CO13 – 2030 Decennial Uses of Administrative Data – Focus Group/Interview screener
Web Survey Screener Specifications 1
Module 1: Key eligibility screener 3
Q3. Federal employment status 3
Module 2: Demographic characteristics 4
Q5. Hispanic/Latino ethnicity Web 4
Module 3: Household characteristics and home ownership 6
Q11. Number of children in household 6
Q12. Children’s relationship 7
Q19. Use of federal statistics 8
Q25. Focus group participation. 9
RTI International, a nonprofit research organization, is conducting research on behalf of the U.S. Census Bureau to improve questions in one of its national surveys.
To determine if you are eligible to participate in the research, we will ask you a few screening questions about your background and your household. [IF FG: Eligible participants can receive $90 for an in-person focus group, which will last 90 minutes.] [IF INTERVIEW: Eligible participants can receive $40 for a virtual interview, which will last 60 minutes.]
If you are eligible for the study, we will call or email you to schedule a time for the [focus group/interview].
Your participation in the eligibility screening is completely voluntary. You may stop at any time or skip questions that you do not want to answer.
This voluntary survey is being conducted under the authority of Title 13 U.S. Code, Sections 6 and 182. Federal law requires that your answers are kept confidential (Title 13, U.S. Code, Section 9), and protects your privacy under the Privacy Act (Title 5 U.S. Code, Section 552a). The purpose of this survey is to improve future censuses and Census Bureau surveys. Routine uses of these data are limited to those identified in the Privacy Act System of Record Notice titled “COMMERCE/CENSUS-5, Decennial Census Programs.” Furnishing this information is voluntary; however, failure to do so will limit the Census Bureau’s ability to gather information used in the development of survey instruments, and other communication materials in order to produce materials that are clear and easy for people to understand. Personally Identifiable Information collected includes name, telephone/cellular phone number, DOB or age, email address, race, or ethnicity. The information provided to us may be shared with other Census Bureau staff, contractors and those who have a need to know for work-related purposes. The Census Bureau can use your responses only to produce statistics and is not permitted to publicly release your responses in a way that could identify you, your business, organization, or institution.
We estimate that completing these screening questions will take 10 minutes on average. This information collection has been approved by the Office of Management and Budget (OMB). You can validate that this survey is a legitimate using the Office of Management and Budget's approval number 0607-0725, which expires 12/31/2025. We are required to tell you this number to conduct this survey. Send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey to [email protected].
If you have questions about the research, you may contact RTI’s project director, Deirdre Middleton, at 919-485-5458 or [email protected] .
Consent to Participate
Do we have your permission to ask you a few questions to find out if you are eligible for this study?
If you agree to participate, please click “Yes, I agree” below and then the “NEXT” button to continue. If you choose not to participate, please click “Exit” and then the “NEXT” button to exit the survey.
1 Yes, I agree [Skip to Q1]
2 Exit [Skip to REFUSAL]
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In what city, state, and ZIP code do you currently live?
City: [______]
State: [______]
ZIP code [______]
[PROGRAMMER: CITY − TEXTBOX with 50 characters Max.; State – TEXTBOX; ZIP code − 5 digits NUMERIC ENTRY ONLY]
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In what country or territory were you born?
This information is being asked to ensure a broad range of experiences are represented in the study. Answers will be strictly kept confidential and will not be shared for any other purpose
1 In United States
2 In some other country or territory ─ please specify
Country: [______]
[PROGRAMMER: Country − TEXTBOX with 50 characters Max]
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How old are you?
[______] [If Q2<18, skip to INELIGIBLE]
[PROGRAMMER: NUMERIC ENTRY ONLY; RANGE = (6-110)]
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Are you employed by the Federal Government? (if federal contractor, mark NO)
1 Yes [skip to INELIGIBLE]
2 No
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What sex were you assigned at birth, on your original birth certificate?
1 Male
2 Female
3 Other (I self-identify as: )_____________
4 I don’t want to answer
Do you currently describe yourself as male, female, or transgender?
1 Male
2 Female
3 Transgender
4 Other (I self-identify as: )_____________
5 I don’t want to answer
Which of the following best represents how you think of yourself? Please select all that apply.
1 Lesbian
2 Gay
3 Bisexual
4 Straight/Heterosexual
5 Asexual
6 Queer
7 Other (I self-identify as: )_____________
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Are you of Hispanic, Latino, or Spanish origin? Please select all that apply.
1 No, not of Hispanic, Latino, or Spanish origin
2 Yes, Mexican, Mexican American., Chicano
3 Yes, Puerto Rican
4 Yes, Cuban
5 Yes, another Hispanic, Latino, or Spanish origin – Enter origin, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, and so on:
[PROGRAMMER: WHEN 5 (“Yes, another Hispanic, Latino, or Spanish origin”) IS SELECTED, DISPLAY “please specify” TEXTBOX. Option 1 to be programmed as exclusive]
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What is your race? Please select all that apply.
1 White
2 Black or African American
3 American Indian or Alaska Native
4 Asian
5 Native Hawaiian or other Pacific Islander
6 Other – please specify
[PROGRAMMER: WHEN 6 (“Other”) IS SELECTED, DISPLAY “please specify” TEXTBOX.]
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What is the highest grade of school you have completed, or the highest degree you have received?
1 Less than high school diploma or equivalent
2 High school diploma (including GED or ABE certificate)
3 Some college, no degree
4 Associate’s degree (AA, AS, or equivalent)
5 Bachelor’s degree (BA, BS, or equivalent)
6 Post Bachelor’s degree (MA, MS, PhD, JD, MD, etc.)
7 I have not completed any formal education
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Does anyone live or stay with you at your current address? Also include people who only sometimes live or stay with you.
1 Yes [ask Q9]
2 No [skip to Q13]
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[Ask if Q8 = Yes] Who lives or stays with you? Please select all that apply.
1 Parent(s)
2 Grandparent(s)
3 Husband/wife/spouse
4 Unmarried partner
5 Children
6 Grandchildren
7 Other relatives(s)
8 Roommates
9 Friends
10 Other – please specify
[PROGRAMMER: WHEN 10 (“Other”) IS SELECTED, DISPLAY “please specify” TEXTBOX.]
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[Ask if Q9 = 7, 8, 9, 10] You indicated that the following people live or stay with you: [Q9]
Are any of these people part of your extended family (such as your uncles, aunts, cousins, nieces, nephews, or in-laws)?
1 Yes
2 No
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[If Q8=1] How many people age 18 or older currently live or stay at your address, INCLUDING yourself?
[______] adult/adults
[PROGRAMMER: NUMERIC ENTRY ONLY; RANGE = (1-19)]
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[If Q8=1] How many people younger than 18 currently live or stay at your address?
[______] child/children
[PROGRAMMER: NUMERIC ENTRY ONLY; RANGE = (0-19)]
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[Ask if Q11>0] What is your relationship to the children living or staying with you? Please select all that apply.]
1 Your biological children
2 Your adopted children
3 Your foster children
4 Your grandchildren
5 Related to you in some other way
6 Not related to you
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[Ask if Q12 in (1:5)] Do any of the children living with you sometimes live or stay somewhere else due to a custody arrangement?
1 Yes
2 No
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Is your home…
1 Owned with a mortgage or loan by you or someone in your household
2 Owned free and clear
3 Rented
4 Occupied without payment or rent
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How long have you been living in your current home?
1 Less than 3 months
2 Between 3 and 6 months
3 Between 6 months and 12 months
4 Between 1 and 2 years
5 Between 2 and 5 years
6 More than 5 years
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[Ask if Q15 in (1:5)] How many times did you move addresses during the last 5 years?
[______] times
[PROGRAMMER: NUMERIC ENTRY ONLY; RANGE = (0-39)]
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How frequently do you use the Internet in your home? This includes accessing the Internet through a cell phone, computer, or tablet.
1 Daily
2 At least once a week
3 At least once a month
4 Less than once a month
5 Rarely
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Now we’d like to ask about your experience with the Census Bureau or government data sources. How did you respond to the most recent decennial census in 2020?
1 I did not respond to the 2020 decennial Census on behalf of my household
2 I responded the 2020 decennial Census online
3 I responded the 2020 decennial Census on the paper form and then sent it back to the Census Bureau
4 I met with and responded the 2020 decennial Census to the Census enumerator
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The population count, the crime rate, and the unemployment rate are examples of statistics produced by the federal government. Have you ever used federal statistics for study or work?
1 Yes
2 No
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Finally, we just have a few more questions about your contact information. If you are eligible and selected to participate in the study, we will use the information to contact you to schedule the [focus group/interview].
What is your name?
Name: [________________________]
What is your email address?
[_________________________________________]
[PROGRAMMER: email verification]
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What is the best telephone number to reach you?
Phone ([___]) [___] − [_______]
What is the best time to reach you by phone?
[_________________________________________]
[PROGRAMMER: textbox character limit: 50, place on the same page with Q22]
Can we have your permission to send text messages? This will be used to communicate about the [focus group/interview].
1 Yes
2 No
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Would you be able to participate in a 90 minute in-person focus group in [LOCATION] at a day/time to be determined in the month of [MONTH]?
1 Yes
2 No
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How did you hear about this study?
1 Community publication (for example, local paper)
2 Flyer
3 Friends or family
4 RTI or Census Bureau employee
5 Craigslist
6 Facebook
7 Reddit
8 Other – specify: _______________
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Thank you for taking the time to answer our questions today. We will get back to you soon if you are eligible [FG: to participate in a focus group / I: for an interview].
Based on your responses, you are not eligible to participate in this study. Thank you for taking the time to answer our questions today.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Weimer, Belinda |
| File Modified | 0000-00-00 |
| File Created | 2025-08-12 |