Attachment A Pretesting Survey Instrument

Attachment A

Burden Pretesting Survey

This is a survey for the US Bureau of Labor Statistics (BLS). This voluntary study is being collected by the Bureau of Labor Statistics under OMB No. 1220-0141. This survey will take approximately 10 minutes to complete. Your participation is voluntary and you have the right to stop at any time.

We are looking for information about how respondents answer our surveys. Please take your time as you answer these questions. The information you provide will contribute to valuable research at the BLS, one of the leading Federal statistical agencies.

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 with this study, you give your consent to participate in this study.

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On the next page, you will see a letter asking you to participate in a Federal survey. 

Please imagine that you received this letter in the mail at your home address. Read the letter carefully, as we will ask you questions about it later.

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<Insert letter; random assignment to the low or high burden condition see Attachments E and F>

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Next, we would like you to answer the following questions about you and your household. Imagine you are answering the questions for the survey you just read about on the previous page.

All questions are voluntary. For statistical purposes, it’s very important to answer ‘don’t know,’ ‘prefer not to say’, instead of giving incorrect answers.

[ ] Please click to indicate that you understand all questions are voluntary.

1. How many people, 15 years old or older, are living or staying with you, including yourself?

   • 1 (just yourself)

   • 2 people

   • 3 people

   • 4 people

   • 5 people

   • 6 or more people

<for 2-5 people> You indicated that more than one other person is living or staying with you. Please enter the initials (first, middle, and last) of each of the people who are living or staying with you (do not include yourself). In the spaces below, please indicate how you are related to each person.

If you have 6 more people living or staying with you, please select 5 of them. 

<for 6+ people> You indicated that 6 or more people are living or staying with you, including yourself. For the purposes of this survey, please enter the initials (first, middle, and last) of 5 people who are living or staying with you (do not include yourself).

<insert appropriate number of text boxes based on response to Q1>

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1. (skip if only 1 person living in the household) You indicated that [TEXT FILL] other [person/people] are living or staying with you. In the space(s) below, please indicate how you are related to [that/each] person. <instrument will randomly select 1 HH members>

[TEXT FILL initials of Other HH member]

<Dropdown menu with the following selections for each person>

• Opposite sex husband/wife/spouse

• Opposite sex unmarried partner

• Same sex husband/wife/spouse

• Same sex unmarried partner

• Child

• Grandchild

• Brother or sister

• Parent

• Other relative (aunt, uncle, cousin, in law)

• Foster child

• Roommate or housemate

• Other nonrelative

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Now, we have some questions about you.

<insert survey questions from Attachment G>

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Next, we have some questions about [insert initials of randomly selected other household member if applicable]

<insert survey questions from Attachment G>

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Thank you for completing those questions.

Next, we’d like to get some feedback from you about your experience completing these questions.

What were your reactions to answering these questions? _______

Did any of the questions stand out as easy or difficult to answer about other members of your household? Please explain. ________

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*How burdensome was it to complete these survey questions?

• Not at all burdensome

• [A little / Somewhat] burdensome

• Moderately burdensome

• Very burdensome

• Extremely burdensome

(If very/extremely): What made the survey burdensome?: _________

*How burdensome would it be to complete this survey one more time?

• Not at all burdensome

• [A little / Somewhat] burdensome

• Moderately burdensome

• Very burdensome

• Extremely burdensome

*How burdensome would it be to complete this survey every month for eight months in a row?

• Not at all burdensome

• [A little / Somewhat] burdensome

• Moderately burdensome

• Very burdensome

• Extremely burdensome

*How much effort did you put into answering these survey questions?

• No effort

• [A little / Somewhat of an] effort

• Moderate effort

• A lot of effort

• A great deal of effort

*How easy or difficult was it to answer these survey questions?

• Very easy

• [A little/Somewhat] easy

• Neither easy nor difficult

• Very difficult

• Extremely difficult

*How sensitive were these survey questions?

• Not at all sensitive

• [A little / somewhat] sensitive

• Moderately sensitive

• Very sensitive

• Extremely sensitive

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Earlier, you answered questions about the following other member of your household,

<insert initials other HH member>

*How burdensome was it to complete the survey questions about <insert initials>?

• Not at all burdensome

• [A little / Somewhat] burdensome

• Moderately burdensome

• Very burdensome

• Extremely burdensome

*How sensitive was it to complete the survey questions about <insert initials>?

• Not at all sensitive

• [A little / somewhat] sensitive

• Moderately sensitive

• Very sensitive

• Extremely sensitive

*How easy or difficult was it to answer the survey questions about <insert initials>?

• Very easy

• [A little/Somewhat] easy

• Neither easy nor difficult

• [A little/Somewhat] difficult

• Very difficult

(If selected Very/Extremely Sensitive or Difficult) Please describe how your experience answering questions about other household members was sensitive/difficult: ___________________

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<Present words in a random order, unlabeled>

From the list below, please select all of the words you would use to describe your experience completing these survey questions.

[insert word bank task]

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For the next task, please rate how positive or negative you find each word, thinking about your thoughts, feelings, and overall experience answering the questions earlier about yourself and your household.

[order of words in each category randomized; participants will receive a subset of 13 randomly selected words to rate distributed across each category]

Word bank task

Positive	Negative	Neutral
Interesting	Bothersome	Fine
Easy	Annoying	Standard
Important	Inconvenient	Typical
Useful	Time-consuming	Normal
Rewarding	Difficult	Reasonable
Motivating	Intrusive	Tolerable
Valuable	Disruptive	Necessary
Good	Stressful	Obligatory
Beneficial	Effortful	Civic Duty
Helpful	Boring	Expected
Relevant	Personal	Appropriate
	Hassle	Responsibility
	Draining
	Repetitive
	Sensitive

How positive or negative do you find the following words?

<insert words>

• Very positive

• A little positive

• Neither positive nor negative

• A little negative

• Very negative

<repeat for 13 words>

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Earlier we asked you about how burdensome it was to complete this survey. Now, we want you think about what words would describe the opposite of being burdened.

In the spaces below, please provide up to five words you think mean the opposite of “burden.” Please do not use external sources, just list the first word(s) that come to mind.”

 

[insert 5 text boxes]

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What other comments or feedback do you have about your experience completing these survey questions and burden of the survey? ______

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Thank you for participating!

To receive payment for participating in this study, please copy the validation code shown below and paste it in the form on this page for this HIT and submit the task. We will check that code you paste in matches our own database and then approve your payment. 

Your code is: _____