Screener

Date: July 13, 2009

Screener

MAYA GROUP SCREENER

Interviewer: _____________________________________ Date: __________________

Time began: _______________________ Time ended: _______________________

Name: ____________________________________________________________

Address: ________________________________________________________________

City: _______________________________ State: ________________ Zip: _________

Telephone (H): _________________________ (W) _______________________________

INTRODUCTION: Hello, I’m (first and last name) from (your facility name). We’re conducting a survey among people in your area for the Census Bureau. Please be assured we are not selling anything and that the information gathered will remain confidential and be used for research purposes only. If you qualify, we may want to include your opinions, for which you would be compensated.

Who is the person in your household who would be most likely to open and read the mail?

(ALL RESPONDENTS MUST SAY THAT THEY ARE)

a) Myself Continue

b) Someone else Ask to speak to person who does and start over.

What is your gender?

a) Male

b) Female

RECRUIT A MIX

What is your exact age? ___________ (ALL MUST BE BETWEEN 18-64 YEARS OLD)

a) Under 18 years old (TERMINATE)

b) 18 - 24 years old

c) 25 - 34 years old

d) 35 - 39 years old

e) 40 - 44 years old RECRUIT A MIX

f) 45 - 50 years old

g) 51 - 55 years old

h) 56-64 years old

i) 65 years old or older (TERMINATE)

ALGORITHM PLACEHOLDER

Algorithm questions will be included in summary grids

Results from algorithm

1. Leading Edge

2. Head Nodders

3. Insulated

4. Unaquainted

5. Cynical Fifth

What language do you, yourself, primarily speak at home? DO NOT READ LIST

1. Armenian

2. Bengali

3. English

4. Farsi

5. Greek

6. Hmong

7. Laotian

8. Portuguese

9. Thai

10. Urdu

11. Spanish

12. Other language WRITE IN _________________ TERMINATE

13. Don’t know/refused TERMINATE

During an average week, approximately how many hours do you spend watching television, listening to the radio or reading newspapers and/or magazines in [READ NAME OF LANGUAGE SPOKEN AT HOME]?

(READ LIST; MUST SAY AT LEAST 8 HOURS TO QUALIFY)

1. Less than two hours TERMINATE

2. Two to five hours TERMINATE

3. Five to eight hours TERMINATE

4. Over eight hours

[ASK ONLY IF ENGLISH NOT LANGUAGE SPOKEN AT HOME:] In what language do you prefer to read, listen and watch media, English or [READ NAME OF LANGUAGE SPOKEN AT HOME]?

1. English always TERMINATE

2. English mostly TERMINATE

3. Both English and your language equally TERMINATE

4. Your language mostly

5. Your language always

Were you born in the United States?

1. Yes

2. No

[ASK ONLY IF NOT BORN IN US] Where did you live prior to coming to the US. [IF NECESSARY] In what country did you spend the most time prior to coming to the US?

1. African country

2. Asian country

3. Caribbean country

4. Central/South American country

5. European country

6. Middle Eastern country

7. Other country

[PROVIDE INTERVIEWER WITH LIST OF COUNTRIES FOR QUALIFICATION PURPOSES]

DISPLACED AUDIENCES ONLY

Do you own or rent the home you currently reside in?

1. Yes CONTINUE TO DISPLACED HOST QUESTION

2. No CONTINUE TO DISPLACED PERSON QUESTION

[DISPLACED HOST] Does anyone currently live in your household who came to reside with you due to being displaced due to a natural disaster (e.g. Hurricane Katrina) or economic reasons (e.g. lost job)?

3. Yes DISPLACED PERSONS HOST

4. No TERMINATE

[DISPLACED PERSON] Did you come to live in your current residence due to being displaced by a natural disaster (e.g. Hurricane Katrina) or economic reasons (e.g. lost job)?

5. Yes DISPLACED PERSONS

6. No TERMINATE

Where did you live prior to coming to the US. [IF NECESSARY] In what country did you spend the most time prior to coming to the US?

8. African country

9. Asian country

10. Caribbean country

11. Central/South American country

12. European country

13. Middle Eastern country

14. Other country

[SEE LIST OF COUNTRIES]

Are you Hispanic or Latino? (READ LIST)

1. Yes

2. No

[DO NOT READ]

3. Don’t know

4. Refused

Which of these categories best describes your race? (READ LIST, ALLOW MULTIPLE RESPONSES)

1. American Indian or Alaska Native

2. Asian

3. Native Hawaiian or Other Pacific Islander

4. Black or African-American

5. White

[DO NOT READ]

6. Other

7. Don’t Know

8. Refused

Which of the following was the last grade of school you completed? READ LIST.

1. Some high school

2. High school graduate

3. Trade/Vocational school RECRUIT A MIX

4. Some college

5. College graduate

6. Post graduate

7. Refused

What is your current marital status? DO NOT READ LIST

1. Single

2. Married

3. Separated or Divorced RECRUIT A MIX

4. Widowed

5. Other

6. Refused

Do you currently have any children under 18 years of age living with you in your home?

1. Yes

2. No RECRUIT A MIX

3. Refused

Which of the following includes your annual household income?

(READ LIST)

1. Less than $25,000

2. $25,000-$49,999

3. $50,000-$74,999 RECRUIT A MIX

4. $75,000-$99,999

5. $100,000+

6. Refused

How well do you read and speak [LANGUAGE OF FOCUS GROUP]? READ LIST

1. I do not speak or read any [LANGUAGE OF FOCUS GROUP] TERMINATE

2. I speak and read some [LANGUAGE OF FOCUS GROUP] TERMINATE

3. I speak and read [LANGUAGE OF FOCUS GROUP] well CONTINUE

4. I am fluent in [LANGUAGE OF FOCUS GROUP] and can read it well CONTINUE

We are interested in talking with people from a variety of professions. Do you, any friends, any member of your household, or extended family work for … (READ LIST)

1. a marketing company or marketing department?

2. a market research firm or a market research department?

3. a public relations or advertising agency?

4. any branch of radio or television broadcasting?

5. working directly for a newspaper or consumer magazine?

6. any online media new/media outlet

7. working for a government agency and/or office?

I f Yes to any one of the above Terminate

None of the above Continue

TERMINATE AND TALLY ANY RESPONDENTS WHO DO NOT SPEAK CLEARLY AND FLUENTLY, THOSE WHO HAVE A STRONG ACCENT, THOSE WHO APPEAR TO HAVE DIFFICULTY UNDERSTANDING WHAT YOU ARE ASKING, OR APPEAR AT ALL UNWILLING TO DISCUSS THEIR THOUGHTS/OPINIONS.

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