2016 Census Test - Focus Group Participants

ID #

Focus Group Worksheet

2016 Census Test

Please answer the following questions based on what you can recall about the 2016 Census Test. Please do NOT include phone calls or messages from the Census Bureau about this focus group.

1. Do you remember being contacted by the Census Bureau about the 2016 Census Test?

• Yes

• I saw advertisements

• I received an email

• I received a postcard

• I received a letter

• I received a phone call

• I received a text message

• Someone came to my home

• No – Skip to question #3

2. How were you instructed to respond to the 2016 Census Test? Select all that apply.

• Through email

• Online form

• By phone

• Mail-in paper form

• In person

3. Did you respond to the 2016 Census Test?

• Yes

• No

• Don’t know

4. Did you respond to the 2010 Census?

• Yes

• No

• Don’t know

****There are more questions on the back****

5. In what year were you born? __________________ year

6. What is the highest grade or year of school you have completed?

• Less than high school

• Completed high school

• Some college, no degree

• Associate’s degree (AA/AS)

• Bachelor’s degree (BA/BS)

• Post-bachelor’s degree (for example, MA, MS, PhD, MD)

7. Are you male or female?

• Male

• Female

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

• Yes

• No

9. What is your race? Choose one or more races.

• White

• Black or African American

• American Indian or Alaska Native

• Asian

• Native Hawaiian or Other Pacific Islander

If you did not respond to the 2016 Census Test, please write why you did not respond in the space below.

3 OMB Control Number: 0607-0989