200x200.htm
n 1 19/
Time started PM 2 Time finished PM Total minutes 20/21
is,i6/17/1B
I'm from The Roper organization and we're conducting a survey about things that are
happening today-
1. considering both the availability and cast of things today, as well as your
present financial circumstances, do you think now is a good time to buy things
you want and need, or a good time.. to wait, or is it someplace in between?
Now is a good time to buy ...1 someplace in between '.3 22/
Now is a good time to wait .2 Don't know Y
2. Do you feel things in this country are generally going in the right direction
today. or do you feel that things have pretty seriously gotten off on the wrong
track?
Right direction 1 Don't know Y 23/
wrong track 2
3. what is your opinion of ~Qfl Federal Government departments and agencies? There
may be exceptions, of course, but would you say your opinion of most Federal
Departments and agencies is highly favorable, or moderately favorable, or noc too
favorable. or rather LLflfavorable?
Highly favorable 1 24/
Moderately favorable .2
Not too favorable 3
Rather LLflfavorable 4
Don't know Y
a. F.T.C. (Federal Trade Commission) 1 2 3 4 Y 2b~
b. F.B.I. (Federal Bureau of investigation) .1 2 3 4 Y 26/
C. o.S.H.A. (occupational safety and Health
Administration) 2 3 4 Y 27/
a. F.C.C. (Federal Communications
commission) 1 2 3 4 Y 28/
e. N.A.S.A. (National Aeronautic and Space
Administration) 1 2 3 4 Y 29/
f. B.A.T.F. (Bureau of Alcohol, Tobacco,
and Firearms) 1 2 3 4 Y 30/
g. I.R.S. (Internal Revenue Service) 1 2 3 4 Y 31/
h. F.A.A. (Federal Aviation Administration) .2 2 3 4 Y 32/
5. Here is a list of some social problems. (RAND RESPONDENT CARD) For each one, please tell me if you think it
affects jjo more, less, or the same as the average person in this country?
ABOUT'
LEqs THSAME
a. Violent crime 1 2 3 Y 33/
b. Pollution 1 2 3 Y 34/
C. Economic hardship 1 2 3 Y 35/
d. Police brutality ......1 2 3 y 36/
e. High taxes 1 2 3 Y 37!
f. Discrimination 1 2 3 Y 38/
6. There has been talk about whether some problems in society have more of an impact
or less of an impact on racial and ethnic n,inorities~than they have on other people.
(USING SAME CARD) For each one, please tell me if you think it affects racial
and ethnic minorities more. l~ss. or about the same as other people?
ABOUT'
'OP' L~S THESAMS
a. Violent crime 1 2 3 y 39!
b. Pollution 1 2 3 y 40/
c. Economic hardship 1 2 3 y 41/
d. Police brutalitv 1 2 3 y 42/
. AssauiL .0
g. Racketeering, extortion 7'
h. Drugs.~ a
i. Prostitution .9
j. speculationandswindling 0
k. Other 1 46/
Noneoftheabove(vol.) 2
Don'tknow Y
8. of course, the problems we face in 9. what about drunk driving? (HAND
our society often have many differ- RESPONDENT CARD) Using this card,
ent causes. I am going to ask you which three or tour things do you
about some different problems in think are the man causes of people
society and for each one I want you becoming drunk drivers?
to tell me what xz' think are the DRUNK
major causes of each problem. DRrVXNG
First, violent crime. (HAND RESPON
DENT CARD) Using this card, which a. Livinginpoverty 1
49/
three or four things do you think b. Parents not teaching
are the main causes of people com
mitting violent crimes? right fromwrong 2
vrcLeNr a. Being abused as a child 3
CRIMS a. Drugabuse 4
a. Living in poverty 1 47/ e. what people see in TV programs S
b. Parents not teaching f. A lack of morals 6
right from wrong 2 g. Alack of education 7
c. Being abused as a child 3 h. A person not seeing any harm in it .8
d. Drug abuse 4 i. Apersonbeingirresponsible 9
e. what people see in TV programs S
j. Influenceoffriends 0
f. A lack of morals S
g. A lack of education 7, k. Being unable to control drinking
h. A person not seeing any harm in it .8 because alcoholism is a
i. A person being irresponsible 9 disease x
1 Influenceottriends 0 1. whatpeopleseeinmovies Y
k. Alcoholabuse x ~ whatpeopleseeinadvertising 1 501
1. what people see in movies Y ~ Bartenders not being responsible....2
m. The advertising and marketing
0. Lowchanceofbeingpunished 3
of toy guns, etc 1 42/
n. Guns being too easy to get 2 p. Friends and family not looking
0. Lowchance of being punished 3 out for each other 4
p. Seeing pornography 4 None of these S
None of these S 4' Don'tknow V
as well as its own employees. L,t,LLu ulily ajy lflb
employees 2
Do you think the IRS should use
outside contractors to contact tax- Doesn't matter (vol.) ...3
payers for the purpose of explaining
the options that are available for Don't know Y
paying taxes that are past due, or
should this be done only by IRS 13. If you personally owed back taxes
to
employees? the IRS, would it bother you more
to
receive a call from an outside
con-
Use outside contractors .1 tractor rather than an IRS
employee,
or wouldn't it make a difference
Done only by IRS which one called?
employees 2
would bother me more
Doesn't matter (vol.) .3 <1 to recieve call from
Don't know Y contractor 1 8/
wouldn't make a
diffGrence 2
Don't know y
14. Turning to a different subject, times today are, of course, different than when
your parents were your age. But taking into account those differences, would you
say that compared to your parents, you (read each item), about the same
amount, or less?
SAME LSSS nflw
a. Have more fun 1 2 3 Y 9/
b. Have more success financially 1 2 3 y 10/
C. Have a happier family 1 2 3 Y 11/
d. work harder 1 2 3 y 12/
e. Have more time to enjoy life 1 2 3 Y 13/
f. Have more stress 1 2 3 Y 14/
g. Have more wisdom 1 2 3 Y 15/
REAL nrsL &'flS- ~L& sins- L
W'Lnn
LIGEITW PLEASED FIED Irns FrED
a. The way things are going
for you personally these
days 1 2 3 4 5 6 7 Y 51/
b. The way things are going
for the country
generally 1 2 3 4 5 6 7 Y 52/
C. How President Clinton
is dealing with the
econony 1 2 3 4 5 6 7 Y 53/
d. How Congress is dealing
withtheecono~ 1 2 3 4 5 6 7 y 54/
e. How your state government is dealing with the
state's econary 1 2 3 4 5 6 7 Y 55/
f. Howsecureyourjobis ....1 2 3 4 5 6 7 Y 56/
9. Yourhealthcarecosts ....1 2 3 4 S 6 7 Y 57/
h. Theamountofycur
householdinc~ne 1 2 3 4 S 6 7 y 58,
1. The rate of inflation 1 2 3 4 5 6 7 Y 59,
j. The amount of taxes
youpay 1 2 3 4 5 6 7 Y 60/
k The level of interest
rates 1 2 3 4 5 6 7 V 61/
1. The cost and value of
yourhousing 1 2 3 4 S 6 7 Y 62/
m. Thelevelofyour
personal debts 1 2 3 4 5 6 7 y 63/
flIlO
e. Yourjob S n. Talkingonthetelephone 2
f. Econo?aicnews 6 o. Writingletters 3
g. News about foreign affairs 7 p. Yard work 4
h. what'sgoingoninwashington .8 q. Doinghousehold repairs S
i. SportsonTV 9 btne 6
j. Most entertainment shows onflr .0 Don~tknaw Y
16. There has been a move to change the form of address for women from Miss and
Mrs. to Ms. Which form of address do you like best for women--Miss and Mrs., or Ms.?
Missandnrs 1 Don'tknow Y rsi
Ms 2
17. Here is a list of household tasks. (HAND RESPONDENT CARD) Would you read down that list, and call off each one
you do at least occasionally?
18.
DIS- DIS
LIXE
IL EN- m&'T SYC- QtEAr
m Joy MST DEAL
a. Shopping for food 1 19/ 1 2 3 4 Y 21/
b. cookinguteals 2 1 2 3 4 Y 22/
C. Washingdishes 3 1 2 3 4 Y 23/
d. vacuming 4 1 2 3 4 Y 241
e. Dusting S 1 2 3 4 V 25/
C. Polishing furniture 6 1 2 3 4 V 26/
9. cleaningbathroomorkitchen floors 7 1 2 3 4 Y 27/
h.cleaning bathtubs, shower stalls, sinks .8 CASK 1 2 3 4 Y 28/
i.cleaning toilets 9 18) 1 2 3 4 Y 29/
2. cleaning glass. mirrors, windows 0 1 2 3 4 Y 30
k. cleaningthecven X 1 2 3 4 Y 31/
1. washing kitchen counters, sinks and
appliances V 1 2 3 4 Y 32/
TvLnoingthelaundry 1 20/ 1 2 3 4 Y 33/
n. Ironing 2 1 2 3 4 Y 34/
0. Recycling (bottles, cans. paper. etc.) .. .3 1 2 3 4 Y IS!
None
Don'tknow ..YjTo19)
18. Now for each of these tasks you do, would you tell me whether it is something you
enjoy doing. or something you don't mind doing, or something you dislike
b.Household cleaners .2 2 2
C. flar~e .3 3 3
d. Toys/garres .4 4 4
C.Recordedmusic (tapes, CDs. etc.) S S S
f. Paperproducts (towels, napkins, etc.) 6 6 6
g. Magazines 7 7 7
h. Beer 8 8 8
i. Cigarettes 9 9 9
2 ~r'all appliances 0 0 0
Ic. Frozen foods x x x
1. Cosmetics Y Y Y
m.Personal careproducts (sharrpoo. deodorant, etc.) .1 37/ 1 40/ 1 43/
n.Dressolothes 2 2 2
0. Casual clothes 3 3 3
p.Underwear, socks, hosiery 4 4 4
q. Shoes S S S
r. Fashionaccessories (scarfs. ties, belts. etc.) . .6 6 6
S. Wine 7 7 7
t. Li~or S a a
U.Towels. linens. sheets 9 9 9
v. Autoaccessories 0 0 0
w. Soft drinks x x x
x. Fruit juice Y Y Y
y. Snack foods 1 38/ 1 41/ 1 44/
z. Take-out/ready-to-eat food 2 2 2
aa.stationery/greetingcards 3 3 3
bo. Hooks 4 4 4
cc. Meat/poultry S S S
dd. Cold cereals 6 6 6
Ce. Cold cuts 7 7 7
ff.Housewares (pots, Pans. silverware. etc.) a a a
fon'tshopthere(vol.) 9 9 9
Dontimow Y Y Y
20. (USING SAME CARD) Using the same list of products would you call off the products you tend to buy when you shop
in a convenience store such as 7-11. Circle K and Mobil Mart? (RECORD ABOVE)
ii (rrcr~r chMP ranfl~ Ahd f1nA~1v '4hAr nroduc~s do vou tend to buv
when vou shop
(ASK EVERYONE)
43. Turning now to a different subject. There are differing opinions as to how
health insurance should be provided. Some people favor the present system of
private insurance and health plans. Others say we should have a national systern
of health insurance provided through the government and paid for like Social
Security now is. Which do you favor--our present system of private health plans,
or a national health insurance plan provided through the government?
Present private plan ......... 1 60/
National plan 2
Don't know Y
44. Thinking of all your medical care needs, not just the doctor. generally speaking,
how satisfied would you say you are with the ~ of the medical care you get--very
satisfied, fairly well satisfied, not too satisfied, or not at all satisfied?
ILL I
QUAL~TY I
or nrnrcn. CARE OF IEDrCAL~ CARE
Very satisfied 1 61/ 1 62/
Fairly well satisfied 2 2
Not too satisfied 3 I 3
Not at all satisfied 4 I 4
non~t know Y Y
45. And how satisfied are you with the availability of medical care when you need it--very satisfied, fairly well satisfied, not too satisfied, or not at al#ww'
rainy reasonan~"'w' ..~... Don't know
Somewhat unreasonable 3
SO. Does the employer pay all or part
of
Very unreasonable 4 the cost of that coverage?
Don't know ............. Y All 1 10/
Part 2
Don't know Y
47. How satisfied are you with the arrangements you have for paying for
51. About how much per month does the
medical care--very satisfied, fairly employer pay for your medical and
well satisfied, not too satisfied, health coverage?
or not at all satisfied?
Very satisfied 1 7/ $ ___________________
______________________
11/12/13/14
Fairly well satisfied .2 (write in)
Not too satisfied 3 Don't know Y
Not at all satisfied . .4
52. And about how much per month, if
Don't know Y any, do you pay for your medical
and
health coverage?
48. Do you and your family have any type $ _________________ 15/16/17/18
of health care plan or hospital (write in)
insurance?
Don~t know Y
Yes 1 (ASK 49) 8/
53. Rising health insurance premiums
may require employers to reduce
avail-
No 2 (SKIP To 56 able health insurance benefits in
ON NEXT PAGE) future years or to reduce the
amount
of future pay increases in order
to
Some in family pay rising insurance costs.
which
covered, others would you prefer--to receive the
not (vol.) 3 (ASK 49) full amount of future pay
increases
but have health insurance
benefits
reduced, or to receive smaller fu
ture pay increases but keep
health
insurance coverage at its current
level?
Full increases, benefits reduced .
.1 9'
smaller increases,
increasing a good deal more
than
b. A traditional insurance the cost of living in general,
planwhereyoucanchoose increasing somewhat more, in-
any doctor you want 2
(ASKSS) creasing at about the same
rate,
or increasing less than the
cost
c. Medicare (over 6S} 3 of living in general?
d. Veteran'sA&dnistration; . .4
e. Medicaid S A good deal more 1 25~
other (vol.) 6
somewhat more 2
None/personally not
covered (vol.) 7 (SKIPTO 56)
About the same 3
Don'tknow Y (ASKSS)
Less 4
$5. Have you or any member of your family living with you ever been without a health plan in the past
two
Don't know V
years?
Yes, went without . ....l (ASK 56) 21/
Yb (SKIPTOSS)
Don'tknow
56. For how many months in the past two years have you or someone in your family not had
a health plan?
Less than 3 months 1 22/
3 months to less than 6 months .2
6 months to less than 12 months .3
L year to less than 2 4
2years (ormore) 5
Don~tknow V
J'1',n-1- nt,n-s
a. T~~s .1 2 Y 26/
b. Children's clothes and accessories 1 2 Y 27/
C. Recordedmusic (CD's. tapes. etc.) 1 2 Y 28/
a. Wal)aaantyperadiosorcassettes 1 2 Y 29/
B. Children'svideocassettes 1 2 Y 30/
f G-ratedmovies 1 2 Y 31/
g. PG-13 rated movies 1 2 y 32/
h. Sneakersandshoes 1 2 Y 33/
i. Cereal 1 2 V 34/
3. Can&r; 1 2 Y 35/
k. Public service announcements about the
dangersofdrugs. smokinganddrinking 1 2 Y 36/
1. Public service announcements about the
dangersofunsafesex 1 2 Y 37/
m. "900 type telephone numbers (recordings of music
andmoviestars, triviagames. sportsupdates) 1 2 Y 38/
60. Which of these sources have you used in the last six months to get information on the nutritional content of food--either
fresh or packaged food? (HAnD RESPONDENT CARD)
useorn j 'nsr
6MonrHS USEFVL
a. Pamphletspublishedbyagovernmentagency 1 39/ I 1 40/
b. Pamphlets prepared by food companies 2 I 2
C. whatotherpeoplehavetoldyouaboutnutritioninfood ....3 I 3
d. Labels on food packages 4 I ~
coursesyoutookinschool S I s
f. Advertisements for foodproducts 6 I 6
g. Newspaperarticles 7 I 7
h Magazinearticles 8 8
1. Televisionprograms 9 I 9
nKCoos~ooks 0 0
None .....x1(SKIP I ~
Don't know ....yjTOE2)
61. of those you have used which one or two of those sources have you found rnos
a. Food manufacturers 1 2 3 4 Y 41/
b. supermarkets 1 2 3 4 Y 42/
c. Fast food restaurants 1 2 3 4 Y 43/
d. Restaurantswithtableservice 1 2 3 4 y 44/
e. Govermantagencies 1 2 3 4 Y 45/
f. Publicschools 1 2 3 4 y 46/
g. The media 1 2 3 4 Y 47/
65. Turning to something else, I'd like to talk with you now about games of chance,
such as the lottery, off-track betting, casino gambling. and so forth. (HAND
RESPONDENT CARD) For each of the types of gambling or games of chance on this card, please tell me whether or not you have done it
in the past vepi.
YES
a. Played games of
chance like Bingo sponsored by
churchgroups. charitaMeorganizations, etc 1 2 Y 50/
b. Played any State-run
lottery games 1 2 Y 51/
c. Betonahorserace .1 2 Y 52/
d. Bet on a dog race 1 2 Y 53/
e. Bet on a Jai-Alai
(HIGH-lie) game 1 2 Y 54/
f. Gambled at a casino 1 2 Y 55/
g. Played card games
formoney. such as poker or black
jack. at a place other than a casino 1 2 Y 56/
h. Played non-legalized
numbers games 1 2 57/
i. Placed sports bets.
such as at your place of work,
in a betting parlor. or through a bookie 1 2 Y 58/
I INTERVIEWER: IF Ally ITEMS CIRCLED IN BOX, ASK Q.66. rwqwi9-0
69. Now here is a list of a number' of different things. (HAND RESPONDENT CARD) Would you read down that list and
call off each one you personally have done in the last week, either at home or at work?
a. Gone shopping for food 1 28/
b. nought take-out food to eat at home 2
c. nought a (special) foodproduct because of its nutritional content 3
d. Boughibottledwater 4
e. Used a credit card S
f. Gone into abank (business orpersonal) 6
g. Donebankingbymail (businessorpersonal) 7
h. Done banking by phone B
i. Usedanautornatictellermachine 9
j. Used an ATM card to pay for a purchase 0
k. Drankdecaffeinatedcoffee x
1. Drankdecaffeinatedtea 1 29/
rn. Drankbeer 2
n. Drankwine 3
0. Drank a wine cooler 4
p. Drank liquor S
q. smokedeigarettes (l/2packormore) S
r. ~ade a long distance phone call (more than 100 miles) at home or
at work 7
5. Madeacollectphonecall 8
t. Tookbottles/canstorecyclingcenter 9
U. Returnedbottles/cans to store a
V. Put out bottles/cans. etc.. forcurbside recycling x
w. Gonetochurchorreligiousservice 1 30~
None 2
Don~t know y
$ L]L]L]L]L].00
42/ 43/ 44/ 45/ 46/
Refused . x
L]~
90106
Don't know . Y
72. Now I am going to ask you about non-essential spending in different categories.
without worrying how much it all adds up to right now, about how much money would
you say your household spends in an average month on (read item)? If you aren't
sure, just guess about how much. (ASK ABOUT EACH)
ncN'r
AMoWfl' NONE 'WOW
a. Clothing for adults ... sL]L}[11Ifl.oo x Y 6/7/8/9
b. clothing for children . $ ~ .00 x Y 10/11112/13
c. Movies, concerts,
sports events $ ~ .00 x Y 14/15/16
d. Dining out $ LilfiLl .00 x Y 17/18/19
e. Travel, weekend
getaways ~ .00 x 20/21/22/23
f. Tapes. records, CDs,
videos, etc $ IffiL-ILL. 00 x Y 24/25/26
g. Things for the home ... $ [5{fl~~ .00 x Y 27/28/29130
h. Reading materials
(books, magazines and rmmimi 00
newspapers) $ ~ x V 31')2
I~m going to read a list of s6me characteristics people might have. For each one,
would you tell ~rne which you think is more important in determining why people are
the way they are--heredity or environment? First, (read item). Is that more due to heredity or
environment? (ASK ABOUT EACH ITEM)
HEswrn'
(STATE- (STATE- ~1n
MENT MErn' EQauY m&'T
A) B) CYOL.)
a. How well a person reads 1 2 3 Y 39
b. whether a person is overweight or not ... 1 2 3 Y 40
c. Whether a person is likely to have
a heart attack 1 2 3 y 41
d. whether someone becomes an alcoholic .... 1 2 3 Y 42
e. whether someone is a heterosexual or
homosexual 1 2 3 Y 43
f. whether someone is a great athlete 1 2 3 Y 44
g. Whether someone gets cancer 1 2 3 y 45
h. whether someone becomes a great
artist or musician 1 2 3 Y 46
Veryconservative . 1 6/
Moderately conservative .... 2 D-S. Are you (CALL OFF APPROPRIATE
Middle-of-the-road 3 CATEGORIES):
Moderatelyliberal 4 Ahornernaker 1 11/
Very liberal 5 Unemplajed 2
Don'tknow Y Astudent 3 (sKIP
D-2. Regardless of how you may have Retired 4 TO fl-i)
voted in the past, what do you Orwhat? (allother) . Y
usually consider yourself--a
Democrat, a Republican. some D-6. what is your occupation? other
party or what?
Executive, administrative, management 1 12/
Danocrat 1 7/ Top talent and maj or or lesser
Republican 2 professional 2
Other specific party 3 owner--small retail store/business 3
Independent (Vol.) 4 Farmers (owners and managers) 4
No particular party (Vol.) S Technicians, minoradministrative S
Refused 6 white collar, clerical (non-supervisory) .6
Don'tknow Y Salesmen 7
D-3 . Now here is a list of things some Skilled and semi-skilled labor S
people do about government or Unskilled labor 9
politics. (HAND RESPONDENT CARD) Serviceandprotectiveworkers 0
Have you happened to have done
any of those things in the past
year? (IF YES') Which ones? (ASK EVERYONE)
fl-i. Do you, or does anyone in your
a. writtenyourcongressmanorSenator 1 8/ family living here at home belong to
b. Attendedapolitical rally a labor union?
or speech 2 13/
c. Attendedapublicmeetingon Respondencbelongstounion 1
town or school affairs 3 Other family member only belongs to
union .2
d. Heldorrunforpoliticaloffice .. 4 noonebelongstounion 3
e. Served on a committee for
some local organization S non't know Y
f. Served as an officer of some
clubororganization 6 D-8. Are you married, widowed, separated,
g. writtenalettertothepaper 7 divorced or have you never been
h. Signedapetition a married?
i Worked forapolitical party 9Married 1 (ASK
14/
1 Madeaspeech 0 D-9)
k. writtenanarticlefora Widowed
magazine or newspaper x .. (SKIP
2 1 ~
1. Seen a member of some group Separated or divorce
like the League of Women d
voters, or some other group D-10)
interestedinbettergovernment . 1 9/ Never been married.
(ASK EVERYONE) tiignscnooigraauate ~it,
n-b. Are you a parent or not? Somecollege(l3-lS) S
College graduate (16).... 6
Yes 1 16/ Post graduate (17+) 7 Yb
2
0-16. Here is a list of age
groups.
n-li. Are there any children living here (RAND RESPONDENT CARD) Would
at home with you: (RECORD FOR EACH you call off the letter of the
CATEGORY) age group you happen to be in?
(IF REFUSED, INTERVIEWER ESTIAge 3 or younger? Yes . 1 Yb . 2 17/ MA~E GROUP)
a. 18 - 20 1 25/
Age 4 through 7? Yes . 1 Yb . 2 18/ b. 21 - 24 2
Age 8 through 12? Yes . 1 No . 2 19/ C. 2$ - 29 3
a. 30 - 34 4
Age 13 through 17? Yes . 1 No . 2 20/ e. 35 - 39 S
D-12. Do you own your own home, rent it, f. 40 - 44 6
or do you have some other arrange- g. 45 - 49 7
ment such as living in the home of h. 50 - 54 8
your parents or children? 1. 55 - 59 9
~. 60 - 64 0
Own 1 21/ k. 65 - 69 x
Rent 2 1. 7oorolder Y
Live in home of parents 3
Liveinhorneofchildren 4 D-17. Now here is a list of income
Other (vol.) S categories. (HAND RESPONDENT
CARD) Would you call off the
D-13. Do you consider yourself the male! letter of the category that best
female head of this household or describes the combined annual
not? income of fli members of this
household, including wages or
Malehead 1 22/ - salary. pensions, interest or
Fernalehead 2 dividends, and all other
sources?
Another ad~t living in
a. Under $7,000 1 26'
the house 3
b. $7,000 to $9,999 2
D-14. Do you personally do most of the c. $10,000 to $14,999 3
grocery shopping for your house- d. $15, 000 to $19,999 4
hold, or does somebody else do most e.$20,000toS24.999 S
of it? f. $25,000 to $29,999 6
g. $30,000 to $34,999 7
Respondent 1 23/ h. $35,000 to $39,999 8
somebody else 2 i. $40,000 to $49,999.. . 9
sharedequally (vol.) .... 3
I. $50,000 to $74,999 0
TN~r'ERVIEWER RECORD
Male 1 28/ White 1 29/
Female 2 Black 2
Asian 3
Other ...... 4 NAME
ADDRESS
APT. *
CITY OR TOWN _____________________________
srATS ________________________________
ZIP CODE ________________________________ (30-34)
AREACODE _________ TELEI _______________________ (35-44) bnFrH/DAY/YEAR _________________________________ (45 54)
pay of we~k.
First Saturday 1 Wednesday 5 55,
Sunday 2 Thursday S
b'and~ 3 Friday 7
Tuesday 4 seconasaturday 8
1
INTERVIEWERS NAME: II
179-01
~80-9~