US Census Bureau
Center for Behavioral Science Methodology (CBSM)
Telephone Screener
Fall, 2018
PART A: CBSM Universal Screener
Hello, I’m _____________ from the Census Bureau. Thank you for contacting us about participating in one of our studies. I just need to get a little bit of background information to start.
[Auto filled: ID Number]
[Auto filled: Last Contact Date]
[Auto filled: Eligible Date]
What is your name?
First name:_____________________
Last name:_____________________
What is your daytime telephone number? [Probe for all 3 phone numbers]
Mobile ([ ]) [ ] – [ ]
Home (if not mobile) ([ ]) [ ] – [ ]
Work (if any) ([ ]) [ ] – [ ] EXT.[ ]
In what city, state, and ZIP code do you currently live?
City:_____________________
State:_____________________
Zip code:__________________
Are you male or female?
Male
Female
In what year were you born?
Are you of Hispanic, Latino, or Spanish origin?
Yes ( score 1 point)
No
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 (if white NOT selected score 1 point)
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?
Full-time (ask follow-up questions a and b)
Part-time (ask follow-up questions a and b)
Not working for pay at this time (skip to next question)
a. What is your current job title or job description? [open text]
Are you employed by the Federal Government? (if federal contractor, mark NO)
Yes
No
How many people age 18 or older currently live in your household, INCLUDING yourself?
( score 1 point for each person)
How many people younger than 18 currently live in your household?
( score 1 point for each person)
Do you speak a language other than English at home?
Yes (ask follow-up question) ( score 1 point)
No (skip to next question)
What language or languages do you speak at home? Please select one or more.
[ ] Spanish
[ ] Chinese
[ ] Korean
[ ] Vietnamese
[ ] Arabic
[ ] Russian
[ ] Other - Specify
Do you own a cell phone?
Yes (ask follow-up question)
No (skip to next question)
Some cell phones are called “smartphones” because of certain features they have. Is your cell phone a smartphone, such as an iPhone, Android, Blackberry or Windows phone, or are you not sure?
What type of smartphone do you have?
Do you own a desktop or laptop computer, or both?
Desktop computer
Laptop computer
Both desktop and laptop computer
Neither
Do you own a tablet computer such as an iPad, Samsung Galaxy Tab, Google Nexus, or Kindle Fire?
Yes
No
Do you have at least one year of Internet experience?
Yes (ask follow-up question)
No (skip to next question)
How often do you use the Internet either on a computer or on a mobile device like a smartphone or tablet?...Several times a day, about once a day, a few times a week, a few times a month, or a few times a year?
Several times a day
About once a day
A few times a week
A few times a month
A few times a year
Not at all [do not read to respondent]
Name two things you do on the Internet besides e-mail.
Internet Activity #1:
Research
Social media/communication (Facebook, Twitter, Craigslist)
Shopping
Banking or paying bills online
Music / movies / videos
Gaming
News
Travel (directions/reservations)
Employment
Other
Internet Activity #2:
Research
Social media/communication (Facebook, Twitter, Craigslist)
Shopping
Banking or paying bills online
Music / movies / videos
Gaming
News
Travel (directions/reservations)
Employment
Other
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?
Yes
No
Would you be willing to come to our office in Suitland, Maryland, to participate in a research study?
Yes
No
What is the e-mail address we should use when sending directions to our office, should you qualify for a study?
Is your household’s annual income …
Less than $15,000? ( score 1 point)
$15,000 to $25,000? ( score 1 point)
$25,000 to$50,000?
$50,000 to $100,000?
More than $100,000?
Are you a United States citizen? You do not have to be a U.S. citizen to participate in our studies.
Yes
No
PART B: Undercount of Young Children Supplement
Is your home owned, rented or occupied without payment of rent?
owned
rented ( score 1 point)
occupied without payment of rent ( score 1 point)
Don’t know/Refused ( score 1 point)
What type of home do you live in?
House or townhouse
Apartment or condo ( score 1 point)
Something else ( score 1 point)
Don’t know/Refused ( score 1 point)
Do any children under age 5 live in your household?
Yes ( score 2 points) 3b. How many?____( score 1 point for each person)
No
Don’t know/refused ( score 2 points)
Do any children under age 5 stay at your household, even if it’s just for a night or two?
Yes ( score 4 points)
No
Don’t know/refused ( score 4 points)
Do any foster children live or stay at your household, even if it’s just for a night or two?
Yes ( score 4 points)
No
Don’t know/refused ( score 4 points)
Is everyone who lives or stays at your household related to each other?
Yes
No ( score 4 points)
Don’t know/Refused ( score 4 points)
Has anyone moved in or out of your household recently – say in the last year or so?
Yes ( score 4 points)
No
Don’t know/Refused ( score 4 points)
Is anyone in your household the grandparent of a child who lives or stays at your household sometimes?
Yes ( score 2 points)
No
Don’t know/Refused ( score 2 points)
Is anyone in your household the mother of a child who lives or stays at your household sometimes?
Yes ( score 1 point) 9a. How old is the mother? ____(if under 30 score 1 pt)
9b. Is the mother…
married
divorced or separated ( score 1 point)
widowed or ( score 1 point)
never married? ( score 1 point)
No
Don’t know/refused ( score 1 point)
Is anyone in your household the father of a child who lives or stays at your household sometimes?
Yes ( score 1 point) 10a. How old is the father? ____(if under 30 score 1 pt)
10b. Is the father…
married
divorced or separated ( score 1 point)
widowed or ( score 1 point)
never married? ( score 1 point)
No
Don’t know/Refused ( score 1 point)
Scoring Algorithm
(more points higher likelihood the household is at-risk for omitting a young child)
From Part A (Questions from CBSM Universal Screener):
Q6 (Hispanic origin): yes=1 point
Q7 (race): “White” not selected=1 point
Q10 (people 18+): 1 point for each person
Q11 (people under 18): 1 point for each person
Q12 (non-English): yes=1 point
Q21 (hh income): under $25K/year=1 point
From Part B (Questions from UYC-Specific Screener):
Q1 (hh tenure): rented, occupied without payment of rent, D/R=1 point
Q2 (type of home): apartment, condo, other, D/R=1 point
Q3 (children under 5 live there): yes, D/R=2 points
Q3b (how many children under 5): 1 point for each child
Q4 (children under 5 stay there): yes, D/R=4 points
Q5 (foster children): yes, D/R=4 points
Q6 (everyone related): no, D/R=4 points
Q7 (moved in/out recently): yes, D/R=4 points
Q8 (grandparent): yes, D/R=2 points
Q9 (mother): yes, D/R=1 point
Q9a (age of mother): under 30=1point
Q9b (marital status of mother: divorced/widowed/never married=1 point
Q10 (father): yes, D/R=1 point
Q10a (age of father): under 30=1point
Q10b (marital status of father): divorced/widowed/never married=1 point
| 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 |