Recruitment Screener

Cognitive Interview Participant Telephone Screener – NSCH Questionnaire Redesign

• ID Number:

• Contact Date:

Hello, I’m _____________ from the Census Bureau. Thank you for contacting us about participating in our research study for the National Survey of Children’s Health.

1. What is your name?

First name:

Last name:

2. (Ask if not obvious) Are you male or female?

o Male

o Female

3. Do you have any Childeren under the age of 18?

• Yes

  • How old are your children? (Continue to Qusetion 2)

  • No

  • I’m sorry, but this study is ony available for people who have children under the age of 18, so you won’t be eligible at this time. Thank you for your time today.

Now I just need to get some background information.

4. In what year were you born?

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

o Yes

o No

6. What is your race? Please select one or more of the following: White, Black or African American, American Indian or Alaska Native, Asian, or Native Hawaiian or other Pacific Islander?

(Allow up to 3 answers)

• White

• Black or African American

• American Indian or Alaska Native

• Asian

• Native Hawaiian or other Pacific Islander

7. What is the highest grade of school you have completed, or the highest degree you have received?

(do not read categories to respondent)

• 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, Ph.D, JD, etc.)

8. Are you working for pay full-time, part-time, or are you not working for pay at this time?

o Full-time (ask both follow-up questions)

o Part-time (ask both follow-up questions)

o Not working for pay at this time (skip to next question)

a. What is your current job title or job description?

2. Are you employed by the Federal Government? (if federal contractor, mark NO)

o Yes

o No

9. In what city, state, and ZIP code do you currently live?

City: State: Zip:

10. How did you hear about this research opportunity?

• E-mail link

• Census Bureau employee

• Friend or family member (but not a Census Bureau employee)

• Facebook

• Craigslist

• Google advertisement

• Flyer

• Newspaper advertisement

• Other – specify:

11. Have you participated in any research studies with the U.S. Census Bureau?

o Yes

o No

12. What is your daytime telephone number?

13. What is the e-mail address we should use when sending directions to our office, should you qualify?

14. 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

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