American Community Survey (ACS) Survey Mail Materials Eye-tracking Study

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Enclosure 2 Demographic questionnaire

American Community Survey (ACS) Survey Mail Materials Eye-tracking Study

OMB: 0690-0030

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Participant #________________



Demographic Information



1. What is your age range?


18-25

26-35

36-45

46-55

56-65

65 and above



2. What is the highest grade or year of school you have completed?

Less than high school

Completed high school

Some college, no degree – Indicate area of study: ____________________________________

Associate’s degree (AA/AS) – Indicate area of study: ____________________________________

Bachelor’s Degree (BA/BS) – Indicate area of study: ____________________________________

Post-Bachelor’s degree – Indicate area of study: ____________________________________


3. Are you male or female?

Male

Female


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

Yes

No




5. What is your race? Choose one or more races.

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleEnclosure 2
Authorroman314
File Modified0000-00-00
File Created2021-01-15

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