Various Demographic Area Pretesting Activities

Phone Screener: Human Factors and Usability Research Group

Thanks for your interest in participating in a Research Study with the U.S. Census Bureau and the University of Maryland. Our study will take about approximately 45 minutes to complete and if you are eligible you will receive a $30 cash reimbursement for traveling expenses to the University of Maryland, which is located in College Park, MD. Prior to scheduling you to participate in this study, I will need to gather some information from you to determine whether you are eligible for this study. The information that you provide is confidential and you can decline to answer any questions if you do not want to provide the information at this time.

General

1. Let’s start with the spelling of your first and last name:

First name Last name

2. Are you male/female? (if necessary)

□ Male
□ Female

3. Have you participated in any research studies in the past year?

□ Yes

How many? ____ (If more than 2, they are not eligible for this study)

□ No

4. Are you currently employed?

□ Yes

□ No

Demographics

5. What is your date of birth – just including the month and year?

MM YYYY

6. Are you of Hispanic, Latino, or Spanish origin?

□ Yes

□ No

7. Choose one or more of the following races:

Note: If reluctant, inform them that this does not impact their ability to participate in our studies-we gather this information to ensure that we have a diverse group of participants for each of our studies

□ White

□ Black or African American

□ Asian

□ American Indian or Alaska Native

□ Native Hawaiian or other Pacific Islander

8. What is your highest level of education COMPLETED?

□ Never completed any school

□ Completed ninth grade or below

□ Some high school

□ Completed high school, or received a GED

□ Vocational training beyond high school

□ Some college

□ Completed college

□ Any graduate or professional education

Computer/Internet Experience

9. Do you have at least one year of internet experience?

□ Yes

□ No (Inform them that most of our studies require at least one year internet experience and that we will keep them in mind for other studies that do not require internet experience.) SKIP to Contact Information

10. Name at least two things that you use the internet to do?

1. ____________________

b.____________________

Contact Information

11. Is there a daytime phone number or email address where you can be reached? (Include preferred contact times if any)

Home_______________

Mobile_______________

Work________________

Email________________

12. How did you hear about our study?

□ Craigslist

□ Flier posting____________

□ Referral

□ Other______________