Decennial Language Research

ID Assigned:

Location:

Recruiter Initials:

Date:

Ad running in R’s area (if ad):

TO09 Study Screener

Project 4.2

[English/Russian/Chinese/Korean/Vietnamese/Arabic/Spanish]

 

Narrative FAQ: Let me tell you a little bit about this study. The Census Bureau is conducting research to make the 2020 Census work better. We will be having a focus group about how people respond to census questions. A focus group is a group discussion between a research professional called a moderator and a small group of people, about 10, who have been pre-selected.  The focus groups last about two hours. We make a videotape of the focus group so we can have the project team review it for their research.  But all information you provide is confidential and protected by law so it cannot be released to anyone outside the research team.  If you do qualify and agree to participate, it is very important that you don’t cancel since only a limited number of people are invited.  If you attend the focus group we will pay you $75. Do you have about 3 minutes for me to ask you the questions now to see if you qualify?

Bulleted FAQs:

• Purpose: The Census Bureau is conducting research to make the 2020 Census work better. They would like to understand more about how people respond to the census as well as how well the census forms work and how to improve them.

• Incentive: If you qualify for this study, we will pay you $75 to help us complete this research.

• RTI/RSS: RTI International is a nonprofit research organization (or RSS is a contract research firm). The Census Bureau contracted with us to conduct this research. We have assisted the Census Bureau with several research studies in the past.

• CONFIDENTIALITY: The study is protected by US Code Title 13. Anyone working at RTI (OR RSS), including the moderator or me, could either go to jail or pay a fine up to $250,000 if we divulge any information about you.

• VERIFICATION: You can call the study’s project manager Mandy Sha at RTI. Her number is (312) 456-5266. I can also have researchers at the Census Bureau who designed this study contact you.

[Note Concerns or Questions]

START HERE

1. What is your name? _____________________

2. If you are eligible, are you available on (DATE) (TIME) to participate in a focus group? The FG will be held in (PLACE)?

   1. Yes

   2. No  (IF UNABLE TO MAKE THE TIME, EXPLAIN THAT THEY DO NOT QUALIFY FOR THIS FOCUS GROUP BUT WE CAN CONTINUE WITH THE SCREENER TO SEE IF THEY QUALIFY FOR FUTURE PORTIONS OF THE PROJECT)

3. Are you male or female?

1. Male

2. Female

3. Other/Something Else

4. And how did you hear about this study?

   1. FRIEND

   2. FLYER

   3. NEWSPAPER AD

   4. Online Google Ad/Website

   5. OTHER, SPECIFY:

5. You said that you [saw] the ad on [way heard]; Can you tell me about your situation and why you thought you might qualify for the study? (Probe: relevant data)

6. Do you work for the United States federal government?

1. YES  Explain: Unfortunately you cannot be paid for your study participation but we would still like you to participate if you qualify. Also, other household members who do not work for the federal government might qualify and could be paid.

2. NO

7. What is your age? ___________________

   1. Under 18 – not Eligible

   2. 18-34

   3. 35 -44

   4. 45-54

   5. 55-64

   6. 65 and older

8. What is the highest level of education you completed

Education System (Specify___________) Probe as necessary for US Equivalent if Respondent does not know equivalent, ask number of total years and record level name in country of origin_______________

1. Less than HS Equivalent

2. HS Equivalent

3. College +

9. Are you of Hispanic, Latino or Spanish origin?

   1. Yes ASK BRACKETED Q10

   2. No

10. What is your race and origin? [What other race or origin are you?] PROBE UNTIL EXHAUSTED

MARK ALL THAT APPLY – for each marked ask Q.11	Can you tell me more about your ancestry or ethnic origin?
a. White
b. Black or African American
c. Middle Eastern
d. North African
e. American Indian/Alaska Native
f. Asian
g. Native Hawaiian or Pacific Islander
h. Some Other Race___________________

12. In what country or territory were you born? [DON’T READ CHOICES. CIRCLE ONE.]

    1. United States

       

       12bi code here

       • 1990s or earlier

       • 2000-2009

       • 2010+

    2. Other (Specify: _________________________________________)

       

       1. When did you first move to the U.S.? ________ [mark code]

       2. How many years in total have you lived in the U.S.? ________

13. Is [TARGET LANGUAGE] your native language, or is your native language some other language?

a. English  SKIP TO Q14

b. [TARGET LANGUAGE]  CONTINUE TO Q 13A

c. Other (Specify:________________)

13A How well do you read [TARGET LANGUAGE]?

a. Very well

b. Well

c. Not well

d. Not at all

13B. How well do you speak English?	a. Very well	b. Well	c. Not well	d. Not at all
13C. How well do you read English?	a. Very well	b. Well	c. Not well	d. Not at all
			Only Cs & Ds circled, Skip to Q14

13D. Do you speak [Target language] better than English, English better than [Target language], or both about equally well?

1. [Target language] better than English

2. English better than [Target language]

3. Both about equally well

I now have a couple of questions about your current living situation.

14. How many people live in your household including yourself? ______________

Now I just need to collect your contact information.

15. What is the best phone number for me to contact you at if you qualify for the study? //Is it OK to leave texts on that number?

Phone: ____________________________Text yes/no

Is there another number as well? ____________________________ Text yes/no

Thank you for your information. I’m going to pass it on to my supervisor [this evening/Monday/etc.] who will let me know if you qualify for the study. If you do [I will call you back to confirm the time, date and location of the FG.

OMB Control Number: xxxx-xxxx; Expiration: xxx 7