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. Are you male or female?

• Male

• Female

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

• Yes

• No

8. 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

• Some other race

9. In what city and country were you born? ______________________________

10. How long have you lived in the U.S.? _______months or  __________ years.

11. What is the highest level of education you have achieved?    

• Primary school (grade school)

• Secondary school, less than HS

• High school or equivalent (GED) 

• Some college, no degree  

• Currently a college student

• Associate’s degree 

• Bachelor’s degree or higher (master’s, PhD, other)

12. Do you prefer to complete forms and questionnaires in Ingles or in Spanish?

• Ingles  

• Spanish  

• Both/no preference

13. Do you sometimes read in English?

• Yes      

• No

14. Please give me a couple of examples of things you read in English:

     ___________________________________________________________________________

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

5 OMB Control Number: 0607-0989