2012 National Census Test

Attachment B
2012 National Census Test (NCT)
Internet Instrument Screen Shots
DRAFT
Screen 1. Welcome

Respondents are first shown a welcome screen that introduces them to the survey and provides the
mandatory “Warning” message, which tells respondents that their usage will be monitored and recorded.

Screen 2. Login1

Next, respondents are asked to log in using the access code found in the mailing materials. This screen
also provides the burden statement, as mandated by OMB.

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Screen 3. Login2

If respondents log into the instrument and their access code is flagged as being used before, they will be
asked to provide their PIN. If they successfully enter their PIN, they are taken to the screen where they
left off during their last login. Respondents who enter the wrong access code and PIN combination three
times in a row are given the opportunity to provide the answer to a security question they selected during
an earlier visit to the survey (security on Screen 4).

Screen 4. Security

If respondents are able to enter the correct response, they are taken to the screen where they left off
during their last login. If a respondent is unable to provide this response, and therefore cannot log in,
they are given a Telephone Questionnaire Assistance number and asked to call that number for help.
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Screen 5. Confirm

This screen is used to make sure that the respondent entered the correct access code, by confirming the
address. In the actual survey, the sample address would be displayed between the question stem and
response options. A “Yes” or blank response goes to PIN (Screen 7) and lets them continue the survey.
A “No” response goes to verify (Screen 6).
Screen 6. Verify

If the access code entered on this screen is the same as the login screen access code, we display a message that
asks the respondent to call a Telephone Questionnaire Assistance number because it appears that the access
code does not match the sample address it was assigned to. If the access code entered on this screen is different
from the login access code, we display confirm (Screen 5) for the new access code, and have them confirm that
address. If the access code is blank or invalid, the respondent is returned to the login1 screen with the “Invalid
access code” error message.
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Screen 7. PIN

This screen gives the respondent the PIN they will use to access the survey on subsequent logins. The
Next button takes the respondent to address (Screen 8).
Screen 8. Address

This screen determines if the respondent lived at the sample address. In the actual survey, the sample
address would be filled into this question stem. The question would be: “Were you living or staying at
on September 5, 2012?” A “Yes” response goes to respondent (Screen 9), where we collect
the respondent’s name. A “No” or blank response goes to anyone (Screen 10), where we determine if
anybody else lived at the sample address.

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Screen 9. Respondent

This screen collects the name and phone number of the respondent who, on address (Screen 8),
identified themselves as being part of the sampled household. From here, half the respondents go to
popcount (Screen 14). The other half go to others (Screen 13).
Screen 10. Anyone

If the respondent does not live at the sample address (a “No” response to address), this screen asks if
anyone lived at the sample address. In the actual survey, the address would be filled into the question
stem. A “Yes” response goes to who (Screen 11), where we ask if the respondent knows who the
household members are. A “No” response, a “Don’t Know” response, or a blank response goes to new
(Screen 12) where we collect the respondent’s address and continue the survey with their household.

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Screen 11. Who

If the respondent does not live at the sample address but knows that somebody did live there, this screen
asks if the respondent knows who those people were. In the actual survey, the address would be filled
into the question stem. A “Yes” response takes half of the respondents to popcount (Screen 14) and the
other half to people (Screen 15). A “No” or blank response takes respondents to new (Screen 12).
Screen 12. New

Screen shot not available. 

Respondents arriving at this screen have indicated that they do not know who lived at the sample
address. In this situation, we ask the respondent for their own address and continue the survey for their
household. A “valid” address must include either (1) a street address; OR (2) a city and state. A “valid”
response goes to respondent (Screen 9), where they provide their name and continue the survey. If a
“valid” address is not provided, the respondent is shown nocomplete (Screen 45) and their session ends.
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Screen 13. Others

In the actual survey, the address would be filled into the question stem. A “Yes” response goes to
people (Screen 15), where the respondent provides a roster. A “No” response takes half the respondents
to miss (Screen 16) and the other half to add1 (Screen 18).
Screen 14. Popcount

This screen asks for a household count using the standard residence rules. In the actual survey, the
address would be filled into the question stem. If the household contains one person, and that person is
the respondent, the next screen is either miss (Screen 16) or add1 (Screen 18). Half of the respondents
go to miss and half go to add1 to determine if anybody was left off the roster. If there is more than one
person in the household, respondents go to people (Screen 15) to build the roster.
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Screen 15. People

This is where respondents build a roster. In the actual survey, the address would be filled into the
question stem. A response is valid if at least one character is entered into any of the name fields. If a
valid response is provided, half the respondents to go miss (Screen 16) and the other half go to add1
(Screen 18) to determine if anybody was left off the roster. If the response is blank, the respondents are
taken to nocomplete (Screen 45) because they cannot continue the survey with a blank roster.
Respondents are given two warning messages stating that names or nicknames are required.
Screen 16. Miss

Half of the respondents receive this version of the undercount question, which is a single item asking if
anybody was left off the roster. In the actual survey, a list of the names already provided would be
displayed. A “Yes” response goes to stay (Screen 17), where the names of those missing people are
provided. A “No” response goes to home (Screen 22).
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Screen 17. Stay

If respondents indicate that they did leave somebody off the roster (“Yes” to miss on Screen 16), this is
the screen where they would provide the name(s). In the actual survey, a list of the names already
provided would be displayed. The Next button takes respondents to home (Screen 22).
Screen 18. Add1

The other half of respondents receive this version of the undercount question, which is a series of
probes, one screen at a time, to determine if anybody was left off the roster. In the actual survey, a list
of the names already provided would be displayed. These probes (Screen 18-21) ask about specific
types of people that are usually left off household roster. Anytime a respondent answers “Yes,” they are
immediately asked to provide the name of the person who was left off. This is accomplished by
revealing a set of response boxes (similar to stay on Screen 17) where names can be entered. The “Next
button takes respondents to add2 on Screen 19.
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Screen 19. Add2

This is the second question in the “add” series. In the actual survey, a list of the names already provided
would be displayed. A “Yes” response reveals a list of boxes so that the respondent can provide the
names of those people they missed. The Next button takes respondents to add3 on Screen 20).
Screen 20. Add3

This is the third question in the “add” series. In the actual survey, a list of the names already provided
would be displayed. A “Yes” response reveals a list of boxes so that the respondent can provide the
names of those people they missed. The Next button takes respondents to add4 on Screen 21).

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Screen 21. Add4

This is the last question in the “add” series. In the actual survey, a list of the names already provided
would be displayed. A “Yes” response reveals a list of boxes so that the respondent can provide the
names of those people they missed. The Next button takes respondents to home on Screen 22.
Screen 22. Home

This is the standard tenure question. Option 1 or 2 (either “owned” option), go to owner (Screen 23) so
that respondents can indicate who owns the property. Option 3 (rented), goes to renter (Screen 24) so
that respondents can indicate who rents the property. Option 4 (no payment) or blank, goes to the first
person-level demographic question (relation on Screen 25).

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Note: The following screens (owner and renter) are used to select the reference person. These screens
ask the respondent to select the person(s) who own or rent the property from the list of rostered persons.
If one person is selected, that person is the reference person. If multiple people are selected, their first
person listed – of those selected – becomes the reference person. If “None of the above” is selected or
no answer is provided, the reference person is the first person on the list. If a respondent indicated that
they occupy the property without payment of rent (option 4 on home), they skip both the owner and
renter screens and the reference person is the first person listed on the roster. The next button, from
either screen, take the respondent to relation (Screen 25).
Screen 23. Owner

Screen 24. Renter

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Screen 25. Relation

The relationship question uses a prefill for the reference person’s name and for the name of the
household member for which the respondent is answering. For example, if John Doe is the reference
person, the question for Jane Doe would be: “Jane Doe is John Doe’s ________.” The relationship
question is displayed for each person on the roster, except the reference person. Then, once all persons
have been displayed, the respondent is taken to sex (Screen 26). One person households are not shown
the relationship question and go directly to sex (Screen 26)
Screen 26. Sex

You can see in this item that the household member’s name (John A. Doe) has been filled into the
question stem. The sex question is displayed for each person on the roster. Then, once all persons have
been displayed, the respondent is taken to age (Screen 27).
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Screen 27. Age

In the actual survey, the name of the household member would be filled in. The age and date of birth
item is displayed for each person on the roster. Then, once all persons have been displayed, half the
respondent are taken to race1 (Screen 28) and the other half are taken to race2 (Screen 29).
Screen 28. Race1

Half of the respondents are given this version of a combined race and Hispanic origin question. In the
actual survey, the name of the household member would be filled in. This questions is displayed for
each person on the roster. Then, once all persons have been displayed, half of the respondents go to
elsewhere (Screen 30) and the other half go to delete1 (Screen 31).

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Screen 29. Race2

Half of the respondents are given this version of a combined race and Hispanic origin question. In the
actual survey, the name of the household member would be filled in. This questions is displayed for
each person on the roster. Then, once all persons have been displayed, half of the respondents go to
elsewhere (Screen 30) and the other half go to delete1 (Screen 31).
Screen 30. Elsewhere

Half of the respondents receive this version of the overcount question. In the actual survey, the name of
the household member would be filled in. In elsewhere, the overcount options are provided on a single
screen, one person at a time. Each time a “Yes” response is provided for a person, the respondent is
taken to fullstay (Screen 38) to provide the additional address(es) for that person. Once the elsewhere
screen has been provided for all household members, and the addresses have been provided as
necessary, respondents are taken to most (Screen 39).
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Screen 31. Delete1

Half of the respondents receive this version of the overcount question, in which the overcount probes are
provided, by topic, one screen at a time. If the respondent provides a “Yes” answer, they are shown the
roster list and asked to select which person(s) lived at another place for this particular reason. Once the
names are selected or, if nobody in the household lived at another address for this probe, respondents are
then taken to the next delete probe (delete2 on Screen 32).
Screen 32. Delete2

This is the second “delete” screen. This probe is only asked if there are household members aged 0-18.
A “Yes” response reveals the list of roster names so that the respondent can select who lives at another
address for this reason. Once the names are selected or, if nobody in the household lived at another
address for this probe, respondents are then taken to the next delete probe (delete3 on Screen 33).
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Screen 33. Delete3

This is the third “delete” screen. This probe is only asked if there are household members aged 18-25.
A “Yes” response reveals the list of roster names so that the respondent can select who lives at another
address for this reason. Once the names are selected or, if nobody in the household lived at another
address for this probe, respondents are then taken to the next delete probe (delete4 on Screen 34).
Screen 34. Delete4

This is the fourth “delete” screen. This probe is only asked if there are household members aged 18-60.
A “Yes” response reveals the list of roster names so that the respondent can select who lives at another
address for this reason. Once the names are selected or, if nobody in the household lived at another
address for this probe, respondents are then taken to the next delete probe (delete5 on Screen 35).
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Screen 35. Delete5

This is the fifth “delete” screen. A “Yes” response reveals the list of roster names so that the respondent
can select who lives at another address for this reason. Once the names are selected or, if nobody in the
household lived at another address for this probe, respondents are then taken to the next delete probe
(delete6 on Screen 36).
Screen 36. Delete6

This is the sixth “delete” screen. A “Yes” response reveals the list of roster names so that the
respondent can select who lives at another address for this reason. Once the names are selected or, if
nobody in the household lived at another address for this probe, respondents are then taken to the next
delete probe (delete7 on Screen 37).
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Screen 37. Delete7

This is the final “delete” screen. A “Yes” response reveals the list of roster names so that the respondent
can select who lives at another address for this reason. Once the names are selected or, if nobody in the
household lived at another address for this probe, respondents are then taken to fullstay (Screen 38) to
provide the additional addresses for those household members identified in delete1 through delete7.
Screen 38. Fullstay

In the actual survey, the name of the household member would be filled in. This screen collects the
additional addresses for any household member that was identified as sometimes living or sleeping at
another place. This includes any of the reasons on elsewhere (Screen 30) or any of the delete questions
(Screens 31 to 37). The elsewhere and delete screens create a flag based on the type of address the
person indicated and that information is filled into the question stem on fullstay. Once all addresses
have been provided, respondents are taken to most (Screen 39).
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Note: The following screens (most and where) display all the addresses that were ever provided for a
household member. This includes the sample address, the address provided on the new screen, and any
addresses provided on fullstay. To be “valid” an address must contain either (1) a street address; OR (2)
a city and state. If a “valid” address was not provided, only the location flag is displayed. For example,
the response options could be any of the following: (a) The college housing address at 123 Main Street;
(b) The military address at Anytown, US; or (c) The prison or jail.
Screen 39. Most

In the actual survey, the name of the household member would be filled in. This item is asked one
person at a time for each person with an additional address provided on fullstay. Once this item has
been asked for each household member, the respondent is taken to where.
Screen 40. Where

In the actual survey, the name of the household member would be filled in. This item is asked one
person at a time for each person with an additional address provided on fullstay. Once this item has
been asked for each household member, the respondent is taken to email.
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Screen 41. Email

This item asks respondents to provide a contact email and is the last content item in the survey. The
Next button takes respondents to review1.
Screen 42. Review1

This screen allows the respondent to submit their survey without a review or review their responses
before submitting. If respondents choose to review, they are taken to review2 (Screen 43). If
respondents chose to submit from this screen, they are shown a screen confirming the date and time their
submission (submit on Screen 44).

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Screen 43. Review2

Screen shot not available. 

This is the review screen. Respondents are shown each answer they provided, for demographic items
only, by person. The responses are hyperlinks which will take respondents back to that item. If a
response was not provided, then [NO ANSWER] will be shown instead. When a respondent clicks a
response, or the “No Answer” link, they are taken to that screen and can change their answer. From
there, the respondent must return to the review screen before changing another response. Once the
respondent clicks the “Submit” button, they are taken to submit (Screen 44), which confirms the date
and time of their submission.
Screen 44. Submit

This screen provides confirmation of the date and time the respondent’s survey was submitted to the
Census Bureau. From here, respondents can close their browser window to end the survey session. At
this point, a respondent’s access code is “locked” and they cannot enter the survey instrument again. If a
respondent attempts to log again with this access code, they will be shown the nocomplete screen.

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Screen 45. NoComplete

Screen shot not available. 

If respondents do not need to complete the survey, they will be shown this screen. The nocomplete
screen simply says: “You do not need to complete this survey. Thank you.” Respondents can reach
this screen in one of three ways: (1) The respondent is trying to log in with an access code for a survey
that has already been submitted. (2) The respondent is unable to satisfy the confirm/verify checks on
Screens 5 and 6. In this case, we must assume that the address for which the respondent is trying to
complete the survey is out of sample because it does not match a valid access code. (3) The respondent
refused to provide any names or nicknames for the roster (people on Screen 15). Respondents are given
two different edit messages explaining why names are necessary and warning them that they cannot
continue the survey if they do not provide roster names. If the respondent still refuses, they are shown
this screen.

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