SECTION C: CHILDCARE
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|___|___| : |___|___| Time |
1. How many children do you have? |___|___|
# OF CHILDREN
IF 00, GO TO WHAT I AM LIKE
2. What are the names, birthdates, and social security numbers of your children? PROBE CATEGORIES IF NECESSARY.
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a. FIRST NAME |
b. LAST NAME |
c. BIRTHDATE |
d. SOCIAL SECURITY # |
e. Who is (CHILD’S FIRST NAME) main caregiver? (ENTER RELATIONSHIP CODE FROM COLUMN AT RIGHT) |
RELATIONSHIP CODES |
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CHILD #1 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
MOTHER (BIOLOGICAL) 01 FATHER (BIOLOGICAL) 02 STEP-MOTHER 03 STEP-FATHER 04 ADOPTIVE MOTHER 05 ADOPTIVE FATHER 06 FOSTER MOTHER 07 FOSTER FATHER 08 FULL SISTER 09 FULL BROTHER 10 HALF SISTER 11 HALF BROTHER 12 STEP SISTER 13 STEP BROTHER 14 FOSTER SISTER 15 FOSTER BROTHER 16 ADOPTIVE SISTER 17 ADOPTIVE BROTHER 18 AUNT 19 UNCLE 20 MATERNAL GRANDMOTHER 21 MATERNAL GRANDFATHER 22 PATERNAL GRANDMOTHER 23 PATERNAL GRANDFATHER 24 COUSIN 25 BABYSITTER 29 SELF 32 FRIEND 33 ROOMMATE 34 PARENTS 35 OTHER BLOOD RELATIVE 36 SPECIFY:_____________________ OTHER NON-RELATIVE 37 SPECIFY:_____________________ |
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CHILD #2 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #3 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #4 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #5 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #6 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #7 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #8 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #9 |
__________________ |
__________________ |
|__|__|/|__|__|/|__|__| |
|___|___|___|-|___|___|-|___|___|___|___| |
|___|___| |
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CHILD #10 |
__________________ |