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2? .INTERVI8!? CHECKPOINT: RESPONDENT: EMPLOYER/PENSION/SOCIAL SECURITY NUMBER

1. 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 primary pension. For this purpose, we need

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

primary pension you expect to receive.

Z2a. EMPLOYER NAME:

ADDRESS:

NUMBER AND STREET

Z2b. PENSION PROVIDER (IF DIFFERENT):

ADDRESS:

NUMBER AND STREET

z2c. r-l EFUSED (EXPLAIN):

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

pension?

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

Number?)

SOCIAL SECURITY NUMBER

Z2f. REFUSED (EXPLAIN):

NEXT PAGE, 24

23. 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 expect

receive. For this reason, we would like to know your Social Security Number...

(what is your Social Security Number)?

SOCIAL SECURITY NUMBER

Z3a. u EFUSED (EXPLAIN):

NEXT PAGE, 24

/

CITY, STATE AND ZIP CODE

/

CITY, STATE AND ZIP CODE

OFFICIAL JOB TIT

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INTERVIEWER CHECKPOINT: SPOUSE: EMPLOYER/PENSION/S%

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

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

71

5. ALL OTHERS (BOX 5 CHECKED AT Y43)-->GO 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 to

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/she)

expects to receive.

EMPLOYER NAME:

ADDRESS: /NUMBER AND STREET CITY, STATE AND ZIP CODE

PENSION PROVIDER (IF DIFFERENT):

ADDRESS:

NUMBER AND STREET

clREFUSED (EXPLAIN):

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

(his/her) primary pension?

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...(what

is [his/her] Social Security Number?)

SOCIAL SECURITY NUMBER

REFUSED (EXPLAIN):

(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)?

SOCIAL SECURITY NUMBER

q EFUSED (EXPLAIN):

3

/CITY, STATE AND ZIP CODE

OFFICIAL JOB TITLE

NEXT PAGE, Rl

NEXT PAGE, Rl

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_

4RECONTACT INFORMATION

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

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

some of our findings as a way of expressing our appreciation for your cooperati

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

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

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

Rla. What is your full legal 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 NAME AND WRITE CLEARLY.)

TITLE:

I I I I I I I I IIFIRST NAME MIDDLE LAST NAME

INITIAL

Rib. What is your address? ADDRESS REFUSED

R2

R3

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

IL-uI

CITY STATE ZIP CODE

INTERVIEWER CHECKPOINT: ADDRESS AT Rlb ABOVE IS:

CO TO R4 CO TO R4

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 IIIIIIIIII -R HAS NO PHONE PHONE NUMBER REFUSE

AREA CODE TELEPHONE NUMBERI

NEXT PAGE, R6

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

FIRST MIDDLE INITIAL LAST

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Is your phone number listed in the current telephone directory?

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

I

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?)

NAME RELATIONSHIP

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

times of the year?

l-l. YES ---> c6a. We may wish to contact you at your other residence. May I

have the address and phone number?

NO

-I.

If

STREET ADDRESS

IADDRESS mw sm~

CITY STATE

(AREA CODE) NUMBER

or 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?

5

ZIP

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6NONINTERVIEW FORM

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

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

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

---> GO TO N13

N12. Did R refuse initially? NI2a. Did R break any appointments?

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

(CHECK ALL THAT APPLY.)

A. SURVEYS WASTE OF

TIME; PREVIOUS

BAD EXPERIENCE

/B. ;;yi 1C. ‘T’T;, j D. STRESSFUL

FAMILY

SITUATION

E. CONFIDEN-

TIALITY

I' I"] 'H. OTHER:

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

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

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

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

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12. C AL L R EC OR D ( C o n t i n u e d f r om p a g e 1)

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

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CONTINUE ON A SUPPLEMENTAL CALL RECORD IF NECESSARY

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3.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

In order to determine whom to interview, I need to know who lives here at this

address --not their names, just their ages and their relationship to you. Let's

start with you- -how old are you? (CONTINUE LISTING a MEMBERS OF THIS HOUSEHOLD BY

RELATIONSHIP TO INFORMANT.)

(a>

Household Members by

Relationship to Informant

INFORMANT

lb ) cc>

SexAge

Cd)Enter "R"

to Identify

Respondent

TO INTERVIEW -- INTERVIEWER INSTRUCTIONS

a. If household contains only a married couple or persons living as though married,

with or without children, interview the person who is most knowledgeable about the

family's assets and debts.

b. If household contains only an adult and their minor children, interview the adult.

C. If household contains unrelated roommates who are 18 years of age or older, list

the household and interview person closest to age 45 as a single person economic

unit.

d. If household contains an extended family (persons related by blood, marriage or

adoption--e.g., adult married children living with parents), interview the person

or persons most knowledgeable about the family's assets and debts. (FAMILY TO BE

INTERVIEWED IS DETERMINED BY WHOSE NAME IS ON THE LEASE OR MORTGAGE.INTERVIEW THE MOST KNOWLEDGEABLE PERSON IN THAT FAMILY.)

e. If unclear whom to interview (especially in case d.)--CALL THE F.O.

f. NOTE: In & situations, the person whose occupation is asked about in Section R is

considered the Resoondent. Indicate R for this cover sheet in Col. (d) above.

4. We would like to conduct the interview with the person or persons in your family who

are most knowledgeable about the family's assets and debts. w ho would that be?

5. IF MOST KNOWLEDGEABLE PERSON IS NOT AT HOME, DETERMINE CONVENIENT TIME FOR IW (AND

PHONE NUMBER IF APPROPRIATE). RECORD THIS INFORMATION IN THE CALL RECORD, ITEM 12.