2020 Census Billinugal Vietnamese, Russian, and Arabic

T

ID Assigned:

Location:

Recruiter Initials:

Date:

Ad running in R’s area (if ad):

O09 Study Screener

Project 1 / 2R1

October 15, 2014

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. If you qualify for this study, we will pay you $40 to complete the interview. The interview needs to be face to face, but our interviewer can meet with you at a time and location convenient to you. The interview takes about 60 minutes. All your answers are confidential and protected by law. I have a few questions for you to make sure 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 $40 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.

• Interviews: An interviewer would conduct an interview with you. Because of the importance of this study, the interview needs to be face to face, but our interviewer can meet with you at a time and location convenient to you. The interview takes on average 60 minutes during which time the interviewer will ask you some questions about how you respond to the census.

• HOUSEHOLD SELECTION:[purchased lists] Your household was selected because we have interviewers in this area.

• CONFIDENTIALITY: The study is protected by US Code Title 13. Anyone working at RTI (OR RSS), including the interviewer 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) 493- 9842. I can also have researchers at the Census Bureau who designed this study contact you. [SPANISH VERSION WILL SAY: Ms. Sha speaks Spanish]

• [WHEN APPROPRIATE] INTERVIEWER: I’m not sure which interviewer will be calling you, the names of the interviewers in this area are [NAME], [NAME], [NAME], but my supervisor assigns the interviewer to the case.

[Note Concerns or Questions]

START HERE

1. What is your name? _____________________

2. Are there other last names that you also use?

3. Are you male or female?

1. Male

2. Female

3. Other/Something Else

4. And how did you hear about this study?

   1. CRAIGSLIST

   2. RTI CLASSIFIEDS/RTI EMPLOYEE

   3. FRIEND

   4. FLYER

   5. NEWSPAPER AD

   6. LETTER

   7. Other Online Google Ad/Website

   8. 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 [confirm with census categories necessary]

   3. 35 and older [confirm with census categories necessary]

8. What is your highest level of education completed [Confirm with Census categories

1. Less than high School Equivalent

2. High school / GED [includes Some college but no degree]

3. college and beyond

4. Other 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?
white
Black or African American
Middle Eastern
North African
American Indian/Alaskan Native
Asian
Native Hawaiian or Pacific Islander
SOME Other RACE ______________________
No other Race [for Hispanic=yes only]

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

    1. United States

    2. Other (Specify: _________________________________________)

       1. When did you first move to the U.S.? ________

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

13. Q13Oa. How well do you speak English?

    1. Very well

    2. Well

    3. Not well

    4. Not at all

    
    

    Q13Ob. How well do you read English?

    1. Very well

    2. Well

    3. Not well

    4. Not at all

    SKIP TO 14

    Is [English/Spanish] your native language, or is your native language some other language?

a. English  SKIP TO Q14

b. Spanish  CONTINUE TO Q 13A

c . Other (Specify:________________)  Ask Other

13A How well do you read Spanish?

1. Very well

2. Well

3. Not well

4. Not at all

13B. How well do you speak English?	1. Very well	2 . Well	3. Not well	4. Not at all
13C. How well do you read English?	1. Very well	2. Well	3. Not well	4. Not at all
			Only 3s & 4s circled, Skip to Q14

4

13D. Do you speak Spanish better than English, English better than Spanish, or both about equally well?

1. Spanish better than English

2. English better than Spanish

3. Both about equally well

13E. Since you are bilingual, we can do the interview in either language. In which language would you prefer to do the interview if you are eligible?

1. English  CODE AS ENG INT

2. Spanish  CODE AS BILIN-SPANISH INT

3. Either one - prefer both equally  CODE AS BILIN-SPANISH INT

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

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

15. For each person who lives in your house, please tell me their relationship to you. You don’t have to tell me their names, just their relationship to you.

MARK RELATIONSHIP HERE

[Probe gender if not clear]

Where indicated ask follow up Question

• Opposite-sex husband/wife/spouse

• Opposite sex unmarried partner

• Same-sex husband/wife/spouse

• Same-sex unmarried partner

• Son or daughter

• Foster child

• Brother or sister

• Father or mother

• Grandchild (Ask Q. 18)

• Parent-in-law

• Son-in-law or daughter-in-law

• Other relative (specify_______ if a child ask Q 18.)

• Roomer or boarder

• Housemate or roommate

• Landlord

• Other nonrelative (Specify_____ if a child ask Q18)

Cohabitating Partner:

16. You mentioned you had a _____, was s/he born in the United States or somewhere else?

1. U.S

2. Somewhere else  Where was s/he born? (Specify)________________

16. Son/Daughter – Repeat For Each

Child	You mentioned your ____, was/were s/he/they born in the United States or somewhere else?	And/are is your son(s)/daughter(s) your biological child(ren), adopted, fostered or something else?
C1
C2
C3
C 4
C 5

Ask For all children in household

16. Are any of the/ Is the children/child you mentioned less than a year old?

    1. Yes  How old is that child?______

    2. No

19. Is there anyone else who stays at this home sometimes, a child with shared custody, someone who lives in a nursing or residential home or a friend who crashes on the couch or stays part time? [probe: for length of time and WHEN last visit occurred]

1. YES, children [specify:_________]

2. Yes, Group home/Institution [Specify: _________]

3. YES, Other [Specify:_______________]

4. NO

19. Do you live in a house, an apartment or condo, or do you live in some other type of housing?

1. House/mobile home

2. Apartment/condo

3. Multiple places – Couch surfer/multiple friend’s places

4. Other [Probe: type of place]___________________

19. Do you/someone in your household rent or own your home?

1. Rent

   1. [check above who lives in household and if not clear confirm:] Does your landlord live in the same [residence] as you?

1. Yes

2. No

1. Own

22. How do you get your mail, that is, does it come to you at your home, at a PO Box or some other way?

    1. PO BOX -->

       1. Do you also get your mail delivered to you at your home or is a PO box the only way you can receive mail?

          1. Home as well

          2. PO Box only

    2. Delivered to someone else in the household

    3. Delivered to R at household

23. [Q4 cited ad for Rural delivery only]: Is your address a Rural Route or RFD address, a street address or something else?

    1. RFD/RR/HC/RTE

    2. Street or other

24.  [FOR LOCATIONS WITH P2/R1 INTERNET TESTING] During some of the interviews we will ask the participant to access a census form on a smartphone, such as an iPhone or Android phone. Do you have a smartphone with A DATA PLAN [INTERNET ACCESS IS PART OF THE PLAN], that you would be willing to use during the interview?

    1. Yes, HAVE SMARTPHONE WITH A DATA PLAN

    2. No, DO NOT HAVE A SMARTPHONE WITH A DATA PLAN

    3. No, HAVE A SMARTPHONE BUT NO DATA PLAN [REQUIRE WIFI FROM ANOTHER SOURCE]

    4. Other:__________

24b. Do you have a tablet with a data plan [wi fi access included]?

1. Yes, HAVE TABLET WITH A DATA PLAN

2. No, DO NOT HAVE A TABLET WITH A DATA PLAN

3. No, HAVE A TABLET BUT NO DATA PLAN [REQUIRE WIFI FROM ANOTHER SOURCE]

4. Other:__________

Now I just need to collect your contact information.

25. 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

25. In case you qualify for the study, I want to pass on to the interviewer some information about your general location. In what neighborhood or town do you live in? [Probe if necessary for subdivision/cross-streets/local library, if you do not know the area get cross streets (i.e. in DC/SD)]

Location: ___________________________________________________________________________________

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 and let you know/an interviewer will also call you to set up an interview].

Screener TO09 P1_P2R1 OMB Control Number: xxxx-xxxx; Expiration: xxx 6