Cai_v1

Attachment O: Version 1, Group 1 & 2 Questions - Latest Revision 04/22/16

American Community Survey

Cognitive Test

Interviewer-administered Survey

Version 1, Group 1 & 2

March 28, 2016

Participant ID #: |___|___|___|___|___|___|___|___|___|___|

HOUSING QUESTIONS (CONTAINS YEAR BUILT AND COMPUTER/INTERNET/TELEPHONE MODULES)

1a. Now I am going to ask about this place… Which best describes this building? Is it a mobile home, single family house, building with two or more apartments, boat, RV or van? SELF-PROPELLING RVS OR MOTORHOMES SHOULD BE INCLUDED IN THE CATEGORY “BOAT, RV, VAN, ETC.” TOWABLE RVS, SUCH AS TRAVEL TRAILERS OR FIFTH-WHEEL TRAILERS, SHOULD BE INCLUDED IN THE CATEGORY “MOBILE HOME.”	 A mobile home  Go to 2a Single-family house  Go to 1b Building with 2 or more apartments  Go to 1c Boat, RV, van, etc.  Go to 2a
1b. Is that a detached house, or is it attached to other houses?	 Detached  Go to 2a Attached  Go to 2a
1c. How many apartments are there in this building?	
(YEAR BUILT: 2a – 2b) *2a. About when was this <house/apartment/mobile home > first built? Was it first built in 2010 or later, between 2000 and 2009, between 1980 and 1999, between 1960 and 1979, between 1940 and 1959, or 1939 or earlier?	2010 or later Go to 2b  2000 – 2009  Go to 3  1980 – 1999  Go to 3  1960 – 1979  Go to 3  1940 – 1959  Go to 3  1939 or earlier  Go to 3
2b. In what year was that? ENTER SPECIFIC YEAR <HOUSE/APARTMENT/MOBILE HOME > WAS BUILT IF 2010 OR LATER.	 Year
3. In what year did (you/householder) move into this <house/apartment/mobile home/unit >?	
INSTRUCTION A IF HOUSE OR MOBILE HOME, GO TO QUESTION 6B. OTHERWISE, GO TO QUESTION 6A.
6a. Is this an efficiency or studio apartment?	 Yes  Go to 7a  No  Go to 6b
6b. The next questions are about the number and kinds of rooms at this place. Rooms must be separated by built-in archways or walls that extend out at least 6 inches and go from floor to ceiling. How many separate rooms are in this <house/apartment/mobile home/unit > not counting bathrooms, porches, balconies, foyers, halls or unfinished basements? INCLUDE BEDROOMS, KITCHENS, ETC.	
6c. Did you include bedrooms?	 Yes  Go to 6d  No  Go to 6e
6d. How many of the <number of rooms from question 6b> rooms would you list as bedrooms if this <house/apartment/mobile home/unit > were for sale or rent? ENTER NUMBER OF BEDROOMS	 Go to 7a
6e. How many rooms would you list as bedrooms if this <house/apartment/mobile home/unit > were for sale or rent? ENTER NUMBER OF BEDROOMS	
7a. Does this <house/apartment/mobile home/unit > have hot and cold running water?	 Yes  No
7b. Does this <house/apartment/mobile home/unit > have a bathtub or shower?	 Yes  No
7c. Does this <house/apartment/mobile home/unit > have a sink with a faucet?	 Yes  No
7d. Does this <house/apartment/mobile home/unit > have a stove or range?	 Yes  No
7e. Does this <house/apartment/mobile home/unit > have a refrigerator?	 Yes  No
(COMPUTER AND INTERNET: 8a – 10f) *8a. At this <house/apartment/mobile home/unit>, do you or any member of this household own or use a desktop, laptop, or a tablet?	 Yes  No
*8b. At this <house/apartment/mobile home/unit>, do you or any member of this household own or use a smartphone?	 Yes  Go to 9  No Go to 10a
*9. Do any of the smartphones owned or used by you or any member of this household have a paid cellular data plan for accessing the Internet?	 Yes Go to 10b  No  Go to 10a
*10a. Do you or any member of this household pay for access to the Internet using a cellular data plan for a mobile device?	 Yes  No
*10b. Do you or any member of this household pay for access to the Internet using a broadband or high speed Internet service such as cable, fiber optic, or DSL service installed in this <house/apartment/mobile home/unit >?	 Yes  No
*10c. Do you or any member of this household pay for access to the Internet using a satellite Internet service installed in this <house/apartment/mobile home/unit >?	 Yes  No
*10d. Do you or any member of this household pay for access to the Internet using a dial-up Internet service installed in this <house/apartment/mobile home/unit >?	 Yes  No
*10e. Do you or any member of this household pay for access to the Internet using some other service?	 Yes  Go to10f  No  Go to Instruction B
*10f. What is this other type of Internet service?	
Instruction B IF YES TO QUESTION 9 (PAID CELLULAR DATA PLAN), SKIP TO INSTRUCTION C. OTHERWISE, GO TO QUESTION 11.
(TELEPHONE SERVICE: 11) *11. Can you or any member of this household both make and receive phone calls when at this <house/apartment/mobile home/unit>? Include calls using cell phones, land lines, or other phone devices.	 Yes  No
INSTRUCTION C CONTINUE WITH DETAILED QUESTIONS FOR PERSON 1 ON PAGE 6 .

DETAILED QUESTIONS—PERSON 1

(CONTAINS YEAR OF NATURALIZATION AND YEAR OF ENTRY MODULES)

		NAME ____________________
7a. I will now be asking a series of questions about you. The next few questions deal with your place of birth and citizenship... Where were you born? ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.		_______ State  Go to INSTRUCTION E OR  Not born in the US Go to 7b
7b. In what country were you born?		___________ Country
INSTRUCTION D IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a. OTHERWISE GO TO QUESTION 8a.
8a. Are you a citizen of the United States?	 Yes  Go to 8b  No  Go to 9a
8b. Were you born abroad of U.S. citizen parent or parents, or did you become a citizen by naturalization?	 Born abroad of U.S. citizen parent or parents  Go to 9a  Citizen by naturalization  Go to 8c
(YEAR OF NATURALIZATION: 8c – 8d) IF THIS PERSON WAS BORN BEFORE 1985, READ THIS: *8c. In what year did you become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS: *8c. In what year did you become a naturalized citizen of the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS: *8c. In what year did you become a naturalized citizen of the United States? Was it between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS: *8c. In what year did you become a naturalized citizen of the United States? Was it between 1995 and 1999, between 2000 and 2004, or 2005 or later?	Before 1985  Go to 9a  1985 – 1989  Go to 9a  1990 – 1994  Go to 9a  1995 – 1999  Go to 9a  2000 – 2004  Go to 9a 2005 or later  Go to 8d
*8d. In what year was that? ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.	Year
(YEAR OF ENTRY: 9a – 9b) IF THIS PERSON WAS BORN BEFORE 1985, READ THIS: *9a. In what year did you come to live in the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year. IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS: *9a. In what year did you come to live in the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year. IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS: *9a. In what year did you come to live in the United States? Was between 1990 and 1994, 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year. IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS: *9a. In what year did you come to live in the United States? Was between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.	Before 1985  Go to INSTRUCTION E  1985 - 1989  Go to INSTRUCTION E  1990 - 1994  Go to INSTRUCTION E  1995 - 1999  Go to INSTRUCTION E  2000 - 2004  Go to INSTRUCTION E 2005 or later  Go to 9b
*9b. In what year was that? ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.	Year
INSTRUCTION E If there is another person to collect detailED person data for, Continue to person 2. Otherwise, end interview.

DETAILED QUESTIONS—PERSON 2

(CONTAINS YEAR OF NATURALIZATION AND YEAR OF ENTRY MODULES)

		NAME ____________________
7a. I will now be asking a series of questions about <Name>. The next few questions deal with <Name’s> place of birth and citizenship... Where was <Name> born? ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER US		_______ State  Go to INSTRUCTION E OR  Not born in the US Go to 7b
7b. In what country was <Name> born?		___________ Country
INSTRUCTION D IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a. OTHERWISE GO TO QUESTION 8a.
8a. Is <Name> a citizen of the United States?	 Yes  Go to 8b  No  Go to 9a
8b. Was <Name> born abroad of U.S. citizen parent or parents, or did <Name> become a citizen by naturalization?	 Born abroad of U.S. citizen parent or parents  Go to 9a  Citizen by naturalization  Go to 8c
(YEAR OF NATURALIZATION: 8c – 8d) IF THIS PERSON WAS BORN BEFORE 1985, READ THIS: *8c. In what year did <Name> become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS: *8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS: *8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS: *8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1995 and 1999, between 2000 and 2004, or 2005 or later? IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS: *8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 2000 and 2004, or 2005 or later?	Before 1985  Go to 9a  1985 – 1989  Go to 9a  1990 – 1994  Go to 9a  1995 – 1999  Go to 9a  2000 – 2004  Go to 9a 2005 or later  Go to 8d
8d. In what year was that? ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.	Year
(YEAR OF ENTRY: 9a – 9b) IF THIS PERSON WAS BORN BEFORE 1985, READ THIS: *9a. In what year did <Name> come to live in the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year. IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS: *9a. In what year did <Name> come to live in the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year. IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS: *9a. In what year did <Name> come to live in the United States? Was between 1990 and 1994, 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year. IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS: *9a. In what year did <Name> come to live in the United States? Was between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year. IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS: *9a. In what year did <Name> come to live in the United States? Was between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.	Before 1985  Go to INSTRUCTION E  1985 - 1989  Go to INSTRUCTION E  1990 - 1994  Go to INSTRUCTION E  1995 - 1999  Go to INSTRUCTION E  2000 - 2004  Go to INSTRUCTION E 2005 or later  Go to 9b
*9b. In what year was that? ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.	Year
INSTRUCTION E end interview.

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