Form 1 Respondent Privacy and Confidentiality Concerns Question

Introduction Screen

Thank you for agreeing to participate in this research study. On the next screen, you will be asked to begin filling out a questionnaire similar to what will be used in the 2020 Census. After you have filled out the questionnaire for yourself and one other person in your household, you will be asked to answer some follow-up questions about the previous question items.

By law, the Census Bureau is required to keep your answers confidential. This survey is voluntary and you may refuse to answer any question. The results of this study will be used to inform future surveys and censuses. This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-0978, confirms this approval. If this number was not displayed, we could not conduct this survey. We estimate that this survey will take about 15 minutes. By proceeding with this study, you give your consent to participate in this study.

Your privacy is protected by the Privacy Act. There are a limited number of uses of your data that are permitted under the Privacy Act. You can find a list of these uses in the System of Records Notice (SORN). For this survey, the SORN is named “COMMERCE/CENSUS-5, Decennial Census Program.” For more information, please visit our website at census.gov and click on "Data Protection and Privacy Policy" at the bottom of the home page.

Decennial Question items

This questionnaire is similar to what you might receive as part of the 2020 Census. Please answer the questions as you would if you were answering from the home where you live or stay most of the time.

1. How many people were living or staying in this house, apartment, or mobile home on April 1, 2019?

Number of people = ________

2. Were there any additional people staying here on April 1, 2019 that you did not include in Question 1? Mark x all that apply.

   • Children, related or unrelated, such as newborn babies, grandchildren, or foster children

   • Relatives, such as adult children, cousins, or in-laws

   • Nonrelatives, such as roommates or live-in babysitters

   • People staying here temporarily

   • No additional people

3. Is this house, apartment, or mobile home – Mark x ONE box.

   • Owned by you or someone in this household with a mortgage or loan? Include home equity loans.

   • Owned by you or someone in this household free and clear (without a mortgage or loan)?

   • Rented?

   • Occupied without payment or rent?

4. What is your telephone number? We will only contact you if needed for official Census Bureau business.

Telephone Number

__ __ __ - __ __ __- __ __ __ __

5. Please provide information for each person living here. If there is someone living here who pays the rent or owns this residence, start by listing him or her as Person 1. If the owner or the person who pays the rent does not live here, start by listing any adult living here as Person 1.

For this survey, please consider yourself Person 1 and answer the questions as if you were Person 1.

What is person 1’s name? Print name below.

First Name MI

________________________________ ____

Last Name(s)

____________________________________________

6. What is Person 1’s sex? Mark x ONE box.

• Male □ Female

7. What is Person 1’s age and what is Person 1’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age.

Age on April 1, 2019 Month Day Year of Birth

__ __ __ Years __ __ __ __ __ __ __ __

NOTE: Please answer BOTH Question 8 about Hispanic origin and Question 9 about race. For this census, Hispanic origins are not races.

8. Is Person 1 of Hispanic, Latino, or Spanish origin?

• No, not of Hispanic, Latino, or Spanish origin

• Yes, Mexican, Mexican Am., Chicano

• Yes, Puerto Rican

• Yes, Cuban

• Yes, another Hispanic, Latino, or Spanish origin – Print, for

example, Salvadoran, Dominican, Colombian, Guatemalan,

Spaniard, Ecuadorian, etc.

________________________________________________

9. What is Person 1’s race?

Mark x one or more boxes AND print origins.

• White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.

_____________________________________________________________

• Black or African Am. – Print, for example, African-American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

__________________________________________­___________________

• American Indian OR Alaska Native – Print name or enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.

___________________________­­­­­­­­__________________________________

□ Chinese □ Vietnamese □ Native Hawaiian

□ Filipino □ Korean □ Samoan

□ Asian Indian □ Japanese □ Chamorro

□ Other Asian-Print for example, □ Other Pacific Islander-

Pakistani, Cambodian, Hmong, etc. Print for example, Tongan, Fijan, Marshallese, etc.

___________________________________________________________

• Some other race- Print race or origin

___________________________________________________________

10. Is Person 1 a citizen of the United States?

• Yes, born in the United States

• Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or

Northern Marianas

• Yes, born abroad of U.S. citizen parent or parents

• Yes, U.S. citizen by naturalization – Print year of naturalization. ______

• No, not a U.S. citizen

11. What is the highest degree or level of school Person 1 has completed?

• No high school

• Some high school

• High school graduate or equivalent (for example GED)

• Some college, but degree not received or is in progress

• Associate degree (for example AA, AS)

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

• Graduate degree (for example master’s, professional, doctorate)

Note: If more people were counted in Question 1 on the front page, continue with Person 2.

1. Print name of Person 2.

First Name MI

________________________________ ____

Last Name(s)

____________________________________________

2. Does this person usually live or stay somewhere else?

Mark x all that apply

• No

• Yes, to college □ Yes, with a parent or other relative

• Yes, for a military assignment □ Yes, at a seasonal or second residence

• Yes, for a job or business □ Yes, in a jail or prison

• Yes, in a nursing home □ Yes, for another reason

3. How is this person related to Person 1? Mark x ONE box.

• Opposite-sex husband/wife/spouse □ Father or mother

• Opposite-sex unmarried partner □ Grandchild

• Same-sex husband/wife/spouse □ Parent-in-law

• Same-sex unmarried partner □ Son-in-law or daughter-in-law

• Biological son or daughter □ Other relative

• Adopted son or daughter □ Roommate or housemate

• Stepson or stepdaughter □ Foster child

• Brother or sister □ Other non-relative

4. What is this person’s sex? Mark x ONE box.

• Male □ Female

5. What is this person’s age and what is this person’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age.

Age on April 1, 2019 Month Day Year of Birth

__ __ __ Years __ __ __ __ __ __ __ __

NOTE: Please answer BOTH Question 6 about Hispanic origin and Question 7 about race. For this census, Hispanic origins are not races.

6. Is this person of Hispanic, Latino, or Spanish origin?

• No, not of Hispanic, Latino, or Spanish origin

• Yes, Mexican, Mexican Am., Chicano

• Yes, Puerto Rican

• Yes, Cuban

• Yes, another Hispanic, Latino, or Spanish origin – Print, for

example, Salvadoran, Dominican, Colombian, Guatemalan,

Spaniard, Ecuadorian, etc.

________________________________________________

7. What is this person’s race?

Mark x one or more boxes AND print origins.

• White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.

_____________________________________________________________

• Black or African Am. – Print, for example, African-American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

__________________________________________­___________________

• American Indian OR Alaska Native – Print name or enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.

___________________________­­­­­­­­__________________________________

□ Chinese □ Vietnamese □ Native Hawaiian

□ Filipino □ Korean □ Samoan

□ Asian Indian □ Japanese □ Chamorro

□ Other Asian-Print for example, □ Other Pacific Islander-

Pakistani, Cambodian, Hmong, etc. Print for example, Tongan, Fijan, Marshallese, etc.

___________________________________________________________

• Some other race- Print race or origin

___________________________________________________________

8. Is this person a citizen of the United States?

• Yes, born in the United States

• Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or

Northern Marianas

• Yes, born abroad of U.S. citizen parent or parents

• Yes, U.S. citizen by naturalization – Print year of naturalization. ______

• No, not a U.S. citizen

9. How many members of your household are under the age of 18? _____

10. How many members of your household are over the age of 18? _____

Thank you for your answers. Since this questionnaire is for testing and research purposes, we do not need detailed information about all members of your household. Now we will ask questions about the information you just provided.

For the next set of questions, please think about the census questionnaire you just completed and what would happen if someone was able to find out this information about you or your household.

1. Would it concern you if someone was able to find out your AGE?

□ Yes

□ No  SKIP TO QUESTION 3

2. If someone was able to find out your AGE, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

3. Would it concern you if someone was able to find out your RACE AND ETHNICITY?

□ Yes

□ No  SKIP TO QUESTION 5

4. If someone was able to find out your RACE AND ETHNICITY, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

5. Would it concern you if someone was able to find out the NUMBER OF PEOPLE IN YOUR HOUSEHOLD?

□ Yes

□ No  SKIP TO QUESTION 7

6. If someone was able to find out the NUMBER OF PEOPLE IN YOUR HOUSEHOLD, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

(If more than 1 person in household, then ask 7-12. Else- skip to Q13) Would it concern you if someone was able to find out the AGE(S) OF OTHERS IN YOUR HOUSEHOLD?

□ Yes

□ No  SKIP TO QUESTION 9

7. If someone was able to find out the AGE(S) OF OTHERS IN YOUR HOUSEHOLD, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

8. Would it concern you if someone was able to find out the RACE AND ETHNICITY OF OTHERS IN YOUR HOUSEHOLD?

□ Yes

□ No  SKIP TO QUESTION 11

9. If someone was able to find out the RACE AND ETHNICITY OF OTHERS IN YOUR HOUSEHOLD, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

10. Would it concern you if someone was able to find out the RELATIONSHIP BETWEEN YOURSELF AND OTHER PEOPLE IN YOUR HOUSEHOLD?

□ Yes

□ No  SKIP TO QUESTION 13

11. If someone was able to find out the RELATIONSHIP BETWEEN YOURSELF AND OTHER PEOPLE IN YOUR HOUSEHOLD, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

12. Would it concern you if someone was able to find out WHETHER YOU OWN OR RENT YOUR HOME?

□ Yes

□ No  SKIP TO QUESTION 15

13. If someone was able to find out WHETHER YOU OWN OR RENT YOUR HOME, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

14. Would it concern you if someone was able to find out your CITIZENSHIP STATUS?

□ Yes

□ No  SKIP TO QUESTION 17

15. If someone was able to find out your CITIZENSHIP STATUS, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

16. When you answered the previous question, were you thinking about your own citizenship status, the citizenship status of others in your household, or the citizenship status of others who do not live in your household? Please answer yes or no.

Your own citizenship status

• Yes

• No

The status of others in your household

• Yes

• No

The status of others who do not live in your household

• Yes

• No

17. (Ask if more than one person in household. Else skip to Q20) Would it concern you if someone was able to find out the CITIZENSHIP STATUS OF OTHER PEOPLE IN YOUR HOUSEHOLD?

□ Yes

□ No  SKIP TO QUESTION 20

18. If someone was able to find out the CITIZENSHIP STATUS OF OTHER PEOPLE IN YOUR HOUSEHOLD, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

19. Would it concern you if someone was able to find out your FULL NAME?

□ Yes

□ No  SKIP TO QUESTION 22

20. If someone was able to find out your FULL NAME, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

21. Would it concern you if someone was able to find out the FULL NAME(S) OF OTHER PEOPLE IN YOUR HOUSEHOLD?

□ Yes

□ No  SKIP TO QUESTION 24

22. (Ask if more than one person in household. Else skip to Q23) If someone was able to find out the FULL NAME(S) OF OTHER PEOPLE IN YOUR HOUSEHOLD, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

23. A few of the questions have asked about the information of others in your household. When you answered these questions, were you thinking about the information that you had reported for others in your household or information that they had reported themselves?

• You reported their information

• They reported their own information

24. Would it concern you if someone was able to find out ALL OF THE INFORMATION included in the Census Bureau questionnaire?

□ Yes

□ No  SKIP TO QUESTION 27 or 28

25. If someone was able to find out ALL OF THE INFORMATION included in the Census Bureau questionnaire, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

26. (Ask if any concerns are reported)You reported that you would be concerned if someone was able to find out some of your information. What types of concerns were you thinking about when you answered these questions?

Select all that apply Note: answer choices will be randomized

• Identity theft or other financial crimes

• Personal safety or safety of others in your household

• Privacy

• Racial discrimination

• Age-based discrimination

• Sexual orientation discrimination

• Immigration enforcement

• Marketing or solicitors

• Stalking

• Debt collectors

• Gentrification

• Redistricting

27. (Ask if no concerns are reported) You reported no concerns about the information. Please explain why you are not concerned.

Open-ended text box

Now please think about some types of information that will not be collected in the 2020 Census, but you might provide to other organizations or businesses.

28. Would it concern you if someone was able to find out your SOCIAL SECURITY NUMBER?

□ Yes

□ No  SKIP TO QUESTION 31

□ Not applicable  SKIP TO QUESTION 31

29. If someone was able to find out your SOCIAL SECURITY NUMBER, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

30. Would it concern you if someone was able to find out your INCOME?

□ Yes

□ No  SKIP TO QUESTION 33

31. If someone was able to find out your INCOME, how concerned would you be?

□ Slightly concerned

□ Somewhat concerned

□ Moderately concerned

□ Very concerned

Every 10 years, the Census Bureau collects information about people living in the United States. Before making any of this information available to the public, the Census Bureau removes information that could be used to identify individuals (such as names and addresses). Although the Census Bureau makes every effort to protect your information, it may be possible for someone to link information you provide to the Census Bureau to your personal identity or address. One way that this could happen is if your information was stolen from the Census Bureau with your identifying details still connected to your responses. This is known as a DATA BREACH or HACKING.

32. Have you ever heard of information being stolen through hacking or a data breach?

□ Yes

□ No

33. How worried are you about information you give to the Census Bureau being stolen through hacking or a data breach?

□ Not at all worried

□ A little worried

□ Moderately worried

□ Very worried

34. How likely do you think it is that information you give the Census Bureau will be stolen through hacking or a data breach?

□ Not at all likely

□ A little bit likely

□ Moderately likely

□ Very likely

Though hacking and data breaches have received a lot of media attention lately, they are not the only way that your identifying information could be accessed. It could also be possible for someone to use anonymous Census Bureau data and combine it with another information source to figure out identifying information about a person or address.

For example, someone could combine Census data about a small geographic area with other publicly-available information and find out that a specific household on a particular block has seven people living in it, including three unrelated people and two adopted children. This practice of finding out identifying information by combining anonymous information with some other data is called RE-IDENTIFICATION.

35. Have you ever heard of information about individuals being discovered through re-identification?

□ Yes

□ No

36. How worried are you about information you give to the Census Bureau being discovered through re-identification?

□ Not at all worried

□ A little worried

□ Moderately worried

□ Very worried

37. How likely do you think it is that the information you give to the Census Bureau will be discovered through re-identification?

□ Not at all likely

□ A little bit likely

□ Moderately likely

□ Very likely

38. The last question asked how worried you are about your data being discovered through re-identification. How difficult was it to answer the question?

• Extremely difficult

• Moderately difficult

• Somewhat difficult

• Not at all difficult

Note: Half of respondents will get the open-ended follow up and half will receive the closed-ended probe.

39. When you answered, how did you understand re-identification? Select one

Was it…

• Getting a new identity

• Having someone identify you in a data set

• Having someone steal your identity

• Something else. Specify _________

40. The last question asked about how worried you are about your data being discovered through re-identification. What does the term re-identification mean in your own words?

Open text box

41. Policy makers, businesses, and researchers use information collected from government surveys to make important decisions. The more detailed the data provided by households like yours, the more useful that information is. This might mean reporting data by ZIP code, for example, instead of by state. But providing more detail may increase the risk that an individual household’s information will be identified, even if that risk is low.

In general, how willing are you to risk your confidentiality so the government can produce useful data and statistics for policy makers, businesses and researchers to use?

□ Not at all willing

□ Slightly willing

□ Somewhat willing

□ Moderately willing

□ Very willing

42. Which of the following statements comes closest to your opinion?

□ A. I am willing to share information about me and my household with some government agencies (like the Census Bureau) so the government can produce more useful data and statistics, even if it means having less control over that information.  SKIP TO QUESTION 44

□ B. I would rather keep information about me and my household private even if it means the data and statistics produced by the government are less useful.  SKIP TO QUESTION 45

□ C. I agree equally with both  SKIP TO QUESTION 46

□ D. I don't agree with either  SKIP TO QUESTION 46

43. (If selected A in question 44) How much more do you agree with statement A than statement B above?

□ I agree much more with A than B  SKIP TO QUESTION 46

□ I agree a little more with A than with B  SKIP TO QUESTION 46

44. (If selected B in question 44) How much more do you agree with statement B than statement A above?

□ I agree much more with B than A

□ I agree a little more with B than with A

45. The last question asked your opinion about willingness to share information with government agencies and keeping information about you and your household private. How difficult was it to answer the question?

• Extremely difficult

• Moderately difficult

• Somewhat difficult

• Not at all difficult

46. As you may know, different government departments and services collect data about individuals, for example your tax records and health records. People have different views about whether this data should be used for new purposes after it has been collected. Using this data can bring benefits, such as finding more effective medical treatments or using information about local communities to plan local schools or roads. But some people worry that other uses for data risk their privacy and security, by linking different types of data together and potentially allowing them to be identified.

Overall, which of the following statements comes closest to your opinion?

□ A. Government should find new ways to use data already collected because it benefits public services and society.  SKIP TO QUESTION 48

□ B. Government should not use data already collected in new ways due to the risks to people’s privacy and security.  SKIP TO QUESTION 49

□ C. I agree equally with both.  SKIP TO QUESTION 50

□ D. I don't agree with either.  SKIP TO QUESTION 50

47. (If selected A in question 47) How much more do you agree with statement A than statement B above?

□ I agree much more with A than B  SKIP TO QUESTION 50

□ I agree a little more with A than with B  SKIP TO QUESTION 50

48. (If selected B in question 47) How much more do you agree with statement B than statement A above?

□ I agree much more with B than A

□ I agree a little more with B than with A

49. The last question asked your opinion about whether the government should use data for new purposes after it has been collected. How difficult was it to answer the question?

• Extremely difficult

• Moderately difficult

• Somewhat difficult

• Not at all difficult

50. How often do you browse personalized recommendations from online services such as Amazon, Netflix, or Facebook?

    • Frequently

    • Sometimes

    • Hardly ever

    • Never

51. The previous question asked how often you browse personalized recommendations from online services. Can you please provide an example of what you were thinking when you answered that question?

Text box

52. When an app on your smartphone or tablet seeks your permission to use your location, how often do you allow it to use your location?

    • Frequently

    • Sometimes

    • Hardly ever

    • Never

53. How often do you use search engines to look up information?

    • Several times a day

    • About once a day

    • A few times a week

    • A few times a month

    • A few times a year

    • Never

54. How often do you rate or review products or purchases on online sites such as Amazon or Netflix?

    • Frequently

    • Sometimes

    • Hardly ever

    • Never

55. The previous question asked how often you rate or review products or purchases online. Can you please provide an example of what you were thinking when you answered that question?

Text box

56. Have you done any of these things to protect your data or avoid intrusion into your privacy? Select all that apply.

• Signed up for the Do Not Call Registry, which removes your number from marketing call lists

• Blocked a smartphone app or stopped an app from accessing other details on your phone, such as GPS location or your contacts

• Changed the default settings on your computer or browser to increase your privacy

• Stopped or avoid using a social media service so that you can protect your privacy

• Changed the privacy settings on your social media accounts

• Started using more secure methods of communication, such as encrypted emails

• Asked a government department, public service or private company to delete any information they hold about you

• Stopped using store loyalty cards so that you can protect your privacy

• Asked a government department, public service or private company what information they hold about you

• None of these

• Don't know

57. How difficult was the previous question to answer?

    • Extremely difficult

    • Moderately difficult

    • Somewhat difficult

    • Not difficult at all

The next question asks about your income. We use this information only to produce statistics. The Census Bureau is required by law to keep your information confidential.

58. What is your total ANNUAL household income, before taxes? Please include income from wages and salaries, remittances from family members living elsewhere, farming, and all other sources.

• Under $720

• $720 to $5,999

• $6,000 to $11,999

• $12,000 to $23,999

• $24,000 to $35,999

• $36,000 to $47,999

• $48,000 to $59,999

• $60,000 to $89,999

• $90,000 to $119,999

• $120,000 to $179,999

• $180,000 to $239,999

• $240,000 and over

• Don’t know

• Prefer not to answer

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