|
OM678
|
 |
M678 WHY NOT APPLY OTHR BENEFITS-SPECIFY |
|
OW200
|
|
Before your health began to limit your ability to work, were you working for someone else, were you self-employed, or what? |
|
OM679
|
|
M679 INJURED AT WRK |
|
OW202
|
|
What kind of business or industry did you work in - that is, what did they make or do at the place where you worked? |
|
OM671M
|
|
M671 WHY NOT APPLY FOR WC BENEFITS |
|
OW201
|
|
What sort of work did you do on that job? Tell me a little more about what you did. |
|
OM554
|
|
M554 RESULT OF ACCIDENT |
|
OW203
|
|
About how many employees work for that company or organization at all locations? |
|
OM701YM586BP
|
|
BRANCHPOINT FOR M701Y |
|
OW204
|
|
Is it fewer than 5, 5 to 14, 15 to 24, 25 to 99, 100 to 499, or 500 or more? |
|
OM600
|
|
M600 HOW LONG W/EMP AFTER LIMITATION |
|
OW205
|
|
What were you earning, before deductions, when you [left that employer/stopped working for that business]? |
|
OM696YM571TOM679
|
|
BRANCHPOINT FOR M696Y |
|
OW206
|
|
Was that per hour, week, month, or year? PER: |
|
OM519
|
|
M519 HEALTH PROBLEM 1ST BOTHER YRS AGO |
|
OW208
|
|
How many hours a week did you usually work for that [employer/business]? |
|
OM518
|
|
M518 WHEN IMPAIRMENT 1ST BOTHER - YR |
|
OW209
|
|
[IWER: READ SLOWLY:] Counting paid vacations as weeks of work, how many weeks per year did you usually work for this [employer/business]? |
|
OM517
|
|
M517 ABLE TO WRK REGULARLY/OCCASIONALLY |
|
OW210
|
|
Were you covered by a union or employee-association contract? |
|
OM516
|
|
M516 ABLE TO WRK FULL OR PART TIME |
|
OW211
|
|
Did your employer get someone to help you? |
|
OM515
|
|
M515 IMPAIRMNT AFFECT BEFORE-AFTER WORK |
|
OW214
|
|
Did your employer shorten your work days? |
|
OM514
|
|
M514 INTERFERE HOUSEWRK-BEGIN AGE |
|
OW217
|
|
Did your employer allow you to change the time you came to and left work? |
|
OM513
|
|
M513 IMPAIRMT BEGIN INTERFERE WORK-MO |
|
OW220
|
|
(Did your employer) allow you more breaks and rest periods? |
|
OM512
|
|
M512 IMPAIRMT BEGIN INTERFERE WORK-YR |
|
OW223
|
|
(Did your employer) arrange for special transportation? |
|
OM511
|
|
M511 IMPAIRMENT BEGIN-AGE |
|
OW226
|
|
(Did your employer) change(d) the job to something you could do? |
|
OM510
|
|
M510 IMPAIRMENT BEGIN-MO |
|
OW227
|
|
(Did your employer) help(ed) you learn new job skills? |
|
OM604
|
|
M604 EMPLOYER CO/ORG RETURNED TO WORK |
|
OW228
|
|
(Did your employer) get you special equipment for the job? |
|
OM595
|
|
M595 AFTER LEFT JOB WHAT R DID-SPECIFY |
|
OW229
|
|
(Did your employer) assist you in receiving rehabilitative services from an external provider? |
|
OM688YM525TOM643
|
|
BRANCHPOINT FOR M688Y |
|
OW230
|
|
Did your employer do any other things to help you out? |
|
OM704YM594TOM611
|
|
BRANCHPOINT FOR M704Y |
|
OW231
|
|
What other things? |
|
OM581
|
|
M581 LAST TIME WRKED B/F LIMITATION-YR |
|
OW238
|
|
Are you still receiving benefits from [Social Security Disability/Social Security]? [IWER: IF R MENTIONS THAT SSDI HAS NOW BEEN CONVERTED TO SOCIAL SECURITY, BACK UP TO M030 AND CHANGE ANSWER TO CODE 6] |
|
OM582
|
|
M582 LAST JOB B/F LIMITATION-YRS AGO |
|
OW256
|
|
Why are you no longer receiving those benefits? Did your household resources increase, did you return to work, are you not working but able to work, or what? |
|
OM690YM527BP
|
|
BRANCHPOINT FOR M690Y |
|
OW239
|
|
IF R IS STILL RECEIVING SSDI BENEFITS (OW.238_1=1): How much did you receive (from the [Social Security Disability/SocialSecurity] program last month? OTHERWISE: How much did you receive from the [Social Security Disability/Social Security] program the last month you received this benefit? (Do not count benefits paid to your spouse or children.) [IWER: DO NOT PROBE DK/RF] |
|
OM584
|
|
M584 LAST JOB WRKD- COMPANY/ORG |
|
OW240
|
|
Did it amount to a total of less than $____ per month, more than $____ per month, or what? PROCEDURE: 2Up1Down BREAKPOINTS: $400, $650, $900, $1,100 ENTRY POINT: $650 |
|
OM585
|
|
M585 LAST JOB WRKD- COMPANY/ORG-SPECIFY |
|
OW244
|
|
In what year did the benefits stop? |
|
OM587
|
|
M587 EMPLOYER HELP R STAY AT WORK |
|
OW243
|
|
What month was that? |
|
OW786
|
|
PRIOR MONTHS |
|
OW245
|
|
Did you appeal or apply again later? |
|
OM700YM584TOW200
|
|
BRANCHPOINT FOR M700Y |
|
OW247
|
|
In what year did you last appeal or apply for benefits? |
|
OM592
|
|
M592 WHY COULD NOT FIND WRK |
|
OW246
|
|
What month was that? |
|
OM636M
|
|
M636 WHO CHANGED WRK HABITS |
|
OW248
|
|
Was your application eventually accepted, rejected, or is it still being considered? |
|
OM672
|
|
M672 WHY NOT APPLY WC BENEFITS-SPECIFY |
|
OW234
|
|
In what year did you start receiving Social Security Disability benefits? |
|
OM673
|
|
M673 EVER APPLIED OTR PROGRAM |
|
OW233
|
|
What month was that? |
|
OM670
|
|
M670 TYPE OF DISABILITY WC- YRS |
|
OW235
|
|
Were you offered rehabilitative services? |
|
OM676
|
|
M676 ACCEPTED OTR |
|
OW237
|
|
In what year were you offered rehabilitative services? |
|
OM675
|
|
M675 1ST APPLIED OTR PROGRAM - MO |
|
OW236
|
|
What month was that? |
|
OM694YM558TOM679
|
|
BRANCHPOINT FOR M694Y |
|
OM710YM505TOM558
|
|
BRANCHPOINT FOR M710Y |
|
OM603
|
|
M603 JOB DETAILS GIVEN |
|
OM602
|
|
M602 WRK AFTER DISABILITY |
|
OM601
|
|
M601 HOW LONG W/EMP AFTER LIMITATN-UNIT |
|
OM607
|
|
M607 LEFT EMPLOYER - YRS AGO |
|
OM606
|
|
M606 LEFT EMPLOYER - YR |
|
OM605
|
|
M605 EMPLOYR CO/ORG RETURNED- SPECIFY |
|
OM609
|
|
M609 EMPLOYER HELP OUT |
|
OM608
|
|
M608 LEFT EMPLOYER - AGE |
|
OM546
|
|
M546 WHEN IMPAIRMENT 1ST BOTHER - YR |
|
OM574
|
|
M574 REC BENEFIT START MO |
|
OM540
|
|
M540 ABLE TO WRK FULL OR PART TIME |
|
OM541
|
|
M541 ABLE TO WRK REGULARLY/OCCASIONALLY |
|
OM576
|
|
M576 REC BENEFIT END MO |
|
OM571
|
|
M571 RECEIVE DISABILITY BENEFITS |
|
OM570
|
|
M570 EVER APPLY FOR DISABILITY BENEFITS |
|
OM544
|
|
M544 IMPAIRMNT BEGIN INTERFER WORK-YR |
|
OM545
|
|
M545 IMPAIRMNT BEGIN INTERFERE WORK-MO |
|
OM547
|
|
M547 WHEN IMPAIRMENT 1ST BOTHER - YR |
|
OM542
|
|
M542 WHEN IMPAIRMENT 1ST BOTHER - YR |
|
OM543
|
|
M543 WHEN IMPAIRMENT 1ST BOTHER - MO |
|
OM548
|
|
M548 IMPAIRMNT BEGIN INTERFER WORK-YR |
|
OM549
|
|
M549 IMPAIRMNT BEGIN INTERFER WORK-MO |
|
OM680
|
|
M680 HOW MANY TIMES INJURED |
|
OM655M
|
|
M655 WHY NOT APPLY FOR SSI BENEFITS |
|
OM677M
|
|
M677 WHY NOT APPLY FOR OTHER BENEFITS |
|
OM647
|
|
M647 1ST APPLIED SSDI - MO |
|
OM646
|
|
M646 1ST APPLIED SSDI - YR |
|
OM645
|
|
M645 EVER APPLY FOR SSDI |
|
OM644
|
|
M644 GOVERNMENT PROGRAMS KNOWN-SPECIFY |
|
OM642
|
|
M642 USE UP SAVINGS |
|
OM648
|
|
M648 SSDI AWARDED BENEFITS |
|
OM706YM600TOM610
|
|
BRANCHPOINT FOR M706Y |
|
OM508
|
|
HEALTH CONDITION CAUSE- LIMIT HOUSEWRK |
|
OM509
|
|
M509 WHEN IMPAIRMENT 1ST BOTHER - YR |
|
OM502
|
|
M502 IF HEALTH AFFECTS WORK |
|
OM503
|
|
M503 HEALTH PROB AFFECT- CAUSE PROBLEM |
|
OM504
|
|
M504 TEMPORARY CONDITION |
|
OM505
|
|
M505 HAD CONDITION BEFORE |
|
OM506
|
|
M506 LIMIT HOUSEWRK |
|
OM507
|
|
M507 LIMIT IN ANY WAY |
|
OM691YM527TOM546
|
|
BRANCHPOINT FOR M691Y |
|
OM703YM591TOM611
|
|
BRANCHPOINT FOR M703Y |
|
OM635
|
|
M635 OTHER FAM MEMBERS WRK CHANGED |
|
OM579
|
|
M579 WHICH COMPANY/ORG |
|
OM578
|
|
M578 DETAILS OF JOB REPORTED EARLIER |
|
OM575
|
|
M575 REC BENEFIT END YR |
|
OM709YW230
|
|
BRANCHPOINT FOR M709Y |
|
OM698YM581TOM643
|
|
BRANCHPOINT FOR M698Y |
|
OM695YM570TOM679
|
|
BRANCHPOINT FOR M695Y |
|
OM712YM515BP
|
|
BRANCHPOINT FOR M712Y |
|
OM649M
|
|
M649 WHY NOT APPLY FOR SSDI BENS |
|
OM683
|
|
M683 DATE OF INJURY - YEAR |
|
OM685
|
|
M685 ASSIST SECTION M2 |
|
OM650
|
|
M650 WHY NOT APPLY FOR SSDI BENS-SPECIFY |
|
OM651
|
|
M651 EVER APPLY FOR SSI |
|
OM563
|
|
M563 WHEN IMPAIRMENT 1ST BOTHER - AGE |
|
OM658
|
|
M658 1ST APPLIED VA - YR |
|
OM659
|
|
M659 1ST APPLIED VA - MO |
|
OM618
|
|
M618 DECISIONS ABOUT PAY/PROMOTION |
|
OM619
|
|
M619 NUMBER PEOPLE R SUPERVISED |
|
OM614
|
|
M614 GOOD EYESIGHT |
|
OM615
|
|
M615 INTENSE CONCENTRATION |
|
OM616
|
|
M616 KEEP PACE W/ OTRS |
|
OM617
|
|
M617 PEOPLE SKILLS |
|
OM610
|
|
M610 EMPLR DOING ANYTHING TO HELP |
|
OM611
|
|
M611 PHYSICAL EFFORT |
|
OM612
|
|
M612 LIFTING HEAVY LOADS |
|
OM613
|
|
M613 STOOPING/KNEELING/CROUCHING |
|
OM630
|
|
M630 SPOUSE WORKING THEN |
|
OM580
|
|
M580 WHICH COMPANY/ORG- SPECIFY |
|
OM531
|
|
M531 WHEN IMPAIRMENT 1ST BOTHER - YR |
|
OM530
|
|
M530 ABLE TO WRK REGULARLY/OCCASIONALLY |
|
OM533
|
|
M533 IMPAIRMENT 1ST BOTHER- AGE |
|
OM532
|
|
M532 IMPAIRMENT 1ST BOTHER- YRS AGO |
|
OM535
|
|
M535 RESULT OF ACCIDENT |
|
OM536
|
|
M536 ACCIDENT WHERE |
|
OM539
|
|
M539 STILL DO SAME WRK |
|
OM538
|
|
M538 EMPLOYER HELP OUT |
|
OM586
|
|
M586 LAST JOB WRKD- EMPLOYER HELP OUT |
|
OM682
|
|
M682 DATE OF INJURY - DAY |
|
OM681
|
|
M681 DATE OF INJURY - MO |
|
OM553
|
|
M553 EXPECT GET WORSE |
|
OM552
|
|
M552 EXPECT IMPROVE |
|
OM551
|
|
M551 HEALTH PROB PREVENT WORK-MO |
|
OM524
|
|
M524 AUTO ACCIDENT |
|
OM577
|
|
M577 EMPLOYED AT TIME LIMITATN BEGAN |
|
OM525
|
|
M525 EMPLOYER HELP TO CONT WRK |
|
OM556
|
|
M556 AUTO ACCIDENT |
|
OM652
|
|
M652 1ST APPLIED SSI - YR |
|
OM653
|
|
M653 1ST APPLIED SSI - MO |
|
OM654
|
|
M654 SSI AWARDED BENEFITS |
|
OM656
|
|
M656 WHY NOT APPLY SSI BENEFITS-SPECIFY |
|
OM657
|
|
M657 EVER APPLIED VA |
|
OW777
|
|
^yearLoop |
|
OW778
|
|
^yearLoop |
|
OM625
|
|
M625 KEEP PACE W/ OTHERS AFTER |
|
OM624
|
|
M624 INTENSE CONCENTRATION AFTER |
|
OM627
|
|
M627 DECISIONS ABOUT PAY/PROMOTION |
|
OM626
|
|
M626 PEOPLE SKILLS AFTER |
|
OM621
|
|
M621 LIFTING HEAVY LOADS AFTER |
|
OM620
|
|
M620 PHYSICAL EFFORT AFTER |
|
OM623
|
|
M623 GOOD EYESIGHT AFTER |
|
OM622
|
|
M622 STOOPING/KNEELING/CROUCHING AFTER |
|
OM629
|
|
M629 MARRIED- WHEN HEALTH AFFECTED WORK |
|
OM628
|
|
M628 NUMBER PEOPLE R SUPERVISED AFTER |
|
OM573
|
|
M573 REC BENEFIT START YR |
|
OM707YM602TOM611
|
|
BRANCHPOINT FOR M707Y |
|
OM689YM526BP
|
|
BRANCHPOINT FOR M689Y |
|
OM693YM558BP
|
|
BRANCHPOINT FOR M693Y |
|
OM572
|
|
M572 RECVD BENEFITS WHICH PROGRAM |
|
OM697YM577BP
|
|
BRANCHPOINT FOR M697Y |
|
OM568
|
|
M568 AUTO ACCIDENT |
|
OM569
|
|
M569 CAUSED BY WRK |
|
OM561
|
|
M561 WHEN IMPAIRMENT 1ST BOTHER - YR |
|
OM562
|
|
M562 WHEN IMPAIRMENT 1ST BOTHER -YRS AG |
|
OM666
|
|
M666 ACCEPTED WORKERS COMP |
|
OM643M
|
|
M643 GOV PROGRAMS KNOWN |
|
OM692YM538TOM643
|
|
BRANCHPOINT FOR M692Y |
|
OM705YM597TOM609
|
|
BRANCHPOINT FOR M705Y |
|
OM669
|
|
M669 TYPE OF DISABILITY WC- PERCENT |
|
OM668
|
|
M668 TYPE OF DISABILITY WC - SPECIFY |
|
OM660
|
|
M660 APPLICATION ACCEPTED VA |
|
OM663
|
|
M663 EVER APPLIED WORKERS COMP |
|
OM662
|
|
M662 WHY NOT APPLY FOR VA BENS-SPECIFY |
|
OM665
|
|
M665 1ST APPLIED WC - MO |
|
OM664
|
|
M664 1ST APPLIED WC - YR |
|
OM667
|
|
M667 TYPE OF DISABILITY WC |
|
OM641
|
|
M641 AFFECT ON INCOME |
|
OM640
|
|
M640 OTR PERSON(S) CHANGE WRK |
|
OM699YM583TOW200
|
|
BRANCHPOINT FOR M699Y |
|
OM522
|
|
M522 HEALTH PROB RESULT OF ACCIDENT |
|
OM523
|
|
M523 ACCIDENT OCCUR AT WORK HOME ELSE |
|
OM520
|
|
M520 HEALTH PROBLEM FIRST BOTHER- AGE |
|
OM521
|
|
M521 EXPECT GET WORSE |
|
OM526
|
|
M526 WHEN IMPAIRMENT AFFECT ACTIVITY |
|
OM527
|
|
M527 IMPAIRMENT KEEPS R FROM WORKING |
|
OM583
|
|
M583 LAST JOB WRKD- DETAILS OF JOB |
|
OM597
|
|
M597 REPORT JOB ALREADY COMP/ORG |
|
OM594
|
|
M594 AFTER LEFT JOB - WHAT DID R DO |
|
OM596
|
|
M596 REPORT JOB ALREADY |
|
OM593
|
|
M593 WHY COULD NOT FIND WRK-SPECIFY |
|
OM591
|
|
M591 LOOKED FOR WRK SINCE LEAVE EMP |
|
OM590
|
|
M590 WRK SINCE LEAVE EMP |
|
OM598
|
|
M598 COMPANY/ORG NOT REPORTED- SPECIFY |
|
OM528
|
|
M528-BEGAN BEFORE WRK- KEEPS R FROM WRK |
|
OM674
|
|
M674 1ST APPLIED OTR - YR |
|
OM599
|
|
M599 EMPLOYER DO SPECIAL |
|
OM713YM539BP
|
|
BRANCHPOINT FOR M713Y |
|
OM529
|
|
M529 ABLE TO WRK FULL OR PART TIME |
|
OM588
|
|
M588 HOW LONG W/EMP AFTER LIMITATION |
|
OM589
|
|
M589 HOW LONG AFTER LIMITATION-UNIT |
|
OM558
|
|
M558 OTR IMPAIRMENT EVER LIMIT WRK |
|
OM686YM516BP
|
|
BRANCHPOINT FOR M686Y |
|
OM566
|
|
M566 RESULT OF ACCIDENT |
|
OM567
|
|
M567 ACCIDENT WHERE |
|
OM564
|
|
M564 AMOUNT OF TIME LIMITATION LASTED |
|
OM534
|
|
M534 EXPECT GET WORSE |
|
OM711YM508BP
|
|
BRANCHPOINT FOR M711Y |
|
OM565
|
|
M565 AMOUNT OF TIME LIMITATN LASTED-UNIT |
|
OM537
|
|
M537 AUTO ACCIDENT |
|
OM687YM525BP
|
|
BRANCHPOINT FOR M687Y |
|
OM560
|
|
M560 HEALTH PROB PREVENT WORKING |
|
OM637
|
|
M637 SP/P CHANGE WRK |
|
OM634
|
|
M634 HOW LONG SP WRKD- PER |
|
OM632
|
|
M632 WEEKS PER YEAR SP WORKED |
|
OM633
|
|
M633 HOW LONG SP WORKED AT THAT JOB |
|
OM631
|
|
M631 HOURS PER WEEK SP WORKED |
|
OM638
|
|
M638 PARENTS CHANGE WRK |
|
OM639
|
|
M639 CHILD(REN) CHANGE WRK |
|
OM708YW200
|
|
BRANCHPOINT FOR M708Y |
|
OM661M
|
|
M661 WHY NOT APPLY FOR VA BENS |
|
OM559
|
|
M559 HEALTH CONDITION- CAUSE OTH PROB |
|
OM550
|
|
M550 HEALTH PROB PREVENT WORK-YR |
|
OM557
|
|
M557 CAUSED BY WRK |
|
OM702YM588TOM610
|
|
BRANCHPOINT FOR M702Y |
|
OM555
|
|
M555 ACCIDENT WHERE |
|
OW232
|
|
What disability rating did you receive? |