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FOR OFFICE USE ONLY
BOX #I--1UER

PANEL

1

SURVEYOF SPLITOFF

CO#SUMRRFIHANCES COVERSHEET

Project 65 (466293) Fall 1989

COMPLETE

INFORMATIOLl BELOU: Intervieuer's Label

1.

Name of '83 R:

la. Splitoff R's Name: lb. Splitoff R's Address: &. Splitoff R's Phone: !. '83 R's ID #: ~r]-nn-n~-o-n cl YES NO '89 PANEL IY HAS BEEN COWJCTED PANEL RESPONDENT YITH

!a. Splitoff's

ID #:

nn-nn-nn-n-o

1 3. Your IW No.

7. Total Calls (Minutes) (Minutes) 5. NO 1. YES-->_(Date)

(Call

# of Final Call)

I 4. Length of Iw I 5. Length of Edit 1 6. Pers. Ltr Req.?

8. Date of Final Result 9. Final Result Code 9a. Mode of 114: 1. F-t-F 2. TEL.

I

REMEMBER TO COMPLETE OBSERVATION SECTION AND THUMBNAIL SKETCH
10.

Hello, my name is with (SPLITOFF R)? 1983?
/l. YES

May I speak , and 1 work for the Survey ResearchXenter at the University of Michigan. Mere you married to ('83 R) in In 1983 ('83 R) participated in a study of family finances.

/5. I

NO--->END

CONTACT

11.

T AS I said, our original interview uas concerned with family finances. and ue'd like to interview you. (GO TO HHL UPDATE SHEET, ITEM #l) CALL RECORD (e) IWER ID

This year we're updating

our original study,

12.

/(a)i(b)
III

/ (C) / cd) / CALL DAY OF TIME 1 # DATE WEEK AM/PM1

/
I

II

ICONTACT WITH APPT. MADE(APPT. KEPT PROVIDE A COMPLETE DESCRIPTION OF CONTACT m ATTEMPT GIVE COMPLETE DETAILS. ._ IR/INF/No ONE YES / NO IYES/NO/INAP TO CONTACT ON THE LINES BELOW.

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[CONTACT UITH~APPT. MADE~APPT. KEPT IPROVIDE A COMPLETE DESCRIPTION OF CONTACT 0~ ATTEMPT !R/INF/No ONEI YES / ~0 IYES/NO/INAPITO CONTACT 0~ THE LINES BELOW. GIVE COMPLETE DETAILS.

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ICONTACT VITHIAPP~~)MADE/APP?'KEPT [,,OVIDE A COMPLETE DE%IPTION OF CONTACT OR ATTEMPT GIVE COMPLEE DETAILS. 1 IR/INF/No ONEI YES / NO IYEs/N~/INAPITO CONTACT ON THE LINES BELOW.

1

I

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

I I1. R

IS COVERED BY A PENSION FROM CURRENT JOB (BOX 1 CHECKED AT Y42) 2. ALL OTHERS, (BOX 2 CHECKED AT Y42)---x;O TO Z3--BOTTOM OF THIS PAGE

IU
22.

In order to I need to get just a few more pieces of information before I leave. obtain the latest available information about the retirement benefits that people with work experience like yours are entitled to, we would like to contact the For this purpose, we need to employer who will be providing your primarv pension. know the name and address of the employer, or other organization, that provides the primarv pension you expect to receive. EMPLOYER NAME: ADDRESS: NUMBER AND STREET
/

Z2a.

CITY, STATE AND ZIP CODE

Z2b.

PENSION PROVIDER ADDRESS:

(IF DIFFERENT):
/

NUMBER AND STREET z2c. rl REFUSED (EXPLAIN):

CITY, STATE AND ZIP CODE

Z2d.

What is the official title of the job from which you expect to receive your primary pension? OFFICIAL JOB TITLE

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 sample, we would like to know your Social Security Number... (what is your Social Security Number?) SOCIAL SECURITY NUMBER

Z2f.

LJ

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 to receive. For this reason, we would like to know your Social Security Number... (what is your Social Security Number)? SOCIAL SECURITY NUMBER
1

Z3a.'

q

REFUSED

(EXPLAIN): NEXT PAGE, 24

3
24. INTERVIEWER CHECKPOINT: SPOUSE: EMPLOYER/PENSION/SS# (BOX 3 CHECKED AT Y43)-->NEXT PAGE, Rl

3. R IS NOT MARRIED

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

rl z5.

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 (In order to with work experience like your (husband/wife) are entitled to receive. 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 primarv pension that (he/she) expects to receive. EMPLOYER NAME: ADDRESS: NUMBER AND STREET
/

Z5a.

CITY, STATE AND ZIP CODE

Z5b.

PENSION PROVIDER ADDRESS:

(IF DIFFERENT):
/

NUMBER AND STREET z5c.

CITY, STATE AND ZIP CODE

LJ

REFUSED

(EXPLAIN):

Z5d.

What is the official title of the job from which (his/her) primarv pension?

(he/she) expects to receive

OFFICIAL JOB TITLE 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...(what is [his/her] Social Security Number?) SOCIAL SECURITY NUMBER

Z5f.

cl

REFUSED

(EXPLAIN): NEXT PAGE, Rl

26.

(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

Z6a.

REFUSED

(EXPLAIN): NEXT PAGE,

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Rl.

RECONTACT

INFORMATION

Thank you very much for this interview.

We value people like you who are willing to 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 interview. 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.1

Rla.

What is your full legal name as it appears on official documents such as your (IWER: VERIFY voter's registration, Social Security Card, or driver's license? SPELLING OF R'S FULL NAME AND WRITE CLEARLY.) TITLE:

1111111111111111111
FIRST NAME MIDDLE INITIAL LAST NAME

Rlb. What is your address?

I I
STREET ADDRESS III CITY STATE

I I I

ZIP CODE

R2.

INTERVIEWER CHECKPOINT:

ADDRESS AT Rlb ABOVE IS:

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?
2. ADDRESS TO WHICH R IS MOVING 7. OTHER:

R4.

And, what is your telephone number?
-

I
NUMBER

R HAS NO PHONE

PHONE NUMBER REFUSED

AREA CODE

TELEPHONE

I
NEXT PAGE, R6 legal name?

R4a. (IF R MARRIED):

What is your (husband's/wife's)

FIRST

MIDDLE INITIAL

LAST

5
R5.

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

R6.

Do you have another place of residence or somewhere else you live during different times of the year? R6a. We may wish to contact you at your other residence. have the address and phone number? [ADDRESS1 STREET ADDRESS

May I

CITY NU*ER (AREA CODE)

STATE

ZIP

R7.

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

R8.

IF R REFUSED ANY RECONTACT INFORMATION: THE INFORMATION WAS REFUSED?

WHAT IS YOUR UNDERSTANDING

OF THE REASON(S)

TURN

TO PAGE

8, ITEM

#13

6
NONINTERVIEW This form MUST be completed for each coversheet Coversheets FORM finalized as a Noninterview. Form completed.

finalized as Nonsamnle do not need to have a Noninterview

Nil.

Did you ever have any contact with the respondent? -> GO TO N13

NI2.

Did R refuse initially?

NI2a. Did R break any appointments?

NI2b. If there was any resistance

from the respondent, what were the reasons given?

jZZZ&)m

III

1

F. INVASION OF PRIVACY

G. NO REASON GIVEN I II

H. OTHER:
I

N13.

Describe here IN DETAIL any interactions you had with the respondent or informant(s) Examples that will help us understand finalizing this coversheet as a Noninterview. of the kind of information we need are attempts made at persuasion--letters, visits, coversheet transfers, excuses/reasons R gave for not participating.

12.

CALL RECORD (Continued

from page 1)

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CONTINTJZ ON A SUPPLEMENTAL

CALL

RECORD

IF NECESSARY

8
13. IWER: CHECK PAGE 1, ITEM 2b OF THIS COVERSHEET. IF '89 PANEL 11 HAS NOT BEEN CONDUCTED WITH PANEL RESPONDENT OBTAIN INFORMATION BELOW. Weld also like to speak with the person you were married to in 1983. Would you please tell me (his/her) name, current address, and telephone number? NAME ADDRESS

TEL. NO.

-.