Section 21, Part A - Work Experience and Income - Second Quarter, Fifth Quarter, or New Households Only

Section 21, Part A collects detailed information about the work experience and income of each member of the household age 14 and older, including occupation, hours and weeks worked, deductions from pay, and amount of income from wages and salaries, self employment, and Social Security. Note that this section is also asked in the 3rd or 4th interview for anyone turning 14 years old or members who previously did not work but are now working.

The next few questions are about income. We know people aren’t used to discussing their income, but please be assured that, like all other information you have provided, these answers will be kept strickly confidential.

  1. Enter 1 to continue

In the past 12 months, including paid vacation and sick leave, how many weeks did you/(NAME) work?

[enter value] ______________
  1. Did not work

In the weeks that you worked, how many hours did you/he/she usually work per week? [enter value] _____________

Which of the following categories best describes the job in which you received the most earnings during the last 12 months?

  1. Administrator, manager
  2. Teacher
  3. Professional
  4. Administrative support, including clerical
  5. Sales, retail
  6. Sales, business goods and services
  7. Technician
  8. Protective service
  9. Private household service
  10. Other service
  11. Machine or transportation operator, laborer
  12. Construction workers, mechanics
  13. Farming
  14. Forestry, fishing, groundskeeping
  15. Armed Forces

For definitions Information Booklet »

Were/Was you:

  1. An employee of a PRIVATE company, business, or individual working for wages or salary?
  2. A Federal government employee?
  3. A State government employee?
  4. A local government employee?
  5. Self-employed in your/his/her OWN business, partnership, professional practice, or farm?
  6. Working WITHOUT PAY in a family business or farm

What was the main reason you did not work during the last 12 months?

Were/Was you/he/she -

  1. Retired?
  2. Taking care of home/family?
  3. Going to school?
  4. Ill, disabled, unable to work?
  5. Unable to find work?
  6. Doing something else? Specify

The next few questions are about income DURING THE PAST 12 MONTHS, that is from [DATE1] TO [DATE2].
Did you/(NAME) receive any wages, salary, tips, bonuses, or commissions?

  1. Yes
  2. No

How much did You/(Name) receive before taxes?

[enter value] ______________
  1. Do not know the exact amount

Could you tell me which range on CARD A best reflects your total wages and salaries for ALL JOBS during the PAST 12 MONTHS?

  1. $0-$4,999
  2. $5,000-$9,999
  3. $10,000-$14,999
  4. $15,000-$19,999
  5. $20,000-$29,999
  6. $30,000-$39,999
  7. $40,000-$49,999
  8. $50,000-$69,999
  9. $70,000-$89,999
  10. $90,000-$119,999
  11. $120,000 and over

For definitions Information Booklet »

Back to top

What was the amount of your last pay before any deductions? [enter value] _____________

What period of time did this cover?

  1. One week
  2. Two weeks
  3. Month
  4. Quarter
  5. Year
  6. Twice a month
  7. Other

* Specify: [enter text] _____________

Does the respondent have a paper or electronic pay check record present for his/her/Name’s/the last paycheck?

  1. Yes
  2. No

Was there any money deducted from your pay for -
Federal income tax?

  1. Yes
  2. No

How much? [enter value] _____________

Was there any money deducted from your pay for -
State or local income tax?

  1. Yes
  2. No

How much? [enter value] _____________

Was there any money deducted from your pay for -
Private pension fund?

  1. Yes
  2. No

How much? [enter value] _____________

Was there any money deducted from your pay for -
Government retirement?

  1. Yes
  2. No

How much? [enter value] _____________

Was there any money deducted from your pay for -
Railroad retirement?

  1. Yes
  2. No

How much? [enter value] _____________

Was there any money deducted from your pay for -
Social Security including Medicare?

  1. Yes
  2. No

Are Social Security payments NORMALLY deducted from your pay?

  1. Yes
  2. No

Does the money deducted for Social Security cover only the Medicare portion of Social Security?

  1. Yes
  2. No

Other than Social Security, did any employer or union contribute to your pension or retirement plan in the last 12 months?

  1. Yes
  2. No

DURING THE PAST 12 MONTHS –
Did You/(Name) receive any self-employment income or have a loss?
(Report income from own businesses (farm or non-farm) including proprietorships and partnerships.)

  1. Yes
  2. No

How much did You/(Name) receive?

[enter value] ______________
  1. Do not know the exact amount
  2. Do not know the exact amount

    Could you tell me which range on CARD A best reflects your income or loss from self-employment during the PAST 12 MONTHS?

    1. Loss
    2. $0-$4,999
    3. $5,000-$9,999
    4. $10,000-$14,999
    5. $15,000-$19,999
    6. $20,000-$29,999
    7. $30,000-$39,999
    8. $40,000-$49,999
    9. $50,000-$69,999
    10. $70,000-$89,999
    11. $90,000-$119,999
    12. $120,000 and over

    For definitions Information Booklet »

    DURING THE PAST 12 MONTHS – ,br> Did You/(Name) receive any Social Security or Railroad Retirement benefits?

    1. Yes
    2. No

    What was the amount of the last Social Security or Railroad Retirement payment received?

    [enter value] ______________
    1. Do not know the exact amount
    2. Could you tell me which range on CARD B best reflects the amount of Your/(Names) last Social Security or Railroad Retirement payment during the PAST 12 MONTHS?

      1. Less than $500
      2. $500-$699
      3. $700-$999
      4. $1,000-$1,299
      5. $1,300-$1,699
      6. $1,700 and over

      For definitions Information Booklet »

      Is this amount AFTER the deduction for a Medicare premium?

      1. Yes
      2. No

      During the past 12 months, how many Social Security or Railroad Retirement payments did you receive? [enter value] _____________

      DURING THE PAST 12 MONTHS –
      did you receive any -
      Supplemental Security Income (SSI) payments?

      1. Yes
      2. No

      What was the amount?

      [enter value] ______________
      1. Do not know the exact amount
      2. Could you tell me which range on CARD C best reflects the amount you received in Supplemental Security income during the past 12 months?

        1. $0-$999
        2. $1,000-$1,999
        3. $2,000-$2,999
        4. $3,000-$3,999
        5. $4,000-$4,999
        6. $5,000-$9,999
        7. $10,000-$14,999
        8. $15,000-$19,999
        9. $20,000-$29,999
        10. $30,000-$39,999
        11. $40,000-$49,999
        12. $50,000 and over

        For definitions Information Booklet »

        DURING THE PAST 12 MONTHS –
        did you place any money in a retirement plan such as an Individual Retirement Account (IRA) or Keogh? Do not include rollovers.

        1. Yes
        2. No

        How much? [enter value] _____________

        End of Section 21A

        Go to Section 21 Part B - Work Experience and Income - Second Quarter, Fifth Quarter, or New Households Only - Ask for entire household as a group »

        Go to CE CAPI Survey Instrument Home Page »

         

        Last Modified Date: April 3, 2013