Skip Navigation

   

|___|___| : |___|___|

Time

Back to Contents SECTION C: CHILDCARE

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.

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

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:_____________________

CHILD #2

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #3

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #4

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #5

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #6

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #7

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #8

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #9

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

CHILD #10

__________________

__________________

|__|__|/|__|__|/|__|__|

|___|___|___|-|___|___|-|___|___|___|___|

|___|___|

 

© , Johns Hopkins University. All rights reserved.
Web policies, 615 N. Wolfe Street, Baltimore, MD 21205