Major Changes to the Internet Spec for 2015 National Test
Changes to internet instrument for 2015 NCT_.docx
2015 National Content Test
Major Changes to the Internet Spec for 2015 National Test
OMB: 0607-0985
Major Changes to the Internet Spec for 2015 National Test
For the National Content Test in September 2015, we will be testing content changes to the roster section, the relationship question, and the race/ethnicity questions. This document will outline the current and test versions of these questions.
Notable changes:
ADDRESS screens
ROSTER
Replication of the current roster series (2015 CT version)
New rules-based version, similar to what was used in 2012
PEOPLE
Current approach: Lines displayed for 6 names on PEOPLE screen, with three additional lines added if “Click her to add more people” is clicked
New approach: One name collected at a time
RELATIONSHIP
Replication of the current version, used in the 2010 Census
New version that eliminates the “husband or wife” and “unmarried partner” categories and replaces them with “same-sex spouse”, “opposite-sex spouse”, “same-sex unmarried partner” and “opposite-sex unmarried partner”
RACE/HISPANIC ORIGIN
One entirely new format of race/Hispanic origin questions
Minor modifications to two other formats which were used in the 2012 and 2014 tests
Addition of Middle Eastern or North African response category
Replacement of “origin” in question stem and response categories with either “ethnicities” or a larger change to remove all terms and use “which categories describe this person”
Replacing the current instruction following the race and Hispanic origin question to remove the visual cue and reiterate to respondents that they can select multiple categories
We will discuss the specific changes outlined above in more detail throughout this document.
Address screens
The 2015 NCT is testing using a mail out internet push strategy in Puerto Rico. Puerto Rico has different address standards than found in the rest of the U.S. Screens used to collect addresses for cases in Puerto Rico will have different fields and a different layout to facilitate Puerto Rican address collection.
Para obtener las direcciones con un nombre de la calle
KM HM
.
PR
Para obtener las direcciones sin un nombre de la calle
PR
Roster
We are testing two approaches to determine who resides in the household on census day. The first is a rules-based approach, which was used in the 2010 Census and the 2012 National Census Test. This approach presents respondents with rules and example situations and asks them to apply these to their household and report a population count. After the number of people is entered, the respondent is asked to provide names for each of those people. An example of the rules-based approach used in 2012 is below:
Roster 1
If the total count of people collected during the roster section of the survey does not match the number entered on ROSTER 1, there is a soft edit: “Earlier, you said that the number of people living or staying at <ADDRESS> <will be/was> <POPCOUNT>, but you have listed a name for <PERSONCOUNT> <person/people>. Please review the people you have listed.”
The second approach is the approach that was used in the 2015 Census Test and doesn’t present rules or ask for an initial count of the people living or staying at the address. ANYONE asks “On September 1, 2015, <will there be/was there> anyone else living or staying at <ADDRESS>?” The rules that are displayed on the Roster 1 screen are instead shown in the help text for the Anyone screen.
Anyone
People
We will have 2 versions of the People screen. The first will collect names as in the spring 2015 test.
People
The second will collect one name at a time and First, Middle Last names will be listed vertically, consistent with the mobile layout. After each name, respondents will click the add more people link to add more hh members.
Relationship
We are testing two versions of the relationship question. The first version replicates what was used in the 2010 Census and has the following response categories:
Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild
Parent-in-law
Son-in-law or daughter-in-law
Other relative
Roomer or boarder
Housemate or roommate
Unmarried partner
Foster child
Other nonrelative
The test version is largely the same as the current, but expands the husband/wife and unmarried partner categories. The specific categories are as follows:
Opposite-sex husband/wife/spouse
Same-sex husband/wife/spouse
Opposite-sex unmarried partner
Same-sex unmarried partner
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild
Parent-in-law
Son-in-law or daughter-in-law
Other relative
Roomer or boarder
Housemate or roommate
Foster child
Other nonrelative
Both of these versions were also tested in the 2014 Census Test.
RACE/HISPANIC ORIGIN
For the race and Hispanic origin questions, we are testing four different question formats, two response categories, two question terms, and two instructions. This results in 32 versions of the race question. The formats described below give an idea of how the different versions of the question will look. We will first describe the changes to the response categories, question terms, and instructions and then provide all combinations of the question, with the new formats.
Question Formats
We will be testing three different versions of the race and Hispanic origin questions. The versions focus on different ways to combine the questions and collect detailed information.
Separate Questions – this version of the question ask Hispanic origin and race as separate questions for each household member, similar to the format used in the 2010 Census. Respondents are first asked the Hispanic origin question which is followed by the race question on the subsequent screen. The major difference from the 2010 version of the question is that write-in spaces and examples are provided for the “White” and “Black or African Am.” categories.
Combined Question with Checkboxes and Write-ins on Separate Screens
This format of the race/Hispanic origin question first asks the mandatory OMB response categories on one page and then uses subsequent screens to collect the detailed origin information. On the first screen, only the OMB checkbox categories are shown. Once the categories have been selected, subsequent screens solicit detail for each category, one at a time, as a single write-in space. The purpose is to elicit more detail for the detailed origins. The same version was used in the 2014 and 2015 Census Tests. Write-in boxes will use predictive text.
Combined Question Branching with Detailed Checkbox Screens
This format of the race/Hispanic origin question is an alternative method of soliciting detailed origin groups using separate screens. On the first screen, only the OMB checkbox categories are shown (As in format #2 above). Once the OMB categories have been selected, subsequent screens solicit detail for each category the respondent selected, one at a time, in a series of additional checkboxes and write-in spaces. This version of the question is new and has not been used in a previous test.
Race Response Categories
We will be testing the inclusion of a “Middle Eastern or North African” (MENA) category. For each of the three formats, we will have one version that contains the MENA category and one that does not. The specific wording of the MENA category is:
Middle Eastern or North African – Enter [origins/ethnicities], for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
When the MENA category is included, the examples for the White category will be modified.
Question Term
The current version of the race and Hispanic origin questions uses the term “origin” to reflect ethnicities and national origins in the question stem, instructions, and examples. For example, we ask people to “enter origin(s)” and “what is the race or origin?”.
There is some concern that the term origin is not clear to all respondents. Therefore, we are testing an two alternative terms. One alternative is to replace “origin(s)” with “ethnicities,” while another is to remove the terms altogether and change the question wording to: “which categories describe NAME?” We will test both the new term and the original term in all three formats with and without the MENA category. If we use “ethnicities,” it will be a simple replacement of the word “origin.” However, if we remove the terms altogether, it will require a larger rewrite of the questions and response options. This document includes all three scenarios. The origin and ethnicity options are combined and are designated by [origin/ethnicity] to represent a fill depending on which version is being used. The new question wording is shown in its own version of the question.
Instructions
Currently, our instructions for the race and Hispanic origin questions ask respondents to “Select one or more boxes.” Focus group and qualitative research have concluded that respondents frequently overlook the instruction. Therefore, we will test a new version of the instruction that explicitly tells respondents they can report multiple groups:
“Select all boxes that apply AND enter the detailed [origin/ethnicity] in the spaces below. Note that you may report multiple groups.”
If we are using the alternative question term, the instruction will be: “Select all boxes that apply AND enter the details in the spaces below. Note that you may report multiple groups.”
This instruction will be tested with each format of the question, the inclusion/exclusion of the MENA category, and the alternative term.
The specific race questions we will be testing, which combine all of the changes described above, constitute the remainder of this document.
PANELS 1-12: SEPARATE QUESTION – NO BRANCHING
Race 1
Separate Question, without MENA, with “Origin,” with original instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select one or more boxes AND enter origins. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select one or more boxes AND enter origins. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec,
Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or origin
Race 2
Separate Question, without MENA, with “Origin,” with new instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select all boxes that apply AND enter origins. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select all boxes that apply AND enter origins in the spaces below. Note, you may report more than one group. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or origin
Race 3
Separate Question, without MENA, with “Ethnicity,” with original instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select one or more boxes AND enter ethnicities. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select one or more boxes AND enter ethnicities. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or ethnicity
Race 4
Separate Question, without MENA, with “Ethnicity,” with new instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select all boxes that apply AND enter ethnicities. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select all boxes that apply AND enter ethnicities. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or ethnicity
Race 5
Separate Question, without MENA, with “Which categories describe this person,” with original instruction
Page 1 – Hispanic origin
Which categories describe NAME? Select one or more boxes AND enter details. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
Which categories describe NAME? Select one or more boxes AND enter details. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race, ethnicity, or origin – Enter details
Race 6
Separate Question, without MENA, with “Which categories describe this person,” with new instruction
Page 1 – Hispanic origin
Which categories describe NAME? Select all boxes that apply AND enter details. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
Which categories describe NAME? Select all boxes that apply AND enter details. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race, ethnicity, or origin – Enter details
Race 7
Separate Question, with MENA, with “Origin,” with original instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select one or more boxes AND enter origins. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select one or more boxes AND enter origins. (Help)
White – Enter, for example, German, Irish, English, Italian, Polish, French, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or origin
Race 8
Separate Question, with MENA, with “Origin,” with new instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select all boxes that apply AND enter origins. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select all boxes that apply AND enter origins in the spaces below. Note, you may report more than one group. (Help)
White – Enter, for example, German, Irish, English, Italian, Polish, French, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or origin
Race 9
Separate Question, with MENA, with “Ethnicity,” with original instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select one or more boxes AND enter ethnicities. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select one or more boxes AND enter ethnicities. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or ethnicity
Race 10
Separate Question, with MENA, with “Ethnicity,” with new instruction
Page 1 – Hispanic origin
Is NAME of Hispanic, Latino, or Spanish origin? Select all boxes that apply AND enter ethnicities. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
What is NAME’s race? Select all boxes that apply AND enter ethnicities in the spaces below. Note, you may report more than one group. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race – Enter race or ethnicity
Race 11
Separate Question, with MENA, with “Which categories describe this person,” with original instruction
Page 1 – Hispanic origin
Which categories describe NAME? Select one or more boxes AND enter details. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
Which categories describe NAME? Select one or more boxes AND enter details. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race, ethnicity, or origin – Enter details
Race 12
Separate Question, with MENA, with “Which categories describe this person,” with new instruction
Page 1 – Hispanic origin
Which categories describe NAME? Select all boxes that apply AND enter details. Note, you may report more than one group. (Help)
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.
Page 2 – Race
Which categories describe NAME? Select all boxes that apply AND enter details. (Help)
White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Black or African Am. – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
American Indian or Alaska Native – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.
Native Hawaiian
Samoan
Chamorro
Other Pacific Islander – Enter, for example, Tongan, Fijian, Marshallese, etc.
Some other race, ethnicity, or origin – Enter details
PANELS 13-24: COMBINED QUESTION 1 – BRANCHING WITH WRITE-IN SCREENS
**See Appendix 1 for full list of Screen 2 examples
Race 13
Combined with Write-Ins, without MENA, with “Origin,” with original instruction
Screen 1:
What is NAME’s race or origin? Select one or more boxes. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or origin
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected race>
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> origins? Enter, for example, <Fill example list corresponding to the selected race>
Race 14
Combined with Write-Ins, without MENA, with “Origin,” with new instruction
Screen 1:
What is NAME’s race or origin? Select all boxes that apply. Note, you may report more than one group. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or origin
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> origins? Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Race 15
Combined with Write-Ins, without MENA, with “Ethnicity,” with original instruction
Screen 1:
What is NAME’s race or ethnicity? Select one or more boxes. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected race>
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> ethnicities? Enter, for example, <Fill example list corresponding to the selected race>
Race 16
Combined with Write-Ins, without MENA, with “Ethnicity,” with new instruction
Screen 1:
What is NAME’s race or ethnicity? Select all boxes that apply. Note, you may report more than one group. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Race 17
Combined with Write-Ins, without MENA, with “Which categories describe this person,” with original instruction
Which categories describe NAME? Select one or more boxes. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>
Race 18
Combined with Write-Ins, without MENA, with “Which categories describe this person,” with new instruction
Which categories describe NAME? Select all boxes that apply. Note, you may report more than one group. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Note, you may report more than one group.
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Note, you may report more than one group.
Race 19
Combined with Write-Ins, with MENA, with “Origin,” with original instruction
Screen 1:
What is NAME’s race or origin? Select one or more boxes. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or origin
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected race>
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected race>
Race 20
Combined with Write-Ins, with MENA, with “Origin,” with new instruction
Screen 1:
What is NAME’s race or origin? Select all boxes that apply. Note, you may report more than one group. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or origin
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Race 21
Combined with Write-Ins, with MENA, with “Ethnicity,” with original instruction
Screen 1:
What is NAME’s race or ethnicity? Select one or more boxes. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected race>
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected race>
Race 22
Combined with Write-Ins, with MENA, with “Ethnicity,” with new instruction
Screen 1:
What is NAME’s race or ethnicity? Select all boxes that apply. Note, you may report more than one group. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected race>. Note, you may report more than one group.
Race 23
Combined with Write-Ins, with MENA, with “Which categories describe this person,” with original instruction
Which categories describe NAME? Select one or more boxes. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>
Race 24
Combined with Write-Ins, with MENA, with “Which categories describe this person,” with new instruction
Which categories describe NAME? Select all boxes that apply. Note, you may report more than one group. (Help)
White – For example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
Hispanic, Latino, or Spanish origin – For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African Am. – For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native – For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African – For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for each race or origin.
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill first category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Note, you may report more than one group.
Screen 3:
You said that NAME is:
<Fill selected categories from screen 1>
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Note, you may report more than one group.
PANLES 25-36: COMBINED QUESTION 2 – BRANCHING WITH DETAILED CHECKBOX SCREENS
**See Appendix 1 for full list of Screen 2 examples
Race 25
Combined with Checkboxes, without MENA, with “Origin,” with original instruction
What is NAME’s race or origin? Select one or more boxes. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Some other race or origin
Screen 2:
Next, we will collect detailed information for each race or origin selected.
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter origins in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter origins in the space below.
Race 26
Combined with Checkboxes, without MENA, with “Origin,” with new instruction
What is NAME’s race or origin? Select all boxes that apply. Note, you may report more than one group. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Some other race or origin
Screen 2:
Next, we will collect detailed information for each race or origin selected. Note, you may report more than one group.
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter origins in the space below. Note, you may report more than one group.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the first - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter origins in the space below. Note, you may report more than one group.
Race 27
Combined with Checkboxes, without MENA, with “Ethnicity,” with original instruction
What is NAME’s race or ethnicity? Select one or more boxes. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or ethnicity selected.
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter ethnicities in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter ethnicities in the space below.
Race 28
Combined with Checkboxes, without MENA, with “Ethnicity,” with new instruction
What is NAME’s race or ethnicity? Select all boxes that apply. Note, you may report more than one group. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or ethnicity selected. Note, you may report more than one group.
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter ethnicities in the space below. Note, you may report more than one group.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter ethnicities in the space below. Note, you may report more than one group.
Race 29
Combined with Checkboxes, without MENA, with “Which categories describe this person,” with original instruction
Which categories describe NAME? Select one or more boxes. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for each category selected.
What are NAME’s <Fill first category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter details in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter details in the space below.
Race 30
Combined with Checkboxes, without MENA, with “Which categories describe this person,” with new instruction
Which categories describe NAME? Select all boxes that apply. Note, you may report more than one group. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for each category selected. Note, you may report more than one group.
What are NAME’s <Fill first category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter details in the space below. Note, you may report more than one group.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter details in the space below. Note, you may report more than one group.
Race 31
Combined with Checkboxes, with MENA, with “Origin,” with original instruction
What is NAME’s race or origin? Select one or more boxes. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Some other race or origin
Screen 2:
Next, we will collect detailed information for each origin selected.
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter origins in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter origins in the space below.
Race 32
Combined with Checkboxes, with MENA, with “Origin,” with new instruction
What is NAME’s race or origin? Select all boxes that apply. Note, you may report more than one group. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Some other race or origin
Screen 2:
Next, we will collect detailed information for each race or origin selected. Note, you may report more than one group.
What are NAME’s <Fill first category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter origins in the space below. Note, you may report more than one group.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> origins? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter origins in the space below. Note, you may report more than one group.
Race 33
Combined with Checkboxes, with MENA, with “Ethnicity,” with original instruction
What is NAME’s race or ethnicity? Select one or more boxes. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or ethnicity selected.
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter ethnicities in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter ethnicities in the space below.
Race 34
Combined with Checkboxes, with MENA, with “Ethnicity,” with new instruction
What is NAME’s race or ethnicity? Select all boxes that apply. Note, you may report more than one group. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Some other race or ethnicity
Screen 2:
Next, we will collect detailed information for each race or ethnicity selected. Note, you may report more than one group.
What are NAME’s <Fill first category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter ethnicities in the space below. Note, you may report more than one group.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> ethnicities? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter ethnicities in the space below. Note, you may report more than one group.
Race 35
Combined with Checkboxes, with MENA, with “Which categories describe this person,” with original instruction
Which categories describe NAME? Select one or more boxes. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for each category selected.
What are NAME’s <Fill first category selected on screen one> categories? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter details in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Select one or more boxes and/or enter details in the space below.
Race 36
Combined with Checkboxes, with MENA, with “Which categories describe this person,” with new instruction
Which categories describe NAME? Select all boxes that apply. Note, you may report more than one group. (Help)
White
Hispanic, Latino, or Spanish origin
Black or African Am.
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Some other race, origin, or ethnicity
Screen 2:
Next, we will collect detailed information for category selected. Note, you may report more than one group.
What are NAME’s <Fill first category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter details in the space below. Note, you may report more than one group.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Screen 3:
Screen 3-X (examples, display the second - X of the selected categories from Screen 1):
What are NAME’s <Fill second category selected on screen one> details? – Enter, for example, <Fill example list corresponding to the selected category>. Select all boxes that apply and/or enter details in the space below. Note, you may report more than one group.
APPENDIX 1. Complete list of options for screens 2-X for Race 13 – Race 24
Original Terminology
White without MENA
What are NAME’s White [origins/ethnicities]? – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
White MENA
What are NAME’s White [origins/ethnicities]? – Enter, for example, German, Irish, English, Italian, Polish, French, etc.
Hispanic
What are NAME’s Hispanic [origins/ethnicities]? – Enter, for example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African American
What are NAME’s Black or African American [origins/ethnicities]? – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian
What are NAME’s Asian [origins/ethnicities]? – Enter, for example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native
What are NAME’s American Indian or Alaska Native [origins/ethnicities]? – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African
What are NAME’s Middle Eastern or North African [origins/ethnicities]? – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander
What are NAME’s Native Hawaiian or Other Pacific Islander [origins/ethnicities]? – Enter, for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race or [origin/ethnicity]
Enter other details about NAME’s [origins/ethnicities]? – Enter details
New Terminology
White without MENA
What are NAME’s White details? – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.
White MENA
What are NAME’s White details? – Enter, for example, German, Irish, English, Italian, Polish, French, etc.
Hispanic
What are NAME’s Hispanic, Latino, or Spanish details? – Enter, for example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.
Black or African American
What are NAME’s Black or African American details? – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.
Asian
What are NAME’s Asian details? – Enter, for example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.
American Indian or Alaska Native
What are NAME’s American Indian or Alaska Native details? – Enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
Middle Eastern or North African
What are NAME’s Middle Easter or North African details? – Enter, for example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.
Native Hawaiian or Other Pacific Islander
What are NAME’s Native Hawaiian or Other Pacific Islander details? – Enter, for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
Some other race, origin, or ethnicity
What are NAME’s other race, origin, or ethnicity details? – Enter details
APPENDIX 2. Complete list of options for screens 2-X for Race 25 – Race 36
Original Terminology
White – Without MENA
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
WHITE
German
Irish
English
Italian
Lebanese
Egyptian
Enter, for example, Polish, French, Iranian, etc.
White – With MENA
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
WHITE
German
Irish
English
Italian
Polish
French
Enter, for example, Scottish, Norwegian, Dutch, etc.
Hispanic
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Black or African American
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
BLACK OR AFRICAN AMERICAN
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somalian
Enter, (for example, Ghanaian, South African, Barbadian, etc.
Asian
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
ASIAN
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Enter, for example, Pakistani, Cambodian, Hmong, etc.
American Indian or Alaska Native
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
AMERICAN INDIAN
ALASKA NATIVE
Enter, for example, Native Village of Barrow Inupiat Traditional Government,
Nome Eskimo Community, Orutsararmuit Native Village, etc.
CENTRAL OR SOUTH AMERICAN INDIAN
Enter, for example, Mayan, Aztec, Taino, etc.
Middle Eastern or North African
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
MIDDLE EASTERN OR NORTH AFRICAN
Lebanese
Iranian
Egyptian
Syrian
Moroccan
Algerian
Enter, for example, Israeli, Iraqi, Tunisian, etc.
Native Hawaiian or Other Pacific Islander
Select all boxes that apply and/or enter [origins/ethnicities] in the space below.
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Enter, for example, Palauan, Tahitian, Chuukese, etc.
Some other race or [origins/ethnicities]
Enter other details about NAME’s [origins/ethnicities]? – Enter details
New Terminology
White – Without MENA
Select all boxes that apply and/or enter details in the space below.
WHITE
German
Irish
English
Italian
Lebanese
Egyptian
Enter, for example, Polish, French, Iranian, etc.
White – With MENA
Select all boxes that apply and/or enter details in the space below.
WHITE
German
Irish
English
Italian
Polish
French
Enter, for example, Scottish, Norwegian, Dutch, etc.
Hispanic
Select all boxes that apply and/or enter details in the space below.
HISPANIC, LATINO, OR SPANISH
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc.
Black or African American
Select all boxes that apply and/or enter details in the space below.
BLACK OR AFRICAN AMERICAN
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somalian
Enter, for example, Ghanaian, South African, Barbadian, etc.
Asian
Select all boxes that apply and/or enter details in the space below.
ASIAN
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Enter, for example, Pakistani, Cambodian, Hmong, etc.
American Indian or Alaska Native
Select all boxes that apply and/or enter details in the space below.
AMERICAN INDIAN
ALASKA NATIVE
Enter, for example, Native Village of Barrow Inupiat Traditional Government,
Nome Eskimo Community, Orutsararmuit Native Village, etc.
CENTRAL OR SOUTH AMERICAN INDIAN
Enter, for example, Mayan, Aztec, Taino, etc.
Middle Eastern or North African
Select all boxes that apply and/or enter details in the space below.
MIDDLE EASTERN OR NORTH AFRICAN
Lebanese
Iranian
Egyptian
Syrian
Moroccan
Algerian
Enter, for example, Israeli, Iraqi, Tunisian, etc.
Native Hawaiian or Other Pacific Islander
Select all boxes that apply and/or enter details in the space below.
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Enter, for example, Palauan, Tahitian, Chuukese, etc.
Some other race, origin, or ethnicity
Enter other details about NAME’s race, origin or ethnicity – Enter details
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Rachel T Horwitz |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |
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