Attachment B Survey 1 Instrument

Attachment B

Survey 1

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 20 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.

Based on your responses, you may receive an invitation to complete a follow-up study through your Mechanical Turk account.

To allow us to contact you again for a follow-up study, please provide your Mechanical Turk Worker ID here: ___________

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Imagine you received the following envelope in your mailbox on <insert current date>. You open the envelope and find this letter. Please read the letter carefully, as you will answer some questions about it later.

<insert low / high burden letter, randomly assigned>

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Now, imagine an interviewer from the federal government has some questions about you and your household. Please answer the following questions.

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

2. <for 1-5 people> Please enter the initials (first, middle, and last) of each of the people who are living or staying with you (do not include yourself).

<for 6+ 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. 

<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 2 HH members>

[TEXT FILL initials of Other HH member]

[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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Next, we have some questions about you.

Insert demographic items (See Attachment G)

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You indicated that [TEXT FILL OTHER HH MEMBER INITIALS], is living or staying with you. Please answer the following questions about Person 2.

Insert demographic items (See Attachment G)

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You indicated that [TEXT FILL OTHER HH MEMBER INITIALS], is living or staying with you. Please answer the following questions about Person 3.

Insert demographic items (See Attachment G)

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Now we have a few questions about your household generally.

[insert questions about household (See Attachment G)]

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?

_______

List up to 10 words that describe your experience completing these survey questions:

1. ________

2. ________

3. ________

4. ________

5. ________

6. ________

7. ________

8. ________

9. ________

10. ________

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From the list below, please select all of the words you would use to describe your experience completing these survey questions. [order of words in each category randomized; 15 words will be selected from the Pre-testing phase to be displayed here; 5 per category]

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

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Questions with * denote that participants will be randomly assigned to receive scale labels with the qualifier ‘A lot’ vs. ‘Somewhat’

Next, we’d like you to rate your experience completing the survey questions about you and your household.

*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?: _________

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Thinking back to the letter you imagined getting in the mail earlier, which of the following factors would contribute to finding this survey burdensome? (select all that apply) display only applicable items for burden condition:

• The survey (is/is not) required by law

• Time it takes to complete the survey

• Number of phone calls made to me

• Number of in person visits made to me

• Number of pieces of mail sent to me

• Number of times I am asked to complete the survey

• The questions included on the survey

• Having to answer about other household members

• None of these; I did not find the survey burdensome

• Other, specify: ___

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

• Extreme effort

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

• Very easy

• [A little/Somewhat] easy

• Neither easy nor difficult

• [A little/Somewhat] difficult

• Very difficult

*How sensitive were these survey questions?

• Not at all sensitive

• [A little / somewhat] sensitive

• Moderately sensitive

• Very sensitive

• Extremely sensitive

Would you say that the survey invaded, or did not invade your privacy?

• Invaded my privacy

• Did not invade my privacy

(If invades) Would you say the survey questions were a little invasive, somewhat invasive, or very invasive?

• A little invasive

• Somewhat invasive

• Very invasive

*How likely would you be to participate in this survey again?

• Not at all likely

• [A little/somewhat] likely

• Moderately likely

• Very likely

• Extremely likely

*How beneficial would it be to society to complete this survey?

• Not at all beneficial

• [A little / Somewhat] beneficial

• Moderately beneficial

• Very beneficial

• Extremely beneficial

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

<insert initials of all other HH members>

*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

<repeat for up to one more HH member>

(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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About how long did you spend answering these survey questions?

____ minutes

Do you feel that the time it took you to complete the survey was less than you expected, about what you expected, or more than you expected?

• Less than I expected

• About what I expected

• More than I expected

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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. 

You may be contacted again in one month to participate in a follow-up survey.

Your code is: _____