Screener, Recruitment Ads, Consent Forms

Attachment III

2018 NCVS PPCS Cognitive Interview Recruitment Eligibility Screener

Screening Questionnaire for PPCS Participant Recruitment:

1. How often did you usually drive in the past 12 months. Did you drive…

 Every day or almost every day?

 A few days a week?

 A few days a month?

 A few times a year?

 Never?

2. Have you had any contact with the police in the last 12 months? This could include times you contacted the police, as well as times that the police initiated the contact.

Yes No DK

3. [If yes] How many contacts have you had with police in the last 12 months? ______

4a. [If one contact] Can you tell me a little about the contact with the police? Write in ________________

4b. [If more than one] Starting with the most recent contact, can you tell me a little about that contact with the police? Write in ________________

Who initiated the contact with the police. Did…

• You contact the police?

• Someone else contact the police for you?

• The police initiate the contact?

• DK

4c. [After asking about most recent] Were any of the other contacts with police for a different reason than the one you just told me about? Yes No DK

4d. [If yes]Can you tell me a little about that contact with the police?

Write in ________________

Who initiated the contact with the police. Did…

• You contact the police?

• Someone else contact the police for you?

• The police initiate the contact?

• DK

Attachment IV

2018 NCVS PPCS Cognitive Interview Recruitment Advertisement

Recruitment advertisement text for Participants

The Census Bureau is looking for people ages 16 or older to help test question wording on a national survey about police-related interactions. Interviews will take place at a convenient location, including at the Census Bureau in Suitland, Maryland. Participants will be given $40 for one hour of their time.

We are looking for people ages 16 or older who have interacted with police in the past 12 months for the following reasons:

• To report a crime

• Were pulled over for a traffic stop (while driving or as a passenger)

• To ask the police for directions

• Other types of interactions with police not listed above

If you or someone you know is interested in participating, please call (301)763-4979 for further information.

U.S. Census Bureau employees are sworn to protect confidentiality by Title 13 of the U.S. Code. People sworn to uphold Title 13 are legally required to maintain the confidentiality of your data. Every person with access to your data is sworn for life to protect your information and understands that the penalties (fines up to $250,000 and up to 5 years in prison) for violating this law are applicable for a lifetime.

2018 NCVS PPCS Cognitive Interview Recruitment Advertisement

Recruitment advertisement text for Census Bureau employee referrals

Broadcast Email Announcement

Subject: Participants needed for questionnaire testing

From the Desk of Paul Beatty, Chief, Center for Survey Measurement...

The Center for Survey Measurement is seeking people ages 16 or older to participate in a questionnaire pretest between June and mid-November of 2017.

We are looking for people ages 16 or older who have interacted with police in the past 12 months for the following reasons:

• To report a crime

• Were pulled over for a traffic stop (while driving or as a passenger)

• To ask the police for directions

• Other types of interactions with police not listed above

If you know anyone who meets these criteria, we'd appreciate it if you let them know of the research opportunity.  Participants will be paid $40. 

Interviews are 60 minutes and take place at the Census Bureau Headquarters in Suitland, MD or a location convenient to the participant.

Contact us at (301) 763-4979 if you are interested or would like further information.

Attachment IV

Consent Form

National Crime Victimization Survey, Police Public Contact Survey

Each year the Census Bureau conducts many different surveys. The Census Bureau routinely tests the questions used on these surveys in order to produce the best information possible.

______________________ [NAME] consents to take part in a study to improve the questions that will be used in the Police Public Contact Survey, a supplement to the National Crime Victimization Survey. In order to have a complete record of all comments, the interview session will be audiotaped. The Census Bureau plans to use the tapes to improve the questionnaire. Staff directly involved in the questionnaire design research project will have access to the tapes. Participation is voluntary and answers will remain strictly confidential.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have agreed to participate in this Census Bureau questionnaire design study, and I give permission for my tapes to be used for the purposes stated above.

____________________________ ___________________________

Participant's Signature Researcher's Signature

____________________________ __________________________

Printed Name Printed Name

___________________________ _______________________

Date Date

Consent Form

National Crime Victimization Survey, Police Public Contact Survey

Each year the Census Bureau conducts many different surveys. The Census Bureau routinely tests the questions used on these surveys in order to produce the best information possible.

______________________ [CHILD’S NAME] has permission to take part in a study to improve the questions that will be used in the Police Public Contact Survey, a supplement to the National Crime Victimization Survey. In order to have a complete record of your child’s comments, the interview session will be audiotaped. The Census Bureau plans to use the tapes to improve the questionnaire. Staff directly involved in the questionnaire design research project will have access to the tapes. Participation is voluntary and answers will remain strictly confidential.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have agreed to allow my child to participate in this Census Bureau questionnaire design study, and I give permission for his/her tapes to be used for the purposes stated above.

____________________________ ___________________________

Parent's Signature Researcher's Signature

____________________________ __________________________

Printed Name Printed Name

___________________________ _______________________

Date Date

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