Form 1 ISR Specification

Generic Clearance for Census Bureau Field Tests and Evaluations

Attachment 1 - 2023 ISR Specification v3.1_OMB Final

2023 Census Survey

OMB: 0607-0971

Document [docx]
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FShape2 all 2023 Census Survey Internet Specification



Fall 2023 Census Survey

Internet Specification



Draft v3.0

August 9, 2023



Note: This Fall 2023 Census Survey Internet Specification is a living document. This document reflects the specification baseline as of the date above.
























General Information



Introduction

This document provides the specifications for the English, self-administered version of the Internet instrument for the 2023 Fall Census Survey.

Translations will be provided in a separate document.

Standard Fills

<ADDRESS>

Street Address, Unit, City, State, Zip

<REFDATE>

November 1, 2023

<OMB STATEMENT>

The U.S. Census Bureau estimates that completing the questionnaire will take 10 minutes on average. Send comments regarding this burden estimate or any other aspect of this burden to: <[email protected]>. Use "Paperwork Reduction Project 0607-0971" as the subject.

This collection of information has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number <TBD> confirms this approval.

<WARNING MESSAGE>

U.S. Census Bureau Notice and Consent Warning

You are accessing a United States Government computer network. Any information you enter into this system is confidential. It may be used by the Census Bureau for statistical purposes and to improve the website. If you want to know more about the use of this system, and how your privacy is protected, visit our online privacy webpage at https://www.census.gov/about/policies/privacy/privacy-policy.html.


Use of this system indicates your consent to collection, monitoring, recording, and use of the information that you provide for any lawful government purpose. So that our website remains safe and available for its intended use, network traffic is monitored to identify unauthorized attempts to access, upload, change information, or otherwise cause damage to the web service. Use of the government computer network for unauthorized purposes is a violation of Federal law and can be punished with fines or imprisonment (PUBLIC LAW 99-474).



Global Requirements



Timeouts

The instrument will time out if a respondent is inactive for 15 minutes.

Languages

There will be a language selection menu allowing users to select either English or Spanish.

Navigation

The respondent will navigate through the instrument using the “Submit”, “Next” or “Previous” buttons located at the bottom of each screen.

URL

For the 2023 Census Survey, the URL will be - <TBD>



LOGIN

Screen Name

LOGIN

Data Needed


Pre-condition


Question Wording

Question Wording Fills



Please Log In



Use the materials we mailed to you. All the information that you provide will remain confidential.



Please enter the 12-digit Census ID found in the materials we mailed to you.



_____-_____-____

(three 4-digit text boxes, separated by a hyphen.)





Start Questionnaire

The U.S. Census Bureau estimates that completing the questionnaire will take 10 minutes on average. Send comments regarding this burden estimate or any other aspect of this burden to: <[email protected] >. Use "Paperwork Reduction Project 0607-0971" as the subject.

This collection of information has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number <TBD> confirms this approval.

U.S. Census Bureau Notice and Consent Warning

You are accessing a United States Government computer network. Any information you enter into this system is confidential. It may be used by the Census Bureau for statistical purposes and to improve the website. If you want to know more about the use of this system, and how your privacy is protected, visit our online privacy webpage at https://www.census.gov/about/policies/privacy/privacy-policy.html. Use of this system indicates your consent to collection, monitoring, recording, and use of the information that you provide for any lawful government purpose. So that our website remains safe and available for its intended use, network traffic is monitored to identify unauthorized attempts to access, upload, change information, or otherwise cause damage to the web service. Use of the government computer network for unauthorized purposes is a violation of Federal law and can be punished with fines or imprisonment (PUBLIC LAW 99-474).

OMB No. <TBD>: Approval Expires 12/31/2025

Response Options


Response Options Fills


Edits/Errors

N/A

Post-condition

If an invalid ID is entered display:

“Login failed. Please try again.”

Special Instructions

If valid Census ID, go to RESIDENCE_NEW

If the user exceeds 3 login attempts, go to NO_COMPLETE


The LOGIN button will not be enabled until 12 digits are entered.







NONID Address Collection - NEW

RESIDENCE_NEW

Screen Name

RESIDENCE_NEW

Data Needed

Pre-condition

Respondent enters a valid user ID on LOGIN screen

Question Wording

Before REFDATE

Please provide a street address for this residence.

Provide the street address you would use to have a package delivered directly to this residence, not a Rural Route or P.O. Box address used for mailing purposes. A street address is the most helpful for processing your response.

Question Wording On or After REFDATE

Please provide a street address for this residence.

Provide the street address you would use to have a package delivered directly to this residence, not a Rural Route or P.O. Box address used for mailing purposes. A street address is the most helpful for processing your response.

Response Options

Street Address Ex: 101 N Main St

100-character text box


Apt/Unit Ex: Apt 23

50-character text box


City

100-character text box


State

Drop down menu with alphabetical 50 states and District of Columbia


ZIP Code

5-digit text box


A user may also select the “I do not have a street address” option.

Edits/Errors

Required Fields:

Street Address AND City AND State AND Zip

If the respondent does not provide the required fields and selects next:

  1. First time: “Please provide a street address, city, state and ZIP code.”

  2. Second time: “In order to continue, you must provide a street address, city, state and ZIP code.”

  3. Third time: End the questionnaire and display NO_COMPLETE.

Post-condition

  • If the respondent provides a valid address and selects “Next”, go to STAN_RESIDENCE_NEW_A

  • If “I do not have a street address,” is checked, go to OTHER_ADDRESS_NEW.

  • Else, if “Next” is selected for the third time and any required address field is blank, go to NO_COMPLETE.

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.



OTHER_ADDRESS_NEW

Screen Name

OTHER_ADDRESS_NEW

Data Needed

Pre-condition

Respondent selects “I do not have a street address” on RESIDENCE_NEW

Question Wording

Before REFDATE

Please describe the physical location of this residence. Also provide a city, state and ZIP Code.

Question Wording

On or After REFDATE

Please describe the physical location of this residence. Also provide a city, state and ZIP Code.

Response Options

Before REFDATE

Please provide as much information as possible.

For example:

  • a rural route address, P.O. Box, or E-911 address or

  • a location description such as “The apartment over the gas station” or “The brick house with the screened porch on the northeast corner of Farm Road and HC 46” or

  • a name of a park, street intersection or shelter, if you will be experiencing homelessness on <REFDATE>, as well as the name of the city and state. For example, “Friendship Park, Anywhere, PA.”

Please provide as much information as possible:

250-character text box

City

100-character text box

State

Drop down menu with alphabetical 50 states and District of Columbia

ZIP Code

5-digit text box

Response Options

On or After REFDATE

Please provide as much information as possible.

For example:

  • a rural route address, P.O. Box, or E-911 address or

  • a location description such as “The apartment over the gas station” or “The brick house with the screened porch on the northeast corner of Farm Road and HC 46” or

  • a name of a park, street intersection or shelter, if you will be experiencing homelessness on <REFDATE>, as well as the name of the city and state. For example, “Friendship Park, Anywhere, PA.”

Please provide as much information as possible:

250-character text box

City

100-character text box

State

Drop down menu with alphabetical states and District of Columbia

ZIP Code

5-digit text box

Edits/Errors

Required Fields:

City AND State AND Zip

If the respondent does not provide the required fields and selects next:

  1. First time: "Please provide as much information as possible. Include a city, state and ZIP Code.”

  2. Second time: “You must provide a city, state and ZIP Code.”

Third Time: End the questionnaire and display NO_COMPLETE screen.

Post-condition

  • If the respondent selects “Next”, go to STAN_OTHER_ADDRESS_NEW_A

  1. Else, if “Next” is selected for the third time and all address fields are blank or an invalid address is provided, go to NO_COMPLETE.

Special Instructions



STAN_RESIDENCE_NEW_A

Screen Name

STAN_RESIDENCE_NEW_A

Data Needed

Respondent provided address from RESIDENCE_NEW.

Pre-condition

All Respondents who provided a valid address on RESIDENCE_NEW.

Question Wording

Please review your address. Here is the address you submitted using standard abbreviations and formatting.

<Street Address space delimiter Apt/Unit #>

<City comma delimiter State space delimiter ZIP Code>


Is the address correct?

Response Options

Respondent will only be able to select one of the following:



Yes

No

Edits/Errors

Required Fields:

Yes

No

If required fields are left blank and the next button is selected, display the following edit message:



“Please answer this question.”

Post-condition

If the respondent selects “No”, go to STAN_RESIDENCE_NEW_B.

If “Yes”, go to VERIFY_ADDRESS.

Special Instructions

Respondent cannot move to the next screen until required fields are provided.

There will only be a “Next” (No “Previous”) button on this screen.



STAN_RESIDENCE_NEW_B

Screen Name

STAN_RESIDENCE_NEW_B

Data Needed

Respondent provided address from RESIDENCE_NEW.

Pre-condition

Respondent selects “No” on STAN_RESIDENCE_NEW_A

Question Wording

Please make the necessary changes in the fields below.

Response Options

Street Address

Ex: 101 N Main St

100-character text box


Apt/Unit

Ex: Apt 23

50-character text box


City

100-character text box


State

Drop down menu with alphabetical 50 states and District of Columbia


ZIP Code

5-digit text box

Edits/Errors

Required Fields:

Street Address AND City AND State AND Zip

If required fields are left blank and the “Submit” button is selected, display the following edit message next to the blank field:



“Please answer this question.”

Post-condition

Go to VERIFY_ADDRESS.

Special Instructions

Respondent cannot move to the next screen until required fields are provided.





STAN_OTHER_ADDRESS_NEW_A

Screen Name

STAN_OTHER_ADDRESS_NEW_A

Data Needed

Respondent provided address from OTHER_ADDRESS_NEW

Pre-condition

All Respondents who provided a valid address on OTHER_ADDRESS_NEW

Question Wording

Please review your address. Here is the address you submitted using standard abbreviations and formatting.

<Description>

<City comma delimiter State space delimiter ZIP Code>


Is the address correct?

Response Options

Respondent will only be able to select one of the following:



Yes

No

Edits/Errors

Required Fields:

Yes

No

If required fields are left blank and the next button is selected, display the following edit message:



“Please answer this question.”

Post-condition

If the respondent selects “No”, go to STAN_OTHER_ADDRESS_NEW_B.

If “Yes”, go to VERIFY_ADDRESS.

Special Instructions

Respondent cannot move to the next screen until required fields are provided.

There will only be a “Next” (No “Previous”) button on this screen.



STAN_OTHER_ADDRESS_NEW_B

Screen Name

STAN_OTHER_ADDRESS_NEW_B

Data Needed

Respondent provided address from OTHER_ADDRESS_NEW.

Pre-condition

Respondent selects “No” on STAN_OTHER_ADDRESS_NEW_A

Question Wording

Please make the necessary changes in the fields below.

Response Options

City

100-character text box


State

Drop down menu with alphabetical 50 states and District of Columbia


ZIP Code

5-digit text box

Edits/Errors

Required Fields:

City AND State AND Zip

If required fields are left blank and the “Submit” button is selected, display the following edit message next to the blank field:



“Please answer this question.”

Post-condition

Go to VERIFY_ADDRESS.

Special Instructions

Respondent cannot move to the next screen until required fields are provided.













Verify Address Screens

VERIFY ADDRESS

Screen Name

VERIFY ADDRESS

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

STAN_RESIDENCE_NEW_A = “Yes”

or

STAN_RESIDENCE_NEW_B

or

STAN_OTHER_ADDRESS_NEW_A = “Yes”

or

STAN_OTHER_ADDRESS_NEW_B

Question Wording

Before REFDATE

On <REFDATE>, will you be living or staying at <ADDRESS>?


Question Wording

On or After REFDATE

On <REFDATE>, were you living or staying at <ADDRESS>?


Response Options

Respondent will only be able to select one of the following:

Yes

No

Response Options Fills

N/A

Edits/Error


Post-condition

If “Yes”, go to RESPONDENT

If “No” or Blank, go to ANYONE

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.

ANYONE

Screen Name

ANYONE

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

VERIFY ADDRESS = “No” or Blank

Question Wording

Before REFDATE

Will anyone be living at <ADDRESS> on <REFDATE>?


Question Wording

On or After REFDATE

Did anyone live at <ADDRESS> on <REFDATE>?

Response Options

Respondent will only be able to select one of the following:


Yes

No

Don’t Know

Response Options Fills

N/A

Edits/Errors


Post-condition

If “No”, go to UNIT STATUS

Else, go to RESPONDENT

Special Instructions




UNIT STATUS

Screen Name

UNIT STATUS

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

ANYONE = “No”

Question Wording

Before REFDATE

Why will no one be living at <ADDRESS> on <REFDATE>?

Question Wording

On or After REFDATE

Why was no one living at <ADDRESS> on <REFDATE>?

Response Options

Respondent will only be able to select one of the following:


Vacant residence

Uninhabitable (under construction, open to elements, condemned, burned out, destroyed, demolished)

Nonresidential building

Empty lot or empty mobile home site

Address does not exist

Duplicate address

Other (Specify)

{Display 30-character text box}

Response Options Fills

N/A

Edits/Errors


Post-condition

If “Vacant residence”, go to VACANCY

Else (or Blank), go to RESPONDENT

Special Instructions

“Other (Specify)” response option will auto-select if text is entered into the text box.



VACANCY

Screen Name

VACANCY

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

UNIT STATUS = “Vacant residence”

Question Wording Before REFDATE

What is the primary reason why no one will be living or staying at <ADDRESS> on <REFDATE>? The unit will be –

Question Wording

On or After REFDATE

What is the primary reason why no one was living or staying at <ADDRESS> on <REFDATE>? The unit was –

Response Options

Respondent will only be able to select one of the following:



For rent

Rented, not occupied

For sale only

Sold, not occupied

For seasonal, recreational, or occasional use

For migrant workers

Other (Specify)

{Display 30-character text box}

Response Options Fills

N/A

Edits/Errors


Post-condition

Go to RESPONDENT

Special Instructions

“Other (Specify)” response option will auto-select if text is entered into the text box.

Roster

RESPONDENT

Screen Name

RESPONDENT

Data Needed

None

Pre-condition

If VERIFY ADDRESS = “Yes”

or

If ANYONE = “Yes”/ “Don’t know”/ Blank

or

If UNIT STATUS is not “Vacant residence”

or

VACANCY

Question Wording

What is your name, telephone number, and email address?

We will only contact you if needed for official Census Bureau business.

Question Wording Fills

N/A

Response Options

First Name

30-character text box



Middle Name

30-character text box



Last Name(s)

30-character text box



Telephone Number

10-digit text box


Email address

50-character text box

Response Options Fills

N/A

Edits/Errors

First Name and Last Name(s) are required fields.



If First and Last Names are left blank and the next button is selected, display the following edit message next to the blank field:



“Please answer this question.”

Post-condition

If VERIFY ADDRESS = “Yes”, go to POPCOUNT



If VERIFY ADDRESS = “No” or Blank, go to OTHER_COMPLETE

  • VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Vacant residence > VACANCY > RESPONDENT

  • VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Else / Blank > RESPONDENT

  • VERIFY ADDRESS = No / Blank > ANYONE = Yes/DK/Blank > RESPONDENT

Special Instructions

This is a force response question. The respondent must provide First and Last Name to continue.

There will only be a “Next” (No “Previous”) button on this screen.

OTHER_COMPLETE

Screen Name

OTHER_COMPLETE

Data Needed

<REFDATE>

<ADDRESS>

Pre-condition

RESPONDENT

and

VERIFY ADDRESS = “No” or Blank

  • VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Vacant residence > VACANCY > RESPONDENT

  • VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Else/Blank > RESPONDENT

  • VERIFY ADDRESS = No / Blank > ANYONE = Yes/DK/Blank > RESPONDENT

Question Wording

Before REFDATE

Thank you for providing information for <ADDRESS>.   Since you will not be living or staying at this address on November 1, 2023, you do not need to provide any additional information for it.  



You may close the browser.

Question Wording

On or After REFDATE

Thank you for providing information for <ADDRESS>.   Since you did not live or stay at this address on November 1, 2023, you do not need to provide any additional information for it.



You may close the browser.

Response Options


Response Options Fills

N/A

Edits/Errors


Post-condition


Special Instructions




POPCOUNT

Screen Name

POPCOUNT

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

RESPONDENT (where VERIFY ADDRESS = “Yes”)

Question Wording

Before REFDATE

Including yourself, how many people will be living or staying at <ADDRESS> on <REFDATE>?

Question Wording

On or After REFDATE

Including yourself, how many people were living or staying at <ADDRESS> on <REFDATE>?

Response Options

Number

One 2-digit numerical text box.

Response Options Fills

N/A

Edits/Errors


If blank or 0 is entered, display:


First time: “Please include yourself when reporting the number of people.”


Second time: “Please include yourself when reporting the number of people.”


Third time: If the field is blank or zero is entered and “Next” is selected go to NO_COMPLETE

Post-condition

If popcount field is zero or blank and selects “Next” for the third time, go to NO_COMPLETE

If POPCOUNT=1, go to UC.

If POPCOUNT=2-99, go to PEOPLE.

Special Instructions

Respondents will only be able to enter numbers 0 - 99. Non-numeric characters will not be allowed to be entered.

A maximum of 3 edits is shown in any combination.

There will only be a “Next” (No “Previous”) button on this screen.

PEOPLE

Screen Name

PEOPLE

Data Needed

<ADDRESS>

<REFDATE>

Name from RESPONDENT

POPCOUNT

Pre-condition

POPCOUNT=2-99

Question Wording

Before REFDATE

What is the name of each person who will be living or staying at <ADDRESS> on <REFDATE>?



Enter names until you have listed everyone who will be living or staying there, then continue to the next page.

Question Wording

On or After REFDATE



What is the name of each person who was living or staying at <ADDRESS> on <REFDATE>?



Enter names until you have listed everyone who was living or staying there, then continue to the next page.

Response Options

First Name

20-character text box



Middle Name

20-character text box



Last Name(s)

20-character text box



“Remove Row” option

“Add another person” option

Response Options Fills

N/A

Edits/Errors


Post-condition

UC

Special Instructions

Display the name from RESPONDENT in the first row of name fields

Only a maximum of 10 rows can be displayed.



UC

Screen Name

UC

Data Needed

<ADDRESS>

<REFDATE>

ROSTER (all names from PEOPLE and RESPONDENT)

Pre-condition

POPCOUNT = 1

or

PEOPLE

Question Wording

Before REFDATE

We do not want to miss any people who might be staying at <ADDRESS> on <REFDATE>.



For example:

  • Children, related or unrelated, such as newborn babies, grandchildren, or foster children

  • Relatives, such as adult children, nieces, nephews, cousins, or in-laws

  • Roommates or other nonrelatives

  • People without a permanent place to live



The names listed so far are:

<LIST OF HOUSEHOLD MEMBER>



Will there be any ADDITIONAL people that you did not already list?

Question Wording

On or After REFDATE

We do not want to miss any people who might have stayed at <ADDRESS> on <REFDATE>.



For example:

  • Children, related or unrelated, such as newborn babies, grandchildren, or foster children

  • Relatives, such as adult children, nieces, nephews, cousins, or in-laws

  • Roommates or other nonrelatives

  • People without a permanent place to live



The names listed so far are:

<LIST OF HOUSEHOLD MEMBER>



Were there any ADDITIONAL people that you did not already list?

Response Options

Respondent will only be able to select one of the following:



Yes

No



IF YES, display:

First Name

30-character text box



Middle Name

30-character text box



Last Name(s)

30-character text box

Response Options Fills

N/A

Edits/Errors


Post-condition

HOME

Special Instructions

The name boxes will only appear when “Yes” is selected. If the respondent clicks “No” (removing a “Yes” entry), the name boxes will disappear.

When “Yes” is selected, only one set of name boxes will appear.



HOME

Screen Name

HOME

Data Needed


Pre-condition

UC

Question Wording

Before REFDATE

On <REFDATE>, will the house, apartment, or mobile home at <ADDRESS> be –

Question Wording

On or After REFDATE

On <REFDATE>, was the house, apartment, or mobile home at <ADDRESS> –

Response Options

Respondent will only be able to select one of the following:



Owned by you or someone in this household with a mortgage or loan (including home equity loans)?

Owned by you or someone in this household free and clear (without a mortgage or loan)?

Rented?

Occupied without payment of rent?

Response Options Fills

N/A

Edits/Errors


Post-condition

If “Occupied without payment of rent” or blank, go to SEX.

or

If PERSONCOUNT =1, go to SEX.

Else, go to OWNER.

Special Instructions

If “Occupied without payment of rent” set <REF NAME> = Person 1.

If PERSONCOUNT= (1) set <REF NAME> = Person 1.

OWNER

Screen Name

OWNER

Data Needed

Roster names

Pre-condition

HOME = “Owned by you or someone in this household with a mortgage or loan (including home equity loans)?” or “Owned by you or someone in this household free and clear (without a mortgage or loan)?” or “Rented” and POPCOUNT= (2-99)

Question Wording

Before REFDATE

Of the people who will be living at <ADDRESS>, who <FILL2> the house, apartment, or mobile home on <REFDATE>?

Select all that apply.


Question Wording

On or After REFDATE

Of the people who were living at <ADDRESS>, who <FILL2> the house, apartment, or mobile home on <REFDATE>?

Select all that apply.


Question Wording Fills

If current date is before <REFDATE>, then

  • If HOME=Rented, <FILL2> = “will rent”

  • Else, <FILL2> = “will own”

If current date is on or after APRIL 1, then

  • If HOME=Rented, <FILL2> = “rented”

  • Else, <FILL2> = “owned”

Response Options

Respondent will be able to select all that apply:

  • A response option for each name from the roster

  • Also, include the response option “None of the above”.

Response Options Fills

N/A

Edits/Errors


Post-condition

SEX

Help Text link

OWNER

Special Instructions

Selecting a response option:

  • A user may select all that apply.



The Reference Person will be set as the Respondent.



There will only be a “Next” (No “Previous”) button on this screen.

Respondent Demographics

RELATIONSHIP

Screen Name

RELATIONSHIP

Data Needed

RESPONDENT

NAME#

Pre-condition

PERSONCOUNT= (2-99) (who is not the Respondent)

RACE (if Demo Questions still need to be completed for remaining rostered persons)

Question Wording

How is <NAME#> related to <REF NAME>?



<NAME#> is <REF NAME>’s ...


Response Options

Respondent will only be able to select one of the following:

Opposite-sex husband/wife/spouse

Opposite-sex unmarried partner

Same-sex husband/wife/spouse

Same-sex unmarried partner

Biological son or daughter

Adopted son or daughter

Stepson or stepdaughter

Brother or sister

Father or mother

Grandchild

Parent-in-law

Son-in-law or daughter-in-law

Other relative

Roommate or housemate

Foster child

Other nonrelative

Edits/Errors

If no response, display the following pop-up modal edit once:

“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question

If Continue without Answering, go to SEX.

If Answer the Question, go back to response options.

Post-condition

Goto SEX

Help Text link

RELATIONSHIP

Special Instructions

  1. This screen is not displayed for single-person households.

  2. This screen is not displayed for the reference person.

  3. Previous and Next buttons on screen.

SEX

Screen Name

SEX

Data Needed

NAME#

Pre-condition

HOME = “Occupied without payment of rent” or blank

or

PERSONCOUNT=1

or

OWNER (Person 1)

or

RELATIONSHIP (Person 2+)

Question Wording

What is <NAME#>’s sex?

Response Options

Respondent will only be able to select one of the following:

Male

Female

Edits/Errors

If no response, display the following pop-up modal edit once:

“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question

If Continue without Answering, go to DOB.

If Answer the Question, go back to response options.

Post-condition

Go to DOB

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.



DOB

Screen Name

DOB

Data Needed

NAME#

Pre-condition

SEX

Question Wording

What is <NAME#>’s date of birth?



Verify or enter correct age as of <REFDATE>.

Response Options

A user can select the Month (number - full word), Day, and Year.



Only valid dates between January 1, 1897 and Dec. 31, 2023 can be selected.



Year drop down box: Starts with <current year> and goes to <current year – 126>.



Age: One 3-character numeric only field followed by “years”. I.e.,” ___ years”. Respondent may enter age in the numeric text box.

Edits/Errors

If no response, display the following pop-up modal edit once:

“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question

If Continue without Answering, go to HISPANIC ORIGIN.

If Answer the Question, go back to response options.

Post-condition

Go to HISPANIC ORIGIN

Special Instructions

Edit Message will only trigger if Month, Day or Year are left blank. If the text box “years” is left blank, the edit message will not trigger.



HISPANIC ORIGIN

Screen Name

HISPANIC ORIGIN

Data Needed

NAME#

Pre-condition

DOB

Question Wording

Is <NAME#> of Hispanic, Latino, or Spanish origin?


Response Options

A user can select either a “No” response or one or more “Yes” responses.

No, not of Hispanic, Latino, or Spanish origin


Yes, Mexican, Mexican American, Chicano


Yes, Puerto Rican


Yes, Cuban


Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.


{Display 200-character text box}

Edits/Errors

If no response, display the following pop-up modal edit once:

“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question

If Continue without Answering, go to RACE.

If Answer the Question, go back to response options.

Post-condition

Go to RACE

Special Instructions

Check boxes and textboxes are tied to each other; the check box will be automatically checked if something is entered into the corresponding text box.



RACE

Screen Name

RACE

Data Needed

NAME#

Pre-condition

HISPANIC ORIGIN

Question Wording

What is <NAME#>’s race?

Select one or more boxes and enter origins. For this survey, Hispanic origins are not races.

Response Options

Respondent may select all that apply:


White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc.

{Display 200-character text box}

Black or African American – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

{Display 200-character text box}

American Indian or Alaska Native – Enter name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.

{Display 200-character text box}

Chinese

Filipino

Asian Indian

Vietnamese

Korean

Japanese

Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc.

{Display 200-character text box}

Native Hawaiian

Samoan

Chamorro

Other Pacific Islander – Enter, for example Tongan, Fijian, Marshallese, etc.

{Display 200-character text box}

Some other race– Enter race or origin.

{Display 200-character text box}

Edits/Errors

If no response, display the following pop-up modal edit once:


“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question


If Continue without Answering, see post-condition below.

If Answer the Question, go back to response options.

Post-condition

If Demo Questions have been completed for the last rostered person:

  • PERSONCOUNT = 1, goto OC

  • PERSONCOUNT= 2-99 , goto OC_HH


Else, go to RELATIONSHIP (PERSONCOUNT= (2-99) who aren’t the reference person)

Special Instructions

Check boxes and textboxes are tied to each other; the check box will be automatically checked if something is entered into the corresponding text box.

Coverage

OC

Screen Name

OC

Data Needed

NAME#

<ADDRESS>

Pre-condition



RACE has been completed and PERSONCOUNT = (1)

Question Wording

Does <NAME#>’s usually live or stay somewhere else, other than <ADDRESS>?

Select all that apply.

Question Wording Fills


Response Options

A respondent may select a “No” response or more than one “Yes” response

No

Yes, with a parent, grandparent, or other person

Yes, while attending college

Yes, for a military assignment

Yes, to be closer to a job or business

Yes, in a nursing home or group home

Yes, in a jail or prison

Yes, at a seasonal or second residence

Yes, for another reason

If “Yes, for another reason” is selected:

For what reason?

{display 250-character textbox}

Edits/Errors


Post-condition

Go to WHOLE/PARTIAL

Special Instructions

Selecting a response option:

A respondent can either select “No” OR one or more than one “Yes, …” options.



OC_HH

Screen Name

OC_HH

Data Needed

NAME#

<ADDRESS>

Pre-condition

RACE and PERSONCOUNT = (2-99)

Question Wording

We would like to make sure everyone is only counted once. Some people live or stay in more than one place.



For example:

  • With a parent, grandparent, or other person

  • While attending college

  • For a military assignment

  • To be closer to a job or business

  • In a nursing home or group home

  • In a jail or prison

  • At a seasonal or second residence



Do any of the following people usually live or stay somewhere else, other than <ADDRESS>?

Select all that apply.

Question Wording Fills






Response Options

Respondent will be able to select any names from the roster or “None of the above”.

<NAMES FROM ROSTER>

None of the above

Edits/Errors

If no response, display the following edit only once:

“Please provide an answer to the question.”

Post-condition

If one or more <Name #> is selected, go to OC_P screen

Else, if POPCOUNT <> PERSONCOUNT go to CD_CHECK

Else, if POPCOUNT = PERSONCOUNT go to WHOLE/PARTIAL

Help Text link

OC

Special Instructions

Selecting a response option:

If any <NAME#> check box is selected, “None of the above” check box will be grayed out and cannot be selected until all <NAME#> check boxes are unselected.

If “None of the above” is selected, and then any other <Name#> is selected, then the “None of the above” check box will be deselected and grayed out. “None of the above” check box option cannot be selected until all <Name#> check boxes are unselected. You will not be able to select a <Name#> check box and “None of the above” check box.



OC_P

Screen Name

OC_P

Data Needed

NAME#

Pre-condition

OC_HH screen for first household member selected or OC_P from previously selected household member from OC_HH

Question Wording

Why does <NAME> usually live or stay somewhere else?

Select all that apply.



If “For another reason” is selected, display:

For what reason?


Question Wording Fills


Response Options

Respondent will be able to select all that apply:



To be with a parent, grandparent, or other person

To attend college

For a military assignment

To be closer to a job or business

In a nursing home or group home

In a jail or prison

At a seasonal or second residence

For another reason



If “For another reason” is selected:

{display 250-character textbox}

Edits/Errors

If no response, display the following edit only once:

“Please provide an answer to the question.”

Post-condition

If number of persons selected on OC_HH > 1, go to OC_P for the next selected person.

If OC_P is the final selected person, and POPCOUNT = PERSONCOUNT, go to WHOLE/PARTIAL

If OC_P is the final selected person, and POPCOUNT <> PERSONCOUNT, go to CD_CHECK

Help Text link

OC_P

Special Instructions




CD_CHECK

Screen Name

CD_CHECK

Pre-condition

OC_HH and POPCOUNT <> PERSONCOUNT

Or

OC_P and POPCOUNT <> PERSONCOUNT

Question Wording

Before REFDATE

Earlier, you said that the number of people living or staying at <ADDRESS> will be <POPCOUNT>, but you have listed <PERSONCOUNT> <FILL1>. Including yourself, how many people will be living or staying at <ADDRESS> on <REFDATE>?

The names you listed are:



<NAMES FROM ROSTER>

Question Wording

On or After REFDATE

Earlier, you said that the number of people living or staying at <ADDRESS> was <POPCOUNT>, but you have listed <PERSONCOUNT> <FILL1>. Including yourself, how many people were living or staying at <ADDRESS> on <REFDATE>?

The names you listed are:



<NAMES FROM ROSTER>

Response Options

Respondent will only be able to select one of the following:

  • Stated popcount

  • Person Count

  • Other



If “Other” is selected:

{display one 2-digit numeric textbox}

Response Options Fills

N/A

Edits/Errors


Post-condition

WHOLE/PARTIAL

Help Text link


Special Instructions

If PERSONCOUNT = 1, <FILL1> = “person”

If PERSONCOUNT = (2-99), <FILL1> = “people”

There will only be a “Next” (No “Previous”) button on this screen.



WHOLE/PARTIAL

Screen Name

WHOLE/PARTIAL

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

OC

or

OC_HH = “None of the Above” or Blank, where POPCOUNT = PERSONCOUNT

or

OC_P, where POPCOUNT = PERSONCOUNT

or

CD_CHECK

Question Wording

Before REFDATE

Did you list everyone living at <ADDRESS> on your questionnaire, or did you list only some of the people?

Question Wording

On or After REFDATE

Did you list everyone living at <ADDRESS> on your questionnaire, or did you list only some of the people?

Response Options

Respondent will only be able to select one of the following:

I live alone and only listed myself.

I live with others and listed everyone.

I live with others but only listed myself.

I live with others but only listed some of the people I live with.



If “I live with others but only listed myself." or “ I live with others but only listed some of the people I live with." is selected, display the following:

The Census Bureau is interested in understanding why some people are not listed on the questionnaire.

Please share your reasons for not listing everyone.

{250-character textbox}

Response Options Fills

N/A

Edits/Errors

If no response, display the following pop-up modal edit once:

“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question

If Continue without Answering, go to VAC_CROWD 1A or 2A

If Answer the Question, go back to response options.

Post-condition

Go to VAC_CROWD_1A or VAC_CROWD_2A (based on sample assignment)

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.



VAC_CROWD_1A

Screen Name

VAC_CROWD_1A

Data Needed


Pre-condition

WHOLE/PARTIAL

Question Wording

Before REFDATE

Imagine standing at your front door looking out to your right. Picture your neighbor's house, apartment unit, or mobile home immediately to your right. Is anyone living in that home?

Why are we asking this question?

Question Wording

On or After REFDATE

Imagine standing at your front door looking out to your right. Picture your neighbor's house, apartment unit, or mobile home immediately to your right. Is anyone living in that home?


Why are we asking this question?

Response Options

Respondent will only be able to select one of the following:


Yes, someone is living there

No, no one is living there

I am unsure if someone is living there

I am unsure of what home this would be

There is no home to my right

Response Options Fills

N/A

Edits/Errors

If no response, display the following pop-up modal edit once:

“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question

If Continue without Answering, go to SUBMIT

If Answer the Question, go back to response options.

Post-condition

If “No, no one is living there” is selected, go to VAC_CROWD_1B

Else, go to SUBMIT

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.



VAC_CROWD_2A

Screen Name

VAC_CROWD_2A

Data Needed


Pre-condition

WHOLE/PARTIAL

Question Wording

Before REFDATE

Do you know the street address of any houses, apartments, or mobile homes that will be vacant on November 1, 2023? This could be homes inside or outside your neighborhood.

Please also consider seasonal or vacation homes or Airbnbs where no one is permanently living.

Why are we asking this question?

Question Wording

On or After REFDATE

Do you know the street address of any houses, apartments, or mobile homes that were vacant on November 1, 2023? This could be homes inside or outside your neighborhood.

Please also consider seasonal or vacation homes or Airbnbs where no one is permanently living.


Why are we asking this question?

Response Options

Respondent will only be able to select one of the following:


Yes

No

Response Options Fills

N/A

Edits/Errors

If no response, display the following pop-up modal edit once:

“There is 1 unanswered question on this page. Would you like to continue?”

Continue without Answering Answer the Question

If Continue without Answering, go to SUBMIT

If Answer the Question, go back to response options.

Post-condition

If “Yes” is selected, go to VAC_CROWD_2B

Else, go to SUBMIT

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.







VAC_CROWD_1B

Screen Name

VAC_CROWD_1B

Data Needed


Pre-condition

VAC_CROWD_1A = “No, no one is living there”

Question Wording

Before REFDATE

What is the address of that vacant home?

Question Wording

On or After REFDATE

What is the address of that vacant home?

Response Options

Street Address Ex: 101 N Main St

100-character text box


Apt/Unit Ex: Apt 23

50-character text box


City

100-character text box


State

Drop down menu with alphabetical 50 states and District of Columbia


ZIP Code

5-digit text box

Response Options Fills

N/A

Edits/Errors


Post-condition

SUBMIT

Special Instructions




VAC_CROWD_2B

Screen Name

VAC_CROWD_2B

Data Needed


Pre-condition

VAC_CROWD_2A = “Yes”

Question Wording

Before REFDATE

What is the address of that vacant home? If you know more than one vacant home address, enter only one.

Question Wording

On or After REFDATE

What is the address of that vacant home? If you know more than one vacant home address, enter only one.

Response Options

Street Address Ex: 101 N Main St

100-character text box


Apt/Unit Ex: Apt 23

50-character text box


City

100-character text box


State

Drop down menu with alphabetical 50 states and District of Columbia


ZIP Code

5-digit text box

Response Options Fills

N/A

Edits/Errors


Post-condition

SUBMIT

Special Instructions




SUBMIT Census Questionnaire

Screen Name

SUBMIT Census Questionnaire

Data Needed


Pre-condition

VAC_CROWD_1A = Blank or “Yes, someone is living there”, or “I am unsure if someone is living there”, or “I am unsure of what home this would be”, or “There is no home to my right”


Or


VAC_CROWD_1B


Or


VAC_CROWD_2A = Blank or “No”



Or



VAC_CROWD_2B

Question Wording

You are almost finished and are now ready to send your responses. Once your questionnaire is submitted, you will not be able to access your information or change any of your responses. After you submit your responses and are shown the confirmation page, you may close the web browser.



You must select SUBMIT to complete your questionnaire.



Question Wording Fills




Response Options

Submit Questionnaire

Response Options Fills

N/A

Edits/Errors


Post-condition

If Submit Questionnaire, go to CONFIRMATION

Special Instructions

There will only be a “Submit Questionnaire” (No “Edit Questionnaire”) button on this screen.





CONFIRMATION

Screen Name

CONFIRMATION

Data Needed

All submitted cases.

Pre-condition

Cases where the user has selected “Submit Questionnaire” from the SUBMIT Census Questionnaire screen.

Question Wording

Thank you for completing the 2023 Census Survey questionnaire for:

<FULL ADDRESS>

Date and time of submission

If you receive other mail from the Census Bureau about the 2023 Census Survey in the next few days, please disregard it. That mail may have been sent out before today.

If you have any questions, please call the phone number printed in your materials.

Confirmation #: <Unique Code>

You may close the browser.

Question Wording Fills


Response Options


Response Options Fills

N/A

Edits/Errors


Post-condition


Special Instructions




NO_COMPLETE

Screen Name

NO_COMPLETE

Data Needed


Pre-condition

Cases where user exceeds 3 login attempts on the LOGIN screen.

Cases where no valid address is provided.

Cases where no popcount is provided on the POPCOUNT screen.

Question Wording

Your 2023 Census Survey could not be completed. You must provide a valid address, respondent name and the number of people in the household to complete this questionnaire. Please complete a paper questionnaire, or start over. Thank you.

You may close the browser.

Question Wording Fills


Response Options


Response Options Fills

N/A

Edits/Errors


Post-condition


Special Instructions


SESSION TIMEOUT

Screen Name

SESSION TIMEOUT

Data Needed


Pre-condition

Total duration within the instrument reaches 15 minutes

Question Wording

Sessions will display a pop-up window when total duration reaches 14 minutes. It will display the following text for 1 minute.

Your session is about to expire. Select Continue to keep working.

Su sesión está a punto de terminar. Seleccione Continuar para seguir trabajando.

<Exit/Salir> <Continue/Continuar>

Special Instructions

If the respondent selects “Continue/Continuar” the respondent will remain in the instrument.

If respondent selects “Exit/Salir” or reaches the maximum duration of 15 minutes (not idle time), the screen display an image file with the following:

For security reasons, this session has been terminated.

If you think you have reached this screen in error, please start the questionnaire over.



You may close the browser.








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