K1. CHECK RTYPE: Is RTYPE...

NAME'S PARENT OR GUARDIAN 01 *Continue*

NAME HIM/HER SELF 02 *Go to K71*

PROXY FOR NAME 03 *Go to K71*

CP, YP

MPR

K2. In addition to earnings from work, families often receive other
income from the government, from private institutions, or from their own
savings. I would like to ask you a few questions about all other sources
of income received in (LAST MONTH) by members of your family, including
(INSERT NAMES OF HOUSEHOLD MEMBERS FROM A42).

In (LAST MONTH) did anybody receive payments from the welfare office,
including Emergency Assistance?

Además de las ganacias por trabajar, las familias con frecuencia reciben
otras ingresos del gobierno, de instituciones privadas, o de sus propios
ahorros. Le gustari'a hacer algunas preguntas acerca de todas las otras
fuentes de ingresos recibidos en (LAST MONTH) por miembros de su familia
incluso (INSERT NAMES OF HOUSEHOLD MEMBERS FROM A42).

En (LAST MONTH), ¿alguien recibió pagos de la oficina del Bienestar
Público (welfare office), incluyendo Asistencia de Emergencia (Emergency
Assistance)?

PROBE: This includes money that you or others may have received from
participating in a work or training activity.

> PROBE: Esto incluye dinero que Ud. u otros quizás recibieron por
> participar en una actividad de trabajo o entrenamiento.
>
> YES 01
>
> ![](media/image1.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (receiving welfare)

Created

K3. Who in your household received the payments from the welfare office?

¿Quién en su hogar recibió pagos de la oficina del Bienestar Público
(welfare)?

PROBE: To whom was the payment made?

PROBE: ¿A quién le dieron el pago?

> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN THE FIRST POSITION).

*Code all that apply*

(NAME) 01

RESPONDENT 02

![](media/image2.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K6*

REFUSED r *Go to K6*

CP, YP (receiving welfare)

MPR

K4. (FILL "WERE YOU" IF K3=02; "WAS (INSERT RECIPIENT'S NAME)" IF
K3=01,03-14; "WAS THAT PERSON" IF K3=15) required to work, attend school
or training, look for work, or anything else in order to receive these
benefits?

¿Fue (FILL "UD." IF K3=02; "INSERT RECIPIENT'S NAME" IF K3=01,03-14; "
esa persona" IF K3=15) requerida(o) a trabajar, a asistir a una escuela
o entrenamiento, a buscar trabajo, o hacer cualquier otra cosa, para
poder recibir estos beneficios?

> PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K3.
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (receiving welfare)

MPR

K5. How much in total (FILL "DID YOU" IF K3=02; "DID (INSERT RECIPIENT'S
NAME)" IF K3=01,03-14; "DID THAT PERSON" IF K3=15) receive in welfare
payments in (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K3=02; "(INSERT RECIPIENT'S
NAME)" IF K3=01,03-14; "Esa persona" IF K3=15) en pagos del bienestar
público (welfare) en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K3.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-2,000)

> DON'T KNOW d
>
> REFUSED r

CP, YP

MPR

K6. In (LAST MONTH) did anybody in your household receive any **other**
kind of welfare assistance, such as help with getting a job, placement
in education or training programs, or help with transportation or child
care?

> En (LAST MONTH), ¿recibió cualquier persona en su hogar cualquier
> **otro** tipo de asistencia del bienestar público (welfare), tal como
> ayuda para encontrar un empleo, colocación en programas de educación o
> entrenamiento, o ayuda en transporte o con el cuidado de niños (child
> care)?

PROBE: Please include only assistance received through welfare.

PROBE: Por favor incluya sólo asistencia recibida por bienestar público.

> YES 01
>
> ![](media/image3.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (receiving other welfare assistance)

Created

K7. Who in the household received this help?

¿Quién en el hogar recibió esta ayuda?

> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION).

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image4.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

CP, YP

NSAF

K8. In (LAST MONTH) did anybody in your household receive any payments
from your state's general assistance program?

En (LAST MONTH), ¿alguien recibió algún pago del programa de asistencia
general (general assistance) de su estado?

PROBE: Low income persons and families that meet the eligibility
criteria for

General Assistance programs receive a monthly financial benefit from the
state to

help cover basic needs such as rent, food, and clothing.

> PROBE: Las personas de ingresos bajos y las familias que cumplen los
> criterios de eligibilidad para programas de asistencia general reciben
> un beneficio financiero mensual para ayudar a cubrir necesidades
> básicas tales como alquiler, comida y ropa.
>
> YES 01
>
> ![](media/image5.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (receiving state general assistance payments)

Created

K9. To whom in the household was the general assistance program payment
made?

¿A quién en el hogar, le dieron el pago del programa de asistencia
general (general assistance)?

> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBER FROM A42,
> EXCLUDING THE RESPONDENT (IN THE FIRST POSITION).

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image6.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K11*

REFUSED r *Go to K11*

CP, YP (receiving state general assistance payments)

NSAF

K10. How much in total (FILL "DID YOU" IF K9=02; "DID (INSERT
RECIPIENT'S NAME)" IF K9=01,03-14; "DID THAT PERSON" IF K9=15) receive
in general assistance payments in (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K9=02; "(INSERT RECIPIENT'S
NAME)" IF K9=01,03-14; "Esa persona" IF K9=15) en pagos de asistencia
general en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K9.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-2,000)

DON'T KNOW d

REFUSED r

CP, YP

NSAF

K11. In (LAST MONTH) did anybody in your household receive any Food
Stamps?

En (LAST MONTH), ¿recibió cualquier persona en su hogar Cupones de
Alimentos (Food Stamps)?

> YES 01
>
> ![](media/image7.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (receiving food stamps)

Created

K12. Who in the household received Food Stamps?

¿Quién en su hogar recibió Cupones de Alimentos (Food Stamps)?

PROBE: Who was authorized to receive Food Stamps last month?

> PROBE: ¿Quién estaba autorizada(o) para recibir Cupones de Alimentos
> (Food Stamps) el mes pasado?
>
> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION).

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image8.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K15*

REFUSED r *Go to K15*

CP, YP (receiving food stamps)

NSAF

K13. Were the Food Stamp benefits (FILL "YOU RECEIVED" IF K12=02; "NAME
RECEIVED" IF K12=01,03 -- 14; "THAT PERSON RECEIVED" IF K12=15) for both
adults and children, or just children?

¿Eran los beneficios de Cupones de Alimentos (Food Stamps) que (FILL
"UD. " IF K12=02, "(INSERT RECIPIENT'S NAME)" IF K12=01,03-14; "Esa
persona" IF K12=15) recibió para ambos adultos y niños o sólo para
niños?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K12.

ADULTS AND CHILDREN 01

JUST CHILDREN 02

DON'T KNOW d

REFUSED r

CP, YP (receiving food stamps)

NSAF

K14. How much in total (FILL "DID YOU" IF K12=02; "DID (INSERT
RECIPIENT'S NAME)" IF K12=01,03-14; "DID THAT PERSON" IF K12=15) receive
in Food Stamps in (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K12=02; "INSERT RECIPIENT'S
NAME" IF K12=01,03-14; "Esa persona" IF K12=15) en Cupones de Alimentos
en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K12.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-2,000)

> DON'T KNOW d

REFUSED r

CP, YP

NSAF

K15. In (LAST MONTH) did anybody **receive** any child support payments?

En (LAST MONTH), ¿**recibió** alguien algún pago de mantenimiento de
niños (child support)?

> INTERVIEWER: Alternative words for "child support" are "pensión
> alimenticia," "manutención infantil" and "manutención de niños"
>
> YES 01
>
> ![](media/image9.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (receiving child support payments)

Created

K16. Who in the household received child support payments last month?

> ¿Quién en el hogar recibió pagos de mantenimiento de niños (child
> support) el mes pasado?
>
> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION).

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image10.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K18*

REFUSED r *Go to K18*

CP, YP (receiving child support payments)

K17. How much in total (FILL "DID YOU" IF K16=02; "DID (INSERT
RECIPIENT'S NAME)" IF K16=01, 03-14; "DID THAT PERSON" IF K16=15)
receive in child support in (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K16=02; "INSERT RECIPIENT'S
NAME" IF K16=01,03-14; "Esa persona" IF K16=15) en pagos de
mantenimiento de niños en (LAST MONTH)?

> PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K16.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

CP, YP

Created

K18. Regardless of whether or not you received payments, are you
**owed** any child support payments for (NAME)?

Sin reparar en si o no recibió pagos, ¿se le debe a Ud. cualquier pago
de mantenimiento de niños (child support) para (NAME)?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

NSAF

K19. In (LAST MONTH) did anybody receive any foster care payments?

> En (LAST MONTH), ¿recibió alguien algún pago para cuidado de crianza
> (foster care)?
>
> YES 01
>
> ![](media/image11.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (receiving foster care payments)

Created

K20. Who in the household received foster care payments for a foster
child last month?

> ¿Quién en su hogar recibió algún pago para cuidado de crianza (foster
> care) el mes pasado?
>
> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION) AND HOUSEHOLD MEMBERS
> UNDER THE AGE OF 18.

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image12.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K22*

REFUSED r *Go to K22*

CP, YP (receiving foster care payments)

NSAF

K21. How much in total (FILL "DID YOU" IF K20=02; "DID (INSERT
RECIPIENT'S NAME)" IF K20=01,03-14; "DID THAT PERSON" IF K20=15) receive
in foster care in (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K20=02; "INSERT RECIPIENT'S
NAME" IF K20=01,03-14; "Esa persona" IF K20=15) para cuidado de crianza
(foster care) en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K20.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-1,000)

DON'T KNOW d

REFUSED r

CP, YP

Created/NSAF

K22. In (LAST MONTH) did anybody in your household, not counting (NAME),
receive any payments from the Supplemental Security Income program, or
SSI?

En (LAST MONTH), ¿alguien en su hogar, ademas de (NAME) recibió algún
pago del programa de Seguridad de Ingreso Suplementario (Supplemental
Security Income), o SSI?

PROBE: SSI, or Supplemental Security Income provides monthly payments to
aged, blind, or disabled people with limited income and resources or
assets. Federal SSI checks are either automatically deposited in the
bank or mailed to arrive on the first of every month. If mailed, they
are sent in a blue colored envelope.

PROBE: SSI, o Seguridad de Ingreso Suplementario proporciona pagos
mensuales a personas ancianas, ciegas o incapacitadas con ingresos,
recursos, o bienes limitados. Cheques federales de SSI son depositados
automáticamente en el banco, o enviados por correo, para llegar el
primero de cada mes. Cuando son enviados por correo, vienen en un sobre
de color azul.

> YES 01 *Continue*
>
> ![](media/image13.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (someone else in household receives SSI)

Created

K23. Who in the household, besides (NAME), received SSI payments last
month?

¿Quién en su hogar, además de (NAME) recibió un pago de SSI el mes
pasado?

> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION).

*Code all that apply*

RESPONDENT 02

![](media/image14.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K25*

REFUSED r *Go to K25*

CP, YP (someone else in household receives SSI)

NSAF

K24. How much in total (FILL "DID YOU" IF K23=02; "DID (INSERT
RECIPIENT'S NAME)" IF K23=03-14; "DID THAT PERSON" IF K23=15) receive in
SSI payments (LAST MONTH), not counting payments for (NAME), if any?

¿Cuánto, en total, recibió (FILL "UD." IF K23=02; "INSERT RECIPIENT'S
NAME" IF K23=03-14; "Esa persona" IF K23=15) en pagos de SSI en (LAST
MONTH) sin contar pagos para (NAME) si los hubo?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K23.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-1,000)

DON'T KNOW d

REFUSED r

CP, YP

NSAF

K25. In (LAST MONTH) did anyone in the household receive any social
security payments? These include retirement benefits, survivor's
benefits, or social security

disability insurance, also known as SSDI.

En (LAST MONTH), ¿recibió cualquier persona en el hogar algún pago de
seguro social (Social Security)? Estos incluyen beneficios de
jubilación, beneficios de sobrevivientes (survivor's benefits), o seguro
de incapacidad de seguro social (Social Security Disability Insurance),
también conocido por las siglas en inglés SSDI.

PROBE: SSDI is different from SSI because SSDI is based on a person's
past work history and not his or her financial need.

PROBE: SSDI es distinto de SSI porque SSDI se base en la historia de
trabajo de una persona en el pasado, y no en su necesidad financiera.

> YES 01
>
> ![](media/image15.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (someone in household receives other SSI payment)

Created

K26. Who in the household received other social security payments last
month?

¿Quién en el hogar recibió otros pagos de seguro social, el mes pasado?

> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION).

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image16.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K29*

REFUSED r *Go to K29*

CP, YP (someone in household receives other SSI payment)

Created

K27. What kind of social security payment did (FILL "YOU RECEIVE" IF
K26=02; "NAME RECEIVE" IF K26=01, 03 -- 14; "THAT PERSON RECEIVE" IF
K26=15) Was it...

> ¿Qué tipo de pago de seguro social recibió (FILL "UD." IF K26=02;
> "INSERT RECIPIENT'S NAME" IF K26=01, 03-14; "Esa persona" IF K26=15)
> ¿Fue...

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K26.

*Read list, code all that apply*

Retirement benefits 01

Survivor's benefits 02

Social security disability insurance, or SSDI 03

Supplemental Security Income (SSI) 04

Beneficios de jubilación (Retirement ) 01

Beneficios de Sobrevivientes (Survivors) 02

Seguro de Incapacidad del Seguro Social

Social security disability insurance, o SSDI 03

Seguridad de Ingreso Suplementario (SSI) 04

DON'T KNOW d

REFUSED r

CP, YP (someone in household receives other SSI payment)

NSAF

K28. How much in total did (FILL "YOU RECEIVE" IF K26=02; "NAME RECEIVE"
IF K26=01, 03 -- 14; "THAT PERSON RECEIVE" IF K26=15) receive in other
social security payments (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K26=02; "INSERT RECIPIENT'S
NAME" IF K26=01, 03-14; "Esa persona" IF K23=15) en otros pagos de SSI
en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K26.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

CP, YP

NSAF

K29. In (LAST MONTH) did anybody in your household receive any kind of
pension or annuity payment?

En (LAST MONTH), ¿recibió cualquier persona en el hogar algún tipo de
pensión o pago de una anualidad (annuity)?

PROBE: An annuity is a fixed monthly payment for a fixed period of time.
Sources of annuity payments are often retirement accounts, insurance
settlements, or lottery winnings.

PROBE: Una anualidad es un pago mensual fijo, por un periodo de tiempo
fijo. Muchas veces, las fuentes de pagos de anualidades son cuentas de
jubilación, pagos de seguros, o ganancias de loterías.

> ![](media/image17.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (someone in household receives pension/annuity payments)

Created

K30. Who in the household received pension or annuity payments last
month?

¿Quién en el hogar recibió pagos de pensión o de anualidad (annuity) el
mes pasado?

> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION).

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image18.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> DON'T KNOW d *Go to K32*
>
> REFUSED r *Go to K32*

CP, YP (someone in household receives pension/annuity payments)

NSAF

K31. How much in total did (FILL "YOU RECEIVE" IF K30=02; "NAME RECEIVE"
IF K30=01,03 -- 14; "THAT PERSON RECEIVE" IF K30=15) in pension or
annuity payments (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K30=02; "INSERT RECIPIENT'S
NAME" IF K30=01, 03-14; "Esa persona" IF K30=15) en pagos de pensión o
de anualidad en (LAST MONTH)

> PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K30.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

> DON'T KNOW d
>
> REFUSED r

CP, YP

NSAF

K32. In (LAST MONTH) did anybody in your household receive payments from
any other sources not mentioned, such as alimony, contributions from
family or friends, VA payments, worker's compensation, or unemployment
compensation?

En (LAST MONTH), ¿recibió cualquier persona en el hogar algún pago de
cualquier otra fuente que no fue mencionada, tal como de pensión de
divorcio (alimony), contribuciones de familia o amistades, pagos de
veteranos (VA), compensación de trabajadores (worker's compensation), o
compensación de desempleo (unemployment)?

> ![](media/image19.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP (someone in household receives other payments)

Created

K33. Who in the household received these payments?

¿Quién en su hogar recibió estos pagos?

> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O3)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A42,
> EXCLUDING THE RESPONDENT (IN FIRST POSITION).

*Code all that apply*

RESPONDENT 01

(NAME) 02

![](media/image20.wmf) LIST HOUSEHOLD MEMBERS 03-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K35*

REFUSED r *Go to K35*

CP, YP (someone in household receives other payments)

NSAF

K34. How much in total did (FILL "YOU RECEIVE" IF K33=02; "NAME RECEIVE"
IF K33=01, 03 -- 14; "THAT PERSON RECEIVE" IF K33=15) in (LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K33=02; "INSERT RECIPIENT'S
NAME" IF K33=01, 03-14; "Esa persona" IF K33=15) en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K33.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

CP, YP

Created

K35. For the purpose of this survey, it is important to learn the total
income received by all members of your household in (LAST MONTH). This
includes money from jobs, and from the sources we just talked about.
What was your household's total income last month before taxes and
deductions? (IF K11=01, RECEIVING FOOD STAMPS, FILL "Do not include the
value of your food stamps.")

Para los propósitos de esta encuesta, es importante aprender cuales
fueron los ingresos, en total, que recibieron todos los miembros de su
hogar en (LAST MONTH). Esto incluye dinero de empleos, y de las fuentes
de las cuales acabamos de hablar. ¿Cuál fue el ingreso total del mes
pasado, antes de impuestos y deducciones? (IF K11=01, RECEIVING FOOD
STAMPS, FILL "Por favor no incluya el valor de sus Cupones de Alimentos
(Food Stamps).")

PROBE: Include money from all sources and for all members of your
household.

PROBE: Incluya dinero de todas las fuentes, y de todos los miembros de
su hogar.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-99,999)  *Go to K37*

DON'T KNOW d

REFUSED r

CP, YP

Created

K36. In (LAST MONTH), would you say your household's monthly income was:

En (LAST MONTH), ¿diría Ud. que el ingreso mensual de su hogar fue:

A. below or above \$500?

> A. menos o más de \$500?
>
> BELOW 01  *Go to K37*
>
> AT OR ABOVE 02
>
> DON'T KNOW d *Go to K37*
>
> REFUSED r *Go to K37*

B. below or above \$750?

> B. menos o más de \$750?
>
> BELOW 01
>
> AT OR ABOVE 02
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K37. Suppose for a minute that your family had an additional \$100 every
month to spend (IF K35=\> 0, FILL "that is, your monthly income was
(INSERT AMOUNT FROM K35 + \$100)"). How would you spend the additional
\$100?

Supóngase por un momento que cada mes, su familia tendría \$100
adicionales para gastar (IF K35\>0, FILL "o sea, que sus ingresos
mensuales serían (INSERT AMOUNT FROM K35+\$100)". ¿En qué gastaría Ud.
los \$100 adicionales?

*Do not read list, code all that apply*

> DISABILITY CARE, EQUIPMENT, OR
>
> SUPPLIES FOR (NAME) 01
>
> FOOD 02
>
> PERSONAL ITEMS (CLOTHING, TOYS, ETC.) 03
>
> HOUSING (MOVE INTO DIFFERENT HOME/
>
> FIX HOME) 04
>
> TRANSPORTATION (BUY A CAR/FIX CAR/
>
> BUY GAS) 05
>
> ENTERTAINMENT/LEISURE/TRAVEL 06
>
> DEBT REDUCTION 07
>
> SAVINGS 08
>
> HEALTH INSURANCE 09
>
> ![](media/image21.wmf) EDUCATION/TRAINING 10
>
> OTHER (SPECIFY) 11
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> ![](media/image22.wmf) DON'T KNOW d *Go to K40*
>
> REFUSED r *Go to K40*

CP, YP

K38. CHECK: Is more than one answer coded in K37?

YES 01 *Continue*

NO 00 *Go to K40*

CP, YP

Created

K39. What would you do first?

¿En qué cosa gastaría primero?

PROBE: What would be your first priority?

PROBE: ¿Cuál sería su primera prioridad?

*Do not read list, code only one answer*

> LIST RESPONSES FROM K37 01-11
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K40. Suppose for a minute that your family had \$100 less every month to
spend (IF K35=\>\$100, FILL "that is, your monthly income was (INSERT
AMOUNT FROM K35 - \$100)"). What would you do to get by?

Supóngase por un momento que cada mes, su familia tendría \$100 menos
para gastar (IF K35=\>\$100, FILL "o sea, que sus ingresos mensuales
serían INSERT AMOUNT FROM K35-\$100"). ¿Qué haría para arreglárselas?

> *Do not read list, code all that apply*

CUT BACK ON DISABILITY CARE,

EQUIPMENT OR SUPPLIES FOR (NAME) 01

CUT BACK ON FOOD 02

CUT BACK ON PERSONAL ITEMS

(CLOTHING, TOYS, ETC.) 03

MOVE TO NEW PLACE 04

CUT BACK ON ENTERTAINMENT/LEISURE 05

USE SAVINGS 06

GET A JOB/ GET A BETTER JOB 07

SEEK ASSISTANCE FROM GOVERNMENT 08

SEEK ASSISTANCE FROM FRIENDS,

FAMILY, CHARITY 09

COULDN'T DO IT/CAN'T HAPPEN 10

NO SPECIFIC THING/SPEND LESS ALL

![](media/image23.wmf) AROUND 11

OTHER (SPECIFY) 12

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K43*

REFUSED r *Go to K43*

CP, YP

K41. CHECK: Is more than one answer coded in K40?

YES 01 *Continue*

NO 00 *Go to K43*

CP, YP

Created

K42. What would you do first?

¿Qué haría primero?

> *Do not read list, code only one answer*
>
> LIST RESPONSES FROM K40 01-12
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K43. Now I'd like to ask about 1996. In 1996, (FILL "WHEN (NAME) WAS
AROUND (INSERT NAME'S AGE IN 1996)"; IF NOT BORN IN 1996, THEN BLANK),
did you have a spouse or partner living with you?

Ahora quiero hacer unas preguntas acerca de 1996. En 1996, (FILL "cuando
(NAME) tenía alrededor de los (INSERT NAME'S AGE IN 1996) años"; IF NOT
BORN IN 1996, THEN BLANK), ¿tenía Ud. un(a) esposo(a) o parejo(a),
viviendo con usted?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K44. As best you can remember, in 1996, (FILL "WHEN (NAME) WAS AROUND
(INSERT NAME'S AGE IN 1996)"; IF NOT BORN IN 1996, THEN BLANK) did
anybody in your household receive payments from the welfare office,
including Emergency Assistance? I'm not going to ask you the amount,
just whether or not anybody received it.

> Según lo que Ud. recuerda, en 1996, (FILL "cuando (NAME) tenía
> alrededor de los (INSERT NAME'S AGE IN 1996) años"; IF NOT BORN IN
> 1996, THEN BLANK) ¿cualquier persona en su hogar recibió pagos de la
> oficina del bienestar público household (welfare), incluyendo
> Asistencia de Emergencia (Emergency Assistance)? No le voy a preguntar
> la suma de dinero, sólo si alguien lo recibió o no lo recibió.
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K45. In 1996, did anybody in your household receive any payments from
your state's general assistance program?

En 1996, ¿cualquier persona en su hogar recibió algún pago del programa
de Asistencia General (general assistance) de su estado?

PROBE: Low income persons and families that meet the eligibility
criteria for

General Assistance programs receive a monthly financial benefit from the
state to

help cover basic needs such as rent, food, and clothing.

> PROBE: Las personas de ingresos bajos y las familias que cumplen los
> criterios de eligibilidad para programas de asistencia general reciben
> un beneficio financiero mensual para ayudar a cubrir necesidades
> básicas tales como alquiler, comida y ropa.
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K46. In 1996, did anybody in your household receive any food stamps?

> En 1996, ¿cualquier persona en su hogar recibió Cupones de Alimentos
> (Food Stamps)?
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K47. In 1996, did anybody in your household receive any child support
payments?

En 1996, ¿cualquier persona en su hogar recibió algún pago de
mantenimiento de niños (child support)?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K48. In 1996, did anybody in your household receive any foster care
payments?

> En 1996, ¿cualquier persona en su hogar recibió algún pago por cuidado
> de crianza (foster care)?
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K49. In 1996, did anybody in your household (if (NAME) born before 1996,
fill "besides (NAME)"; ELSE BLANK) receive any Supplemental Security
Income, or SSI payments?

En 1996, ¿cualquier persona en su hogar (IF (NAME) BORN BEFORE 1996,
FILL "además de (NAME)"; ELSE BLANK), recibió algún pago de Supplemental
Security Income (Seguridad de Ingreso Suplementario), o SSI?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K50. In 1996, did anybody in your household receive any other social
security payments?

These include retirement benefits, survivor's benefits, or social
security disability insurance, also known as SSDI.

En 1996, ¿cualquier persona en su hogar recibió algún otro pago del
Seguro Social? Estos incluyen beneficios de jubilación, beneficios de
sobrevivientes (survivor's benefits), o seguro de incapacidad de seguro
social (Social Security Disability Insurance), también conocido por las
siglas en inglés SSDI.

> PROBE: SSDI is different from SSI because SSDI is based on a person's
> past work history and not their financial need.

PROBE: SSDI es distinto de SSI porque SSDI se base en la historia de
trabajo de una persona en el pasado, y no en su necesidad financiera.

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K51. In 1996, did anybody in your household receive any other kind of
pension or annuity?

En 1996, ¿cualquier persona en su hogar recibió algún otro tipo de
pensión o anualidad (annuity)?

PROBE: An annuity is a fixed monthly payment you receive for a fixed
period of time. Sources are often retirement accounts, insurance
settlements, or lottery winnings.

PROBE: Una anualidad es un pago mensual fijo, por un periodo de tiempo
fijo. Muchas veces, las fuentes de pagos de anualidades son cuentas de
jubilación, pagos de seguros, o ganancias de loterías.

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

Created

K52. In 1996, did anybody in your household receive any payments from
any other sources not mentioned, such as alimony, contributions from
family or friends, VA payments, worker's compensation, or unemployment
compensation?

En 1996, ¿cualquier persona en su hogar recibió algún pago de cualquier
otra fuente que no fue mencionada, tal como de pensión de divorcio
(alimony), contribuciones de familia o amistades, pagos de veteranos
(VA), compensación de trabajadores (worker's compensation), o
compensación de desempleo (unemployment)?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

NSAF

K53. Now I'd like you to think about the past 12 months. In the past 12
months, were you or anyone in this household on WIC, the Women, Infants,
and Children's nutrition program?

> Ahora quiero que piense en los últimos 12 meses. En los últimos 12
> meses, ¿estaba Ud. o alguna persona en este hogar en el programa de
> nutrición de WIC, (Women, Infants, and Children's nutrition program)?
>
> YES 01
>
> NO 00
>
> DON'T KNOW d

REFUSED r

CP, YP

NSAF

K54. In the past 12 months, did this household receive any energy
assistance from the federal, state, or local government?

En los últimos 12 meses, ¿recibió este hogar alguna asistencia de
energia (energy assistance) del gobierno federal, estatal, o local?

PROBE: Energy assistance is help paying your utility bills.

> PROBE: Asistencia de energia (Energy assistance) es ayuda para pagar
> las
>
> cuentas de las utilidades.
>
> YES 01
>
> NO 00
>
> DON'T KNOW d

REFUSED r

CP, YP

NSAF

K55. In the past 12 months, did any of the children living with you
receive free or reduced price school lunches because they qualified for
the Federal School Lunch Program?

En los últimos 12 meses, ¿recibió cualquiera de los niños que viven con
Ud. almuerzos en la escuela, gratis o a precio reducido, porque estaban
calificados para el Federal School Lunch Program (Programa Federal de
Almuerzos de Escuela)?

> YES 01
>
> NO 00
>
> CHILD(REN) NOT IN SCHOOL 02
>
> DON'T KNOW d

REFUSED r

CP, YP

Created (Source: SSI application)

K56. Next I'd like to ask about your household's assets. These are
resources that you (FILL "AND YOUR SPOUSE" IF B2=01; "AND YOUR PARTNER"
IF B2=02; ELSE BLANK) have and could turn into cash.

In (LAST MONTH), did you (FILL "AND YOUR SPOUSE" IF B2=01; "AND YOUR
PARTNER" IF B2=02; ELSE BLANK) have, either separately or with someone
else, any of the following items?

Ahora le quiero preguntar acerca de los bienes (assets) de su hogar.
Estos son recursos que le(s) pertenecen a Ud. (FILL "y su esposo(a)" IF
B2=01; "Y SU PAREJO(A)" IF B2=02; ELSE BLANK), y podrían convertir a
dinero en efectivo.

En (LAST MONTH), ¿le(s) pertenecían a Ud. (FILL "Y A su esposo(a)" IF
B2=01; Y A SU "PAREJO(A))" IF B2=02; ELSE BLANK), sólo(s) o con alguien
más, cualquiera de las siguientes cosas?

> *Read list, mark yes or no for each. If yes, follow-up with value.*

+----------------------------+-----------------+-----------------------+
| ITEM                       |                 | At the end of (LAST   |
|                            |                 | MONTH), what was the  |
|                            |                 |                       |
|                            |                 | value of your (FILL   |
|                            |                 | "AND YOUR SPOUSE'S"   |
|                            |                 | IF                    |
|                            |                 |                       |
|                            |                 | B2=01; "AND YOUR      |
|                            |                 | PARTNER'S" IF B2=02;  |
|                            |                 | ELSE BLANK) (INSERT   |
|                            |                 | ITEM)?                |
|                            |                 |                       |
|                            |                 | ¿Cuál era el valor de |
|                            |                 | sus (INSERT ITEM) de  |
|                            |                 | Ud. (FILL "Y DE su    |
|                            |                 | esposo(a)" IF B2=01;  |
|                            |                 | "Y DE SU PAREJO(A)"   |
|                            |                 | IF B2=                |
|                            |                 |                       |
|                            |                 | 02; ELSE BLANK), al   |
|                            |                 | fin de (LAST MONTH)?  |
+============================+=================+=======================+
| A. Checking accounts       | YES 01          | \$\_\_\_              |
|                            |                 | \_\_\_\_\_\_\_\_\_.00 |
| Sus cuentas de cheque      | NO 00           |                       |
|                            |                 | (0-10,000) IF DK/RF:  |
| (Checking accounts)        | DON'T KNOW d    | Was it above or below |
|                            |                 | \$500?                |
|                            | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
|                            |                 | \$500?                |
|                            |                 |                       |
|                            |                 | \$500                 |
|                            |                 | +..............01     |
|                            |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused               |
|                            |                 | .........\...r        |
+----------------------------+-----------------+-----------------------+
| B. Savings accounts        | YES 01          | \$\_\_\_              |
|                            |                 | \_\_\_\_\_\_\_\_\_.00 |
| Sus cuentas de ahorros     | NO 00           |                       |
|                            |                 | (0-100,000) IF DK/RF: |
| (Savings accounts)         | DON'T KNOW d    | Was it above or below |
|                            |                 | \$500?                |
|                            | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
|                            |                 | \$500?                |
|                            |                 |                       |
|                            |                 | \$500                 |
|                            |                 | +..............01     |
|                            |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| C. Certificates of         | YES 01          | \$\_\_\_              |
| deposit, notes,            |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| stocks, mutual funds, or   |                 | (0-100,000) IF DK/RF: |
|                            | DON'T KNOW d    | Was it above or below |
| bonds                      |                 | \$500?                |
|                            | REFUSED r       |                       |
| > Sus certificados de      |                 | ¿Era más o menos de   |
| > depósitos, notas         |                 | \$500?                |
| > bancarias, títulos de    |                 |                       |
| > valores, acciones o      |                 | \$500                 |
| > "stocks", fondos         |                 | +..............01     |
| > mutuales, o bonos        |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| D. Cash at home with you   | YES 01          | \$\_\_\_              |
| or                         |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| someone else               |                 | (0-100,000) IF DK/RF: |
|                            | DON'T KNOW d    | Was it above or below |
| Su dinero en efectivo      |                 | \$500?                |
| (cash)                     | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
| en su casa con Ud.o en     |                 | \$500?                |
|                            |                 |                       |
| manos de otra persona      |                 | \$500                 |
|                            |                 | +..............01     |
| PROBE: All the cash you    |                 |                       |
|                            |                 | \< \$500              |
| have, that is not in the   |                 | .............02       |
| bank.                      |                 |                       |
|                            |                 | Don't Know ........d  |
| PROBE: Todo el dinero que  |                 |                       |
|                            |                 | Refused ............r |
| tiene, lo que no está en   |                 |                       |
| el                         |                 |                       |
|                            |                 |                       |
| banco.                     |                 |                       |
+----------------------------+-----------------+-----------------------+
| E. Household or personal   | YES 01          | \$\_\_\_              |
| items                      |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| worth more than \$500 each |                 | (0-100,000) IF DK/RF: |
|                            | DON'T KNOW d    | Was it above or below |
| Sus artículos personales o |                 | \$500?                |
| del                        | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
| hogar con valor de más de  |                 | \$500?                |
|                            |                 |                       |
| \$500 cada uno             |                 | \$500                 |
|                            |                 | +..............01     |
|                            |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| F. Money set aside for     | YES 01          | \$\_\_\_              |
| burial                     |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| expenses such as burial    |                 | (0-20,000) IF DK/RF:  |
|                            | DON'T KNOW d    | Was it above or below |
| contracts, trusts, or      |                 | \$500?                |
|                            | REFUSED r       |                       |
| agreements                 |                 | ¿Era más o menos de   |
|                            |                 | \$500?                |
| Su dinero reservado para   |                 |                       |
|                            |                 | \$500                 |
| gastos de entierro, tales  |                 | +..............01     |
|                            |                 |                       |
| como contratos de          |                 | \< \$500              |
| entierro, o                |                 | .............02       |
|                            |                 |                       |
| arreglos fiduciarios de    |                 | Don't Know ........d  |
| Ud.                        |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| G. Any other items that    | YES 01          | \$\_\_\_              |
| could be                   |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| turned into cash,          |                 | (0-100,000) IF DK/RF: |
| excluding                  | DON'T KNOW d    | Was it above or below |
|                            |                 | \$500?                |
| cars or other vehicles and | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
| your home itself, if you   |                 | \$500?                |
| own it.                    |                 |                       |
|                            |                 | \$500                 |
| Cualquier otro artículo    |                 | +..............01     |
| que                        |                 |                       |
|                            |                 | \< \$500              |
| puede ser convertido a     |                 | .............02       |
| dinero                     |                 |                       |
|                            |                 | Don't Know ........d  |
| en efectivo, sin incluir   |                 |                       |
| carros                     |                 | Refused               |
|                            |                 | .........\...r        |
| u otros vehículos y su     |                 |                       |
| casa, si                   |                 |                       |
|                            |                 |                       |
| Ud. es (la/el) dueña(o).   |                 |                       |
+----------------------------+-----------------+-----------------------+

CP, YP

Created

K57. How many cars or other vehicles do you (FILL "AND YOUR SPOUSE" IF
B2=01; "AND YOUR PARTNER" IF B2=02; ELSE BLANK) own, if any?

> ¿Cuántos carros le(s) pertenecen a Ud. (FILL "Y A su esposo(a)" IF
> B2=01; "Y A SU PAREJO(A)" IF B2=02; ELSE BLANK), si los hay?

PROBE: Do not include cars or other vehicles that are leased.

PROBE: No incluya carros u otros vehículos que se arrendan

> 0 00 *Go to K64*
>
> 1 01 *Continue*
>
> 2 or more 02 *Go to K60*
>
> DON'T KNOW d *Go to K64*

REFUSED r  *Go to K64*

CP, YP (household w/one car)

Created

K58. What is the estimated value of that car?

¿Cuál es el valor estimado de ese carro?

PROBE: How much could you sell it for?

PROBE: ¿Por cuánto lo podría vender?

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| ESTIMATED VALUE (0-40,000)

> DON'T KNOW d

REFUSED r

CP, YP (household w/one car)

Created

K59. About how much money do you owe on that car, if any?

Más o menos, ¿cuánto aún debe por ese carro, si aún tiene deuda?

PROBE: Your best guess is fine.

PROBE: Una aproximación está bien.

ENTER "00,000" if car is paid for

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| (0-40,000)  *Go to K64*

> DON'T KNOW d *Go to K64*

REFUSED r *Go to K64*

CP, YP (household w/more than one car)

Created

K60. Please think about your oldest car. What is the estimated value of
that car?

> Por favor piense en su carro más viejo. ¿Cuál es el valor estimado de
> ese carro?

PROBE: How much could you sell it for?

PROBE: ¿Por cuánto lo podría vender?

> \$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| ESTIMATED VALUE (0-40,000)
>
> DON'T KNOW d

REFUSED r

CP, YP (household w/more than one car)

Created

K61. About how much money do you owe on that car, if any?

Más o menos, ¿cuánto aún debe por ese carro, si aún tiene deuda?

PROBE: Your best guess is fine.

PROBE: Una aproximación está bien.

ENTER "00,000" if car is paid for

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| (0-40,000)

> DON'T KNOW d

REFUSED r

CP, YP (household w/more than one car)

Created

K62. Please think about your next oldest car. What is the estimated
value of that car?

Por favor piense en su siguiente carro más viejo. ¿Cuál es el valor
estimado de ese carro?

PROBE: How much could you sell it for?

PROBE: ¿Por cuánto lo podría vender?

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| ESTIMATED VALUE (0-40,000)

> DON'T KNOW d

REFUSED r

CP, YP (household w/more than one car)

Created

K63. About how much money do you owe on that car, if any?

Más o menos, ¿cuánto aún debe por ese carro, si aún tiene deuda?

PROBE: Your best guess is fine.

PROBE: Una aproximación está bien.

ENTER "00,000" if car is paid for

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| (0-40,000)

> DON'T KNOW d

REFUSED r

CP, YP

K64. CHECK NAME'S AGE: IS NAME...

> 16+ 01 *Continue*

\<16 00 *Go to K68*

CP, YP (age 16+)

Created

K65. Does (NAME) own a car?

¿Tiene (NAME) su propio carro?

> YES 01
>
> ![](media/image24.wmf)NO 00
>
> DON'T KNOW d

REFUSED r

CP, YP (name owns a car)

Created

K66. What is the estimated value of that car?

¿Cuál es el valor estimado de ese carro?

PROBE: How much could you sell it for?

PROBE: ¿Por cuánto lo podría vender?

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| ESTIMATED VALUE (0-40,000)

> DON'T KNOW d

REFUSED r

CP, YP (name owns a car)

Created

K67. About how much money is owed on that car, if any?

Más o menos, ¿cuánto aún debe por ese carro, si aún tiene deuda?

> PROBE: Your best guess is fine.
>
> PROBE: Una aproximación está bien.
>
> ENTER "00,000" if car is paid for.

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| (0-40,000)

> DON'T KNOW d

REFUSED r

CP, YP

MEPS (modified)

K68. Do you (FILL "AND YOUR SPOUSE" IF B2=01; "AND YOUR PARTNER" IF
B2=02; ELSE BLANK) have debts such as credit card balances, medical
debts, life insurance policy loans, loans from relatives, and so forth?
Do not include mortgage debt or money you owe for motor vehicles.

¿Tiene Ud. (FILL "Y su esposo(a)" IF B2=01; Y SU "PAREJO(A))" IF B2=02;
ELSE BLANK) deudas tales como de balances de tarjetas de crédito (credit
card), deudas médicas, préstamos de pólizas de seguro de vida (life
insurance), préstamos de parientes o familiares, etc.? Por favor no
incluya deudas por hipotecas (mortgage) o dinero que Ud. debe por
vehículos motorizados.

> YES 01
>
> ![](media/image25.wmf)NO 00
>
> DON'T KNOW d

REFUSED r

CP, YP (has other debts)

MEPS

K69. About how much do these debts amount to?

Más o menos, ¿a qué suma llegan estas deudas?

*Read list if necessary*

\$0 01

\$1 - 500 02

\$501 -- 1,000 03

\$1,001 -- 5,000 04

\$5,001 -- 10,000 05

\$10,001 -- 25,000 06

\$25,001 -- 50,000 07

Over \$50,000 08

DON'T KNOW d

REFUSED r

CP, YP (has other debts)

Created

K70. About how much of this debt, if any, is related to medical care,
services, or supplies for (NAME)?

¿Más o menos cuánto de esta deuda es relacionada al cuidado (a la
atención) medico(a) de (NAME), o a servicios o provisiones para (NAME)?

*Read list if necessary*

\$0 01

\$1 - 500 02

\$501 -- 1,000 03

\$1,001 - 5,000 04

\$5,001 -- 10,000 05

\$10,001 -- 25,000 06

\$25,001 -- 50,000 07

Over \$50,000 08

DON'T KNOW d

REFUSED r

  -----------------------------------------------------------------------
  **GO TO PART L**

  -----------------------------------------------------------------------

YA, YX

K71. CHECK A91: IS NAME LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN?

> YES 01
>
> NO 00

YA, YX

MPR

K72. In addition to earnings from work, people often receive other
income from the government, from private institutions, or from their own
savings. I would like to ask you a few questions about all other income
received in (LAST MONTH) by (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR
ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK),
including (INSERT NAMES OF HOUSEHOLD MEMBERS FROM A91).

> In (LAST MONTH) did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03) (FILL

"OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR

> ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE
>
> BLANK) receive payments from the welfare office, including Emergency
>
> Assistance?
>
> Además de las ganancias por trabajar, la gente con frecuencia recibe
> otros
>
> ingresos: del gobierno, de instituciones privadas, o de sus propios
> ahorros. Le
>
> quiero hacer algunas preguntas acerca de todas los otros ingresos
> recibidos en
>
> (LAST MONTH) por (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03) (FILL "y
>
> cualquier persona en su hogar" IF K71=01), incluyendo a (INSERT

NAMES OF HOUSEHOLD MEMBERS FROM A91).

> En (LAST MONTH) recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
> (FILL "o cualquier persona en su hogar" IF K71=01) pagos de la oficina
> del Bienestar Público (welfare office), incluyendo Asistencia de
> Emergencia (Emergency Assistance)?

PROBE: This includes money that (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE
=03) or others may have received from participating in a work or
training activity.

PROBE: Esto incluye dinero que (FILL "UD" IF RTYPE=02; "NAME" IF
RTYPE=03) u otros quizás recibieron por participar en una actividad de
trabajo o entrenamiento.

> ![](media/image26.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (living in own household, receiving welfare)

Created

K73. (ASK IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR
CHILDREN; ELSE SET K73=01, GOTO K74) Who in the household received the
payments from the welfare office?

(ASK IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN;
ELSE GOTO K76) ¿Quién en el hogar recibió pagos de la oficina del
Bienestar Público (welfare)?

PROBE: To whom was the payment made?

> PROBE: ¿A quién le dieron el pago?
>
> PROGRAMMER NOTE: THE RESPONSE LIST (STARTING WITH CODE O2)
>
> SHOULD BE CUSTOMIZED TO INCLUDE NAMES OF HOUSEHOLD MEMBERS FROM A91.

*Code all that apply*

(NAME) 01

![](media/image27.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K76*

REFUSED r *Go to K76*

YA, YX (living in own household, receiving welfare)

MPR

K74. (FILL "WERE YOU" IF K73=01 AND RTYPE=02; "WAS NAME" IF K73=01 AND
RTYPE=03; "WAS (INSERT RECIPIENT'S NAME)" IF K73=02-14; "WAS THAT
PERSON" IF K73=15) required to work, attend school or training, look for
work, or anything else in order to receive these benefits?

¿Fue (FILL "UD." IF K73=01 AND RTYPE=02; "NAME" IF K73=01 AND RTYPE=03;
"(INSERT RECIPIENT'S NAME)" IF K73=02-14; "ESA PERSONA" IF K73=15)
requerida(o)(s) a trabajar, asistir a una escuela o entrenamiento,
buscar trabajo, o hacer cualquier otra cosa, para poder recibir estos
beneficios?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K73.

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (living in own household, receiving welfare)

MPR

K75. How much in total (FILL "DID YOU" IF K73=01 AND RTYPE=02; "DID
NAME" IF K73=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF
K73=02-14; "DID THAT PERSON" IF K73=15) receive in welfare payments in
(LAST MONTH)?

¿Cuánto, en total, recibió (FILL "UD." IF K73=01 AND RTYPE=02; "NAME" IF
K73=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K73=02-14; "ESA
PERSONA" IF K73=15) en pagos del bienestar público (welfare) en (LAST
MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K73.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-2,000)

> DON'T KNOW d
>
> REFUSED r

YA, YX

MPR

K76. In (LAST MONTH) did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL \"OR ANYBODY IN NAME\'S HOUSEHOLD" IF K71=01 AND RTYPE=03; "OR

ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; ELSE BLANK) receive
any OTHER kind of welfare assistance, such as help with getting a

> job, placement in education or training programs, or help with
> transportation or child
>
> care?

En (LAST MONTH), ¿recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL \"o cualquier persona en su hogar cualquier" IF K71=01; ELSE
BLANK) OTRO tipo de asistencia del bienestar público (welfare), tal como
ayuda para encontrar un empleo, colocación en programas de educación o
entrenamiento, o ayuda en transporte o con el cuidado de niños (child
care)?

PROBE: Please include only assistance received through welfare.

> PROBE: Por favor incluya solo asistencia recibida por el bienestar
> público.
>
> YES 01
>
> ![](media/image28.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (living in own household, receiving other welfare assistance)

Created

K77. (ASK IF K71=01, NAME IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN;
ELSE SET K77=01, GOTO K78) Who in the household received this help?

> (ASK IF K71=01, NAME IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN;
> ELSE SET K77=01, GOTO K78) ¿Quién en el hogar recibió esta ayuda?

*Code all that apply*

(NAME) 01

![](media/image29.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

YA, YX (living in own household)

NSAF

K78. In (LAST MONTH) did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR

> ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE
>
> BLANK) receive any payments from your state's general assistance
> program.

En (LAST MONTH), ¿recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL \"o cualquier persona en su hogar" IF K71=01; ELSE BLANK) algún
pago del programa de asistencia general (general assistance) de su
estado?

PROBE: Low income persons and families that meet the eligibility
criteria for

General Assistance programs receive a monthly financial benefit from the
state to

help cover basic needs such as rent, food, and clothing.

> PROBE: Las personas de ingresos bajos y las familias que cumplen los
> criterios de eligibilidad para programas de asistencia general reciben
> un beneficio financiero mensual para ayudar a cubrir necesidades
> básicas tales como alquiler, comida y ropa.
>
> YES 01
>
> ![](media/image30.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (living in own household, receiving state general assistance
payments)

Created

K79. (IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN,
ELSE SET K79=01, GO TO K80) To whom in the household was the general
assistance program payment made?

> (IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN, ELSE
> SET K79=01, GO TO K80) ¿A quién en el hogar, le dieron el pago del
> programa de asistencia general (general assistance)?

*Code all that apply*

(NAME) 01

![](media/image31.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K81*

REFUSED r*Go to K81*

YA, YX (living in own household, receiving state general assistance
payments)

NSAF

K80. How much in total (FILL "DID YOU" IF K79=01 AND RTYPE=02; "DID
NAME" IF K79=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF
K79=02-14; "DID THAT PERSON" IF K79=15) receive in (LAST MONTH)?

> ¿Cuánto, en total, recibió (FILL "UD." IF K79=01 AND RTYPE=02; "NAME"
> IF K79=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K79=02-14; "ESA
> PERSONA" IF K79=15) en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K79.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-2,000)

DON'T KNOW d

REFUSED r

YA, YX

NSAF

K81. In (LAST MONTH) did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR

ANYBODY IN (NAME\'S) HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE

BLANK) receive any Food Stamps?

![](media/image32.wmf) En (LAST MONTH), ¿recibió (FILL "UD." IF
RTYPE=02; "NAME" IF RTYPE=03) (FILL \"o cualquier persona en su hogar"
IF K71=01; ELSE BLANK) algunos Cupones de Alimentos (Food Stamps)?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (receiving food stamps)

Created

K82. (IF K71=01 (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN,
ELSE SET K82=01, GOTO K85) Who in the household received food stamps?

(IF K71=01 (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN, ELSE
SET K82=01, GOTO K85) ¿Quién en el hogar recibió cupones de alimentos
(Food Stamps)?

PROBE: Who was authorized to receive Food Stamps last month?

> PROBE: ¿Quién estaba autorizada(o) para recibir Cupones de Alimentos
> (Food Stamps) el mes pasado?

*Code all that apply*

(NAME) 01

![](media/image33.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K85*

REFUSED r*Go to K85*

YA, YX (receiving food stamps)

NSAF

K83. How much in total (FILL "DID YOU" IF K82=01 AND RTYPE=02; "DID
NAME" IF

K82=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF K82=02-14; "DID
THAT PERSON" IF K82=15) receive in Food Stamps last month?

¿Cuánto, en total, recibió (FILL "UD." IF K82=01 AND RTYPE=02; "NAME" IF
K82=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K82=02-14; "ESA
PERSONA" IF K82=15) en Cupones de Alimentos el mes pasado?

> PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K82.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-2,000)

DON'T KNOW d

REFUSED r

YA, YX (receiving food stamps)

Created

K84. Were the Food Stamp benefits for both adults and children, or just
children?

> ¿Eran los beneficios de Cupones de Alimentos (Food Stamps) para ambos
> adultos y niños, o sólo para niños?

ADULTS AND CHILDREN 01

JUST CHILDREN 02

DON'T KNOW d

REFUSED r

YA, YX

K85. CHECK IF A91D_2-D_15=11: Does (NAME) have his/her own children
living with him/her?

YES 01 *Continue*

NO 00 *Go to K90*

YA, YX (own children in household)

NSAF

K86. In (LAST MONTH) did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR

ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK)
receive any child support payments?

En (LAST MONTH), ¿recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL \"o cualquier persona en su hogar" IF K71=01; ELSE BLANK) algún
pago de mantenimiento de niños (child support)?

> INTERVIEWER: Alternative words for "child support" are "pensión
> alimenticia," "manutención infantil" and "manutención de niños".
>
> ![](media/image34.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (own children in household, receiving child support payments)

Created

K87. (IF K71=01, NAME IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN,
ELSE SET K87=01, GOTO K89) Who in the household received child support
payments last month?

(IF K71=01, NAME IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN, ELSE SET
K87=01, GOTO K89) ¿Quién en el hogar recibió pagos de mantenimiento de
niños (child support) el mes pasado?

*Code all that apply*

(NAME) 01

![](media/image35.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to K89*

REFUSED r *Go to K89*

YA, YX (own children in household, receiving child support payments)

K88. How much in total (FILL "DID YOU" IF K87=01 AND RTYPE=02; "DID
NAME" IF K87=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF
K87=02-14; "DID THAT PERSON" IF K87=15) receive in child support last
month?

¿Cuánto, en total, recibió (FILL "UD" IF K87=01 AND RTYPE=02; "NAME" IF
K87=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K87=02-14; "ESA
PERSONA" IF K87=15) en pagos de mantenimiento de niños (child support)
el mes pasado?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K87.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

YA, YX (own children in household)

Created

K89. Regardless of whether or not (FILL "YOU" IF RTYPE=02; "NAME" IF
RTYPE=03) received payments, (FILL "ARE YOU" IF RTYPE=02; "IS NAME" IF
RTYPE=03) owed any child support payments?

SIn reparar en si recibió o no recibió (FILL "UD." IF RTYPE=02; "NAME"
IF RTYPE=03) algún pago, ¿se le debe a (FILL "UD." IF RTYPE=02; "NAME"
IF RTYPE=03) cualquier pago de mantenimiento de niños (child support)?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX

NSAF

K90. In (LAST MONTH) did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR

ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK)
receive any foster care payments?

> En (LAST MONTH), ¿recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
> (FILL \"o cualquier persona en su hogar" IF K71=01; ELSE BLANK) algún
> pago para cuidado de crianza (foster care)?
>
> YES 01
>
> ![](media/image36.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (receiving foster care payments)

Create

K91. (IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN,
ELSE SET K91=01, GOTO K92) Who in the household received foster care
payments last month?

> (IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN, ELSE
> SET K91=01, GOTO K92) ¿Quién en el hogar recibió algún pago para
> cuidado de crianza (foster care) el mes pasado?

*Code all that apply*

(NAME) 01

![](media/image37.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K93*

REFUSED r*Go to K93*

YA, YX (receiving foster care payments)

NSAF

K92. How much in total (FILL "DID YOU" IF K91=01 AND RTYPE=02; "DID
NAME" IF

K91=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF K91=02-14; "DID
THAT PERSON" IF K91=15) receive in foster care payments last month?

¿Cuánto, en total, recibió (FILL "UD." IF K91=01 AND RTYPE=02; "NAME" IF
K91=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)"; IF K91=02-14 "ESA
PERSONA" IF K91=15) en pagos para cuidado de crianza (foster care) el
mes pasado?

> PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K91.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

YA, YX

K93. CHECK: Is K71=01, (NAME) living with his/her own spouse or
children?

YES 01 *Continue*

NO 00 *Go to K97*

YA, YX (living with spouse/children)

Created/NSAF

K94. In ( LAST MONTH), did anybody else in (FILL "YOUR" IF RTYPE=02;
"NAME'S" IF RTYPE=03) household, besides (FILL "YOU" IF RTYPE=02; "NAME"
IF RTYPE=03), receive any payments from the Supplemental Security Income
program, or SSI?

En (LAST MONTH), ¿Recibió alguien en (FILL "su hogar" IF RYTPE=02; "el
hogar de name" IF RTYPE=03), además de (FILL "UD." IF RTYPE=02; "NAME"
IF RTYPE=03) cualquier pago del programa de Seguridad de Ingreso
Suplementario o SSI?

PROBE: SSI, or Supplemental Security Income provides monthly payments to
aged, blind, or disabled people with limited income and resources or
assets. Federal SSI checks are either automatically deposited in the
bank or mailed to arrive on the first of every month. If mailed, they
are sent in a blue colored envelope.

PROBE: SSI, o Seguridad de Ingreso Suplementario (Supplemental Security
Income) proporciona pagos mensuales a personas ancianas, ciegas o
incapacitadas, con ingresos, recursos, o bienes limitados. Cheques
federales de SSI son depositados automáticamente en el banco, o enviados
por correo, para llegar el primero de cada mes. Cuando son enviados por
correo, vienen en un sobre de color azul.

> ![](media/image38.wmf)YES 01 *Continue*
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (someone else in household receives SSI)

Created

K95. Who in the household besides (FILL "YOU" IF RTYPE=02; "NAME" IF
RTYPE=03) received SSI payments last month?

¿Quién en el hogar además de (FILL "UD" IF RTYPE=02; "NAME" IF RTYPE=03)
recibió algún pago de SSI el mes pasado?

*Code all that apply*

![](media/image39.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K97*

REFUSED r*Go to K97*

YA, YX (someone else in household receives SSI)

NSAF

K96. How much in total did (FILL "DID YOU" IF K95=01 AND RTYPE=02; "DID
NAME" IF K95=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF
K95=02-14; "DID THAT PERSON" IF K95=15) receive in SSI payments last
month?

¿Cuánto, en total, recibió (FILL "UD." IF K95=01 AND RTYPE=02; "NAME" IF
K95=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K95=02-14; "ESA
PERSONA" IF K95=15) en pagos de SSI el mes pasado?

> PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K95.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-1,000)

DON'T KNOW d

REFUSED r

YA, YX

NSAF

K97. In (LAST MONTH) did (FILL "NAME" IF RTYPE=03; "YOU" IF RTYPE=02)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR

ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK)
receive any other social security payments? These include retirement
benefits, survivor's benefits, or social security disability insurance,
also known as SSDI.

En (LAST MONTH), ¿recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL \"o cualquier persona en su hogar" IF K71=01; ELSE BLANK) algún
otro pago del Seguro Social (Social Security)? Estos pueden incluir
beneficios de jubilación, beneficios de sobrevivientes (survivor's
benefits), o seguro de incapacidad del Seguro Social (Social Security
Disability Insurance), también conocido por las siglas en inglés SSDI.

PROBE: SSDI is different from SSI because SSDI is based on a person's
past work history and not their financial need.

PROBE: SSDI es diferente de SSI porque SSDI es basado en la historia del
trabajo en el pasado de una persona, y no en sus necesidades
financieras.

> ![](media/image40.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (living with spouse/children, someone in household receives other
SSA payment)

Created

K98. (IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN
ELSE GOTO K99) Who in the household received social security payments
last month?

(IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN ELSE
SET K98=01, GOTO K99) ¿Quién en el hogar recibió pagos del Seguro Social
(Social Security) el mes pasado?

*Code all that apply*

(NAME) 01

![](media/image41.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K101*

REFUSED r *Go to K101*

YA, YX (someone in household receives other SSA payment)

Created

K99. What kind of other social security payment (FILL "DID YOU" IF
K98=01 AND

RTYPE=02; "DID NAME" IF K98=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S
NAME)" IF K98=02-14; "DID THAT PERSON" IF K98=15) receive? Was it

¿Qué otro tipo de pagos del seguro social (social security) recibió
(FILL "UD." IF K98=01 AND RTYPE=02; "NAME" IF K98=01 AND RTYPE=03;
"(INSERT RECIPIENT'S NAME)" IF K98=02-14; "ESA PERSONA" IF K98=15)?
¿Fue...

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K98.

*Read list, code all that apply.*

Retirement benefits 01

Survivor's benefits 02

Social security disability insurance, or SSDI 03

Supplemental Security Income (SSI) 04

Beneficios de jubilación (Retirement ) 01

Beneficios de Sobrevivientes (Survivors) 02

Seguro de Incapacidad del Seguro Social

Social security disability insurance, or SSDI 03

SUPPLEMENTAL SECURITY INCOME

Seguridad de Ingreso Suplementario (SSI) 04

DON'T KNOW d

REFUSED r

YA, YX (someone in household receives other SSA payment)

NSAF

K100. How much in total (FILL "DID YOU" IF K98=01 AND RTYPE=02; "DID
NAME" IF K98=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF
K98=02-14; "DID THAT PERSON" IF K98=15) receive in other social security
payments last month?

¿Cuánto, en total, recibió (FILL "UD." IF K98=01 AND RTYPE=02; "NAME" IF
K98=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K98=02-14; "ESA
PERSONA" IF K98=15) en otros pagos del Seguro Social (Social Security)
el mes pasado?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K98.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

YA, YX

NSAF

K101. In (LAST MONTH) did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR

ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK)
receive any kind of pension or annuity payment?

En (LAST MONTH), ¿Recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL \"o cualquier persona en su hogar" IF K71=01; ELSE BLANK) algún
tipo de pensión o pago de una anualidad (annuity)?

PROBE: An annuity is a fixed monthly payment you receive for a fixed
period of time. Sources are often retirement accounts, insurance
settlements, or lottery winnings.

PROBE: Una anualidad es un pago mensual fijo, por un periodo de tiempo
fijo. Muchas veces, las fuentes de pagos de anualidades son cuentas de
jubilación, pagos de seguros, o ganancias de loterías.

> ![](media/image42.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (someone in household receives pension/annuity payments)

Created

K102. (IF K71=01, NAME IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN;
ELSE SET K102=01, GOTO K103) Who in the household received pension or
annuity payments last month?

> (IF K71=01, NAME IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN; ELSE
> SET K102=01, GOTO K103) ¿Quién en el hogar recibió pagos de pensión o
> de anualidad (annuity) el mes pasado?

*Code all that apply*

(NAME) 01

![](media/image43.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K104*

REFUSED r *Go to K104*

YA, YX (someone in household receives pension/annuity payments)

NSAF

K103. How much in total (FILL "DID YOU" IF K102=01 AND RTYPE=02; "DID
NAME" IF K102=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF
K102=02-14; "DID THAT PERSON" IF K102=15) receive in pension or annuity
payments last month?

¿Cuánto, en total, recibió (FILL "UD." IF K102=01 AND RTYPE=02; "NAME"
IF K102=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K102=02-14; "ESA
PERSONA" IF K102=15) en pagos de pensión o de anualidad (annuity) el mes
pasado?

> PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN
> K102.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

YA, YX

NSAF

K104. In (LAST MONTH) did (FILL "YOU" IF RTYPE=02, "NAME" IF RTYPE=03)
(FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02; \"OR
ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK)
receive payments from any other sources not mentioned, such as alimony,
contributions from family or friends, VA payments, worker's
compensation, or unemployment compensation?

En (LAST MONTH), ¿Recibió (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
(FILL \"o cualquier persona en su hogar" IF K71=01; ELSE BLANK) algún
pago de cualquier otra fuente que no fue mencionada, tal como de pensión
de divorcio (alimony), contribuciones de familia o amistades, pagos de
veteranos (VA), compensación de trabajadores (worker's compensation), o
compensación de desempleo (unemployment)?

> ![](media/image44.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (someone in household receives other payments)

Created

K105. (IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN;
ELSE SET K105=01, GOTO K106) Who in the household received these
payments?

> (IF K71=01, (NAME) IS LIVING WITH HIS/HER OWN SPOUSE OR CHILDREN; ELSE
> SET K105=01, GOTO K106) ¿Quién en el hogar recibió estos pagos?

*Code all that apply*

(NAME).....................................................01

![](media/image45.wmf) LIST HOUSEHOLD MEMBERS 02-14

> OTHER (SPECIFY) 15

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d*Go to K107*

REFUSED r*Go to K107*

YA, YX (someone in household receives other payments)

NSAF

K106. How much in total did (FILL "DID YOU" IF K105=01 AND RTYPE=02;
"DID NAME" IF K105=01 AND RTYPE=03; "DID (INSERT RECIPIENT'S NAME)" IF
K105=02-14; "DID THAT PERSON" IF K105=15) receive in (LAST MONTH)?

> ¿Cuánto, en total, recibió (FILL "UD." IF K105=01 AND RTYPE=02; "NAME"
> IF K105=01 AND RTYPE=03; "(INSERT RECIPIENT'S NAME)" IF K105=02-14;
> "ESA PERSONA" IF K105=15) en (LAST MONTH)?

PROGRAMMER NOTE: REPEAT QUESTION FOR EACH RECIPIENT IDENTIFIED IN K105.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-5,000)

DON'T KNOW d

REFUSED r

YA, YX

K107. CHECK: Is (NAME) living with his/her own spouse or children?

> YES 01 *Continue*
>
> NO 00 *Go to K110*

YA, YX (living with spouse/children)

Created

K108. For the purpose of this survey, it is important to learn the total
income received by all members of (FILL "YOUR" IF RTYPE=02; "NAME'S" IF
RTYPE=03) household in (LAST MONTH). This includes money from jobs, and
from the sources we just talked about. What was (FILL "YOUR" IF
RTYPE=02; "NAME'S" IF RTYPE=03) total income last month before taxes and
deductions? (IF K81=01, RECEIVING FOOD STAMPS, FILL "Do not include the
value of (FILL "YOUR" IF RTYPE=02; "NAME'S" IF RTYPE=03) food stamps";
else blank).

Para los propósitos deesta encuesta, es importante aprender cuales
fueron los ingresos, en total, que recibieron todos los miembros (FILL
"DE su hogar" IF RTYPE=02 ; "DEL HOGAR DE (NAME)" IF RTYPE=03) en (LAST
MONTH). Esto incluye dinero de empleos, y de las fuentes de las cuales
acabamos de hablar. ¿Cuál fue el ingreso total de (FILL "UD." IF
RTYPE=02; "NAME" IF RTYPE=03) el mes pasado, antes de impuestos y
deducciones? (IFK81=01, RECEIVING FOOD STAMPS, FILL "Por favor no
incluya el valor de sus Cupones de Alimentos (Food Stamps)"; else
blank).

PROBE: Include money from all sources and from all members of (FILL
"NAME'S" IF RTYPE=03; "YOUR" IF RTYPE=02) household.

PROBE: Incluya dinero de todas las fuentes, y de todos los miembros
(FILL "DE su hogar" IF RTYPE=02; "DEL HOGAR DE NAME" IF RTYPE=03) en
(LAST MONTH).

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-99,999)  *Go to K112*

DON'T KNOW d

REFUSED r

YA, YX (living with spouse/children)

Created

K109. In (LAST MONTH), would you say (FILL "YOUR" IF RTYPE=02; "NAME'S"
IF RTYPE=03) household's monthly income was:

> En (LAST MONTH), ¿diría Ud. que el ingreso mensual (FILL "su hogar" IF
> RTYPE=02; "EL HOGAR DE (NAME)" IF RTYPE=03) fue:

A.  below or above \$500?

> A. menos o más de \$500?
>
> BELOW 01  *Go to K112*
>
> AT OR ABOVE 02
>
> DON'T KNOW d
>
> REFUSED r

B. below or above \$750?

B. menos o más de \$750?

> ![](media/image46.wmf)
>
> BELOW 01
>
> AT OR ABOVE 02
>
> DON'T KNOW d
>
> REFUSED r

YA, YX (not living with spouse/children)

Created

K110. For the purpose of this survey, it is important to learn the total
income received by (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03) in (LAST
MONTH). This includes money from jobs, and from the sources we just
talked about. What was (FILL "YOUR" IF RTYPE=02; "NAME'S" IF RTYPE=03)
total income last month before taxes and deductions? (IF K81=01,
RECEIVING FOOD STAMPS, FILL "Do not include the value of (FILL "YOUR" IF
RTYPE=02; "NAME'S" IF RTYPE=03) food stamps"; else blank).

Para los propósitos de esta encuesta, es importante aprender cuales
fueron los ingresos, en total, que recibio (FILL "UD." IF RTYPE=02;
"NAME" IF RTYPE=03) en (LAST MONTH). Esto incluye dinero de empleos, y
de las fuentes de las cuales acabamos de hablar. ¿Cuál fue el ingreso
total de (FILL "UD." IF RTYPE=02; "NAME IF RTYPE=03) el mes pasado,
antes de impuestos y deducciones? (IF K81=01, RECEIVING FOOD STAMPS,
FILL "Por favor no incluya el valor de sus Cupones de Alimentos (Food
Stamps)".

PROBE: Include money from all sources.

PROBE: Incluya dinero de todas las fuentes.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_.00 AMOUNT (0-10,000)  *Go to K112*

DON'T KNOW d

REFUSED r

YA, YX (not living with spouse/children)

Created

K111. In (LAST MONTH), would you say (FILL "YOUR" IF RTYPE=02; "NAME'S"
IF RTYPE=03) monthly income was:

> En (LAST MONTH), ¿diría Ud. que el ingreso mensual de (FILL "UD." IF
> RTYPE=02; "NAME" IF RTYPE=03) fue:

A. below or above \$500?

> A. menos o más de \$500?
>
> BELOW 01  *Go to K112*
>
> AT OR ABOVE 02
>
> DON'T KNOW d
>
> REFUSED r

B. below or above \$750?

> B. menos o más de \$750?
>
> BELOW 01
>
> AT OR ABOVE 02
>
> DON'T KNOW d
>
> REFUSED r

YA, YX

Created

K112. Suppose for a minute that (FILL "YOU" IF RTYPE=02; "NAME" IF
RTYPE=03) (FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02;
\"OR ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK)
had an additional \$100 every month to spend (IF K108 or K110=\> \$100
FILL "that is, (FILL "YOUR" IF RTYPE=01,02, "HIS/HER" IF RTYPE=03)
monthly income was (INSERT AMOUNT FROM K108 or K110 + \$100)"; else
blank) How would (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03) spend the
additional \$100?

Supóngase por un momento que cada mes, (FILL "UD." IF RTYPE=02 ; "NAME"
IF RTYPE=03) (FILL \"o cualquier persona en su hogar" IF K71=01; ELSE
BLANK) tendría \$100 adicionales para gastar (IF K108 or K110=\> \$100,
FILL "o sea, que sus ingresos mensuales serían (INSERT AMOUNT FROM K108
or K110+\$100 ); ELSE BLANK). ¿En qué gastaría (FILL "UD." IF RTYPE=02;
"NAME" IF RTYPE=03) los \$100 adicionales?

*Do not read list, code all that apply*

> DISABILITY CARE, EQUIPMENT, OR
>
> SUPPLIES FOR NAME 01
>
> FOOD 02
>
> PERSONAL ITEMS (CLOTHING, TOYS, ETC.) 03
>
> HOUSING (MOVE INTO DIFFERENT HOME/
>
> FIX HOME) 04
>
> TRANSPORTATION (BUY A CAR/FIX CAR/
>
> BUY GAS) 05
>
> ENTERTAINMENT/LEISURE/TRAVEL 06
>
> DEBT REDUCTION 07
>
> SAVINGS 08
>
> HEALTH INSURANCE 09

![](media/image47.wmf) EDUCATION/TRAINING 10

OTHER (SPECIFY) 11

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> DON'T KNOW d
>
> REFUSED r

YA, YX

K113. CHECK: Is more than one answer coded in K112?

YES 01 *Continue*

NO 00 *Go to K115*

YA, YX

Created

K114. What would (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03) spend the

> money on first?

¿En qué cosa lo gastaría (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03)
primero?

> What would be (FILL "YOUR" IF RTYPE=02; "NAME'S" IF RTYPE=03) first
> priority?

*Do not read list, code only one answer*

> LIST RESPONSES FROM K112 01-11
>
> DON'T KNOW d
>
> REFUSED r

YA, YX

Created

K115. Suppose for a minute that (FILL "YOU" IF RTYPE=02; "NAME" IF
RTYPE=03) (FILL "OR ANYBODY IN YOUR HOUSEHOLD\" IF K71=01 AND RTYPE=02;
\"OR ANYBODY IN NAME\'S HOUSEHOLD\" IF K71=01 AND RTYPE=03; ELSE BLANK)
had \$100 less every month to spend (IF K108 OR 110=\> \$100, FILL "that
is, (FILL "YOUR" IF RTYPE=02, "HIS/HER" IF RTYPE=03) monthly income was
(INSERT AMOUNT FROM K35 - \$100)"; else blank). What would (FILL "YOU"
IF RTYPE=02; "NAME" IF RTYPE=03) do to get by?

> Supóngase por un momento que cada mes, (FILL "UD." IF RTYPE=02; "NAME"
> IF RTYPE=03) (FILL \"o cualquier persona en su hogar" IF K71=01; ELSE
> BLANK) tendría \$100 menos para gastar (IF K108 OR 110=\> \$100, FILL
> "o sea, que sus ingresos mensuales serían (INSERT AMOUNT FROM K108 OR
> K110-\$100); else blank). ¿Qué haría (FILL "UD." IF RTYPE=02; "NAME"
> IF RTYPE=03) para arreglárselas?
>
> *Do not read list, code all that apply*

CUT BACK ON DISABILITY CARE,

EQUIPMENT OR SUPPLIES FOR (NAME) 01

CUT BACK ON FOOD 02

CUT BACK ON PERSONAL ITEMS

(CLOTHING, TOYS, ETC.) 03

MOVE TO NEW PLACE 04

CUT BACK ON ENTERTAINMENT/LEISURE 05

USE SAVINGS 06

GET A JOB/ GET A BETTER JOB 07

SEEK ASSISTANCE FROM GOVERNMENT 08

SEEK ASSISTANCE FROM FRIENDS,

FAMILY, CHARITY 09

COULDN'T DO IT/CAN'T HAPPEN 10

NO SPECIFIC THING/SPEND LESS ALL

![](media/image48.wmf) AROUND 11

OTHER (SPECIFY) 12

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

YA, YX

K116. CHECK: Is more than one answer coded in K115?

YES 01 *Continue*

NO 00 *Go to K118*

YA, YX

Created

K117. What would (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03) do first?

¿Qué haría (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03) primero?

> *Do not read list, code only one answer*
>
> LIST RESPONSES FROM K115 01-12
>
> DON'T KNOW d
>
> REFUSED r

YA, YX

K118. CHECK: Is (NAME) living with his/her own spouse or children?

> YES 01 *Continue*
>
> NO 00 *Go to K123*

YA, YX (living with spouse/children)

NSAF

K119. Now I'd like you to think about the past 12 months. In the past 12
months, were (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03) (IF
A91D_2-A91D_14=10 AND RTYPE=02, FILL "OR YOUR SPOUSE"; IF
A91D_2-A91D_14=10 AND RTYPE=03 FILL "OR (NAME'S) SPOUSE"; ELSE BLANK) on
WIC, the Women, Infants, and Children's nutrition program?

Ahora quiero que piense en los últimos 12 meses. En los últimos 12
meses, ¿estaba (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03) (IF
A91D_2-A91D_14=10 FILL "O SU esposo(a)"; ELSE BLANK) en el programa de
nutrición de WIC, (Women, Infants, and Children's nutrition program)?

> YES 01
>
> NO 00
>
> DON'T KNOW d

REFUSED r

YA, YX

NSAF

K120. In the past 12 months, did (FILL "YOUR" IF RTYPE=02; "NAME'S" IF
RTYPE=03) household receive any energy assistance from the federal,
state, or local government?

En los últimos 12 meses, ¿recibió (FILL "SU HOGAR" IF RTYPE=02; "EL
HOGAR DE (NAME)" IF RTYPE=03) alguna asistencia de energia (energy
assistance) del gobierno federal, estatal, o local?

PROBE: Energy assistance is help paying your utility bills.

PROBE: Asistencia de energia (Energy assistance) es ayuda para pagar las
cuentas de las utilidades.

> YES 01
>
> NO 00
>
> DON'T KNOW d

REFUSED r

YA, YX

K121. CHECK A91: Does (NAME) have children living with him/her?

> YES 00 *Continue*
>
> NO 01 *Go to K123*

YA, YX (living with children)

NSAF

K122. In the past 12 months, did any of the children living with (FILL
"YOU" IF RTYPE=02; "NAME" IF RTYPE=03) receive free or reduced price
school lunches because they qualified for the Federal School Lunch
Program?

En los últimos 12 meses, ¿recibió cualquiera de los niños que viven con
(FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03) almuerzos en la escuela,
gratis o a precio reducido, porque estaban calificados para el Federal
School Lunch Program (Programa Federal de Almuerzos de Escuela)?

> YES 01
>
> NO 00
>
> CHILD(REN) NOT IN SCHOOL 02
>
> DON'T KNOW d

REFUSED r

YA, YX

Created (Source: SSI application)

K123. Next I'd like to ask about (FILL "YOUR" IF RTYPE=02; "NAME'S" IF
RTYPE=03) household's assets. These are resources that (FILL "YOU HAVE"
IF RTYPE=02; "(NAME) HAS" IF RTYPE=03; "YOU AND YOUR SPOUSE HAVE" IF
A91D_2-A91D_14=10 AND RTYPE=02; "(NAME) AND (NAME'S) SPOUSE HAVE" IF
A91D_2-A91D_14=10 AND RTYPE=03) and could turn into cash.

In (LAST MONTH), did (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03; "YOU
AND YOUR SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=02; "NAME AND NAME'S
SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=03) have, either separately or
with someone else, any of the following items?

Ahora le quiero preguntar acerca de los bienes (assets) (FILL "DE su
hogar" IF RTYPE=02; "DEL HOGAR DE (NAME)" IF RTYPE=03). Estos son
recursos que le pertenecen a (FILL "UD." IF RTYPE=02; "NAME" IF
RTYPE=03) (IF A91D_2-A91D_14=10, FILL "Y SU esposo(a)"; ELSE BLANK), y
podrían convertir a dinero en efectivo.

En (LAST MONTH), ¿le pertenecía a (FILL "UD." IF RTYPE=02; "NAME" IF
RTYPE=03) (IF A91D_2-A91D_14=10, FILL " y SU esposo(a)"; ELSE BLANK),
sólos o con alguien más, cualquiera de las siguientes cosas?

> *Read list, code yes or no for each. If yes, follow-up with value.*

+----------------------------+-----------------+-----------------------+
| ITEM                       |                 | At the end of (LAST   |
|                            |                 | MONTH), what was the  |
|                            |                 | value of (FILL "YOUR" |
|                            |                 | IF RTYPE=02; "NAME"   |
|                            |                 | IF RTYPE=03) (FILL    |
|                            |                 | "AND YOUR SPOUSE'S"   |
|                            |                 | IF A42D_2-A42D_14=10; |
|                            |                 | ELSE BLANK) (INSERT   |
|                            |                 | ITEM)?                |
|                            |                 |                       |
|                            |                 | ¿Cuál era el valor de |
|                            |                 | (INSERT ITEM) de      |
|                            |                 | (FILL "UD." IF        |
|                            |                 | RTYPE=02; "NAME" IF   |
|                            |                 | RTYPE=03) (IF         |
|                            |                 | A91D_2-A91D_14=10 AND |
|                            |                 | RTYPE=02, FILL "Y DE  |
|                            |                 | SU esposo(a)"; ELSE   |
|                            |                 | BLANK) al fin de      |
|                            |                 | (LAST MONTH)?         |
+============================+=================+=======================+
| A. Checking accounts       | YES 01          | \$\_\_\_              |
|                            |                 | \_\_\_\_\_\_\_\_\_.00 |
| Sus cuentas de cheques     | NO 00           |                       |
|                            |                 | (0-10,000) IF DK/RF:  |
| (Checking accounts)        | DON'T KNOW d    | Was it above or below |
|                            |                 | \$500?                |
|                            | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
|                            |                 | \$500?                |
|                            |                 |                       |
|                            |                 | \$500                 |
|                            |                 | +..............01     |
|                            |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused               |
|                            |                 | .........\...r        |
+----------------------------+-----------------+-----------------------+
| B. Savings accounts        | YES 01          | \$\_\_\_              |
|                            |                 | \_\_\_\_\_\_\_\_\_.00 |
| Sus cuentas de ahorros     | NO 00           |                       |
|                            |                 | (0-100,000) IF DK/RF: |
| (Savings accounts)         | DON'T KNOW d    | Was it above or below |
|                            |                 | \$500?                |
|                            | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
|                            |                 | \$500?                |
|                            |                 |                       |
|                            |                 | \$500                 |
|                            |                 | +..............01     |
|                            |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| B.  C. Certificates of     | YES 01          | \$\_\_\_              |
|     deposit, notes,        |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| > stocks, mutual funds, or |                 | (0-100,000) IF DK/RF: |
| > bonds                    | DON'T KNOW d    | Was it above or below |
| >                          |                 | \$500?                |
| > Sus certificados de      | REFUSED r       |                       |
| > depósitos, notas         |                 | ¿Era más o menos de   |
| > bancarias, títulos de    |                 | \$500?                |
| > valores, acciones o      |                 |                       |
| > "stocks", fondos         |                 | \$500                 |
| > mutuales, o bonos        |                 | +..............01     |
|                            |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| D. Cash at home with (FILL | YES 01          | \$\_\_\_              |
|                            |                 | \_\_\_\_\_\_\_\_\_.00 |
| "YOU" IF RTYPE=02;         | NO 00           |                       |
|                            |                 | (0-100,000) IF DK/RF: |
| "NAME" IF RTYPE=03) or     | DON'T KNOW d    | Was it above or below |
|                            |                 | \$500?                |
| someone else               | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
| Dinero en efectivo (cash)  |                 | \$500?                |
|                            |                 |                       |
| en su casa con (FILL "UD." |                 | \$500                 |
| IF                         |                 | +..............01     |
|                            |                 |                       |
| RTYPE=02; "NAME" IF        |                 | \< \$500              |
|                            |                 | .............02       |
| > RTYPE=03) o con EL/ELLA  |                 |                       |
| >                          |                 | Don't Know ........d  |
| > o en manos de otra       |                 |                       |
| > persona                  |                 | Refused ............r |
|                            |                 |                       |
| PROBE: All the cash you    |                 |                       |
|                            |                 |                       |
| have, that is not in the   |                 |                       |
| bank.                      |                 |                       |
|                            |                 |                       |
| PROBE: Todo el dinero que  |                 |                       |
|                            |                 |                       |
| tiene (FILL "UD." IF       |                 |                       |
|                            |                 |                       |
| RTYPE=02; "NAME" IF        |                 |                       |
|                            |                 |                       |
| RTYPE=03) que no está en   |                 |                       |
| el                         |                 |                       |
|                            |                 |                       |
| banco.                     |                 |                       |
+----------------------------+-----------------+-----------------------+
| E. Household or personal   | YES 01          | \$\_\_\_              |
|                            |                 | \_\_\_\_\_\_\_\_\_.00 |
| items worth more than      | NO 00           |                       |
| \$500                      |                 | (0-100,000) IF DK/RF: |
|                            | DON'T KNOW d    | Was it above or below |
| each                       |                 | \$500?                |
|                            | REFUSED r       |                       |
| Sus artículos personales o |                 | ¿Era más o menos de   |
|                            |                 | \$500?                |
| del hogar con valor de más |                 |                       |
| de                         |                 | \$500                 |
|                            |                 | +..............01     |
| \$500 cada uno             |                 |                       |
|                            |                 | \< \$500              |
|                            |                 | .............02       |
|                            |                 |                       |
|                            |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| F. Money set aside for     | YES 01          | \$\_\_\_              |
| burial                     |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| expenses such as burial    |                 | (0-20,000) IF DK/RF:  |
|                            | DON'T KNOW d    | Was it above or below |
| contracts, trusts, or      |                 | \$500?                |
|                            | REFUSED r       |                       |
| agreements                 |                 | ¿Era más o menos de   |
|                            |                 | \$500?                |
| Su dinero reservado para   |                 |                       |
|                            |                 | \$500                 |
| gastos de entierro, tales  |                 | +..............01     |
|                            |                 |                       |
| como contratos de          |                 | \< \$500              |
| entierro, o                |                 | .............02       |
|                            |                 |                       |
| arreglos fiduciarios       |                 | Don't Know ........d  |
|                            |                 |                       |
|                            |                 | Refused ............r |
+----------------------------+-----------------+-----------------------+
| G. Any other items that    | YES 01          | \$\_\_\_              |
| could be                   |                 | \_\_\_\_\_\_\_\_\_.00 |
|                            | NO 00           |                       |
| turned into cash,          |                 | (0-100,000) IF DK/RF: |
| excluding                  | DON'T KNOW d    | Was it above or below |
|                            |                 | \$500?                |
| cars or other vehicles and | REFUSED r       |                       |
|                            |                 | ¿Era más o menos de   |
| your home itself, if you   |                 | \$500?                |
| own                        |                 |                       |
|                            |                 | \$500                 |
| it.                        |                 | +..............01     |
|                            |                 |                       |
| Cualquier otro artículo    |                 | \< \$500              |
| que                        |                 | .............02       |
|                            |                 |                       |
| puede ser convertido a     |                 | Don't Know ........d  |
|                            |                 |                       |
| dinero en efectivo, sin    |                 | Refused ............r |
| incluir                    |                 |                       |
|                            |                 |                       |
| a carros u otros           |                 |                       |
| vehículos, y               |                 |                       |
|                            |                 |                       |
| su casa, si (FILL "UD" IF  |                 |                       |
|                            |                 |                       |
| RTYPE=02; "NAME" IF        |                 |                       |
|                            |                 |                       |
| RTYPE=03) es (el/la)       |                 |                       |
|                            |                 |                       |
| dueño(a).                  |                 |                       |
+----------------------------+-----------------+-----------------------+

YA, YX

Created

K124. How many cars or other vehicles are owned by (FILL "YOU" IF
RTYPE=02; "NAME" IF RTYPE=03) (FILL "AND YOUR SPOUSE" IF
A91D_2-A91D_14=10 AND RTYPE=02; "AND NAME'S SPOUSE" IF A91D_2-A91D_14=10
AND RTYPE=03; ELSE BLANK), if any?

> ¿Cuántos carros les pertenecen a (FILL "UD." IF RTYPE=02; "NAME" IF
> RTYPE=03) (IF A91D_2-A91D_14=10 FILL "y SU esposo(a)"; ELSE BLANK), si
> los hay?

PROBE: Do not include cars or other vehicles that are leased.

PROBE : No incluya carros u otros vehículos motorizados que se arrendan.

> 0 00 *Go to K131*
>
> 1 01 *Continue*
>
> 2 or more 02 *Go to K127*
>
> DON'T KNOW d *Go to K131*

REFUSED r  *Go to K131*

YA, YX (household w/one car)

Created

K125. What is the estimated value of that car?

¿Cuál es el valor estimado de ese carro?

> PROBE: How much could you sell it for?
>
> PROBE: ¿Por cuánto lo podría(n) vender (FILL "UD." IF RTYPE=02; "NAME"
> IF RTYPE=03)?

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| ESTIMATED VALUE (0-40,000)

DON'T KNOW d

REFUSED r

YA, YX (household w/one car)

Created

K126. About how much money (FILL "DO YOU" IF RTYPE=02; "DOES NAME" IF
RTYPE=03; "DO YOU AND YOUR SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=02;
"DO NAME AND NAME'S SPOUSE" IF A A91D_2-A91D_14=10 AND RTYPE=03) owe on
that car, if any?

> Más o menos, ¿cuánto aún debe(n) (FILL "UD." IF RTYPE=02; "NAME" IF
> RTYPE=03) (FILL "Y SU ESPOSO(A)" IF A91D_2-A91D_14=10) por ese carro,
> si aún tiene(n) deuda?

PROBE: Your best guess is fine.

PROBE: Una aproximación está bien.

ENTER "0" if car is paid for

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| (0-40,000)  *Go to K131*

DON'T KNOW d *Go to K131*

REFUSED r *Go to K131*

YA, YX (household w/more than one car)

Created

K127. Please think about (FILL "YOUR" IF RTYPE=02; "NAME'S" IF RTYPE=03)
(FILL "AND YOUR SPOUSE'S" IF A91D_2-A91D_14=10 AND RTYPE=02; "AND NAME'S
SPOUSE'S" IF A91D_2-A91D_14=10 AND RTYPE=03; ELSE BLANK), oldest car.
What is the estimated value of that car?

> Por favor piense en el carro más viejo de (FILL "UD." IF RTYPE=02;
> "NAME" IF RTYPE=03) (FILL "Y SU ESPOSO(A)" IF A91D_2-A91D_14=10; ELSE
> BLANK),. ¿Cuál es el valor estimado de ese carro?
>
> PROBE: How much could (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
> sell it for?
>
> PROBE: ¿Por cuánto lo podría vender (FILL "UD." IF RTYPE=02; "NAME" IF
> RTYPE=03)?

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| ESTIMATED VALUE (0-40,000)

DON'T KNOW d

REFUSED r

YA, YX (household w/more than one car)

Created

K128. About how much money (FILL "DO YOU" IF RTYPE=02; "DOES NAME" IF
RTYPE=03; "DO YOU AND YOUR SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=02;
"DO NAME AND NAME'S SPOUSE" IF A A91D_2-A91D_14=10 AND RTYPE=03), owe on
that car, if any?

> Más o menos, ¿cuánto aún debe(n) (FILL "UD." IF RTYPE=02; "NAME" IF
> RTYPE=03) (IF A91D_2-A91D_14=10 FILL "Y SU esposo(a)"; ELSE BLANK) por
> ese carro, si aún tiene(n) deuda?

PROBE: Your best guess is fine.

PROBE: Una aproximación está bien.

ENTER "0" if car is paid for

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| (0-40,000)

DON'T KNOW d

REFUSED r

YA, YX (household w/more than one car)

Created

K129. Please think about (FILL "YOUR" IF RTYPE=02; "NAME'S" IF RTYPE=03)
(FILL "AND YOUR SPOUSE'S" IF A91D_2-A91D_14=10 AND RTYPE=02; "AND NAME'S
SPOUSE'S" IF A91D_2-A91D_14=10 AND RTYPE=03; ELSE BLANK), next oldest
car. What is the estimated value of that car?

Por favor piense en el siguiente carro más viejo (FILL "DE UD." IF
RTYPE=02; "DE (NAME)" IF RTYPE=03) (FILL "Y SU ESPOSO(A)" IF
A91D_2-A91D_14=10; ELSE BLANK), ¿Cuál es el valor estimado de ese carro?

> PROBE: How much could (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03)
> (FILL "AND YOUR SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=02; "AND NAME'S
> SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=03; ELSE BLANK), sell it for?
>
> PROBE: ¿Por cuánto lo podría(n) vender (FILL "UD." IF RTYPE=02; "NAME"
> IF RTYPE=03) (FILL "Y SU ESPOSO(A)" IF A91D_2-A91D_14=10 A91D_14=10;
> ELSE BLANK)?

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| ESTIMATED VALUE (0-40,000)

DON'T KNOW d

REFUSED r

YA, YX (household w/more than one car)

Created

K130. About how much money (FILL "DO YOU" IF RTYPE=02; "DOES NAME" IF
RTYPE=03; "DO YOU AND YOUR SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=02;
"DO NAME AND NAME'S SPOUSE" IF A A91D_2-A91D_14=10 AND RTYPE=03), owe on
that car, if any?

> Más o menos, ¿cuánto aún debe(n) (FILL "UD." IF RTYPE=02; "NAME" IF
> RTYPE=03) (IF A91D_2-A91D_14=10 FILL "Y SU esposo(a)"; ELSE BLANK) por
> ese carro, si aún tiene(n) deuda?

PROBE: Your best guess is fine.

PROBE: Una aproximación está bien.

ENTER "0" if car is paid for

\$\|\_\_\|\_\_\|,\|\_\_\|\_\_\|\_\_\| (0-40,000)

DON'T KNOW d

REFUSED r

YA, YX

MEPS (modified)

K131. (FILL "DO YOU" IF RTYPE=02; "DOES NAME" IF RTYPE=03) (FILL "OR
MEMBERS OF YOUR HOUSEHOLD" IF K71=01 AND RTYPE=02; "OR MEMBERS OF
(NAME'S) HOUSEHOLD" IF K71=01 AND RTYPE=02; ELSE BLANK) have debts such
as credit card balances, medical debts, life insurance policy loans,
loans from relatives, and so forth? Do not include mortgage debt or
money (FILL "YOU" IF RTYPE=02; "NAME" IF RTYPE=03) (FILL "AND YOUR
SPOUSE" IF A91D_2-A91D_14=10 AND RTYPE=02; "AND NAME'S SPOUSE" IF
A91D_2-A91D_14=10 AND RTYPE=03; ELSE BLANK) owe for motor vehicles.

¿Tiene(n). (FILL "UD. IF RTYPE=02; "NAME" IF RTYPE=03) (FILL "y miembros
de su hogar" IF K71=01; ELSE BLANK) deudas tales como de balances de
tarjetas de crédito (credit card), deudas médicas, préstamos de pólizas
de seguro de vida (life insurance), préstamos de parientes o familiares,
etc.? Por favor no incluya deudas por hipotecas (mortgage) o dinero que
(FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03) (IF A91D_2-A91D_14=10 FILL
"Y SU esposo(a)"; ELSE BLANK) debe(n) por vehículos motorizados.

> ![](media/image49.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d

REFUSED r

YA, YX (has other debts)

MEPS

K132. About how much do these debts amount to?

Más o menos, ¿a qué suma llegan estas deudas?

*Read list if necessary*

\$0 01

\$1 - 500 02

\$501 -- 1,000 03

\$1,001 -- 5,000 04

\$5,001 -- 10,000 05

\$10,001 -- 25,000 06

\$25,001 -- 50,000 07

\$Over 50,000 08

DON'T KNOW d

REFUSED r

YA, YX (has other debts)

Created

K133. About how much of this debt, if any, is related to (FILL "YOUR" IF
RTYPE=02; "NAME'S" IF RTYPE=03) medical care, medical services, or
supplies?

¿Más o menos cuánto de esta deuda es relacionada al cuidado médico, o a
servicios o equipo o provisiones para (FILL "UD." IF RTYPE=02; "NAME" IF
RTYPE=03)?

*Read list if necessary*

\$0 01

\$1 - 500 02

\$501 -- 1,000 03

\$1,001 -- 5,000 04

\$5,001 -- 10,000 05

\$10,001 -- 25,000 06

\$25,001 -- 50,000 07

\$Over 50,000 08

DON'T KNOW d

REFUSED r