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Appendix G: Parent Interview
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A Feasibility Study of Head Start Recruitment and Enrollment
Spring 00 Parent Interview
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COVER SHEET
| Respondent ID number: | ______ | ______ | ______ |
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Date of Interview |
___ ___/ | ___ ___/ | ___ ___ |
| month | day | year | |
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Time of interview start: |
______ : |
______ |
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| hour | minute | ||
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Time of interview end: |
______ : |
______ |
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| hour | minute |
| Interview location: | ||
| CHILD’s home | 02 | |
| Other (Please specify) | 03 | |
PHONE ELIGIBILITY SCREEN (Level 1)Hello, this is (INTERVIEWER NAME) and we are preparing to do a study to learn more about preschool education and child care services. The study is sponsored by the Federal Department of Health and Human Services in Washington, D.C. I’m not asking for any money or trying to sell you anything -- I’d only like to ask you a few brief questions. |
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| No | 01 | Ask for someone 18 years old and member of household | |||||
| Yes | 02 | ||||||
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| No | 01 | Terminate interview | |||||
| Yes | 02 | ||||||
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| No | 01 | Ask to speak to Primary Caregiver | |||||
| Yes | 02 | ||||||
| [DEFINITION OF WHO IS SPONSORING STUDY, IF RESPONDENT ASKS: The Administration on Children, Youth and Families is part of the Department of Health and Human Services. ACYF is the part of the federal government that administers programs for children and their families]. | |||||||
PHONE ELIGIBILITY SCREEN (Level 2) |
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| No | 01 | ||||
| Yes | 02 | Go to 8 | |||
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| No | 01 | ||||
| Yes | 02 | Go to 8 | |||
| Size of Family Unit | Income |
|---|---|
| 1 | $8,240 |
| 2 | 11,060 |
| 3 | 13,880 |
| 4 | 16,700 |
| 5 | 19,520 |
| 6 | 22,340 |
| 7 | 25,160 |
| 8 | 27,980 |
| For family units with more than 8 members, add $2,820 for each additional member. |
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| Below or at | 01 | Go to 8 | ||||
| Above | 02 | Terminate Interview | ||||
PHONE ELIGIBILITY SCREEN (Level 3) |
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| No | 01 | Go to Page 5 | ||
| Yes | 02 | |||
| 8a. How did you hear about the Head Start Program? | ||||
| DO NOT READ LIST. CIRCLE ONE RESPONSE. | ||||
| Family/friend | 01 | |||
| Referral from another agency | 02 | |||
| Word of mouth | 03 | |||
| Head Start came to visit at our home | 04 | |||
| Previous children in Head Start | 05 | |||
| Flyer/mailing | 06 | |||
| Saw Head Start in community | 07 | |||
| Through older child’s school | 08 | |||
| Other (please specify) __________________________ | 09 | |||
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| No | 01 | |||
| Yes | 02 | Terminate interview | ||
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| No | 01 | |||
| Yes | 02 | Terminate interview | ||
SCHEDULE INTERVIEW APPOINTMENTWe will be in your area from ( ) and would like to interview you in person. We can come to your home or meet you at a public place such as a library or a McDonalds. The interview will take less than 45 minutes and you will be paid $25 to cover any costs you might incur such as for babysitting or transportation. Once we schedule an appointment, I will mail you a letter with information about the study, a consent form to sign, and an invoice to complete so we may pay you after the interview is finished. |
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| May I have please have your address? _____________________________________________________________________ | |||||
| (Street) | |||||
| ________________________________________________________________________ | |||||
| (Town/City) | (State) | (Zip Code) | |||
| And your name? __________________________________________________________ | |||||
| I will be available from (state availability). What day and time will be most convenient for us to interview you? | |||||
Appointment day and time:_____________________________________________ |
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Interview Location ____________________________________________________ |
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| Thank you very much. We really appreciate your help with this important study. I look forward to meeting you next week. | |||||
INTRODUCTIONThank you for agreeing to talk with me. As I explained on the phone, the purpose of this study is to learn more about preschool education and child care options for families with preschool age children. We know that sometimes families with young children face many challenges. We want to learn about these from a parent’s point of view. Information from this study will be used to help develop better services for children and their families. I will ask you questions and write down your answers. You may stop me at any time, and you may go back to earlier questions to change your answers. No one will ever know your answers because your name will never be attached. Your participation is completely voluntary. If you choose not to complete this interview, it will not affect you or your child in anyway. The things you do tell me are very important, so please be as accurate as possible. Occasionally, I may have to ask a question that does not apply to you. If that happens, just tell me and I will move on the next question. Our interview should take approximately 45 minutes. At the end of the interview, I will give you your money and some addresses as well as some phone numbers in case you would like more information about the study or this interview. Do you have any questions? |
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| A1. What is the first name of your 3 to 5 year old child? | ______________________________________________ | |||||
| A2. Are you the person most responsible
for CHILD’s care? |
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| No | 01 | |||||
| Yes | 02 | |||||
A3. Who is most responsible for CHILD’s care? |
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| Name: ________________________________________________________________________ | ||||||
Address: ______________________________________________________________________ |
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Phone: ________________________________________________________________________ |
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| TERMINATE
INTERVIEW. Reschedule time with correct respondent |
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A4. What is your relationship to CHILD?
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| DO NOT READ LIST. CIRCLE ONE RESPONSE. | |||||||
| Mother .........................................Is that birth or adopted? | |||||||
birth |
01 | SKIP TO A6 | |||||
adopted |
02 | SKIP TO A6 | |||||
| Father...........................................Is that birth or adopted? | |||||||
birth |
03 | SKIP TO A6 | |||||
adopted |
04 | SKIP TO A6 | |||||
| Stepmother | 05 | SKIP TO A6 | |||||
| Stepfather | 06 | SKIP TO A6 | |||||
| Grandmother | 07 | ||||||
| Grandfather | 08 | ||||||
| Great Grandmother | 09 | ||||||
| Great Grandfather | 10 | ||||||
| Sister/stepsister | 11 | ||||||
| Brother/stepbrother | 12 | ||||||
| Other Relative or In-law (Female) | 13 | ||||||
| Other Relative or In-law (Male) | 14 | ||||||
| Foster Parent (Female) | 15 | ||||||
| Foster Parent (Male) | 16 | ||||||
| Other Non-relative (Female) | 17 | ||||||
| Other Non-relative (Male) | 18 | ||||||
| Parent’s Partner (Female) | 19 | ||||||
| Parent’s Partner (Male) | 20 | ||||||
| Don’t Know/ Didn’t Respond | 99 | ||||||
| A5. Are you CHILD’s legal guardian? | ||||||
No |
01 | |||||
| Yes | 02 | |||||
| A6. Is CHILD a boy or a girl? | ||||||
Boy |
01 | |||||
| Girl | 02 | |||||
| A7. What is CHILD’S birth date? | ____ | ____/ | _____ _____/ | _____ _____ | ||
| Month | Day | Year | ||||
B. ACTIVITIES WITH YOUR CHILDNow I have some questions about you and CHILD at home. B1. How many times have you or someone in your family read to CHILD in the past week? Would you say... |
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| READ LIST. CIRCLE ONE RESPONSE. | ||||||
| Not at all | 01 | SKIP TO B2 | ||||
| Once or twice | 02 | |||||
| Three or more times | 03 | |||||
| Every day | 04 | |||||
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| B1a. Who read to CHILD in the past week? | ||||||
| DO NOT READ LIST. CIRCLE ALL THAT APPLY. | ||||||
| Mother/Mother-figure | 01 | |||||
| Father/Father-figure | 02 | |||||
| Other household member | 03 | |||||
| Non-household member | 04 | |||||
| B3. In the past week, have you or
someone in your family done the following things with CHILD? (READ
LIST BELOW) B4. IF YES: How many times have you done this in the past week? Would you say one or two times, or three or more? |
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| B3.
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B4 | B5 | ||||||
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| How many times? | Who (READ ITEM)?
DO NOT READ CHOICES. CIRCLE ALL THAT APPLY. |
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| 1-2 | 3+ | Mother/ Mother Figure |
Father/ Father figure | Other Household Member |
Non- Household Member |
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| NO | YES | |||||||
| a. Told (him/her) a story? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| b. Taught (him/her) letters, words, or numbers? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| c. Taught (him/her)songs or music? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| d. Worked on arts and crafts with (him/her)? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| e. Played with toys or games indoors? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| f. Played a game, sport, or exercised together? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| g. Took (him/her) along while doing errands like going to the post office, the bank, or the store? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| h. Involved (him/her) in household chores like cooking, cleaning, setting the table, or caring for pets? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| i. Talked about what happened during (his/her) day? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| j. Talked about TV programs or videos? | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| k. Played counting games like singing? songs with numbers or reading books with numbers | 01 | 02 | 1-2 | 3+ | 01 | 02 | 03 | 04 |
| B6. | In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD? | |||||
| B6.
In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD? |
B7. [ASK ONLY AFTER COMPLETING ALL OF B6] Who has (READ ITEM) with CHILD? [DO NOT READ CHOICES. CIRCLE ALL THAT APPLY. IF NOT MOTHER/ OR
FATHER/, CLARIFY IF HOUSEHOLD |
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| Mother/ Mother Figure |
Father/ Father figure | Other Household Member |
Non- Household Member |
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| NO | YES | |||||
| a. Visited a library? | 01 | 02 | 01 | 02 | 03 | 04 |
| b. Gone to a movie? | 01 | 02 | 01 | 02 | 03 | 04 |
| c. Gone to a play, concert, or other live show? | 01 | 02 | 01 | 02 | 03 | 04 |
| d. Gone to a mall? | 01 | 02 | 01 | 02 | 03 | 04 |
| e. Visited an art gallery, museum, or historical site? | 01 | 02 | 01 | 02 | 03 | 04 |
| f. Visited a playground, park, or gone on a picnic? | 01 | 02 | 01 | 02 | 03 | 04 |
| g. Visited a zoo or aquarium? | 01 | 02 | 01 | 02 | 03 | 04 |
| h. Talked with CHILD about (his/her) family history or ethnic heritage? | 01 | 02 | 01 | 02 | 03 | 04 |
| i. Attended an event sponsored by a community, ethnic, or religious group? | 01 | 02 | 01 | 02 | 03 | 04 |
| j. Attended an athletic or sporting event in which CHILD was not a player? | 01 | 02 | 01 | 02 | 03 | 04 |
C. DISABILITIES
| C1. | Does CHILD have any special needs or disabilities--for example, physical, emotional, language, hearing, learning difficulty, or other special needs? |
| No | 01 | SKIP TO D1 | |
| Yes | 02 | ||
| Don't Know | 99 | SKIP TO D1 |
| C2. | How would you describe CHILD’s special need or needs? PROBE: Any others? |
| DO NOT READ LIST. CIRCLE ALL THAT APPLY. |
| A specific learning disability | 01 | |
| Mental retardation | 02 | |
| A speech impairment | 03 | |
| A language impairment | 04 | |
| An emotional/behavioral disorder | 05 | |
| Deafness | 06 | |
| Another hearing impairment | 07 | |
| Blindness | 08 | |
| Another visual impairment | 09 | |
| An orthopedic impairment | 10 | |
| Another health impairment lasting six months or more | 11 | |
| Autism | 12 | |
| Traumatic brain injury | 13 | |
| Non-categorical/Developmental delay | 14 | |
| Other (Please specify) | 15 | |
| Don't Know | 99 |
| C3. | Does CHILD receive services for (his/her) disability? |
| No | 01 | |
| Yes | 02 |
D. YOUR CHILD’S BEHAVIOR
| D1. | In general, thinking about CHILD now or over the past month, tell me how well the following statements describe CHILD’S usual behavior: For each one, tell me if it is very true or often true, sometimes or somewhat true, or not true. |
| Very True or Often True |
Somewhat or Sometimes True |
Not True | |
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| a. Makes friends easily? | 01 | 02 | 03 |
| b. Enjoys learning? | 01 | 02 | 03 |
| c. Has temper tantrums or hot temper? | 01 | 02 | 03 |
| d. Can't concentrate, can't pay attention for long? | 01 | 02 | 03 |
| e. Is very restless, and fidgets a lot? | 01 | 02 | 03 |
| f. Likes to try new things? | 01 | 02 | 03 |
| g. Shows imagination in work and play? | 01 | 02 | 03 |
| h. Is unhappy, sad, or depressed? | 01 | 02 | 03 |
| i. Comforts or helps others? | 01 | 02 | 03 |
| j. Hits and fights with others? | 01 | 02 | 03 |
| k. Worries about things for a long time? | 01 | 02 | 03 |
| l. Accepts friends' ideas in sharing and playing? | 01 | 02 | 03 |
| m. Doesn't get along with other kids? | 01 | 02 | 03 |
| n. Wants to hear that he or she is doing okay? | 01 | 02 | 03 |
| o. Feels worthless or inferior? | 01 | 02 | 03 |
| p. Makes changes from one activity to another with difficulty? | 01 | 02 | 03 |
| q. Is nervous, high-strung, or tense? | 01 | 02 | 03 |
| r. Acts too young for (his/her) age? | 01 | 02 | 03 |
| s. Is disobedient at home? | 01 | 02 | 03 |
E. HOUSEHOLD RULES
Now I’d like to ask you a few questions about rules and setting limits in the home
E1. In your house, are there rules or routines about. . .
| NO | YES | NA | |
|---|---|---|---|
| a. What TV programs CHILD can watch? | 01 | 02 | 03 |
| b. How many hours CHILD can watch TV? | 01 | 02 | 03 |
| c. What kinds of food CHILD eats? | 01 | 02 | 03 |
| d. What time CHILD goes to bed? | 01 | 02 | 03 |
| e. What chores CHILD does? | 01 | 02 | 03 |
| E2. | Sometimes children mind pretty well and sometimes they don’t. Have you spanked CHILD in the past week for not minding? |
| No | 01 | SKIP TO E4 | |
| Yes | 02 |
| E3. | About how many times in the past week? |
___ ___ number of times |
| E4. | Have you used time out or sent CHILD to (his/her) room in the past week for not minding? |
| No | 01 | SKIP TO F1 | |
| Yes | 02 |
| E5. | About how many times in the past week? |
___ ___ number of times |
F. YOU AND YOUR FAMILY
Now I’m going to ask you some questions about you and your family.
| F1. What is your birth date? | ____ ____/ | _____ _____/ | _____ _____ | |
| Month | Day | Year |
| F2. | What is your current marital status? |
| Single, never married | 01 | |
| Married | 02 | |
| Separated | 03 | |
| Divorced | 04 | |
| Widowed | 05 |
| F3. | How old were you at the birth of your first child? |
____ ____ years old |
| IF OLDER THAN 15: | |||
| F5. First Name |
F6. What is NAME’s relationship to CHILD? (See codes below) |
F7. How old is NAME? |
F8. Is NAME employed? 01=No 02=Yes 90=NA 99=DK |
| a.(Respondent) | |||
| b. | |||
| c. | |||
| d. | |||
| e. | |||
| f. | |||
| g. | |||
| h. | |||
| i. | |||
| j. | |||
| k. | |||
| l. | |||
| m. | |||
| RELATIONSHIP CODES:
01=Mother (biological) |
09=Great grandmother |
15=Foster parent (female) |
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INTERVIEWER: |
IF MOTHER IS RESPONDENT |
SKIP TO F16 |
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IF MOTHER IS NOT RESPONDENT AND |
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NOT IN HOUSEHOLD |
GO TO F9 |
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IN HOUSEHOLD |
SKIP TO F14 |
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| F9. | Does CHILD’s mother live within an
hour’s ride of CHILD? |
| No | 01 | ||
| Yes | 02 | ||
| Mother is deceased | 03 | Ask F12 and F13, then Skip to F16 | |
| Don't Know | 99 |
| F10. | Does she contribute to the financial support
of the child? |
| No | 01 | ||
| Yes | 02 | ||
| Don't Know | 99 |
| F11. | How often does CHILD see (his/her) mother? Does (he/she) see her ... |
| READ LIST. CIRCLE ONE RESPONSE. |
| Rarely or never | 01 | |
| Several times a year | 02 | |
| Several times a month | 03 | |
| Several times a week | 04 | |
| Every day | 05 | |
| Don’t know | 99 |
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REMINDER -- IF MOTHER IS DECEASED, ASK F12-F15 THEN SKIP TO F16 |
| F12. | Is there anyone else who is like a mother
to CHILD? |
| No | 01 | SKIP TO F14 | |
| Yes | 02 |
| F13. | Who is this person? |
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DO NOT READ LIST. CIRCLE ONE RESPONSE. |
| The respondent, | 01 | |
| The respondent’s (spouse/partner) who lives in the household, | 02 | |
| The respondent’s (spouse/partner) who doesn’t live in the household, | 03 | |
| A relative of the child who lives in the household, | 04 | |
| A relative of the child who doesn’t live in the household | 05 | |
| A friend of the family who lives in the household, or | 06 | |
| A friend of the family who doesn’t live in the household | 07 |
| F14. |
What is the highest grade or year of regular school that CHILD’s mother completed?
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DO NOT READ LIST. CIRCLE ONE RESPONSE.. |
| No formal schooling | 00 | |
| Less than 8th grade | 07 | |
| 8th grade | 08 | |
| 9th grade | 09 | |
| 10th grade | 10 | |
| 11th grade | 11 | |
| 12th grade | 12 | |
| High school diploma | 13 | |
| GED | 14 | |
| Some college | 15 | |
| Associate’s degree | 16 | |
| Bachelor’s degree | 17 | |
| Graduate degree | 18 | |
| Don’t know | 99 |
| F15. |
Is she currently working, in school, in a training program, or
is she doing something else? |
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DO NOT READ LIST. CIRCLE ALL THAT APPLY. |
| Working | 01 | ||
| IF YES: What is her occupation? ________________________________________ | |||
| Is that: Full-time | 02 | ||
| Part-time | 03 | ||
| Seasonal | 04 | ||
| Unemployed, not looking for work | 05 | ||
| Looking for Work | 05 | ||
| Laid off | 07 | ||
| In School/training | 08 | ||
| In Jail/prison | 09 | ||
| In Military | 10 | ||
| Something Else (Please specify)________________.... | 11 | ||
| Don’t Know | 99 |
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INTERVIEWER: |
IF FATHER IS RESPONDENT |
SKIP TO F23 |
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IF FATHER IS NOT RESPONDENT AND |
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NOT IN HOUSEHOLD |
GO TO F16 |
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IN HOUSEHOLD |
SKIP TO F21 |
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| F16. | Does CHILD’s father live within an
hour’s ride of CHILD? |
| No | 01 | ||
| Yes | 02 | ||
| Father is deceased | 03 | Ask F19 and F20, then Skip to F23 | |
| Don't Know | 99 |
| F17. | Does he contribute to the financial support
of the child? |
| No | 01 | ||
| Yes | 02 | ||
| Don't Know | 99 |
| F18. | How often does CHILD see (his/her) father? Does (he/she) see him ... |
| READ LIST. CIRCLE ONE RESPONSE. |
| Rarely or never | 01 | |
| Several times a year | 02 | |
| Several times a month | 03 | |
| Several times a week | 04 | |
| Every day | 05 | |
| Don’t know | 99 |
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REMINDER -- IF FATHER IS DECEASED, ASK F19-F20, THEN SKIP TO F23 |
| F19. | Is there anyone else who is like a father
to CHILD? |
| No | 01 | SKIP TO F21 | |
| Yes | 02 |
| F20. | Who is this person? |
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DO NOT READ LIST. CIRCLE ONE RESPONSE. |
| The respondent, | 01 | |
| The respondent’s (spouse/par |


