SCOPE Confidentiality Language Testing

Survey Monkey Confidentiality Survey

6.9.16

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Introduction

This is a survey for the US Census Bureau. This voluntary study is being collected by the Census Bureau under OMB No 0607-0725. This survey will take approximately 10 minutes to complete. Your participation is voluntary and you have the right to stop at any time.

We are looking for information about how respondents answer our surveys. Please take your time as you answer these questions. The information you provide will contribute to valuable research at the Census Bureau.

This survey is being administered by Survey Monkey and resides on a server outside of the Census Bureau Domain. The Census Bureau cannot guarantee the protection of survey responses and advises against the inclusion of sensitive personal information in any response. By proceeding with this study, you give your consent to participate in this study.

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Please read the below information about confidentiality at the Census Bureau:

Confidentiality at the Census Bureau: {Insert one of four pledge versions, randomly assigned}

Please click to indicate that you’ve read the above information about confidentiality at the Census Bureau.

{I have read about confidentiality at the Census Bureau}

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1. In your own words, please summarize the information about confidentiality at the Census Bureau.

2. Please list as many words or phrases as you can from that information:

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1. Please check the words that were part of the information about confidentiality:

   1. Census Bureau

   2. Department of Labor (DOL)

   3. Internal Revenue Service (IRS)

   4. Department of Homeland Security (DHS)

   5. Consumer Financial Protection Bureau (CFPB)

   6. Mandatory

   7. Voluntary

   8. Law

   9. Statistical

   10. Security

   11. Monitoring

   12. Consent

   13. Confidential

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Here is the text about how your information is kept confidential at the Census Bureau again {show one of four versions}.

3. Now that you see the text again, please rephrase it using your own words.

4. Do you have any concerns about how the Census Bureau would keep your information confidential?

   1. Yes

   2. No

5. Would how the Census Bureau keeps your information play a role in your decision to participate in a Census Bureau survey or not?

   1. Yes

   2. No

6. According to this pledge, who would have access to the information you provided on a Census Bureau survey? (mark all that apply)

   1. Census Bureau

   2. Department of Labor (DOL)

   3. Internal Revenue Service (IRS)

   4. Social Security Administration (SSA)

   5. Department of Homeland Security (DHS)

   6. The Census Bureau

   7. Congress

   8. The White House

   9. All government agencies

   10. Other, please specify:

7. According to this pledge, what could be done with the information you provided on a Census Bureau survey? (mark all that apply)

   1. It could be combined with other respondents’ survey answers to create statistics

   2. It could be given to other statistical agencies for policy making

   3. It could be given to other federal agencies for law enforcement

   4. It could be given to the IRS for tax enforcement

   5. It could be given to private companies for telemarketing

   6. Other

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The Census Bureau is a federal agencies that conducts many surveys, most notably a head count of the U.S. population every 10 years. Many other agencies rely on data from the Census Bureau also, so it is extremely important that the information collected by the Census Bureau be as accurate and as representative of the population as possible.

1. Prior to today, had you heard of the Census Bureau?

   1. Yes

   2. No

2. Have you ever completed a survey for the US Government?

   1. Yes

   2. No

3. How do you think the government keeps survey data confidential? {open ended}

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8. Are you male or female?

   1. Male

   2. Female?

9. What is your age?

   1. Under 18

   2. 18-24

   3. 25-34

   4. 35-44

   5. 45-54

   6. 55-64

   7. 65+

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

    1. Yes

    2. No

11. What is your race?

    1. White

    2. Black or African American

    3. American Indian or Alaska Native

    4. Asian

    5. Native Hawaiian or Other Pacific Islander

12. What the your highest level of education?

    1. Less than high school diploma or GED

    2. High school diploma or GED

    3. Some college

    4. College Graduate or Professional Degree

13. In the last 3 months, have you attended school or college?

    1. Yes

    2. No

14. Last week, did you work for pay at a job (or business)?

    1. Yes

    2. No – Did not work (or Retired)

15. Did you work for –

    1. A government (federal , state, local) office or agency?

    2. A college or university?

    3. Another private organization or were self-employed?

16. What is your occupation?

    1. Education, training and library (e.g., teachers, professors)

    2. Community and social service (e.g., social workers)

    3. Management, business, and science occupations (e.g., human resource workers, economists)

    4. Legal occupations

    5. Healthcare practitioners and technical occupations

    6. Heathcare support occupation

    7. Sales and office occupations (e.g., real estate agents, billing clerks)

    8. Other, specify:______

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1. Any final comments or thoughts about confidentiality at the Census Bureau?

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