Telephone Screener - NSSRN
Hello, I’m _____________ from the Census Bureau. Thank you for contacting us about participating in our research study on Registered Nurses. I just need to get a little bit of background information to start.
ID Number:
Contact Date:
What is your name?
First name:
Last name:
(Ask if not obvious) Are you male or female?
o Male
o Female
In what year were you born?
Are you employed by the Federal Government? (if federal contractor, mark NO)
o Yes
o No
Are you licensed to practice as a registered nurse in the United States?
Yes
No
If yes:
Are you currently working as a registered nurse or nurse practitioner?
Yes
No
In what city, state, and ZIP code do you currently live?
City: State: Zip:
E-mail link
Census Bureau employee
Friend or family member (but not a Census Bureau employee)
Craigslist
Google advertisement
Flyer
Newspaper advertisement
Other – specify:
Have you participated in any research studies with the U.S. Census Bureau?
o Yes
o No
What is your daytime telephone number?
What is the e-mail address we should use when sending directions to our office, should you qualify?
Are you a United States citizen? You do not have to be a U.S. citizen to participate in our studies.
o Yes
o No
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Slight changes to participate |
| Author | Dawn V Nelson |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |