Cognitive Interview Participant Telephone Screener
NSCH Screener Experiment
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.
What is your name?
First name:
Last name:
(Ask if not obvious) Are you male or female?
o Male
o Female
Do you have any Children under the age of 18?
Yes
How old are your children? (Continue to Question 4)
Child 1:
Child 2:
Child 3:
Child 4:
Child 5:
Other children:
No
Now I just need to get some background information.
In what year were you born?
Are you of Hispanic, Latino, or Spanish origin?
o Yes
o No
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?
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
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.)
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?
Are you employed by the Federal Government? (if federal contractor, mark NO)
o Yes
o No
In what city, state, and ZIP code do you currently live?
City: State: Zip:
How did you hear about this research opportunity?
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?
| 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 | 2021-01-20 |