Various Pretesting Activities

Generic Clearence for Questionnaire Pretesting Research

omb1006ACSSpanishCATICAPIenc1

Various Pretesting Activities

OMB: 0607-0725

Document [doc]
Download: doc | pdf

Section: Housing (Phase I)

INTRO_CP

1. Yes

2. No


Hello. I'm... from the United States Census Bureau.

[Here is my identification card (show ID card).]


We are conducting the [American/ Puerto Rico] Community Survey to collect current population and housing information.

I have some questions to ask you. Did you receive our mailings?

ADRSVER_CP


1. Yes

2. No

I need to verify the address where this unit is located.

Is this address:


YBL



2000 or later

 1990 – 1999 MVY

 1980 – 1989 MVY

 1970 – 1979 MVY

1960 – 1969 MVY

1950 – 1959 MVY

1940 – 1949 MVY

1939 or earlier MVY


About when was this <FILL BUILDING TYPE> first built?



YBL1






(What year was this <FILL BUILDING TYPE> built?)


Enter specific year <FILL BUILDING TYPE> was built if 2000 or later.


MVY





In what year did (you/<HHOLDERNAME) move into this [FILL BUILDING TYPE]?





MVM


<1> January

<2> February

<3> March

<4> April

<5> May

<6> June

<7> July

<8> August

<9> September

<10> October

<11> November

<12> December

In what month was that?


(What was the month that [you/HHOLDERNAME] moved into this [FILL BUILDING TYPE]?)

ACR


Less than 1 acre(s) Go to RMS

1 to 9.9 acre(s)

10 or more acre(s)

Is this [BUILDING TYPE] on less than 1 [acre/cuerda], between 1 and 9.9 [acres/cuerdas], or 10 or more [acres/cuerdas]?


AGSA



Yes

No Go to RMS


IN THE PAST 12 MONTHS, were there any sales of agricultural products from this property?


AGSB


$1 - $999

$1,000 - $2,499

$2,500 - $4,999

 $5,000 - $9,999

$10,000 or more


How much were the sales?

RMS





The next questions are about the number and kinds of rooms at this place. Rooms must be separated by built-in archways or walls that extend out at least 6 inches and go from floor to ceiling.

How many separate rooms are in this [BUILDING TYPE] not counting bathrooms, porches, balconies, foyers, halls or unfinished basements?

INCLUDE bedrooms, kitchens, etc.

INCLBED

Yes

 No Go to BDSINC


Did you include bedrooms?


BDSINC





How many of the (<RMS> rooms) would you list as bedrooms if this <BUILDING TYPE> were for sale or rent?


Enter number of rooms



VEH


None

1

2

3

4

5

6 or more

How many cars, vans, and trucks of one-ton capacity or less are kept at home for use by members of this household?

(If a business vehicle is available for personal use, it should be included.)

FSX



Yes

No


IN THE PAST 12 MONTHS, did anyone in this household receive Food Stamps or a Food Stamp benefit card?


IN THE PAST 12 MONTHS, did anyone in this household receive Nutritional Assistance Program benefits or a Nutritional Assistance Program benefit card?



In some states the Food Stamps program may be known as the Supplemental Nutrition Assistance Program (SNAP)

CONX


Yes

No Go to TEN


The next few questions refer to this [BUILDING TYPE].

Is this [BUILDING TYPE] part of a condominium?

CONPAY



Yes

No Go to TEN

Is there a condominium fee?


CONFEE





$_______.00


What is the MONTHLY condominium fee?


Estimate monthly amount in dollars.

TEN



Own with a mortgage or loan including home equity loans

Own free and clear

Rent

Occupy without having to pay rent


(Do you / Do you or does someone in this household / Does <HHoldername> or someone in this household)] own this [BUILDING TYPE] with a mortgage or loan including home equity loans, own it free and clear, rent it, or occupy it without having to pay rent?


TENRENT


  1. Yes

2. No

(Do you / Do you or does someone in this household / Does <HHoldername> or someone in this household)] pay rent?








TENMORT



  1. Yes

2. No

(Do you / Do you or does someone in this household / Does <HHoldername> or someone in this household)] pay a mortgage?


TENTAX



  1. Yes

2. No


(Do you / Do you or does someone in this household / Does <HHoldername> or someone in this household)] pay real estate taxes?



RNTTEMP



________

How much is the rent for this [BUILDING TYPE]?




RNTPAY


1. Daily

2. Weekly

3. Monthly

4. Quarterly

5. Other

How often is the rent paid?





RNTOTH


________

How often is the rent paid?




RenterRN


________

What is the MONTHLY rent for this [BUILDING TYPE]?


RNTM



1. Yes

2. No


Does the MONTHLY rent include any meals?

VALPROP


________

How much do you think this <house and lot/apartment/mobile home - and lot, if owned - / unit > would sell for if it were for sale?



TAX


________

What are the annual real estate taxes on THIS property?


INS


________

What is the annual payment for fire, hazard, and flood insurance on THIS property?





MRGX


  1. Yes, mortgage, deed of trust, or similar debt

  2. Yes, contract to purchase

3. No

Earlier I recorded that there is a mortgage or loan on this property. Is it a mortgage, deed of trust, contract to purchase, or similar debt?

MRGFR



1. Yes

2. No

Earlier I recorded that this property is owned free and clear. Is this correct?


MRG


________

What is the regular MONTHLY mortgage payment on this property?


MRGT



1. Yes, taxes included in payment

2. No, taxes paid separately or taxes not required


Does the regular MONTHLY mortgage payment include payments for real estate taxes?


MRGI



1. Yes, insurance included in payment

2. No, insurance paid separately or no insurance

Does the regular MONTHLY mortgage payment include payments for fire, hazard, or flood insurance?


SMXA



1. Yes

2. No


Is there a second or junior mortgage on this property?

SMXB


1. Yes

  1. No


Is there a home equity loan on this property?


SM


________

What is the regular MONTHLY payment on all second or junior mortgages and all home equity loans on this property?


MH


________

What are the total annual costs for personal property taxes, site rent, registration fees, and license fees on THIS mobile home and its site?


THANKYOU


Thank you very much for your participation in this important survey.

You've been very helpful.


File Typeapplication/msword
File TitleYBL
AuthorBureau Of The Census
Last Modified Bydemai001
File Modified2010-02-01
File Created2010-02-01

© 2024 OMB.report | Privacy Policy