Form 5800-055 Recommended Survey Questions for Citizen Stewardship

OMB Control Number: 2003-NEW
Expiration Date: XX/XX/XXXX

Recommended Survey Questions for Citizen Stewardship
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control
No. 2003-NEW). Responses to this collection of information are voluntary (33 U.S.C. 1267). An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 0.417
hours per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden
estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S.
Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control
number in any correspondence. Do not send the completed form to this address.

Introduction and Screening
This is ____________, calling with a survey about issues affecting your community. This is
not a sales or marketing call. You have been selected at random to represent the views of
people in your community.
May I please speak with the (age and gender rotation) adult who is at home right now?
S1.
Before we begin, I need to know if I have reached you on a cell phone. (If yes): Are
you in a place where you can talk safely without endangering yourself or others?
1 No, not on cell
2 Yes, cell and can talk safely
3 Yes, cell but cannot talk safely (Seek callback time and telephone number.)
9 Refused to say/Not sure (Thank and terminate.)
S2A. In what county or independent city do you live? (County-based; see Excel doc.)
S2B. What is your zip code at home? (Enter 5-digit zip code; 99999=Not sure/Refused to
say)
S3.
Do you have a yard or property that you are responsible for maintaining?
1 Yes
2 No
8 Refused to say
9 Not sure
S4.
Does your home have a grass lawn that you are responsible for maintaining?
1 Yes
2 No
8 Refused to say
9 Not sure

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(If yes):
S4A. Who typically cares for that grass lawn? (Read options. Allow multiple but do not
probe.)
1 Yourself
2 Another family member
3 Someone you hire like a lawn service or a contractor
(Do not read):
4 Friend or neighbor
5 No one/Mother Nature
7 Other (Specify.)
8 Refused to say
9 Not sure
(All):
S5.
Does your home have a septic system to handle its waste, or are you connected to a
public sewer system?
1 Septic
2 Public sewer
8 Refused to say
9 Not sure
S6.
Does your home have gutters and downspouts that you are responsible for
maintaining?
1 Yes
2 No
8 Refused to say
9 Not sure
S7.

Do you have a dog?

1 Yes
2 No
8 Refused to say
9 Not sure
S8.

Do you own or lease a vehicle?

1 Yes
2 No
8 Refused to say
9 Not sure
S9.
Are you responsible for the electricity that is used at your home, or is that provided by
someone else like a landlord?
1 I am/We are responsible
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2 Provided by landlord or someone else
8 Refused to say
9 Not sure
Stewardship Behaviors
I would like to ask about a few things that you may or may not have done. There are no
right or wrong answers to these questions. Just answer each one based on your own
experience.
In the last several years, have you…? (Read and randomize B1-4; do not randomize B5-8.)
B1.

(If S4=1): Replaced an area of grass lawn with native low-maintenance plants.

B2.
(If S3=1 or S4=1): Created a rain garden, or an area specifically designed to capture
and quickly absorb excess rainwater.
B3.

(If S5=1): Had your septic system inspected or pumped out.

B4.

Planted a tree.

1 Yes
2 No
8 Refused to say
9 Not sure/Can’t remember
B8.

Installed low flow sinks, shower heads or toilets to conserve water at your home?

B5.
(If S6=1): Do any of your downspouts drain directly to hard surfaces like a driveway,
sidewalk, or street gutter?
B6.
(If S6=1): Do you have a rain barrel, which is a container that collects rain water from
your downspouts?
B7.
(If yes): Is your rain barrel connected to a downspout and being emptied between
rain storms?
B20. Reduced the amount of single-use plastics that you use, like water bottles, grocery
bags, or straws?
B21.

(If S4=1): Do you or your lawn service company put fertilizer on your grass lawn?

1 Yes
2 No
8 Refused to say
9 Not sure/Can’t remember
B21a. (If yes): How many times is your lawn fertilized per year?

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1 One to two
2 Three to four
3 More than four
9 I don’t know how many times.
B22.

(If S8=1): Is the main vehicle you drive powered by gas, diesel, electric, or hybrid?

1 Gas
2 Diesel
3 Electric
4 Hybrid
8 Do not own a vehicle
9 Not sure or prefer not to say
B23. (If S8=1): Compared to a few years ago, are you driving (randomize): [more, less,
(or) about the same number of miles] today as you used to do?
1 More
2 Less
3 About the same number
8 Refused to say
9 Not sure/Can’t remember
B24. (If S9=1): Do you get your electricity at home from (rotate): [renewable sources like
solar or wind, (or is it from) conventional sources through your electric utility]?
1 Renewable
2 Conventional
3 Combination of renewable and conventional
8 Refused to say
9 Not sure/Can’t remember
For the next few things, please tell me if you never, seldom, sometimes, frequently, or very
frequently do it. (Read and randomize B16, 18, 19, 20.)
B18. Use pesticides in or around your home, for example mosquito spray or poison for
rodents.
B19. (If S3=1 or S4=1): Use herbicide to control weeds in your yard.
(Asked for access; does not figure into Indicator):
B20. Go kayaking, canoeing, boating, fishing, or crabbing.
1 Never
2 Seldom
3 Sometimes
4 Frequently
5 Very frequently
8 (Do not read): Refused to say
9 (Do not read): Not sure

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For each of the following things, please tell me if you never, seldom, sometimes, usually, or
always do it. (Read and randomize B9-15, 17.)
B9.
(If S7=1; yoke B9A & B9B so they are always asked together): Pick up your dog’s
waste and dispose of it in the trash when you are…
A.
On your own property.
B.
Off your property.
B10. (If S3=1 or S4=1): Bag, mulch, or compost the leaves that fall on your property.
B11. (If S4=1): Blow or rake leaves and grass clippings off your lawn and onto hard
surfaces like the driveway or street.
B12. Pick up other people’s litter when you see it.
B13. Toss food wrappers, cups, or cigarette butts on the ground when you are not near a
trash can.
B14. Dispose of medicine or prescription drugs down the drain or by flushing them down
the toilet.
B15. Wash used cooking oil or grease down the drain.
B17. (If fertilize at least sometimes; i.e., B16=3, 4, 5): Sweep lawn fertilizer off hard
surfaces, or use a spray guard to keep it off hard surfaces.
1 Never
2 Seldom
3 Sometimes
4 Usually
5 Always
8 (Do not read): Refused to say
9 (Do not read): Not sure/Does not apply
Future Likelihood
Now we're going to look to the future. I am going to ask you about a few of those actions
again. Looking forward over the next year or so, how likely are you to do each of these
things using the scale (rotate high to low/low to high): [very likely, somewhat likely, (or) not
likely]?
L1.

(If B1=2, 8, or 9): Replace an area of grass lawn with native low-maintenance plants.

L2.
(If B2=2, 8, or 9): Create a rain garden, or an area specifically designed to capture
and quickly absorb excess rainwater.
L3

(If B3=2, 8, or 9): Have your septic system inspected or pumped out.

L4.

(If B4=2, 8, or 9): Plant a tree.

L5.
(If B5=1, 8, or 9): Redirect one or more downspouts to planted areas rather than hard
surfaces.
L6.

(If B6=2, 8, or 9): Install a rain barrel at your home.

L7.

(If B7=2, 8, or 9): Empty your rain barrel between rainstorms.

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L8.
(If B8=2, 8, or 9): Install low flow sinks, shower heads or toilets to conserve water at
your home.
L9A. (If B9A=1, 2, 8 or 9): Pick up your dog’s waste and dispose of it in the trash while you
are on your own property.
L9B. (If B9B=1, 2, 8 or 9): Pick up your dog’s waste and dispose of it in the trash while you
are off your property.
L10.

(If B10=1, 2, 8 or 9): Bag, mulch, or compost the leaves that fall on your property.

L11. (If B11=3, 4, 5, 8 or 9): Blow or rake leaves and grass clippings off your lawn and
onto hard surfaces like the driveway or street.
L12.

(If B12=1, 2, 8 or 9): Pick up other people’s litter when you see it.

L13. (If B13=3, 4, 5, 8 or 9): Toss food wrappers, cups, or cigarette butts on the ground
when you are not near a trash can.
L14. (If B14=3, 4, 5, 8 or 9): Dispose of medicine or prescription drugs down the drain or
by flushing them down the toilet.
L15.

(If B15=3, 4, 5, 8 or 9): Wash used cooking oil or grease down the drain.

L16.

(If B16=3, 4, 5, 8 or 9): Put fertilizer on your grass lawn.

L17. (If B17=1, 2, 8 or 9): Sweep lawn fertilizer off hard surfaces, or use a spray guard to
keep it off hard surfaces.
L18. (If B18=3, 4, 5, 8 or 9): Use pesticides in or around your home, for example mosquito
spray or poison for rodents.
L19.

(If B19=3, 4, 5, 8 or 9): Use herbicide to control weeds in your yard.

L20. (If B20=2, 8 or 9): Reduce the amount of single-use plastics that you use, like water
bottles, grocery bags, or straws.
L21.

(If B21=2, 8 or 9): Put fertilizer on your grass lawn more often than once per year.

L22.

(If B22=1 or 2): Buy or lease an electric or hybrid vehicle.

L23.

(If B23=1 or 3): Drive fewer miles than you do today.

L24.

(If B24=2): Get your electricity at home from renewable sources like solar or wind.

1 Very likely
2 Somewhat likely
3 Not likely
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8 (Do not read): Refused to say
9 (Do not read): Not sure
Volunteerism
(All):
Thinking back over the past year, have you done the following things never, seldom,
sometimes, frequently, or very frequently?
V1.

Volunteered your time for a charitable organization.

V2.
Volunteered your time to help clean up and protect local waters or the natural
environment, for example a community clean-up or tree planting.
V3.
Donated money to a charitable organization, other than any money you may have
given to your own religious congregation.
V4.
Donated money to an organization that helps clean up and protect local waters or the
natural environment.
1 Never
2 Seldom
3 Sometimes
4 Frequently
5 Very frequently
8 (Do not read): Refused to say
9 (Do not read): Not sure
V5.
Can you think of at least one group in your local area that is working to clean up and
protect local waters and the natural environment? (If yes): Can you name that group?
1 Yes (Specify name.)
2 Yes, but can’t name the group
3 No, can’t think of a group
9 Not sure
Civic Engagement
E12. Thinking back over the past year, have you never, seldom, sometimes, frequently, or
very frequently gotten personally involved in an issue that was important to you by attending
a public hearing, a demonstration or a rally, writing a letter to the editor or blog post, calling
talk radio, or anything like that?
1 Never
2 Seldom
3 Sometimes
4 Frequently
5 Very frequently
8 (Do not read): Refused to say
9 (Do not read): Not sure
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(If sometimes, frequently, or very frequently in E12):
E13. Was any of that activity related to an environmental cause, like land or water
protection, or climate change? (If yes): Were you siding with environmental advocates, or
against them?
(Do not read):
1 Yes, siding with environmental advocates
2 Yes, against environmental advocates
3 Yes, both for and against
4 Not related to environmental cause
8 Refused to say
9 Not sure
(All):
E14. If you were to consider all the issues and challenges facing our region today, where
would the health of local rivers, streams, and the Chesapeake Bay rank on that priority list
for you? (Rotate top to bottom, bottom to top.)
1 At the top
2 Above average
3 In the middle of the pack
4 Below average
5 At the bottom
9 (Do not read): Not sure/Refused
E15. When there is an election, do you vote seldom, sometimes, usually, or always, or are
you not registered to vote?
1 Not registered
2 Vote seldom
3 Vote sometimes
4 Vote usually
5 Vote always
9 (Do not read): Not sure/Refused to say

Individual Engagement: Perceptions and Attitudes
For each of the statements that follow please tell me if you strongly disagree, somewhat
disagree, are neutral, somewhat agree, or strongly agree. (Read and randomize E1-11.)
E1.

My daily activities contribute to water pollution where I live.

E2.

Polluted water affects me personally.

E3.

I want to do more to help make local creeks, rivers, and lakes healthier.

E4.

I know some things I can do to help reduce water pollution where I live.
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E5.

If people work together, water pollution around here can be fixed.

E6.
If I wanted to volunteer to help the natural environment locally, I would know how to
do that.
E7.
I could see myself contacting elected officials or talking with my neighbors on behalf
of clean water.
E8.
There is convenient access to the water for boating, fishing, or swimming near where
I live.
E9.

The water near where I live is healthy and safe for boating, fishing, or swimming.

E10. I consider myself to be very health-minded, because I eat healthy foods, exercise for
my health, or read a lot about health issues.
E11.

Strong federal and state action is needed to help clean up the Chesapeake Bay.

E16.

I trust my neighbors.

E17.

I care about the community where I live.

1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 (Do not read): Refused to say
9 (Do not read): Not sure
Classification
(All):
The last few questions are to classify the survey only.
C1.

What is your age? (Read categories until stopped.)

1 Less than 25
2 25 to 34
3 35 to 44
4 45 to 54
5 55 to 64
6 65 to 74
7 75 or more
8 (Do not read): Refused to say
9 (Do not read): Not sure
C2.

What is the last grade in school or level of education that you completed?
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(Do not read list):
1 Less than 12th grade
2 12th grade/High school diploma/GED
3 Some college/Associate’s degree
4 Four-year degree/Bachelor’s degree
5 Graduate work/Advanced degree
8 (Do not read): Refused to say
9 (Do not read): Not sure
C4. Including yourself, how many people live in your household?
(Key in number; valid range 1 – 97; 98=Refused to say; 99=Not sure.)
(If C4 > 1):
C5. How many of those people are under the age of 18?
(Key in number; valid range 1 – 97; 98=Refused to say; 99=Not sure.)
(All):
C6.

Do you own or rent your home?

1 Own
2 Rent
8 (Do not read): Refused to say
9 (Do not read): Not sure
C7. Is your home single-family detached; a rowhouse, townhouse, or duplex; or a multifamily building like an apartment or condo?
1 Single-family detached
2 Rowhouse/Townhouse/Duplex/Anything attached
3 Multi-family
8 (Do not read): Refused to say
9 (Do not read): Not sure
C8.

Which of these best describes the area in which you live? (Read choices.)

1 Urban, in other words a city
2 Suburban
3 Small town
4 Rural
8 (Do not read): Refused to say
9 (Do not read): Not sure
C9.

Is your immediate family involved in farming or agriculture?

1 Yes
2 No
8 (Do not read): Refused to say
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9 (Do not read): Not sure
C10. What is your religious affiliation, if any?
(Do not read):
1 Catholic
2 All other Christian/Protestant/Non-denominational Christian
3 Jewish
4 Muslim
5 Hindu
6 Buddhist
7 Not religious/Agnostic/Atheist
8 Spiritual/No specific religion
97 Other (Specify.)
98 Refused to say
99 Not sure
(All except C10-7, 98, 99):
C11. Do you attend religious worship weekly, once or twice a month, several times a year,
or less often than that?
1 Weekly
2 Once or twice a month
3 Several times a year
4 Less often than that
(Do not read):
8 Refused to say
9 Not sure
(All):
C12. Do you identify your race or ethnicity as (randomize): [White, African-American or
Black, Hispanic or Latino, Asian], or some other? Please mention any that apply to you.
(Allow multiple.)
1 White
2 African-American/Black
3 Hispanic/Latino
4 Asian
5 Other (Specify or code below.)
(Do not read):
6 Native American, American Indian, or Alaskan Native
7 Native Hawaiian or Other Pacific Islander
8 Mixed/Multi-racial (unspecified)
9 Middle Eastern or North African (MENA)
98 Refused to say
99 Not sure

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C13. About what was the total income for all members of your household last year before
taxes? Stop me when I get to the right category. (Read categories until stopped.)
(If necessary): Just give me your best guess.
1 Less than $25,000
2 25 to less than $50,000
3 50 to less than $75,000
4 75 to less than $100,000
5 100 to less than $150,000
6 $150,000 or more
8 (Do not read): Refused to say
9 (Do not read): Not sure
C14. What is your gender identity?
1 Male
2 Female
3 Another gender category (Specify.)
8 (Do not read): Refused to say
That’s all the questions I have. Thank you for your time. Goodbye.
EPA Form: 5800-055

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