Attachment B
Network Scale-Up Method (NSUM) Questionnaire
Screener Survey
Introduction
We are conducting a survey on behalf of the National Center for Science and Engineering Statistics within the National Science Foundation to estimate the size of personal networks and certain populations in the United States. You will not be asked to provide any personal information, only limited demographic information on people that you know. Your response is voluntary and failure to provide some or all of the requested information will not in any way adversely affect you. Actual time to complete the questionnaire is approximately 5 minutes.
OMB No.: 3145-0174
Approval Expires: 07/31/2025
1. Are you
[Radio button]
(1) Male
(2). Female
2. What is your age?
[Fill In]
Age ___
What is the highest degree or level of school you have completed? Mark one
[Radio Button]
Less than high school/secondary school graduate
Regular high school diploma
GED or alternative credential
Some college credit, but less than 1 year of college credit
1 or more years of college credit, no degree
Associate’s degree (for example: AA, AS)
Bachelor’s degree (for example: BA, BS)
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)
Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)
Not applicable/Unknown
You will be asked to report on the number of people you know that fit into different categories. For the purpose of this survey, you know someone if you know them and they know you by sight or by name, you have had some contact with them in the past two years, and you could contact them now if you had to.
[randomize questions within each block and randomize the ordering of the blocks]
How many people do you know that currently reside in the US who were…
[Fill in, randomize within block]
Born in the United States and has a college degree in biology or life sciences?
Born in the United States and has a college degree in math or computer science?
Born in the United States and has a college degree in physics or chemistry?
Born in the United States and has a college degree in social sciences?
Born in the United States and is an engineer?
Born in the United States with a degree in science or engineering?
How many people do you know that currently reside in the US who were…
[Fill in, randomize within block]
Born outside the United States and has a college degree in biology or life sciences?
Born outside the United States and has a college degree in math or computer science?
Born outside the United States and has a college degree in physics or chemistry?
Born outside the United States and has a college degree in social sciences?
Born outside the United States and is an engineer?
Born outside the United States with a degree in science or engineering and are contemplating returning to their country of origin?
How many people do you know that currently reside in the US who…
[Fill in, randomize within block]
Work as a Registered Nurse (RN)?
Work as a school teacher?
Are a U.S. veteran?
How many people do you know that currently reside in the US who…
[Fill in, randomize within block]
Smoke cigarettes?
Had a stroke in the last three years?
Been diagnosed with cancer in the last year?
Women who gave birth within the last year?
Died within the last year ?
Died from COVID in the U.S.?
How many people do you know that currently reside in the US who…
[Fill in, randomize within block]
Has been arrested within the last year?
Has been physically attacked by someone within the last year?
Had their home illegally entered by another person without permission within the last year?
How many people do you know that currently reside in the US who…
[Fill in, randomize within block]
Has the first name Mary?
Has the first name Elizabeth?
Has the first name Patricia?
Has the first name James?
Has the first name Robert?
Has the first name Michael?
End of Survey
Thank you for your time.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | McCulloh, Ian |
| File Modified | 0000-00-00 |
| File Created | 2023-08-26 |