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APPENDIX C 49 Program cash payments (generally includes basis of paymentâwhether weekly, monthly, quarterly, etc.; number of payments; who in household received; reasons for receipt) State or federal unemployment compensation Supplemental unemployment benefits Union unemployment or strike benefits Worker's compensation payments Social Security payments last year and month Social Security received for children last year and month Supplemental Security Income SSI received for children Public assistance or welfare payments from state or local welfare office; type of assistance (AFDC, other, both) Veterans' payments by type Survivors' benefits by type (e.g., private or public widows' pensions, estates, trusts, annuities; excluding Social Security or VA) Disability benefits by type (excluding Social Security or VA) Pension or retirement benefits by type (excluding Social Security or VA) Asset income (generally includes who owns, basis of payment, number of payments) Interest income Dividend income Property income (including rent, royalties, income from estates or trusts) Other Income Child support payments Alimony payments Regular financial assistance from friends or relatives Income from hobbies, home businesses, or farms not already covered Income from unemployment compensation, severance pay, welfare, foster child payments, or other money income not already covered Educational assistance from Pell Grants; from other sources In-Kind Program Participation Number of children who ate lunch at school; number who qualified for free or reduced price lunch Whether live in public housing project or have subsidized rent Whether household received food stamps; who covered; monthly amount; number of months Receipt of heating assistance; amount [Note: There are no questions on welfare program participation prior to the previous year.] Health and Health Insurance Coverage Health problem that prevents or limits work Ever retired or left a job for health reasons Self-assessment of health status (poor to excellent)
APPENDIX C 50 Health insurance coverage from current or former employer or union; policyholders; who covered; whether current or former employer or union paid all, part, or none of premium Health insurance coverage purchased directly; policyholders; who covered Health insurance coverage from non-household member; who covered Medicare coverage; who covered Medicaid coverage; who covered; number of months covered CHAMPUS or CHAMPVA coverage; who covered Coverage by any other state health insurance plan or any other coverage (plans in 26 states listed as possibilities); who covered [Note: Above questions are for coverage any time during previous year; type of coverage last week also ascertained. There are no questions on reasons for lack of coverage.]
