Various Demographic Area Pretesting Activities

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ID Assigned:

Location:

Recruiter Initials:

Date:

020 Census Coverage Study Screener

Full Set of Questions

January 10, 2012

Narrative FAQ: Let me tell you a little bit about this study. The Census Bureau is conducting research to make the 2020 Census work better. They would like to understand more about how people answer Census questions as well as how well the census forms work and how to improve them. If your household qualifies for this study, we will pay you $40 to complete the interview. The interview needs to be face to face, but our interviewer can meet with you at a time and location convenient to you. The interview takes about 60 minutes. All your answers are confidential and protected by law. I have a few questions for you to make sure you qualify.

Bulleted FAQs:

• Purpose: The Census Bureau is conducting research to make the 2020 Census work better. They would like to understand more about how people respond to the census as well as how well the census forms work and how to improve them.

• Incentive: If you qualify for this study, we would like to pay you $40 to help us complete this research.

• RTI/RSS: RTI International is a nonprofit research organization (or RSS is a contract research firm). The Census Bureau contracted with us to conduct this research. We have assisted the Census Bureau with several research studies in the past.

• Interviews: An interviewer would conduct an interview with you. Because of the importance of this study, the interview needs to be face to face, but our interviewer can meet with you at a time and location convenient to you. The interview takes on average 60 minutes. The interviewer will use an interview guide designed by the Census Bureau and ask you some questions about how you respond to the census.

• HOUSEHOLD SELECTION: [Generally only used for those who were selected through purchased lists] Your household was selected because we have interviewers in this area.

• CONFIDENTIALITY: The study is protected by US Code Title 13. Anyone working at RTI (OR RSS), including the interviewer or me, will either go to jail or pay a fine up to $250,000 if we divulge any information about you.

• VERIFICATION: You can call the study’s project manager Dr. Murrey Olmsted at RTI. His number is (919) 485- 5586. I can also have researchers at the Census Bureau who designed this study to contact you.

• [WHEN APPROPRIATE] INTERVIEWER: I’m not sure which interviewer will be calling you, the names of the interviewers in this area are [NAME], [NAME], [NAME], but my supervisor assigns the interviewer to the case.

[Note Concerns or Questions]

Initial qualifying info (ASK ALL):

1. What is your name?

2. Are you male or female?

   1. Male

   2. Female

3. And how did you hear about this study?

   1. CRAIGSLIST

   2. RTI CLASSIFIEDS/RTI EMPLOYEE

   3. FRIEND

   4. FLYER

   5. NEWSPAPER AD

   6. LETTER

   7. OTHER, SPECIFY:

4. And the [way heard], what did it say that makes you think you qualify for the study?

Eligible for incentive (ASK ALL):

5. Do you work for the United States federal government?

   1. NO

   2. YES  Explain: Unfortunately you cannot be paid for your study participation but we would still like you to participate if you qualify. Also, other household members who do not work for the federal government might qualify and could be paid.

Broad Household characteristics (ASK ALL)

6. Do you live in a house, an apartment or condo, or do you live in some other type of housing? Instruction: If R responds with more than one circle ALL that apply; make note of any specific response. For other type of housing, be as detailed as possible. If type of housing isn’t clear, ask for name and address for lookup.

   1. House/mobile home (Circle one) [Probe for detail/length if Q4=no address/tenuous/doubled ]

   2. Apartment/condo (Circle one)

   3. Some other type of housing (Specify)

      1. Homeless Shelter [PROBE: How length of stay, Same bed every night?]

      2. Group Home

      3. Rehab facility

      4. Other [Probe: Details on length of stay, type of place]

[IF MORE THAN ONE PLACE IN Q6] For the next questions I’m going to ask you about who lives with you, if there are different people at your different homes, please let me know for all places and be sure to tell me which one.

7. How many people live in your household? Household A:_____________ Household B: ______________

8. [IF MORE THAN 1 PERSON IN Q6] Just so I get a full picture of the household(s), could you tell me how they relate to you? For example spouse, sibling, friend… PROBE: Anyone else, even someone you don’t consider part of your family? Check all that apply based on response:

   1. Nuclear family only

   2. Non-nuclear family members--Specify: ___________________________

   3. Non-family households, e.g., housemates/roommates, renters, boarders – Specify:______________________________________________________

   4. Other--Specify: _____________________________________________

[All Questions for Selected Household Characteristics]

[Selection of the following questions will be asked based on advertising for that week in that region and the need to fill certain cells– these will change weekly or even daily depending on the needs of the project to fill certain targets – order will remain the same]

[RECRUITER CHECK: If screener is being used on identified homeless or tenuously attached Go to Q15 PO Box, otherwise continue to Q9.]

9. Is there anyone else who is away right now or is sometimes away part of the year but you consider part of the household? Like someone who’s on active duty in the military or in college or boarding school or away for work or anything like that?

   1. Yes Go to Q9a

   2. No  Skip to Q10

9a [IF YES to Q9] PROBE to get information about which situation applies

1. College students living away

2. Military deployment

3. Maintains other residence to be closer to work

4. Other eligible situation (describe):

5. Other non-eligible situation (describe):

10. Is there anyone else who stays at this home sometimes, such as children with shared custody, family or friends who come for an extended visit, or a friend who crashes on the couch or stays part time?

    1. Yes Go To Q10a

    2. No  Skip To Q11

10a [IF YES to 10] PROBE to get information about which situation applies

1. Child Custody

2. Other (including length/frequency of stay)--

Specify: ________________________________________________

11. And what about you, is there any other place you stay part of the time? [PROBE: Like do you have or rent a vacation or second home /or do you stay any length of time anywhere else during the year?]

    1. Vacation or second home--Specify (Distance/length of stay): ____________________________

    2. Highly mobile (e.g., moves around a lot, bounces from place to place, constantly crashing with friends)—Specify lengths of stay: _________________________________

    3. Maintains a residence closer to work: Specify Distance/length of stay_____________________

    4. Other--Specify Distance/Location/Purpose/Length of Stay: _____________________

12. Have you or anyone in the household moved recently? (Probe: For example, within the last few months?)

1. Yes [PROBE When was that?] __________________________________________

2. No

13. [Ask Only If Q6 = House or Other Specify is relevant] Is there anyone else living on the same property that’s not part of your household? Like in a separate apartment or an in-law apartment or renters or boarders, anyone like that?

    1. Yes [PROBE for specifics, including length of stay]

    2. No

14. Do you have any exchange students or international visitors or family staying with you?

    1. Yes  [PROBE for specifics, including length of stay]

    2. No

15. Do you get your mail [at your home/where you stay], at a PO Box or somewhere else?

    1. Home (or Home and PO Box)

    2. PO BOX ONLY  PROBE: Why do you use a PO BOX rather than where you live?

    3. Somewhere else only – [PROBE for specifics]

Demographic and Scheduling Information (ASK ALL):

I have just a few demographic questions and then I’ll collect your contact information so if you qualify for the study we can reach to set up an interview

16. What is your age? ___________________

17. Are you of Hispanic or Latino origin? Yes No

18. What is your race or races?

1. American Indian or Alaska Native

2. Asian

3. Black/African American

4. Native Hawaiian or other Pacific Islander

5. White

19. What is your highest level of education completed

1. Some high school

2. High school / GED

3. Some college

4. Associates Degree

5. Bachelors Degree

6. Post bachelors degree (Masters/PhD/MD/Professional)

20. Do you live in an urban (city), suburban, or rural area?

1. Urban (city)

2. Suburban

3. Rural area

21. In general how comfortable are you using computers?

    1. VERY COMFORTABLE

    2. SOMEWHAT COMFORTABLE

    3. NOT AT ALL COMFORTABLE

22. In general how comfortable are you using a ‘Smart’ Cell phone, like the kind that you can use to download applications or check the internet or email?

    1. VERY COMFORTABLE

    2. SOMEWHAT COMFORTABLE

    3. NOT AT ALL COMFORTABLE

23. What is the best phone number for me to contact you at if you qualify for the study? __________________________

24. Is there another number as well? ______________________________________________

If you are scheduled for an interview, do you want me to send you a reminder by email, if so I’ll need your email address: _________________________________________________________________________

25. I’d like to let the interviewer know some good days and times for you to conduct the interview in case you qualify for the study. Could you please tell me the best days and times you can be interviewed in the [time period area interviewers are available]

DAYS: MON TUE WED THU FRI SAT SUN

TIMES: MORNING AFTERNOON EVENING ALL DAY

OR SPECIFIY: __________________________________________________

26. And when are some good times for the interviewer to reach you to schedule the interview?

DAYS: MON TUE WED THU FRI SAT SUN

SPECIFIY TIME: __________________________________________________

Thank you for your information. I’m going to pass it on to my supervisor [this evening/Monday] who will let me know if you qualify for the study. If you do I will call you back and let you know. [An interviewer will also call you to set up an interview].

Screener 2020 Coverage Study (January, 10 2011) OMB Control Number: 0607-0725; Expiration: August 31, 2013 11