Screener

Screener.docx

Generic Clearance for Internet Nonprobability Panel Pretesting

Screener

OMB: 0607-0978

Document [docx]
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Telephone Screener


Hello, I’m _____________ from the Census Bureau. Thank you for contacting us about participating in our focus groups. I just need to get a little bit of background information to start.


  • ID Number:

  • Contact Date:



  1. What is your name?

First name:

Last name:



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

o Male

o Female



  1. In what year were you born?

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

o Yes

o No



  1. 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

  1. 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.)


  1. 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?



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

o Yes

o No



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

City: State: Zip:



  1. How many people age 18 or older currently live in your household, INCLUDING yourself?



  1. How many people younger than 18 currently live in your household?



  1. Is your house, apartment, or mobile home –

  • Owned by you or someone in this household with a mortgage or loan? Include home equity loans.

  • Owned by you or someone in this household free and clear (without a mortgage or loan)?

  • Rented?

  • Occupied without payment of rent?




  1. Do you own a cell phone?

o Yes (ask follow-up question)

o No (skip to next question)



    1. 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?

  • Yes

  • No

  • Not sure





  1. Do you own a desktop or laptop computer, or both?

o Desktop computer

o Laptop computer

o Both desktop and laptop computer

o Neither



  1. Do you own a tablet computer such as an iPad, Samsung Galaxy Tab, Google Nexus, or Kindle Fire?

o Yes

o No




  1. Do you have at least one year of Internet experience?

o Yes (ask follow-up question)

o No (skip to next question)



    1. 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]



    1. Name two things you do on the Internet besides e-mail.


1.


2.

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


c. If you were asked to do a survey, would you rather complete it on paper, over the phone, or online?

  • On paper

  • Over the phone

  • Online



  1. 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:



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

o Yes

o No



  1. What is your daytime telephone number?



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



  1. Is your household’s annual income …


o Less than $15,000?

o $15,000 to $25,000?

o $25,000 to$50,000?

o $50,000 to $75,000?

o $75,000 to $100,000?

o More than $100,000?


  1. 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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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSlight changes to participate
AuthorDawn V Nelson
File Modified0000-00-00
File Created2021-01-23

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