Screener

ID Assigned:

Location:

Recruiter Initials:

Date:

Ad running in R’s area (if ad):

Census Project C Screener

February - November, 2018

Narrative FAQ: Let me tell you a little bit about this study. The Census Bureau is conducting research to make the 2020 Census work better. If you qualify for this study, we will pay you $60 to complete an interview. The interview needs to be face to face, but our interviewer can meet with you at a time and location convenient to you. The interview takes about 90 minutes. All your answers are confidential and protected by law. I have a few questions for you to make sure you qualify.

Bulleted FAQs:

• Purpose: The Census Bureau is conducting research to make the 2020 Census work better. They would like to understand more about how people respond to the census as well as how well the census forms work on smartphones and tablets and how to improve them.

• Incentive: If you qualify for this study, we will pay you $60 to help us complete this research.

• RTI/RSS: RTI International is a nonprofit research organization (or RSS is a contract research firm). The Census Bureau contracted with us to conduct this research. We have assisted the Census Bureau with several research studies in the past.

• Interviews: An interviewer would conduct an interview with you. The interview needs to be face to face, and our interviewer can meet with you at a time and location convenient to you. The interview takes on average 90 minutes during which time you will complete a census form on an electronic device (either your device or one that we provide), then the interviewer will ask you some questions about how you responded to the census.

• CONFIDENTIALITY: The study is protected by U.S. Code Title 13. Title 13 of the U.S. Code is a federal law that protects the confidentiality of all your information and anyone working at RTI (OR RSS), including the interviewer or me, could either go to jail or pay a fine up to $250,000 if we divulge any information about you.

• VERIFICATION: You can call the study’s project manager Patricia LeBaron at RTI. Her number is (312) 777-5204. I can also have researchers at the Census Bureau who designed this study contact you.

• [WHEN APPROPRIATE] INTERVIEWER: I’m not sure which interviewer will be calling you, the names of the interviewers in this area are [NAME], [NAME], [NAME], but my supervisor assigns the interviewer to the case.

[Note Concerns or Questions]

START HERE

1. What is your name? _____________________

2. Are you male or female?

1. Male

2. Female

3. And how did you hear about this study?

   1. CRAIGSLIST

   2. FRIEND

   3. FLYER

   4. NEWSPAPER AD

   5. Other Online Google Ad/Website

   6. OTHER, SPECIFY:

4. You said that you [saw] the ad on [way heard]; Can you tell me about your situation and why you thought you might qualify for the study? (Probe: relevant data)

5. Do you work for the United States federal government? [IF FEDERAL CONTRACTOR, MARK NO]

1. YES  Explain: Unfortunately you cannot be paid for your study participation but we would still like you to participate if you qualify. Also, other household members who do not work for the federal government might qualify and could be paid.

2. NO

6. What is your age? ___________________ YEARS OLD

CODE AGE CATEGORY:

1. Under 18 – not Eligible

2. 18-34

3. 35-44

4. 45-54

5. 55-64

6. 65 and older

7. What is your highest level of education completed

1. Less than high School Equivalent

2. Completed High school / GED

3. Some college, no degree

4. college

5. Graduate education

6. Other Education System (Specify___________) Probe as necessary for US Equivalent if Respondent does not know equivalent, ask number of total years and record level name in country of origin_________________________

CODE EDUCATION CATEGORY

1. Less than HS Equivalent

2. HS Equivalent OR SOME COLLEGE

3. college+

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

   1. Yes

   2. No

9. What is your race? Please select one or more. 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

10. . Can you tell me more about your ancestry or ethnic origin?

11. Where were you born? [DON’T READ CHOICES. CIRCLE ONE.]

    1. United States, including U.S. territories

    2. Other (Specify: _________________________________________)

       1. When did you first move to the U.S? ________

       2. How many years in total have you lived in the U.S? ________

I now have a couple of questions about your current living situation.

12a. How many people live in your household including yourself? ______________

12b. And for each of the [number] people you mentioned I’d like to get their relationship to you. I don’t need their names, just their relationship to you.

MARK RELATIONSHIP HERE
_______ spouse/Partner	_______ Son-in-law or daughter-in-law
_______ Son or daughter/ Foster child	_______ Other relative
_______ Brother or sister	_______ Housemate or roommate
_______ Father or mother	_______ Landlord
_______ Grandchild	_______ Other nonrelative
_______ Parent-in-law
_______ Roomer or boarder

13. Is [TARGET LANGUAGE*] your native language, or is your native language some other language?

a. English is native language  Not preferred

b. TARGET LANGUAGE is native language

c. Other (Specify:________________)

* For Chinese, either Mandarin or Cantonese native speakers are acceptable.

[IF NEEDED: It’s not necessary that you speak English to participate in one of our studies, but I need to ask you a few questions about English now.]

14a. How well do you speak English?	a. Very well	b. Well	c. Not well	d. Not at all
14b. How well do you read English?	a. Very well	b. Well	c. Not well	d. Not at all
			IF Only Cs & Ds circled (r is monolingual), Skip to Q14 (reading ability)

14c. Do you speak [TARGET LANGUAGE] better than English, English better than [TARGET LANGUAGE], or both about equally well?

1. [TARGET LANGUAGE] better than English

2. English better than [TARGET LANGUAGE]  screen out

3. Both about equally well

14d. When you have a choice between English and [TARGET LANGUAGE], do you typically participate in surveys or fill out forms in…?

a. [TARGET LANGUAGE]

b. English  Not preferred

c. Both equally often

14e. [IF BILINGUAL] Since you are bilingual, we can do the interview in either language. In which language would you prefer to do the interview if you are eligible?

1. [TARGET LANGUAGE]  CODE AS bilingual

2. English  Screen out

c. Either one - prefer both equally  CODE AS bilingual

15. How well do you read [TARGET LANGUAGE]?

a. Very well

b. Well Not preferred

c. Not well Not preferred

d. Not at all  Not eligible

16a. How well do you speak [TARGET LANGUAGE]?

a. Very well

b. Well

c. Not well Not preferred

d. Not at all  Not eligible

INTERNET PROFICIENCY QUESTIONS

17.  During the interviews [we will ask you/we are asking some participants] to access a census questionnaire on a smartphone. Do you have a smartphone with internet access?

RECRUITER: MARK A RESPONSE BASED ON WHAT THE R SAYS

1. What kind of phone is that? An iPhone, android or something else?

______________________

1. SMARTPHONE WITH DATA PLAN

2. SMARTPHONE WITHOUT DATA PLAN

[REQUIRE WIFI FROM ANOTHER SOURCE]

3. NO SMARTPHONE

4. Other:__________

1. What kind of tablet is that? A Kindle, iPad or something else? ______________________

18. Do you have a tablet with internet access?

RECRUITER: MARK A RESPONSE BASED ON WHAT THE R SAYS

a. TABLET WITH DATA PLAN

b. TABLET WITHOUT DATA PLAN

[REQUIRE WIFI FROM ANOTHER SOURCE]

c. NO TABLET

d. Other:__________

19. How comfortable are you using your [smartphone/tablet] to access the internet?

a. Very comfortable

b. Somewhat comfortable

c. Not very comfortable  Not preferred

d. Not at all comfortable  Not eligible

20. How long (in years and / or months) have you used a smartphone?

_____ year _____ month

21. On average, how many total hours per week do you use your smartphone to access the Internet?

_______ hours per week

22. Can you think of any forms that you’ve filled out online? [IF NEEDED: Like an internet survey, to set up an account at a website, to renew your driver’s license, to register for an event, to complete a school form, etc.?]

2. IF YES: What kinds of forms have you filled out online? [Record up to two]

________________________________

________________________________

a. Yes

b. No  Not preferred

22. Have you participated in any research studies for the U.S. Census Bureau?

o Yes

o No  SKIP TO Q29

21b. IF YES: What study did you participate in? ________ [IF NEEDED: Do you remember what the survey was about? Was it on the internet, on paper, or did someone read the survey out loud to you?] IF PREVIOUSLY PARTICIPATED IN DECENNIAL CENSUS STUDY, SCREEN OUT.

Now I just need to collect your contact information.

24. What is the best phone number for me to contact you at if you qualify for the study? //Is it OK to send texts to that number?

Phone: ____________________________Text yes/no

Is there another number as well? ____________________________ Text yes/no

25. In case you qualify for the study, I want to pass on to the interviewer some information about your general location. In what neighborhood or town do you live? [Probe if necessary for subdivision/cross-streets/local library, if you do not know the area get cross streets (i.e. in DC/SD)]

Location: ___________________________________________________________________________________

Thank you for your information. I’m going to pass it on to my supervisor [this evening/Monday/etc.] who will let me know if you qualify for the study. If you do [I will call you back and let you know/an interviewer will also call you to set up an interview].

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