Various Customer Feedback Activities

Appendix B: Screener

American Community Survey, US Census Bureau

Deliberative Focus Group Screener

Final Version

November 21, 2013

Candidates will be screened to ensure that all participants fall into categories that indicate they are ambivalent, distrustful, cynical, or suspicious with regard to data collection by the federal government. Questions about socio-economic backgrounds are also included in the screener to achieve representation across diverse groups when possible.

Introduction

/* DISPLAY */ Hello, my name is ______ and I'm calling from XXXXX, a focus group facility working with Reingold. Reingold is a firm working on behalf of the US Census Bureau to help improve communications and program outreach. We are conducting a focus group with individuals in the area, and you have previously indicated a desire to participate in focus groups. If you are still interested in participating in a focus group, and if you are available the evening of XX/XX/XX, I will ask you a few questions to see if you qualify for this focus group. This focus group will take between thirty minutes and four hours, and you will be compensated for your time. The questions I will ask on this call will take approximately five to ten minutes.

Before we start, I want to tell you a few things about the focus group and these questions I will be asking you. Your participation in this focus group and this telephone call is voluntary, but your responses are important. You can choose not to answer any or all questions.

The questions I am about to ask you and this focus group have been approved by US Office of Management and Budget, approval number XXX, expiring on XXX. If you have any questions or comments about this survey you may send them to [email protected].

If you are willing to participate, I would like to start off with a few questions to see if you qualify for this study.

/* QParticipate */ Are you willing to participate in this study?

1. Yes

2. No /* TERMINATE */

3. Don’t know (DO NOT READ) /* TERMINATE */

Screening questions

Attitudinal questions:

Please indicate your level of agreement to the statements I will read to you shortly. You may respond:

-- Strongly agree

-- Somewhat agree

-- Neither agree nor disagree

-- Somewhat disagree

-- Strongly disagree

1. The federal government can be trusted to use my information responsibly.

2. I trust the federal government to keep my best interests in mind.

3. When I give information to the federal government, I know it will be kept safe.

4. The government should collect information about the population so that it can make the right decisions.

5. I don’t think public officials care much what people like me think.

6. The government knows more about me than it needs to.

7. People have lost all control over how personal information about them is used.

8. People’s rights to privacy are well protected.

Background questions

Into which of these age categories do you belong?

1. 17 and under /* TERMINATE */

2. 18-24

3. 25-34

4. 35-44

5. 45-54

6. 55-64

7. 65 and over

(Ask or verify) Are you male or female?

1. Male

2. Female

What is your marital status?

1. Now married

2. Widowed

3. Divorced

4. Separated

5. Never married

What is the highest grade or year of regular school you completed?

1. Less than grade school

2. Less than high school graduate

3. High school graduate

4. Some college

5. College graduate

6. Post-graduate

Do you rent or own your own house or apartment?

1. Rent

2. Own

3. Other

Were you born in the United States?

1. Yes

2. No

Are you Hispanic or Latino?

1. Yes

2. No

Which of these categories describes your race? Please select one or more.
/* MULTIPLE RESPONSES PERMITTED */

1. American Indian or Alaska Native

2. Asian

3. Native Hawaiian or other Pacific Islander

4. Black or African-American

5. White

6. Other /* SPECIFY */ (DO NOT READ ANSWER CHOICE #6)

What language is spoken most often in your household? (DO NOT READ ANSWER CHOICES)

1. English

2. Spanish

3. An Asian or Pacific Islander language such as Chinese, Japanese, Tagalog, or Vietnamese

4. Other /* SPECIFY */

What is your total household income?

1. Less than $25,000

2. Between $25,000 and $50,000

3. Between $50,000 and $75,000

4. Between $75,000 and $100,000

5. Between $100,000 and $150,000

6. More than $150,000