Merit Review Survey: 2021 and 2023 Assessment of Applicant and Reviewer Experiences

NSF 2021 Merit Review Survey OMB Appendix A January 25, 2021

Appendix A: 2021 Merit Review Survey

[SECTION: SURVEY INTRODUCTION]

[ALL, NOT REQUIRED]

Welcome

Thank you for participating in this survey. Your responses will help NSF understand the factors that affect researchers as they submit proposals or review proposals, and lead to improvements in NSF proposal submission and review processes to better support the research community.

Your participation is voluntary but critical to the success of NSF improvement efforts. Your decision to participate or not to participate in this survey will not adversely affect consideration of your pending or future proposals.

This survey should take about 20 minutes to complete. Responses will be kept confidential and only aggregate findings will be reported. For example, the 2019 survey results indicated that 73 percent of reviewers and 62 percent of applicants reported being satisfied with NSF’s merit review process overall.

Please contact [email protected] for assistance with or questions about this survey.

Please scroll down and click the "Forward" arrow to proceed with the survey.

Note: Do not use your browser "back" button while taking this survey, as it may result in the loss of your responses. Instead, use the blue navigation arrows that appear at the bottom of the survey page.

 

[ALL, NOT REQUIRED]

Paperwork Burden Statement

OMB: This information is collected under the authority of the National Science Foundation Act of 1950, as amended. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time required to complete this voluntary information collection is estimated to average 20 minutes, including the time to review instructions, and complete and review responses. If you have any comments or concerns about the contents or the status of your individual submission of this questionnaire, e-mail [email protected] or call toll-free XXX-XXX-XXXX.

[ALL, NOT REQUIRED]

About This Survey

This survey focuses on your experiences as someone who has reviewed proposals for NSF and/or submitted proposals to NSF. It also has some questions about your background to help NSF understand how experiences may vary for different groups of individuals, such as junior versus senior faculty. Throughout the survey, someone who submits a proposal to NSF, a proposer, is also called a Principal Investigator (PI).

For the purpose of this survey, please do not count post-doctoral fellowship applications or student fellowship applications as proposals.

[ALL, REQUIRED]

Q1A. * Since October 1, 2017, have you reviewed a proposal for NSF, other than a post-doctoral or student fellowship application?

• Yes 1

• No 0

[ALL, REQUIRED]

Q1B. * Since October 1, 2017, have you submitted a proposal to NSF as PI, other than a post-doctoral or student fellowship application? (Do not include your experience as a co-investigator.)

• Yes 1

• No 0

[IF Q1A=0 AND Q1B=0, GO TO THANK YOU]

[Q1A=1 OR Q1B=1, NOT REQUIRED]

Q2. Since October 1, 2017, with which NSF Directorate have your proposal submission or review activities been most often affiliated? (Note: If your work aligns with more than one, select the directorate or office with which your activities have been most often affiliated since October 1, 2017.) Think of proposal submission or review activities for that directorate when completing the survey.

[SELECT ONE; DIVISIONS WILL APPEAR AS A POP-UP REFERENCE WINDOW WHEN THE RESPONDENT HOVERS ABOVE THE DIRECTORATE.]

Directorate/Office	Division (appears in pop-up reference window)
BIO = Biological Sciences (01)	DBI = Biological Infrastructure DEB = Environmental Biology EP = Emerging Frontiers IOS = Integrative Organismal Systems MCB = Molecular & Cellular Biosciences
CISE = Computer & Information Science & Engineering (02)	OAC = Office of Advanced Cyberinfrastructure (formerly, Division of Advanced Cyberinfrastructure) CNS = Computer & Networking Systems CCF = Computing & Communication Foundations CCF = Computing & Communication Foundations IIS = Information & Intelligent Systems
EHR = Education & Human Resources (03)	DGE = Graduate Education HRD = Human Resource Development DRL = Research on Learning in Formal & Informal Settings DUE = Undergraduate Education
ENG = Engineering (04)	CBET = Chemical, Bioengineering, Environmental, and Transport Systems CMMI = Civil, Mechanical & Manufacturing Innovation ECCS = Electrical, Communications & Cyber Systems EEC = Engineering Education & Centers EFMA = Merging Frontiers and Multidisciplinary Activities IIP = Industrial Innovation & Partnerships
GEO = Geosciences (05)	AGS = Atmospheric & Geospace Sciences EAR = Earth Sciences OCE = Ocean Sciences OPP = Office of Polar Programs (formerly, Division of Polar Programs)
MPS = Mathematical & Physical Sciences (06)	AST = Astronomical Sciences CHE = Chemistry DMR = Materials Research DMS = Mathematical Sciences PHY = Physics
SBE = Social, Behavioral & Economic Sciences (07)	BCS = Behavioral & Cognitive Sciences SES = Social & Economic Sciences
OIA = Office of Integrative Activities (08)
OISC = International Science & Engineering (09)
None of the above (10)

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You have reached the end of the first survey section.

If you wish to modify any of your responses to this section, click the back arrow below. After clicking the forward arrow, you will not be able to navigate back to this section of the survey.

[IF Q1A=0 AND Q1B=1, GO TO PI_Intro]

[SECTION: EXPERIENCES AS A REVIEWER]

[Q1A=1, NOT REQUIRED]

[Reviewer_Intro] The following questions ask about your experiences reviewing NSF proposals since October 2017. For these questions, please use the definitions below.

There are two types of reviewers:

• An ad hoc reviewer is someone who submits a written review of a proposal but does not participate in a discussion of the proposal with other reviewers.

• A panelist, or panel reviewer, is someone who participates in a discussion of a proposal (usually more than one proposal) with other reviewers. A panelist may or may not prepare a written review but has access to the reviews written by others. Panelists may meet face to face or remotely.

[Q1A=1, NOT REQUIRED]

Q3. Since October 2017, I have served as ____ for NSF (note options below):

• An ad hoc reviewer only 1

• A panelist/panel reviewer only 2

• Both an ad hoc reviewer and a panelist/panel reviewer 3

[Q1A=1, NOT REQUIRED]

Q4. Approximately how many reviews of individual proposals have you written for NSF since October 1, 2017, regardless of whether as an ad hoc reviewer or a panelist? (Your best estimate is fine; no decimals, please.) [text box] [NUMBER VALIDATION: “Please enter a number less than 1,000 and greater than zero; no decimals, please.”]

[Q1A=1, REQUIRED]

Q5. * During the past 12 months, have you declined to…

Yes 1

No 0

Was not asked to participate 2

Q5A. Serve as an ad hoc reviewer for NSF?

Q5B. Serve as a face-to-face panelist on an NSF review panel?

Q5C. Serve as a remote panelist on an NSF review panel?

[Q1A=1 AND Q5A=1, Q5B=1, OR Q5C=1, NOT REQUIRED; QUESTION WILL BE SPLIT ACROSS TWO SCREENS Q6A-E & Q6F-J]

Q6. Thinking about the most recent time you declined to participate in a review, to what extent did the following factors influence your decision?

To a Great Extent 3

To a Moderate Extent 2

To a Small Extent 1

Not at all 0

Q6A. Proposal or program was not related to my professional interests

Q6B. Lack of time

Q6C. Conflict of interest

Q6D. Too many NSF review requests

Q6E. Competing professional pressures (including teaching, organizational administration service, etc.)

Q6F. Dissatisfaction with the proposal review process

Q6G. Increasing commitments as a reviewer to other funding agencies

Q6H. [SHOW IF Q5B=1] Unable to travel to a face-to-face panel

Q6I. [SHOW IF Q5C=1] Dislike participating in discussions over phone, video-conference, or web-based meeting technology

Q6J. Some other factor (Specify): ­­­­­­[text box]

[Q1A=1, NOT REQUIRED]

Q7. Thinking about the most recent time you wrote a review of an NSF proposal, please estimate the amount of time (rounded to the nearest hour) that it took you to read the proposal, write, and submit that single written review. Please do not count time spent travelling to or sitting in panels.

(Please enter the number of hours in the box below; no decimals, please). [text box] [NUMBER VALIDATION: “Please enter a value less than 1,000 and greater than zero; no decimals, please.”]

[Q1A=1, NOT REQUIRED]

Q8. When do you typically read proposals and write reviews of NSF proposals?

• Mainly during normal working hours 1

• Mainly outside of normal working hours 2

• Both during and outside normal working hours 3

[Q1A=1, NOT REQUIRED]

Q9. How does your employer view your participation as a reviewer (for NSF or other funding agencies)?

• My employer considers my participation as a reviewer to fall within the scope of my normal work duties. 1

• My employer considers my participation as a reviewer to fall outside the scope of my normal work duties. 2

• I am unsure how my employer views my participation. 3

[Q1A=1, NOT REQUIRED]

[OverallPropQual_Intro] The following questions will ask you about your perceptions about the quality of the proposals you have reviewed.

[Q1A=1, NOT REQUIRED]

Q10. Based on your experience reviewing proposals for NSF, to what extent do you agree or disagree with the following statements?

Strongly Agree 4

Agree 3

Disagree 2

Strongly Disagree 1

Q10A. Overall, the majority of proposals I have reviewed in recent years have been of high quality.

Q10B. Individuals submitting proposals are treated fairly.

[Q1A=1, NOT REQUIRED]

[RO_Intro] The following questions ask about your experience preparing to review proposals for NSF.

[Q1A=1, NOT REQUIRED; SPLIT ACROSS TWO SCREENS-AQ11A-E & Q11F-J]

Q11. To what extent do you use the following strategies when completing proposal reviews?

To a Great Extent 3

To a Moderate Extent 2

To a Small Extent 1

Not at All 0

Q11A. Read the merit review criteria before you read the proposal(s)

Q11B. Take notes when reading the proposal

Q11C. Focus on strengths and weaknesses with respect to the review criteria

Q11D. Include specific and concrete examples

Q11E. Critically read your review before submitting it

Q11F Actively reflect on your own thought processes

Q11G. Think of alternative views

Q11H. Play a devil’s advocate to your own assessment

Q11I. Take time with your decision

Q11J. Use some other strategy (specify and rate): _________________

[Q1A=1, NOT REQUIRED]

Q12. To what extent are you familiar with the following unconscious cognitive biases that can affect reviews?

To a Great Extent 3

To a Moderate Extent 2

To a Small Extent 1

Not at All 0

Q12A. Anchoring bias: Relying too heavily on one piece of information or an initial impression (the anchor) and neglecting subsequent information.

Q12B. Confirmation bias: Unconsciously attending to evidence that confirms our existing beliefs or expectations.

Q12C. Halo effect: When an overall positive impression of a person’s past achievements influences judgements of the specific merits of a proposal.

Q12D. Language bias: Tendency to judge ideas or statements from non-native speakers more critically.

Q12E. Social stereotype bias: Unconscious and automatic thoughts and feelings about other people influenced by social categories (e.g., age, ethnicity, race, nationality, gender, occupation).

[Q1A=1, REQUIRED]

Q13. * NSF offers reviewer orientation information in a 20-minute video with tips about how to prepare a high-quality review. Have you seen this video?

• Yes 1

• No 0 [GO TO Q18]

• Unsure 2 [GO TO Q18]

[Q1A=1 AND Q13=1, NOT REQUIRED]

Q14. At what stage of the review process did you watch the reviewer orientation video? If you watched it at multiple stages, please select all that apply.

□ Prior to reviewing the proposal(s) 1

□ After reading the proposal(s) but before writing my review(s) 2

□ After writing my review(s) but before participating in the panel discussion 3

□ Not sure/can’t remember [Exclusive answer] 0

[Q1A=1 AND Q13=1, NOT REQUIRED]

Q15. Please indicate the degree to which you found the information in the following video segments to be helpful when conducting your reviews:

Very Helpful 4

Moderately Helpful 3

Slightly Helpful 2

Not Helpful 1

Do Not Recall 0

Q15A. Tips on how to prepare an analytical review

Q15B. Guidance to reviewers on the broader impact criterion

Q15C. Information about strategies to mitigate the effects of unconscious cognitive biases

[Q1A=1 AND Q13=1, NOT REQUIRED]

Q16. Please indicate the degree to which you found the reviewer orientation video helpful when you prepared your reviews:

Very Helpful 4

Moderately Helpful 3

Slightly Helpful 2

Not Helpful 1

Do Not Recall 0

[Q1A=1 AND Q13=1, NOT REQUIRED]

Q17. Do you now recall any of the tips provided in the reviewer orientation video?

• Yes 1

• No 0

[Q1A=1, NOT REQUIRED]

Q18. To what extent has participating as an NSF reviewer…

To a Great Extent 3

To a Moderate Extent 2

To a Small Extent 1

Not at All 0

N/A 99

Q18A. Improved your understanding of the proposal process?

Q18B. Provided useful information for improving your next proposal?

Q18C. Influenced you to submit to another funding agency?

Q18D. Discouraged you from submitting your proposals to NSF?

[IF Q1A=1 AND Q1B=0, GO TO Q31]

[SECTION: EXPERIENCES AS A PRINCIPAL INVESTIGATOR]

[Q1B=1, NOT REQUIRED]

[PI_Intro] NSF is interested in your experience seeking funding from NSF and other sources. Please answer the following questions based on your experience as a principal investigator (PI), not on any experience that you may have had as a co-investigator. Please think only of the proposals you have submitted to NSF since October 1, 2017.

[Q1B=1, REQUIRED]

Q19. * Since October 1, 2017, how many proposals have you submitted to NSF? (Note: Please enter a whole number in the box below; no decimals please.) [textbox] [NUMBER VALIDATION: “Please enter a value greater than zero; no decimals, please.”]

[Q1B=1, REQUIRED]

Q20. * Since October 1, 2017, have you applied for funding from a federal agency other than NSF?

• Yes 1

• No 0 [GO TO Q22]

[Q1B=1 AND Q20=1, NOT REQUIRED]

Q21. Compared to other federal agencies' proposal submission systems, how much effort, on the part of a researcher preparing a proposal, does it take to write and complete a proposal in the required format and submit it to NSF?

• More Effort 3

• Nearly the Same Effort 2

• Less Effort 1

[Q1B=1, NOT REQUIRED]

Q22. Thinking about the most recent proposal you submitted to NSF, how much time did you spend preparing (writing, formatting, and submitting) the proposal?

• Less than 40 hours 1

• 41 - 80 hours 2

• 81 - 120 hours 3

• 121 - 160 hours 4

• 161 - 200 hours 5

• More than 200 hours 6

[Q1B=1, REQUIRED]

Q23. * Since October 1, 2017, have you received a funding decision for any proposals you submitted to NSF?

• Yes, I have received a decision for at least 1 proposal submitted to NSF since October 1, 2017. 1

• No. 0

[Q1B=1, REQUIRED]

Q24. * Have you ever submitted a proposal to NSF that was declined?

• Yes 1

• No 0 [GO TO PI_Sat_Intro]

[Q1B=1 AND Q24=1, NOT REQUIRED]

Q25. To what extent did the written reviews that accompanied the decline of one of your NSF proposals…

To a Great Extent 3

To a Moderate Extent 2

To a Small Extent 1

Not at All 0

Q25A. Improve your understanding of the proposal process?

Q25B. Provide useful information for revising and improving your next proposal?

Q25C. Influence you to submit to another funding agency?

Q25D. Discourage you from revising and submitting your proposals to NSF?

[Q1B=1 AND Q23=1, NOT REQUIRED]

[PI_Sat_Intro] For the following question, please refer to the most recent proposal that you submitted to NSF for which you have received an award or decline decision.

[Q1B=1 AND Q23=1, NOT REQUIRED]

Q26. How satisfied or dissatisfied were you with...

Very Satisfied 5

Somewhat Satisfied 4

Neither Dissatisfied nor Satisfied 3

Somewhat Dissatisfied 2

Very Dissatisfied 1

Not Applicable 0

Q26A. The quality of the information NSF provided during the proposal submission process (i.e., FastLane, FAQs, website content)

Q26B. The timeliness of the decision to award or decline funding

Q26C. Your interaction with NSF staff

[Q1B=1, NOT REQUIRED; SPLIT ACROSS TWO SCREENS-Q27A-E & Q27F-H]

Q27. Based on your experience submitting proposals to NSF, to what extent do you agree or disagree with the following statements?

Strongly Agree 4

Agree 3

Disagree 2

Strongly Disagree 1

Not Applicable 0

Q27A. Written reviews are thorough

Q27B. Written reviews are technically sound

Q27C. Overall, written reviews are of high quality

Q27D. The panel summary or summaries are of high quality

Q27E. The information provided regarding the outcomes of the competition is of high quality

Q27F. The program officer comments I viewed in FastLane helped me understand the decision to decline or award my proposal

Q27G. The conversations (email, phone, face-to-face) I had with my program officer provided me with helpful feedback about my proposal

Q27H. Individuals submitting proposals are treated fairly

Some NSF programs have deadlines or target dates for the submission of proposals. Some NSF programs do not have submission deadlines or target dates; instead, proposals can be submitted for review at any time.

Q28. Have you submitted at least one proposal to a program with submission deadlines or target dates between October 1, 2017 and September 30, 2020?

• Yes 1

• No 0

Q29. Have you submitted at least one proposal to a program without submission deadlines or target dates between October 1, 2017 and September 30, 2020?

• Yes 1

• No 0

[Q28=1 AND Q29=1, NOT REQUIRED]

Q30. Based on each of the following dimensions, to which merit review process would you prefer to submit your proposals?

Without Submission Deadlines or Target Dates 1

No Preference 0

With Submission Deadlines or Target Dates 2

• Q30A. Fairness with which proposals are treated

• Q30B. Time to receipt of decision about decline or award

• Q30C. Thoroughness of reviews

• Q30D. Technical soundness of reviews

• Q30E. Likelihood that reviews contain feedback that I can use to improve my future proposals

• Q30F. Time spent writing proposals

[SECTION: OVERALL EXPERIENCES]

[ALL, NOT REQUIRED]

Q31. Please indicate whether you agree or disagree with the following statements:

Strongly Agree 5

Agree 4

Neither Agree nor Disagree 3

Disagree 2

Strongly Disagree 1

Q31A. Overall, I am satisfied with NSF’s merit review process

Q31B. Overall, I think NSF’s merit review process is fair

Q31C. Overall, I think NSF’s merit review process is effective

Q31D. [SHOW IF Q1A=1] Overall, I intend to continue to review proposals for NSF in the future

Q31E. [SHOW IF Q1B=1] Overall, I intend to continue to submit proposals to NSF in the future

[ALL, NOT REQUIRED]

Q32. This survey has asked about your experiences with NSF’s merit review process. In your opinion, improving which one of the following factors will have the most significant effect on improving the merit review process? Please select one.

• Timeliness of decisions about, and responsiveness to, proposals by NSF staff 1

• Quality of feedback to PIs in the form of comments in written reviews 2

• Quality of feedback to PIs in the form of comments in panel summaries 3

• Quality of PI conversations with, and written comments from, program officers 4

• Quality of information available during proposal submission 5

• Quality of the review process from the perspective of a reviewer 6

[ALL, NOT REQUIRED]

Q33. Please enter any additional comments you may have about NSF’s merit review process in the space below: ____ [Essay text box]

[ALL, NOT REQUIRED]

[SECTION: EDUCATION HISTORY & EMPLOYMENT]

The following questions will prompt you to provide basic information on your early career experience with NSF, and your institution/organization as well as some demographic information. If you work for multiple organizations, please pick the one you consider to be your primary employer and answer in terms of that organization. (Data will be reported at an aggregate level and are requested to help us understand the experiences of different groups.)

[ALL, NOT REQUIRED]

Q34. In what year did you receive your highest degree? (Please do not count honorary degrees.) Please select a year from the drop-down menu. [drop down menu including years 1950 through 2020 + ‘before 1950’]

[ALL, NOT REQUIRED]

Q35. Did you receive any financial support (e.g., research assistantship, fellowship, traineeship, scholarship, other grants) from NSF as an undergraduate or graduate student?

• Yes 1

• No 0 [GO TO Q37]

• Don’t know 2 [GO TO Q37]

[Q36=1, NOT REQUIRED]

Q36. What type of financial support did you receive from NSF while you were an undergraduate or graduate student?

Yes 1

No 0

Q36A. REU (research experience for undergraduates) support

Q36B. Research assistantship

Q36C. Fellowship support

Q36D. Traineeship support

Q36E. Scholarship

Q36F. Travel grant

Q36G. Other (please specify): [… Text box …]

[ALL, REQUIRED]

Q37. * Do you work for an institution of higher education?

• Yes 1

• No 0 [GO TO Q40]

[Q37=1, NOT REQUIRED]

Q38. Please select the basic classification that best describes your institution.

• Doctoral University. Includes institutions that award at least 20 research/scholarship doctoral degrees/year. Excludes Special Focus Institutions and Tribal Colleges. 1

• Master's College or University. Generally includes institutions that award at least 50 master's degrees and fewer than 20 doctoral degrees/year. Excludes Special Focus Institutions and Tribal Colleges. 2

• Baccalaureate College. Includes institutions where baccalaureate or higher degrees represent at least 50 percent of all degrees but where fewer than 50 master's degrees or 20 doctoral degrees are awarded/year. Excludes Special Focus Institutions and Tribal Colleges. 3

• Baccalaureate/Associate's College. Includes four-year colleges that confer more than 50 percent of degrees at the associate's level/year. Excludes Special Focus Institutions and Tribal Colleges, and institutions that have sufficient master’s or doctoral degrees to fall into those categories. 4

• Associate's College. Institutions at which the highest level degree awarded is an associate's degree. Excludes Special Focus Institutions and Tribal Colleges. 5

• Special Focus Institution. Institutions where a high concentration of degrees is in a single field or set of related fields. Excludes Tribal Colleges. 6

• Tribal College. Colleges and universities that are members of the American Indian Higher Education Consortium. 7

[Q37=1 AND Q38≠7, NOT REQUIRED]

Q39. Is it a minority-serving institution (i.e., a Tribal College or University, an Historically Black College or University, or an Hispanic-Serving Institution)? (These are Department of Education Title IV designations for institutions of higher education that enroll populations with significant percentages of undergraduate minority students.)

• Yes 1

• No 0

[Q37=1, NOT REQUIRED]

Q40. What is your position?

• Post-doctoral fellow 1

• Assistant Professor 2

• Associate Professor 3

• Full Professor 4

• Adjunct Professor 5

• Emeritus/Emerita Professor 6

• Retired 7

• Other (please specify): 8 [… Text box …]

[IF Q37=1, GO TO Demographics_Info]

[Q37=0, REQUIRED]

Q41. * Which of the following best describes your organization?

• Non-higher-education academic institutions 1

• Non-profit organizations 2

• For-profit organizations 3

• Federally-funded R&D centers 4

• Government (local, state, federal, or tribal) 5

• Other (please specify) 6

[SECTION: DEMOGRAPHICS]

[ALL, NOT REQUIRED]

The next questions request demographic information. NSF will only use these data to generate statistics to inform whether our programs and other opportunities in science and technology reach and benefit a diverse set of researchers. Please pick the category or categories that you feel best describe yourself. You may also select the option to not specify a category for each question.

[ALL, NOT REQUIRED]

Q42. Are you a veteran?
[DEFINTION WILL APPEAR IN POP-UP INFORMATION WINDOW] ⓘ A veteran is a person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable (Title 38 of the Code of Federal Regulations).

• Yes, I am a veteran 1

• No, I am not a veteran 2

• I do not wish to provide this information 3

[ALL, NOT REQUIRED]

Q43. What is your current gender?

• Woman 1

• Man 2

• Non-binary 3

• Prefer to self-describe (specify__________) 4

• Prefer not to say 5

[ALL, NOT REQUIRED]

Q44. Are you Hispanic or Latino?
[DEFINTION WILL APPEAR IN POP-UP INFORMATION WINDOW] ⓘ A Hispanic or Latino is a person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race (Research.gov).

• Yes, I am Hispanic or Latino 1

• No, I am not Hispanic or Latino 2

• I do not wish to provide this information 3

[ALL, NOT REQUIRED]

Q45. What is your race? (select one or more)

[RACE CATEGORY DEFINITIONS WILL APPEAR IN POP-UP INFORMATION WINDOW] ⓘ

American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam

Black or African American - A person having origins in any of the Black racial groups of Africa

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa

□ American Indian or Alaska Native 1

□ Asian 2

□ Black or African American 3

□ Native Hawaiian or Other Pacific Islander 4

□ White 5

□ Other (please specify) [exclusive answer] 6

□ I do not wish to provide this information [exclusive answer] 7

Q46. What is the usual degree of difficulty you have with...?

Q46A. Seeing words or letters in ordinary newsprint (with glasses/contact lenses, if you usually wear them)?

□ None 1

□ Slight 2

□ Moderate 3

□ Severe 4

□ Unable to do 5

□ Do not wish to provide 6

Q46B. Hearing what is normally said in conversation with another person (with hearing aid, if you usually wear one)?

□ None 1

□ Slight 2

□ Moderate 3

□ Severe 4

□ Unable to do 5

□ Do not wish to provide 6

Q46C. Walking or using stairs without human or mechanical assistance?

□ None 1

□ Slight 2

□ Moderate 3

□ Severe 4

□ Unable to do 5

□ Do not wish to provide 6

Q46D. Lifting or carrying something as heavy as 10 pounds, such as a bag of groceries?

□ None 1

□ Slight 2

□ Moderate 3

□ Severe 4

□ Unable to do 5

□ Do not wish to provide 6

Q46E. Concentrating, remembering, or making decisions because of a physical, mental, or emotional condition?

□ None 1

□ Slight 2

□ Moderate 3

□ Severe 4

□ Unable to do 5

□ Do not wish to provide 6

[ALL, NOT REQUIRED]

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