Various Demographic Area Pretesting Activities

Online Screener Questions

1. First Name:_____________________________________

2. Last Name:_____________________________________

3. Are you employed by the federal government?

[ ] Yes

[ ] No

4. What is your daytime phone number?

Home (___)____-_____

Mobile (___)____-_____

Work (___)____-_____

5. Are you male or female?

[ ] Male

[ ] Female

6. What is your date of birth (Month/Day/Year)? ____/___/_____

7. Have you participated in any research studies with the U.S. Census Bureau or outside the U.S. Census Bureau in the past year?

[ ] Yes. If yes, how many? ______

[ ] No

8. What is the highest grade of school you have completed, or the highest degree you have received?

[ ] Never completed any school

[ ] Completed 9^th grade or below

[ ] Some High School

[ ] Completed High School, or received a GED

[ ] Vocational Training beyond High School

[ ] Some College

[ ] Completed College

[ ] Master’s Degree

[ ] Doctorate or Professional Degree

9. Do you consider yourself to be of Hispanic, Latino or Spanish origin?

[ ] Yes

[ ] No

10. Choose one of more or the following races:

[ ] White

[ ] Black or African American

[ ] Asian

[ ] American Indian or Alaska Native

[ ] Native Hawaiian or other Pacific Islander

11. Is English your native language?

[ ] Yes

[ ] No

12. Are you currently working for pay full-time, part-time or are you not working for pay at this time?

[ ] Full-time

[ ] Part-time

[ ] Not working for pay

13. What is your job title or job description?

__________________________________________________________________________________________________________________________________________________________________________

14. How many people 18 or older live in your household INCLUDING yourself? ________

17a. Are they all related? [ ] Yes [ ] No

15. How many people younger than 18 live in your household? ______

16. Do any of the people in tour household (including you) have more than one place to live or stay? (Examples of this are people living here temporarily until they find another place, people living away from here at college or in boarding school, children who are in shard custody situations or adults who have more than place to live for work or for pleasure.)

[ ] Yes, Explain _________________________________________________________________________

[ ] No

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

[ ] Yes

[ ] No

18. Name at least 2 things that you use the internet to do

1. _________________________________________

2. _________________________________________

19. Do you currently use the internet at least twice per week for searching information, filling out forms, or shopping online?

[ ] Yes

[ ] No

20. What city and state do you live in? _________________________________________________