Form Attachment A Attachment A Survey Protocol

Cognitive and Psychological Research

Attachment A - Survey Protocol

Understanding Electronic Record Use

OMB: 1220-0141

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Attachment A: Survey content

---start---


Welcome! Thanks for your interest in this survey. We will be asking you about your experience with certain expenses, so before we can get started we need to ask you a few questions to determine if you are eligible to participate.


Screener for Group 1 (All responses must match *):
Do you have a mortgage for your home?
Yes*
No


Do you own a vehicle?
Yes*
No


Do you have any education expenses? Please include daycare expenses and payments on education loans.
Yes*
No


How familiar are you with your household’s home ownership, vehicle, and education expenses?
Very familiar*
Somewhat familiar*
Not at all familiar


Screener for Group 2 (All responses must match *):
Which category best describes the regularity of your income? (1/2 sample of each)
My income is regular - it stays pretty much the same from paycheck to paycheck
My income is irregular - the amount changes frequently


Do you have health insurance?
Yes*
No


Have you or anyone in your household had any medical expenses in the last three months?
Yes*
No


How familiar are you with your household’s income and expenses for health insurance and medical care?
Very familiar*
Somewhat familiar*
Not at all familiar


---page break---

If not eligible:

Thank you for your time, but you do not meet the qualifications for this study.


---page break---

If eligible:

Great! You have the experience we are looking for.


We need your help to improve instructions on a national survey on household spending.

On the following pages, you’ll be asked about how you organize and access your household’s financial records. We won’t ask about your expenses – we just want to know what information you have stored online and whether and how you would access it during an interview.

The survey should take no more than 20 minutes. Please do not use your browser’s back button.

This voluntary study is being collected by the Bureau of Labor Statistics under OMB No. 1220-0141. This survey will take no more than 20 minutes to complete. Your participation is voluntary, and you have the right to stop at any time. This survey is being administered by Qualtrics and resides on a server outside of the BLS domain. The BLS cannot guarantee the protection of survey responses and advises against the inclusion of sensitive personal information in any response. By proceeding, you give your consent to participate in this study.

---page break---


If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.


Paper includes bills or statements you got in the mail, checkbooks, receipts, a ledger or any other record that you have a hard copy for.
Electronic includes e-mail receipts, bills or statements you access online, account history on an app or website.
If you had that expense but no longer have a record of it, select
No Record.
Hover over the headers in the tables to see these definitions.


If you’ve never had that expense, select No Expense.


Group 1:

Housing

No Expense

Paper

Electronic

No Record

Mortgage total amount paid

[radio]

[check]

[check]

[check]

Mortgage, of total amount, interest paid





Mortgage, total amount owed before last payment





Regular payments to a homeowners or condo association





Special payments to management service





Special assessments to local government for construction, repair of roads, sidewalks or other things like that





Ground or land rent





Total monthly rental payments for all rented properties






---page break---

If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.

Phone/Cable/Internet and Utilities

No Expense

Paper

Electronic

No Record

Residential telephone, including Voice over IP

[radio]

[check]

[check]

[check]

Cellular phone service





Pre-paid long distance telephone cards/minutes





Internet connection





Cable or satellite TV





Satellite radio services





Electricity





Natural gas





Fuel oil





Bottled or tanked gas





Other fuels (wood, coal, etc.)





Water and sewerage maintenance





Trash/Garbage collection





Septic tank cleaning





Water softening service






---page break---

If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.

Education

No Expense

Paper

Electronic

No Record

Tuition (including daycare and college)

[radio]

[check]

[check]

[check]

Food or board while attending school





Test preparation or tutoring services





Purchase of any school books, reference books, supplies, or equipment





Support for college students





School bus






---page break---

If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.

Vehicle purchase and maintenance

No Expense

Paper

Electronic

No Record

Purchase or lease of cars or trucks

[radio]

[check]

[check]

[check]

Purchase or lease of RVs and recreational vehicles





Sale of any vehicle





Rental of any vehicle





Vehicle maintenance or repair expenses





Vehicle insurance





Vehicle registration





Vehicle inspection





Driver’s license fees





Towing charges






---page break---

If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.

Legal, financial, and other

No Expense

Paper

Electronic

No Record

Legal fees

[radio]

[check]

[check]

[check]

Bank account charges





Credit card memberships or annual fees





Child support and alimony





Contributions to charities and organizations






---page break---


Group 2:

Medical and health

No Expense

Paper

Electronic

No Record

Physician, dental, and eye care services

[radio]

[check]

[check]

[check]

Care of invalids and elderly





Hospital rooms and hospital services





Eyeglasses and hearing aids





Medical equipment – purchase, repair, rental






---page break---

If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.

Insurance policies

No Expense

Paper

Electronic

No Record

Health insurance, amount spent on premiums, including payroll deductions

[radio]

[check]

[check]

[check]

Medicare Prescription Drug plan monthly premium





Life insurance (or other policies that provide benefits in case of death or disability) premium





Long term care insurance premium





Homeowner's or renter's insurance premium





Other (non-vehicle nor property) insurance premium






---page break---

If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.

Income for the last 12 months

No Expense

Paper

Electronic

No Record

Wages, salary, tips, bonuses, or commissions

[radio]

[check]

[check]

[check]

Self-employment income or loss





Supplemental Security Income (SSI) payments





Social Security or Railroad Retirement benefits





Retirement plan such as an Individual Retirement Account (IRA) or Keogh





Amount of last pay before any deductions





Deductions from pay





Employer or union contributions to a pension or retirement plan





Welfare payments or cash assistance from state or local welfare office





Cash value of food stamps or Electronic Benefit Transfers (EBT) received





Regular income from other sources, such as veterans’ (VA) payments, unemployment compensation, child support, or alimony





Lump-sum payments from insurance, estates, trusts, royalties, child support, alimony, prize or games of chance, or from people outside of the household





Other money income, including from cash scholar-ships and fellowships, stipends not based on working and the care of foster children






---page break---
If you wanted to look up an expense from the last 12 months, where would you find it?
Mark all that apply.

Assets and liabilities for the last 12 months

No Expense

Paper

Electronic

No Record

Retirement accounts such as 401(k)s, IRAs, and Thrift Savings Plans

[radio]

[check]

[check]

[check]

Directly-held stocks, bonds, and mutual funds not in retirement accounts





Checking, savings, money market accounts, and certificates of deposit or CDs





Whole life insurance or other life insurance policies that can be surrendered for cash or borrowed against prior to the death of the person insured





Other financial assets, such as annuities, trusts, and royalties





Balance on any major credit cards including store cards and gas cards





Student loans





Other debt such as medical loans or personal loans






---page break---

All participants:

We are particularly interested in the kinds of electronic records that people keep and how people access them. Below are the expenses that you said you had electronic records for. Please tell us how you would typically find your statements and records.
Mark all that apply.


[Repeat the same blocks shown previously, all on one screen with no page breaks. Include only expenses (rows) for which the participant said they have electronic records.]

[Name of expenditure category]

Financial software (not online)

E-mail

Online account that you can access

Online account that someone else in the household can access

App on your phone

Other

[Name of expenditure]

[check]

[check]

[check]

[check]

[check]

[text entry]























---page break---


Thanks for that information. Now we’d like to learn about how you would use electronic records in an interview.


We will be using your feedback to decide what is reasonable to ask of our respondents. Please consider the questions carefully and give your honest feedback. Focus on what you would actually do - not a friend or anyone else.

---page break---


Think about an interview that:

  • Takes place in your home.

  • Is conducted by a U.S. Census Bureau interviewer.

  • Is completely confidentially- no one would be able to identify you or your expenses.

  • Is not mandatory.

  • Is private; if you choose to use records during the interview, you would not have to share them with anyone else.

During an interview like that, which electronic records would you use to answer questions about your expenses?


[Repeat the same blocks shown previously, all on one screen with no page breaks. Include only expenses (rows) for which the participant said they have electronic records.]

[Name of expenditure category]

Would Use

Would Not Use

Reason (optional)

[Name of expenditure]

[check]

[check]

[text entry]









---page break---


[Display only if said would use at least one expense, above]

And how would you use these electronic records during the interview?

Mark all that apply.


-Print them before the interview

-Take screenshots before the interview

-Email them to myself before the interview

-Log in to the accounts as needed during the interview

-[open text entry]

-[open text entry]

-[open text entry]


---page break---


Would you store and share your electronic records with us in an online, secure data storage bank? This cloud storage would be maintained by the U.S. Census Bureau.
Yes
No



Consider the cloud storage features listed below. Please mark all the features that you would want or expect to be provided.
Mark all that apply.


  • No one would know that I was using the cloud or know which files were mine

  • No one would be able to steal my information

  • No one, not even my interviewer, could look at my files without my permission

  • My interviewer would be able to look at my files before my interview

  • I would have to create a username and password

  • I would be able to access the cloud on my smartphone through a mobile-friendly website to upload and view files

  • I would be able to e-mail my files to a secure e-mail address and have them show up in my account

  • I would be able to download a smartphone app to upload and view files

  • I would be able to link information from my other apps, like Mint or my bank account

  • I would be able to black-out or redact any private information that I didn’t want to share

  • I would be instructed on how to label the files so that it was easy to use them during the interview

  • My interviewer would be able to look at my files on her computer during my interview

  • [open text entry]

  • [open text entry]

  • [open text entry]



In the future, we may be able to automatically read the information we need from records that you upload to an online data storage bank. Instead of meeting us in-person for an interview, you could just upload your files instead. Would you be willing to do that?

Yes
No



---page break---


And now just a few questions about yourself.

  1. In what year were you born?

[open text box; numeric]


  1. What is your sex?

Male
Female

  1. Are you Hispanic or Latino?

Yes
No


  1. What is your race? (Please select one or more)

American Indian or Alaska native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

  1. What is the highest degree you have received?

No schooling completed
Elementary school diploma
High school diploma or the equivalent (GED)

Associate degree

Bachelor’s degree

Master’s degree

Professional or doctorate degree



---page break---


Thanks very much for your responses. Your feedback will help us to improve our surveys.


Your HIT verification code is:

[random numeric code]




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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKincaid, Nora - BLS
File Modified0000-00-00
File Created2021-01-22

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