Internet Version 1 Group 1

Attachment S: ACS Respondent Burden Testing Internet Survey Instrument: Group 1, Version 1

INET_G1_V1_Packet 1

2010 or later - Specify year

2000 to 2009
1980 to 1999
1960 to 1979
1940 to 1959
1939 or ealier

INET_G1_V1_Packet 1

When did you move into this house?

INET_G1_V1_Packet 1

a. How many separate rooms are in this house? Rooms must be separated by built-in
archways or walls that extend out at least 6 inches and go from floor to ceiling.

b. How many of these rooms are bedrooms? Count as bedrooms those rooms you would list if
this unit were for sale or rent. If this is an efficiency/studio apartment, enter "0".

INET_G1_V1_Packet 1

Does this house have -

INET_G1_V1_Packet 1

a. At this house, do you or any member of this household own or use a desktop, laptop
or a tablet?

INET_G1_V1_Packet 1

b. At this house, do you or any member of this household own or use a smartphone?

INET_G1_V1_Packet 1

ŽĂŶLJŽĨƚŚĞƐŵĂƌƚƉŚŽŶĞƐŽǁŶĞĚŽƌƵƐĞĚďLJLJŽƵŽƌĂŶLJŵĞŵďĞƌŽĨƚŚŝƐŚŽƵƐĞŚŽůĚ
ŚĂǀĞĂƉĂŝĚĐĞůůƵůĂƌĚĂƚĂƉůĂŶĨŽƌĂĐĐĞƐƐŝŶŐƚŚĞ/ŶƚĞƌŶĞƚ͍

INET_G1_Packet 2

ŽLJŽƵŽƌĂŶLJŵĞŵďĞƌŽĨƚŚŝƐŚŽƵƐĞŚŽůĚƉĂLJĨŽƌĂĐĐeƐƐƚŽƚŚĞ/ŶƚĞƌŶĞƚƵƐŝŶŐĂͲ

Broadband (high speed) Internet service, such as cable,
fiber optic, or DSL service installed in this house?
Satellite Internet service installed in this house?
Dial-Up Internet service installed in this house?
Some other service? Specify service

INET_G1_Packet 3a

ŽLJŽƵŽƌĂŶLJŵĞŵďĞƌŽĨƚŚŝƐŚŽƵƐĞŚŽůĚƉĂLJĨŽƌĂĐĐĞƐƐƚŽƚŚĞ/ŶƚĞƌŶĞƚƵƐŝŶŐĂͲ

Cellular data plan for a mobile device?
Broadband (high speed) Internet service, such as cable, fiber optic,
or DSL service installed in this house?
Satellite Internet service installed in this house?
Dial-Up Internet service installed in this house?
Some other service? Specify service

INET_G1_Packet 3b

ĂŶLJŽƵŽƌĂŶLJŵĞŵďĞƌŽĨƚŚŝƐŚŽƵƐĞŚŽůĚďŽƚŚŵĂŬĞĂŶĚƌĞĐĞŝǀĞƉŚŽŶĞĐĂůůƐ
when ĂƚƚŚŝƐhouse͍/ŶĐůƵĚĞĐĂůůƐƵƐŝŶŐĐĞůůƉŚŽŶĞƐ͕ůĂŶĚůŝŶĞƐ͕ŽƌŽƚŚĞƌƉŚŽŶĞĚĞǀŝĐĞƐ.

INET_G1_Packet 3b