2010 Census ICP Ev 2010 Census ICP Evaluation Questionnaire Wave 1

Census 2010 CICCE Questionnaire (REVISED 5/26/096/19/007/21/09)

SCREENER AND WAVE 1 QUESTIONNAIRE

NOTE1 TO REVIEWERS: NORC computer-assisted questionnaires have designated reserve codes for Don’t Know and Refused options which would be activated for these questionnaires. These options are not noted explicitly in this draft except where their selection affects skip patterns, or where we propose alternative categories which would replace these options.

NOTE2 TO REVIEWERS: NORC has received instructions from the Bureau regarding specific language that must be used with respect to the Privacy Act, matching with Title 13 data, etc. This language will appear in the consent statement rather than the questionnaire.

NOTE3 TO REVIEWERS: There will be multiple modes of data collection (CATI, CAPI, and possibly web and mail) and this questionnaire is the CATI instrument to be administered by interviewers.

NOTE4 TO REVIEWERS: Cognitive interviews of the instrument have been conducted. The instrument is modified based on results from cognitive interview results.

NOTE5 TO REVIEWERS: Items regarding paid media messaging will be finalized after the paid media campaign is better developed (later in 2009). The Q19 series of items is therefore a placeholder rather than final content.

INTRODUCTION: Hello, I’m calling from the University of Chicago to ask people about their attitudes and experiences toward different government programs and how they can be improved.

SCREENER

S1. First, I would like to ask you a few questions about your household.

S2. How many adults currently live in your household?

Number of people

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: if S2=1, SKIP TO S9. ELSE, ASK S3.*/

S3. Are you one of the main people who usually opens the mail for this household?

¹  Yes YES  SKIP TO S9

²  NoNO  (ASK S4)

⁷⁷  DON’T KNOW  (ASK S4)

⁹⁹  REFUSED  (ASK S4)

S4. These next questions are about the person who usually handles the mail. Is that person male or female?

¹  MaleMALE

²  FemaleFEMALE

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

S5. Is (he/she) of Hispanic or Latino origin?

¹  Yes YES  (Ask S5A)

²  No NO  (SKIP TO S6)

⁷⁷  DON’T KNOW  (SKIP TO S6)

⁹⁹  REFUSED  (SKIP TO S6)

S5a. Is (he/she)…

¹  Mexican, Mexican American, Chicano;  SKIP TO S6

²  Puerto Rican;  SKIP TO S6

³  Cuban;  SKIP TO S6

⁴  or of another Hispanic, Latino, or Spanish origin; for example, Argentinean,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on?  (ASK S5B)

⁵  DO NOT READ: HISPANIC ORIGIN NOT SPECIFIED  SKIP TO S6

⁷⁷  DON’T KNOW  SKIP TO S6

⁹⁹  REFUSED  SKIP TO S6

S5b. What is that origin? (For example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

S6. Please choose one or more of the following races that this person considers him/herself to be. (CODE ALL THAT APPLY)

¹  White

²  Black or African American

³  Asian

⁴  Native Hawaiian or other Pacific Islander

⁵  American Indian or Alaska Native

⁶  DO NOT READ: OTHER

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S6=1 OR 2, SKIP TO INSTRUCTION BEFORE S7. ELSE SKIP TO INSTRUCTIONS ABOVE S6A.*/

/*SKIP INSTRUCTION: IF S6=3 THEN ASK S6A. ELSE SKIP TO INSTRUCTION ABOVE S6B*/

S6a. Is (he/she)…

¹  Asian Indian

²  Chinese

³  Filipino

⁴  Japanese

⁵  Korean

⁶  Vietnamese

⁷  Or another Asian group, for example, Hmong, Laotian, Thai, Pakistani,
Cambodian, and so on?  (ASK S6A1)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IS S6A=7 ASK S6A1. ELSE SKIP TO INSTRUCTION ABOVE S6B*/

S6A1. What is the other Asian group? (For example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S6=4, THEN ASK S6B. ELSE SKIP TO INSTRUCTION ABOVE S6C.*/

S6b. Is (he/she) …

¹  Native Hawaiian

²  Guamanian or Chamorro

³  Samoan

⁴  Oor another pacific Island group, for example, Fijian, Tongan,
and so on  (ASK S6b1)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S6B=4 THEN ASK S6B1. ELSE SKIP TO INSTRUCTION ABOVE S6C.*/

S6b1. What is that other Pacific Islander group?
(For example, Fijian, Tongan, and so on)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S6=5 ASK S6C. ELSE SKIP TO INSTRUCTION ABOVE S6D*/

S6C. What is his/her enrolled or principal tribe?

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S6=6 ASK S6D. ELSE SKIP TO INSTRUCTION ABOVE S7*/

S6D. What is his/her other race group?

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IS THIS HOUSEHOLD ELIGIBLE FOR INCLUSION IN THE STUDY BASED ON SAMPLING CRITERIA? IF YES, ASK S8. ELSE, READ S7.*/

S7. Thank you for speaking with me today, those are all of the questions that I have for you. TERMINATE INTERVIEW.

S8. May I speak with that person now?

¹  SELECTED RESPONDENT AVAILABLE  SKIP TO Q1.

²  SELECTED RESPONDENT UNAVAILABLE, ASK S8A.

⁷⁷  DON’T KNOW  ASK S8A

⁹⁹  REFUSED  ASK S8A

S8A. May I have the first name of that person so I can ask for them
directly when I get back in touch?

⁷⁷  DON’T KNOW  ASK S8B

⁹⁹  REFUSED ASK S8B

S8B.  Does he/she live at (ADDRESS)?

¹  YES  (APPOINTMENT)

²  NO  (TERMINATE)

⁷⁷  DON’T KNOW (APPOINTMENT)

⁹⁹  REFUSED (APPOINTMENT)

CALLBACK TO INITIATE INTERVIEW WITH APPROPRIATE RESPONDENT, STARTING INTERVIEW AT Q1.

S9. CODE RESPONDENT SEX.

ASK IF NEEDED: I am required to ask if you are male or female.

¹  MaleMALE

²  FemaleFEMALE

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

S10. Are you of Hispanic or Latino origin?

¹  Yes YES  (ASK S10A)

²  No NO  (ASK S11)

⁷⁷  DON’T KNOW  (ASK S11)

⁹⁹  REFUSED (ASK S11)

S10a. Are you…

¹  Mexican, Mexican American, Chicano;  SKIP TO S11

²  Puerto Rican;  SKIP TO S11

³  Cuban;  SKIP TO S11

⁴  of another Hispanic, Latino, or Spanish origin; for example, Argentinean,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on?
 (ASK S10B)

⁵  DO NOT READ: HISPANIC ORIGIN NOT SPECIFIED  SKIP TO S11

⁷⁷  DON’T KNOW  SKIP TO S11

⁹⁹  REFUSED (ASK S11)SKIP TO S11

S10b. What is that origin? (For example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

S11. Please choose one or more of the following races that you consider yourself to be.
(CODE ALL THAT APPLY)

¹  White

²  Black or African American

³  Asian

⁴  Native Hawaiian or other Pacific Islander

⁵  American Indian or Alaska Native

⁶  OTHER

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S11=1 OR 2, THEN ASK Q1. ELSE SKIP TO INSTRUCTION ABOVE S11A*/

/*SKIP INSTRUCTION: IF S11=3 THEN ASK S11A. ELSE SKIP TO INSTRUCTION ABOVE S11B*/

S11a. Are you

¹  Asian Indian

²  Chinese

³  Filipino

⁴  Japanese

⁵  Korean

⁶  Vietnamese

⁷  Or another Asian group, for example, Hmong, Laotian, Thai, Pakistani,
Cambodian, and so on?  (ASK S11A1)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IS S11A=7 ASK S11A1. ELSE SKIP TO INSTRUCTION ABOVE S11B*/

S11A1. What is the other Asian group? (For example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S11=4, THEN ASK S11B. ELSE SKIP TO INSTRUCTION ABOVE S11C.*/

S11b. Are you…

¹  Native Hawaiian

²  Guamanian or Chamorro

³  Samoan

⁴  Oor another Pacific Island group, for example, Fijian, Tongan, and so on  (ASK s11b1)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S11B=4 THEN ASK S11B1. ELSE SKIP TO INSTRUCTION ABOVE S11C.*/

s11b1. What is that other Pacific Islander group? (For example, Fijian, Tongan,
and so on)

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S11=5 ASK S11C. ELSE SKIP TO INSTRUCTION ABOVE S11D*/

S11C. What is your enrolled or principal tribe?

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF S11=6 ASK S11D. ELSE SKIP TO Q1*/

S11D. What is your other race group?

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

WAVE 1 QUESTIONNAIRE (estimated fielding date: Summer/Fall 2009)

We expect the rest of this interview to take 25 minutes. Your answers will help improve government programs and how people living in the U.S. learn about those programs. You may choose not to answer any question for any reason. You do not have to reveal any specific information about your own experiences unless you choose to do so. You may stop participating at any time, and there are no consequences for you if you choose to stop.

This survey has been approved by U.S. Office of Management and Budget approval number XXXXXX. Without this number, we could not conduct this survey. If you have comments about the survey, you may send them to an address I will provide at the conclusion.

Shall we start?

1. I am going to read you a list of activities. Please tell me whether or not you participated in the activity in the last 12 months. [IF NEEDED: by participation, I mean attending meetings, volunteering your time for regular activities, or working at sponsored events.]	2. How often did you participate in this type of activity in the past year? [IF MORE THAN ONE TYPE OF ACTIVITY IS MENTIONED, ASK: Thinking about all activities of this type, about how often did you participate in them in the past year?]
1a. In the last 12 months —that is since [MONTH] of last year—have you attended any meetings or events of a school group, neighborhood, or community association such as PTA or neighborhood watch group? 1  YES  ask Q2 2  NO 77 DON’T KNOW 99 REFUSED	1  Once a year 2  Several times a year 3  Once a month 4  Several times a month 5  Once a week 6  neverNEVER 77  DON’T KNOW 99  REFUSED
1b. How about a community service organization such as a food pantry or a tutoring program? 1  YES  ask Q2 2  NO 77 DON’T KNOW 99 REFUSED	1  Once a year 2  Several times a year 3  Once a month 4  Several times a month 5  Once a week 6  NEVER 77  DON’T KNOW 99  REFUSED 6  never
1c. In the last 12 months have you attended services or any other events at a church, synagogue, mosque or other religious institution or organization? 1  YES  ask Q2 2  NO 77 DON’T KNOW 99 REFUSED	1  Once a year 2  Several times a year 3  Once a month 4  Several times a month 5  Once a week 6  NEVER 77  DON’T KNOW 99  REFUSED 6  never
1d. Is there any other type of activity that you have attended meetings for or worked at sponsored events for that I have not mentioned? Please count any type of volunteering work you did. 1  YES  ask Q2 2  NO 77 DON’T KNOW 99 REFUSED	1  Once a year 2  Several times a year 3  Once a month 4  Several times a month 5  Once a week 6  NEVER 77  DON’T KNOW 99  REFUSED 6  never
1e. Have you given blood in the last 12 months? 1  YES 2  NO 77 DON’T KNOW 99 REFUSED

3. Would you say that you vote in elections always, almost always, usually, seldom or never?

¹⁵  ALWAYS

²⁴  ALMOST ALWAYS

³³  USUALLY

⁴²  SELDOM

⁵¹  NEVER

⁶  DO NOT READ: R NOT ELIGIBLE TO VOTE

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

.

		READ LIST. RECORD ONE ANSWER FOR EACH ITEM.
	I’m going to read you two statements that people might make about where they live.	Strongly agree	Agree	Disagree	Strongly disagree	[do not read] NEITHER / NO OPINION
3a.	The first statement is, “I know many of my neighbors.” Do you strongly agree, agree, disagree or strongly disagree with this statement?	14 	23 	32 	41 	97 
3b.	The next statement is, “If I had to move away from my neighborhood, I would miss it.” [IF NEEDED: Would you say you strongly agree, agree, disagree or strongly disagree with this statement?]	14 	23 	32 	41 	97 

4. Next I would like to ask you about three government programs.

4A. (Have you ever heard of ) The Medicare Part D prescription drug benefit?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

4B. (Have you ever heard of ) The No Child Left Behind Act?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

4C. (Have you ever heard of ) The Census?

¹  YES  (SKIP TO INSTRUCTION ABOVE Q6)

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

5. The Census is the count of all the people who live in the United States. Have you ever heard of that before?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF Q5 NOT EQUAL 1, SKIP TO Q28.*/

/*SKIP INSTRUCTION: IF Q4A=1, ASK Q6. ELSE, SKIP TO INSTRUCTION ABOVE Q7.*/

6. Have you heard or seen anything recently about the Medicare part D prescription drug benefit?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF Q4B=1, ASK Q7. ELSE, SKIP TO INSTRUCTION ABOVE Q8.*/

7. Have you heard or seen anything recently about the No Child Left Behind Act?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF Q4C=1 OR Q5=1, ASK Q8. ELSE, SKIP TO INSTRUCTION ABOVE Q9.*/

8. Have you heard or seen anything recently about the 2010 Census?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF Q5 NOT EQUAL 1 AND Q8=2 THEN SKIP TO Q287*/

9. If the Census were held today, how likely would you be to participate? By participate, we mean fill out and mail in a Census form. Would you say you…?

¹⁵  Ddefinitely would

²⁴  Pprobably would

³³  Mmight or might not

⁴²  Pprobably would not

⁵¹  Ddefinitely would not

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

10. What about most of your friends and neighbors? If the Census were held today, how likely do you think they would be to participate? By participate, we mean fill out and mail in a Census form. Would you say they …?

¹⁵  definitely would

²⁴  probably would

³³  might or might not

⁴²  probably would not

⁵¹  definitely would not

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

⁵  Definitely would

⁴  Probably would

³  Might or might not

²  Probably would not

¹  Definitely would not

11. How likely are you to recommend participating in the Census to a family member or friend? Would you say you…?

¹⁵  Ddefinitely will

²⁴  Pprobably will

³³  Mmight or might not

⁴²  Pprobably will not

⁵¹  Ddefinitely will not

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF QS2=1 THEN SKIP TO Q12*/

11a. Is there someone else in your household who disagrees with you about whether or not your household should complete and return a census form?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

112. Overall, how would you describe your general feelings about the Census? Do you feel…?

¹⁵  Hhighly favorable

²⁴  Mmoderately favorable

³³  Nneutral

⁴²  Nnot too favorable

⁵¹  Rrather unfavorable

⁷⁷  DON’T KNOW  SKIP TO 13

⁹⁹  REFUSED  SKIP TO 13

12A. How sure are you that you are [INSERT RESPONSE FROM 12 HERE] about the census? Would you say very sure, somewhat sure, somewhat unsure, or very unsure?

¹  VERY SURE

²  SOMEWHAT SURE

³  SOMEWHAT UNSURE

⁴  VERY UNSURE

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

13. In general, how familiar are you with the way Census data impacts you and your community.
Would you say…?

¹⁴  Vvery familiar

²³  Ssomewhat familiar

³²  Nnot very familiar

⁴¹  Nnot familiar at all

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

14. So far as you know, does the law require you to answer the census questions?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

15. People have different ideas about what the Census is used for. I am going to read some of them to you. As I read each one, please tell me by indicating yes or no whether you think that the Census is used for that purpose. Is the Census used…?

		YES	NO	DK	REF
a.	Tto decide how much money communities will get from the government?	1	2	77	99
b.	Tto decide how many representatives each state will have in Congress?	1	2	77	99
c.	Tto count both citizens and non-citizens?	1	2	77	99
d.	Tto determine property taxes?	1	2	77	99
e.	Tto help the police and FBI keep track of people who break the law?	1	2	77	99
f.	Tto help businesses and governments plan for the future?	1	2	77	99
g.	Tto locate people living in the country illegally?	1	2	77	99

16. Next, I’m going to read some opinions about the Census. As I read each one, tell me if you strongly agree, agree, disagree, or strongly disagree with each of the statements:	Strongly agree	Agree	Disagree	Strongly disagree		DO NOT READ: NEITHER AGREE NOR DISAGREE /DON’T KNOW
16A. Filling out the Census will let the government know what my community needs. Do you strongly agree, agree, disagree, or strongly disagree with this statement?	14	23	32	41		97
16B. The Census is an invasion of privacy. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32	41		97
16C. The Census Bureau’s promise of confidentiality can be trusted. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32	41		97
16D. I am concerned that the information I provide will be misused. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32		41	97
16E. Taking part in the Census shows I am proud of who I am. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32		41	97
16F. My answers to the Census could be used against me. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32		41	97
16G. Answering and sending back the Census matters for my family and community. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32		41	97
16H. The government already has my personal information, like my tax returns, so I don’t need to fill out a Census form. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32		41	97
16I. I just don’t see that it matters much if I personally fill out the Census form or not. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32		41	97
16J. It takes too long to fill out the Census information, I don’t have time. (IF NEEDED: Do you strongly agree, agree, disagree, or strongly disagree with this statement?)	14	23	32		41	97

/*SKIP INSTRUCTION: IF Q8 NOT EQUAL 1 THEN SKIP TO Q28*/

These next questions are about the Census to be held in 2010 and what you may have heard or seen about it.

First I will ask you about advertisements you might have heard or seen in the media. Then I’ll ask you about places in your community you might have heard or seen something about the Census. After that, I will ask you about other stories or features you might have heard or seen about the Census.

PAID MEDIA CENSUS EXPOSURE (17 to 19H)

Let us start with advertisements you might have heard or seen in the media.

17. Have you heard or seen advertisements about the Census..

a. on television?	1 YES	2 NO	77 DK	99REF
b. on the radio?	1 YES	2 NO	77 DK	99REF
c. in magazines?	1 YES	2 NO	77 DK	99REF
d. in newspapers?	1 YES	2 NO	77 DK	99REF
e. on the Internet?	1 YES	2 NO	77 DK	99REF
f. in other places such as coffee cups, billboards or park benches?	1 YES	2 NO	77 DK	99REF

/*IF YES TO AT LEAST ONE MEDIUM IN 17A-F, ASK 18. ELSE SKIP TO 19*/

18. Thinking about all of the advertisements you heard or saw in the past 30 days about the Census, how many different times in the past 30 days would you say you saw or heard something about the Census?

¹⁰  nNone

¹²  oOnce or twice

²³  tThree to five times

³⁴  sSix to 10 times

⁴⁵  eEleven or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

PAID MEDIA MESSAGING

/* IN WAVE 1, THERE WILL BE A SINGLE ‘AD’ ASKED ABOUT, A ‘FALSE’ AD THAT WILL CAPTURE ALLEGED REPORTS OF EXPOSURE TO AN AD THAT HAS NOT IN FACT RUN. IN WAVES 2 AND 3, THE SAME SET OF QUESTIONS WILL BE ASKED ABOUT THE INITIAL FALSE AD, AS WELL AS 2 OR 3 TRUE ADS. THESE ITEMS WILL BE SPECIFIED ONCE EXECUTIONS HAVE BEEN FINALIZED BY DRAFTFCB.*/

19A. Have you recently seen an advertisement that showed various film and music celebrities filling out their Census form or going to mail it in?

¹  YES

²  MAYBE, NOT SURE

³  NO  [SKIP TO PARTNERSHIP MESSAGING ITEM 20]

⁹⁹ REFUSED  [SKIP TO PARTNERSHIP MESSAGING ITEM 20]]

19B. What happens in this ad? (DO NOT READ RESPONSE CATEGORIES AND CODE ALL THAT ARE MENTIONED.)

¹  SPECIFIC CELEBRITIES MENTIONED

²  SPECIFIC SLOGAN OR MESSAGE MENTIONED

³  SPECIFIC ACTION MENTIONED (COMPLETING FORM, WALKING TO MAILBOX, ETC.)

⁴  SPECIFIC SONG, LOCATION, OR VISUAL IMAGE MENTIONED

⁵  OTHER SPECIFICS MENTIONED

⁶  NO SPECIFICS MENTIONED, GENERAL COMMENTS ONLY

7 Other, specify:

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

19C. During the past 30 days, how often have you seen this advertisement? Would you say…

⁰¹  nonenever

¹²  once or twice

²³  three to five times

³⁴  six to 10 ten times

⁴  eleven or more times

⁷⁷ DON’T KNOW

⁹⁹ REFUSED

⁴ eleven or more

19D. Where did you see this ad? (CODE ALL THAT APPLY)

¹  TELEVISION

²  RADIO

³  MAGAZINES

⁴  NEWSPAPERS

⁵  INTERNET

⁶  OTHER PLACES SUCH AS COFFEE CUPS, BILLBOARDS, PARK BENCHES

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

19E. Tell me how much you agree or disagree with the following statement: This ad is convincing. Would you say you strongly agree, agree, disagree, or strongly disagree?

¹  STRONGLY AGREE

²  AGREE

³  DISAGREE

⁴  STRONGLY DISAGREE

⁵  DO NOT READ: NEITHER AGREE NOR DISAGREE

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

19F. Would you say the ad grabbed your attention?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

19G. Would you say the ad gave you good reasons to mail back your Census form?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

19H. Did you talk to your friends, family, or other people you know about this ad?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

T19I. As I read each of the following statements about the Census 2010 ad campaign, tell me if you strongly agree, agree, disagree, or strongly disagree with them.

19i_a: The Census 2010 ad campaign is about civic participation. [Do you…]

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19i_b: [Again, thinking about the Census 2010 ad campaign…]

The campaign is about gathering important information for our country. [Do you…]

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19i_c. [Again, thinking about the Census 2010 ad campaign…]

The campaign is about helping people in my community. [Do you…]

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19i_d. [Again, thinking about the Census 2010 ad campaign…]

The campaign is about making sure everyone like me is counted in the Census. [Do you…]

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19i_e. What else do you think the Census 2010 ad campaign is about?

19J. As I read each of the following statements about the Census 2010 ad campaign, tell me if you strongly agree, agree, disagree, or strongly disagree with them.

19j_a. When I think of the Census 2010 ad campaign, I think returning the Census form is the right thing to do. [Do you…]

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19j_b. When I think of the campaign, I think people in my community are all returning the Census form.

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19j_c. When I think of the campaign, I think the Census is about people like me.

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19j_d. When I think of the campaign, I think the Census is trying to improve the lives of people in my community.

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19j_e. When you think of the Census 2010 ad campaign, what else do you think?

19K. For the next series of questions, please tell me whether you agree or disagree with each statement. As I read each one, tell me if you strongly agree, agree, disagree, or strongly disagree with each of the statements:

(RANDOMIZE ORDER OF 19K_1 AND 19K_2)

19K_1. I’d show my support for the Census by wearing a Census button or t-shirt. Would you say you:

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19K_2. The Census 2010 ad campaign is meant for people just like me. Would you say you:

1.  Strongly agree

2.  Agree

3.  Disagree

4.  Strongly Disagree

5.  NEITHER AGREE NOR DISAGREE/NEUTRAL

77.  DON’T KNOW

99  REFUSED

19I. As I read each of the following statements, tell me if you strongly agree, agree, disagree, strongly disagree with them: Do you think [FILL IN MEMORABLE NAME OR PHRASE TO DESCRIBE CENSUS CAMPAIGN] is about:

/*IF R VOLUNTEERS “DON’T KNOW,” OR “NEVER HEARD ABOUT IT,” SKIP TO Q20. ELSE GO TO Q19J.*/

19J. As I read each of the following statements, tell me if you strongly agree, agree, disagree, strongly disagree with them: When you think of the [FILL IN MEMORABLE NAME OR PHRASE TO DESCRIBE CENSUS CAMPAIGN] you think:

[sub-items are based on messaging of final DFCB executions, but might include items such as: Returning the Census form is the right thing to do, People in my community are all returning the Census form, This Census is about people like me, The Census is trying to improve lives of people in my community, Other (specify)]

19K. For the next series of questions, please tell me whether you agree or disagree with each statement. As I read each one, tell me if you strongly agree, agree, disagree, strongly disagree with each of the statements:

PARTNERSHIP MESSAGING (20-2-2772F)

These next questions are about places in your community where you may have heard or seen something about the Census.

20. Have you heard or seen anything about the Census…

a. in a meeting of a religious group?	1 YES	2 NO	77 DK	99REF
b. at an activity of a community organization?	1 YES	2 NO	77 DK	99REF
c. at a meeting or gathering held by a tribal, state or local government?	1 YES	2 NO	77 DK	99REF
d. at a speech made by a local leader?	1 YES	2 NO	77 DK	99REF
e. at a local event like a festival or fair?	1 YES	2 NO	77 DK	99REF
f. on a sign, poster or meeting exhibit?	1 YES	2 NO	77 DK	99REF
g. in a paystub or utility bill insert?	1 YES	2 NO	77 DK	99REF

/*IF YES TO AT LEAST ONE MEDIUM IN 20, ASK 21a. ELSE GO TO 21b.*/

21a. Thinking about all of the places in your community we’ve just talked about, how many different times during the past 30 days would you say you heard or saw something about the census from any of those sources?

⁰¹  nNone

¹²  oOnce or twice

²³  tThree to five times

³⁴  sSix to 10 ten times

⁴⁵  eEleven or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

21b. During the past 30 days, about how many different times would you say you had conversations about the Census with friends, family, or other people you know, for example at home, at work, or at the barbershop?

⁰¹  nNone

¹²  oOnce or twice

²³  tThree to five times

³⁴  sSix to 10 ten times

⁴⁵  eEleven or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

21c. During the past 30 days, how many different times would you say you saw someone with a personal item about the Census -- like a baseball cap, bumper sticker or pen?

⁰¹  nNone

¹²  oOnce or twice

²³  tThree to five times

³⁴  sSix to 10 ten times

⁴⁵  eEleven or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF R TALKED WITH SOMEONE IN THE COMMUNITY (21b>0), ASK 22a. ELSE SKIP TO NEXT SKIP INSTRUCTION.*/

/*SKIP INSTRUCTION: IF R REPORTS EXPOSURE TO PARTNERSHIP ACTIVITIES FOR AT LEAST ONE CATEGORY (YES TO 20a THROUGH 20g), ASK Q22. ELSE, SKIP TO Q22D.*/

22. Have you spoken to or heard someone in your community talk about the Census?

¹  YES (ASK 22A)

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

IF NOT YES, SKIP TO 22D.

22A. Who in your community have you spoken to or heard talk about the Census? DO NOT READ CATEGORIES EXCEPT TO PROBE.

RECORD VERBATIM: __________________________

THEN CODE ALL THAT APPLY.

¹  Government official

²  Religious leader

³  Someone from my union or workplace

⁴  Someone from a community organization

⁵  A friend, relative or neighbor

⁶  Other

⁷  DON’T RECALL/DIDN’T KNOW THEM

⁹⁹  REFUSED

22B. Would you say the messages you’ve heard in your community about the Census changed some of what you believe about the Census?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

22B1. Would you say the messages in your community about the Census changed some of what your friends and family believe about the Census?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

22C. Would you say the messages you’ve heard in your community about the Census gave you good reasons to complete and mail back a Census form?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

CENSUS IN SCHOOLS EXPOSURE

22D. Do you have children in your household who attend Kindergarten through 12^th grade in public, private or tribal school?

¹  YES (ASK 22E)

²  NO (ASK 24)

⁷⁷  DON’T KNOW (ASK 24)

⁹⁹  REFUSED (ASK 24)

22E. Did the student(s) tell you anything about the 2010 Census?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

22F. Did the student (s) show you printed materials or information about the 2010 Census?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

/*SKIP INSTRUCTION: IF Q22E=1 OR Q22F=1, ASK Q22G. ELSE SKIP TO Q24*/

22G. Thinking about all of the ways the students told you or showed you something about the Census during the past 30 days, how many different times in the past 30 days would you say they told you or showed you something about the Census?

⁰¹  nNone

¹²  oOnce or twice

²³  tThree to five times

³⁴  sSix to 10 ten times

⁴⁵  eEleven or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

23. QUESTION OMITTED.

EARNED MEDIA CENSUS EXPOSURE (24-2-2775)

These next questions are about stories or features in newspapers, magazines, television, radio or internet you may have heard or seen about the Census.

24. Not including advertisements, have you heard or seen any stories or features about the Census…

a. in a newspaper or magazine article?	1 YES	2 NO	77 DK	99REF
b. on television or radio?	1 YES	2 NO	77 DK	99REF
c. on the internet?	1 YES	2 NO	77 DK	99REF

/*IF YES TO 24C, ASK 24d-f, ELSE SKIP TO INSTRUCTION ABOVE 25*/

24. On the internet, did you hear or see anything about the Census on…

d. internet blogs?	1 YES	2 NO	77 DK	99REF
e. social networking sites (e.g., Facebook, Myspace)?	1 YES	2 NO	77 DK	99REF
f. regular web sites?	1 YES	2 NO	77 DK	99REF

/*IF YES TO AT LEAST ONE MEDIUM IN 24A-C, ASK 25. ELSE SKIP TO 26A*/

25. Thinking about all of the places you heard or saw stories or features about the Census in the past 30 days, how many different times in the past 30 days would you say you heard or saw something about the Census?

⁰¹  nNone

¹²  oOnce or twice

²³  tThree to five times

³⁴  sSix to 10 ten times

⁴⁵  eEleven or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

26A. Did you hear or see anything about the Census in Census job announcements?

¹  YesYES

²  NoNO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

26b. Thinking about all the possible sources we have just talked about, including advertisements, places in your community, and other media, how many different times during the past 30 days would you say you saw or heard something about the Census?

⁰¹  nNone

¹²  oOnce or twice

²³  tThree to five times

³⁴  sSix to 10 ten times

⁴⁵  eEleven or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

26c. Again thinking about all the possible sources we have talked about, what specific groups, people, or sources of information would you say you rely on the most to learn about the Census?

RECORD VERBATIM THEN CODE: _________________________________

⁰¹  FAMILY MEMBER OR OTHER PERSONAL ACQUAINTANCE

¹²  CLERGY MEMBER, ETHNIC GROUP LEADER, OTHER CIVIC LEADER

²³  TELEVISION SOURCE (E.G., NEWS, CHANNEL, OR OTHER SHOW)

³⁴  INTERNET SOURCE (E.G., BLOGS, ON-LINE NEWSPAPER, LISTSERV, ETC.)

⁴⁵  OTHER MEDIA SOURCE (E.G., NEWSPAPER, RADIO, MAGAZINES)

⁵⁶  OTHER SOURCE

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

26d. Have you heard or seen anything about the Census in a language other than English?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

<MODE SPECIFIC CUEING ITEMS – THESE ITEMS APPEAR ONLY IN WAVES 2 AND 3>

27. QUESTION OMITTED

27A. QUESTION OMITTED

27B. QUESTION OMITTED

27C. QUESTION OMITTED

<End MODE SPECIFIC CUEING ITEMS>

GENERAL MEDIA USE

Now I have a few questions about how you spend your time in a typical seven day week.

28A. How many hours per week do you usually spend working for pay?

Number of hours

IF R UNABLE TO PROVIDE NUMBER, CODE INTO CATEGORIES:

¹  NONE

²  ONE TO NINETEEN HOURS

³  TWENTY TO THIRTY-NINE HOURS

⁴  FORTY AND MORE HOURS

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

28B. During a typical day, about how many hours do you usually spend watching television, including hours when you are doing something else at the same time?

Number of hours

IF R UNABLE TO PROVIDE NUMBER, CODE INTO CATEGORIES:

¹  NONE

²  LESS THAN THREE HOURS

³  THREE HOURS OR MORE

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

29. During a typical 7-day week, how many hours do you usually spend listening to the radio, either at home, in your car, through the internet, or elsewhere?

Number of hours

IF R UNABLE TO PROVIDE NUMBER, CODE INTO CATEGORIES:

¹  NONE

²  ONE TO NINETEEN HOURS

³  TWENTY OR MORE HOURS

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

30. About how many hours in a typical 7 day week do you usually spend reading newspapers or magazines?

Number of hours

IF R UNABLE TO PROVIDE NUMBER, CODE INTO CATEGORIES:

¹  NONE

²  ONE TO TWO HOURS

³  THREE OR MORE HOURS

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

31. About how many hours in a typical 7 day week do you spend using social networking tools such as instant messaging, Facebook or Myspace?

Number of hours

IF R UNABLE TO PROVIDE NUMBER, CODE INTO CATEGORIES:

¹  NONE

²  ONE TO TWENTY HOURS

³  MORE THAN TWENTY HOURS

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

32. About how many hours in a typical 7 day week do you spend on the Internet doing other things such as checking email, looking for information, shopping or reading, writing or commenting on blogs?

Number of hours

IF R UNABLE TO PROVIDE NUMBER, CODE INTO CATEGORIES:

¹  NONE

²  ONE TO TWENTY HOURS

³  MORE THAN TWENTY HOURS

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

32B In a typical week, do you spend any time reading newspapers or newsletters produced locally by an ethnic or religious group?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

DEMOGRAPHICS

I just have a few questions left about you and your household.

33. Which of the following best describes your age?

¹  18 to 29

²  30 to 44

³  45 to 64

⁴  65 or older

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

34. How long have you lived at your current address?

READ LIST IF NECESSARY. RECORD ONE ANSWER.

¹  Less than 1 year

²  1-3 years

³  4-7 years

⁴  8-10 years

⁵  More than 10 years but not whole life

⁶  All of my life

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

35. What is the highest grade or year of regular school you have completed?

¹  Less than high school

²  Some high school, no diploma

³  High school diploma

⁴  Some college, no diploma

⁵  College degree

⁶  Graduate or professional studies after college

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

36. In the past six months, have you attended a class in an adult education program, including one in a college or university?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

37. Were you born in the United States?

¹  YES

²  NO

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

38. What is your marital status?

¹  Now married

²  Widowed

³  Divorced

⁴  Separated

⁵  Never married

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

39. Do you rent or own your home?

¹  RENT

²  OWN

³  OTHER

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

40. What language is usually spoken in this household?

⁰¹  ENGLISH

¹²  ARABIC

²³  CANTONESE

³⁴  FRENCH CREOLE

⁴⁵  HINDI

⁵⁶  JAPANESE

⁶⁷  KHMER

⁷⁸  KOREAN

⁸⁹  MANDARIN

⁹¹⁰  POLISH

¹⁰¹¹  RUSSIAN

¹¹¹²  SPANISH

¹²¹³  TAGALOG

¹³¹⁴  VIETNAMESE

¹⁴¹⁵  OTHER (SPECIFY) _____________________

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

41. I am going to read you a list of income categories. Please stop me when I reach the category that best describes the combined annual income of all members of this household in the last calendar year, including wages or salary, pensions, interest or dividends, and all other sources before taxes and other deductions?

¹  Less than $25,000

²  $25,000 to $59,999

³  $60,000 to $119,999

⁴  $120,000 or more

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

CONTACT INFORMATION

42. I have your street address as {ADDRESS}. Is that correct?

¹  YES  (ASK 43)

²  NO  (ASK 42A)

⁷⁷  DON’T KNOW (ASK 42A)

⁹⁹  REFUSED (ASK 42A)

42A. What is your correct street address?

Street

City

State

Zip

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

43. Thank you very much; you’ve given us some valuable information today. We will be recontacting some participants in this survey to make sure that we collected our data properly and to follow-up on some of the questions that we discussed today. May we contact you in the future?

¹  YES  (ASK 44)

²  NO  (ASK43a)

⁷⁷  DON’T KNOW (ASK43a)

⁹⁹  REFUSED (ASK43a)

43A. You always have the right in the future to refuse to speak to us further, or to receive additional information about the value of participating in this study. May I record your contact information so that we may approach you in the future?

¹  YES  (ASK 44)

²  NO  (END)

⁷⁷  DON’T KNOW  (END)

⁹⁹  REFUSED  (END)

44. Please tell me your full name.

First

Last

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

45. What is the best telephone number for us to reach you?

Telephone

(

)

―

⁷⁷  DON’T KNOW  (SKIP TO 46)

⁹⁹  REFUSED  (SKIP TO 46

45A. Is this a home phone, a cell phone, a phone at your workplace, or another type of phone?

¹  HOME

²  CELL/MOBILE

³  WORKPLACE

⁴  OTHER

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

46. Is there another telephone number where we may try to reach you?

Telephone

(

)

―

⁷⁷  DON’T KNOW  (SKIP TO 47)

⁹⁹  REFUSED  (SKIP TO 47)

46A. Is this a home phone, a cell phone, a phone at your workplace, or another type of phone?

¹  HOME

²  CELL/MOBILE

³  WORKPLACE

⁴  OTHER

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

47. Do you have an e-mail address where we may try to reach you?

@

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

48 Please tell me about someone who will always know how to find you. What is that person’s name?

First

Last

⁷⁷  DON’T KNOW  (SKIP TO END)

⁹⁹  REFUSED  (SKIP TO END)

48a. Please tell me two ways that we may try to reach that person if we are unable to contact you, for example, a telephone number, an e-mail address, or a mailing address.

Telephone

(

)

―

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

Email

@

Street

City

State

Zip

⁷⁷  DON’T KNOW

⁹⁹  REFUSED

END. Those are all of the questions I have for you today. Thank you very much for speaking with me.

Do you want the address where you can provide comments on this survey? IF NEEDED: Send comments regarding this burden estimate or any other aspect of this collection of information to: Paperwork Project 0607-0947, U.S. Census Bureau, 4600 Silver Hill Road, Room 3K138, Washington, DC 20233. You may e-mail comments to Paperwork@census.gov; use "Paperwork Project xxxxxxx" as the subject.

SCREENER AND WAVE 1 QUESTIONNAIRE 8