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I

I P ANB L 8uR vEY O F C OblS uI a EP F I xAhI C ES Project 65 (466293

F O R O F F I C E U S E O NL Y /

I

1 . S A MP L E L A B E L

P ANEL- ONLY COVBRSEBET Fall 1989

1

2 . I n t e r v i e w e r l s L a b e l

3 . T h i s I U N o .

4 . L e n g t h o f I u ( Mi n u t e s )

5 . L e n g t h o f E d i t ( Mi n u t e s )

- -

6 . P e r s . L t r R e q ? U S . N O u l . Y E S - - > D a t e 9 a . Mo d e o f I w :c l

1 . F - t - Fc l

2 . T E L

i REMEMBER TO COMPLETE OBSERVATION SECTION JWJ) THTJMBNAIL SKETCH

L

7 . T o t a l C a l l s ( C a l l # o f F i n a l C a l l )

8. D a t e o f F i n a l R e s u l t

9 . F i n a l R e s u l t C o d e

10. H e l l o , my n a me i s a n d I w o r k f o r t h e S u r v e y R e s e a r c h C e n t e r a t t h e U n i v e r s i t y o f Mi c h i g a n .

t o r e a c h ( R ) , w h o u a s k i n d e n o l g h t o p a r t i c i p a t e i n o u r s t u d y i n 1 9 8 3 . D o e s ( h e / s h e ) l i v e here?

I a m t r y

nil. Y E S c ] 5 . N O - - > 1 D a . P R E - E D I T - - R MA R RI E D I N ' 8 3 :

r

9

YE S qO - - > G O T O I T E M 1 2

l o b . We ' r e a l s o t r y i n g t o r e a c h t h e p e r s o n t o u h o m ( R ) w a s ma r r i e d i n 1983;

d o e s ( S P OU S E ) live h e r e ?

r - l 1 . Y E S r - l

T

- 5 . N O - - > GO T O I T E M 12

1 1 . T o v e r i f y o u r o f f i c e r e c o r d s , I n e e d t o a s k i f y o u a r e c u r r e n t l y l i v i n g a t ( R E AD S AMP L E AD D R E S S O N ' 8 3 C O V E RS HE E T

0 1 . Y E S , R q . Y E S , ' 8 3 S P O US E O NL Y i - i 5 . N O, N EI T HE R R N OR S

G O T O I T E M 1 4 G O T O P I N K S P L I T O F F

C O VE R S H E E T , C O ND UC T P A NE L I W I

f12. I N T E R VI E U E R C H E CK P O I N T - - S E E S A MP L E L A B E L , T R A C KI N G I N S T R U C T I O WS L O U E R R I G HT C OR N E R

r

I n1 1 Il. T R AC K N O O NE - - - - - - - - - - - - - - - > D O N O T C ON D U CT AN Y I Y A T T HI S MI - - C Q) E C OV E R S H EE T ' 9 2 ' .

I -

/4 I2 . T R AC K R ( A ND ' 8 3 S P OU S E ) - - - > R E CO RD A NY N E W A DD RE S S I N F GR HA TI o l l I N I T E W 13 BELW AND wTI

P A N E L I U U I T H ' 8 3 R ( A N D ' 8 3 S P OU S E) , O R ' 8 3 S P OU S E- I1 I I

v

1 3 . i N A M E :

I

N E W S T R E E T A D DR E S S :

1 N EW C I T Y , S T A T E, Z I P :

I N E W A R E A C O D E A N D T E L E P H O N E N U MB E R :

1 4 . T h e U n i v e r s i t y o f Mi c h i g a n i s c o n d u c t i n g a n a t i o n wi d e S t u d y o f C o n s u me r F i n a n c e s . Y o u w e r e k i n d e n o u g h t o

p a r t i c i p a t e i n 1 9 8 3 ( a n d 1 9 8 6 ) a n d w e w o u l d L i k e t o s p e a k wi t h y o u a g a i n . ( M T O H H L U P DA T E S H E E T , I T E M # l . )

1 5 . C A L L R E C O R D O N P A G E 7 O F C O VE R S H E E T



2Zl.INTERVIEWER CHECKPOINT: RESPONDENT: EMPLOYER/PENSION/SOCIAL SECURITY NUMBER

Y. R IS COVERED BY A PENSION FROM CURRENT JOB (BOX 1 CHECKED AT Y42)

02. ALL OTHERS, (BOX 2 CHECKED AT Y42)--->GO TO Z3--BOTTOM OF THIS PAGE

22. I need to get just a few more pieces of information before I leave. In order to

obtain the latest available information about the retirement benefits that peoplewith work experience like yours are entitled to, we would like to contact the

employer who will be providing your primarv pension. For this purpose, we need

know the name and address of the employer, or other organization, that provides

primarv pension you expect to receive.

Z2a EMPLOYER NAME:

ADDRESS:

NUMBER AND STREET/

CITY, STATE AND ZIP CODE

Z2b. PENSION PROVIDER (IF DIFFERENT):

ADDRESS: /

NUMBER AND STREET CITY, STATE AND ZIP CODE

zzc.I

REFUSED (EXPLAIN):

Z2d. What is the official title of the job from which you expect to receive your prima

pension?

OFFICIAL JOB TIT

Z2e. In order to get complete information on the adequacy of pension and retirement

income and to examine health care benefit information of households in our sampl

we would like to know your Social Security Number... (what is your Social Securit

Number?)

SOCIAL SECURITY NUMBER

Z3a

u EFUSED (EXPLAIN):

NE XT PAGE, 24

The Survey Research Center would like to obtain the latest available information

about the retirement and health benefits that you and others like you can expectreceive. For this reason, we would like to know your Social Security Number...

(what is your Social Security Number)?


0 REFUSED (EXPLAIN):

NEXT PAGE, 24



24. INTERVIEWER CHECKPOINT: SPOUSE: EMPLOYER/PENSION/SS#

25.

Z5a. EMPLOYER NAME:

ADDRESS:

NUMBER AND STREET

Z5b. PENSION PROVIDER (IF DIFFERENT):

ADDRESS:

NUMBER AND STREET

z5c. cl EFUSED (EXPLAIN):

Z5d. What is the official title of the job from which (he/she) expects to receive

(his/her) primarv pension?

Z5e. In addition, to get complete information about your (husband's/wife's) retirement

and health benefits, we would like to know (his/her) Social Security Number...(wha

is [his/her] Social Security Number?)

Z5f.

26.

Z6a.

1 I . R IS NOT MARRIED (BOX 3 CHECKED AT Y43)-->NEXT PAGE, Rl

7

4. S IS COVERED BY A PENSION FROM CURRENT JOB (BOX 4 CHECKED AT Y43)

5. ALL OTHERS (BOX 5 CHECKED AT Y43)--x;O TO Z6--BOTTOM OF THIS PAGE-

We would also like to obtain information about the retirement benefits that people

with work experience like your (husband/wife) are entitled to receive. (In order

do this, we would like to contact the employer who will be providing (his/her)

primary pension.) For this purpose, we would like to know the name and address of

the employer, or other organization, that provides the primary pension that (he/sh

expects to receive.

/


/


OFFICIAL JOB TITLE


cl EFUSED (EXPLAIN):

NEXT PAGE, Rl

(The Survey Research Center would like to obtain the latest available information

about the retirement and health benefits that your [husband/wife] and others like[him/her] can expect to receive.) (For this reason,) we would like to know your

(husband's/wife's) Social Security Number... (what is [his/her] Social Security

Number)?


l-lREFUSED (EXPLAIN):

NEXT PAGE, Rl



4

Rl.

Rla

RECONTACT INFORMATION

Thank you very much for this interview. We value people like you who are willing

contribute their experiences to our research. We will be sending you a report of

some of our findings as a way of expressing our appreciation for your cooperation.

Our Regional Supervisor may also be calling or writing you to verify this intervie

For these reasons I would like to ask for your name, address and telephone number.

(FOR WOMEN OBTAIN THEIR FIRST NAME, NOT THEIR HUSBAND'S FIRST NAME.)

What is your full lenal name as it appears on official documents such as your

voter's registration, Social Security Card, or driver's license? (IWER: VERIFY

SPELLING OF R'S FULL NkEfE ND WRITE CLEARLY.)

TITLE:

lull

FIRST NAME MIDDLE LAST NAME

INITIAL

Rlb. What is your address?

11 l I l I I I I I I I I I I I I l l l l l l l ISTREET ADDRESS

llllllll1lu_l Iu_l_l_u

CITY STATE ZIP CODE

GO TO R4 GO TO R4

R3. Is this a mailing address for your home, an address you will be moving to, a

relative's address, the address of a friend, a business address, or what?

R4. And, what is your telephone number?

I I I I II l I I I II I I I I II

jR ’

PHONE NUMBER REFUSED

AREA CODE TELEPHONE NUMBERI

NEXT PAGE, R6

R4a. (IF R MARRIED): What is your (husband's/wife's) legal name?

FIRSTMIDDLE INITIAL

LAST



Is your phone number listed in the current telephone directory?

1. YES, LISTED 5. NO, NOT LISTED 8. NOT SURE, DON'T KNOW

GO TO R6

R5a. Is your phone listed in your name?

----> R5b. In whose name is the phone listed? (What

relation is this person to you?)

I NAME RELATIONSHIP

Do you have another place of residence or somewhere else you live during different

times of the year?

I1. YES ---> R6a. We may wish to contact you at your other residence. May I

have the address and phone number?

STREET ADDRESS

I CITY STATE ZIP

\(AREA CODE) NUMBER

5

If for any reason we should have difficulty contacting you, could you give me the

name, address, and telephone number of a close friend or relative who will know how

to get in touch with you? (And what is this person's relationship to you?)

NAME: RELATIONSHIP TO R:

ADDRESS:

TELEPHONE:

IF R REFUSED ANY RECONTACT INFORMATION: WHAT IS YOUR UNDERSTANDING OF THE REASON(S)

THE INFORMATION WAS REFUSED?

TURN TO PAGE 8, ITEM #16



6NONINTERVIEW FORM

This form MUST be completed for each coversheet finalized as a Noninterview.

Coversheets finalized as Nonsamnle do not need to have a Noninterview Form completed.

Nil. Did you ever have any contact with the respondent?

il.1 PI---> GO TO N13

t

NI2. Did R refuse initially? NI2a. Did R break any appointments?

NI2b. If there was any resistance from the respondent, what were the reasons give

(CHECK ALL THAT APPLY.)

1*1

F. INVASION OF

0

G. NO REASON

I I

H. OTHER:

PRIVACY GIVEN

N13. Describe here IN DETAIL any interactions you had with the respondent or informant(

that will help us understand finalizing this coversheet as a Noninterview. Exampl

of the kind of information we need are attempts made at persuasion--letters, visit

coversheet transfers, excuses/reasons R gave for not participating.



Cj )

KEPT PROVIDE A COMPLETE DESCRIPTION OF CONTACT E ATTEMPT

IDATEI WEEK IAM/PM~ ID R/INF/NO ONE YES / NO IYES/NO/INAP TO CONTACT ON THE LINES BELOW. GIVE COMPLETE DETAILS.

’

I ,

cc) 1 (d) (e) 1 ‘(f) (40 (h ) Cj )

DAY O F T IUE IUER CONTACT YITH APPT. MADE APPT. KEPT PROVIDE A COMPLETE DESCRIPTION OF CONTACT B ATTEMPT

DATE WEEK AM/PM ID R/INF/NO ONE YES / NO YES/NO/INAP TO CON TACT ON THE LINES B ELOU. GIVE COMPLETE DETAILS. .

1

i (b) i (C) i (d) (e) (f) / (g) (hl Cj>IDAY OF TIME IUER CO NTACT UITH APPT. M ADE APPT. KEPT PRO VIDE A CO M PLETE DESCRIPTIO N O F CO NTACT B ATTEM PT

IDATE I UEEK AM/PM ID R/INF/NO ONE YES / NO YES/NO/INAP TO CONTACT ON THE LINES BELOU. GIVE COHPLETE DETAILS. .

I I

(C) (d) (e) (f) (B ) (h ) I Cj)J IDAY OF TIME 1 IUER ICONTACT UITH)APPT. MADEIAPPT. KEPT IPROVIDE A COMPLETE DESCRIPTION OF CONTACT B ATTEMPT 1

IDATEI WEEK AM/PMI ID IR/ INF/NO ONEI YES / NO IYES/NO/INAP~TO CONTACT ON THE LINES BELOW . GIVE CCMPLETE DETAILS. [

1 (Cl W 1 ,;k; 1

DAY OF TIME

IDATEI UEEK AM/PHI

(f ) 1 ($0 1 (h) Cj)

CO NTACT UITH APPT. UADE APPT. KEPT PROVIDE A COMPLETE DESCRIPTION OF CONTACT a ATTEMPT IID IR/ INF/NO ONEI YES / NO IYES/NO/INAP TO CONTACT ON THE LINES BEL OW. GIVE COMPLETE DETAILS. 1

I I I I I

I

I I/ (Cl 1 cd) / (e) I

/ I I

(f) I (g) I (h) i Cj)DAY OF TIME IUER CO NTACT UITH A PPT. M ADE APPT. KEPT PROVIDE A COMPLETE DESC RIPTION OF CO NTACT 2 ATTEM PT

DATE UEEK AM/PM ID R/INF/NO ONE YES / NO YES/NO/INAP TO CONTACT ON THE LINES BELOW. GIVE COMPLETE DETAILS. _II I I I

CONTINUE ON A SUPPLEMENTAL CALL RECORD IF NECESSARY

-, _ - . . . . .



16. IWER: IF '83 SPOUSE IS BOT LIVIBG WITB R ABD A PANBL IW BAS BOT YET

BEEN COBDUCTED WITB (HER/HIM), OBTAIB CURREBT ADDRESS

INFORNATION BELOW,

17. We'd also like to speak with the person you were married to in 1983. Would you

please tell me (her/his) name, current address, and telephone number?

NAME

ADDRESS

c.

TEL. NO.

REMEMBER A (PINK) SPLITOFF COVERSHEET MUST BE

FILLED OUT FOR ALL '83 SPOUSES NOT LIVING WITH '83 R.COMPLETE INFORMATION FOR SPLITOFF R IN BOX #I.

CONDUCT PANEL INTERVIEW WITH PERSON NAMED IN ITEM 17.

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