Questionnaire for the Jewish Federation community study

THE JEWISH FEDERATION OF LAS VEGAS 1995 DEMOGRAPHIC STUDY Date:__ __ Editor Init: _ _ Coder Init: _ _ Interviewer Init: _ _ Time Began: A. Tel#: ___-____ Area__ B. Number of Call: _ _ C. Call Outcome: Record the outcome of each attempt to the same number. Record information for 4 calls, if needed (after 4 callbacks, the number may be discarded). one company recording) Hello, My name is and I?m calling from the Center for Business and Economic Research at the University of Nevada, Las Vegas. We are not soliciting or selling any products or services. We are conducting a survey of the religious composition of residences in Southern Nevada. Your number was selected at random. Your answers will be completely anonymous and confidential. The survey will take 2-3 minutes. Are you 18 years or older? YES - Continue the survey NO - ?Is someone else home who is 18 or older?? If new person comes to phone, repeat introduction [Check if respondent is: _ Male _ Female] D. SCREENING OUTCOME: FOR EACH CONTACT MAKE RECORD OUTCOME (If refusal or other reason, call up to 2 more times). mp oyee aIlSwere When would be a convenient time to When would be a convenient time to When would be a convenient Is this phone number ***-****? t- Yes - CONTINUE WITH SCREENING INTERVIEW 2_ No - TERMINATE E. F. G. H. I. Jf the respondent hanas up during the interview, write 86 for thejirst question left unanswered, Including yourself, how many people live in this household?_ B._ Don?t know 99._ Refused Do you own or rent your home? Owned 2 Rented 98. Don?t know What is your zipcode? 99. Refused How many phone lines are in your household? I._ One-GOTOSl 3._ Three P8._ Don?t know 2_ Two Q- Four or more 99._ Refused Is there any line that is used only for a fax machine or a computer? I._ Yes 98._ Don?t know - GO TO Sl I_ No - GO TO Sl 99._ Refused - GO TO Sl J. How many? I._ One 3._ Three x_ Don?t know I_ Two 4._ Four or more 99._ Refused READ: NOW WE HAVE SOME QUESTIONS ABOUT YOUR RELIGION. Sl. What is your religion, or what religions are practiced in your house? Are you Catholic, Protestant, Mormon, Jewish or something else? I._ Catholic - GO TO S3 Something else - GO TO S2 2_ Protestant - GO TO S3 %a._ Din?t know - GO TO S3 3._ Mormon - GO TO S3 99._ Refused - GO TO S3 4._ Jewish If Jewish, READ: We will be conducting a community survey on behalf of the Jewish Federation of Las Vegas. We will he asking some basic information about your household. We are interested in interviewing persons at random. We are not asking for contributions or selling anything. All the information will be completely anonymous and confidential. We would like to call you back later at a convenient time and speak with the Jewish person in the household with the most recent birthday who is 18 years or older. I._ No z_ Yes Who would that be? When would he a convenient time to call back? [If no, complete Screening Outcome in D] s2. What is that? I._ Baptist 2_ Buddhist 12._ 3._ Christian 13._ 4._ Christian Science 14_. 5._ Episcopalian 6._ Evangelical/Born 16_. Again Christian n._ 7._ Greek Orthodox ~8_. a._ Hindu 9._ Islamic IO._ Jehovah Witness II._ Latter-day Saints 21. Shintoist Lutheran z_ Taoist Methodist 23._ Unitarian Mormon 24_. Agnostic IS. Moslem 2.5_. Other religion Nazarene 26_. None/no religion Pentecostal u._ Jewish and Other Presbyterian religion - GO TO 19_. Russian Orthodox INTRO., Pg. 5 20._ Seventh-Day 97._ Other (specify) Adventist 99._ Refused If YES, for Q S3-S6 READ: We will be conducting a community survey on behalf of the Jewish Federation of Las Vegas. We will be asking some basic information about your household. We are interested in interviewing persons at random. We are not asking for contributions or selling anything. All the information will be completely anonymous and confidential. We would like to call you back later at a convenient time and speak with the Jewish person in the household with the most recent birthday who is 18 years or older. I._ No z_ Yes Who would that be? When would be a convenient time to call back? [If no, complete Screening Outcome in D] s3. s4. s5. S6. Do you, or does anyone else in your household have a Jewish mother or a Jewish father? I._ Yes 98._ Don?t know 2_ No 99._ Refused Was anyone in your household born Jewish? I._ Yes 98._ Don?t know I_ No 99_. Refused Was anyone in your household raised Jewish? I._ Yes s._ Don?t know 2_ No 99_. Refused Is there anyone in your household who consider himself/herself Jewish? I._ Yes 98._ Don?t know - TERMINATE I_ No - TERMINATE %I._ Refused - TERMINATE Termination Statement: That?s the end of the interview. Thank you for your time and cooperation. NO (If refusal or other reason, call up to 2 more times) employee answered) empl&$tee answered) When would be a convenient When would be a When would be a ime to call back? convenient time to call convenient time to call view recent birthday) #nth most recent with most recent When would be a convenient time to call back? When would be a When would be a 12 - MAIN INTERVIEW BEGINS. READ: May I speak with ? Hello, my name is and I?m calling from the Center for Business and Economic Research at the University of Nevada, Las Vegas. We called you earlier about a survey we were conducting on behalf of the Jewish Federation of Las Vegas. At that time, you agreed to participate in the study. Is this a convenient time? If no, complete Screening Outcome in D. 1. Would you please tell me the first name of each person living in your household, beginning with individuals 18 and over, and then continuing with children under 18. [Record names directly on top of the columns on pages 8 to 111 [RECORD NUMBER OF UP TO 12 HOUSEHOLD MEMBERS] [QUESTIONS 2-10 ASK FOR ALL H.H. MEMBERS (UP TO 12 TIMES)] Go across columns Q 2-5: 1st page of 4 pages 1 Name: 1 Name: 1 Name: . What is Respondent 1 Respondent 1 Respondent 1 IXiIlE?S) Spouse/husband Spouse/husband Spouse/husband .elationship to YXl? Adopted child Adopted child Adopted child Parent-in-law Parent-in-law Parent-in-law Sibling-in-law ajibling-in-law CSibling-in-law Other relative Mther relative IDther relative housemate 13 housemate 13 housemate 13 Paid employee @aid employee @aid employee Other non- Other non- Other non- 5 relative 15 relative 15 Ex-spouse 16 Ex-spouse 16 Ex-spouse 16 Don't know 98 Don't know 98 Don't know 98 last birthday? Don't know 98 Don't know 98 Don't know 98 jeptember 1994, ms (name) 3ttended any type ,f school? [For ?ersons O-5, ADD: Don't know 98 Don't know 98 Don't know 98 'Preschool, or GO TO 07 GO TO Q7 GO TO Q7 jay care )rogram?"l Refused Befused J9lefused GO TO Q7 GO TO Q7 GO TO Q7 2nd page of 4 pages :name's) Spouse/husband Spouse/husband Spouse/husband relationship to KXI? Adopted child Adopted child Adopted child Parent-in-law Parent-in-law Parent-in-law Sibling-in-law ffiibling-in-law ffiibling-in-law Other relative lOther relative &her relative Boarder, roomer, Boarder, roomer, housemate 13 housemate 13 housemate 13 Paid employee @aid employee @aid employee Other non- Other non- Other non- 5 relative 15 relative 15 Ex-spouse 16 Ex-spouse 16 Ex-spouse 16 Don't know 98 Don't know 98 Don't know 98 name s last birthday? Don't know 98 Don't know 98 Don't know 98 September 1994, has (name) sttended any type GO TO Q7 GO TO Q7 GO TO Q7 >f school? [For ?ersons O-5, ADD: Don't know 98 Don't know 98 Don't know 98 "Preschool, or GO TO Q7 GO TO 47 GO TO Q7 Clay care program?"] Refused IL&fused Refused GO TO Q7 GO TO Q7 GO TO Q7 Q 2-5: 3rd page of 4 pages 3. What is (name's) Spouse/husband Spouse/husband relationship to (OU? Adopted child Adopted child Adopted child Parent-in-law Parent-in-law Parent-in-law ffiibling-in-law Ojibling-in-law Other relative 33ther relative lother relative Boarder, roomer, housemate 13 housemate 13 housemate 13 Paid employee @aid employee @aid employee Other non- Other non- Other non-relative 15 relative 15 relative 15 Ex-spouse 16 Ex-spouse 16 Don't know 98 Don't know 98 Don't know 98 Don't know 98 Don't know 98 September 1994, 1as (name) Ittended any type ,f school? [For ?ersons O-5, ADD: Don't know 98 Don't know 98 Don't know 98 'Preschool, or GO TO Q7 GO TO (17 GO TO Q7 lay care ?rogram?"] Refused L&fused .19iefused GO TO Q7 GO TO Q7 GO TO Q7 nale or female? IAsk only if not relationship to ?OU? Adopted child Adopted child Adopted child Parent-in-law Parent-in-law Parent-in-law Sibling-in-law IE;ibling-in-law Ojibling-in-law Other relative IXher relative IOther relative Boarder, roomer, Boarder, roomer, Boarder, roomer, housemate 13 housemate 13 housemate 13 Paid employee @aid employee @aid employee Other non- Other non- Other non- 5 relative 15 relative 15 Ex-spouse 16 Ex-spouse 16 Ex-spouse 16 Don't know 98 Don't know 98 Don't know 98 5. since zeptember 1994, 1as (name) ittended any type ,f school? [For ,ersons O-5, ADD: Don't know 98 Don't know 98 Don't know 98 'Preschool, or GO TO Q7 GO TO Q7 lay care ?rogram?"l Refused aifiefused !Jfflefused GO TO Q7 GO TO Q7 GO TO Q7 5A-6A: 1st page of 4 pages Name : Name : Name : x year is (NAME) Preschool IPreschool 01 ?nrolled? Kindergarten Kindergarten 2nd grade 04 2nd grade 04 2nd grade 04 3rd grade 05 3rd grade 05 3rd grade 05 4th grade 06 4th grade 06 4th grade 06 5th grade 07 5th grade 07 5th grade 07 6th grade 08 6th grade 08 6th grade 08 7th grade 09 7th grade 09 7th grade 09 8th grade 10 8th grade 10 8th grade 10 9th grade 11 9th grade 11 9th grade 11 10th grade 12 10th grade 12 10th grade 12 11th grade 13 11th grade 13 11th grade 13 12th grade 14 12th grade 14 12th grade 14 College freshman College freshman College junior Tollege junior 7Zollege senior College senior 83ollege senior graduate/Graduate graduate/Graduate graduate/Graduate Don't know 98 Don't know 98 Don't know 98 mblic or private school? Private school Private school Private school ;A. Is it Jewish )r non-Jewish? Non-Jewish 2 Non-Jewish 2 Non-Jewish 2 Don't know 98 Don't know 98 Don't know 98 Q 5A-6A: 2nd page of 4 pages Name : Name: Name: jA. In what grade Nursery school/ Nursery school/ Ntiee~!$~~&ool/Ol x year is (NAME) Preschool 01 Kindergarten PSschool 01 ?nrolled? Kindergarten l&S grade KDfidergarten 1st grade 288 grade 04 1st grade 2nd grade 04 3rd grade 05 2nd grade 04 3rd grade 05 4th grade 06 3rd grade 05 4th grade 06 5th grade 07 4th grade 06 5th grade 07 6th grade 08 5th grade 07 6th grade 08 7th grade 09 6th grade 08 7th grade 09 8th grade 10 7th grade 09 8th grade 10 9th grade 11 8th grade 10 9th grade 11 10th grade 12 9th grade 11 10th grade 12 11th grade 13 10th grade 12 11th grade 13 12th grade 14 11th grade 13 12th grade 14 College freshman 126h grade 14 College freshman CdSlege sophomore caaege freshman College sophomore Cdljlege junior 17 College sophomore College junior 17 College senior 18 College junior 17 College senior 18 Post College senior 18 Post graduate/Graduate Post graduate/Graduate student 19 graduate/Graduate student 19 Other 20 student 19 Other 20 Don't know 98 Other 20 Don't know 98 Refused 99 Don't know 98 Refused 99 Refused 99 5. Is it a Public school 1 Public school 1 Public school 1 nblic or private GO TO Q7 GO TO Q7 GO TO Q7 xhool? Private school 2 Private school 2 Private school 2 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 ;A. Is it Jewish Jewish 1 Jewish 1 Jewish 1 x non-Jewish? Non-Jewish 2 Non-Jewish 2 Non-Jewish 2 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 02 03 :A. In what grade Nursery school/ Nursery school/ Nursery school/ x year is (NAME) Preschool 01 Preschool 01 Preschool 01 ?nrolled? Kindergarten )Xindergarten OXindergarten 1st grade 1ZUst grade 131st grade 2nd grade 04 2nd grade 04 2nd grade 04 3rd grade 05 3rd grade 05 3rd grade 05 4th grade 06 4th grade 06 4th grade 06 5th grade 07 5th grade 07 5th grade 07 6th grade 08 6th grade 08 6th grade 08 7th grade 09 7th grade 09 7th grade 09 8th grade 10 8th grade 10 8th grade 10 9th grade 11 9th grade 11 9th grade 11 10th grade 12 10th grade 12 10th grade 12 11th grade 13 11th grade 13 11th grade 13 12th grade 14 12th grade 14 12th grade 14 College freshman .Plollege freshman ZCollege freshman College sophomore .fZollege sophomore ..&llege sophomore College junior .Zollege junior .YCollege junior College senior .83011ege senior .Eollege senior Post Post Post graduate/Graduate graduate/Graduate graduate/Graduate student -student :.%tudent other 20 Other 20 Other 20 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 6. Is it a Public school 1 Public school 1 Public school 1 public or private GO TO Q7 GO TO Q7 GO TO Q-i school? Private school .! Private school :! Private school Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 6~. Is it Jewish Jewish -Jewish -Jewish or non-Jewish? Non-Jewish 2 Non-Jewish 2 Non-Jewish 2 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 Q 5A-6A:4 th page of 4 pages Name : Name : Name : 1 iA. In what grade Nursery school/ Nursery school/ NUrSe??y school/ x year is (NAME) Preschool 01 Preschool 01 Preschool 01 znrolled? Kindergarten KDiZdergarten Kfltidergarten 1st grade 18?3 grade 1@3 grade 2nd grade 04 2nd grade 04 2nd grade 04 3rd grade 05 3rd grade 05 3rd grade 05 4th grade 06 4th grade 06 4th grade 06 5th grade 07 5th grade 07 5th grade 07 6th grade 08 6th grade 08 6th grade 08 7th grade 09 7th grade 09 7th grade 09 8th grade 10 8th grade 10 8th grade 10 9th grade 11 9th grade 11 9th grade 11 10th grade 12 10th grade 12 10th grade 12 11th grade 13 11th grade 13 11th grade 13 12th grade 14 12th grade 14 12th grade 14 College freshman CBljlege freshman caaege freshman College sophomore CMXege sophomore CUlege sophomore College junior 17 College junior 17 College junior 17 College senior 18 College senior 18 College senior 18 Post Post Post graduate/Graduate graduate/Graduate graduate/Graduate student 19 student 19 student 19 Other 20 Other 20 Other 20 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 j. Is it a Public school 1 Public school 1 Public school 1 lublic or private GO TO Q7 GO TO Q7 GO TO Q7 school? Private school 2 Private school 2 Private school 2 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 ;A. Is it Jewish Jewish 1 Jewish 1 Jewish 1 x non-Jewish? Non-Jewish 2 Non-Jewish 2 Non-Jewish 2 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 t E Q 7-13 ONLY FOR PEOPLE I8 AND OLDER, OTHERWISE GO TO Q14 Q 7-9: lstpage of 4 pages Name: Name: Name: 02 03 15 16 ? What was the [READ IF [REAL? IF [READ IF lighest educational NECESSARY1 NECESSARY] NECESSARY] evelobtained by :NAME) ? Less than high Less than high Less than high school 00 school 00 school 00 High school High school High school diploma 01 diploma 01 diploma 01 Vocational school V&%tional school V&?ational school Associate 03 Associate 03 Associate 03 Bachelors 04 Bachelors 04 Bachelors 04 Registered Nurse Registered Nurse Registered Nurse (R.N.) 05 (R.N.) 05 (R.N.) 05 Masters 06 Masters 06 Masters 06 Ph.D./Doctorate PA37D./Doctorate PW7D./Doctorate D.D.S. 08 D.D.S. 08 D.D.S. 08 M.D. 09 M.D. 09 M.D. 09 LabI 10 LabI 10 Law 10 Other Other Other professional professional professional degree 11 degree 11 degree 11 None 12 None 12 None 12 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 33 3. IS (NAME) Married 1 Married 1 Married 1 xrrently Never married 2 Never married 2 Never married 2 narried, never GO TO 12 GO TO 12 GO TO 12 narried, divorced, Divorced 3 Divorced 3 Divorced 3 separated or Separated 4 Separated 4 Separated 4 <idowed? Widowed 5 Widowed 5 Widowed 5 Live in partner L&e in partner L&e in partner Don't know 98 Don't know 98 Don't know 98 GO TO 12 GO TO 12 GO TO 12 Refused 99 Refused 99 Refused 99 GO TO 12 GO TO 12 GO TO 12 9. How many zimes, including Trecord # of -&cord # of Trecord # of zhe current times1 times1 times1 narriage, has Don't know 98 Don't know 98 Don't know 98 (NAME) been Refused 99 Refused 99 Refused 99 narried? /l7-0.31r,f"""""~A nnnnc 02 07 6 ?. What was the lighest educational eve1 obtained by :NAME) ? 3. Is (NAME) xrrently narried, never narried, divorced, separated or uidowed? 9. How many times, including the current narriage, has (NAME) been narried? ^__ _. * > EC3All IF UECESSAFtY] Less than high school 00 -Iigh school diploma 01 ilocationals chool 9ssociate 03 Bachelors 04 Registered Nurse (R.N.) 05 "iasters 06 Ph.D./Doctorate D.D.S. 08 M.D. 09 Law 10 Xher professional degree 11 NOlE 12 Don't know 98 Refused 99 Married 1 Never married 2 GO TO 12 Divorced 3 Separated 4 Widowed 5 Live in partner Don't know 98 GO TO 12 Refused 99 GO TO 12 - lrecord # of times1 Don't know 98 Refused 99 [READ IF NECESSARY] Less than high school 00 High school diploma 01 V&&ational school Associate 03 Bachelors 04 Registered Nurse (R.N.) 05 Masters 06 Pti7D./Doctorate D.D.S. 08 M.D. 09 L.?lW 10 Other professional degree 11 NOIE 12 Don't know 98 Refused 99 Married 1 Never married 2 GO TO 12 Divorced 3 Separated 4 Widowed 5 LSve in partner Don't know 98 GO TO 12 Refused 99 GO TO 12 Trecord # of times] Don't know 98 Refused 99 [READ IF NECESSARY] Less than high school 00 High school diploma 01 V&ational school Associate 03 Bachelors 04 Registered Nurse (R.N.) 05 Masters 06 Pl?J7D./Doctorate D.D.S. 08 M.D. 09 Law 10 Other professional degree 11 None 12 Don't know 98 Refused 99 Married 1 Never married 2 GO TO 12 Divorced 3 Separated 4 Widowed 5 Lljve in partner Don't know 98 GO TO 12 Refused 99 GO TO 12 Trecord # of times] Don't know 98 Refused 99 g /-Y:5rd page 0J 4page~ I Name : Name : Name : 02 07 6 ? What was the lighest educational eve1 obtained by :NAME) ? 3. Is (NAME) xrrently narried, never narried, 3ivorced, separated or *lidowed? 9. How many times. including the current marriage, has (NAME) been [READ IF XECESSARY] Less than high school 00 High school diploma 01 Vocational school Associate 03 Bachelors 04 Registered Nurse (R.N.) 05 Masters 06 Ph.D./Doctorate D.D.S. 08 M.D. 09 Law 10 Other professional degree 11 NOIX 12 Don't know 98 Refused 99 Married 1 Never married 2 GO TO 12 Divorced 3 Separated 4 Widowed 5 Live in partner Don't know 98 GO TO 12 Refused 99 GO TO 12 ;record # of times] Don't know 98 Refused 99 [READ IF NECESSARY] Less than high school 00 High school diploma 01 V&ational school Associate 03 Bachelors 04 Registered Nurse (R.N.) 05 Masters 06 PB7D./Doctorate D.D.S. 08 M.D. 09 L.XW 10 Other professional degree 11 NOIll? 12 Don't know 98 Refused 99 Married 1 Never married 2 GO TO 12 Divorced 3 Separated 4 Widowed 5 L&e in partner Don't know 98 GO TO 12 Refused 99 GO TO 12 Trecord # of times1 Don't know 98 Refused 99 [RRAD IF w.xSSARYI &ss than high school 00 high school iiploma 01 J&%tional school 4ssociate 03 3achelors 04 Xegistered Nurse (R.N.) 05 YIasters 06 PW7D./Doctorate D.D.S. 08 \I.D. 09 Law 10 Xher professional degree 11 NOIX? 12 Don't know 98 Refused 99 Married 1 Never married 2 GO TO 12 Divorced 3 Separated 4 Widowed 5 L&e in partner Don't know 98 GO TO 12 Refused 99 GO TO 12 ;record # of times] Don't know 9E Refused 99 Name : Name : Name : 02 07 6 '. What was the [READ IF [READ IF [READ IF lighest NFCESSARYI NECESSARY] NECESSARY] educational level obtained by Less than high Less than high Less than high :NAME) ? school 00 school 00 school 00 High school High school High school diploma 01 diploma 01 diploma 01 Vocational school VaXational school V&%tional school Associate 03 Associate 03 Associate 03 Bachelors 04 Bachelors 04 Bachelors 04 Registered Nurse Registered Nurse Registered Nurse (R.N.) 05 (R.N.) 05 (R.N.) 05 Masters 06 Masters 06 Masters 06 Ph.D./Doctorate Pfi7D./Doctorate P~7D./Doctorate D.D.S. 08 D.D.S. 08 D.D.S. 08 M.D. 09 M.D. 09 M.D. 09 Law 10 Law 10 Law 10 Other Other Other professional professional professional degree 11 degree 11 degree 11 None 12 None 12 None 12 Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused 99 Refused 99 3. IS (NAME) Married 1 Married 1 Married 1 xrrently Never married 2 Never married 2 Never married 2 narried, never GO TO 12 GO TO 12 GO TO 12 narried, zlivorced, Divorced 3 Divorced 3 Divorced 3 separated 01 Separated 4 Separated 4 Separated 4 widowed? Widowed 5 Widowed 5 Widowed 5 Live in partner L&e in partner L&e in partner Don't know 98 Don't know 98 Don't know 98 GO TO 12 GO TO 12 GO TO 12 Refused 99 Refused 99 Refused 99 GO TO 12 GO TO 12 GO TO 12 9. HOW many times, including .&cord # of ;record # of Trecord # of the current times] times1 times1 marriage, has Don't know 98 Don't know 98 Don't know 9E (NAME) been Refused 99 Refused 99 Refused 99 married? QIO ONLY FOR PEOPLE 18 AND OLDER, OTHERWISE GO TO Q14 QlO: 1st page of 4 pages Name : Name : Name : I 02 07 6 10. What was year of your/fNAMEI current or most recent marriage? _ _ [RECORD YEAR] Don't know 98 Refused 99 !- _- [RECORD YEAR] Don't know 98 Refused 99 _ [RECORD YEAR] Don't know 98 Refused99 QlO: 2nd page of 4 pages Name: Name : Name : 10. What was year _ _ [RECORD _ _ [RECORD _ [RECORD of your/fN?iMEI YEAR] YEAR] YEAR] current or most recent marriage? Don't know 98 Don't know 98 Don't know 98 Refused99 Refused 99 Refused 99 , IYCIIIIS. , LValllC ; , lYcullr : 10. what ~a.3 year _ _ [RECORD _ [RECORD _ [RECORD of YOW/(NAME) YEAR] YEAR] YEAR] current or most recent marriage? Don't know 98 Don't know 98 Don't know 98 Refused 99 Refused99 Refused 99 QlO: 3rd page of 4 pages QIO: 4th page of 4 pages 10. What was year of your/(NAME) current or most recent marriage? Name : _ _ [RECORD YEAR] Don't know 98 Refused 99 Q 11-11A ONLY FOR PEOPLE 18 AND OLDER, OTHERWISE GO TO Q14 11. Do you or your spouse have any children under 18 born in a previous marriage that live with you? I._ Yes %a._ Don?t know - GO TO Q12 2_ No - GO TO Q12 99_. Refused - GO TO Q12 11A. Do/does the child/children live with you? [READ LIST] I._ Yes, full time No 2_ Yes, most of the time 98._ Din? know 3._ Yes, part-time or joint custody 99_. Refused Q 12-13 ONLY IF RESPONDENT OR SPOUSE UNDER 45 YRS, OTHERWISE GO TO Q14 12. 13. Do you plan to have any children in the next three years? I._ Yes 98._ Don?t know I_ No 99._ Refused Do you plan to adopt any children in the next 3 years? I._ Yes 98_. Don?t know I_ No w._ Refused QUESTIONS 14-16B ASK FOR ALL HOUSEHOLD MEMBERS UP TO 12 TIMES Q14-16B: lstpage of 4pages religion were/was [record religion] (NAME) born? [see pink code sheet] [code religion] [code religion] [code religion] [see pink code sheet] [code religion] [code religion] Icode religion] [record religion] [record religion] [record religion] and Other Religion. [code religion1 [code religion] [code religion] [see pink code sheet] (NAME?S) current [code religion] [code religion1 [code religion] [code religion] 16B. Specify Other. _ - [see pink code sheet] [code religion] [code religion1 [code religion] 014-168: 2nd paye of 4 pages Name : Name : Name : Q14-16B: 3rd page of 4 pages LYclnlc . Iva-llltz; lYdlllf2 : 14. In what _ - religion were/was [record religion] [record religion] [record religion] (NAME) born? [see pink code sheet] 14A. Specify Jewish and Other ycode religion] ycode religion] ycode religion] Religion. [see pink code sheet] 148. Specify - - Other. [see pink [code religion] [code religion] [code religion] code sheet] 15. In what - religion were/was [record religion] Trecord religion] yrecord religion] (NAME) raised? [see pink code sheet] 15A. Specify _ - Jewish and Other [code religion] [code religion] ycode religion] Religion. [see pink code sheet] 15B. Specify - Other. [see pink [code religion] [code religion] Tcode religion] code sheet] 16. What is _ - (NAME'S) current [record religion] [record religion1 ~record religion] religion? [see pink code sheet] 16A. Specify - Jewish and Other [code religion] [code religion] ycode religion] Religion. [see pink code sheet] 168. Specify Other. isee pink [code religion] ?code religion] ?code religion] code sheet] Q14-16B: 4th page of 4 pages Name : Name : Name : 14. In what religion were/was [record religion] [record religion] Trecord religion] (NAME) born? [see pink code sheet] 14A. Specify _ Jewish and Other [code religion] [code religion] Tcode religion] Religion. isee pink code sheet] 148. Specify _ - Other. [see pink [code religion1 [code religion] [code religion1 code sheet] 15. In what religion were/was Trecord religion] record religion] ;record religion] CNAMEJ raised? [see pink code sheet] 15A. Specify - - Jewish and Other [code religion1 [code religion] Tcode religion] Religion. [see pink code sheet] 158. Specify - Other. [see pink [code religion] Tcode religion] code religion] code sheet1 16. What is fNAME'S) current [record religion] [record religion] [record religion] religion? I see pink code sheet] 16A. Specify Jewish and Other ycode religion] ycode religion] Tcode religion] Religion. [see pink code sheet] 168. Specify - Other. [see pink [code religion] [code religion] [code religion] code sheet1 17. Do you or anyone else in your household currently have any kind of physical, mental, behavior; 1 - Yes 2 _ No - RECORD ?NO? FOR EACH PERSON IN Q17A 98. _ Don?t Know- RECORD ?NO? FOR EACH PERSON IN Q17A 99._ Refused- RECORD ?NO? FOR EACH PERSON IN Q17A Q 17A: Istpageof4pages Name: Name: Name: I7A. What are the Yes 1 Yes 1 Yes 1 first names of those No 2 No 2 No 2 person? Refused to Refused to Refused to mention names !Bnention names IBnention names ENTER ?YES? FOR NAMES MENTIONED, ?NO? FOR OTHER PERSONS OR FOR EVERYBODY IF RESPONSE FOR Q17 WAS 2,98, OR 99 Q 17A: 2nd page of 4 pages Name: Name: Name: 17A. What are the Yes 1 Yes 1 Yes 1 first names of those No 2 No 2 No 2 person? Refused to Refused to Refused to mention names IBnention names IBnention names ENTER ?YES? FOR NAMES MENTIONED, ?NO? FOR OTHER PERSONS OR FOR EVERYBODY IF RESPONSE FOR Q17 WAS 2,98, OR 99 . Q I7A: 3rd page of 4 pages Name: Name: Name: 17A. What are the Yes 1 Yes 1 Yes 1 first names of those No 2 No 2 No 2 person? Refused to Refused to Refused to mention names 99 mention names 99 mention names 99 ENTER ?YES? FOR NAMES MENTIONED, ?NO? FOR OTHER PERSONS OR FOR EVERYBODY IF RESPONSE FOR Q17 WAS 2,98, OR 99 Q 17A: 4th page of 4 pages 17A. What are the first names of those person? ENTER ?YES? FOR NAMES MENTIONED, ?NO? FOR OTHER PERSONS OR FOR EVERYBODY IF RESPONSE FOR Q17 WAS 2,98, OR 99 Name: Yes 1 No 2 No 2 Refused to Refused to mention names 99 mention names 99 Name: Yes 1 Name: Yes 1 No 2 Refused to mention names 99 ASK FOR HOUSEHOLDS WITH ANYBODY 65 YEARS OLD AND OLDER. 18. Have you or anybody else in your household who is 65 years old and older been hospitalized in the last 12 months? 1 - Yes 98._ Don?t Know 2_ No 99._ Refused Q18A -18B: lstpage of 4pages IF YES IN 18 1 N_ ame. 1 Nnme. 1 Name. .I**-. _ .X__._. I .1...1. DA. What are their names? If yes in QU days days days 18B. For how many days has [NAME] been hospitalized during the last 12 months (including all times spent at the hospital)? Q18A -18B: 2ndpage of 4pages Name: Name: Name: 18A. What are their i-lG?WS? If yes in Q18 days days days 18B. For how many days has [NAME] been hospitalized during the last 12 months (including all times spent at the hospital)? Q18A -18B: 3rd page of 4pages Name: Name: Name: 18A. What are their names? If yes in QlS days days days 18B. For how many days has [NAME] been hospitalized during the last 12 months (including all times spent at the hospital)? Q18A -18B: 4th page of 4 pages 1 Name: 18A. What are their 1 names? If yes in QU days 1 Name: days 1 Name: days 18B. For how many days has [NAME] been hospitalized during the last 12 months (including all times spent at the hospital)? QUESTZONS 19 TO 27 ONLY FOR PERSONS 18 AND OLDER (UP TO 9 TZMES) Q 19-21: lstpage of 3pages Name : Name: Name: 19. What is the Working full time Working full time Working full time employment status for pay -for pay .-for pay of (NAME)? IS GO TO Q21 GO TO Q21 GO TO Q21 he/she working full time for Working part time Working part time Working part time Pay, retired, a for pay .! for pay :! for pay homemaker, GO TO Q21 GO TO Q21 GO TO Q21 disabled, unemployed, Unemployed/not Unemployed/not Unemployed/not student, or working 3 working 3 working 3 something else? Retired 4 Retired 4 Retired 4 [ALLOW MULTIPLE Homemaker 5 Homemaker 5 Homemaker 5 ANSWERS UP TO Disabled 6 Disabled 6 Disabled 6 THREE1 Student full Student full Student full time/student part time/student part time/student part time time time I 7 1 Something else Something else Something else (specify in Q19A) (specify in Q19A) (specify in Q19A) 8 8 8 Don't Know 98 Don't Know 98 Don't Know 98 Refused 99 Refused 99 Refused 99 19A. Specify from Specify Specify Specify Q19 something else. 20. Has (NAME) Yes 1 Yes 1 Yes 1 been looking for No 2 NO 2 NO 2 work in the past GO TO 424 GO TO 424 GO TO Q24 6 months? Don't Know 98 Don't Know 98 Don't Know 98 GO TO Q24 GO TO 424 GO TO Q24 Refused 99 Refused 99 Refused 99 GO TO 424 GO TO Q24 GO TO Q24 21. How many _ [RECORD -- [RECORD -- [RECORD hours does (NAME) HOURS] HOURS] HOURS] work for pay in a Don't Know 98 Don't Know 98 Don't Know 98 typical working Refused 99 Refused 99 Refused 99 week? Name : Name : Name : ?9. What is the Working full time Working full time Working full time mployment status of for pay :-for pay -for pay NAME)? Is he/she GO TO Q21 GO TO Q21 GO TO Q21 vorking full time for pay, retired, a Working part time Working part time Working part time wnemaker, disabled, for pay :! for pay :! for pay memployed, student, GO TO Q21 GO TO Q21 GO TO Q21 >r something else? [ALLOW MULTIPLE Unemployed/not Unemployed/not Unemployed/not working 3 working 3 working 3 LNSWERS UP TO Retired 4 Retired 4 Retired 4 PIiREE] Homemaker 5 Homemaker 5 Homemaker 5 Disabled 6 Disabled 6 Disabled 6 Student full Student full Student full time/student part time/student part time/student part time time time 7 I I Something else Something else Something else (specify in Q19A) (specify in Q19A) (specify in Q19A) 8 8 8 Don't Know 98 Don't Know 98 Don't Know 98 Refused 99 Refused 99 Refused 99 19A. Specify from Specify Specify Specify 219 something else. 30. Has (NAME) Ye5 1 Yes 1 Yes 1 xen looking for No 2 NO 2 NO 2 ark in the past GO TO 424 GO TO 424 GO TO Q24 j months? Don't Know 98 Don't Know 98 Don't Know 98 GO TO Q24 GO TO Q24 GO TO 424 Refused 99 Refused 99 Refused 99 GO TO Q24 GO TO Q24 GO TO 424 11. HOW many _ [RECORD _ _ [RECORD _ _ [RECORD louzs does (NAME) HOURS] HOURS] HOURS] uork for pay in a Don't Know 98 Don't Know 98 Don't Know 98 typical working Refused 99 Refused 99 Refused 99 #leek? Q 19-21: 3rd page of 3 pages Name : Name : Name : ?I 19. What is the ?mployment status sf (NAME)? IS he/she working full time for ?aY, retired, a homemaker, zlisabled, unemployed, student, or something else? [ALLOW MULTIPLE ANSWERS UP TO THREE] 19A. Specify from Q19 something else. 20. Has (NAME) been looking for work in the past 6 months? 21. How many hours does (NAME) work for pay in a typical working week? Working full time for pay GO TO Q21 Working part time for pay GO TO Q21 Unemployed/not working 3 Retired 4 Homemaker 5 Disabled 6 Student full time/student part time 7 Something else (specify in Q19A) 8 Don't Know 98 Refused 99 Specify Yes 1 NO 2 GO TO Q24 Don't Know 98 GO TO Q24 Refused 99 GO TO 024 _ _ [RECORD HOURS] Don't Know 98 Refused 99 Q 22-27: 1st page of 3pages 22. What are the rhours tha t (NAME] usually work? (approximately) Name : 7 am - 3:30 pm 1 9 am - 5:oo pm 2 3:30 pm - 11:30 pm ll:oo pm - 7:oo am Don't know 98 Refused 99 &a-k