Various Demographic Area Pretesting Activities

Household Form – Paper Protocol (Round 3)

INTERVIEW ID: ____________

INTERVIEW DATE: ____/____/____ START TIME: ______ AM / PM

Hello, my name is ___________. I work for RTI/RSS a research company that has been hired by the Census Bureau to conduct research on the census forms. Thanks for agreeing to help us today. Let me start by telling you a little about what we will be doing. Every ten years the United States conducts a census, or count, of everyone who is living in the United States.

At that time a census form is mailed to households in the United States with the request that it be completed and returned. The form we’re working on today is the kind you would receive in the mail at your home. It would have your address printed on it. So when the form says “this address” let’s assume that we are referring to the place that you live.

Permission to Record:

Because it would be hard to keep track of everything you say today, I would like to record this session. [HAND RESPONDENT THE CONSENT FORM.] Please read over this consent form and let me know if you have any questions. When you are ready, please sign the form. I want you to know that your responses will be kept strictly confidential and will only be seen by members of the project team, and the Census Bureau. Your participation in this study is completely voluntary and you can decline to answer any particular question. At the end of the study, we will delete any record of your responses from our machines. Your name will never be used in any reports.

Think-out-loud Instructions:

What I’ll ask you to do today is to fill the questionnaire out, just as you would if you received it at home. It would come to your address, but it wouldn’t have your name. So let’s write your address back here, where it would be printed. [WRITE RESPONDENT’S ADDRESS ON THE BACK OF THE PAPER FORM.]

So I can keep track of what you are doing, I’d like you to describe what you are doing and thinking as you go along. Talk it through as you are filling out your answers: what you are looking at or what you are thinking about as you read the questions. I might remind you to do this from time to time. [The following think aloud example is optional.] Later, I may ask you questions about what you’ve read and written. I’m interested in what you were thinking when you answered. For example, if the question in the survey was “How many cars do you have?” you probably wrote in a number. But it would help me to understand if you told me, “Well I have an SUV that I drive every day and I also have an old truck. But the truck does not currently run. I assume that you mean working cars, so…one. I just have one car.” This kind of response will help me understand how you understood and interpreted the question so that we can see what each question means to you. Even though some of these questions may sound like I am giving you a test, there are no right or wrong answers. We are interested in how these questions work for you.

At the end of the interview, we’ll also ask you some general questions about your opinions on different ways of responding to the Census in 2020.

Do you have any questions before we begin?

[HAND FORM TO PARTICIPANT AND ASK THEM TO COMPLETE IT]

General Observations

1. NOTE HOW THE PARTICIPANT USES THE INSTRUCTIONS IN PART A AND PART B:

• NOTE WHERE the R aPPEARS TO start, Whether R reads both sets of INSTRUCTIONS.

• wHAT EVIDENCE IS THERE OF r’S READING OF pART a AND pART b?

• dOES r MARK THE BOXES IN pART a?

• dOES r APPEAR TO LOOK FOR SOMETHING TO MARK IN pART B?

• dOES r MAKE ANY COMMENTS ABOUT EITHER pART a OR b? qUOTE VERBATIM AND INDICATE WHEN THE COMMENT WAS MADE.

2. DOES R COMMENT ABOUT ONLINE FORM WHEN READING THE INSTRUCTIONS OR FILLING OUT THE FORM?

• No

• Yes: Quote comments verbatim, and describe the actions R took spontaneously at this point.

3. If R decides at this point that they would fill out the form on-line, probe: Why do you think you should respond online? THEN SAY: Thanks. I understand the reasons that you think you should respond online. But just for today, let’s assume that you can’t go on-line and you’ve decided to fill out the paper form instead.

4. USE THIS SPACE TO WRITE NOTES FOR A NARRATIVE ON HOW THE RESPONDENT READS/USES QUESTIONS 1 THROUGH 5.

• INCLUDE ANY COMMENTS, QUESTIONS, OR DISCUSSIONS WHICH OCCUR DURING THE INITIAL FILLING OF THE FORM. QUOTE VERBATIM AND INDICATE WHEN THE COMMENT WAS MADE.

• ARE THE QUESTIONS FILLED IN ORDER?

• Note if R fillS out q1 prior to reading instructions or if r makeS any changes to the person counts in q1?

• DOES R MARK MORE THAN ONE CATEGORY IN Q. 2? FIND THE “NO” IF APPROPRIATE?

• IS THERE EVIDENCE OF READING THE INSTRUCTIONS FOLLOWING QUESTIONS 2 AND 4.

• NOTE ANY CHANGES WHICH ARE SPONTANEOUSLY MADE DURING THE INITIAL FILLING OF THE QUESTIONNAIRE: WHAT WAS CHANGED? WHEN DID THE CHANGE OCCUR? DID R EXPLAIN THE CHANGES?

5. DESCRIBE ANY ISSUES WITH COMPLETING THE PERSON PAGES: COLUMN 1

• note whether r appears to read instructions

• Note if questions are not filled out in order or R jumps back and forth.

• nOTE WHETHER THE NUMBER OF PERSON PAGES FILLED MATCHES THE NUMBER OF PEOPLE INDICATED ON PAGE 1. NOTE IF RECRUITING INFORMATION DIFFERS FROM THIS NUMBER.

• bRIEFLY NotE ANY SPONTANEOUS COMMENTS ON DEMOGRAPHIC QUESTIONS.

• NOTE ANY CHANGES WHICH ARE SPONTANEOUSLY MADE DURING THE INITIAL FILLING OF THE QUESTIONNAIRE: WHAT WAS CHANGED? WHEN DID THE CHANGE OCCUR? DID R EXPLAIN THE CHANGES?

6. DESCRIBE ANY ISSUES WITH COMPLETING THE PERSON PAGES: COLUMN 2.

USE THIS SPACE TO WRITE NOTES FOR A NARRATIVE ON HOW THE R READS/USES COLUMN 2.

• INCLUDE ANY COMMENTS, QUESTIONS, OR DISCUSSIONS WHICH OCCUR DURING THE INITIAL FILLING OF THE FORM.

• ARE ALL QUESTIONS ANSWERED IN ORDER FOR ALL PERSONS?

• ARE ADDRESSES PROVIDED, WHERE APPROPRIATE?

• WERE ANY CHANGES MADE, AND WHEN WERE THEY MADE?

When R is finished with the form, review the form and note any problems to follow-up on during retrospective probing

P7. Were all of the people you listed everyone you were thinking of in Questions 1 and 2? Were they all living with you on June 1? If NO: Who wasn’t living there then? Can you tell me more about that?

P8. IF PERSON PAGES DO NOT MATCH NUMBER OF PEOPLE INDICATED: The number of people you listed in the Person Pages is different from the number of people in Questions 1 and 2. Can you tell me how you decided who to make a page for and who not make a page for? (IF THERE IS INFORMATION FROM RECRUITING ABOUT ANY OTHER PERSONS, MENTION THEM AT THIS POINT.) I think the recruiter told me you mentioned (a long term visitor, a tenant, etc.) How did you decide whether or not to include them?

Page 1

GIVE the PAPER FORM BACK TO THE R AND ADMINISTER RETROSPEctive Probes. Note any changes to the written answers which are made during probing. What change was made? When was it made? What comments did the respondent make to explain the changes? if the change was made during probing for a different question than the one that was changed, note which question or probes elicited the change.

1. START HERE

Did your household recently move?

No, did not move -- You may use this form to provide your answers OR go to www.census.gov.

Moved on or before June 1, 2013 – You may use this form to provide your answers OR go to www.census.gov.

Moved AFTER June 1, 2013 – Go to www.census.gov to provide your answers. If you cannot go online, use this form and provide your previous address in Question 7.

7. What was the first thing you saw on this page? Where did you start to read? How much of these instructions did you read? Did you look at both Part A and Part B?

8. In part A, I noticed you marked ___. Can you tell me why you marked that? OR: I noticed that you didn’t mark anything in Part A. Can you tell me why you didn’t make any mark here?

9. Can you tell me in your own words what “Did your household recently move?” means here? What would you consider “recently?”

10. Who is supposed to fill out the form online? [IF NECESSARY:] Can anyone complete the Census online?

11. If you had moved on June 2, but you found this form waiting in your mailbox, what do you think you would have really done?

12. (If R says they would go online) What would you have done with this paper form?

13. Let’s say you were moving to a new address on May 30, and you got this form in the mail at your old address on May 28^th. What would you have done with it?

14. Let’s say that you rented a room to someone, and they recently moved in. What answer would you give for this question? Why?

2. HOW TO FILL OUT THIS FORM:

Provide information for:

• Anyone who, on June 1, 2013, was living or staying at the address printed on this form.

• Anyone who sleeps most of the time at this address, even if they do not live here.

15. In general, who should be listed on the form?

16. The second bullet says “anyone who sleeps most of the time at this address, even if they do not live here.” Can you tell me in your own words what kind of situation that might refer to?

17. The first bullet says “living or staying” and in the second bullet it says “sleeps most of the time at this address”: do these mean the same thing to you, or do they mean something different? How so?

Question 1: NOTE: THE DATES IN THE SCREEN SHOT SHOULD BE UPDATED.

18. In your own words, what is Question 1 asking you?

19. You answered (NUMBER). Who were the people you were counting? How did you decide who to include in this question? (NOTE: IF YOU HAVE PROBED ABOUT THIS NUMBER BECAUSE OF A MISMATCH WITH THE NUMBER OF PERSON PAGES, DO NOT REPEAT IT HERE.)

20. Was there anyone that you were unsure whether you should include or not? IF YES: Can you tell me more about that?

Probe: Was there anyone you included as living or staying here, who was actually away on June 1? For example, away on a business trip, for vacation or for any other reason? [How did you know to include this person?]

21. IF R LEFT Q1 BLANK: Why didn’t you write anything in here?

22. IF NECESSARY: I noticed that you changed your answer to Question 1. Can you tell me what you were thinking when you did that?

Question 2:

1. Were there any additional people staying here on June 1, 2013 who you did not include in Question 1?

Children, such as newborn babies or foster children?

Relatives, such as adult children, cousins or in-laws?

Nonrelatives, such as roommates or live in baby-sitters?

People staying here temporarily?

Anyone else staying here who had no permanent place to live?

No additional people

Be sure to provide information inside this form about everyone you listed in Questions 1 and 2.

23. How did you choose your answer to this question?

24. IF ANY YES ANSWER IS MARKED: Who were you thinking of? PROBE ON RELATIONSHIP TO PARTICIPANT. determine if these are the same people R thought of in answering Q1 or additional people.

25. IF ADDITIONAL PEOPLE ARE MENTIONED: Initially you did not include this person, when you thought about your answer to Q. 1. Can you tell me more about that?

26. IF THE SAME PERSON IS MARKED IN TWO CATEGORIES: I see you marked [Name] in two places: how did you decide to do that?

27. IF NECESSARY: Why didn’t you mark any boxes in Question 2?

FOR ALL RESPONDENTS:

28. In your own words, what is Question 2 asking you?

29. In general, what do you think the purpose of Question 2 is? Why do you think they are asking about these kinds of people?

30. What does “Anyone staying here who had no permanent place to stay” mean in this question? How about “People staying temporarily?” Are those the same or different? How so?

31. Did you see the instruction after Question 2? What is it telling you to do?

32. How helpful or unhelpful was this list of individuals – babies, foster children, etc.?

Question 3: Telephone number: NO PROBES.

Question 4:

Is this house, apartment, or mobile home—Mark  ONE box

Owned by you or someone in this household with a mortgage or loan? Include home equity loans.

Owned by you or someone in this household free and clear (without a mortgage or loan)?

Rented?

Occupied without payment of rent?

Answer for the owner or leaseholder if you rent space from someone who also lives here.

33. Why did you choose [ANSWER]?

34. Are these answer choices okay or did you want to provide a different answer? IF YES: What did you want to answer?

35. Can you tell me in your own words what the instruction after this question is telling you to do? Did you see this instruction the first time through? If necessary: If someone is renting a room from the owner of a house, what do you think they are supposed to answer?

Question 5.

1. Is the residence to which this form was sent vacant for any reason, such as being for rent or under renovation, or is it a seasonal home where no one lives for the entire year?

Yes – Call 888- 123-5678 to provide additional information about this vacant residence.

No – Continue with the form on Page 2

36. Can you tell me in your own words what this question is asking?

37. What does “vacant” mean in this question? IF NECESSARY: What else might be meant by “vacant” besides “for rent or under renovation?”

38. What does “a seasonal home where no one lives for the entire year” mean? Can you think of an example? IF NECESSARY: How about “where no one lives for the entire year?”

39. What is the instruction next to the Yes telling you to do? What should you do with the paper form if that applies to you?

40. If you answered “yes” to Question 5, because the address to which the form was sent was vacant for some reason, what would you do? Would you call? What would you do with the rest of the form? [IF NECESSARY]: Why wouldn’t you call? Why wouldn’t you continue with the form?

Person 1

Question 6

6. Please provide information for each person counted in Questions 1 and 2. Start with a person living here who owns or rents this house, apartment, or mobile home. If the owner or renter lives somewhere else, start with any adult living here. This will be Person 1.

What is Person 1’s name? Print name below.

First Name

Middle Name

Last Name

41. NOTE WHETHER FULL NAME IS PROVIDED AND IF IT IS FORMATTED CORRECTLY.

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

1. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

2. IF YES: How do you decide which way to write it on different forms?

3. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Did you see that you were supposed to provide your middle name? Do you have a middle name? How did you decide to leave it blank?

42. In your own words, what is Question 5 asking? [IF NECESSARY: What was the instruction after Question 5 telling you?]

43. IF MORE THAN ONE PERSON: This question asks you to start with a person who “owns or rents” this place. What did that mean in your situation?

Demographic Questions 7-9

• if they have an objection, let them comment. Quote Verbatim any spontaneous comments about Question 9, race and origin.

p44. Did you notice the examples in Question 9? If Yes: How were they helpful or unhelpful?

Question 10

10. In the past year, did Person 1 sometimes live or stay somewhere else?

No – Skip to Question 13

Yes – If there is more than one place, mark the OTHER place where this person stays most of the time

Mark  all that apply

In college housing

In the military

For a job or business

With a parent or grandparent

At a second or seasonal residence

With a friend

For another reason

Because of a move -- What date?

Month Day Year

P44. NOTE IF R FINDS ‘NO’ AND SKIPS CORRECTLY, IF APPROPRIATE.

• FOR EACH YES RESPONSE: Why did you choose that answer? Can you tell me more about that place?

• Were there any places that you were unsure whether you should select or not? IF YES: Can you tell me more about that? IF NECESSARY: Did you notice earlier where it says “mark all that apply?”

• [IF ADDRESS IS SOMEONE ELSE’S HOME: Whose place is/was that? Is this a place you stay frequently? How often? When were you there last?]

• [IF ADDRESS REPRESENTS A MOVE: When did you move? How certain are you of the date? Tell me about that move. Where did [you/he/she] move from? Why did [you/he/she] move? IF NECESSARY: I notice you didn’t put in a date for the move, why was that?

• [If address is COLLEGE HOUSING OR MILITARY: What kind of place did [you/he/she] stay in? When were [you/he/she] there last? How long did [you/he/she] stay that time?]

PROBES FOR EVERYONE:

P45. What does “sometimes live or stay somewhere else” mean in this question? IF NECESSARY: what does “sometimes” mean here?

P 46. What would “at a second or seasonal home” mean in this question?

P47. How about “with a parent or grandparent?” What kind of situation would that be?

P48. How about “with a friend?”

P49. What kind of places might be included with “another place” here?

Question 11:

1. If you marked yes in Question 10, please provide the address of the other place where this person sometimes lived or stayed most of the time.

Street Address

Apartment Number

City

State

Zip Code

P50. NOTE WHETHER R CORRECTLY ANSWERED THIS QUESTION BASED ON SKIP LOGIC. INCLUDE SPONTANEOUS COMMENTS INDICATING THAT R KNOWS AN ADDRESS IS REQUIRED OR NOT, REQUIRED BASED ON PREVIOUS ANSWERS. INDICATE WHICH FIELDS WERE SPONTANEOUSLY FILLED OUT PRIOR TO THE BEGINNING OF THE PROBES.

P51. What does the phrase “the other place” mean to you in this context?

P52. IF MORE THAN ONE ‘YES’ IN Q. 10: How easy or difficult was it to determine which address to provide in Question 11? IF NECESSARY: How did you choose which address to provide?

P53. IF PARTIAL INFORMATION IS PROVIDED: Can you tell me why you left some fields blank here? NOTE: IF R ADDS INFORMATION OR CHANGES A RESPONSE DURING PROBING, FLAG WHICH INFORMATION IS ADDED OR CHANGED.

P54. How sure are you of the address you put down? Are you certain of all the parts, or just some? IF NECESSARY: Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P55. If Q11 is blank after a yes answer: Can you tell me why you chose not to write an address in Question 11?

Question 12.

1. Where did Person 1 stay most of the time?

The address printed on the back of this questionnaire

The address or location listed in Question 11

Some other place

P56. How did you determine where PERSON 1 lives or stays most of the time? NOTE WHETHER THIS RESPONSE MATCHES THE INTERVIEWER’S UNDERSTANDING OF R’S LIVING SITUATION.

P 57. IF NECESSARY: What does “most of the time” mean in this question?

P58. IF “SOME OTHER PLACE”: Can you tell me a little about that place?

P59. I’m going to ask you the question a little differently: “Around June 1, 2013, where did Person 1 live and sleep most of the time?” Would your answer be the same or different? Why or why not?

Question 13:

1. On the night of June 1, 2013, did this person stay in a facility such as a jail, shelter, or nursing home or some other kind of facility?

No

Yes – Provide the facility name, street address, city and state below

Facility Name

Street Address

City

State

P60. How did you choose your answer to Question 13? OR: Why didn’t you mark an answer in Question 13?

P61. Can you tell me in your own words what Question 13 is asking? NOTE IF THE PARAPHRASE INCLUDES THE SPECIFIC DATE.

P61. What does “facility” mean in this question? What might be included as a “facility” here, besides a jail, shelter or nursing home?

P 62: FOR ANY YES ANSWER: Can you tell me about that place?

P63: How sure are you that [you/he/she] [was/were] there “on the night of June 1, 2013?”

P64: How certain are you of the address you provided here? Which parts are you certain about? Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P65. NOTE IF ALL PARTS OF THE ADDRESS FIELD ARE FILLED OUT. IF NOT: I notice that you omitted [certain parts of the address] [all of the address.] Can you tell me why that was?

Person 2 (IF NO PERSON 2, GO TO DEBRIEFING)

Question 1;

What is Person 2’s name? Print name below.

First Name

Middle Name

Last Name

P66. NOTE WHETHER FULL NAME IS PROVIDED AND IF IT IS FORMATTED CORRECTLY.

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

4. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

5. IF YES: How do you decide which way to write it on different forms?

6. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Do you/he/she have a middle name? How did you decide to leave it blank?

Demographic Questions 2-5

• if they have an objection, let them comment. Quote Verbatim any spontaneous comments about Question 2, Relationship, and Question 5, race and origin.

Probe: Could you find a relationship category that fit [Name]? How did you choose your answer? Is there something else you would rather call your relationship to [Name]? If yes, what is that term? Why do you think that is better?

Question 6

6. In the past year, did Person 2 sometimes live or stay somewhere else?

No – Skip to Question 9

Yes – If there is more than one place, mark the OTHER place where this person stays most of the time

Mark  all that apply

In college housing

In the military

For a job or business

With a parent or grandparent

At a second or seasonal residence

With a friend

For another reason

Because of a move -- What date?

Month Day Year

P67. NOTE IF R FINDS ‘NO’ AND SKIPS CORRECTLY, IF APPROPRIATE.

• FOR EACH YES RESPONSE: Why did you choose that answer? Can you tell me more about that place?

• Were there any places that you were unsure whether you should select or not? IF YES: Can you tell me more about that?

• [IF ADDRESS IS SOMEONE ELSE’S HOME:] Whose place is/was that? Is this a place [you/he/she] stays frequently? How often? When was [you/he/she] there last?]

• [IF NOT A WHOLE HOUSEHOLD MOVE:] When did [you/he/she] move? How certain are you of the date? Tell me about that move. Where did [you/he/she] move from? Why did [you/he/she] move? IF NECESSARY: I notice you didn’t put in a date for the move, why was that?

• [If address is COLLEGE HOUSING OR MILITARY: ] What kind of place did [you/he/she] stay in? When [were/was] [you/he/she] there last? How long did [you/he/she] stay that time?]

Question 7.

7. If you marked yes in Question 6, please provide the address of the other place where this person sometimes lived or stayed most of the time.

Street Address

Apartment Number

City

State

Zip Code

P68. NOTE WHETHER R CORRECTLY ANSWERED THIS QUESTION BASED ON SKIP LOGIC. INCLUDE SPONTANEOUS COMMENTS INDICATING THAT R KNOWS AN ADDRESS IS REQUIRED OR NOT, REQUIRED BASED ON PREVIOUS ANSWERS. INDICATE WHICH FIELDS WERE SPONTANEOUSLY FILLED OUT PRIOR TO THE BEGINNING OF THE PROBES.

P69. IF MORE THAN ONE ‘YES’ IN Q. 6: How easy or difficult was it to determine which address to provide in Question 7? IF NECESSARY: How did you choose which address to provide?

P70. IF PARTIAL INFORMATION IS PROVIDED: Can you tell me why you left some fields blank here? NOTE: IF R ADDS INFORMATION OR CHANGES A RESPONSE DURING PROBING, FLAG WHICH INFORMATION IS ADDED OR CHANGED.

P71. How sure are you of the address you put down? Are you certain of all the parts, or just some? IF NECESSARY: Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P72. If Q7is blank after a yes answer: Can you tell me why you chose not to write an address in Question 7?

Question 8.

8. Where did Person 2 stay most of the time?

The address printed on the back of this questionnaire

The address or location listed in Question 7

Some other place

P73. How did you determine where this person lives or stays most of the time? NOTE WHETHER THIS RESPONSE MATCHES THE INTERVIEWER’S UNDERSTANDING OF R’S LIVING SITUATION.

P74. IF “SOME OTHER PLACE”: Can you tell me a little about that place?

P75. Around June 1, 2013, where did Person 2 live and sleep most of the time?

Question 9:

9. On the night of June 1, 2013, did this person stay in a facility such as a jail, shelter, or nursing home or some other kind of facility?

No

Yes – Provide the facility name, street address, city and state below

Facility Name

Street Address

City

State

P76. How did you choose your answer to Question9? OR: Why didn’t you mark an answer in Question 9?

P.77 FOR ANY YES ANSWER: Can you tell me about that place?

P78: How sure are you that [you/he/she] was there “on the night of June 1, 2013?”

P79: How certain are you of the address you provided here? Which parts are you certain about? Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P80. NOTE IF ALL PARTS OF THE ADDRESS FIELD ARE FILLED OUT. IF NOT: I notice that you omitted [certain parts of the address] [all of the address.] Can you tell me why that was?

Person 3 (IF NO PERSON 3, GO TO DEBRIEFING)

Question 1;

What is Person 3’s name? Print name below.

First Name

Middle Name

Last Name

P66. NOTE WHETHER FULL NAME IS PROVIDED AND IF IT IS FORMATTED CORRECTLY.

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

7. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

8. IF YES: How do you decide which way to write it on different forms?

9. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Do you/he/she have a middle name? How did you decide to leave it blank?

Demographic Questions 2-5

• if they have an objection, let them comment. Quote Verbatim any spontaneous comments about Question 2, Relationship, and Question 5, race and origin.

Probe: Could you find a relationship category that fit [Name]? How did you choose your answer? Is there something else you would rather call your relationship to [Name]? If yes, what is that term? Why do you think that is better?

Question 6

6. In the past year, did Person 3 sometimes live or stay somewhere else?

No – Skip to Question 9

Yes – If there is more than one place, mark the OTHER place where this person stays most of the time

Mark  all that apply

In college housing

In the military

For a job or business

With a parent or grandparent

At a second or seasonal residence

With a friend

For another reason

Because of a move -- What date?

Month Day Year

P67. NOTE IF R FINDS ‘NO’ AND SKIPS CORRECTLY, IF APPROPRIATE.

• FOR EACH YES RESPONSE: Why did you choose that answer? Can you tell me more about that place?

• Were there any places that you were unsure whether you should select or not? IF YES: Can you tell me more about that?

• [IF ADDRESS IS SOMEONE ELSE’S HOME:] Whose place is/was that? Is this a place [you/he/she] stays frequently? How often? When [were/was] [you/he/she] there last?]

• [IF NOT A WHOLE HOUSEHOLD MOVE:] When did [you/he/she] move? How certain are you of the date? Tell me about that move. Where did [you/he/she] move from? Why did [you/he/she] move? IF NECESSARY: I notice you didn’t put in a date for the move, why was that?

• [If address is COLLEGE HOUSING OR MILITARY: ] What kind of place did [you/he/she] stay in? When [were/was] [you/he/she] there last? How long did [you/he/she] stay that time?]

Question 7.

10. If you marked yes in Question 6, please provide the address of the other place where this person sometimes lived or stayed most of the time.

Street Address

Apartment Number

City

State

Zip Code

P68. NOTE WHETHER R CORRECTLY ANSWERED THIS QUESTION BASED ON SKIP LOGIC. INCLUDE SPONTANEOUS COMMENTS INDICATING THAT R KNOWS AN ADDRESS IS REQUIRED OR NOT, REQUIRED BASED ON PREVIOUS ANSWERS. INDICATE WHICH FIELDS WERE SPONTANEOUSLY FILLED OUT PRIOR TO THE BEGINNING OF THE PROBES.

P69. IF MORE THAN ONE ‘YES’ IN Q. 6: How easy or difficult was it to determine which address to provide in Question 7? IF NECESSARY: How did you choose which address to provide?

P70. IF PARTIAL INFORMATION IS PROVIDED: Can you tell me why you left some fields blank here? NOTE: IF R ADDS INFORMATION OR CHANGES A RESPONSE DURING PROBING, FLAG WHICH INFORMATION IS ADDED OR CHANGED.

P71. How sure are you of the address you put down? Are you certain of all the parts, or just some? IF NECESSARY: Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P72. If Q7 is blank after a yes answer: Can you tell me why you chose not to write an address in Question 7?

Question 8.

11. Where did Person 3 stay most of the time?

The address printed on the back of this questionnaire

The address or location listed in Question 7

Some other place

P73. How did you determine where this person lives or stays most of the time? NOTE WHETHER THIS RESPONSE MATCHES THE INTERVIEWER’S UNDERSTANDING OF R’S LIVING SITUATION.

P74. IF “SOME OTHER PLACE”: Can you tell me a little about that place?

P75. Around June 1 2013, where did Person 3 live and sleep most of the time?

Question 9:

12. On the night of June 1, 2013, did this person stay in a facility such as a jail, shelter, or nursing home or some other kind of facility?

No

Yes – Provide the facility name, street address, city and state below

Facility Name

Street Address

City

State

P76. How did you choose your answer to Question9? OR: Why didn’t you mark an answer in Question 9?

P.77 FOR ANY YES ANSWER: Can you tell me about that place?

P78: How sure are you that [you/he/she] was there “on the night of June 1, 2013?”

P79: How certain are you of the address you provided here? Which parts are you certain about? Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P80. NOTE IF ALL PARTS OF THE ADDRESS FIELD ARE FILLED OUT. IF NOT: I notice that you omitted [certain parts of the address] [all of the address.] Can you tell me why that was?

Person 4 (IF NO PERSON 4, GO TO DEBRIEFING)

Question 1;

What is Person 4’s name? Print name below.

First Name

Middle Name

Last Name

P66. NOTE WHETHER FULL NAME IS PROVIDED AND IF IT IS FORMATTED CORRECTLY.

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

10. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

11. IF YES: How do you decide which way to write it on different forms?

12. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Do you/he/she have a middle name? How did you decide to leave it blank?

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

13. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

14. IF YES: How do you decide which way to write it on different forms?

15. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Do you/he/she have a middle name? How did you decide to leave it blank?

Demographic Questions 2-5

• if they have an objection, let them comment. Quote Verbatim any spontaneous comments about Question 2, Relationship, and Question 5, race and origin.

Probe: Could you find a relationship category that fit [Name]? How did you choose your answer? Is there something else you would rather call your relationship to [Name]? If yes, what is that term? Why do you think that is better?

Question 6

6. In the past year, did Person 4 sometimes live or stay somewhere else?

No – Skip to Question 9

Yes – If there is more than one place, mark the OTHER place where this person stays most of the time

Mark  all that apply

In college housing

In the military

For a job or business

With a parent or grandparent

At a second or seasonal residence

With a friend

For another reason

Because of a move -- What date?

Month Day Year

P67. NOTE IF R FINDS ‘NO’ AND SKIPS CORRECTLY, IF APPROPRIATE.

• FOR EACH YES RESPONSE: Why did you choose that answer? Can you tell me more about that place?

• Were there any places that you were unsure whether you should select or not? IF YES: Can you tell me more about that?

• [IF ADDRESS IS SOMEONE ELSE’S HOME:] Whose place is/was that? Is this a place [you/he/she] stays frequently? How often? When [were/was] [you/he/she] there last?]

• [IF NOT A WHOLE HOUSEHOLD MOVE:] When did [you/he/she] move? How certain are you of the date? Tell me about that move. Where did [you/he/she] move from? Why did [you/he/she] move? IF NECESSARY: I notice you didn’t put in a date for the move, why was that?

• [If address is COLLEGE HOUSING OR MILITARY: ] What kind of place did [you/he/she] stay in? When [were/was] [you/he/she] there last? How long did [you/he/she] stay that time?]

Question 7.

13. If you marked yes in Question 6, please provide the address of the other place where this person sometimes lived or stayed most of the time.

Street Address

Apartment Number

City

State

Zip Code

P68. NOTE WHETHER R CORRECTLY ANSWERED THIS QUESTION BASED ON SKIP LOGIC. INCLUDE SPONTANEOUS COMMENTS INDICATING THAT R KNOWS AN ADDRESS IS REQUIRED OR NOT, REQUIRED BASED ON PREVIOUS ANSWERS. INDICATE WHICH FIELDS WERE SPONTANEOUSLY FILLED OUT PRIOR TO THE BEGINNING OF THE PROBES.

P69. IF MORE THAN ONE ‘YES’ IN Q. 6: How easy or difficult was it to determine which address to provide in Question 7? IF NECESSARY: How did you choose which address to provide?

P70. IF PARTIAL INFORMATION IS PROVIDED: Can you tell me why you left some fields blank here? NOTE: IF R ADDS INFORMATION OR CHANGES A RESPONSE DURING PROBING, FLAG WHICH INFORMATION IS ADDED OR CHANGED.

P71. How sure are you of the address you put down? Are you certain of all the parts, or just some? IF NECESSARY: Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P72. If Q7 is blank after a yes answer: Can you tell me why you chose not to write an address in Question 7?

Question 8.

8. Where did Person 4 stay most of the time?

The address printed on the back of this questionnaire

The address or location listed in Question 7

Some other place

P73. How did you determine where this person lives or stays most of the time? NOTE WHETHER THIS RESPONSE MATCHES THE INTERVIEWER’S UNDERSTANDING OF R’S LIVING SITUATION.

P74. IF “SOME OTHER PLACE”: Can you tell me a little about that place?

P75. Around June 1 2013, where did Person 4 live and sleep most of the time?

Question 9:

14. On the night of June 1, 2013, did this person stay in a facility such as a jail, shelter, or nursing home or some other kind of facility?

No

Yes – Provide the facility name, street address, city and state below

Facility Name

Street Address

City

State

P76. How did you choose your answer to Question9? OR: Why didn’t you mark an answer in Question 9?

P.77 FOR ANY YES ANSWER: Can you tell me about that place?

P78: How sure are you that [you/he/she] [were/was] there “on the night of June 1, 2013?”

P79: How certain are you of the address you provided here? Which parts are you certain about? Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P80. NOTE IF ALL PARTS OF THE ADDRESS FIELD ARE FILLED OUT. IF NOT: I notice that you omitted [certain parts of the address] [all of the address.] Can you tell me why that was?

Person 5 (IF NO PERSON 5, GO TO DEBRIEFING)

Question 1;

What is Person 5’s name? Print name below.

First Name

Middle Name

Last Name

P66. NOTE WHETHER FULL NAME IS PROVIDED AND IF IT IS FORMATTED CORRECTLY.

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

16. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

17. IF YES: How do you decide which way to write it on different forms?

18. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Do you/he/she have a middle name? How did you decide to leave it blank?

Demographic Questions 2-5

• if they have an objection, let them comment. Quote Verbatim any spontaneous comments about Question 2, Relationship, and Question 5, race and origin.

Probe: Could you find a relationship category that fit [Name]? How did you choose your answer? Is there something else you would rather call your relationship to [Name]? If yes, what is that term? Why do you think that is better?

Question 6

6. In the past year, did Person 5 sometimes live or stay somewhere else?

No – Skip to Question 9

Yes – If there is more than one place, mark the OTHER place where this person stays most of the time

Mark  all that apply

In college housing

In the military

For a job or business

With a parent or grandparent

At a second or seasonal residence

With a friend

For another reason

Because of a move -- What date?

Month Day Year

P67. NOTE IF R FINDS ‘NO’ AND SKIPS CORRECTLY, IF APPROPRIATE.

• FOR EACH YES RESPONSE: Why did you choose that answer? Can you tell me more about that place?

• Were there any places that you were unsure whether you should select or not? IF YES: Can you tell me more about that?

• [IF ADDRESS IS SOMEONE ELSE’S HOME:] Whose place is/was that? Is this a place [you/he/she] stays frequently? How often? When was he/she there last?]

• [IF NOT A WHOLE HOUSEHOLD MOVE:] When did [you/he/she] move? How certain are you of the date? Tell me about that move. Where did [you/he/she] move from? Why did [you/he/she] move? IF NECESSARY: I notice you didn’t put in a date for the move, why was that?

• [If address is COLLEGE HOUSING OR MILITARY: ] What kind of place did [you/he/she] stay in? When [were/was] [you/he/she] there last? How long did [you/he/she] stay that time?]

Question 7.

15. If you marked yes in Question 6, please provide the address of the other place where this person sometimes lived or stayed most of the time.

Street Address

Apartment Number

City

State

Zip Code

P68. NOTE WHETHER R CORRECTLY ANSWERED THIS QUESTION BASED ON SKIP LOGIC. INCLUDE SPONTANEOUS COMMENTS INDICATING THAT R KNOWS AN ADDRESS IS REQUIRED OR NOT, REQUIRED BASED ON PREVIOUS ANSWERS. INDICATE WHICH FIELDS WERE SPONTANEOUSLY FILLED OUT PRIOR TO THE BEGINNING OF THE PROBES.

P69. IF MORE THAN ONE ‘YES’ IN Q. 6: How easy or difficult was it to determine which address to provide in Question 7? IF NECESSARY: How did you choose which address to provide?

P70. IF PARTIAL INFORMATION IS PROVIDED: Can you tell me why you left some fields blank here? NOTE: IF R ADDS INFORMATION OR CHANGES A RESPONSE DURING PROBING, FLAG WHICH INFORMATION IS ADDED OR CHANGED.

P71. How sure are you of the address you put down? Are you certain of all the parts, or just some? IF NECESSARY: Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P72. If Q7 is blank after a yes answer: Can you tell me why you chose not to write an address in Question 7?

Question 8.

16. Where did Person 5 stay most of the time?

The address printed on the back of this questionnaire

The address or location listed in Question 7

Some other place

P73. How did you determine where this person lives or stays most of the time? NOTE WHETHER THIS RESPONSE MATCHES THE INTERVIEWER’S UNDERSTANDING OF R’S LIVING SITUATION.

P74. IF “SOME OTHER PLACE”: Can you tell me a little about that place?

P75. Around June 1 2012, where did Person 5 live and sleep most of the time?

Question 9:

17. On the night of June 1, 2013, did this person stay in a facility such as a jail, shelter, or nursing home or some other kind of facility?

No

Yes – Provide the facility name, street address, city and state below

Facility Name

Street Address

City

State

P76. How did you choose your answer to Question9? OR: Why didn’t you mark an answer in Question 9?

P.77 FOR ANY YES ANSWER: Can you tell me about that place?

P78: How sure are you that [you/he/she] [was/were] there “on the night of June 1, 2013?”

P79: How certain are you of the address you provided here? Which parts are you certain about? Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P80. NOTE IF ALL PARTS OF THE ADDRESS FIELD ARE FILLED OUT. IF NOT: I notice that you omitted [certain parts of the address] [all of the address.] Can you tell me why that was?

Person 6 (IF NO PERSON 6, GO TO DEBRIEFING)

Question 1;

What is Person 6’s name? Print name below.

First Name

Middle Name

Last Name

P66. NOTE WHETHER FULL NAME IS PROVIDED AND IF IT IS FORMATTED CORRECTLY.

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

19. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

20. IF YES: How do you decide which way to write it on different forms?

21. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Do you/he/she have a middle name? How did you decide to leave it blank?

I see that you wrote ________________ as your/his/her name. Is that a full name or a nickname? NOTE DIFFERENCES WITHOUT USING PII.

Would you ever use a different version of your/his/her name on a form like this?

22. IF YES: How else might you list this name? NOTE DIFFERENCES WITHOUT USING PII.

23. IF YES: How do you decide which way to write it on different forms?

24. IF HISPANIC: Do you/he/she have two surnames? IF YES, ASK: How did you decide which surname to provide on the Census form?

IF MIDDLE NAME BLANK OR JUST INITIAL: Do you/he/she have a middle name? How did you decide to leave it blank?

Demographic Questions 2-5

• if they have an objection, let them comment. Quote Verbatim any spontaneous comments about Question 2, Relationship, and Question 5, race and origin.

Probe: Could you find a relationship category that fit [Name]? How did you choose your answer? Is there something else you would rather call your relationship to [Name]? If yes, what is that term? Why do you think that is better?

Question 6

6. In the past year, did Person 6 sometimes live or stay somewhere else?

No – Skip to Question 9

Yes – If there is more than one place, mark the OTHER place where this person stays most of the time

Mark  all that apply

In college housing

In the military

For a job or business

With a parent or grandparent

At a second or seasonal residence

With a friend

For another reason

Because of a move -- What date?

Month Day Year

P67. NOTE IF R FINDS ‘NO’ AND SKIPS CORRECTLY, IF APPROPRIATE.

• FOR EACH YES RESPONSE: Why did you choose that answer? Can you tell me more about that place?

• Were there any places that you were unsure whether you should select or not? IF YES: Can you tell me more about that?

• [IF ADDRESS IS SOMEONE ELSE’S HOME:] Whose place is/was that? Is this a place [you/he/she] stays frequently? How often? When was [you/he/she] there last?]

• [IF NOT A WHOLE HOUSEHOLD MOVE:] When did [you/he/she] move? How certain are you of the date? Tell me about that move. Where did [you/he/she] move from? Why did [you/he/she] move? IF NECESSARY: I notice you didn’t put in a date for the move, why was that?

• [If address is COLLEGE HOUSING OR MILITARY: ] What kind of place did [you/he/she] stay in? When was [you/he/she] there last? How long did [you/he/she] stay that time?]

Question 7.

18. If you marked yes in Question 6, please provide the address of the other place where this person sometimes lived or stayed most of the time.

Street Address

Apartment Number

City

State

Zip Code

P68. NOTE WHETHER R CORRECTLY ANSWERED THIS QUESTION BASED ON SKIP LOGIC. INCLUDE SPONTANEOUS COMMENTS INDICATING THAT R KNOWS AN ADDRESS IS REQUIRED OR NOT, REQUIRED BASED ON PREVIOUS ANSWERS. INDICATE WHICH FIELDS WERE SPONTANEOUSLY FILLED OUT PRIOR TO THE BEGINNING OF THE PROBES.

P69. IF MORE THAN ONE ‘YES’ IN Q. 6: How easy or difficult was it to determine which address to provide in Question 7? IF NECESSARY: How did you choose which address to provide?

P70. IF PARTIAL INFORMATION IS PROVIDED: Can you tell me why you left some fields blank here? NOTE: IF R ADDS INFORMATION OR CHANGES A RESPONSE DURING PROBING, FLAG WHICH INFORMATION IS ADDED OR CHANGED.

P71. How sure are you of the address you put down? Are you certain of all the parts, or just some? IF NECESSARY: Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P72. If Q7 is blank after a yes answer: Can you tell me why you chose not to write an address in Question 7?

Question 8.

19. Where did Person 6 stay most of the time?

The address printed on the back of this questionnaire

The address or location listed in Question 7

Some other place

P73. How did you determine where this person lives or stays most of the time? NOTE WHETHER THIS RESPONSE MATCHES THE INTERVIEWER’S UNDERSTANDING OF R’S LIVING SITUATION.

P74. IF “SOME OTHER PLACE”: Can you tell me a little about that place?

P75. Around June 1 2012, where did Person 6 live and sleep most of the time?

Question 9:

20. On the night of June 1, 2013, did this person stay in a facility such as a jail, shelter, or nursing home or some other kind of facility?

No

Yes – Provide the facility name, street address, city and state below

Facility Name

Street Address

City

State

P76. How did you choose your answer to Question9? OR: Why didn’t you mark an answer in Question 9?

P.77 FOR ANY YES ANSWER: Can you tell me about that place?

P78: How sure are you that [you/he/she] was there “on the night of June 1, 2013?”

P79: How certain are you of the address you provided here? Which parts are you certain about? Is this an address you keep a record of somewhere, so you could look it up if you needed to?

P80. NOTE IF ALL PARTS OF THE ADDRESS FIELD ARE FILLED OUT. IF NOT: I notice that you omitted [certain parts of the address] [all of the address.] Can you tell me why that was?

Final Debriefing

Thanks, we’re almost finished. I have just a few more questions for you.

71. Was there anything in these questions that you found sensitive or uncomfortable to answer?

72. Was there any information that you would be hesitant to provide on the census form?

73. Aside from the things we’ve talked about, were there any questions or instructions that you find confusing or difficult to answer?

74. Did you find parts of the interview repetitive? If so, what parts?

If you were going to answer your census questionnaire on your own, without an interviewer, how would you prefer to do it?

Yes No On a smartphone? (What kind:____________________________________________)

Yes No On a tablet? (What kind:____________________________________________)

Yes No On a laptop or desktop?

Yes No On a paper form?

FOR EACH “Yes” ANSWER CHOSEN, ASK: Why?

75. If you don’t answer the census on your own, an interviewer might be sent to your home to get your census information. How would you feel about the interviewer using….. CHECK ALL THAT APPLY.

• a smartphone to do the interview?

• a tablet, like an iPad?

• a laptop computer?

• a paper form?

Which do you prefer and why?

76. Now, thinking of an interviewer using a smartphone, a tablet or a laptop computer, would it make a difference to you if the interviewer used her own device or a government-issued device?

IF R SHOWED CONCERN WITH PERSONAL DEVICE: The information people give will not be saved in the personal machines. Instead, they will be encrypted through a secure internet server and the machine is just used to get to the secure server. Would this explanation assure you? (IF NOT: What should the Census Bureau say to assure you that interviewers’ personal devices work the same as government-issued devices?

77. Do you own or have access to…

____ A smartphone? (What kind:____________________________________________)

____ A tablet? (What kind:____________________________________________)

____ A laptop or desktop?

HAND R THE PRINTOUT WITH THIS QUESTION: I have one more question to ask you about technology that might be used to improve the next Census. Please look at this: “In order to count people in the right place, the Census Bureau must collect detailed geographic information about each person's place of residence. If you were at home completing your census on a smartphone or tablet, we could determine your location easily and accurately using GPS technology. Would you allow the Census Bureau to collect GPS coordinates on a one-time-only basis to determine where to count you in the census?”

78. Tell me why/why not? [IF NECESSARY: What additional information would you want to know?]

79. What does geographic information mean to you in this question?

80. End Time:________ THANK YOU

Household Paper Protocol 33