3 Experimental Task Questionnaire

Generic Clearance for Questionnaire Pretesting Research

4. Experimental task Revised

Census Roster Omission Study

OMB: 0607-0725

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Experimental Task

During this study, you will read a series of statements with different situations. Your task will be to imagine that each of these statements represent your current life situation and to select the person(s) you would count on the census under these different situations.

  1. Baseline

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in your house your house by yourself

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • No one

Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related/Adult/Short term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. You have rented the additional room to your sister, who needs a place to stay for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related/Adult/Long term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. You have rented the additional room to your sister who needs a place to stay for one year.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • No one

Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated/Adult/Short term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. You have rented the additional room to your friend, who needs a place to stay for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend

  • No one

Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult





  1. Unrelated/Adult/Long term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. You have rented the additional room to your friend who needs a place to stay for one year.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your coworker

  • No one

Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related/Adult/Short term stay/separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. You have rented the garage room to your sister, who needs a place to stay for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related/Adult/Long term stay/separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. You have rented the garage room to your sister, who needs a place to stay for one year.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated/Adult/Short term stay/separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. You have rented the garage room to your friend, who needs a place to stay for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult

  1. Unrelated/Adult/Long term stay/separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. You have rented the garage room to your friend, who needs a place to stay for one year.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related/young child/Short term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your niece, who is currently going to kindergarten, is staying in the additional room for one month while her parents find permanent housing.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your niece

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related/young child/Long term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your niece, who is currently going to kindergarten, is staying in the additional room for one year while her parents find permanent housing

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your niece

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated/Young child/Short term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your friend’s daughter, who is currently going to kindergarten, is staying in the additional room for one month while your friend finds permanent housing.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend’s daughter

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated/Young child/Long term stay/single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your friend’s daughter, who is currently going to kindergarten, is staying in the additional room for one year while your friend finds permanent housing.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend’s daughter

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult





Vignettes with scenario where correct answer would be to exclude the additional person:

Today is census day and you are completing the census form. Imagine that this is your current living situation:

  1. You have full custody of your daughter, who is currently going to kindergarten. The school district where your ex-spouse lives is better than the school district where you live. So, your daughter stays with you Friday through Sunday and with your ex-spouse Monday through Friday so she can attend a better school.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your daughter

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult





Today is census day and you are completing the census form. Imagine that this is your current living situation:

  1. You live in a two-bedroom house. Your daughter, who is currently going to college in a different town, stays in the additional room when she comes to visit.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your daughter

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult





Today is census day and you are completing the census form. Imagine that this is your current living situation:

  1. You live in a two-bedroom house. Your mom (who lived in the additional room in your house) moved to a nursing home last week. She will be deciding within the next month whether she wants to stay there or go back to your house.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your mom

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related family/ long term/ single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your sister and her child (your niece, who is currently going to kindergarten) are renting the additional room for one year.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • Your niece

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related family/ short term/ single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your sister and her child (your niece, who is currently going to kindergarten) are renting the additional room for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • Your niece

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult





  1. Related family/ long term/ separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. Your sister and her child (your niece, who is currently going to kindergarten) are renting the garage room for one year.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • Your niece

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Related family/ short term/ separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. Your sister and her child (your niece, who is currently going to kindergarten) are renting the garage room for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your sister

  • Your niece

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated family/ long term/ single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your friend and her child (who is currently going to kindergarten) are renting the additional room for one year.

T Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend

  • Your friend’s child

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated family/ short term/ single unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a two-bedroom house. Your friend and her child (who is currently going to kindergarten) are renting the additional room for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend

  • Your friend’s child

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated family/ long term/ separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:

You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. Your friend and her child (who is currently going to kindergarten) are renting the garage room for one year.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend

  • Your friend’s child

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



  1. Unrelated family/ short term/ separate unit

Today is census day and you are completing the census form. Imagine that this is your current living situation:



You live in a house that has an additional room in the garage. This garage room has its own entrance and is not connected to the house. Your friend and her child (who is currently going to kindergarten) are renting the garage room for one month.

Please check the box(es) for the person(s) that you would count when answering this census question:

How many people are living or staying at your home?

  • Yourself

  • Your friend

  • Your friend’s child

  • No one



Please rate how easy or difficult it was for you to answer this question

1 2 3 4 5 6 7

Extremely easy Extremely Difficult



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorAlda G Rivas (CENSUS/CBSM FED)
File Modified0000-00-00
File Created2021-01-14

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