Government Units Survey (GUS) Cognitive Interview Questionnaire and Protocol
We will use the following general probes (for questions where the respondents seems to be having difficulty):
What were you thinking when you were answering this question?
How did you arrive at your answer?
You reported ______. Can you tell me more about that?
Mailing and Contact Information
Please respond within 14 days of receipt.
RETURN VIA MAIL TO:
U. S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
Introduction and Survey Purpose:
This survey collects descriptive information on the basic characteristics of local governments in preparation for the 2012 Census of Governments. Data from this survey will also be used to produce the official count of local government units in the United States and to update and verify the mailing addresses of government units.
Please use a blue or black ink pen to complete the survey form.
A. BACKGROUND INFORMATION
If your government has ceased to exist, please mark (X) the box below, enter the effective date, and return the form.
□ My government has ceased to exist
Effective Date: Month (MM) _______ Day (DD)_______ Year (YYYY)________
Is the mailing address listed above correct? Yes No
Does your government have an Internet website that contains information about your government and its activities?
Yes -- Enter the web address (e.g. www.mylocalgov.state.us)_______________________________
No
What is the ending date of your government’s fiscal year?
Month (MM)________ Day (DD)___________
Is your government’s physical location the same as the location shown in the mailing address? (P.O. Box and rural route addresses are not physical locations).
Yes
No -- Enter physical location._____________________________________
What year was your government was first incorporated or formed?
Year____________
Does your government have a homerule charter?
Yes – Enter the year your homerule charter was adopted ____________
No
Probes:
In your own words, what do you think this question is asking?
How did you arrive at your answer?
What does the term “homerule charter” mean to you?
B. DEBT
Does your government have the authority to issue debt?
Yes
No – Skip to Q10
What type of debt does your government have the authority to issue? (Mark “Yes” or “No” for each item)
Short-term debt Yes No
Long-term conduit debt Yes No
Long-term general purpose debt Yes No
General obligation Yes No
Revenue bond Yes No
Utilized debt Yes No
Other debt (Specify_____________) Yes No
Probes:
In your own words, what did you think this question was asking?
How did you arrive at your answers?
What does the term “debt” mean to you in this question?
What does the term “long-term conduit debt” mean to you?
If respondent reports “other debt,” probe that type of debt (see if it could possibly fall into another category): You said your government has the authority to issue _____ type of debt. Can you tell me more about that kind of debt?
C. TAX AND LICENSING
What types of taxes does your government have the authority to levy? (Mark “Yes” or “No” for each item)
Property Taxes Yes No
General Sales and Gross Receipts Taxes Yes No
Alcoholic Beverages Sales Tax Yes No
Amusements Sales Tax Yes No
Motor Fuels Sales Tax Yes No
Insurance Premiums Sales Tax Yes No
Pari-mutuels Sales Tax Yes No
Public Utilities Sales Tax Yes No
Tobacco Products Sales Tax Yes No
Individual Income Taxes Yes No
Corporation Net Income Taxes Yes No
Death and Gift Taxes Yes No
Documentary and Stock Transfer Taxes Yes No
Severance Taxes Yes No
Other taxes (Specify___________) Yes No
Probes:
In your own words, what did you think this question was asking?
How did you arrive at your answers?
What does the term “taxes” mean to you?
If the respondent reports some “other type of tax, probe.
If the respondent doesn’t understand other terms, probe.
What types of license and permit fees does your government have the authority to impose? (Mark “Yes” or “No” for each item)
Alcoholic Beverages License Yes No
Amusement License Yes No
Hunting and Fishing License Yes No
Motor Vehicles License Yes No
Motor Vehicle Operators License Yes No
Public Utilities License Yes No
Occupation and Businesses License Yes No
Other licenses or permit fees (Specify___________) Yes No
Probes:
If the respondent appears to have difficulty with any of the terms, probe.
D. RETIREMENT/PENSION PLAN.
Does your government operate a pension system for your own employees? Yes No
List the plans:
________________________________________________________________________________
Do your employees participate in the pension system of another government? Yes No
List the plans:
________________________________________________________________________________
Does your government offer other post employment benefits (e.g., health insurance, long-term care, etc.)? Yes No
List other post employment benefits:
________________________________________________________________________________
Does your government offer a defined benefit pension plan? Yes No
Does your government offer a defined contribution plan? Yes No
Does your government offer a hybrid pension plan? Yes No
E. GOVERNMENT ACTIVITY
Exclude regulation of privately owned utilities when answering these questions.
Does your government operate a water supply utility? Yes No
Does your government operate a gas utility? Yes No
Does your government operate an electric utility? Yes No
Does your government operate a transit authority? Yes No
Does your government operate at least one liquor store? Yes No
Does your government operate an airport? Yes No
Does your government operate a sea or in-land port? Yes No
Does your government operate a hospital? Yes No
Does your government offer refuse collection? Yes No
Does your government operate a landfill? Yes No
Does your government operate a sewage system? Yes No – skip to Q30
Is the sewer system separate from the water system? Yes No
Is the sewage authority separate from the water authority? Yes No – skip to Q30
Do you keep separate records for sewer and water? Yes No
Does your government construct, operate, or support housing and redevelopment projects?
(For example, community development block grants)
Yes
No
Probes:
In your own words, what did you think this question was asking?
How did you arrive at your answer?
Probe these activities. Find out if the government contracts out the services.
Does your government regulate industries that develop, utilize, or affect natural resources?
(For example, irrigation, drainage, flood control, or soil conservation)
Yes
No
Probes:
In your own words, what did you think this question was asking?
How did you arrive at your answer?
Probe these activities. Find out if the government contracts out the services.
Probe any of the terms that respondents might not understand.
Does your government provide or support recreational and cultural facilities?
(For example, art galleries, zoos, botanical gardens, memorials, or community music programs)
Yes
No
Probes:
In your own words, what did you think this question was asking?
How did you arrive at your answer?
Probe these activities. Find out if the government contracts out the services.
Probe any of the terms that respondents might not understand.
Is your government responsible for highways, streets, roads, alleys, bridges, tunnels, ferry boats, or related structures?
Yes
No
Probes:
In your own words, what did you think this question was asking?
How did you arrive at your answer?
Probe these activities. Find out if the government contracts out the services.
Probe any of the terms that respondents might not understand.
[We could probe these at the end of the series, revisiting each question individually.]
F. PUBLIC SERVICES
Is your government responsible for providing police protection services? Yes No
Is your government responsible for providing fire protection services? Yes No
Is your government responsible for providing emergency medical services (EMS)? Yes No – skip to Q38
Are emergency medical services separate from the fire services? Yes No
Probes:
If respondent reports EMS services, probe Q37a. Find out if they have separate funding sources.
Is your government responsible for providing regulation and inspection services?
(Include buildings and construction regulation, licensing and regulation of financial institutions, and the examination of professional occupations)
Yes
No
Probes:
In your own words, what did you think this question was asking?
How did you arrive at your answer?
Probe these activities. Find out if the government contracts out the services.
Probe any of the terms that respondents might not understand.
Does your government provide welfare services? Yes No
Does your government provide library services? Yes No – skip to Q43
What type of library services does your government provide? (Mark “Yes” or “No” for each item)
Public regional libraries Yes No
Public community libraries Yes No
Academic libraries Yes No
Law libraries Yes No
Other library services (Specify__________) Yes No
G. JUDICIAL OPERATIONS
If your government does not provide Judicial Operations SKIP to Section H
At what level does your government perform its judicial and legal operations?
County
Municipality
City
Town or township
Other level(Specify_____________)
Does your government operate any of the following types of correctional facilities? (Mark “Yes” or “No” for each item)
Prison Yes No
Jail Yes No
Juvenile Yes No
Other correctional facility (Specify_____________) Yes No
H. FINANCE
Estimates are acceptable.
Revenue
How much revenue did your government raise in the last completed fiscal year?
(Include all taxes, charges, state or Federal grants, etc.. Exclude borrowings). If none, enter 0.
$_________________________
Expenditure
How much did your government expend in the last completed fiscal year?
(Include salaries, wages, capital outlay, interest on debt, current operations, payments to other governments, etc.). If none, enter 0.
$_________________________
Debt
How much outstanding debt did your government have at the end of the last completed fiscal year?
(Include general purpose long term debt, short-term debt, conduit debt). If none, enter 0.
$_________________________
Payroll
What was your government’s annual gross payroll (before deductions) in the last completed fiscal year?
(Include salaries, wages, fees, or commissions, overtime, premium, night differential pay, bonuses and incentive payments. Exclude lump sum payments, and the value of living quarters and subsistence allowances furnished for employees.)
$_________________________
I. REMARKS (Please use this space for any explanations that may be important to understanding any of your responses)
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________
Name of person to contact regarding this report Title Telephone Fax
__________________________________
Internet e-mail address
THANK YOU FOR COMPLETING YOUR XXXX GUS SURVEY FORM
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | coaxu001 |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |