AQE Reinterview for Cognitive Test
April 30, 2009
A1. Hello, I’m (your Name) from the U.S. Census Bureau. We recently conducted the 2009 Census. Now we’re doing a study to find out how well we did our job. This interview should take about 7 minutes to complete.
A3. Did you live or stay at <ADDRESS> on April 1, 2009?
[] Yes – continue
[] No – conduct interview about address where R stayed on April 1, 2009
A6. Your response to this census is protected by law under Title 13 of the United States Code. This is the same law that protects your privacy. No one outside the Census Bureau will see your answers.
B1. We need to list people living or staying there on April 1, 2009. We want to list people where they usually live and sleep. For example, college students and armed forces personnel should be listed where they live and sleep most of the time.
Let’s start with you, what is your first name? Middle initial? Last name?
What is the first name of the next person who was living and sleeping there on April 1, 2009? Middle initial? Last name? Anyone else? (List entire roster)
B2. We do not want to miss any people who might have been staying there on April 1st. Were there any additional people that you didn’t mention, for example:
Babies?
If yes, What is that child’s first name? Middle initial? Last name? Any other children?
Foster children?
If yes, What is that child’s first name? Middle initial? Last name? Any other children?
Any other relatives?
If yes, What is that person’s first name? Middle initial? Last name? Anyone else?
Roommates?
If yes, What is that person’s first name? Middle initial? Last name? Anyone else?
Any other nonrelatives?
If yes, What is that person’s first name? Middle initial? Last name? Anyone else? How about anyone staying here on April 1st who had no other permanent place to live?
If yes, What is that person’s first name? Middle initial? Last name? Anyone else?
B3a. Now thinking of all the people you just mentioned, in April, (Were you/ was anyone) living in college housing?
Yes – if more than one person in household – Who was living in college housing?
No -
B3b. In April, (Were you/ Was anyone) living away for the military?
Yes – if more than one person in household – Who was living away for the military?
No
B3c. On April 1, 2009, (were you/ was anyone) in a place like a nursing home or a jail or prison?
Yes – Who was living away in a place like a nursing home or jail or prison?
No
C1. We are going to ask information about you and one other person in the household, <Name>.
Read if necessary: We have randomly selected <NAME> from your household. We are selecting only one other person because we want to keep the interview short.
C2. What was your age on April 1, 2009?
Read aloud when necessary: If you don’t know the exact age, please estimate.
Make sure the respondent gives the age in completed years as of April 1, 2009. Do not round up.
Do not enter age in months.
For babies less than 1 year old, enter 0 as the age.
C3. How about <Name>? What was <Name’s> age on April 1, 2009?
Read aloud when necessary: If you don’t know the exact age, please estimate.
Make sure the respondent gives the age in completed years as of April 1, 2009. Do not round up.
Do not enter age in months.
For babies less than 1 year old, enter 0 as the age.
C4. How is <NAME> related to you?
1-Husband or wife
2-Son or daughter - Is <NAME> your biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
1-Biological son or daughter
2- Adopted son or daughter
3- Stepson or stepdaughter
4-Foster son or daughter (DO NOT READ)
3- Brother or sister
4- Father or mother
5-Grandchild
6-Parent-in-law
7-Son-in-law or daughter-in-law
8-Other relative
9-Roomer or boarder
10-Housemate or roommate
11-Unmarried partner
12-Other nonrelative
Don’t Know
Refused
C5. Is <NAME> male or female?
Ask or verify sex. Do not enter/record sex based upon observation or responses to other items.
D1. What is your race or origin?
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D2. Do you identify with any other race or origin?
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D3. Now, I am going to ask you a series of questions about race and origin and would like you to respond to each one. You may identify with as many races and/or origins as you wish. These questions may seem repetitive, but it is important that we ask them of each person to measure the quality of our census.
D4. Are you White?
Yes
No
Don’t know
Refused
D5. Are you Black or African American?
Yes
No
Don’t know
Refused
D6. Are you Mexican, Mexican American, or Chicano?
Yes
No
Don’t know
Refused
D7. Are you Puerto Rican?
Yes
No
Don’t know
Refused
D8. Are you Cuban?
Yes
No
Don’t know
Refused
D9. Are you another Hispanic, Latino, or Spanish origin not yet mentioned?
Yes What is that origin?
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No
Don’t know
Refused
D9A. If respondent reports a general term such as “Hispanic,” “Latino,” or “Spanish” to question 9, then ask:
Read if necessary: Origin can be viewed as the heritage, nationality group, lineage, or country of birth of the person or the person's parents or ancestors before their arrival in the United States
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D10. Are you American Indian or Alaska Native?
Yes What is your enrolled or principal tribe?
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No
Don’t know
Refused
D11. Are you Asian Indian?
Yes
No
Don’t know
Refused
D12. Are you Chinese?
Yes
No
Don’t know
Refused
D13. Are you Filipino?
Yes
No
Don’t know
Refused
D14. Are you Japanese?
Yes
No
Don’t know
Refused
D15. Are you Korean?
Yes
No
Don’t know
Refused
D16. Are you Vietnamese?
Yes
No
Don’t know
Refused
D17. Are you another Asian race or origin not yet mentioned?
Yes What is that race or origin?
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No
Don’t know
Refused
D18. Are you Native Hawaiian?
Yes
No
Don’t know
Refused
D19. Are you Guamanian or Chamorro?
Yes
No
Don’t know
Refused
D20. Are you Samoan?
Yes
No
Don’t know
Refused
D21. Are you another Pacific Islander race or origin not yet mentioned?
Yes What is that race or origin?
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No
Don’t know
Refused
D22. Are you Some other race or origin not yet mentioned?
Yes What is that race or origin?
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No
Don’t know
Refused
D22b. If respondent reports biracial, multiracial, mixed, mestizo to question D22, then ask:
Can you be more specific?
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D23. Interviewer Question: Did Respondent report:
White only D24
Black only D25
White and another race or origin D26
Black and another race or origin D27
Neither white nor black D28
D24. If respondent reports White only, then ask:
Earlier you said you were White. What is your specific origin? For example: German, Irish, Lebanese, Egyptian, and so on.
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D25. If respondent reports Black only, then ask:
Earlier you said you were Black. What is your specific origin? For example: African American, Haitian, Nigerian, and so on.
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D26. If respondent reports multiple responses including White, then ask:
One of the responses you gave was White. What is your specific White origin? For example: German, Irish, Lebanese, Egyptian, and so on.
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D27. If respondent reports multiple responses including Black, then ask:
One of the responses you gave was Black. What is your specific Black origin? For example: African American, Haitian, Nigerian, and so on.
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D28. We have asked you a lot of questions about your race or origin. Have I missed a race or origin you want to tell me about?
Yes What is that race or origin?
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No
Don’t know
Refused
E1. Now I’m going to ask you some questions about <Name>.
E2. What is <Name’s> race or origin?
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E3. Does he/she identify with any other race or origin?
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E4. Is [he/she] White?
Yes
No
Don’t know
Refused
E5. Is [he/she] Black or African American?
Yes
No
Don’t know
Refused
E6. Is [he/she] Mexican, Mexican American, or Chicano?
Yes
No
Don’t know
Refused
E7. Is [he/she] Puerto Rican?
Yes
No
Don’t know
Refused
E8. Is [he/she] Cuban?
Yes
No
Don’t know
Refused
E9. Is [he/she] of another Hispanic, Latino, or Spanish origin not yet mentioned?
Yes What is that origin?
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No
Don’t know
Refused
E9A. If respondent reports a general term such as “Hispanic,” “Latino,” or “Spanish” to question 9, then ask:
Read if necessary: Origin can be viewed as the heritage, nationality group, lineage, or country of birth of the person or the person's parents or ancestors before their arrival in the United States
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E10. Is [he/she] American Indian or Alaska Native?
Yes What is your enrolled or principal tribe?
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No
Don’t know
Refused
E11. Is [he/she] Asian Indian?
Yes
No
Don’t know
Refused
E12. Is [he/she] Chinese?
Yes
No
Don’t know
Refused
E13. Is [he/she] Filipino?
Yes
No
Don’t know
Refused
E14. Is [he/she] Japanese?
Yes
No
Don’t know
Refused
E15. Is [he/she] Korean?
Yes
No
Don’t know
Refused
E16. Is [he/she] Vietnamese?
Yes
No
Don’t know
Refused
E17. Is [he/she] of another Asian race or origin not yet mentioned?
Yes What is that race or origin?
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No
Don’t know
Refused
E18. Is [he/she] Native Hawaiian?
Yes
No
Don’t know
Refused
E19. Is [he/she] Guamanian or Chamorro?
Yes
No
Don’t know
Refused
E20. Is [he/she] Samoan?
Yes
No
Don’t know
Refused
E21. Is [he/she] of another Pacific Islander race or origin not yet mentioned?
Yes What is that race or origin?
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No
Don’t know
Refused
E22. Is [he/she] of Some other race or origin not yet mentioned?
Yes What is that race or origin?
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No
Don’t know
Refused
E22b. If respondent reports biracial, multiracial, mixed, mestizo to question 22, then ask:
Can you be more specific?
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E23. Interviewer Question:Did Respondent report:
White only E24
Black only E25
White and another race or origin E26
Black and another race or origin E27
Neither white nor black E28
E24. If respondent reports White only for Second Person, then ask:
Earlier you said <Name> was White. What is his/her specific origin? For example: German, Irish, Lebanese, Egyptian, and so on.
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E25. If respondent reports Black only for Second Person, then ask:
Earlier you said <Name> was Black. What is his/her specific origin? For example: African American, Haitian, Nigerian, and so on.
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E26. If respondent reports multiple responses, including White, for the Second Person, then ask:
Earlier you said one of <Name’s> responses was White. What is that specific White origin? For example: German, Irish, Lebanese, Egyptian, and so on.
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E27. If respondent reports multiple responses, including Black, for the Second Person, then ask:
Earlier you said one of <Name’s> responses was Black. What is that specific Black origin? For example: African American, Haitian, Nigerian, and so on.
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E28. We have asked you a lot about how <Name> identifies his/her race or origin. Have I missed a race or origin you want to tell me about for him/her?
Yes What is that race or origin?
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No
Don’t know
Refused
Respondent Debriefing
F1. I just have a few more questions….
F2. Do people view your race or origin differently from how you view yourself?
Yes How do others view your race or origin?
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No
Don’t know
Refused
F3. If respondent reports Middle Eastern or North African descent in Some Other Race, but did not report as White, Black, etc., then ask:
F4a. Do you consider yourself White?
Yes
No
Don’t know
Refused
F4b. Do you consider yourself Caucasian?
Yes
No
Don’t know
Refused
F4c. Do you think other people consider you White or Caucasian?
Yes
No
Don’t know
Refused
F5. If respondent reports Caribbean or African descent in Some Other Race, but did not report White, Black, etc., then ask:
F5a. Do you consider yourself Black?
Yes
No
Don’t know
Refused
F5b. Do you consider yourself African American?
Yes
No
Don’t know
Refused
F5c. Do you think other people consider you either Black or African American?
Yes
No
Don’t know
Refused
F6. If respondent reports multiple races or origins then ask:
You reported more than one race or origin for yourself. Do you more closely identify with one of these groups?
Yes What is that group?
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No
Don’t know
Refused
F7. What is the race or origin of your mother?
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F8. What is the race or origin of your father?
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G1. Do people view <Name's> race or origin differently from how he/she views himself/herself?
Yes How do others view his/her race or origin?
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No
Don’t know
Refused
G3. If respondent reports Middle Eastern or North African descent in Some Other Race, but did not report as White, Black, etc., then ask:
G3a. Does <Name> consider himself/herself White?
Yes
No
Don’t know
Refused
G3b. Does <Name> consider himself/herself Caucasian?
Yes
No
Don’t know
Refused
G3c. Do you think other people consider <Name> White or Caucasian?
Yes
No
Don’t know
Refused
G4. If respondent reports Caribbean or African descent in Some Other Race, but did not report White, Black, etc., then ask:
G4a. Does <Name> consider himself/herself Black?
Yes
No
Don’t know
Refused
G4b. Does <Name> consider himself/herself African American?
Yes
No
Don’t know
Refused
G4c. Do you think other people consider <Name> either Black or African American?
Yes
No
Don’t know
Refused
G5. I If respondent reports multiple races or origins for Person 2 then ask:
You reported more than one race or origin for <NAME>. Does he/she more closely identify with one of these groups?
Yes What is that group?
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No
Don’t know
Refused
(Relationship based skip pattern:)
G6. What is the race or origin of <Name’s> mother?
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G7. What is the race or origin of <Name’s> father?
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H4. Thank you. We have reached the end of the interview. I appreciate you sharing your thoughts and time to assist us with our research.
File Type | application/msword |
File Title | Ideas for Race and Hispanic Origin Yes/No Questions and Write-in |
Author | rasto001 |
Last Modified By | Bureau Of The Census |
File Modified | 2009-05-04 |
File Created | 2009-05-04 |