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					             FU04

Followup Interview for 04 Status
                                                                                                                                Rev. 1/29/96
                                                                                                                           OMB No: 1820-0611
                                                                                                                             Expires:   8/97




                        A LONGITUDINAL STUDY OF THE VOCATIONAL
                            REHABILITATION SERVICE PROGRAM




                                FOLLOWUP INTERVIEW FOR 04 STATUS




                                             ED Contract Number HR920-22-001


Public reporting burden for this collection of information is estimated to vary from 17 to 23 minutes per response, with an average of 20 minutes
per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing the burden, to VR Longitudinal Project Director, RTI-CRE, P. O. Box 12194, RTP, NC 27709, or
to the Office of Management and Budget, Washington, DC 20503.
              GENERAL INSTRUCTIONS FOR COMPLETING THE INTERVIEW




READ THE FOLLOWING TO THE RESPONDENT:


Thank you for agreeing to help us by completing this interview. We would like to ask you some questions about
your current work status, any services or other assistance you may be receiving, and what kinds of activities other
than work you may participate in. All of your answers will be completely confidential. The information we obtain
from this interview will be reported as part of a group, and you will never be identified by name. Do you have any
questions before we begin? (If yes, answer) All right, then, let's begin.


                            PARTICIPANT FOLLOWUP INTERVIEW - STATUS 04


1.      We understand that some time after we first contacted you, the VR agency placed you on a waiting list for
        services. Are you still on a waiting list to receive VR agency services?


        01       Yes → (GO TO ITEM 3)
        02       No
        03       Do not know

2.      Are you now receiving VR agency services?

        01       Yes → (STOP HERE AND INITIATE SATISFACTION INTERVIEW)
        02       No

3.      Are you still interested in receiving VR agency services?

        01       Yes → (GO TO ITEM A1)
        02       No

4.      Why are you no longer interested in receiving VR agency services?

       01       Decided I did not want to work
       02       Decided to go to school
       03       I have already found a job → (GO TO PART B)
       04       Other (Please specify): ________________________________________




                                                           1
Today's Date:____/_____/_____                                             Client ID #:___________



                           PART A: CURRENT EMPLOYMENT STATUS



These questions are about your job status. I will read the questions and then some possible answers.
Please select the answer that best describes your circumstances.

Al.      Have you worked at all during the past 12 months?

        01       Yes (Specify number of jobs) _____________
        02       No → GO TO QUESTION A3

A2.      Are you currently working?

        01       Yes → GO TO QUESTION A6
        02       No

A3.      What is your current status?

         01      Homemaker
         02      Unpaid family worker
         03      Student
         04      Trainee or worker in noncompetitive employment (such as a sheltered workshop)
         05      Volunteer worker
         06      Not working, but looking for work
         07      Not working and not looking for work

A4.      Are you currently trying to find a job?

        01       Yes → GO TO PART B
        02       No

A5.     Why have you decided not to look for a job?

        01       To retain my SSI/SSDI benefits
        02       Health reasons
        03       Personal or family responsibilities
        04       Enrolled in school
        05       Discouraged about working
        06       Other (Please specify) _________________________________________________________




                                        GO TO PART B



                                                       2
A6.    What type of job do you have?

       01      Competitive regular labor market
       02      Sheltered work (in a workshop)
       03      Self-employed (work for yourself)
       04      Supported employment (with a job coach)
A7.    Which of the following occupational areas best describes your current job?

       01      Professional, managerial, or technical
       02      Clerical or Sales
       03      Service (e.g., food and beverage preparation, lodging, barbering and cosmetology)
       04      Agriculture, fishery, forestry, and related
       05      Processing (e.g., processing of food, petroleum, chemicals, glass)
       06      Machine trades (e.g., textile manufacturing, wood and metal working)
       07      Benchwork (e.g., manufacture, assembly, and repair of electronic equipment)
       08      Structural work (e.g., welding, painting, cementing)
       09      Miscellaneous
               (Specify)_______________________________________________________
                        _______________________________________________________

A8.    What is your job title?

       _______________________________________________________

A9.    Is this a temporary or permanent position?

       01      Temporary
       02      Permanent

A10.   How many days per week do you work?

       01      1 day per week
       02      2 days per week
       03      3 days per week
       04      4 days per week
       05      5 days per week
       06      More than 5 days per week
       07      Varies from week to week

A11.   On average, how many hours do you work per week?
       ________hours




                                                       3
A12.   How much do you earn in this position? (PLEASE FILL IN THE AMOUNT AND CIRCLE
       ONE NUMBER FOR PAY PERIOD)
       $_____________per        01       Hours
                                02       Week
                                03       Two-week period
                                04       Month
                                05       Year

A13.   How long have you been working in this job?

       01      3 months or less
       02      4 to 6 months
       03      7 to 9 months
       04      10 to 12 months
       05      13 to 18 months
       06      19 to 24 months
       07      More than 24 months


A14.   Have you received a promotion during the past year?
       01      Yes
       02      No
A15.   Have you received a raise during the past year?

       01      Yes
       02      No

A16.   Have you had any long absences from work during the past year?

       01      Yes (Please specify reason)_____________________________________
       02      No

A17.   When you were looking for work, what kinds of methods did you use in your job search?
       YES     NO

       01      02       a.      Contacted public employment agency (like the Job Service)
       01      02       b.      Contacted private employment agency (like Olsten Temporary)
       01      02       c.      Approached employers directly
       01      02       d.      Contacted friends or relatives
       01      02       e.      Contacted school/university placement office
       01      02       f.      Contacted union/professional association registers
       01      02       g.      Obtained help from VR counselor or placement specialist
       01      02       h.      Sent out resumes/filled out applications
       01      02       i.      Placed or answered ads
       01      02       j.      Other (Please specify) ________________________________




                                                         4
A18.    Which method helped you find your current job?

        01      Public employment agency (like the Job Service)
        02      Private employment agency (like Olsten Temporary)
        03      Direct contact with employer
        04      Friends or relatives
        05      School/university placement office
        06      Union/professional association
        07      VR counselor/placement specialist
        08      Employer response to resume/application
        09      Newspaper ad
        10      Other (Please specify) ________________________________________________________


A19.   Do you receive any of the following benefits in your current job?

       YES      NO

        01     02       a.       Health insurance
        01     02       b.       Vacation leave
        01     02       c.       Sick leave
        01     02       d.       Life insurance
        01     02       e.       Pension plan or other retirement plan
        01     02       f.       Dental insurance
        01     02       g.       Other (Please specify)

A20.   I will read aloud some characteristics that people look for in their jobs. In your current job, are you not
       satisfied, satisfied, or very satisfied with these things?

                                                              Not                                 Very
                                                              Satisfied        Satisfied          Satisfied

       a.       Earnings                                      01               02                03
       b.       Fringe benefits                               01               02                03
       c.       Integration in the workplace (sense
                of belonging and extent of involve-
                ment you have experienced at work             01               02                03
       d.       Opportunity for advancement                   01               02                03
       e.       Employer support (any help your
                employer gives you to make sure you
                can stay on the job.)                         01               02                03




                                                          5
      PART B: RECEIPT OF FINANCIAL ASSISTANCE AND OTHER SERVICES




B1.   Are you currently receiving any financial assistance?

      01      Yes
      02      No  GO TO ITEM B4

B2.   Next, I will read you a list of sources from which you might be receiving financial support. For each
      source, please tell me how much support you receive each month, if any, and the number of months you
      have received it.
                                                                         Amount of
        Source of                                                         Support          Number of
        Support                                                          per Month           Months

      YES NO

      01      02      a.     SSI-Aged ......................................................... la. _____ ...............2a. ____
      01      02      b.     SSI-Blind ........................................................ lb. _____ ................2b. ____
      01      02      c.     SSI-Disabled .................................................. lc. _____ ................2c. ____
      01      02      d.     SSDI ............................................................... ld. _____ ................2d. ____
      01      02      e.     General assistance (welfare) .......................... le. _____ ................2e. ____
      01      02      f.     AFDC ............................................................. lf. _____ ................2f. ____
      01      02      g.     Veterans' disability ......................................... lg. _____ ................2g. ____
      01      02      h.     Other disability ............................................... lh. _____ ................2h. ____
      01      02      i.     Other public support ....................................... li. _____ .................2i. ____
      01      02      j.     Family and friends ......................................... lj. _____ .................2j. ____
      01      02      k.     Workers' compensation .................................. lk. _____ ................2k. ____
      01      02      1.     Private relief agency ....................................... ll. _____ .................2l. ____
      01      02      m.     Private insurance ............................................ lm. _____ ...............2m. ___
      01      02      n.     Public institution (tax-supported) ................... ln. _____ ................2n. ____
      01      02      o.     All other support (excluding wages) .............. lo. _____ ................2o. ____

B3.   What is your primary source of support?

      01       Earnings
      02       Benefits
      03       Family or friends

B4.   Are you receiving any services such as counseling or transportation assistance?

      01      Yes
      02      No  GO TO PART C

                                                                6
B5.     I will name some services that people with disabilities sometimes receive. Please tell me
        which ones you are receiving, if any, and whether you are paying for the service.
       Services                                                                      Client Paying for
       Received                                                                              Service


       YES     NO

       01       02       a.    Counseling                                                     1a._____
       01       02       b.    Medical treatment                                              1b._____
       01       02       c.    Independent living                                             1c._____
       01       02       d.    Personal assistance services                                   1d._____
       01       02       e.    Transportation                                                 1e._____
       01       02       f.    Assistive devices or services                                  1f._____
       01       02       g.    Job coaching or other employment supports                      1g._____
       01       02       h.    Education                                                      1h._____.
       01       02       i.    Other ____________________________
                               _________________________________
                               _________________________________                              1i._____




                              PART C: COMMUNITY INTEGRATION




These questions ask about your participation in social and other types of events.


C1.    Does your disability prevent you IN ANY WAY from getting around, attending cultural or sports
       events, or socializing with friends outside your home as much as you would like to?

        01     Yes, prevents  ASK QUESTION C2
        02     No, does not prevent  GO TO QUESTION C4
        -4     Not sure  GO TO QUESTION C4
       -7      Refused  GO TO QUESTION C4



                                                        7
C2.   I am going to read you some reasons why people don't get around, attend events, or socialize with friends
      outside their homes as much as they want to. For each reason that I name, please tell me whether it is or is
      not an important reason why you don't get around, socialize, or attend events as much as you would like
      to. (READ EACH ITEM, ASK: Is that an important reason for you, or not?)
                                                                                                    Not
                                                                                   Important        Important

      a.       Because you are NOT able to use public transportation
               or because you can't get special transportation or
               someone to give you a ride when you need one ............................                      01         ......   02

      b.       Because you come across many public buildings and
               places that you can't get into .........................................................       01         ......   02

      c.       Because you come across many public buildings and
               places that have bathrooms that you can't use ..............................                   01         ......   02

      d.       Because you have difficulty in seeing, talking, or hearing ...........                         01         ......   02

      e.       Because you need someone to go with you or help you
               but don't always have someone ....................................................             01         ......   02

      f.       Because of fear that your disability or health problem
               might cause you to get hurt, sick, or victimized by crime ............                         01         ......   02

      g.       Because you are not comfortable in groups of people ..................                         01         .....    02

      h.       Because you are self-conscious about your disability                                           01                  02


C3.   From the list of items that I just read, what is the MOST IMPORTANT REASON why you don't
      get around, attend cultural or sports events, or socialize with friends as much as you would like
      to?
      ______________________________________________________________________
      ______________________________________________________________________
      _________________________________________________________________________


C4.   About how often do you:
                                                                            About                 About
                                                                 At least    once                 once      Less than
                                                               twice a week a week                a month once a month                 Never
      a. Socialize with close friends, relatives
         or neighbors?                                        ....... 01             ..02 ...             03 .........   04 ...          05

      b. Visit a supermarket or food store? ....              ....... 01             ..02 ...             03 .........   04 ...          05

      c. Go to a restaurant?                                  ....... 01             ..02 ...             03 .........   04 ...          05

      d. Go to a place of worship such as a
          church or synagogue?                                ....... 01             ..02 ...             03 .........   04 ...          05
                                                                     8
C5.   Are you very active, somewhat active, or not active in any community group such as a religious group,
      volunteer group, or recreation group?

      01      Very active
      02      Somewhat active
      03      Not active

C6.   Have you ever participated in any group or activity designed especially for people
      with disabilities?

      01      Yes
      02      No

C7.   The next several questions ask about going to the movies or to cultural events or other places.

      a.       Approximately how many times did you go to the movies in the past 12
               months? ____________________ times

      b.      Approximately how many times did you go to live music performances in the
              past 12 months? ____________________ times

      c.      Approximately how many times did you go to live theater performances in the
              past 12 months? _________________times

      d.      Approximately how many times did you go to a sports event in the past 12
              months? ______________________ times

      e.      Please explain your answers. ________________________________________

      ______________________________________________________________________


C8.   Most local and state governments offer job counseling and employment services for
      people with disabilities or health problems. How familiar are you with these services?

      01      Very familiar
      02      Somewhat familiar
      03      Not too familiar
      04      Not familiar at all

C9.   Do you feel that your disability or health problem has IN ANY WAY prevented you
      from reaching your full abilities as a person?

      01      Yes
      02      No




                                                       9
C10.   If you are not married, has your disability or health problem been a major obstacle, a minor obstacle, or no
       obstacle to your opportunities to marry?

       01      Major obstacle
       02      Minor obstacle
       03      No obstacle
       -3      Not applicable; already married

C11.   What about having children?

       a.     Ability: Has your disability or health problem had a positive impact, a negative impact, or no
              impact at all on your ability to have children?

              01         Positive impact
              02         Negative impact
              03         No impact at all

       b.     Interest: Has your disability or health problem had a positive impact, a negative impact, or no
              impact at all on your interest in having children?

              01        Positive impact
              02        Negative impact
              03        No impact at all

C12.   I'm going to read you some services available to persons with disabilities. Please say if you are familiar or
       not familiar with each service.

       a.      Are you familiar with independent living centers?

               01        Yes
               02        No 4  GO TO QUESTION C12c

       b.      Have you used an independent living center?

               01       Yes
               02       No

       c.      Are you familiar with Section 8 and other housing for disabled people?

               01       Yes
               02       No  GO TO QUESTION C12e

       d.      Have you used Section 8 or other housing for disabled people?

               01        Yes
               02        No
                                                         10
        e.      Are you familiar with transportation services for disabled people?

                01       Yes
                02       No  GO TO QUESTION CI2g

        f.              Have you used transportation services for disabled people?

                01      Yes
                02      No

        g.      Are you familiar with medical and rehabilitation services for disabled people?

                01       Yes
                02       No  GO TO QUESTION C13


       h.      Have you used medical and rehabilitation services for disabled people?

               01       Yes
               02       No

C13. If you have used more than one service, which of these services that you have used has helped you the most?

        01     Independent living centers
        02     Section 8 and other housing for disabled people
        03     Transportation services for disabled persons
       04      Medical and rehabilitation services for disabled people
       -3      Not applicable




                                                       11
                                        PART D: SELF-ESTEEM




For this next part, please think about your behavior or feelings in the past year. I am going to
read several sentences that may or may not describe you and ask you whether you agree with,
disagree with, or have no opinion about each. Again, answer by thinking about the past year.,
TO BE ANSWERED BY APPLICANTS, CLIENTS, OR THEIR INTERPRETERS ONLY.



                                                                  Agree     No opinion    Disagree

                                                                      01           02                03
Dl.    I feel that I am a person of worth, at least
       equal with others                                          .... 01   ........ 02   ............ 03

D2.     I feel that I have a number of good qualities ....        .... 01   ........ 02   ............ 03

D3.    All in all, I am inclined to feel that I am
       a failure                                                  .... 01   ........ 02   ............ 03

D4.     I am able to do things as well as most people                 01    ........ 02   ............ 03

D5.     I feel I do not have much to be proud of                  .... 01   ........ 02   ........... 03

D6.     I take a positive attitude toward myself                  .... 01   ........ 02   ............ 03

D7.     On the whole, I am satisfied with myself                  .... 01   ........ 02   ............ 03

D8.     I wish I could have more respect for myself ....          .... 01   ........ 02   ............ 03

D9.     I certainly feel useless at times                         .... 01   ........ 02   ............ 03

D10.    At times I think I am no good at all                      .... 01   ........ 02   ............ 03




THANK YOU VERY MUCH FOR YOUR ASSISTANCE. WE WILL BE IN CONTACT
WITH YOU AGAIN NEXT YEAR.




                                                             12

				
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