Various Demographic Area Pretesting Activities

3

Header: Core / Universal Questions

Intro: Hello, I’m _____________ from the Census Bureau. Thanks for calling us about participating in one of our studies. I just need to get a little bit of background information to start.

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Calendar picker

ID:

X months from last study date (un-editable)

Last Contact Date:

Eligible Date:

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1. What is your name?

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First Name:

Last Name:

Dropdown: Male/Female

2. (Ask if not obvious) Are you male or female?
   
   
   
   

Dropdown: Married, widowed, never married

3. Are you married, widowed, divorced, separated, or have you never been married?
   
   
   
   
   

4. What is your date of birth? (MM/DD/YYYY)?

MM/DD/YYYY

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

Drop-down: Yes/No

Drop-down: White, Black or African American, Asian, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander.

6. Which of the following races do you consider yourself to be? Please select one or more.

Race:

Same as above

Categories

Same as above

Race 2 (if any):

Race 3 (if any):

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

Dropdown: 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, associate’s degree, completed college, any graduate or professional education, Master’s degree, Doctorate or Professional degree

If College or Higher go to Q7A or Q7B, ELSE Q8 and Q7A and Q7B will be hidden.

Dropdown: Yes/ No

1. Did you receive any scholarships or loans for your college studies?
   
   
   
   

   

   Dropdown: Yes/ No

2. Did you receive any scholarships or loans for your graduate studies?
   
   
   
   
   

1. Are you employed by the Federal Government?

Dropdown: Yes/No

Dropdown: Yes/ No

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

   

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10. Name at least two things you use the Internet to do besides e-mail.

Thing 1:

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Thing 2:

Dropdown: Yes/ No

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

    

    Dropdown: Yes/No/ Not sure

12. Some cell phones are called ‘smartphones’ because of certain features they have. Is your cell phone a smartphone or not, or are you not sure?
    
    
    
    IF yes, ask follow-up, ELSE go to next question.

    1. What smartphone do you have?

Dropdown with Android / iOS / Windows Phone / Blackberry / Other

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13. How did you hear about this study? (if there’s already data here, ask them to verify the existing information)

Dropdown: Yes/No

14. If necessary, would you be able to come to our facility in Suitland, MD to be interviewed?

Dropdown: Yes/ No

15. Have you participated in any testing of questionnaires or websites outside of the Census Bureau in the past year?

Dropdown: Yes/ No

16. Have you participated in any testing of Census Bureau’s questionnaires or websites in the last year?

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17. What is your daytime phone # so I can contact you?

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Home (or main):

Cell (if not main):

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Work (if any):

18. Is there an e-mail address I could send directions to if you qualify for an interview?

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Email address:

19. Are you a United States citizen?

Dropdown: Yes/No

Header: Study Specific Questions

Intro: Now I have some questions that relate to some of the questionnaires we will be testing. We will use them to determine what studies you are eligible to participate in.

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

IF any go to Q20A ELSE go to Q21 and hide Q20A

Dropdown: Yes/No

1. Are they all related?

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

IF any go to Q21A ELSE go to Q22 and hide Q21A and Q21B

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1. What are the ages of each of the children younger than 18 living in your household?

Child 1:

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Child 2:

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Child 3:

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Child 4:

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Child 5:

Child 6:

Dropdown: Yes/No

2. Do any of these children have special needs or disabilities?
   
   
   
   

Dropdown: Yes/No

22. Do any of the people in your 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 shared custody situations or adults who have more than one place to live for work or for pleasure.)
    
    
    
    
    

IF YES go to Q22A ELSE go to Q23 and hide Q22A

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1. Please explain:
   
   
   
   

Dropdown: Full-time, part-time, not working for pay

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

    

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24. What is your job title or job description?
    
    
    
    
    
    

    

    Dropdown: Yes/No

    1. Is your job related to any of the following fields: computer science, math, life sciences, physical sciences, social sciences, engineering or health sciences?
       
       
       
       
       
       

    

    Dropdown: Yes/No

25. Have you changed jobs in the last two years?
    
    
    
    

    

    Dropdown: Yes/No

26. Do you currently have more than one job?
    
    
    
    

    

    Dropdown: Yes/No

27. Do you contribute to one or more pension plan, including 401(k)s, IRAs, or pension plans?
    
    
    
    
    

    

    Dropdown: Yes/No

28. Are you self-employed?

Dropdown: Yes/No

29. Are you disabled or unable to work for health reasons?
    
    
    
    

    

    Dropdown: Yes/No

30. Do you have any problems doing daily activities like dressing, walking, or lifting?
    
    
    
    
    

    

    Dropdown: Yes/No

31. Have you had any type of contact with police with the last 12 months?
    
    
    
    

    

    Dropdown: Yes/No

32. Do you hunt game or other wildlife?
    
    
    
    

    

    Dropdown: Yes/No

33. Do you fish recreationally?
    
    
    
    

    

    Dropdown: Yes/ No

34. Do you observe, feed, or photograph wildlife?
    
    
    
    

    

    Dropdown: Yes/No

35. Do you have a tablet computer such as an iPad, Samsung Galaxy Tab, Google Nexus, or Kindle Fire?
    
    
    IF yes, ask follow-up, ELSE go to next question.

    

    Dropdown with Android / iOS / Windows / Other

    1. What tablet do you have?
       
       
       
       
       

    

    Dropdown: Desktop / Laptop / Both

36. Do you own a desktop, laptop, or both?
    
    
    
    
    

37. What city, state, and zip code do you live in?

    

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    1. City:
       
       
       
       

       

       Dropdown: State names

    2. State:
       
       
       
       

       

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    3. Zip Code:
       
       
       
       

       

       Dropdown: Yes/No

    4. Do you have a P.O. box?
       
       
       

If Yes show below ELSE go to Q31

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What is your P.O. Box?

Dropdown: Own/Rent/Not owned

38. Do you own or rent the place you currently live?
    
    
    
    

    

    Dropdown: Yes/No

39. Is the place where you currently live (owned/rented) in your name or in the name of someone else in your household?
    
    
    
    

    

    Dropdown:

    Single family home, townhouse or duplex, apartment, another type

40. Do you live in a single family home, a townhouse or duplex, an apartment, or another type of housing?

41. Is your household’s annual income..

    

    Dropdown: Yes/No

    1. Above $25,000?
       
       
       
       

       

       Dropdown: Yes/No

    2. Above $50,000?
       
       
       
       

       

       Dropdown: Yes/No

    3. Above $100,000?
       
       
       
       
       

Header: Research and miscellaneous questions

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42. How many times in the past month did you go grocery shopping?

43. How many times in the past month did you eat out?

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