Form Attachment G Attachment G Demographic Questions

Appendix G: Demographic questions

Note that participants will answer these questions about themselves and for up to one additional household member in the Pretesting survey, and up to two randomly selected household members in Survey 1 and 2.

Note that for every question except the items listed under “Household Questions,” participants will be asked to answer this question on behalf of other household member(s), e.g., “What is [insert HH member’s initials] age?”

Note that these are all questions that currently appear on federal surveys, were pretested to potentially appear on federal surveys, or are approximately the same questions that currently appear on a federal survey, but adapted and simplified to be appropriate for an online, self-administered mode using mTurk participants.

Table at the bottom indicates the survey from which was question was drawn.

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.

What is your age?

• _____

• Prefer not to say

What is the highest level of education you’ve completed?

• Less than high school

• High school diploma or GED

• Some college

• Associate degree

• Bachelor’s degree

• Graduate school degree

• Prefer not to say

What is your annual income? ____

• Don’t know

• Prefer not to say

[If blank], In which of these ranges does your annual income fall?

• Less than $25,000

• $25,000 - $50,000

• $50,001 – $75,000

• $75,001 - $100,000

• More than $100,000

• Don’t know

• Prefer not to say

What is your annual household income? ____

• Don’t know

• Prefer not to say

[If blank] In which of these ranges does your annual household income fall?

• Less than $25,000

• $25,000 - $50,000

• $50,001 – $75,000

• $75,001 - $100,000

• More than $100,000

• Don’t know

• Prefer not to say

In the past 3 months, how much money have you given to benefit charities or other organizations? ____

• Don’t know

• Prefer not to say

What has been your usual monthly expense for alcohol, including beer and wine to be served at home? _____

1. Don’t know

2. Prefer not to say

Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?

• Yes

• No

• Don’t know

• Prefer not to say

Do you have difficulty dressing or bathing?

• Yes

• No

• Don’t know

• Prefer not to say

Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?

• Yes

• No

• Don’t know

• Prefer not to say

What is your sex?

• Male

• Female

• Transgender

• Something else, specify: ____

• Don’t know

• Prefer not to say

Which of the following best represents how you think of yourself?

• Gay or Lesbian

• Bisexual

• Straight, that is not gay, lesbian, or bisexual

• Something else, specify: ____

• Don’t know

• Prefer not to say

What is your current marital status?

• Married

• Widowed

• Divorced

• Separated

• Never married

• Don’t know

• Prefer not to say

Are you of Hispanic, Latino, or Spanish origin?

• Yes

• No

(If yes to above) Are you Mexican, Mexican American, or Chicano; Puerto Rican; Cuban, Cuban American, or of another Hispanic, Latino, or Spanish origin; for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on?

• Mexican

• Mexican American

• Chicano

• Puerto Rican

• Cuban

• Cuban-American

• Other, specify: _____

Below is a list of five race categories. Please choose one or more races that you consider yourself to be.

• White

• Black or African American

• American Indian or Alaska Native

• Asian

• Native Hawaiian or Other Pacific Islander

(If Asian selected) Are you Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or another Asian group, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on?

• Asian Indian

• Chinese

• Filipino

• Japanese

• Korean

• Vietnamese

• Other Asian, specify:______

(If Native Hawaiian or Other Pacific Islander selected) Are you Native Hawaiian; Guamanian or Chamorro; Samoan; or another Pacific Islander group, for example, Fijian, Tongan, and so on?

• Native Hawaiian

• Guamanian or Chamorro

• Samoan

• Other Pacific Islander, specify: ____

Last week, did you work for pay at job or business?

• Yes (go to leave question)

• No

• Don’t know

• Prefer not to say

Last week, did you do any work for pay, even for as little as one hour?

• Yes

• No (skip to the layoff question)

• Don’t know

• Prefer not to say

What time did this person usually leave home to go to work last week?

___hour; ___minute AM/PM

• Don’t know

• Prefer not to say

How many minutes did it usually take for you to get from home to work last week?

____ minutes

• Don’t know

• Prefer not to say

Last week, were you on layoff from a job?

• Yes

• No (go to question on looking for work)

• Don’t know

• Prefer not to say

Last week, were you temporarily absent from a job or a business?

• Yes

• No

• Don’t know

• Prefer not to say

Have you been informed that you will be recalled to work within the next 6 months or been given a date to return to work?

• Yes

• No

• Don’t know

• Prefer not to say

During the last 4 weeks, have you been actively looking for work?

• Yes

• No

• Don’t know

• Prefer not to say

Last week, could you have started a job if offered one, or returned to work if recalled?

• Yes, could have gone to work

• No, because of own temporary illness

• No, because of all other reasons (in school, etc)

• Don’t know

• Prefer not to say

When did you last work, even for a few days?

• Within the past 12 months

• 1 to 5 years

• Over 5 years ago or never worked

• Don’t know

• Prefer not to say

During the past 12 months (52 weeks), did you work 50 or more weeks? Count paid time off as work

• Yes

• No

• Don’t know

• Prefer not to say

Housing questions

Which best describes the building where you live? Include all apartments, flats, etc., even if vacant

• A mobile home

• A one-family house detached from any other house

• A one-family house attached to one or more houses

• A building with 2 apartments

• A building with 3 to 4 apartments

• A building with 5 to 9 apartments

• A building with 10 to 19 apartments

• A building with 20 to 49 apartments

• A building with 50 or more apartments

• Boat, RV, van, etc.

About when was the building where you live first built?

• 2000 or later, specify year: _______

• 1990 to 1999

• 1980 to 1989

• 1870 to 1979

• 1960 to 1969

• 1950 to 1959

• 1940 to 1949

• 1939 or earlier

What fuel is used most for heating the house, apartment, or mobile home where you live?

• Gas: from underground popes serving the neighborhood

• Gas: bottled, tank, or LP

• Electricity

• Fuel oil, kerosense, etc.

• Coal or coke

• Wood

• Solar energy

• Other fuel

• No fuel used

Age	This or similar question appears on the CPS and ACS. To protect participants’ confidentiality, we do not ask for date of birth but rather directly for age. The CPS uses date of birth to determine age, ACS asks for it directly.
Education	Shortened version the CPS and ACS education questions
Income	ACS and CPS
Income brackets	CPS
Household income	CPS
Household income brackets	CPS
Charity donations	Consumer Expenditure Interview
Alcohol spending	Consumer Expenditure Interview
Disability – concentrating	CPS Disability Supplement
Disability – bathing	CPS Disability Supplement
Disability – errands	CPS Disability Supplement
Sex	ACS and CPS; response options pretested for these surveys
Sexual Orientation	Included in CPS SOGI pretesting study, not in production
Ethnicity	CPS (R/E Standards)
Race	CPS (R/E Standards)
All employment questions	ACS
All housing questions	ACS