Form 1 Paper Questionnaire

62 In what country or territory were you born?

68

¡ In the United States (SKIP to question 64)
¡ Outside

of the United States (specific name of

¡ Now married
¡ D
 ivorced
¡ S eparated

country, or Puerto Rico, Guam, etc.)

Answer question 63 if you were born outside
of the U.S.; otherwise, SKIP to question 64.
63 When did you first move to the U.S.?

¡
¡
¡
¡

1990 or earlier
1991-1999
2000-2009
2010 or later

or Northern Marianas

69

Adults age 18 years or older

70

Children age 6 to 17 years old

71

Children age 0 to 5 years old (include babies)

72

73

74

Very well
Well
Not well
Not at all

¡ $100,000 - $149,999
¡ $150,000 - $199,999
$50,000 - $74,999 ¡ $200,000 and above

Respond now at:

Your User ID is:

Puede contestar esta encuestra en Español por Internet.

¡ Employed

full-time working

Here is some helpful information:

¡ Employed,

part-time working

§ T
 his survey should be completed by the person who typically opens the mail for your household.

Unemployed but looking for work
Homemaker or stay-at-home parent
Full-time student
Other /

Have you ever served in the U.S. military or
the military reserves?

¡ No

Do you rent or own your house or apartment?

¡ Rent

¡ Occupied without payment of rent
Which of the following best represents how
you think of yourself?

¡
¡
¡
¡
¡

§ Y
 ou can validate that this survey is a legitimate federally-approved information collection
using the U.S. Office of Management and Budget approval number XXXX-XXXX, expiring
on XX/XX/XXXX. Federal agencies may not sponsor surveys without a valid control number.
§ T
 o learn more about this survey go to: www.census.gov/CBAMS or call 1-800-XXX-XXXX.

Retired

Gay or lesbian

§ R
 esponses are voluntary, but your opinion is important. The Census Bureau will
use the results of this survey to help plan the upcoming population count.
§ W
 e will keep your answers anonymous by not asking for your name, or other personal
information that could easily identify you. Your household was selected at random to
take part in this important research study sponsored by the U.S. Census Bureau.
§ O
 nce you have completed the questionnaire, please return it using the enclosed self-addressed
stamped envelope. In case the envelope is lost, please mail the questionnaire to:
Census Attitudes Survey
c/o PSB Research
P.O. Box XXXXX
Washington, DC 20005

Straight

(that is, not gay or lesbian)
Bisexual


On behalf of the U.S. Census Bureau, thank you for completing this survey.

Other

I don’t know the answer/Prefer not to answer

THANK YOU!
OMB XXXX-XXXX

Welcome! Thank you for participating in this survey sponsored by the U.S. Department
of Commerce, U.S. Census Bureau. This survey is being conducted by PSB Research, an
independent research company working on behalf of the U.S. Census Bureau. Completing
this short 15-minute survey will help the U.S. Census Bureau conduct the 2020 Census.

$35,000 - $49,999

¡ Own

76

¡
¡
¡
¡

$25,000 - $34,999

¡ Yes

66 What is this language? If more than one,
other than English what language do
you speak most often at home? ¿

Help Improve The 2020 Census

Which of the following best describes you?

¡
¡
¡
¡
¡

75

67 How well do you speak English?

$75,000 - $99,999

less than 30 hours per week

¡ No (SKIP to question 68)

Answer questions 66 & 67 if you speak
a language other than English at home;
otherwise, SKIP to question 68.

Less than $25,000
¡

30 or more hours per week

65 Do you speak a language other than English
at home?

Census Attitudes Survey

In 2016 what was your total household
income before taxes?

¡
❍
❍
❍

¡ Yes, born abroad of U.S. citizen parent(s)
¡ Yes, U.S. citizen by naturalization
¡ No, not a U.S. citizen

¡ Yes

¡ W
 idowed
¡ N
 ever married

How many people live in your household,
including yourself?

64 Are you a citizen of the United States?

¡ Yes,

born in the United States
¡ Y es, born in Puerto Rico, Guam, the U.S. Virgin Islands,

What is your marital status?

PLEASE RETURN PROMPTLY
(see instructions on front)

The U.S. census is the count of all the people
who live in the United States. It happens
every 10 years. It asks how many people live
in your household, their age, gender, race
and ethnicity. The next census is in 2020.
1 How familiar are you with the U.S. census?

¡
¡
¡
¡
¡

7

Extremely familiar
Somewhat familiar
Not too familiar
Not at all familiar

Extremely familiar

8

Somewhat familiar

9

Not at all likely

Extremely likely
Somewhat likely
Not too likely

10

Almost constantly
Several times a day

minutes

6 Thinking about the census overall, how important
do you feel it is for you to fill out the census form?
Extremely important
Very important

¡ S ome college, but degree not received or is in
progress

About once a day
Several times a week
Once a week
Less often
Never

 hich of the following have you done online
W
in the PAST 7 DAYS? Please select all that apply.

servant to express your views

¨ Attended a neighborhood or community meeting
¨ Participated in an organized protest or rally of any kind
¨ Donated money or raised funds for social or

radio programs, or podcasts online

60

55 Thinking about the 2016 general election for President
and other offices, did you happen to vote in the election,
or did things come up that kept you from voting?

¡ Yes, voted in 2016 election
¡ No, did not vote in 2016 election

¨
¨
¨
¨
¨

Listened to satellite radio (for example Sirius XM)

Are you of Hispanic, Latino or Spanish origin?

¡
¡
¡
¡
¡

¨ None of the above

61

No, not of Hispanic, Latino or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino or Spanish origin

(specify origin, for example Argentinian,
Columbian, Nicaraguan, Spaniard and so on) ¿

What is your race? Please select all that apply.

¨ White
¨ Black, African American
¨ A
 merican Indian or Alaska Native

(specify name of enrolled or principal tribe) ¿

Listened to local broadcast radio
Read a newspaper or magazine (online or in print)
Watched network or cable TV

None of the above

57 What year were you born?

(for example YouTube or Netflix)

Professional, Doctorate)

political activity

These final questions are for statistical
purposes only…

¨ Searched for a job
¨ Watched videos over the internet

¡ Associate degree (for example AA, AS)
¡ Bachelor’s degree (for example BA, BS, AB)
¡ G
 raduate degree (for example Master’s,

¨ Volunteered at an organization
¨ Worn

a button/bracelet/pin for an issue or cause
¨ C
 ontacted, or attempted to contact, a politician or civil

56 Which of the following have you done in the
PAST 7 DAYS? Please select all that apply.

¨ Used email
¨ Streamed or downloaded music,

Not at all likely

5 Based on your past experience or just your best
guess, how long do you think it would take you
personally to fill out the census?

¡
¡
¡
¡
¡

About how often do you use the internet?

¡
¡
¡
¡
¡
¡
¡

Not too likely

Very likely

Which of the following internet services
do you have? Please select all that apply.

¨ N
 ot sure
¨ D
 o not have internet

4 Thinking about most people you know,
if the census were held today how likely
would they be to fill out the census form?

¡
¡
¡
¡
¡

Not at all likely

(for example work, school, or library)

Extremely likely

(for example GED)

social issues online

Not too likely

¨ Internet access on your cellphone or tablet
¨ Internet access outside your home

Not at all familiar

Somewhat likely

Somewhat likely

(for example DSL, cable, or fiber optic) at home

Not too familiar

Very likely

Very likely

What is the highest degree or
level of school you have completed?

¡ No high school
¡ Some high school
¡ H
 igh school graduate or equivalent

54 Which of the following have you ever done, if any?
Please select all that apply.

¨ Voted in an election
¨ Signed a petition (including online petitions)
¨ P osted your own thoughts or comments on political or

Extremely likely

¨ Dial-up internet service at home
¨ Higher-speed broadband service

Very familiar

3 If the census were held today, how likely
would you be to fill out the census form?

¡
¡
¡
¡
¡

How likely are you to encourage someone
you know to fill out the census form?

¨
¨
¨
¨
¨

Very familiar

2 How familiar are you with the way the census
impacts you and your community?

¡
¡
¡
¡
¡

59

¨ S hopped online, made travel reservations,

¨
¨
¨
¨

Asian Indian
Chinese
Filipino
G
 uamanian
or Chamorro

¨ O
 ther Asian (specify race,
for example, Hmong,
Laotian, Thai, Pakistani,
Cambodian, and so on) ¿

¨
¨
¨
¨
¨

Japanese
Korean
Vietnamese
Native Hawaiian
Samoan

¨ O
 ther Pacific Islanders
(specify race, for
example Fijian, Tongan,
and so on) ¿

or other consumer services

¨ Financial services (for example banking,
investing, or paying bills online)

¨ Other
¨ None of the above

58 Are you…

¡ Male

¨ Some other race (specify race) ¿
¡ Female

Somewhat important
Not too important
Not at all important

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11 Which devices do you use most often to access
the internet? Please select all that apply.

45 How much of the time do you think you can trust
your LOCAL government to do what is right?

¡
¡
¡
¡

Most of the time
Only some of the time
None of the time

¡
¡
¡
¡
¡

51

Extremely concerned
Very concerned
Somewhat concerned
Not at all concerned

52

Extremely concerned
Very concerned
Somewhat concerned
Not too concerned

48 How concerned are you, if at all, that the
Census Bureau will share answers with
other government agencies?

¡
¡
¡
¡
¡

Extremely concerned
Very concerned
Somewhat concerned
Not too concerned
Not at all concerned

49 How concerned are you, if at all, that the
information you provide to the Census Bureau
will be used against you?

¡
¡
¡
¡
¡

53

A moderate amount
A little
Not at all

Benefit
Harm
Both benefit and harm
Neither benefit nor harm

Benefit
Harm
Both benefit and harm
Neither benefit nor harm

How much do public officials care about
what people like you think?

¡
¡
¡
¡
¡

A great deal
A lot
A moderate amount
A little

¡
¡
¡
¡
¡

Somewhat comfortable
Not too comfortable

The following questions are about the census
in general. Please answer to the best of your
knowledge. There is no need to look up this
information. Based on what you know, do you think
the census is used for any of the following or not?

Very concerned
Somewhat concerned
Not too concerned

19

and non-citizens

¡ No, used only for counting citizens
¡ Don’t know
20

Is the census used to determine the rate of
unemployment, or is it not used for this?

¡ Yes, used for this
¡ No, not used
¡ Don’t know
21

14 Is the census used to decide how many
representatives each state will have in Congress,
or is it not used for this?

¡ Yes, used for this
¡ No, not used
¡ Don’t know

Does the census count both citizens
and non-citizens, or not?

¡ Y es, used for counting both citizens

13 Is the census used to decide how much money
communities will get from the government,
or is it not used for this?

¡ Yes, used for this
¡ No, not used
¡ Don’t know

Is the census used to locate people living in
the country illegally, or is it not used for this?

¡ Yes, used for this
¡ No, not used
¡ Don’t know

Very comfortable

¡ Yes, used for this
¡ No, not used
¡ Don’t know

Extremely concerned

18

Extremely comfortable

Not at all comfortable

Is the census used to help the police and
FBI keep track of people who break the
law, or is it not used for this?

¡ Yes, used for this
¡ No, not used
¡ Don’t know

¨ Other device

15 Is the census used to see what changes have taken
place in the size, location, and characteristics of the
people in the United States, or is it not used for this?

Not at all

17

Galaxy Tab, or Kindle Fire)

12 In 2020, people will be able to complete their census
form online. How comfortable would you feel
completing the 2020 Census online?

A lot

And what about your community? Do you believe
answering your census form could benefit your
community in any way, harm your community,
neither benefit nor harm your community,
or both benefit and harm your community?

¡
¡
¡
¡

Not at all concerned

A great deal

Do you believe that answering your census
form could personally benefit you in any way,
personally harm you, neither benefit nor harm
you, or both benefit and harm you?

¡
¡
¡
¡

Not too concerned

47 How concerned are you, if at all, that the
information you provide to the Census Bureau
will be misused?

How much, if at all, do you think it matters
if you personally fill out the census form?

¡
¡
¡
¡
¡

Just about always

46 How concerned are you, if at all, that the Census
Bureau will not keep answers confidential?

¡
¡
¡
¡
¡

50

¨ Desktop or laptop computer
¨ Smartphone (for example an iPhone, Android, or Blackberry)
¨ T ablet computer (for example an iPad, Samsung

As far as you know, does the law require
you to answer the census questions, or is
this not required by law?

¡ Yes, required by law
¡ No, not required by law
¡ Don’t know
22

As far as you know, is the Census Bureau
required by law to keep information
confidential, or is this not required by law?

¡ Yes, required by law
¡ No, not required by law
¡ Don’t know

16 Is the census used to determine property taxes,
or is it not used for this?

Not at all concerned

¡ Yes, used for this
¡ No, not used
¡ Don’t know
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Below are some ways in which the census
35 is used. How important, if at all, are each
of these uses to you personally?

23 As far as you know, if you DO NOT fill out a census
form, will a census worker come to your door to
ask the census questions, or will nobody come to
your door?

¡ Yes, Census worker will come
¡ No, Census worker will not come
¡ Don’t know

29

24 As far as you know, does the U.S. Constitution
require that the census be conducted every
10 years or is this not something the
Constitution requires?

¡ Yes, Constitution requires
¡ No, Constitution does not require
¡ Don’t know

30

25 Care for the elderly

¡
¡
¡
¡
¡

Very important
Somewhat important
Not too important
Not at all important

Very important
Somewhat important
Not too important
Not at all important

Extremely important
Very important
Somewhat important
Not too important

33

Somewhat important
Not too important
Not at all important

35

Extremely important
Very important
Somewhat important
Not too important
Not at all important

Extremely important

¡
¡
¡
¡
¡

Very important
Somewhat important
Not too important
Not at all important

Very important

41

Not too important
Not at all important

¡
¡
¡
¡
¡

Not too important
Not at all important

Extremely important
Very important

¡
¡
¡
¡
¡

Not too important
Not at all important

Extremely important
Somewhat important

¡
¡
¡
¡
¡

Not too important
Not at all important

Continued on next page

Not at all important

Which of the following is the most
important reason, to you personally,
that you should fill out the census form?

¡ It is used to enforce civil rights laws
¡ It provides information for my local

Somewhat important

government to plan for changes in the
size of my community

Not too important
Not at all important

¡
¡
¡
¡

Extremely important
Very important
Somewhat important

42

It shows that I'm proud of my cultural heritage
It is my civic responsibility
It makes sure my voice is heard
It contributes to a better future for
my community

Do you think that what happens to people
in your community will have something
to do with what happens in your life?

¡ Y es

¡ No

To what extent do you agree or disagree
with the following statement?

Extremely important
Very important
Somewhat important
Not too important

43

Not at all important

Very important
Somewhat important
Not too important
Not at all important

Extremely important
Very important
Somewhat important
Not too important

How much of the time do you think you
can trust the FEDERAL government to do
what is right?

¡
¡
¡
¡

Extremely important

39 Contributing to a better future for
your community

Very important

Not too important

state has in Congress

38 Showing you’re proud of your cultural heritage

Somewhat important

Somewhat important

¡ It determines how many elected officials my

Very important

Not at all important

Very important

my community needs, like schools and fire
departments

Extremely important

Not too important

Extremely important

¡ It helps determine funding for services

37 Making sure your voice is heard

Somewhat important

Not at all important

OMB XXXX-XXXX

Somewhat important

How important, if at all, is each of the
following to you personally?

Extremely important

28 Police stations

¡
¡
¡
¡
¡

Very important

36 Enforcing civil rights laws

Schools and the education system

¡
¡
¡
¡
¡

Extremely important

Providing information for your local government
to plan for changes in your community

¡
¡
¡
¡
¡

Public transportation

¡
¡
¡
¡
¡

Extremely important

27 Fire stations

¡
¡
¡
¡
¡

32

Very important

Roads and highways

¡
¡
¡
¡
¡

Extremely important

26 Daycare for children

¡
¡
¡
¡
¡

31

Extremely important

Job training programs

¡
¡
¡
¡
¡

How important, if at all, are each of these
public services to you personally?

¡
¡
¡
¡
¡

Fulfilling your civic responsibility

¡
¡
¡
¡
¡

34 Determining how many elected
representatives your state has in Congress

Hospitals and healthcare

¡
¡
¡
¡
¡

40

44

Just about always
Most of the time
Only some of the time
None of the time

How much of the time do you think you can
trust your STATE government to do what
is right?

¡
¡
¡
¡

Just about always
Most of the time
Only some of the time
None of the time

Not at all important

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