Version A Version A

Generic Clearance for Questionnaire Pretesting Research

Attachment B RE_Vertical_Question_Testing_Instrument_rev

Cognitive testing for the 2023 Race and Ethnicity Questions: Census Household

OMB: 0607-0725

Document [docx]
Download: docx | pdf



R/E Vertical Question Testing Instrument



Start of Block: Start Block


Intro Thank you for agreeing to participate in this research study. On the next screen, you will be asked to begin filling out a short questionnaire. After you have filled out the questionnaire for yourself and others in your household, we will talk about your answers.


End of Block: Start Block


Start of Block: Default Question Block


Privacy Act Statement: By law, the Census Bureau is required to keep your answers confidential. This survey is voluntary and you may refuse to answer any question. The results of this study may be used to inform future surveys and censuses. This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-0725, confirms this approval. We are required to display this number to conduct this survey. We estimate that this survey will take about xx minutes. By proceeding with this study, you give your consent to participate in this study.

The U.S. Census Bureau is conducting this study under the authority of 13 U.S.C., Sections 131, 141, , 182, 193, and 196. Your privacy is protected by the Privacy Act of 1974 (5 U.S.C. Section 552a). There are a limited number of uses of your data that are permitted under the Privacy Act. You can find a list of these uses in the System of Records Notice (SORN). For this survey, the SORNs are named: COMMERCE/Census -3, Demographic Survey Collection (Census Bureau Sampling Frame); COMMERCE/CENSUS-5, Decennial Census Programs; and COMMERCE/CENSUS-4, Economic Survey Collections.




Page Break




Number in HH This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of the time.

1. How many people were living or staying in this house, apartment, or mobile home on April 1, 2023?

________________________________________________________________


End of Block: Default Question Block


Start of Block: Vertical R/E 


P1a Name Please provide information for each person living here. Please start by listing yourself.

2. What is your name?
Type your name below.

  • First name (1) __________________________________________________

  • MI (2) __________________________________________________

  • Last name (3) __________________________________________________





P1a Sex 3. Are you male or female?

  • Male (1)

  • Female (2)





P1a Age 4. What is your age and what is your date of birth?

  • Age on April 1, 2023 (1) __________________________________________________

  • Date of birth (mm/dd/yyyy) (2) __________________________________________________




Page Break




P1a Race Ethnicity 5. What is your race and/or ethnicity? (Help)
Select all that apply.

  • White For example, German, Irish, English, Italian, Polish, French, etc. (1)

  • German (2)

  • Irish (3)

  • English (4)

  • Italian (5)

  • Polish (6)

  • French (7)

  • Enter, for example, Scottish, Norwegian, Dutch, etc. (8) __________________________________________________

  • Hispanic or Latino For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. (9)

  • Mexican or Mexican American (10)

  • Puerto Rican (11)

  • Cuban (12)

  • Salvadoran (13)

  • Dominican (14)

  • Colombian (15)

  • Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. (16) __________________________________________________

  • Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. (17)

  • African American (18)

  • Jamaican (19)

  • Haitian (20)

  • Nigerian (21)

  • Ethiopian (22)

  • Somali (23)

  • Enter, for example, Ghanaian, South African, Barbadian, etc. (24) __________________________________________________

  • Asian For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. (25)

  • Chinese (26)

  • Filipino (27)

  • Asian Indian (28)

  • Vietnamese (29)

  • Korean (30)

  • Japanese (31)

  • Enter, for example, Pakistani, Cambodian, Hmong, etc. (32) __________________________________________________

  • American Indian or Alaska NativeFor example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Tribal Government, Tlingit, etc. (33) __________________________________________________

  • Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. (34)

  • Lebanese (35)

  • Iranian (36)

  • Egyptian (37)

  • Syrian (38)

  • Moroccan (39)

  • Israeli (40)

  • Enter, for example, Algerian, Iraqi, Kurdish, etc. (41) __________________________________________________

  • Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. (42)

  • Native Hawaiian (43)

  • Samoan (44)

  • Chamorro (45)

  • Tongan (46)

  • Fijian (47)

  • Marshallese (48)

  • Enter, for example, Palauan, Tahitian, Chuukese, etc. (49) __________________________________________________




Page Break



Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 2


P2a Name 6. Type name of Person 2.

  • First name (1) __________________________________________________

  • MI (2) __________________________________________________

  • Last name (3) __________________________________________________




Page Break



Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 2


P2a Relationship 7. How is ${P2a Name/ChoiceTextEntryValue/1} related to you? 

  • Opposite-sex husband/wife/spouse (1)

  • Opposite-sex unmarried partner (2)

  • Same-sex husband/wife/spouse (3)

  • Same-sex unmarried partner (4)

  • Biological son or daughter (5)

  • Adopted son or daughter (6)

  • Stepson or stepdaughter (7)

  • Brother or sister (8)

  • Father or mother (9)

  • Grandchild (10)

  • Parent-in-law (11)

  • Son-in-law or daughter-in-law (12)

  • Other relative (13)

  • Roommate or housemate (14)

  • Foster child (15)

  • Other non-relative (16)




Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 2


P2a Sex 8. What is ${P2a Name/ChoiceTextEntryValue/1}'s sex?

  • Male (1)

  • Female (2)




Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 2


P2a Age 9. What is ${P2a Name/ChoiceTextEntryValue/1}'s age and date of birth? 
For babies less than 1 year old, do not type the age in months. Type 0 as the age.

  • Age on April 1, 2023 (1) __________________________________________________

  • Date of birth (mm/dd/yyyy) (2) __________________________________________________




Page Break



Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 2


P2a Race Ethnicity 10. What is ${P2a Name/ChoiceTextEntryValue/1}'s race and/or ethnicity? (Help)
Select all that apply.

  • White For example, German, Irish, English, Italian, Polish, French, etc. (1)

  • German (2)

  • Irish (3)

  • English (4)

  • Italian (5)

  • Polish (6)

  • French (7)

  • Enter, for example, Scottish, Norwegian, Dutch, etc. (8) __________________________________________________

  • Hispanic or Latino For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. (9)

  • Mexican or Mexican American (10)

  • Puerto Rican (11)

  • Cuban (12)

  • Salvadoran (13)

  • Dominican (14)

  • Colombian (15)

  • Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. (16) __________________________________________________

  • Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. (17)

  • African American (18)

  • Jamaican (19)

  • Haitian (20)

  • Nigerian (21)

  • Ethiopian (22)

  • Somali (23)

  • Enter, for example, Ghanaian, South African, Barbadian, etc. (24) __________________________________________________

  • Asian For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. (25)

  • Chinese (26)

  • Filipino (27)

  • Asian Indian (28)

  • Vietnamese (29)

  • Korean (30)

  • Japanese (31)

  • Enter, for example, Pakistani, Cambodian, Hmong, etc. (32) __________________________________________________

  • American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Tribal Government, Tlingit, etc. (33) __________________________________________________

  • Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. (34)

  • Lebanese (35)

  • Iranian (36)

  • Egyptian (37)

  • Syrian (38)

  • Moroccan (39)

  • Israeli (40)

  • Enter, for example, Algerian, Iraqi, Kurdish, etc. (41) __________________________________________________

  • Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. (42)

  • Native Hawaiian (43)

  • Samoan (44)

  • Chamorro (45)

  • Tongan (46)

  • Fijian (47)

  • Marshallese (48)

  • Enter, for example, Palauan, Tahitian, Chuukese, etc. (49) __________________________________________________




Page Break



Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 3


P3a Name 11. Type name of Person 3.

  • First name (1) __________________________________________________

  • MI (2) __________________________________________________

  • Last name (3) __________________________________________________




Page Break



Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 3


P3a Relationship 12. How is ${P3a Name/ChoiceTextEntryValue/1} related to you? 

  • Opposite-sex husband/wife/spouse (1)

  • Opposite-sex unmarried partner (2)

  • Same-sex husband/wife/spouse (3)

  • Same-sex unmarried partner (4)

  • Biological son or daughter (5)

  • Adopted son or daughter (6)

  • Stepson or stepdaughter (7)

  • Brother or sister (8)

  • Father or mother (9)

  • Grandchild (10)

  • Parent-in-law (11)

  • Son-in-law or daughter-in-law (12)

  • Other relative (13)

  • Roommate or housemate (14)

  • Foster child (15)

  • Other non-relative (16)




Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 3


P3a Sex 13. What is ${P3a Name/ChoiceTextEntryValue/1}'s sex?

  • Male (1)

  • Female (2)




Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 3


P3a Age 14. What is ${P3a Name/ChoiceTextEntryValue/1}'s age and date of birth? 
For babies less than 1 year old, do not type the age in months. Type 0 as the age.

  • Age on April 1, 2023 (1) __________________________________________________

  • Date of birth (mm/dd/yyyy) (2) __________________________________________________




Page Break



Display This Question:

If If This questionnaire is similar to what you might receive as part of a government survey. Please answer the questions as you would if you were answering from the home where you live or stay most of t... Text Response Is Greater Than or Equal to 3


P3a Race Ethnicity 15. What is ${P3a Name/ChoiceTextEntryValue/1}'s race and/or ethnicity? (Help)
Select all that apply.

  • White For example, German, Irish, English, Italian, Polish, French, etc. (1)

  • German (2)

  • Irish (3)

  • English (4)

  • Italian (5)

  • Polish (6)

  • French (7)

  • Enter, for example, Scottish, Norwegian, Dutch, etc. (8) __________________________________________________

  • Hispanic or Latino For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. (9)

  • Mexican or Mexican American (10)

  • Puerto Rican (11)

  • Cuban (12)

  • Salvadoran (13)

  • Dominican (14)

  • Colombian (15)

  • Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. (16) __________________________________________________

  • Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. (17)

  • African American (18)

  • Jamaican (19)

  • Haitian (20)

  • Nigerian (21)

  • Ethiopian (22)

  • Somali (23)

  • Enter, for example, Ghanaian, South African, Barbadian, etc. (24) __________________________________________________

  • Asian For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. (25)

  • Chinese (26)

  • Filipino (27)

  • Asian Indian (28)

  • Vietnamese (29)

  • Korean (30)

  • Japanese (31)

  • Enter, for example, Pakistani, Cambodian, Hmong, etc. (32) __________________________________________________

  • American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Tribal Government, Tlingit, etc. (33) __________________________________________________

  • Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. (34)

  • Lebanese (35)

  • Iranian (36)

  • Egyptian (37)

  • Syrian (38)

  • Moroccan (39)

  • Israeli (40)

  • Enter, for example, Algerian, Iraqi, Kurdish, etc. (41) __________________________________________________

  • Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. (42)

  • Native Hawaiian (43)

  • Samoan (44)

  • Chamorro (45)

  • Tongan (46)

  • Fijian (47)

  • Marshallese (48)

  • Enter, for example, Palauan, Tahitian, Chuukese, etc. (49) __________________________________________________





Q97
Do not click NEXT until your interviewer asks and moves on to the next page with you together.


End of Block: Vertical R/E 


Start of Block: Probing Screens


Q89 Thank you for your participation in our study. Please turn your attention back to your interviewer.

Do not click NEXT until your interviewer asks and moves on to the next page with you together.





Vertical Main Probe Now I'd like to review and discuss the questions. Please look at your answer to the question below.

5. What is your race and/or ethnicity? (Help)
Select all that apply.

You selected:
${P1a Race Ethnicity/ChoiceGroup/SelectedChoices}

  • White For example, German, Irish, English, Italian, Polish, French, etc. (1)

  • Hispanic or Latino For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. (2)

  • Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. (3)

  • Asian For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. (4)

  • American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Tribal Government, Tlingit, etc. (5)

  • Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. (6)

  • Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. (7)





Q90
Do not click NEXT until your interviewer asks and moves on to the next page with you together.




Page Break




Q91 TEXT TO INSTRUCT THEM TO CLICK THE CATEGORIES THEY SELECTED





Vertical Full Probe 5. What is your race and/or ethnicity? (Help)
Select all that apply.

You selected or entered:
${P1a Race Ethnicity/ChoiceGroup/SelectedChoicesTextEntry}

  • White For example, German, Irish, English, Italian, Polish, French, etc. (1)

  • German (2)

  • Irish (3)

  • English (4)

  • Italian (5)

  • Polish (6)

  • French (7)

  • Enter, for example, Scottish, Norwegian, Dutch, etc. (8) __________________________________________________

  • Hispanic or Latino For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. (9)

  • Mexican or Mexican American (10)

  • Puerto Rican (11)

  • Cuban (12)

  • Salvadoran (13)

  • Dominican (14)

  • Colombian (15)

  • Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. (16) __________________________________________________

  • Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. (17)

  • African American (18)

  • Jamaican (19)

  • Haitian (20)

  • Nigerian (21)

  • Ethiopian (22)

  • Somali (23)

  • Enter, for example, Ghanaian, South African, Barbadian, etc. (24) __________________________________________________

  • Asian For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. (25)

  • Chinese (26)

  • Filipino (27)

  • Asian Indian (28)

  • Vietnamese (29)

  • Korean (30)

  • Japanese (31)

  • Enter, for example, Pakistani, Cambodian, Hmong, etc. (32) __________________________________________________

  • American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Tribal Government, Tlingit, etc. (33) __________________________________________________

  • Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. (34)

  • Lebanese (35)

  • Iranian (36)

  • Egyptian (37)

  • Syrian (38)

  • Moroccan (39)

  • Israeli (40)

  • Enter, for example, Algerian, Iraqi, Kurdish, etc. (41) __________________________________________________

  • Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. (42)

  • Native Hawaiian (43)

  • Samoan (44)

  • Chamorro (45)

  • Tongan (46)

  • Fijian (47)

  • Marshallese (48)

  • Enter, for example, Palauan, Tahitian, Chuukese, etc. (49) __________________________________________________





Q92
Do not click NEXT until your interviewer asks and moves on to the next page with you together.




Page Break




AltB Intro TEXT TO INTRODUCE ALTERNATE OF RACE/ETHNICITY VERSION B HERE





AltB RE 5. What is your race and/or ethnicity? (Help)
Select all that apply.

  • White For example, German, Irish, English, Italian, Polish, French, etc. (1)

  • Hispanic or Latino For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. (2)

  • Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. (3)

  • Asian For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. (4)

  • American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat, Tribal Government, Tlingit, etc. (5)

  • Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. (6)

  • Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. (7)




Page Break



Display This Question:

If If 5. What is your race and/or ethnicity? (Help) Select all that apply. q://QID75/SelectedChoicesCount Is Greater Than 0


AltB RE FU Intro 5a. Next, we will collect detailed information for each race or ethnicity selected.




Display This Question:

If 5. What is your race and/or ethnicity? (Help)Select all that apply. = <strong>White</strong> <em>For example, German, Irish, English, Italian, Polish, French, etc.</em>


AltB White detail You said that you are White. Provide details below.
Select all that apply.

  • German (1)

  • Irish (2)

  • English (3)

  • Italian (4)

  • Polish (5)

  • French (6)

  • Enter, for example, Scottish, Norwegian, Dutch, etc. (7) __________________________________________________




Display This Question:

If 5. What is your race and/or ethnicity? (Help)Select all that apply. = <strong>Hispanic or Latino</strong> <em>For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc.</em>


AltB Hispanic detail You said that you are Hispanic or Latino. Provide details below.
Select all that apply.

  • Mexican or Mexican American (1)

  • Puerto Rican (2)

  • Cuban (3)

  • Salvadoran (4)

  • Dominican (5)

  • Colombian (6)

  • Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. (7) __________________________________________________




Display This Question:

If 5. What is your race and/or ethnicity? (Help)Select all that apply. = <strong>Black or African American</strong> <em>For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.</em>


AltB Black AA detail You said that you are Black or African American. Provide details below.
Select all that apply.

  • African American (1)

  • Jamaican (2)

  • Haitian (3)

  • Nigerian (4)

  • Ethiopian (5)

  • Somali (6)

  • Enter, for example, Ghanaian, South African, Barbadian, etc. (7) __________________________________________________




Display This Question:

If 5. What is your race and/or ethnicity? (Help)Select all that apply. = <strong>Asian</strong> <em>For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.</em>


AltB Asian detail You said that you are Asian. Provide details below.
Select all that apply.

  • Chinese (1)

  • Filipino (2)

  • Asian Indian (3)

  • Vietnamese (4)

  • Korean (5)

  • Japanese (6)

  • Enter, for example, Pakistani, Cambodian, Hmong, etc. (7) __________________________________________________




Display This Question:

If 5. What is your race and/or ethnicity? (Help)Select all that apply. = <strong>American Indian or Alaska Native</strong> <em>For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat, Tribal Government, Tlingit, etc.</em>


AltB AIAN detail You said that you are American Indian or Alaska Native. Please enter, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Tribal Government, Tlingit, etc.

________________________________________________________________




Display This Question:

If 5. What is your race and/or ethnicity? (Help)Select all that apply. = <strong>Middle Eastern or North African</strong> <em>For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc.</em>


AltB MENA detail You said that you are Middle Eastern or North African. Provide details below.
Select all that apply.

  • Lebanese (1)

  • Iranian (2)

  • Egyptian (3)

  • Syrian (4)

  • Moroccan (5)

  • Israeli (6)

  • Enter, for example, Algerian, Iraqi, Kurdish, etc. (7) __________________________________________________




Display This Question:

If 5. What is your race and/or ethnicity? (Help)Select all that apply. = <strong>Native Hawaiian or Pacific Islander</strong> <em>For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.</em>


AltB NHPI detail You said that you are Native Hawaiian or Pacific Islander. Provide details below.
Select all that apply.

  • Native Hawaiian (1)

  • Samoan (2)

  • Chamorro (3)

  • Tongan (4)

  • Fijian (5)

  • Marshallese (6)

  • Enter, for example, Palauan, Tahitian, Chuukese, etc. (7) __________________________________________________





Q95
Do not click NEXT until your interviewer asks and moves on to the next page with you together.




Page Break




Q94 INTRO TEXT FOR HELP PROBE TASK





Q93 5. What is your race and/or ethnicity? (Help)
Select all that apply.

  • White For example, German, Irish, English, Italian, Polish, French, etc. (1)

  • German (2)

  • Irish (3)

  • English (4)

  • Italian (5)

  • Polish (6)

  • French (7)

  • Enter, for example, Scottish, Norwegian, Dutch, etc. (8) __________________________________________________

  • Hispanic or Latino For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. (9)

  • Mexican or Mexican American (10)

  • Puerto Rican (11)

  • Cuban (12)

  • Salvadoran (13)

  • Dominican (14)

  • Colombian (15)

  • Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. (16) __________________________________________________

  • Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. (17)

  • African American (18)

  • Jamaican (19)

  • Haitian (20)

  • Nigerian (21)

  • Ethiopian (22)

  • Somali (23)

  • Enter, for example, Ghanaian, South African, Barbadian, etc. (24) __________________________________________________

  • Asian For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc. (25)

  • Chinese (26)

  • Filipino (27)

  • Asian Indian (28)

  • Vietnamese (29)

  • Korean (30)

  • Japanese (31)

  • Enter, for example, Pakistani, Cambodian, Hmong, etc. (32) __________________________________________________

  • American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Tribal Government, Tlingit, etc. (33) __________________________________________________

  • Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Israeli, etc. (34)

  • Lebanese (35)

  • Iranian (36)

  • Egyptian (37)

  • Syrian (38)

  • Moroccan (39)

  • Israeli (40)

  • Enter, for example, Algerian, Iraqi, Kurdish, etc. (41) __________________________________________________

  • Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. (42)

  • Native Hawaiian (43)

  • Samoan (44)

  • Chamorro (45)

  • Tongan (46)

  • Fijian (47)

  • Marshallese (48)

  • Enter, for example, Palauan, Tahitian, Chuukese, etc. (49) __________________________________________________





Q96
Do not click NEXT until your interviewer asks and moves on to the next page with you together.


End of Block: Probing Screens



Page 19 of 19


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleR/E Vertical Question Testing Instrument
AuthorQualtrics
File Modified0000-00-00
File Created2025-08-12

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