1 Web Specs

Generic Clearance for Census Bureau Field Tests and Evaluations

Attachment 1 - 2023 ISR Specification 12212022 FINAL for OMB

OMB: 0607-0971

Document [docx]
Download: docx | pdf

2023 Census Test Internet Specification



2023 Census Test

Internet Self-Response Instrument

Specification



Final

December 21, 2022





Note: This 2023 SmaRT Internet Self-Response automated data collection test 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 Census Test.

Translations will be provided in a separate document.

Standard Fills

<ADDRESS>

Street Address, Unit, City, State, Zip

<REFDATE>

March 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 0607-0971 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).



Instructions

The instructions and other relevant information will be displayed on the Login Screen.

FAQs

Frequently Asked Questions (FAQs), provided from a link on the Banner, should include the following:

1. What is the 2023 Census Test?

The goal of the census test is to help inform the next census. The next census will count every

person living in the United States once, only once and in the right place. Article I, Section 2 of

the U.S. Constitution mandates that this population and housing count occur every 10 years.

Census data guide how more than $675 billion in federal funding is distributed to states and

communities each year.


2. Am I required to respond to this survey?

Yes, you are required by law to respond to this survey. We are conducting this survey under

the authority of Title 13, U.S. Code, Sections 141 and 193. This collection of information has

been approved by the Office of Management and Budget (OMB). The eight-digit OMB

approval number is 0607-0971. If this number were not displayed, we could not conduct the survey.


3. How long will my 2023 Census Test questionnaire take?

The 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.


4. Who should complete the questionnaire?

This questionnaire should be completed by the person who owns or rents the living quarters or any other person who is at least 15 years of age with knowledge of the household.


5. How do I change my answers?

For questions where you must choose a single response from a list, clicking another response will change your answer to that response.



If it is a “select all that apply” question, you may click on a selected check box to unselect the box and remove it as one of your answers.


7. How will the Census Bureau use the information I provide?

By law, the Census Bureau can only use your responses to produce statistics.

8. Is it safe to complete the questionnaire online?

Yes. For each online questionnaire, we are required to provide an explanation to respondents about the confidentiality of the data and the laws that protect those data (e.g., Title 13, U.S. Code Section 9(a)).

Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data. All web data submissions are encrypted in order to protect your privacy, even in the remote chance that your responses are intercepted.

More information on this topic can be found on the Data Protection and Privacy Policy webpage (https://www.census.gov/privacy/).


9. Do I have to complete the questionnaire for my household members?

Yes, you will be asked to provide information for each household member.


10. How do I submit my responses?

At the end of the questionnaire, you will submit your questionnaire and see a confirmation page. Then, you may close the web browser. Once your questionnaire is submitted, you will not be able to access your information or change any of your responses.



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 Test, the URL will be -

USDS Text for “An official website of the United States government.

The ISR instrument will also display USDS text. See link for approved wording. https://designsystem.digital.gov/components/headers/



LOGIN

Screen Name

LOGIN

Variable Names

REPUNIT_SPONSOR_CASE_ID: NUM 12

Data Needed


Pre-condition

Question Wording



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 0607-0971 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. 0607-0971: Approval Expires 12/31/2025

Question Wording Fills






Response Options


Response Options Fills

N/A

Edits/Errors

If an invalid ID is entered display:

“Login failed. Please try again.”

If the user exceeds 3 login attempts, goto NO_COMPLETE_AUTH

Post-condition

If valid Census ID, goto RESIDENCE_OLD or RESIDENCE_NEW.

If invalid Census ID, display error message

Special Instructions

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







NONID Address Collection - OLD

RESIDENCE_OLD

Screen Name

RESIDENCE_OLD

Variable Names

Respondent-Provided Street Address Fields
ADR_STNU_TEXT: VARCHAR2 (20)

ADR_STNM_TEXT: VARCHAR2 (50)
ADR_UNIT_TEXT: VARCHAR2 (50)
ADR_CITY_TEXT: VARCHAR2 (100)
ADR_STATE_TEXT: VARCHAR2 (2)
ADR_ZIP_TEXT: VARCHAR2 (5)

ADR_NO_STREET_ADDRESS_IND: 0,1

Data Needed

Pre-condition

Respondent enters a valid user ID on the LOGIN screen

Question Wording

Before REFDATE

Where will you be living on <REFDATE>?

Please provide a complete street address for your residence. Provide the street address you would use to have a package delivered directly to your 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

Where were you living on <REFDATE>?

Please provide a complete street address for your residence. Provide the street address you would use to have a package delivered directly to your 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

Address Number

Ex: 101

20-character text box


Street Name

Ex: N Main St

50-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:

Address Number AND Street Name AND City AND State AND Zip

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

  1. First time: “Please provide your full address.”

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

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

Address boxes will be highlighted, so the respondent is alerted to where required information is invalid or missing.

Post-condition

  • If the respondent provides a valid address and selects “Next”, goto STAN_RESIDENCE_OLD_A.

  • If respondent leaves responses blank or provides invalid responses and checks “I do not have a street address,” goto RURAL_ROUTE_OLD.

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

Special Instructions


RURAL_ROUTE_OLD



Screen Name

RURAL_ROUTE_OLD

Variable Names

ADR_IS_RURAL_YES_IND: 0,1

ADR_IS_RURAL_NO_IND: 0,1

Data Needed

Pre-condition

Respondents who checked “I do not have a street address” and provided blank or invalid responses on the RESIDENCE_OLD screen.

Question Wording

Do you have a Rural Route address?

Question Wording Fills

Response Options

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

Yes

No

Response Option Fills

Edits/Errors

If no response, display the following edit only once:

“Please provide an answer to the question.”

Post-condition

  • If “Yes”, goto RR_ADDRESS_OLD

  • If “No” or blank, goto HOMELESS_OLD

Special Instructions

RR_ADDRESS_OLD

Screen Name

RR_ADDRESS_OLD

Variable Names

Respondent-Provided Rural Route Address Fields

ADR_RR_DESC_TEXT: VARCHAR 2 (3) (RR, HC, SR, PSC, RTE)

ADR_RR_NUM_TEXT: VARCHAR 2 (10)

ADR_RR_BOX_NUM_TEXT: VARCHAR 2 (10)

ADR_CITY_TEXT: VARCHAR 2 (100)

ADR_STATE_TEXT: VARCHAR 2 (2)

ADR_ZIP_TEXT: VARCHAR 2 (5)

Physical Description Field

ADR_LOC_DESC_TEXT: VARCHAR 2 (250)

Data Needed

Pre-condition

RURAL_ROUTE_OLD = “Yes”

Question Wording

Before REFDATE

Please provide the Rural Route address where you will be living on <REFDATE>. Also, provide a description of the physical location in the space provided.

Question Wording

On or After REFDATE

Please provide the Rural Route address where you were living on <REFDATE>. Also, provide a description of the physical location in the space provided.

Response Options

RR Descriptor

Drop down menu with the following options

  • RR

  • HC

  • SR

  • PS

  • RTE

Rural Route #

10-character text box

RR Box ID #

10-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

Please provide as much information as possible.

For example: If you also have a street address associated with your residence, such as one used for emergency services (E-911) or for you to have a package delivered to your home, then please provide it here.

250-character text box

Response Option fills

Edits/Errors

Required Fields:

RR Descriptor AND RR # AND RR Box ID AND City AND State AND Zip

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

  1. First time: “Please provide your full address.”

  2. Second time: “In order to continue, you must provide a Rural Route Descriptor, Number, and Box ID#. Any address you provide should also include a city, state and a ZIP Code.”

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


Post-condition

  • Goto STAN_RR_ADDRESS_OLD_A.

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

Special Instructions


HOMELESS_OLD

HOESSScreen Name

HOMELESS_OLD

Variable Names

ADR_IS_HOMELESS_YES_IND: 0,1

ADR_IS_HOMELESS_NO_IND: 0,1

Data Needed

Pre-condition

RURAL_ROUTE_OLD = “No” or blank

Question Wording

Before REFDATE

Will you be experiencing homelessness on <REFDATE>?

Question Wording

On or After REFDATE

Were you experiencing homelessness on <REFDATE>?

Response Options

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

Yes

No

Edits/Errors

If no response, display the following edit only once:

“Please provide an answer to the question.”

Post-condition

Goto OTHER_ADDRESS_OLD

Special Instructions



OTHER_ADDRESS_OLD

Screen Name

OTHER_ADDRESS_OLD

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Physical Description Field

ADR_LOC_DESC_TEXT: VARCHAR2 (250)

Data Needed

Pre-condition

HOMELESS_OLD = “Yes”, “No” or blank

Question Wording

Before REFDATE

Please provide a city and state, or ZIP Code where you will be living on <REFDATE>.

Also, describe the physical location in the space provided.


Question Wording

On or After REFDATE

Please provide a city and state, or ZIP Code where you were living on <REFDATE>.

Also, describe the physical location in the space provided.

Response Options

Before REFDATE

City

100-character text box

State

Drop down menu with alphabetical states and District of Columbia

ZIP Code

5-digit text box

Please provide as much information as possible.

For example:

  1. 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

  2. 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.”

250-character text box

Response Options

On or After REFDATE

City

100-character text box

State

Drop down menu with alphabetical states and District of Columbia

ZIP Code

5-digit text box

Please provide as much information as possible.

For example:

  1. 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

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

250-character 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 your full address. Any address that you provide should also include a city, state and ZIP Code.”

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

  3. Third Time: End the questionnaire and display NO_COMPLETE screen.


Post-condition

  • If the respondent selects “Next”, goto STAN_OTHER_ADDRESS_OLD_A

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

Special Instructions







STAN_RESIDENCE_OLD_A

Screen Name

STAN_RESIDENCE_OLD_A

Variable Names

Standardized Street Address Fields

ADR_STNU_TEXT: VARCHAR2 (20)

ADR_STNM_TEXT: VARCHAR2 (50)

ADR_UNIT_TEXT: VARCHAR2 (50)

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Data Needed

Respondent provided address from RESIDENCE_OLD

Pre-condition

Respondents who provided a valid address on the RESIDENCE_OLD

Question Wording

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

<Full standardized address>

Is the address correct?

Response Options

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



Yes

No

Edits/Errors

Required Fields:

Street Number AND Street Name AND City AND State AND Zip

If required fields 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 the respondent selects “No”, goto STAN_RESIDENCE_OLD_B.

  • If “Yes”, goto VERIFY_ADDRESS.

Special Instructions

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



STAN_RESIDENCE_OLD_B

Screen Name

STAN_RESIDENCE_OLD_B

Variable Names

Standardized Street Address Fields

ADR_STNU_TEXT: VARCHAR2 (20)

ADR_STNM_TEXT: VARCHAR2 (50)

ADR_UNIT_TEXT: VARCHAR2 (50)

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Data Needed

Respondent provided address from RESIDENCE_OLD

Pre-condition

Respondent selects “No” on STAN_RESIDENCE_OLD_A

Question Wording

Please make the necessary changes in the fields below.

Response Options

Address Number

Ex: 101

20-character text box


Street Name

Ex: N Main St

50-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 Number AND Street Name AND City AND State AND Zip

If required fields 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

Goto VERIFY_ADDRESS.

Special Instructions

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



STAN_RR_ADDRESS_OLD_A

Screen Name

STAN_RR_ADDRESS_OLD_A

Variable Names

Respondent-Provided Rural Route Address Fields

ADR_RR_DESC_TEXT: VARCHAR2 (3) (1=RR, 2=HC, 3=SR, 4=PSC, 5=RTE)

ADR_RR_NUM_TEXT: VARCHAR2 (10)

ADR_RR_BOX_NUM_TEXT: VARCHAR2 (10)

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Data Needed

Respondent provided address from RR_ADDRESS_OLD.

Pre-condition

All Respondents who provided a valid address on RR_ADDRESS_OLD

Question Wording

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

<Full standardized address>


Is the address correct?

Response Options

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



Yes

No

Edits/Errors

Required Fields:


RR Descriptor AND RR # AND RR Box ID AND

City AND State AND Zip

If required fields 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 the respondent selects “No”, goto STAN_RR_ADDRESS_OLD_B.

  • If “Yes”, goto VERIFY_ADDRESS.

Special Instructions

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



STAN_RR_ADDRESS_OLD_B

Screen Name

STAN_RR_ADDRESS_OLD_B

Variable Names

Respondent-Provided Rural Route Address Fields

ADR_RR_DESC_TEXT: VARCHAR2 (3) (1=RR, 2=HC, 3=SR, 4=PSC, 5=RTE)

ADR_RR_NUM_TEXT: VARCHAR2 (10)

ADR_RR_BOX_NUM_TEXT: VARCHAR2 (10)

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Data Needed

Respondent provided address from RR_ADDRESS_OLD.

Pre-condition

Respondent selects “No” on STAN_RR_ADDRESS_OLD_A

Question Wording

Please make the necessary changes in the fields below.

Response Options

RR Descriptor

Drop down menu with the following options

  • RR

  • HC

  • SR

  • PS

  • RTE

Rural Route #

10-character text box

RR Box ID #

10-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

Please provide as much information as possible.

For example: If you also have a street address associated with your residence, such as one used for emergency services (E-911) or for you to have a package delivered to your home, then please provide it here.

250-character text box

Edits/Errors

Required Fields:


RR Descriptor AND RR # AND RR Box ID AND

City AND State AND Zip

If required fields 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 “Yes”, goto VERIFY_ADDRESS.

Special Instructions

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



STAN_OTHER_ADDRESS_OLD_A

Screen Name

STAN_OTHER_ADDRESS_OLD_A

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Data Needed

Respondent provided address from OTHER_ADDRESS_OLD

Pre-condition

All Respondents who provided a valid address on the OTHER_ADDRESS_OLD

Question Wording

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

<Discription>

<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:

City AND State AND Zip


If required fields 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 the respondent selects “No”, goto STAN_OTHER_ADDRESS_OLD_B.

If “Yes”, goto VERIFY_ADDRESS.

Special Instructions

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



STAN_OTHER_ADDRESS_OLD_B

Screen Name

STAN_OTHER_ADDRESS_OLD_B

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Data Needed

Respondent provided address from OTHER_ADDRESS_OLD

Pre-condition

Respondent selects “No” on STAN_OTHER_ADDRESS_OLD_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 states and District of Columbia

ZIP Code

5-digit text box

Please provide as much information as possible.

For example:

  1. 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

  2. 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.”

250-character text box

Edits/Errors

Required Fields:

City AND State AND Zip


If required fields 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

Goto VERIFY_ADDRESS.

Special Instructions

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



NONID Address Collection - NEW

RESIDENCE_NEW

Screen Name

RESIDENCE_NEW

Variable Names

Respondent-Provided Street Address Fields
ADR_STADR_TEXT: VARCHAR2 (100)
ADR_UNIT_TEXT: VARCHAR2 (50)
ADR_CITY_TEXT: VARCHAR2 (100)
ADR_STATE_TEXT: VARCHAR2 (2)
ADR_ZIP_TEXT: VARCHAR2 (5)

ADR_NO_STREET_ADDRESS_IND: 0,1

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”, goto STAN_RESIDENCE_NEW_A

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

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

Special Instructions

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



OTHER_ADDRESS_NEW

Screen Name

OTHER_ADDRESS_NEW

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Physical Description Field

ADR_LOC_DESC_TEXT: VARCHAR2 (250)

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 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.”

  3. Third Time: End the questionnaire and display NO_COMPLETE screen.

Post-condition

  • If the respondent selects “Next”, goto STAN_OTHER_ADDRESS_NEW_A

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

Special Instructions

STAN_RESIDENCE_NEW_A

Screen Name

STAN_RESIDENCE_NEW_A

Variable Names

Respondent-Provided Street Address Fields
ADR_STADR_TEXT: VARCHAR2 (100)
ADR_UNIT_TEXT: VARCHAR2 (50)
ADR_CITY_TEXT: VARCHAR2 (100)
ADR_STATE_TEXT: VARCHAR2 (2)
ADR_ZIP_TEXT: VARCHAR2 (5)

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:

Street Address AND City AND State AND Zip

If required fields 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 the respondent selects “No”, goto STAN_RESIDENCE_NEW_B.

If “Yes”, goto VERIFY_ADDRESS.

Special Instructions

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







STAN_RESIDENCE_NEW_B

Screen Name

STAN_RESIDENCE_NEW_B

Variable Names

Respondent-Provided Street Address Fields
ADR_STADR_TEXT: VARCHAR2 (100)
ADR_UNIT_TEXT: VARCHAR2 (50)
ADR_CITY_TEXT: VARCHAR2 (100)
ADR_STATE_TEXT: VARCHAR2 (2)
ADR_ZIP_TEXT: VARCHAR2 (5)

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

Goto 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

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Physical Description Field

ADR_LOC_DESC_TEXT: VARCHAR2 (250)

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.

<Discription>

<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:

Street Address AND City AND State AND Zip

If required fields 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 the respondent selects “No”, goto STAN_OTHER_ADDRESS_NEW_B.

If “Yes”, goto VERIFY_ADDRESS.

Special Instructions

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



STAN_OTHER_ADDRESS_NEW_B

Screen Name

STAN_OTHER_ADDRESS_NEW_B

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: VARCHAR2 (5)

Physical Description Field

ADR_LOC_DESC_TEXT: VARCHAR2 (250)

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

Goto 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

Variable Names

H_OCC_YES_IND: 0,1

H_OCC_NO_IND: 0,1

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

STAN_RESIDENCE_NEW_A

or

STAN_RESIDENCE_NEW_B

or

STAN_OTHER_ADDRESS_NEW_A

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 RESPONDENT

If “No” or Blank, goto ANYONE

Special Instructions

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

ANYONE

Screen Name

ANYONE

Variable Names

H_OCC_YES_PRX_IND: 0,1

H_OCC_NO_PRX_IND: 0,1

H_OCC_DK_PRX_IND: 0,1

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

Variable Names


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

Variable Names

H_VAC_FORRENT_IND: 0,1

H_VAC_RENTNOTOCC_IND: 0,1

H_VAC_FORSALE_IND: 0,1

H_VAC_SOLDNOTOCC_IND: 0,1

H_VAC_SEASON_IND: 0,1

H_VAC_MIGRANT_IND: 0,1

H_VAC_OTHER_IND: 0,1

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

UNIT STATUS = “Vacant”

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

Variable Names

P_FIRST_NAME: CHAR 20

P_MIDDLE_NAME: CHAR 20

P_LAST_NAME: CHAR 20

RESP_PH_AREA_ID: NUM 3

RESP_PH_PREFIX_ID: NUM 3

RESP_PH_SUFFIX_ID: NUM 4

P_RESPONDENT_IND: 0,1

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, goto OTHER_COMPLETE

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

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

Variable Names

RESP_OTHERID_YES_IND: 0,1

RESP_OTHERID_NO_IND: 0,1

SOLICIT_LINKED_ID: NUM 12

Data Needed

<REFDATE>

<ADDRESS>

Pre-condition

RESPONDENT

and

VERIFY ADDRESS = “No” or Blank

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

  • VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Else > 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 March 1, 2022, you do not need to provide any additional information for it.  

Question Wording

On or After REFDATE

Thank you for providing information for <ADDRESS>.   Since you did not live or stay at this address on March 1, 2022, you do not need to provide any additional information for it.

Response Options


Response Options Fills

N/A

Edits/Errors


Post-condition


Special Instructions

Display “You may close the browser.”

POPCOUNT

Screen Name

POPCOUNT

Variable Names

H_SIZE_STATED_CNT: NUM 2 [1-99]

H_OCC_CHECK_YES_IND: 0,1

H_OCC_CHECK_NO_IND: 0,1

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 goto NO_COMPLETE

Post-condition

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

If POPCOUNT=1, goto UC.

If POPCOUNT=2-99, goto 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

Variable Names

P_FIRST_NAME: CHAR 20

P_MIDDLE_NAME: CHAR 20

P_LAST_NAME: CHAR 20

P_ORIGROST_ADD_IND: 0,1

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 if VERIFY_ADDRESS = YES and WHOLE/PARTIAL is not “Some of the people at this address not including myself”





UC

Screen Name

UC

Variable Names

H_UC_ADD_YES_IND: 0,1

H_UC_ADD_NO_IND: 0,1

P_FIRST_NAME: CHAR 20

P_MIDDLE_NAME: CHAR 20

P_LAST_NAME: CHAR 20

P_WAS_UNDERCOUNT_IND: 0,1

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

If “Yes” is selected on HOMELESS, goto SEX (for OLD path)

Else, goto 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

Variable Names

H_TENURE_OWNED_MORT_IND: 0,1

H_TENURE_OWNED_FREE_IND: 0,1

H_TENURE_RENTED_IND: 0,1

H_TENURE_OCC_NOPAY_IND: 0,1

Data Needed


Pre-condition

UC

And

(If “No” is selected on HOMELESS_OLD)

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

Goto SEX

Special Instructions


Respondent Demographics

SEX

Screen Name

SEX

Variable Names

P_SEX_MALE_IND: 0,1

P_SEX_FEMALE_IND: 0,1

Data Needed

NAME#

Pre-condition

HOME

Or

UC (If “Yes” is selected on HOMELESS_OLD)

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, goto DOB.

If Answer the Question, go back to response options.

Post-condition

Goto DOB

Special Instructions

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



DOB



Screen Name

DOB

Variable Names

P_BIRTH_MONTH_INT: NUM 2

P_BIRTH_DAY_INT: NUM 2

P_BIRTH_YEAR_INT: NUM 4

P_AGE_INT: NUM 3

Data Needed

NAME#

Pre-condition

SEX

Question Wording

Before REFDATE

What is <NAME#>’s date of birth?



Verify or enter correct age as of <REFDATE>.

Question Wording

On or After REFDATE

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 will 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, goto HISPANIC ORIGIN.

If Answer the Question, go back to response options.

Post-condition

Goto HISPANIC ORIGIN

Special Instructions

If month, day, and year is provided, calculate age and display in text field.



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

Variable Names

P_HISP_NO_IND: 0,1

P_HISP_YES_MEXICAN_IND: 0,1

P_HISP_YES_PR_IND: 0,1

P_HISP_YES_CUBAN_IND: 0,1

P_HISP_YES_OTH_IND: 0,1

P_HISP_YES_OTH_TEXT: CHAR 200

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, goto RACE.

If Answer the Question, go back to response options.

Post-condition

Goto 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

Variable Names

P_RACE_WHITE_IND: 0,1

P_RACE2_WHITE_TEXT: CHAR 200

P_RACE_BLACK_IND: 0,1

P_RACE2_BLACK_TEXT: CHAR 200

P_RACE_AIAN_IND: 0,1

P_RACE2_AIAN_TEXT: CHAR 200

P_RACE2_CHINESE_IND: 0,1

P_RACE2_FILIPINO_IND: 0,1

P_RACE2_ASIANINDIAN_IND: 0,1

P_RACE2_VIETNAMESE_IND: 0,1

P_RACE2_KOREAN_IND: 0,1

P_RACE2_JAPANESE_IND: 0,1

P_ASIAN_OTHER_IND: 0,1

P_ASIAN_OTHER_TEXT: CHAR 200

P_RACE2_NATHAWAIIAN_IND: 0,1

P_RACE2_SAMOAN_IND: 0,1

P_RACE2_CHAMORRO_IND:0,1

P_NHPI_OTHER_IND: 0,1

P_NHPI_OTHER_TEXT: CHAR 200

P_RACE_SOR_IND: 0,1

P_RACE2_SOR_TEXT: CHAR 200

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, goto OC.

If Answer the Question, go back to response options.

Post-condition

Goto OC

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.

OC

Screen Name

OC

Variable Names

P_LOC_ELSE_NO_IND: 0,1

P_LOC_ELSE_RELATIVES_IND: 0,1

P_LOC_ELSE_COLLEGE_IND: 0,1

P_LOC_ELSE_MILITARY_IND: 0,1

P_LOC_ELSE_JOB_IND: 0,1

P_LOC_ELSE_NURSINGHOME_IND: 0,1

P_LOC_ELSE_JAIL_IND: 0,1

P_LOC_ELSE_SEASONAL_IND: 0,1

P_LOC_ELSE_OTHER_IND: 0,1

P_LOC_ELSE_OTHER_TEXT: CHAR 250

Data Needed

NAME#

<ADDRESS>

Pre-condition

RACE

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

Goto WHOLE/PARTIAL

Special Instructions

Selecting a response option:

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



WHOLE/PARTIAL

Screen Name

WHOLE/PARTIAL

Variable Names


Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

OC

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.

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, goto PEOPLE

If Answer the Question, go back to response options.

Post-condition

Goto SUBMIT

Special Instructions

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



SUBMIT Census Questionnaire

Screen Name

SUBMIT Census Questionnaire

Variable Names

RESP_SUBMIT_IND: 0,1

Data Needed


Pre-condition

WHOLE/PARTIAL

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, goto 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 Test questionnaire for:

<FULL ADDRESS>

Date and time of submission

If you receive other mail from the Census Bureau about the 2023 Census Test 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 no valid address is provided.

Cases where no popcount is provided on the POPCOUNT screen.

Question Wording

Your 2023 Census Test 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

Center all text.

SESSION TIMEOUT

Screen Name

SESSION TIMEOUT

Data Needed


Pre-condition

Respondent is inactive more than 15 minutes

Question Wording

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.

Special Instructions

Center all text.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKristen A Hearns(CENSUS/DCMD FED)
File Modified0000-00-00
File Created2024-07-20
© 2024 OMB.report | Privacy Policy