Form 2020 CBAMS Survey 2020 CBAMS Survey 2020 CBAMS Survey

<Insert DOC Seal here> US DEPARTMENT OF COMMERCE

Economics and Statistics Administration

US CENSUS BUREAU

2020 Census Planning Survey

Thank you for participating. Completing this short 15-minute survey will help the U.S. Census Bureau conduct the next census in 2020. This survey is not the census.

Start Here

Respond online today at:

https://respond.census.gov/plan

OR

Complete this form and mail it back as soon as possible.

Puede contestar esta encuesta en español por internet en:
https://respond.census.gov/plan

This survey should be completed by the person who typically opens the mail for your household. We will keep your answers confidential.

To learn more about this survey go to: <WEBSITE URL> or call 1-800-XXX-XXXX.

Please complete pages 2, 3, and 4.

The U.S. census is the count of all the people who live in the United States. It happens every 10 years. It asks questions such as how many people live in your household, their age, gender, race, and ethnicity. This survey is not the census. The next census is in 2020.

1. How familiar are you with the U.S. census? Mark (X) ONE box.

1. Extremely familiar

2. Very familiar

3. Somewhat familiar

4. Not too familiar

5. Not at all familiar

2. If the census were held today, how likely would you be to fill out the census form? Mark (X) ONE box.

1. Extremely likely

2. Very likely

3. Somewhat likely

4. Not too likely

5. Not at all likely

3. Thinking about most people you know, if the census were held today how likely would they be to fill out the census form? Mark (X) ONE box.

1. Extremely likely

2. Very likely

3. Somewhat likely

4. Not too likely

5. Not at all likely

4. Based on your past experience or just your best guess, how long do you think it would take you personally to fill out the 2020 Census? Please print a number.

__________ minutes

5. How likely are you to encourage someone you know to fill out the 2020 Census form? Mark (X) ONE box.

1. Extremely likely

2. Very likely

3. Somewhat likely

4. Not too likely

5. Not at all likely

6. About how often do you use the internet? Mark (X) ONE box.

1. Almost constantly

2. Several times a day

3. About once a day

4. Several times a week

5. Once a week

6. Less than once a week

7. Never

7. Which devices do you often use to access the internet? Mark (X) all that apply.

1. Desktop or laptop computer

2. Smartphone (for example an iPhone, Android, Blackberry)

3. Tablet computer (for example an iPad, Samsung Galaxy Tab, Kindle Fire)

4. I don’t use the internet

8. Which of the following comes closest to your view? Mark (X) ONE box.

1. I prefer to fill out paper forms instead of online forms

2. I prefer to fill out online forms instead of paper forms

3. I have no preference between completing online or paper forms

The following questions are about the 2020 Census in general. There is no need to look up this information. As you understand it, will the 2020 Census be used in any of the following ways or not?

## Note for designers: The question box above refers to Q9-Q16 below. ##

9. Is the census used to determine property taxes, or is it not used for this? Mark (X) ONE box.

1. Yes, used for this

2. No, not used

3. Don’t know

10. Does the census count both citizens and non-citizens, or only citizens? Mark (X) ONE box.

1. Yes, used for counting both citizens and non-citizens

2. No, used only for counting citizens

3. Don’t know

11. Is the census used to determine the rate of unemployment, or is it not used for this? Mark (X) ONE box.

1. Yes, used for this

2. No, not used

3. Don’t know

12. Is the census used to decide how much money communities will get from the government, or is it not used for this? Mark (X) ONE box.

1. Yes, used for this

2. No, not used

3. Don’t know

13. Is the census used to see what changes have taken place in the size, location, and characteristics of the people in the United States, or is it not used for this? Mark (X) ONE box.

1. Yes, used for this

2. No, not used

3. Don’t know

14. Is the census used to locate people living in the country without documentation, or is it not used for this? Mark (X) ONE box.

1. Yes, used for this

2. No, not used

3. Don’t know

15. Is the census used to help the police and FBI keep track of people who break the law, or is it not used for this? Mark (X) ONE box.

1. Yes, used for this

2. No, not used

3. Don’t know

16. Is the census used to decide how many representatives each state will have in Congress, or is it not used for this? Mark (X) ONE box.

1. Yes, used for this

2. No, not used

3. Don’t know

17. As far as you know, does the law require you to answer the census questions, or is this not required by law? Mark (X) ONE box.

1. Yes, required by law

2. No, not required by law

3. Don’t know

18. As far as you know, is the Census Bureau required by law to keep information confidential, or is this not required by law? Mark (X) ONE box.

1. Yes, required by law

2. No, not required by law

3. Don’t know

19. As far as you know, does the U.S. Constitution require that the census be conducted, or is this not something the Constitution requires? Mark (X) ONE box.

1. Yes, Constitution requires

2. No, Constitution does not require

3. Don’t know

How important, if at all, are each of these programs and services to you personally?

## Note for designers: The question box above refers to Q20-Q27 below. ##

20. Hospitals and healthcare. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

21. Police departments. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

22. Fire departments. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

23. Daycare for children. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

24. Schools and the education system. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

25. Public transportation. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

26. Roads and highways. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

27. Job training programs. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

How important, if at all, is each of the following to you personally?

## Note for designers: The question box above refers to Q28-Q31 below. ##

28. That civil rights laws are enforced. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

29. Contributing to a better future for your community. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

30. Fulfilling your civic duty (for example, voting, jury duty, paying taxes). Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

31. Showing you’re proud of your cultural heritage. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

Below are some ways in which the 2020 Census will be used. How important, if at all, are each of these uses to you personally?

## Note for designers: The question box above refers to Q32-Q33 below. ##

32. Providing information for your local government to plan for changes in your community. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

33. Determining how many elected representatives your state has in Congress. Mark (X) ONE box.

1. Extremely important

2. Very important

3. Somewhat important

4. Not too important

5. Not at all important

34. Which ONE of the following is the most important reason, to you personally, that you should fill out the census form? Mark (X) ONE box.

1. It helps determine funding for public services in my community, like schools and fire departments

2. It is used to enforce civil rights laws

3. It contributes to a better future for my community

4. It is my civic duty (along with voting, jury duty, paying taxes)

5. It shows that I'm proud of my cultural heritage

6. It provides information for my local government to plan for changes in my community

7. It determines how many elected representatives my state has in Congress

35. How much of the time do you think you can trust the FEDERAL government to do what is right? Mark (X) ONE box.

1. Just about always

2. Most of the time

3. Only some of the time

4. None of the time

36. How much of the time do you think you can trust your STATE government to do what is right? Mark (X) ONE box.

1. Just about always

2. Most of the time

3. Only some of the time

4. None of the time

37. How much of the time do you think you can trust your LOCAL government to do what is right? Mark (X) ONE box.

1. Just about always

2. Most of the time

3. Only some of the time

4. None of the time

38. How concerned are you, if at all, that the Census Bureau will not keep answers to the 2020 Census confidential? Mark (X) ONE box.

1. Extremely concerned

2. Very concerned

3. Somewhat concerned

4. Not too concerned

5. Not at all concerned

39. How concerned are you, if at all, that the Census Bureau will share answers to the 2020 Census with other government agencies? Mark (X) ONE box.

1. Extremely concerned

2. Very concerned

3. Somewhat concerned

4. Not too concerned

5. Not at all concerned

40. How concerned are you, if at all, that the answers you provide to the 2020 Census will be used against you? Mark (X) ONE box.

1. Extremely concerned

2. Very concerned

3. Somewhat concerned

4. Not too concerned

5. Not at all concerned

41. How much, if at all, do you think it matters if you personally are counted in the 2020 Census? Mark (X) ONE box.

1. A great deal

2. A lot

3. A moderate amount

4. A little

5. Not at all

42. Do you believe that answering your 2020 Census form could harm or benefit YOUR COMMUNITY in any way? Mark (X) ONE box.

1. Harm

2. Benefit

3. Both harm and benefit

4. Neither harm nor benefit

43. Do you believe that answering your 2020 Census form could personally harm or benefit YOU in any way? Mark (X) ONE box.

1. Harm

2. Benefit

3. Both harm and benefit

4. Neither harm nor benefit

44. Which of the following have you ever done, if any? Mark (X) all that apply.

1. Donated money or raised funds for social or political activity

2. Participated in an organized protest or rally of any kind

3. Attended a neighborhood or community meeting

4. Contacted, or attempted to contact, a politician or civil servant to express your views

5. Worn a button/bracelet/pin for an issue or cause

6. Volunteered at any organization

7. Posted your own thoughts or comments on political or social issues online

8. Signed a petition (including online petitions)

9. Voted in an election

10. None of the above

45. Thinking about the 2016 general election for President and other offices, did you happen to vote in the election, or did things come up that kept you from voting? Mark (X) ONE box.

1. Yes, voted in 2016 election

2. No, did not vote in 2016 election

These final questions are for statistical purposes only.

46. What year were you born? Please print a number.

___ ___ ___ ___

47. Are you… Mark (X) ONE box.

1. Male

2. Female

48. What is the highest degree or level of school you have completed? Mark (X) ONE box.

1. No high school

2. Some high school

3. High school graduate or equivalent (for example GED)

4. Some college, but degree not received or is in progress

5. Associate degree (for example AA, AS)

6. Bachelor’s degree (for example BA, BS, AB)

7. Graduate degree (for example Master’s, Professional, Doctorate)

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

1. No, not of Hispanic, Latino, or Spanish origin

2. Yes, Mexican, Mexican American, Chicano

3. Yes, Puerto Rican

4. Yes, Cuban

5. Yes, another Hispanic, Latino, or Spanish origin (print origin, for example Argentinian, Colombian, Nicaraguan, Spaniard, and so on)

______________________________________

50. What is your race? Mark (X) all that apply.

1. White

2. Black or African American

3. American Indian or Alaska Native (print name of enrolled or principal tribe)

_______________________________________

4. Asian Indian

5. Chinese

6. Filipino

7. Japanese

8. Korean

9. Vietnamese

10. Other Asian (print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on)

_______________________________________

11. Native Hawaiian

12. Chamorro

13. Samoan

14. Other Pacific Islanders (print race, for example Fijian, Tongan, and so on)

_______________________________________

15. Some other race (print race)

_______________________________________

51. In what country or territory were you born? Mark (X) ONE box.

1. In the United States

2. Outside of the United States (print name of country, or Puerto Rico, Guam, etc.)

_______________________________________

52. Do you speak a language other than English at home? Mark (X) ONE box.

1. Yes

2. No  SKIP to question 55

Answer questions 53 & 54 if you speak a language other than English at home; otherwise, SKIP to question 55.

53. What is this language? If more than one, other than English what language do you speak most often at home?

___________________________________________

54. How well do you speak English? Mark (X) ONE box.

1. Very well

2. Well

3. Not well

4. Not at all

55. What is your marital status? Mark (X) ONE box.

1. Now married

2. Divorced

3. Separated

4. Widowed

5. Never married

56. Are there any children 5 years old or younger (including babies) currently living in your household? Mark (X) ONE box.

1. Yes

2. No

57. Are there any children ages 6 to 17 years old currently living in your household? Mark (X) ONE box.

1. Yes

2. No

58. How many total people — adults and children— currently live in your household, including yourself? Please print a number.

_____________

59. In 2016 what was your total household income before taxes? Mark (X) ONE box.

1. Less than $25,000

2. $25,000 - $34,999

3. $35,000 - $49,999

4. $50,000 - $74,999

5. $75,000 - $99,999

6. $100,000 - $149,999

7. $150,000 - $199,999

8. $200,000 and above

60. Do you rent or own your house or apartment? Mark (X) ONE box.

1. Own

2. Rent

3. Occupied without payment of rent

61. Which of the following best represents how you think of yourself? Mark (X) ONE box.

1. Lesbian or gay

2. Straight, that is not lesbian or gay

3. Bisexual

4. Something else (please specify)

_______________________________________

5. I don’t know the answer

Mailing Instructions

Please make sure you have answered all questions.

Once you have completed the questionnaire, please return it using the enclosed self-addressed stamped envelope. If the envelope has been misplaced, please mail the questionnaire to:

U.S. Census Bureau

STREET ADDRESS

CITY, STATE ZIP

Please make sure the barcode above your address appears in the window of the return envelope.

On behalf of the U.S. Census Bureau, thank you for participating in the 2020 Census Planning Survey.

OMB 0607-0978, expired on 08/31/2020