Employment Processes_Instrument 4_Interviewee Demographic Information Form 05-2023 2 (clean)

Attachment X– Interviewee Demographic Form

OMB Control No: 0970-0356

Expiration Date: 02/29/2024

Interviewee Demographic Form

Site (site visitor pre-populates):

Interview Number (site visitor pre-populates):

INSTRUCTIONS: Please answer each question below. This information will help the research team understand the overall demographic composition of the people we talk to. Please do not include your name.

1. What is the highest level of education you have completed? (Please mark one.)

☐ Less than high school

☐ High school diploma or equivalent

☐ Some college, no degree

☐ Associate’s degree or vocational degree

☐ Bachelor’s degree

☐ Master’s degree or higher

2. What is your gender identity? (You can select as many as apply)

☐ Woman

☐ Man

☐ Transgender

☐ Non-binary/ third gender

☐ Prefer to self-describe (specify):_______

☐ Prefer not to say

3. What is your age? (Please mark one.)

☐ Under 25 years

☐ 25-30 years

☐ 31-40 years

☐ 41-50 years

☐ Over 50 years

4. Are you Hispanic or Latino?

☐ Yes

☐ No

5. What is your race? (You can select as many as apply.)

☐ American Indian or Alaska Native

☐ Asian

☐ Black, African American

☐ Native Hawaiian or Other Pacific Islander

☐ White

☐ Other (specify) ____________________

The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to understand how employment processes can present barriers for workers of color and to identify promising strategies to address bias in the low-wage labor market. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 OMB number and expiration date for this collection are OMB #: 0970-0356, Exp: 02/29/2024. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to [email protected].