- Do you currently have the following items in your home, in working condition? (Yes/No)
- Washing machine
- Clothes dryer
- Stand-alone food freezer (separate from refrigerator)
- Color television
- Gas or electric stove (with or without an oven)
- Microwave oven
- Videocassette recorder (VCR)
- Air conditioner (central or room)
- Personal computer
- Cellular phone or car phone
- Regular telephone
- You didn't list a washing machine in your home. Is there a washing machine in your BUILDING provided for your use?
- You didn't list a dryer in your home. Is there a dryer in your BUILDING provided for your use?
- You didn't list a telephone in your home. Is there a way for people to reach you by telephone?
- Yes, neighbor's phone, common phone, pay phone
- Yes, cell phone
- Yes, other device
- No, cannot be reached by phone
This section comprises five questions with the following lead-in:
The next set of questions are about the quality of your neighborhood, crime in your neighborhood, and the type of services available to you. First, I will ask about your home.
- How many rooms are there in your home? Count the kitchen but do not count the bathrooms.
- Are any of the following conditions present in your home?
- Problem with pests such as rats, mice, roaches, or other insects
- A leaking roof or ceiling
- Broken window glass or windows that can't shut
- Exposed electrical wires in the finished areas of your home
- A toilet, hot water heater, or other plumbing that doesn't work
- Holes in the walls or ceiling, or cracks wider than the edge of a dime
- Holes in the floor big enough for someone to catch their foot on
This module's lead-in is:
Next are questions about difficulties people sometimes have in meeting their essential household expenses for such things as mortgage or rent payments, utility bills, or important medical care.
A general question is then asked, but a negative response DOES NOT lead to skipping out of the rest of the section:
During the past 12 months, has there been a time when (you/your household) did not meet all of your essential expenses?
The module then asks about seven forms of hardship, with this lead-in:
The following are some of the specific difficulties people experience with household expenses.
For each of the forms of hardship, a gateway question is asked about occurrence of difficulty, and then two follow-up questions:
When (you/your household) had this problem, did any person or organization help? Who was that?
- A family member or relative
- A friend, neighbor or other non-relative
- A department of social services
- A church or non-profit group
The seven gateway questions are:
- Was there any time in the past 12 months when (you/your household) did not pay the full amount of the rent or mortgage?
- In the past 12 months (were./was) (you/anyone in your household) evicted from your home or apartment for not paying rent or mortgage?
- How about not paying the full amount of the gas, oil or electricity bills? Was there a time in the past 12 months when that happened to (you/your household)?
- In the past 12 months did the gas or electric company turn off service, or the oil company not deliver oil?
- How about the telephone company disconnecting service because payments were not made?
- In the past 12 months, was there a time (you/anyone in your household) needed to see a doctor or go to the hospital but did not go?
- In the past 12 months, was there a time (you/anyone in your household) needed to see a dentist but did not go?
This section opens with the basic food security question and a follow-up to establish the time frame of food insecurity:
- Getting enough food can also be a problem for some people. Which of these statements best describes the food eaten in your household in the last four months:
- Enough of the kinds of food we want
- Enough but not always the kinds of food we want to eat
- Sometimes not enough to eat
- Often not enough to eat
- In which of the last four months did (you/anyone in your household) NOT have enough to eat?
It then asks six items adapted from the full food security module that appears in the March supplement to the Current Population Survey:
I'm going to read you some statements that people have made about their food situation. For these statements, please tell me whether it was OFTEN TRUE, SOMETIMES TRUE, or NEVER TRUE for (you/anyone in your household) in the past four months:
- The food that (I/we) bought just didn't last and (I/we) didn't have money to get more.
- (I/we) couldn't afford to eat balanced meals.
- (My child was/our child was/the children were) not eating enough because (I/we) couldn't afford enough food.
The next questions refer to adults in the household. In the past four months did (you/anyone in your household/you or the other adults in the household/you or the other adult in the household) ever:
- Cut the size of your meals or skip meals because there wasn't enough money for food.
- Eat less than you felt you should because there wasn't enough money to buy food.
- Not eat for a whole day because there wasn't enough money for food.