2 Study 2 questionnaire

Study 3

1. Please select the state where you are currently completing this survey.

[drop down of 50 states and District of Columbia]

2. What is your age?

[numeric field] years old

3. What is your date of birth?

Month [drop down]

Day [drop down]

Year [drop down]

4. What is your sex?

• Male

• Female

4. What is your race or ethnicity? Select all boxes that apply AND enter origins

• White [text field]

• Hispanic, Latino or Spanish [text field]

• Black or African American [text field]

• Asian [text field]

• American Indian or Alaska [text field]

• Native Hawaiian or Other Pacific Islander [text field]

• Some other race [text field]

4. Are there any children or youth age 20 or younger living in this household?

• Yes

• No

4. How many children or youth age 20 or younger live in this household?

none

[2 digit text field]

4. What is the highest degree or level of school you have COMPLETED?

Please specify your major field of study. If you did not have one, please write “N/A”

• No high school diploma

• High school diploma or GED

• Associate’s degree – Specify: [text field]

• Bachelor’s degree (e.g., BS, BA, AB) – Specify: [text field]

• Master’s degree (e.g., MS, MA, MBA) – Specify: [text field]

• Doctorate (e.g., PhD, DSc, EdD)- Specify: [text field]

• Other prof degree (e.g., JD, LLB, MD, DDS, DMV)- Specify: [text field]

• Other-Specify: [text field]

4. In the past week, did you eat any evening meals alone?

• Yes

• No

4. Last week, how many days did you eat the evening meal alone?

none or [2 digit numeric field]

4. Please answer the following questions about your house, apartment, or mobile home.

Which best describes this building? 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 or 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.

4. How many rooms are in this [house/apartment/mobile home/home]?

• INCLUDE bedrooms, kitchens, family rooms, living rooms, dining rooms, etc.

• EXCLUDE bathrooms, porches, balconies, foyers, halls, or unfinished rooms

[numeric field]

4. How many rooms in this [house/apartment/mobile home] are there in each of the following categories?

Bedrooms (two digit numeric field)

Kitchens (two digit numeric field)

Bathrooms (two digit numeric field)

Family rooms (two digit numeric field)

Living rooms (two digit numeric field)

Dining rooms (two digit numeric field)

Other finished rooms (two digit numeric field)

Unfinished rooms (two digit numeric field)

4. Does anyone in your household pay for water or sewer? Select “Yes” if water and sewer are billed together

• Yes

• No

4. LAST MONTH, what was the cost of water for this [house/apartment/mobile home/home]?

None or $-,---.00

4. Does anyone in your household pay for natural gas or propane?

• Yes

• No

4. LAST MONTH, what was the cost of gas for this [house/apartment/mobile home/home]?

none or $-,---.00

4. Please enter the state where you are currently completing this survey.

Please enter the first three letters and not the full state name.

[open ended text field]

4. Does anyone in this household pay for electricity?

   1. Yes

   2. No

4. LAST MONTH, what was the cost of electricity for this [house/apartment/mobile home/home]?

$ [numeric field] .00

4. What is the easiest way for you to tell us the amount your household pays for electricity?

• Weekly

• Monthly

• Every 3 Months

• Annually

4. Did you receive any wages, salary, commissions, bonuses, or tips during the PAST 12 MONTHS?

• Yes

• No

4. What was the amount? Report amount from all jobs before any deductions for taxes, bonds, dues, or other items

$ [numeric field].00

4. What is the easiest way for you to tell us the amount of wages, salary, commissions, bonuses, or tips you receive? This includes jobs before any deductions for taxes, bonds, dues, or other items.

• Weekly

• Every 2 weeks

• Twice a month

• Monthly

• Annually

4. Please select “Neither agree nor disagree” below (to make sure the system is working correctly).

• Strongly agree

• Agree

• Slightly agree

• Neither agree nor disagree

• Slightly disagree

• Disagree

• Strongly disagree

4. How easy or difficult was it for you to complete this survey?

• Extremely easy

• Somewhat easy

• Neither easy nor difficult

• Somewhat difficult

• Extremely difficult

4. There are few ways to present additional instructions after a survey question. Which one do you prefer, if any?

• Instructions are in italicized font and are on the same line as the survey question (with image attached as example)

• Instructions are in italicized font and are on a different line than the survey question (with image attached as example)

• Instructions are in regular font and are on the same line as the survey question (with image attached as example)

• Instructions are in regular font are on a different line than the survey question (with image attached as example)

• No preference

4. There are 3 ways for respondents to report “0” or “none” when answering a question. Which one do you prefer, if any?

• Check a “none” box (with image attached as example)

• Answer a yes/no filter question first so the question is only presented to people without “0” or “none” (with image attached as example)

• Enter “0” in the box if there is no number to report (with image attached as example)

• No preference

4. Here are two ways that asks respondent to report dollar amounts. Which one do you prefer, if any?

• Image of example of Q22 and Q23 together

• Image of example of Q22, Q23, and Q24 together