CONJOINT EXERCISE #2: SURVEY QUESTIONNAIRE
August 21, 2015
Thank you for participating! As you know, the U.S. census is conducted every 10 years. This survey is your opportunity to provide input to the U.S. Census Bureau as it considers new ways to encourage people to participate in the census.
1 |
The Federal Government uses information from the census for a variety of purposes. Which of the following purposes do you think is most important? |
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Calculate the number of people eligible for Social Security and Medicare benefits |
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Monitor compliance with anti-discrimination laws such as Voting Rights Act and Civil Rights Act |
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Help allocate funds to your state, community, and school district for services including education, health care, and new business development. |
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Help ensure the political representation of your community by allocating seats in the House of Representatives |
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No opinion |
2 |
Which of these statements would compel you to fill out your Census form? |
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You are required by law to respond to the Census. |
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The Census is required by law (Title 13 U.S. Code Sections 141 and 193). |
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Collection of the information is Mandatory and is collected under Title 13 U.S. Code Sections 141 and 193. |
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None of these/No opinion |
3 |
Which of these statements would compel you to fill out your Census form? |
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If you do not respond, the Census Bureau may use other government records to complete the census for you. |
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If you do not respond, a Census Bureau interviewer may visit you to complete the census. |
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If you do not respond, a Census Bureau interviewer may visit you to complete the census or we may use other government records to complete the census for you. |
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None of these/No opinion |
4 |
There are several different ways that the Census Bureau could describe how it protects your information.
Which of the following do you think is the best way to describe the Census Bureau's promise of confidentiality? Select one. |
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The Census Bureau is required by U.S. law to keep your answers confidential. This means that the Census Bureau cannot give out information that identifies you or your household. |
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The Census Bureau is required by U.S. law to keep your answers confidential. Your answers will only be used for statistical purposes, and no other purpose. |
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The Census Bureau is required by U.S. law (Title 13, Section 193) to keep your answers confidential. |
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None of these/No opinion |
Conjoint Exercise #2
5 |
The next series of questions presents several different ways that the U.S. census could be presented to people. There are two choices on each page. Please pick the best choice on each page. |
NOTE TO PROGRAMMER: USE THE ‘BEST CHOICE’ MODE FOR PROGRAMMING. ALSO, SHOW ONLY TWO CHOICES PER PAGE. INVESTIGATE USE OF LINES OR SHADING TO DIFFERENTIATE ROWS, AS WELL AS NAMING DIFFERENT CHOICES.
Below are two different ways that the Census Bureau could describe the census. Comparing the two descriptions, which one would you be more likely to respond to?
|
Attribute |
Level 1 |
Level 2 |
Level 3 |
Level 4 |
1 |
Use of Data |
Calculate the number of people eligible for Social Security and Medicare benefits |
Monitor compliance with anti-discrimination laws such as Voting Rights Act and Civil Rights Act |
Help allocate funds to your state, community, and school district for services including education, health care, and new business development. |
Help ensure the political representation of your community by allocating seats in the House of Representatives
|
2 |
What Is Required |
You are required by law to respond to the census. |
The census is required by law (Title 13 U.S. Code Sections 141 and 193). |
Collection of the information is Mandatory and is collected under Title 13 U.S. Code Sections 141 and 193. |
You are required by law to respond to the census. |
3 |
What Happens If You Do Not Respond |
The Census Bureau may use other government records to complete the census for you. |
A Census Bureau interviewer may visit you to complete the census. |
A Census Bureau interviewer may visit you to complete the census or we may use other government records to complete the census for you. |
|
4 |
Confidentiality Protection |
The Census Bureau is required by U.S. law to keep your answers confidential. This means that the Census Bureau cannot give out information that identifies you or your household |
The Census Bureau is required by U.S. law to keep your answers confidential. Your answers will only be used for statistical purposes, and no other purpose. |
The Census Bureau is required by U.S. law (Title 13, Section 193) to keep your answers confidential. |
|
Demographics
6 |
Are you male or female? |
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Male |
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Female |
7 |
What is your age? |
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Less the 18 years old |
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18-24 |
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25-34 |
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35-44 |
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45-54 |
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55-64 |
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65 -74 |
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75 or older |
8 |
Are you of Hispanic or Latino origin? |
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Yes > SHOW: “Hispanics can be any race” in Q9 |
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No |
9 |
(IF HISPANIC – YES IN Q8 - SHOW: “Hispanics can be of any race.”) What is your race? You may select one or more. |
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White |
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Black or African American |
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American Indian or Alaska Native |
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Asian |
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Native Hawaiian or other Pacific Islander |
10 |
What is your highest level of education? |
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Less than high school diploma or GED |
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High school diploma or GED |
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Some college |
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College graduate or professional degree |
11 |
In the past last 3 months, have you attended school or college? |
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Yes |
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No |
12 |
Last week, did you work for pay at a job (or business)? |
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Yes |
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No |
13 |
Did you work for … |
|
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A government (federal, state, local) office or agency? |
|
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A college or university? |
|
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Another private organization or were self-employed? |
|
14 |
What was your occupation? |
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Education, training, and library (e.g., teachers, professors) |
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Community and social service (e.g., social workers) |
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Management, business, and science occupations (e.g., human resources workers, economists) |
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Legal occupations |
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Healthcare practitioners and technical occupations |
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Healthcare support occupations |
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Sales and office occupations (e.g., real estate agents, billing clerks) |
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Other: Please specify |
GO TO CLOSE
CLOSE. Thank you very much for participating in this important study. Your responses will be extremely helpful to the U.S. Census Bureau.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Rebecca Quarles |
File Modified | 0000-00-00 |
File Created | 2021-01-28 |