2016 ASEC SUPPLEMENT
CPS FIELD REPRESENTATIVE / CATI INTERVIEWER
ITEMS BOOKLET
U.S. DEPARTMENT OF COMMERCE
U.S. Census Bureau
1 BASIC CPS ITEMS
1.1 MOVER ITEMS
HH32b
November 19, 2015?
2 No
HH32d
November 19, 2015?
2 No
1.2 FAMILY INCOME
S FAMINC
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?
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
16 150,000 to more
INCDKR
2 Below
2 INTRODUCTION and WORK EXPERIENCE
Pr incom
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.
Q29a
2 No
Q29b
for a few days during 2015?
2 No
Q30
trying to find a job or on layoff?
2 No
Q31
Q32
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
Include paid vacation and sick leave as work.
Enter 97 if respondent can only answer in months
________________
Q33mon
(1-12)
________________
Q33ver
2 No - back to Q33 and obtain estimate
Q35
(were/was) on layoff from a job or lost a job?
1 Yes
2 No
7 Mistake made in number of weeks worked last year - Specify in Q35SP
________________
Q36
How many OF THE REMAINING (number) WEEKS (was/were)
(you/he/she) looking for work or on layoff from a job?
________________
Q37
2 No - two stretches
3 No - 3 or more stretches
Q38
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
_________________________________________________
Q39
If more than one at the same time, only count it as one employer.
2 Two
3 Three or more
Q41
_________________________________________________
Q43
Exclude time off with pay because of holidays, vacation, days off, or sickness.
2 No
Q44
(Number of weeks was reported in item Q33)
(1-52)
Q45
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
Was it:
(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
during 2015?))
(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 2015)
Q47b
For example: TV and radio manufacturing, retail shoe store, farm
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
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
For example: Electrical Engineer, Stock Clerk, Typist
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
For example: Types, keeps account books, files, sells cars, operates printing press,
finishes concrete.
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
For example: Types, keeps account books, files, sells cars, operates printing press,
finishes concrete.
The current job description is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/ If longest job last year is military job, enter NA)
Q47E1
(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?
2 Private for profit company
3 Non profit organization including tax exempt and charitable organizations
4 Self employed
5 Working in family business
Q47E1a
2 State
3 Local (county, city, township)
Q47E1b
2 No
Q47E1c
2 No
Q4788
1 under 10
2 10-49
3 50-99
4 100-499
5 500-999
6 1,000+
3 EARNED INCOME
Q48aa
deductions during 2015?
Enter 0 for none
Q48aarn1
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 2015?
2 Between $45,000 and $60,000
3 Over $60,000
Q48aarn2
less than $15,000
between $15,000 and $30,000
or over $30,000
from this employer during 2015?
2 Between $45,000 and $60,000
3 Over $60,000
Q48aap
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q48a1
________________
Q48aC2
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
2 No
Q48a2
Q48aap: (periodicity)
Q48a1: (number of pay periods)
Enter dollar amount
Q48a3
2 No
Q48aad
Q48aadrn1
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 2015?
2 Between $1,000 and $3,000
3 Over $3,000
Q48aadrn2
less than $100
between $100 and $500
or over $500
in tips, bonuses, overtime pay, or commissions from this employer during 2015?
2 Between $100 and $500
3 Over $500
Q48b
during 2015?
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b char
Q48BL
Enter annual amount only
Q48brn1
during 2015?
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48brn2
less than $15,000
between $15,000 and $30,000
or over $30,000
from this business/farm after expenses during 2015?
2 Between $15,000 and $30,000
3 Over $30,000
Q48bp
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
7 Yearly
Q48B1A
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
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
business/farm after expenses in 2015?
Q48bp: (periodicity)
Enter dollar amount
Q48b2L
business/farm after expenses in 2015?
Q48bp: (periodicity)
Enter dollar amount
Q48b3
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b3 char
Q48B3L
Q48b4
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b4 char
Q48B4L
Q48b5
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b5 char
Q48B5L
Q48b6
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b6 char
Q48B6L
Q48b7
(name/you) may have received from this business in 2015?
2 No
Q48b7
in 2015?
Q48badrn1
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 2015?
2 Between $1,000 and $3,000
3 Over $3,000
Q48badrn2
less than $100
between $100 and $500
or over $500
in tips, bonuses, overtime pay, or commissions during 2015?
2 Between $100 and $500
3 Over $500
Q49a
2 No
Q49b1d
Enter "0" for None
Q49b1drn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q49b1drn2
less than $1,000
between $1,000 and $5,000
or over $5,000
from all other employers before taxes and other deductions during 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q49b1p
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
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 2015?
________________
Q49B1C
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
2 No
Q49B12
Q49b1p: (periodicity)
Q49b11: (number of pay periods)
Enter dollar amount
Q49B13
(name/you) may have received from all other employers in 2015?
2 No
Q49B1A
Q49B1ARN1
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 2015?
2 Between $1,000 and $3,000
3 Over $3,000
Q49B1ARN2
less than $100
between $100 and $500
or over $500
in tips, bonuses, overtime pay, or commissions from all other employers in 2015?
2 Between $100 and $500
3 Over $500
Q49b2
Enter "0" for None
If response is "Lost Money" press enter
Enter annual amount only
Q49b2rn1
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?
2 Between $10,000 and $20,000
3 Over $20,000
Q49b2rn2
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?
2 Between $1,000 and $5,000
3 Over $5,000
Q49b2 char
Q49b3
Q49b4
Enter "0" for None
If response is "Lost money" press enter
Enter annual amount only
Q49b4rn1
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?
2 Between $10,000 and $20,000
3 Over $20,000
Q49b4rn2
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?
2 Between $1,000 and $5,000
3 Over $5,000
Q49b4 char
Q49b5
[NOTE: CPS DOCUMENTATION INCLUDES A TABLE THAT IS NOT SHOWN ON THIS ENUMERATION FORM]
4 INCOME SOURCES
4.1 UNEMPLOYMENT AND WORKERS COMPENSATION (Source)
Q51A1
2 No
Q51A1b
Who received State or Federal unemployment compensation?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q51A2
Supplemental Unemployment Benefits (SUB)?
2 No
Q51A2b
Who received Supplemental Unemployment Benefits?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q51A3
Unemployment or Strike Benefits?
2 No
Q51A3b
Who received Union Unemployment or Strike Benefits?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q52A
Exclude sick pay and/or disability retirement.
2 No
Q52Ab
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.
Q52b
1 State Worker's Compensation
2 Employer or employer's insurance worker's compensation
3 Own insurance worker's compensation
4 Other
Q52Cs1
Enter "Worker's Compensation" if the answer is "Don't Know"
4.2 SOCIAL SECURITY (Source)
Q56a
payments from the U.S. Government?
2 No
Q56b
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.
SSR
Mark all that apply
Probe: Any Other Reason?
2 Disabled
3 Widowed
4 Spouse
5 Surviving child
6 Dependent child
7 On behalf of surviving, dependent, or disabled children
8 Other
SSRs
SSC
Probe: Anyone Else?
Enter all that apply, separate by commas.
Enter 0 if none listed
SSCR
Security in 2015?
Mark all that apply
Probe: Any Other Reason?
2 Surviving child
3 Dependent child
4 Other
SSDIa1
2 No
4.3 SOCIAL SECURITY FOR CHILDREN (Source)
Q56f
Includes all children under 19 years of age
Social Security Income previously reported will appear here
1 Yes
2 No
Q56g
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?
SSC-R
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
SSCR
Security in 2015?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
2 Surviving child/children
3 Dependent child/children
4 Other
4.4 SUPPLEMENTAL SECURITY INCOME (SSI) (Source)
Q57a
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.
2 No
Q57b
Who received SSI?
Supplemental Security Income
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
SSIR
Income in 2015?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
2 Blind
3 On behalf of a disabled child
4 On behalf of a blind child
5 Other ________________
4.5 SUPPLEMENTAL SECURITY INCOME (SSI) (Source)
Q57d
Includes all children under 18 years of age
SSI previously reported will appear here
1 Yes
2 No
Q57e
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?
RSSI
Income on behalf of children in 2015?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
2 On behalf of a blind child/children
3 Other ________________
CSSI
in 2015?
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
4.6 DISABILITY INCOME (Source)
Q59AR
2 No
Q59b
Who is that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q60a
2 No
Q61b
2 No
Q61C
Asking About: (name) (blank/- -CURRENT RESPONDENT)
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
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
Enter "Other Health Problem/Disability" if the answer is "Don't Know"
4.7 VETERANS PAYMENTS (Source)
Q60A88
Any Veterans' (VA) payments?
Include assistance received by children of veterans
2 No
Q60b_88
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?
Q60C8
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?
2 Survivor Benefits
3 Veterans' Pension
4 Educational assistance (including assistance received by children of veterans)
5 Other Veterans' payments ________________
Q60D88
Department of Veterans' Affairs?
2 No
4.8 SURVIVOR BENEFITS (Source)
Q58a
2 No
line number (1-16)
Q58C
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?
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
Enter "Survivor Benefits" if the answer is "Don't Know"
4.9 PUBLIC ASSISTANCE (Source)
Q59A88
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
2 No
Q59A89
2 No
Q59b_88
Enter line number
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q59C8r
Enter all that apply
Probe: Any Other Program?
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)
SSI
Energy assistance
WIC
School meals
Transportation, childcare, rental or education assistance
Q59C8s
Specify other source of cash assistance
Enter "Cash" if the answer is "Don't Know"
4.10 FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (Source)
Q87r
Do not include WIC benefits.
2 No
Q87ar
Do not include WIC benefits.
2 No
Q88
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?
4.11 PENSIONS (Source)
Q62Ar
PLEASE DO NOT INCLUDE DISTRIBUTIONS OR WITHDRAWALS FROM
IRAs, 401(k)s, OR SIMILAR ACCOUNTS!
2 No
Q62b
Who received pension or retirement income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q62Cra
Company or union pension (include profit sharing)?
Enter all that apply, separate using the space bar or a comma.
If "Yes," probe to identify which source
2 Union Pension
3 Neither
Q62Crb
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
2 State Government Pension
3 Local Government Pension
4 None of the above
Q62Crc
2 No
Q62Crd
2 No
Q62Dr
Enter all that apply
Probe as needed: Who received this source?
Probe: Any Other pension income?
2 Other sources or don't know - Specify -
Enter other source of pension income
_____________________________________________
Q62Cs1
Enter "Other Pension" if the answer is "Don't Know"
4.12 ANNUITIES (Source)
Q96Ar
2 No
Q96Br
Who received annuity income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
4.13 RETIREMENT ACCOUNTS (Source)
Q97Ar
2 No
Q97Br
Who had such a retirement account?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q97Cr
READ EACH CATEGORY!
Enter all that apply, separate using the space bar or a comma.
2. 403(b)
3. Roth IRA
4. Regular IRA
5. KEOGH plan ("KEE-OH")
6. SEP plan (Simplified Employee Pension)
7. another type of retirement account
Q97Dr
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Probe: Any Other retirement income?
_____________________________________________
Q98Ar
(IF AGE 70+ ADD: including distributions you may have been required to take?)
2 No
4.14 INCOME-EARNING ACCOUNTS OUTSIDE OF RETIREMENT (Source)
Q99ArA
(Now I will ask about assets that may have paid interest or dividends in 2015 outside
of the retirement account(s).)
At anytime during 2015, did (you/anyone in this household):
Have money in an interest-earning checking account?
2 No
Q99ArB
Have a savings account?
2 No
Q99ArC
Have a money-market fund?
2 No
Q99ArD
Have CDs (certificates of deposit)?
2 No
Q99ArE
Have Savings bonds?
2 No
Q99ArF
Have shares of stock in corporations or mutual funds?
2 No
Q99ArG
2 No
CAPGDIS
2 No
Q99Br
Enter all that apply
Probe as needed: Who received this source?
_____________________________________________
4.15 PROPERTY INCOME (Source)
Q65A1
Own any land, business property, apartments, or houses which were rented to
others?
2 No
Q65A2
Receive income from royalties or from roomers or boarders? (exclude amounts paid
by relatives)
2 No
Q65A3
Receive income from estates or trusts? (exclude estates or trusts already reported)
2 No
Q65b
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?
4.16 EDUCATION ASSISTANCE (Source)
Q66a
(include vocational, business, or trade schools)
2 No
Q66b
Exclude loans, assistance from household members, and VA educational benefits
2 No
Q66c
Which member received assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q66d
Exclude assistance from household members
Enter all that apply, separate using the space bar or a comma.
Probe: Any other assistance?
3 Assistance from a welfare or social service office
4 Some other government assistance
5 Scholarships, grants, etc.
6 Other assistance (employers, friends, etc.)
4.17 CHILD SUPPORT (Source)
Q70a
Any child support payments?
2 No
Q70b
Who received these payments?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
4.18 REGULAR FINANCIAL ASSISTANCE (Source)
Q72a
Do not include loans
2 No
Q72b
Who received this assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
4.19 OTHER MONEY INCOME (Source)
Q73A1R
income from foster child care, alimony, jury duty, armed forces reserves, severance pay, hobbies, or any other source?
2 No
Q73A1b
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Q73A1Rc
Asking about: (fill from Q73A1b)
__________________________
5 INCOME AMOUNTS
AMINTRO
5.1 UNEMPLOYMENT AND WORKER'S COMPENSATION (Amounts)
Q51A1p
unemployment compensation; weekly, every other week, twice a month, monthly, or
yearly?
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q51A11
month/monthly/ ) in State or Federal unemployment compensation during 2015?
________________
Q51A11r1
less than $10,000
between $10,000 and $20,000
or over $20,000
in State or Federal unemployment compensation during 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q51A11r2
less than $1,000
between $1,000 and $5,000
or over $5,000
in State or Federal unemployment compensation during 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q51A1C
The annual rate appears out of range. The total State or Federal unemployment compensation received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q51A12
(name/you) receive from State or Federal unemployment compensation during
2015?
________________
Q51A13
2 No
Q51A14
Q51A1p: (periodicity)
Q51A12: (number of pay periods)
Enter dollar amount
________________
Q51A2p
Unemployment Benefits; weekly, every other week, twice a month, monthly, or
yearly?
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q51A21
month/monthly/ ) in Supplemental Unemployment Benefits during 2015?
_____________
Q51A21r1
less than $10,000
between $10,000 and $20,000
or over $20,000
in Supplemental Unemployment Benefits during 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q51A21r2
less than $1,000
between $1,000 and $5,000
or over $5,000
in Supplemental Unemployment Benefits during 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q51A2C
The annual rate appears out of range. The total Supplemental Unemployment Benefits received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q51A22
(name/you) receive from Supplemental Unemployment Benefits during 2015?
________________
Q51A23
Supplemental Unemployment Benefits during 2015. Does that sound about right?
2 No
Q51A24
Q51A2p: (periodicity)
Q51A22: (number of pay periods)
Enter dollar amount
________________
Q51A3p
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q51A31
month/monthly/ ) in Union Unemployment or Strike Benefits during 2015?
________________
Q51A31r1
less than $10,000
between $10,000 and $20,000
or over $20,000
in Union Unemployment or Strike Benefits during 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q51A31r2
less than $1,000
between $1,000 and $5,000
or over $5,000
in Union Unemployment or Strike Benefits during 2015
2 Between $1,000 and $5,000
3 Over $5,000
C251A3
The annual rate appears out of range. The total Union Unemployment or Strike Benefits received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q51A32
(name/you) receive from Union Unemployment or Strike Benefits during 2015?
________________
Q51A33
2 No
Q51A34
Q51A3p: (periodicity)
Q51A32: (number of pay periods)
Enter dollar amount
________________
Q52cp
weekly, every other week, twice a month, monthly, or yearly?
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q52c1
month/monthly) in (Fill Q52b or Q52Cs1) during 2015?
________________
Q52cr1
less than $10,000
between $10,000 and $20,000
or over $20,000
in (Fill Q52b or Q52Cs1) during 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q52cr2
less than $1,000
between $1,000 and $5,000
or over $5,000
in (Fill Q52b or Q52Cs1) during 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q52cC2
The annual rate appears out of range. The total worker's compensation received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q52c2
(name/you) receive from (Fill Q52b or Q52Cs1) during 2015?
________________
Q52c3
2 No
Q52c4
received from (Fill Q52b or Q52Cs1) during 2015?
Q52cp: (periodicity)
Q52c2: (number of pay periods)
Enter dollar amount
________________
5.2 SOCIAL SECURITY (Amounts)
Q56dp
5 Quarterly
7 Yearly
Q56d
If already included in amount reported for another household member, press Enter
________________
Q56d Char
________________
Q56drn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in Social Security payments in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q56d2
________________
Q56d3
Medicare deduction?
2 Before Deduction
Q56md
________________
Q56dC2
The annual rate appears out of range. The total Social Security received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q56d5
2 No
Q56d6
Security during 2015?
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)
Enter dollar amount
________________
5.3 SOCIAL SECURITY DISABILITY (Amounts)
Q562dp
5 Quarterly
7 Yearly
Q562d
If already included in amount reported for another household member, press Enter
________________
Q562d Char
________________
Q562d2
________________
Q562drn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in Social Security Disability payments in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q562drn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in Social Security Disability payments in 2015?
5 Between $1,000 and $5,000
6 Over $5,000
Q562d3
2 Before Deduction
Q562md
________________
Q562dC2
The annual rate appears out of range. The total Social Security received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
BACKPAY1
(This is sometimes done to make up for a delay in the start of payments)
2 No
BACKPAY2
______________
Q562d5
2 No
Q562d6
Security Disability during 2015?
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)
Enter dollar amount
________________
5.4 SOCIAL SECURITY FOR CHILDREN (Amounts)
Q56r
behalf of children in the household.
Q56ip
5 Quarterly
7 Yearly
Q56i
If already included in amount reported for another household member, press Enter
________________
Q56i Char
________________
Q56irn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in Social Security payments for children in this household in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q56irn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in Social Security payments for children in this household in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q56i2
________________
Q56iC2
The annual rate appears out of range. The total Social Security received for children in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q56i4
2 No
Q56i5
Security for children in this household during 2015?
Q56ip: (periodicity)
Q56i2: (number of pay periods)
Enter dollar amount
________________
5.5 SUPPLEMENTAL SECURITY INCOME (SSI) (Amounts)
Q57cp
5 Quarterly
7 Yearly
Q57c
________________
Q57crn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in Supplemental Security Income payments in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q57crn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in Supplemental Security Income payments in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q57c2
________________
Q57cC2
The annual rate appears out of range. The total Supplemental Security Income received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q57c4
Supplemental Security Income in 2015. Does that sound about right?
2 No
Q57c5
Supplemental Security Income during 2015?
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)
Enter Dollar Amount
________________
5.6 SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (Amounts)
Q57R
2 Combined
Q57ip
Income (name/you) received on behalf of children?
5 Quarterly
7 Yearly
Q57i
________________
Q57irn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in Supplemental Security Income on behalf of children in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q57irn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in Supplemental Security Income on behalf of children in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q57i2
________________
Q57iC2
The annual rate appears out of range. The total Supplemental Security Income received on behalf of children in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q57i4
Supplemental Security Income on behalf of children in 2015.
Does that sound about right?
2 No
Q57i5
Supplemental Security Income on behalf of children during 2015?
Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)
Enter dollar amount
________________
5.7 DISABILITY INCOME (Amounts)
Q61E1P
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q61E1
monthly) before deductions in (fill first answer from Q61C or Q61Cs1) payments in
2015?
_______________
Q61E1rn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q61E1rn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill first answer from Q61C or Q61Cs1) during 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q61E12
(name/you) receive in (fill first answer from Q61C or Q61Cs1) payments in 2015?
______________
Q61E1C
The annual rate appears out of range. The total (fill from first answer in Q61c or Q61cs1) payments received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q61E13
( first answer from Q61C or Q61Cs1) payments in 2015. Does that sound about
right?
2 No
Q61E14
Q61E1P: (periodicity)
Q61E12: (number of pay periods)
Enter dollar amount
_______________
Q61E2P
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q61E2
_______________
Q61e2rn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q61e2rn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill SECOND answer from Q61C or Q61Cs1) during 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q61E22
_______________
Q61E2C
The annual rate appears out of range. The total (fill from second answer in Q61c or Q61cs1) payments received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q61E23
from (fill second answer from Q61C or Q61Cs1) payments in 2015. Does that
sound about right?
2 No
Q61E24
Q61E2P: (periodicity)
Q61E22: (number of pay periods)
Enter dollar amount
_______________
5.8 VETERANS PAYMENTS (Amounts)
Q60V1P
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q60V1
_______________
Q60V1rn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in (fill from first answer in Q60c8) payments in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q60V1rn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill from first answer in Q60c8) payments in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q60V12
(name/you) receive in (fill from first answer in Q60c8) in 2015?
________________
Q60V1C
The annual rate appears out of range. The total (fill from first answer in Q60c8) received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q60V13
2 No
Q60V14
Q60V1P: (periodicity)
Q60V12: (number of pay periods)
Enter dollar amount
________________
Q60V2P
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q60V2
month/monthly) before deductions in (fill from second answer in Q60c8) in 2015?
_______________
Q60v2rn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in (fill from second answer in Q60c8) payments in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q60v2rn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill from second answer in Q60c8) payments in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q60V22
(name/you) receive in (fill from second answer in Q60c8) in 2015?
________________
Q60V2C
The annual rate appears out of range. The total (fill from second answer in Q60c8) received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q60V23
(fill from second answer in Q60c8) in 2015. Does that sound about right?
2 No
Q60V24
(fill from second answer in Q60c8) during 2015?
Q60V2P: (periodicity)
Q60V22: (number of pay periods)
Enter dollar amount
________________
5.9 SURVIVOR BENEFITS - Amounts
Q58E1P
in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly,
or yearly?
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q58E1
monthly) in (fill from first answer in Q58C or Q58Cs1) in 2015?
_______________
Q58E1rn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q58E1rn2
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 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q58E12
________________
Q58E1C
The annual rate appears out of range. The total (fill from first answer in Q58C or
Q58Cs1) received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q58E13
(fill from first answer in Q58C or Q58Cs1) in 2015. Does that sound about right?
2 No
Q58E14
Q58E1P: (periodicity)
Q58E12: (number of pay periods)
Enter dollar amount
________________
Q58E2P
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q58E2
monthly/ ) in (fill from second answer in Q58C or Q58Cs1) in 2015?
________________
Q58E2rn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q58E2rn2
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 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q58E22
(name/you) receive in (fill from second answer in Q58C or Q58Cs1) in 2015?
________________
Q58E2C
The annual rate appears out of range. The total (fill from second answer in Q58C or
Q58Cs1) received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q58E23
(fill from second answer in Q58C or Q58Cs1) in 2015.
Does that sound about right?
2 No
Q58E24
Q58E2P: (periodicity)
Q58E22: (number of pay periods)
Enter dollar amount
________________
Q58E3P
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q58E3
monthly) in (fill from third answer in Q58C or Q58Cs1) in 2015?
________________
Q58E3rn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q58E3rn2
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 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q58E32
(name/you) receive in (fill from third answer in Q58C or Q58Cs1) in 2015?
________________
Q58E3C
The annual rate appears out of range. The total (fill from third answer in Q58C or
Q58Cs1) received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q58E33
2 No
Q58E34
Q58E3P: (periodicity)
Q58E32: (number of pay periods)
Enter dollar amount
_______________
5.10 PUBLIC ASSISTANCE (Amounts)
Q59ep
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q59e
___________
Q59ern1
less than $1,000
between $1,000 and $3,000
or over $3,000
in TOTAL CASH assistance payments in 2015?
2 Between $1,000 and $3,000
3 Over $3000
Q59ern2
less than $100
between $100 and $500
or over $500
in TOTAL CASH assistance payments in 2015?
2 Between $100 and $500
3 Over $500
Q59e2
payments did (name's/your) receive in 2015?
________________
Q59eC2
The annual rate appears out of range. The total cash assistance received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
________________
Q59e3
2 No
Q59e4
Q59ep: (periodicity)
Q59e2: (number of pay periods)
Enter dollar amount
________________
Q59f
2 Children only
3 Adults only
Q59g
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
5.11 FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE
PROGRAM (SNAP) (Amounts)
Q90p
monthly or yearly?
2 Yearly
3 Already included with TANF/AFDC payment
Q90
________________
Q90rn1
less than $1,000
between $1,000 and $3,000
or over $3,000
in food assistance in 2015?
2 Between $1,000 and $3,000
3 Over $3000
Q90rn2
less than $100
between $100 and $500
or over $500
in food assistance in 2015?
2 Between $100 and $500
3 Over $500
Q902
________________
Q90C2
The annual rate appears out of range. The total food assistance payments received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q903
2 No
Q904
during 2015?
Q90p: (periodicity)
Q902: (number of pay periods)
Enter dollar amount
________________
5.12 PENSIONS (Amounts)
Q62E1PR
FROM Q62C-R or Q62DR); weekly, every other week, twice a month, monthly, or
yearly?
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q62E1R
monthly/ ) in (first answer FILL IN FROM Q62C-R or Q62DR) in 2015?
______________
Q62E1rn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q62E1rn2
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 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q62E12R
(name/you) receive in (first answer FILL IN FROM Q62CR or Q62DR) in 2015?
_______________
Q62E1CR
The annual rate appears out of range. The total (fill from first answer in Q62c or Q62cs1) payments received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q62E13R
2 No
Q62E14R
answer FILL IN FROM Q62C-R or Q62DR) during 2015?
Q62E1P: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount
_______________
Q62E2PR
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q62E2R
monthly) in (second answer FILL IN FROM Q62C-R or Q62D-R) in 2015?
_______________
Q62E2rn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q62E2rn2
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 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q62E22R
(name/you) receive in (second answer FILL IN FROM Q62C-R or Q62DR) in
2015?
_______________
Q62E2CR
The annual rate appears out of range. The total (fill from first answer in Q62c or Q62cs1) payments received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q62E23R
2 No
Q62E24R
Q62E1P: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount
_______________
5.13 ANNUITIES (Amounts)
ANNNEW1
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
ANNNEW2
monthly) in annuities in 2015?
_______________
ANNNEWrn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in annuity payments in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
ANNNEWrn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in annuity payments in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
ANNNEW3
_______________
ANNNEW4
ANNNEW3: (periodicity)
1 Yes
2 No
ANNNEW5
_______________
5.14 WITHDRAWALS/DISTRIBUTION FROM RETIREMENT PLAN (Amounts)
DISTNEW1
distributed from (name's/your) [(ACCOUNT TYPE) FILL FROM Q97CR or
Q97DR)] in 2015: monthly, quarterly, every 6 months, or yearly?
5 Quarterly
6 Every 6 months
7 Yearly
DISTNEW2
_______________
DISTNEW3
DISTNEWrn1
less than $10,000
between $10,000 and $20,000
or over $20,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
DISTNEWrn1
less than $10,000
between $10,000 and $20,000
or over $20,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
DISTNEWrn2
less than $1,000
between $1,000 and $5,000
or over $5,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
DISTNEW2
_______________
DISTNEWrn1
less than $10,000
between $10,000 and $20,000
or over $20,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
DISTNEWrn2
less than $1,000
between $1,000 and $5,000
or over $5,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
DISTNEW4
2 No
DISTNEW5
distribution received from the [(ACCOUNT TYPE) FILL FROM Q97CR or
Q97DR)] during 2015?
_______________
ROLLA
2 No
ROLLAMTA
_______________
ROLLB
2 No
ROLLAMTB
_______________
DISTNEW6
5 Quarterly
6 Every 6 months
7 Yearly
DISTNEW7
_______________
DISTNEW8
_______________
DISTNEWrn3
less than $10,000
between $10,000 and $20,000
or over $20,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
DISTNEWrn4
less than $1,000
between $1,000 and $5,000
or over $5,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
DISTNEW9
2 No
DISTNEW10
distribution received from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR
or Q97DR)] during 2015?
_______________
ROLLC
2 No
ROLLAMTC
_______________
ROLLD
2 No
ROLLAMTD
_______________
5.15 INTEREST/DIVIDENDS ON RETIREMENT ACCOUNTS (Amounts)
RETIRENEW1
_____________
RETIRENEWrn1
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 Q97DR] during 2015?
2 Between $1,000 and $3,000
3 Over $3,000
RETIRENEWrn2
less than $100
between $100 and $500
or over $500
in interest or dividends from [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97DR] during 2015?
2 Between $100 and $500
3 Over $500
RETIRENEW2
____________
5.16 INTEREST/DIVIDENDS ON NON-RETIREMENT ACCOUNTS (Amounts)
NONRETIRENEW(1-7)1
Enter dollar amount
_____________
NONRETIRENEW(1-7)rn1
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 2015?
2 Between $1,000 and $3,000
3 Over $3,000
NONRETIRENEW(1-7)rn2
less than $100
between $100 and $500
or over $500
in interest or dividends from [FILL IN Q99AR or Q99BR] during 2015?
2 Between $100 and $500
3 Over $500
NONRETIRENEW(1-7)2
_____________
Q63cp
Is this a weekly, every other week, twice a month, monthly, quarterly, every 6 months, or yearly amount?
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly
Q63c2
Q63c3
2 No
Q63c4
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
_______________
CAPGDAMT
_______________
CAPGDAMTrn1
less than $10,000
between $10,000 and $20,000
or over $20,000
for the TOTAL yearly amount in capital gains during 2015?
2 Between $10,000 and $20,000
3 Over $20,000
CAPGDAMTrn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in capital gains during 2015?
2 Between $1,000 and $5,000
3 Over $5,000
5.17 PROPERTY INCOME (Amounts)
Q65c
estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill
from Q65A1-3) AFTER EXPENSES during 2015?
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 "L" for Lost Money
Enter "X" for None
Q65cL
Q65crn1
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 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q65crn2
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 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q65cp
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
7 Yearly
Q65c2
(roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or
royalties/, estates or trusts) AFTER EXPENSES in 2015?
Q65cp: (periodicity)
Enter dollar amount
_______________
Q65cC2
The annual rate appears out of range. The total income received from rent (roomers or boarders, estates, trusts, or royalties) was (amount) in 2015. Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q65c2L
Q65cp: (periodicity)
Enter dollar amount
_______________
5.18 EDUCATIONAL ASSISTANCE (Amounts)
Q69F88
________________
Q69Frn1
less than $1,000
between $1,000 and $3,000
or over $3,000
in Pell Grants during 2015?
2 Between $1,000 and $3,000
3 Over $3,000
Q69Frn2
less than $100
between $100 and $500
or over $500
in Pell Grants during 2015?
2 Between $100 and $500
3 Over $500
Q66HP
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q66H
monthly/ ) in educational assistance during 2015?
________________
Q66H2
(name/you fill Q66c) receive in educational assistance in 2015?
________________
Q66Hrn1
less than $1,000
between $1,000 and $3,000
or over $3,000
in educational assistance during 2015?
2 Between $1,000 and $3,000
3 Over $3,000
Q66Hrn2
less than $100
between $100 and $500
or over $500
in educational assistance during 2015?
2 Between $100 and $500
3 Over $500
Q66HC2
The annual rate appears out of range. The total educational assistance received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q66H3
educational assistance in 2015. Does that sound about right?
2 No
Q66H4
educational assistance during 2015?
Q66hp: (periodicity)
Q66h2: (number of pay periods)
Enter dollar amount
________________
5.19 CHILD SUPPORT (Amounts)
Q70cp
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q70c
monthly) in child support payments in 2015?
________________
Q70c2
payments did (name/you) receive in 2015?
________________
Q70c1rn1
less than $10,000
between $10,000 and $20,000
or over $20,000
in child support payments in 2015?
2 Between $10,000 and $20,000
3 Over $20,000
Q70c1rn2
less than $1,000
between $1,000 and $5,000
or over $5,000
in child support payments in 2015?
2 Between $1,000 and $5,000
3 Over $5,000
Q70cC2
The annual rate appears out of range. The total child support payments received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q70c3
support payments in 2015. Does that sound about right?
2 No
Q70c4
Q70cp: (periodicity)
Q70c2: (number of pay periods)
Enter dollar amount
________________
5.20 REGULAR FINANCIAL ASSISTANCE (Amounts)
Q72cp
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q72c
monthly) in regular financial assistance in 2015?
________________
Q72c2
(name/you) receive in regular financial assistance in 2015?
_______________
Q72crn1
less than $1,000
between $1,000 and $3,000
or over $3,000
in regular financial assistance in 2015?
2 Between $1,000 and $3,000
3 Over $3,000
Q72crn2
less than $100
between $100 and $500
or over $500
in regular financial assistance in 2015?
2 Between $100 and $500
3 Over $500
Q72cC2
The annual rate appears out of range. The total regular financial assistance payments received in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q72c3
2 No
Q72c4
regular financial assistance during 2015?
Q72cp: (periodicity)
Q72c2: (number of pay periods)
________________
5.21 OTHER MONEY INCOME (Amounts)
Q731P
Q73A1Rc); weekly, every other week, twice a month, monthly, or yearly?
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q731
monthly) in income from (fill from Q73A1Rc) during 2015?
________________
Q7312
(name/you) receive in income from (fill from Q73A1Rc) during 2015?
________________
Q73rn1
less than $1,000
between $1,000 and $3,000
or over $3,000
in income not already covered?
2 Between $1,000 and $3,000
3 Over $3,000
Q73rn2
less than $100
between $100 and $500
or over $500
in income not already covered?
2 Between $100 and $500
3 Over $500
Q731C2
The annual rate appears out of range. The total income from (fill from Q73A1Rc) in 2015 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q7313
Does that sound about right?
2 No
Q7314
Q731P: (periodicity)
Q7312: (number of pay periods)
Enter dollar amount
________________
6 HEALTH INSURANCE
6.1 INTRODUCTION TO HEALTH INSURANCE SECTION
HINTRO
Press 1 to Continue
PINTRO
Press 1 to Continue
FHINTRO
Press 1 to Continue
6.2 CURRENT COVERAGE
MCARE1
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"
2 No
ANYCOV
2 No
MEDI
(Are/Is/Was/Were) (name/you) covered by Medicaid, Medical Assistance, or
(CHIP/or Medicare)?
2 No
OTHGOVT
Stop reading list if respondent says "YES"
2 No
VET
2 No
VERIFY
2 No, is covered
6.3 TYPE OF COVERAGE
SRCEGEN
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?
1. JOB
Former job/Retiree Union
Spouse/parent's job
Job with the government
COBRA
TRICARE/TRICARE For Life
2. GOVERNMENT OR STATE
Medical Assistance
Medicaid
Medicare (Parts A+B; Part C)
Medicare Advantage
State-provided health coverage
VA Care/CHAMPVA/other military
3. OTHER WAY
Privately purchased
Parent or spouse
Medicare Supplements
Exchange plan/Marketplace
Group or association
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"]
2 Government or State
3 Some other way
SRCEDEPDIR
(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?
1. PARENT OR SPOUSE
Parent
Spouse
2. BUY IT DIRECTLY
Buy it
Parent or spouse buys it
Medicare Supplement
3. SOME OTHER WAY
Former employer
Group or association
Indian Health Service
School
2 Buy it
3 Some other way
SRCEOTH
(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?
2 Union
3 Group or association
4 Indian Health Service
5 School
6 Some other way
JOBCOV
READ IF NECESSARY: Include coverage through FORMER employers and unions, and COBRA plans.
2 No
MILPLAN
(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
2 No
GOVTYPE
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?
2 CHIP
3 Medicare
4 Military
5 Other
MILTYPE
(Is/Was) that plan through TRICARE, TRICARE for Life, CHAMPVA, VA Care,
military health care, or something else?
2 TRICARE for Life
3 CHAMPVA
4 Veterans Administration (VA) care
5 Military health care
6 Other
POLHOLDER
Whose name (is/was) the policy in? (Who (is/was) the policyholder?)
17 Someone living outside the household
Enter persons line number (1-16), or 17 for person not in the household
SRCEPTSP
(Do/Did) they get that coverage through their job, (do/did) they buy it themselves, or
(do/did) they get it some other way?
2 Buy it
3 Some other way
GOVPLAN
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]
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)
_______________
PORTAL
(Is/Was) that coverage through (State Exchange Portal Name), which may also be
known as (State Exchange Program Name 1, Name 2, Name 3)?
2 No
EXCHTYPE
What do you call it - State Exchange Program (Portal, Name 1, Name 2, Name 3)?
HIPAID
Report here employer's contribution to employee's health insurance premiums, not the employee's medical bills.
2 Part
3 None
SHOP
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)?
2 No
POLHOLDER2
Whose name (is/was) the policy in? (Who [is/was] the policyholder?)
17 Someone living outside the household
Enter persons line number (1-16), or 17 for person not in the household
PREMYN
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.
2 No
PREMSUBS
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.
2 No
6.4 MONTHS OF COVERAGE
BEFORAFT
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.)
2 No
MNTHBEG1/2
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.)
This question refers to (plan type).
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December
YEARBEG
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).
2 2016
CNTCOV
(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.)
READ IF NECESSARY: If the gap in coverage was less than 3 weeks, consider the
coverage "continuous."
This question refers to (plan type).
2 No
SPELLADD
2 No
ANYTHIS
2 February 2016
3 March 2016
4 April 2016
20 All months of 2016
21 No months of 2016
ANYLAST
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 2015 until December 2015
21 No months from January 2015 until December 2015
WMNTHS
2 February 2015
3 March 2015
4 April 2015
5 May 2015
6 June 2015
7 July 2015
8 August 2015
9 September 2015
10 October 2015
11 November 2015
12 December 2015
13 January 2016
14 February 2016
15 March 2016
16 April 2016
20 All months from January 2015 until now
21 No months from January 2015 until now
6.5 OTHER HOUSEHOLD MEMBERS
OTHMEMB
(name/you) ALSO covered by (plan type)?
2 No
COVWHO
PROBE: Anyone else?
1-16 Person 1 through 16's name
96 All persons listed
SAMEMNTHS
This question refers to (plan type)
2 None covered from January 2015 until now
MNTHS P(1-16)M
This question refers to (plan type)
2 February 2015
3 March 2015
4 April 2015
5 May 2015
6 June 2015
7 July 2015
8 August 2015
9 September 2015
10 October 2015
11 November 2015
12 December 2015
13 January 2016
14 February 2016
15 March 2016
16 April 2016
20 All months from January 2015 until now
21 No months from January 2015 until now
OTHOUT
2 No
OTHWHO
Mark all that apply
2 19-25 years old
3 Older than 25
6.6 ADDITIONAL PLANS
ADDGAP
READ IF NECESSARY: Do not include plans that cover only one type of care, such as dental or vision plans.
2 No
ADDOTH
READ IF NECESSARY: Do not include plans that cover only one type of care, such as dental or vision plans.
2 No
6.7 EMPLOYER-SPONSORED INSURANCE OFFERS AND TAKEUP
ESIINTRO
OFFER
2 No
COULD
2 No
WNTAKE
Choose all that apply
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
WNELIG
Choose all that apply
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
6.8 HEALTH STATUS
HealthStatus Intro
HealthStatus
2 Very good
3 Good
4 Fair
5 Poor
6.9 MEDICAL EXPENDITURES
MedExp Intro
Press 1 to Continue
HIPREM
(your/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.)
________________
MEDAMT
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.
________________
OTCMEDAMT
[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.
If unsure of the amount, a best guess is acceptable.
________________
7 EMPLOYER'S PENSION PLAN
Q74a
2 No
Q74b
2 No
8 LOW INCOME ITEMS
8.1 SCHOOL LUNCHES
Q80
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Q83
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
8.2 PUBLIC HOUSING
Q85
2 No
Q86
2 No
SPHS8
2 Some other government program
3 Not sure
8.3 WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC)
SWRWIC
2 No
SWRW
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
8.4 ENERGY ASSISTANCE
Q93
In 2015, (have you/has this household) received assistance of this type from the federal, state, or local government?
2 No
Q93pr1
2 No
Q93pr2
2 No
Q94
________________
Q94rn1
less than $1,000
between $1,000 and $3,000
or over $3,000
in energy assistance during 2015?
2 Between $1,000 and $3,000
3 Over $3000
Q94rn2
less than $100
between $100 and $500
or over $500
in energy assistance during 2015?
2 Between $100 and $500
3 Over $500
9 MIGRATION
9.1 5-Year Migration
M5GSAM
2 No, different house in U.S.
3 No, outside the U.S.
M5GPLC
Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME
M5GSTA
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
Zip Code
Current: (zip)
Enter correct Zip Code or press ENTER for SAME
M5GCLM
2 No, outside city limits or post office name only
M5GCOU
Enter "IND CITY" if an independent city, not a county
S M5GCN1
M5GM
person's name/you) five years ago?
PROBE: Anyone else?
Enter all that apply, separate using the space bar or a comma.
N5TSAM
2 No, different house in U.S.
3 No, outside the U.S.
N5TPLC
Name of city/town/post office
Current: (city) Enter correct city/town/post office or
Press ENTER for SAME
N5TSTA
Where did (name/you) live five years ago?
Name of State
Current: (state)
Enter correct State or press ENTER for SAME
N5TZIP
Zip Code Current: (zip)
Enter correct zip code or
Press ENTER for SAME
N5TCLM
2 No, outside city limits or post office name only
N5TCOU
Enter "IND CITY" if an independent city, not a county
N5TCN1
9.2 1-Year Migration
MIGSAM
5 No, different house in U.S.
6 No, outside the U.S.
MIGPLC
Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME
MIGSTA
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
MIGCLM
4 No, outside city limits or post office name only
MIGCOU
Enter "IND CITY" if an independent city, not a county
S MIGCN1
MI1RES
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
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
MIGALL
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?
2 No, some or all did not live with (reference person's name/you)
MIGM
person's name/you) one year ago?
PROBE: Anyone else?
Enter all that apply, separate using the space bar or a comma.
NXTSAM
5 No, different house in U.S.
6 No, outside the U.S.
NXTPLC
Name of city/town/post office
Current: (city) Enter correct city/town/post office or
Press ENTER for SAME
NXTSTA
Where did (name/you) live one year ago?
Name of State
Current: (state)
Enter correct State or press ENTER for SAME
NXTZIP
Zip Code Current: (zip)
Enter correct zip code or
Press ENTER for SAME
NXTCLM
4 No, outside city limits or post office name only
NXTCOU
Enter "IND CITY" if an independent city, not a county
S NXTCN1
NX1RES
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
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)
NXT1OTH
SUNITS
How many housing units are in your building?
2 Two
3 Three or four
4 Five to nine
5 Ten or more
10 SUPPLEMENTAL POVERTY MEASURE
10.1 PROPERTY VALUE/PRESENCE OF MORTGAGE
VALPROP
would sell for if it were for sale?
________________
VALPROPR
would sell for:
less than $100,000
between $100,000 and $250,000
between $250,000 and $500,000
or $500,000 or more?
2 Between $100,000 and $250,000
3 Between $250,000 and $500,000
4 $500,000 or more
MORTYN
2 No
SMORTYN
2 Yes, second mortgage.
3 Yes, second mortgage and home equity loan.
4 No
10.2 CHILD CARE
Q95
Did (you/ anyone in this household) PAY for the care of (your/their) (child/children)
while (you/they) worked in 2015?
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.
2 No
Q95A
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter 96 for All persons
CCFREQ
household) paid for child care while (you/they) worked in 2015: weekly, every other
week, twice a month, monthly, or yearly?
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
CCAMT
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
(you/they) make during 2015?
CCTOT
2 No
CCEST
while (you/they) worked in 2015?
10.3 CHILD SUPPORT PAID
CSPCHILD
2 No
CSPWHO
Enter line number
Enter all that apply, separate using the space bar or a comma.
CSPREQ
2 No
CSPAMT
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
1) High-range income follow-up brackets:
? Between $45,000 and $60,000
? $60,000 or more
? Between $15,000 and $30,000
? $30,000 or more
? Between $10,000 and $20,000
? $20,000 or more
? Between $1,000 and $5,000
? $5,000 or more
? Between $1,000 and $3,000
? $3,000 or more
? Between $100 and $500
? $500 or more
[NOTE: CPS DOCUMENTATION INCLUDES A TABLE THAT IS NOT SHOWN ON THIS ENUMERATION FORM]
Income Source and Follow-Up Question Range Level