Participant Screener

2024 NSCH Content Cognitive Interviewing Screener

The US Census Bureau is looking for participants to help test questions for an upcoming survey on children’s health topics. Thank you for your interest in this research opportunity. Eligible participants who complete a 60-minute research session will receive a $50 stipend. In order to establish your eligibility to participate, we need to ask you a few simple questions.

Eligibility Questions

E1. Are you employed by the federal government? If you are a contractor, mark "No".

Yes

No

E1a. (If yes) Since you are a federal employee, we are not able to pay you the $50 stipend. However, you may still be eligible for the study. Are you still interested in participating?

Yes

No ->Ineligible

E2. Have you participated in any other research studies with the U.S. Census Bureau in the past year?

Yes ->Ineligible

No

E3. Eligible participants who complete the research session will receive $50, sent by USPS Priority Mail. Do you have an address where we can mail the money? This could be a home address, a P.O. box, or an address of a friend or family member. 

Yes

No ->Ineligible

E4. This research study will take place remotely via video chat. You and the researcher will each be in your own homes and will use a video chat application to talk and screen share.  Do you have a desktop, laptop, or tablet capable of using video chat applications? We do not recommend using a phone to screen share.

Yes

No ->Ineligible

Screening Questions

1. Are you a parent or primary caregiver of any children, stepchildren, or foster children age 2-17?

Yes

No -> Ineligible

[If yes, (for topical age group screening)]

2. How many children, stepchildren, or foster children age 2-17 do you have?

Number of children ___________

3a. [If only one child] How old is this child? ________

3a1. Does this child wear glasses, sunglasses or contact lenses?

Yes, prescription lenses

Yes, corrective lenses (but not prescription)

No

3a1a. (IF YES), how often does this child wear their glasses, sunglasses or contact lenses?

All of the time

Regularly

Occasionally

Rarely

3a2. Does this child use hearing aids or cochlear implants?

Yes, hearing aids

Yes, cochlear implants

No

3a3. Does this child currently use any equipment or assistance for walking or getting around?

Yes

Yes, but only temporarily

No

3a4. Does this child currently use a wheelchair?

Yes

Yes, but only temporarily

No

3a5. Does this child have difficulties in any of the following areas? Mark yes or no for each item.

Communicating or speaking Yes No

Learning, remembering, or concentrating Yes No

Fine motor skills Yes No

Mental or emotional health Yes No

3b. [If more than one child]

What is the age of your oldest child (between the ages of 2-17)?

AGE:

3b1. Does this child wear glasses, sunglasses or contact lenses?

Yes, prescription lenses

Yes, corrective lenses (but not prescription)

No

3b1a. (IF YES), how often does this child wear their glasses, sunglasses or contact lenses?

All of the time

Regularly

Occasionally

Rarely

3b2. Does this child use hearing aids or cochlear implants?

Yes, hearing aids

Yes, cochlear implants

No

3b3. Does this child currently use any equipment or assistance for walking or getting around?

Yes

Yes, but only temporarily

No

3b4. Does this child currently use a wheelchair?

Yes

Yes, but only temporarily

No

3b5. Does this child have difficulties in any of the following areas? Mark yes or no for each item.

Communicating or speaking Yes No

Learning, remembering, or concentrating Yes No

Fine motor skills Yes No

Mental or emotional health Yes No

3c. What is the age of your next oldest child (between the ages of 2-17)?

3c1. Does this child wear glasses, sunglasses or contact lenses?

Yes, prescription lenses

Yes, corrective lenses (but not prescription)

No

3c1a. (IF YES), how often does this child wear their glasses, sunglasses or contact lenses?

All of the time

Regularly

Occasionally

Rarely

3c2. Does this child use hearing aids or cochlear implants?

Yes, hearing aids

Yes, cochlear implants

No

3c3. Does this child currently use any equipment or assistance for walking or getting around?

Yes

Yes, but only temporarily

No

3c4. Does this child currently use a wheelchair?

Yes

Yes, but only temporarily

No

3c5. Does this child have difficulties in any of the following areas? Mark yes or no for each item.

Communicating or speaking Yes No

Learning, remembering, or concentrating Yes No

Fine motor skills Yes No

Mental or emotional health Yes No

Repeat for each child.

Demographics

[IF RESPONDENT IS ELIGIBLE]

Demo 1. What is your name?

First and Last Name ___________________

Demo 2. Are you male or female?

Male

Female

Demo 3. What is the highest grade of school you have completed, or the highest degree you have received?

Less than high school

Completed high school

Some college, no degree

Associate degree (AA/AS)

Bachelor’s degree (BA/BS)

Post-Bachelor's degree (For example MA, MS, Ph.D, JD, etc.)

Demo 4. What is your current age?

Age ______________

Demo 5. Are you of Hispanic, Latino, or Spanish origin?

Yes

No

Demo 6. What is your race? Select all that apply.

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Other (Specify)

Demo 7. In what city, state, and ZIP code do you currently live?

City ___________________________

State __________________________

Zip Code _______________________

Demo 8. What is your time zone?

Eastern Standard Time

Central Standard Time

Mountain Standard Time

Pacific Standard Time

Alaska Standard Time

Hawaii-Aleutian Standard Time

Demo 9. How did you hear about this research opportunity? __________________________________

Demo 10. What is your telephone number? ____________________________________

Demo 11. What is your email address? ______________________________________

Thank you for your time.
You may be selected to participate in our study. If you are selected, our staff will contact you to schedule a time that works best for you.
 

END SCREENER

[IF RESPONDENT IS INELIGIBLE]

Unfortunately, you are not eligible to participate in this research project. Would you like us to keep your contact information on file for future research opportunities?

Yes

No -> END SCREENER

What is your name? _______________________________________

What is your email address? ______________________________________