Which one of the following best describes your principal employer during the week of February 1, 2013? Were you:
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER
1 [ ] in a non-incorporated business, professional practice, or farm
2 [ ] in an incorporated business, professional practice, or farm
PRIVATE SECTOR employee
3 [ ] in a for-profit company or organization
4 [ ] in a non-profit organization (including tax-exempt and charitable organizations)
GOVERNMENT employee
5 [ ] in a local government (e.g., city, county, school district)
6 [ ] in a state government (including state colleges/ universities)
7 [ ] in the U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] in the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer ____________________________

Which one of the following best describes your principal employer during the week of February 1, 2013? Were you...
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER
1 [ ] in a non-incorporated business, professional practice, or farm
2 [ ] in an incorporated business, professional practice, or farm
PRIVATE SECTOR employee
3 [ ] in a for-profit company or organization
4 [ ] in a non-profit organization (including tax-exempt and charitable organizations)
GOVERNMENT employee
5 [ ] in a local government (e.g., city, county, school district)
6 [ ] in a state government (including state colleges/ universities)
7 [ ] in the U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] in the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer ____________________________

1 [ ] Yes
2 [ ] No (Go to page 4, question A19)

(If Yes) Was the educational institution where you worked a...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system (Go to page 4, question A19)
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify

Which one of the following best describes your principal employer during the week of October 1, 2010? Were you...
Mark one answer.

1 [ ] SELF-EMPLOYED or a BUSINESS OWNER in a non-incorporated business, professional practice, or farm
2 [ ] in an incorporated business, professional practice, or farm
3 [ ] PRIVATE SECTOR employee in a for-profit company or organization
4 [ ] in a non-profit organization (including tax-exempt and charitable organizations)
5 [ ] GOVERNMENT employee in a local government (e.g., city, county, school district)
6 [ ] in a state government (including state colleges/ universities)
7 [ ] in the U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] in the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer

1 [ ] Yes
2 [ ] No (Go to page 3, question A16)

(If Yes) Was the educational institution where you worked a...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify

Were you working for pay or profit during the week of October 1, 2010?
Working includes being self-employed, on a postdoctoral appointment, or on any type of paid or unpaid leave, including vacation.
Use an X to mark your answer.

1 [ ] Yes (Go to question A8)
2 [ ] No

(If No) Did you look for work during the four weeks preceding October 1, 2010? This would be between September 3rd and October 1st.

1 [ ] Yes
2 [ ] No

Which one of the following best describes your principal employer during the week of October 1, 2010? Were you ...
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER

1 [ ] In a non-incorporated business, professional practice, or farm
2 [ ] In an incorporated business, professional practice, or farm

PRIVATE SECTOR employee

3 [ ] In a for-profit company or organization
4 [ ] In a non-profit organization (including tax-exempt and charitable organizations)

GOVERNMENT employee

5 [ ] In a local government (e.g., city, county, school district)
6 [ ] In a state government (including state colleges/universities)
7 [ ] In the U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] In the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer __________________________

1 [ ] Yes
2 [ ] No (Go to pave 6, question B15)

(If Yes) Was the educational institution where you worked a...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify ____________________________

Which one of the following best describes your principal employer during the week of October 1, 2008? Were you...
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER
1 [ ] in a non-incorporated business, professional practice, or farm
2 [ ] in an incorporated business, professional practice, or farm
PRIVATE SECTOR employee
3 [ ] in a for-profit company or organization
4 [ ] in a non-profit organization (including tax-exempt and charitable organizations)
GOVERNMENT employee
5 [ ] in a local government (e.g., city, county, school district)
6 [ ] in a state government (including state colleges/universities)
7 [ ] in the U.S. military service, active duty or Commissioned Corps (e.g., civilian employee)
8 [ ] in the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer: _______________

1 [ ] Yes
2 [ ] No (Go to page 3, question A14)

(If Yes) Was the educational institution where you worked a ...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify: ____________________________________

1 [ ] Yes
2 [ ] No (Go to page 3, question A17)

(If Yes) Was the educational institution where you worked a ...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system (Go to page 4, question A19)
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify: ____________________________________

During the week of October 1, 2008, what type of academic position(s) did you hold at this institution?
Mark Yes or No for each item.

1 [ ] President, Provost, or Chancellor (any level)

2 [ ] Dean (any level), department head, or department chair

3 [ ] Research faculty, scientist, associate, or fellow

4 [ ] Teaching faculty

5 [ ] Adjunct faculty

6 [ ] Postdoc (e.g., postdoctoral fellow or associate)

7 [ ] Research assistant

8 [ ] Teaching assistant

9 [ ] Other position ? Specify: ____________________________

Which one of the following best describes your principal employer during the week of October 1, 2010? Were you ...
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER

1 [ ] In a non-incorporated business, professional practice, or farm
2 [ ] In an incorporated business, professional practice, or farm

PRIVATE SECTOR employee

3 [ ] In a for-profit company or organization
4 [ ] In a non-profit organization (including tax-exempt and charitable organizations)

GOVERNMENT employee

5 [ ] In a local government (e.g., city, county, school district)
6 [ ] In a state government (including state colleges/universities)
7 [ ] In the U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] In the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer __________________________

1 [ ] Yes
2 [ ] No (Go to page 6, question B14)

(If Yes) Was the educational institution where you worked a...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify ____________________________

Which one of the following best describes your principal employer during the week of April 1, 2006? Were you...
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER
1 [ ] in a non-incorporated business, professional practice, or farm
2 [ ] in an incorporated business, professional practice, or farm
PRIVATE SECTOR employee
3 [ ] in a for-profit company or organization
4 [ ] in a non-profit organization (including tax-exempt and charitable organizations)
GOVERNMENT employee
5 [ ] in a local government (e.g., city, county, school district)
6 [ ] in a state government (including state colleges/universities)
7 [ ] in the U.S. military service, active duty or Commissioned Corps (e.g., civilian employee)
8 [ ] in the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer: _______________

1 [ ] Yes
2 [ ] No (Go to page 3, question A14)

(If Yes) Was the educational institution where you worked a ...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify: ____________________________________

Which one of the following best describes your principal employer during the week of April 1, 2006? Were you...
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER
1 [ ] in a non-incorporated business, professional practice, or farm
2 [ ] in an incorporated business, professional practice, or farm
PRIVATE SECTOR employee
3 [ ] in a for-profit company or organization
4 [ ] in a non-profit organization (including tax-exempt and charitable organizations)
GOVERNMENT employee
5 [ ] in a local government (e.g., city, county, school district)
6 [ ] in a state government (including state colleges/universities)
7 [ ] in the U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA
8 [ ] in the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer: _______________

1 [ ] Yes
2 [ ] No (Go to page 3, question A17)

(If Yes) Was the educational institution where you worked a ...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system (Go to page 4, question A17)
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify: ____________________________________

Which one of the following best describes your principal employer during the week of April 1, 2006? Were you ...
Mark one answer.

SELF-EMPLOYED or a BUSINESS OWNER

1 [ ] In a non-incorporated business, professional practice, or farm
2 [ ] In an incorporated business, professional practice, or farm

PRIVATE SECTOR employee

3 [ ] In a for-profit company or organization
4 [ ] In a non-profit organization (including tax-exempt and charitable organizations)

GOVERNMENT employee

5 [ ] In a local government (e.g., city, county, school district)
6 [ ] In a state government (including state colleges/universities)
7 [ ] In the U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] In the U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer __________________________

1 [ ] Yes
2 [ ] No (Go to page 7, question B14)

(If Yes) Was the educational institution where you worked a...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify ____________________________

Which one of the following best describes your principal employer during the week of October 1?
Mark (X) one answer.

1 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice or farm
2 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice or farm
3 [ ] A PRIVATE FOR-PROFIT organization or individual working for wages, salary or commissions
4 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (e.g., civilian employee)
9 [ ] Other ? Specify _______________

1 [ ] Yes
2 [ ] No (Go to page 3, question A21)

(If Yes) Was the educational institution where you worked a . . .
Mark (X) one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify

Which one of the following best describes your principal employer during the week of October 1? Were you...
Mark one answer.

1 [ ] SELF-EMPLOYED in own non-incorporated business, professional practice, or farm
2 [ ] SELF-EMPLOYED in own incorporated business, professional practice, or farm
3 [ ] A PRIVATE FOR-PROFIT organization or individual working for wages, salary, or commissions
4 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. government (e.g., civilian employee)
9 [ ] OTHER type of employee ? Specify type of employer: _______________

1 [ ] Yes
2 [ ] No (Go to page 4, question A21)

(If Yes) Was the educational institution where you worked a ...
Mark one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system (Go to page 4, question A21)
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify: ____________________________________

Which one of the following best describes your principal employer during the week of October 1? Were you ...
Mark (X) one answer.

1 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice or farm
2 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice or farm
3 [ ] A PRIVATE FOR-PROFIT organization or individual working for wages, salary or commissions
4 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. Government (e.g., civilian employee)
9 [ ] Other ? Specify ________________________

1 [ ] Yes
2 [ ] No (Go to question B20)

(If Yes) Was the educational institution where you worked a...
Mark (X) one answer.

1 [ ] Preschool, elementary, middle, or secondary school or system (Go to question B20)
2 [ ] Two-year college, community college, or technical institute
3 [ ] Four-year college or university, other than a medical school
4 [ ] Medical school (including university-affiliated hospital or medical center)
5 [ ] University-affiliated research institute
6 [ ] Other ? Specify ____________________________

Was your principal employer during the week of April 15...
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "state government" for state schools: most private schools are "private not-for-profit")
Mark (X) ONLY One

1 [ ] A PRIVATE FOR-PROFIT company, business or individual, working for wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. Government (e.g., civilian employee)
9 [ ] Other ? Specify: ____________________________

1 [ ] Yes
2 [ ] No (SKIP to A18)

(IF EDUCATIONAL INSTITUTION) Was this educational institution a...
Mark (X) ONLY One

1 [ ] Preschool, elementary, or middle school or system
2 [ ] Secondary school or system
3 [ ] Two-year college, community college, technical institute
4 [ ] Four-year college or university, other than medical school
5 [ ] Medical school (including university-affiliated hospital or medical center)
6 [ ] University-affiliated research institute
7 [ ] Something else ? Specify: _________________________

Was your principal employer during the week of April 15...
If employer was a school: Mark the type of organizational charter (e.g., mark "state government" for state schools; most private schools are "private not-for-profit")
Mark only one

1 [ ] A private for-profit company, business or individual, working for wages, salary or commissions
2 [ ] A private not-for-profit, tax-exempt, or charitable organization
3 [ ] Self-employed in own not incorporated business, professional practice, or farm
4 [ ] Self-employed in own incorporated business, professional practice, or farm
5 [ ] Local government (e.g., city, county)
6 [ ] State government
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. government (e.g., civilian employee)
9 [ ] Other ? Specify ______________________________________________

Was your principal employer an educational institution?
1 [ ] Yes
2 [ ] No (Skip to A20)

(If educational institution) Was this educational institution a...
Mark only one

1 [ ] Preschool, elementary, or middle school system (Skip to A20)
2 [ ] Secondary school or system (Skip to A20)
3 [ ] Two-year college, community college, technical institute
4 [ ] Four-year college or university, other than a medical school
5 [ ] Medical school (including university-affiliated hospital or medical center)
6 [ ] University-affiliated research institute
7 [ ] Something else ? Specify ________________________________________

Which of the following categories best describes your employer during the week of April 15, 1999?
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "state government" for state schools or "local government" for schools run by the local school district. Most private schools are "private not-for-profit".).
Mark (X) ONLY one

1 [ ] A PRIVATE FOR-PROFIT company, business or individual, paying you wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
3 [ ] SELF-EMPLOYMENT in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYMENT in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty, or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT as a civilian employee
91 [ ] Other ? Specify: ___________________________________

1 [ ] Yes
2 [ ] No (SKIP to B16)

(IF EDUCATIONAL INSTITUTION) Was this educational institution . . .
Mark (X) ONLY one

1 [ ] A preschool, elementary, or middle school or system
2 [ ] A secondary school or system
3 [ ] A 2-year college, junior college, or technical institute
4 [ ] A 4-year college or university, other than a medical school
5 [ ] A medical school (including university-affiliated hospital or medical center)
6 [ ] A university-affiliated research institute
91 [ ] Something else ? Specify: ____________________________________

Was your principal employer during the week of April 15 . . .
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "state government" for state schools, most private schools are "private not-for-profit")
Mark (X) ONLY one

1 [ ] A PRIVATE FOR-PROFIT company, business or individual, working for wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (e.g., city, county)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (e.g., civilian employee)
9 [ ] Other ? Specify: __________________________

1 [ ] Yes
2 [ ] No (SKIP to A18)

(IF EDUCATIONAL INSTITUTION) Was this educational institution a . . .
Mark (X) ONLY one

1 [ ] Preschool, elementary, or middle school or system
2 [ ] Secondary school or system
3 [ ] Two-year college, community college, technical institute
4 [ ] Four-year college or university, other than a medical school
5 [ ] Medical school (including university-affiliated hospital or medical center)
6 [ ] University-affiliated research institute
7 [ ] Something else ? Specify: ___________________________________

Was your principal employer during the week of April 15 . . .
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "State government" for state schools, most private schools are "private not-for-profit")
Mark (X) one

1 [ ] A PRIVATE FOR-PROFIT company, business or individual, working for wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (city, county, etc.)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (civilian employee)
9 [ ] Other - Specify: ______________________________

1 [ ] Yes
2 [ ] No (SKIP to A20, page 4)

(IF EDUCATIONAL INSTITUTION) Was this educational institution . . .
Mark (X) one

1 [ ] A preschool, elementary, or middle school or system (SKIP to A20, page 4)
2 [ ] A secondary school or system (SKIP to A20, page 4)
3 [ ] A 2-year college, junior college, or technical institute
4 [ ] A 4-year college or university, other than a medical school
5 [ ] A medical school (including university-affiliated hospital or medical center)
6 [ ] A university-affiliated research institute
7 [ ] Other - Specify: _______________________________________

Who was your principal employer during the week of April 15, 1997?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week.
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked.

Employer Name: _____________________________
City or Town: ________________________________
State/Foreign Country: _________________________
ZIP Code: ___________________________________

Was your principal employer during the week of April 15 . . .
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "state government" for state schools, most private schools are "private not-for-profit")
Mark (X) one

1 [ ] A PRIVATE FOR-PROFIT company, business or individual, working for wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (city, county, etc.)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (civilian employee)
9 [ ] Other - Specify:

1 [ ] Yes
2 [ ] No (SKIP to A16)

(IF EDUCATIONAL INSTITUTION) Was this educational institution a . . .
Mark (X) one

1 [ ] Preschool, elementary, or middle school or system
2 [ ] A secondary school or system
3 [ ] A 2-year college, junior college, technical institute
4 [ ] A 4-year college or university, other than a medical school
5 [ ] A medical school (including university-affiliated hospital or medical center)
6 [ ] A university-affiliated research institute
7 [ ] Other - Specify: ______________________________

Was your principal employer during the week of April 15 . . .
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "State government" for state schools, most private schools are "private not-for-profit")
Mark (X) one

1 [ ] A PRIVATE FOR-PROFIT company, business or individual, working for wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (city, county, etc.)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (civilian employee)
9 [ ] Other - Specify: ______________________________

1 [ ] Yes
2 [ ] No (SKIP to A18)

(IF EDUCATIONAL INSTITUTION) Was this educational institution . . .
Mark (X) one

1 [ ] A preschool, elementary, or middle school or system (SKIP to A18)
2 [ ] A secondary school or system (SKIP to A18)
3 [ ] A 2-year college, junior college, or technical institute
4 [ ] A 4-year college or university, other than a medical school
5 [ ] A medical school (including university-affiliated hospital or medical center)
6 [ ] A university-affiliated research institute
7 [ ] Other - Specify: _______________________________________

Was your employer during the week of April 15 . . .
IF EMPLOYER WAS A SCHOOL: Mark (X) the type of organizational charter (e.g., mark "State government" for state schools, most private schools are "private not-for-profit")
Mark (X) one

1 [ ] A PRIVATE FOR-PROFIT company, business or individual, working for wages, salary or commissions
2 [ ] A PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
3 [ ] SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
4 [ ] SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
5 [ ] Local GOVERNMENT (city, county, etc.)
6 [ ] State GOVERNMENT
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. GOVERNMENT (civilian employee)
9 [ ] Other ? Specify: ___________________________________________________

1 [ ] Yes
2 [ ] No 6 SKIP to B16

(IF EDUCATIONAL INSTITUTION) Was this educational institution a...
Mark (X) one

1 [ ] Preschool, elementary, or middle school or system
2 [ ] A secondary school or system
3 [ ] A 2-year college, junior college, technical institute
4 [ ] A 4-year college or university, other than a medical school
5 [ ] A medical school (including university-affiliated hospital or medical center)
6 [ ] A university-affiliated research institute
7 [ ] Other - Specify

1 [ ] Yes
2 [ ] No SKIP TO A13

1 [ ] An elementary, middle, or secondary school or system
2 [ ] A 2-year college, junior college, technical institute
3 [ ] A 4-year college or university, other than a medical school
4 [ ] A medical school (including university-affiliated hospital or medical center)
5 [ ] A university-affiliated research institute
6 [ ] Other (Specify:______________)

01 [ ] A Private for Profit company, business or individual, working for wages, salary or commissions
02 [ ] A Private Not-for-Profit, tax-exempt, or charitable organization
03 [ ] Self-Employed in own NOT INCORPORATED business, professional practice, or farm
04 [ ] Self-Employed in own INCORPORATED business, professional practice, or farm
05 [ ] Local government (city, county, etc.)
06 [ ] State government
07 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
08 [ ] U.S. government (civilian employee)
09 [ ] Other (Specify: ____________)

Who was your principal employer during the week of April 15?

Employer: _________________________________
Name: ____________________________________
City/Town: ________________________________
State/Foreign Country: _______________________
ZIP Code: _________________________________

1 [ ] Yes
2 [ ] No (SKIP TO A16)

1 [ ] An elementary, middle, or secondary school or system (SKIP TO A17 (PAGE 3))
2 [ ] A 2-year college, junior college, technical institute
3 [ ] A 4-year college or university, other than a medical school
4 [ ] A medical school (including university-affiliated hospital or medical center)
5 [ ] A university-affiliated research institute
6 [ ] Other (Specify:_______________________________________)

1 [ ] A Private for Profit company, business or individual, working for wages, salary or commissions
2 [ ] A Private Not-for-Profit, tax-exempt, or charitable organization
3 [ ] Self-Employed in own NOT INCORPORATED business, professional practice, or farm
4 [ ] Self-Employed in own INCORPORATED business, professional practice, or farm
5 [ ] Local government (city, county, etc.)
6 [ ] State government
7 [ ] U.S. military service, active duty or Commissioned Corps (e.g., USPHS, NOAA)
8 [ ] U.S. government (civilian employee)
9 [ ] Other (Specify:)

_______________________________________________
_______________________________________________

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