was) that coverage through (State Exchange Portal Name), which may also be known as (State Exchange Program Name 1, Name 2, Name 3)?

1 Yes
2 No

EXCHTYPE

ASK OR VERIFY
What do you call it -- State Exchange Program (Name 1, Name 2, Name 3)?

1-4 State Exchange Programs Names

HIPAID

(Does/Did) (your/policyholder name's/the policyholder's) employer or union pay for all, part, or none of the health insurance premium?

Report here employer's contribution to employee's health insurance premiums, not the employee's medical bills.

1 All
2 Part
3 None

SHOP

Small businesses can offer health coverage to their employees through (State Exchange SHOP Portal Name). (Is/Was) the coverage at all related to (State Exchange SHOP Portal Name), (such as State SHOP Name 1, Name 2, Name 3)?

1 Yes
2 No

POLHOLDER2

ASK OR VERIFY
Whose name (is/was) the policy in? (Who [is/was] the policyholder?)

1-16 Name on roster
17 Someone living outside the household
Enter persons line number (1-16), or 17 for person not in the household

PREMYN

Is there a monthly premium for this plan?

A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.

1 Yes
2 No

PREMSUBS

Is the cost of the premium subsidized based on (your/family) income?

A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.
Subsidized health coverage is insurance with a reduced premium. Low and middle income families are eligible to receive tax credits that allow them to pay lower premiums for insurance bought through healthcare exchanges or marketplaces.

1 Yes
2 No

MONTHS OF COVERAGE

BEFORAFT

Did (name's/your) coverage from (plan type) start before January 1, 2014?

READ IF NECESSARY: Your best estimate is fine.
(READ IF NECESSARY: If (policyholder) switched employers or plans through (your/their) employer, consider it the same plan.)
(READ IF NECESSARY: If (policyholder) switched plans that (you/he/she) (buy/buys), consider it the same plan.)

1 Yes
2 No

MNTHBEG1/2

In which month did (that/this) coverage start?

1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December

YEARBEG

ASK OR VERIFY
Which year was that?

(READ IF NECESSARY: If (policyholder) switched employers or plans through (your/their) employer, consider it the same plan.)
(READ IF NECESSARY: If (policyholder) switched plans that (you/he/she) (buy/buys), consider it the same plan.)
This question refers to (plan type)

1 2014
2 2015

CNTCOV

Has it been continuous since (beginning month)?

1 Yes
2 No

SPELLADD

I have recorded that (name/you) (was/were) covered by (plan type) in (months of coverage). Were there any OTHER months between January 2014 and now that (name/you) (was/were) also covered by (plan type)?

1 Yes
2 No

ANYTHIS

Which months (was/were) (name/you) covered by (plan type) THIS year -- in 2015?

1 January 2015
2 February 2015
3 March 2015
4 April 2015
20 All months of 2015
21 No months of 2015

ANYLAST

Which months (was/were) (name/you) covered by (plan type) LAST year -- in 2014?

1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December
20 All months from January 2014 until December 2014
21 No months from January 2014 until December 2014

WMNTHS

Which months between January 2014 and now (was/were) (name/you) covered by (plan type)?

1 January 2014
2 February 2014
3 March 2014
4 April 2014
5 May 2014
6 June 2014
7 July 2014
8 August 2014
9 September 2014
10 October 2014
11 November 2014
12 December 2014
13 January 2015
14 February 2015
15 March 2015
16 April 2015
20 All months from January 2014 until now
21 No months from January 2014 until now

OTHER HOUSEHOLD MEMBERS

OTHMEMB

Between January 1, 2014 and now, was anyone in the household other than (name/you) ALSO covered by (plan type)?

1 Yes
2 No

COVWHO

Who else was covered? Who else was covered by (plan type)?

PROBE: Anyone else?
0 No one listed
1-16 Person 1 through 16's name
96 All persons listed

SAMEMNTHS

(Were/Was) (name/names) also covered from January 2014 until now?

This Question refers to (plan type)

1 All also covered until now
2 None covered until now

MNTHS_P(1-16)M

Which months between Jan 2014 and now was (NAME) covered? [How about (NAME)?]

This Question refers to (plan type)

OTHOUT

Does that plan cover anyone living outside this household?

1 Yes
2 No

OTHWHO

How old are they -- under 19, 19-25 or older than 25?

Mark all that apply

1 Under 19
2 19-25 years old
3 Older than 25

ADDITIONAL PLANS

ADDGAP

So far I have recorded that (name/you) (was/were) NOT covered in (months of no coverage). (Were/Was) (name/you) covered by any type of health plan or health coverage in those months/that month?

READ IF NECESSARY: Do not include plans that cover only one type of care, such
as dental or vision plans.

1 Yes
2 No

ADDOTH

Other than (plan type[s]), (were/was) (name/you) covered by any other plans type of health plan or health coverage AT ANY TIME between January 1, 2014 and now?

READ IF NECESSARY: Do not include plans that cover only one type of care, such as dental or vision plans.

1 Yes
2 No

EMPLOYER-SPONSORED INSURANCE OFFERS AND TAKEUP

ESIINTRO

Earlier I recorded that (name/you) (are/is) employed but (do/does) not have health coverage through (your/his/her) job.

1 Enter 1 to continue

OFFER

Does (employer name) offer a health insurance plan to any of its employees?

1 Yes
2 No

COULD

Could (name/you) be in this plan if (you/he/she) wanted to?

1 Yes
2 No

WNTAKE

Why (aren't/isn't) (you/he/she) in this plan?

Choose all that apply

1 Covered by another plan
2 Traded health insurance for higher pay
3 Too expensive
4 Don't need health insurance
5 Have a pre-existing condition
6 Haven't yet worked for this employer long enough to be covered
7 Contract or temporary employees not allowed in plan
8 Other/specify

WNTAKESPEC

Please specify other reason why not in the plan

WNELIG

Why not? Why can't (name/you) be in this plan if (you/he/she) wanted to?

Choose all that apply

1 Don't work enough hours per week or weeks per year
2 Contract or temporary employees not allowed in plan
3 Haven't yet worked for this employer long enough to be covered
4 Have a pre-existing condition
5 Too expensive
6 Other/specify

WNELIGSPEC

Please specify other reason why not eligible.

________________

HEALTH STATUS

HealthStatus_Intro

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

HealthStatus

Would you say (name's/your) health in general is excellent, very good, good, fair, or poor?

1 Excellent
2 Very good
3 Good
4 Fair
5 Poor

MEDICAL EXPENDITURES

MedExp_Intro

Next I would like to ask about out-of-pocket medical expenses during 2014.

Press 1 to Continue
1 Enter 1 to continue

HIPREM

[Earlier I recorded that (your/name's) employer or union did not pay for (his/her) entire health insurance premium.] Last year, how much did (you/name) pay out-of-pocket for ALL health insurance premiums [covering (yourself/himself/herself) or others in the household]? Include both comprehensive and supplemental plans (such as vision and dental insurance).
[What about (you/name)?]
(Include prescription drug insurance such as Medicare Part D premiums and Medicare Advantage premiums. DO NOT include Medicare Part B premiums.)

Enter dollar amount
___________________

MEDAMT

?[F1]
Last year, how much was paid out-of-pocket for (your/name's) OWN medical care, such as copays for doctor and dentist visits, diagnostic tests, prescription medicine, glasses and contacts, and medical supplies?
[What about (you/name)? Last year, how much was paid out-of-pocket for (your/name's) OWN medical care, such as copays for doctor and dentist visits, diagnostic tests, prescription medicine, glasses and contacts, and medical supplies?]
Include any amount paid out-of-pocket on (your/his/her) behalf by anyone in this household.

Enter dollar amount

________________

OTCMEDAMT

Last year, how much was paid out-of-pocket for (your/name's) non-prescription healthcare products such as vitamins, allergy and cold medicine, pain relievers, quit smoking aids, AND anything else not yet reported?
[What about (you/name)? Last year, how much was paid out-of-pocket for (your/name's) non-prescription healthcare products such as vitamins, allergy and cold medicine, pain relievers, quit smoking aids, AND anything else not yet reported?]
Include any amount paid out-of-pocket on (your/his/her) behalf by anyone in this household.

Enter dollar amount

If unsure of the amount, a best guess is acceptable.

________________

EMPLOYER'S PENSION PLAN

Q74a

Other than Social Security did (ANY) employer or union that (name/you) worked for in 2014 have a pension or other type of retirement plan for any of its employees?

1 Yes
2 No

Q74b

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

1 Yes
2 No

LOW INCOME ITEMS

SCHOOL LUNCHES

Q80

During 2014 which of the children ages 5 to 18 in this household usually ate a complete lunch offered at school?

Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Enter persons line number (1-16)

Q83

During 2014 which of the children in this household received free or reduced priced lunches because they qualified for the Federal School Lunch Program?

Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Enter persons line number (1-16)

PUBLIC HOUSING

Q85

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

1 Yes
2 No

Q86

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

1 Yes
2 No

SPHS8

Is this through Section 8 or through some other government program?

1 Section 8
2 Some other government program
3 Not sure

WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC)

SWRWIC

At any time during 2014, (was/were) (you/ anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?

1 Yes
2 No

SWRW

Who received WIC for themselves or on behalf of a child?

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

ENERGY ASSISTANCE

Q93

The government has an energy assistance program which helps pay heating and cooling costs. This assistance can be received directly by the household or it can be paid directly to the electric company, gas company, or fuel dealer. In 2014, (have you/has this household) received assistance of this type from the federal, state, or local government?

1 Yes
2 No

Q93pr1

Do you remember receiving an additional or unexpected check that was sent during the year to help pay heating or cooling costs?

1 Yes
2 No

Q93pr2

Was it used to pay heating or cooling costs?

1 Yes
2 No

Q94

Altogether, how much energy assistance has been received in 2014?

Enter annual amount only

________________

Q94rn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in energy assistance during 2014?

1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3000

Q94rn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in energy assistance during 2014?

1 Less than $100
2 Between $100 and $500
3 Over $500

MIGRATION

5-Year Migration

M5GSAM

(Were/Was) (reference person's name/you) living in this house (or apartment) 5 years ago?

1 Yes, this house (apt)
2 No, different house in U.S.
3 No, outside the U.S.

M5GPLC

Where did (reference person's name/you) live five years ago?

Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME

_______________

M5GSTA
?[F1]

Where did (reference person's name/you) live five years ago?

Name of State
Current: (state)
Enter W for person living on a ship at sea
Enter correct State or press ENTER for SAME

_______________

M5GZIP

Where did (reference person's name/you) live five years ago?

Zip Code
Current: (zip)
Enter correct Zip Code or press ENTER for SAME

_______________

M5GCLM

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

M5GCOU

What (county/parish) is (place name) in?

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

_____________________________________________

S_MIGCN1

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

M5GM

Which of the other members of this household did NOT live with (reference person's name/you) five years ago?

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

N5TSAM

Did (name/you) live in this house (apartment) five years ago?

1 Yes , this house
2 No, different house in U.S.
3 No, outside the U.S.

N5TPLC

Where did (name/you) live five years ago?

Name of city/town/post office
Current: (city) Enter correct city/town/post office or
Press ENTER for SAME

_____________________________________________

N5TSTA

?[F1]
Where did (name/you) live five years ago?

Name of State
Current: (state)
Enter correct State or press ENTER for SAME

_____________________________________________

N5TZIP

Where did (name/you) live five years ago?

Zip Code Current: (zip)
Enter correct zip code or
Press ENTER for SAME

_______________

N5TCLM

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

N5TCOU

What (county/parish) is (place name) in?

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

_____________________________________________

S_N5TCN1

What country did (name/you) live in five years ago?

1- Year Migration

MIGSAM

(Were/Was) (reference person's name/you) living in this house (or apartment) one year ago?

4 Yes, this house (apt)
5 No, different house in U.S.
6 No, outside the U.S.

MIGPLC

Where did (reference person's name/you) live one year ago?

Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME

_______________

MIGSTA

?[F1]
Where did (reference person's name/you) live one year ago?

Name of State
Current: (state)
Enter W for person living on a ship at sea
Enter correct State or press ENTER for SAME

_______________

MIGZIP

Where did (reference person's name/you) live one year ago?

Zip Code
Current: (zip)
Enter correct Zip Code or press ENTER for SAME

_______________

MIGCLM

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

3 Yes, inside city limits
4 No, outside city limits or post office name only

MIGCOU

What (county/parish) is (place name) in?

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

S_MIGCN1

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

MI1RES

What was (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)

MI1s

What was the reason for moving?

_____________________________________________

MIGALL

(There are (number) other persons in this household ages 1 year or over/ ) Did (all of these persons/this person) live with (reference person's name/you) (in this house/in City, State/outside the U.S.) one year ago?

1 Yes, all lived with (reference person's name/you)
2 No, some or all did not live with (reference person's name/you)

MIGM

Which of the other members of this household did NOT live with (reference person's name/you) one year ago?

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

NXTSAM

Did (name/you) live in this house (apartment) one year ago?

4 Yes , this house
5 No, different house in U.S.
6 No, outside the U.S.

NXTPLC

Where did (name/you) live one year ago?

Name of city/town/post office
Current: (city) Enter correct city/town/post office or
Press ENTER for SAME
_____________________________________________

NXTSTA

?[F1]
Where did (name/you) live one year ago?

Name of State
Current: (state)
Enter correct State or press ENTER for SAME
__________________________________

NXTZIP

Where did (name/you) live one year ago?

Zip Code Current: (zip)
Enter correct zip code or
Press ENTER for SAME
_______________

NXTCLM

Did (name/you) live inside the city limits of (place name)?

3 Yes, inside city limits
4 No, outside city limits or post office name only

NXTCOU

What (county/parish) is (place name) in?

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

S_NXTCN1

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

NX1RES

What was (name's/your) main reason for moving to this house (apartment)?

The answer categories are separated into the following groups:
FAMILY-RELATED REASONS 1-3
EMPLOYMENT-RELATED REASONS 4-8
HOUSING-RELATED REASONS 9-13
OTHER REASONS 14-18

NX1OTH

What was the reason for moving?

_____________________________________________

SUNITS

Ask if necessary How many housing units are in your building?

1 Only one
2 Two
3 Three or four
4 Five to nine
5 Ten or more

SUPPLEMENTAL POVERTY MEASURE
PROPERTY VALUE/PRESENCE OF MORTGAGE

VALPROP

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

Enter dollar amount

________________

VALPROPR

Could you tell me if (name/you) think this (house and lot/apartment/mobile home) would sell for less than $100,000, between $100,000 and $250,000, between $250,000 and $500,000, or $500,000 or more?

1 Less than $100,000
2 Between $100,000 and $250,000
3 Between $250,000 and $500,000
4 $500,000 or more

MORTYN

Not counting home equity loans, do you or any other member of this household have a mortgage, deed of trust, contract to purchase, or similar debt on THIS property?

1 Yes
2 No

SMORTYN

Do you or any member of this household have a second mortgage or a home equity loan on THIS property?

1 Yes, home equity loan.
2 Yes, second mortgage.
3 Yes, second mortgage and home equity loan.
4 No

CHILD CARE

Q95

Now we want to ask about some of your expenses for children. Did (you/ anyone in this household) PAY for the care of (your/their) (child/children) while (you/they) worked in 2014?

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

Q95A

Which children needed care while their parents worked?

Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter 96 for All persons
Enter persons line number (1-16)

CCFREQ

What is the easiest way for you to tell us how much (you/you and others in this household) paid for child care while (you/they) worked in 2014: weekly, every other week, twice a month, monthly, or yearly?

1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly

CCAMT

How much did (you/they) pay for child care?

Include child care payments made for all children in the household. For example, if there are two adults in the household with childcare expenses use the total paid by both adults. Do not try to separate the payments. Record one total for the entire household.

________________

CCNUMPAY

How many (weekly/every other week/twice a month/monthly) payments did (you/they) make during 2014?

________________

CCTOT

Then (you/they) paid (total dollar amount) altogether in child care while (you/they) worked during 2014. Does that sound about right?

1 Yes
2 No

CCEST

What is your best estimate of the correct amount (you/they) paid for child care while (you/they) worked in 2014?

________________

CHILD SUPPORT PAID

CSPCHILD

Does anyone in this household have any children who lived elsewhere with their other parent or guardian at anytime during 2014?

1 Yes
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.

________________

CSPREQ

In 2014, (were/was) (name/you) required to pay child support?

1 Yes
2 No

CSPAMT

How much child support did (name/you) pay in 2014?

Enter dollar amount
COUNT ALL FORMS OF CHILD SUPPORTS PAYMENTS, INCLUDING: PAYMENTS MADE DIRECTLY TO THE OTHER PARENT/GUARDIAN; PAYMENTS MADE THROUGH A COURT OR AGENCY; AND PAYMENTS WITHHELD FROM THIS PERSON'S PAYCHECK

Income Range Follow-up Questions

The three levels of income range follow-up questions are:

1) High-range income follow-up brackets:

? Less than $45,000
? Between $45,000 and $60,000
? $60,000 or more

If the respondent selects the lowest bracket (Less than $45,000), then the following ranges will be presented to the respondent:

? Less than $15,000
? Between $15,000 and $30,000
? $30,000 or more

2) Mid-range income follow-up questions:

? Less than $10,000
? Between $10,000 and $20,000
? $20,000 or more

If the respondent selects the lowest bracket (Less than $10,000), then the following ranges will be presented to the respondent:

? Less than $1,000
? Between $1,000 and $5,000
? $5,000 or more

3) Low-range income follow-up questions:

? Less than $1,000
? Between $1,000 and $3,000
? $3,000 or more

If the respondent selects the lowest bracket (Less than $1,000), then the following ranges will be presented to the respondent:

? Less than $100
? Between $100 and $500
? $500 or more

Income Source and Follow-Up Question Range Level
The following table displays the income source and range level used in the follow-up range questions.

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