Cai_v1

Attachment O CAI_V1_Group 1 and 2.docx

Generic Clearance for Questionnaire Pretesting Research

CAI_V1

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Attachment O: Version 1, Group 1 & 2 Questions - Latest Revision 04/22/16







American Community Survey

Cognitive Test

Interviewer-administered Survey




Version 1, Group 1 & 2



March 28, 2016



Participant ID #: |___|___|___|___|___|___|___|___|___|___|


HOUSING QUESTIONS (CONTAINS YEAR BUILT AND COMPUTER/INTERNET/TELEPHONE MODULES)

1a. Now I am going to ask about this place…

Which best describes this building? Is it a mobile home, single family house, building with two or more apartments, boat, RV or van?

SELF-PROPELLING RVS OR MOTORHOMES SHOULD BE INCLUDED IN THE CATEGORY “BOAT, RV, VAN, ETC.” TOWABLE RVS, SUCH AS TRAVEL TRAILERS OR FIFTH-WHEEL TRAILERS, SHOULD BE INCLUDED IN THE CATEGORY “MOBILE HOME.”



A mobile home Go to 2a

Single-family house Go to 1b

Building with 2 or more apartments Go to 1c

Boat, RV, van, etc. Go to 2a



1b. Is that a detached house, or is it attached to other houses?



Detached Go to 2a

Attached Go to 2a



1c. How many apartments are there in this building?






(YEAR BUILT: 2a – 2b)

*2a. About when was this <house/apartment/mobile home > first built?


Was it first built in 2010 or later, between 2000 and 2009, between 1980 and 1999, between 1960 and 1979, between 1940 and 1959, or 1939 or earlier?


2010 or later Go to 2b

2000 – 2009 Go to 3

1980 – 1999 Go to 3

1960 – 1979 Go to 3

1940 – 1959 Go to 3

1939 or earlier Go to 3


2b. In what year was that?


ENTER SPECIFIC YEAR <HOUSE/APARTMENT/MOBILE HOME > WAS BUILT IF 2010 OR LATER.




 Year



3. In what year did (you/householder) move into this <house/apartment/mobile home/unit >?







INSTRUCTION A

IF HOUSE OR MOBILE HOME, GO TO QUESTION 6B.

OTHERWISE, GO TO QUESTION 6A.




6a. Is this an efficiency or studio apartment?


Yes Go to 7a

No Go to 6b




6b. The next questions are about the number and kinds of rooms at this place. Rooms must be separated by built-in archways or walls that extend out at least 6 inches and go from floor to ceiling.

How many separate rooms are in this <house/apartment/mobile home/unit > not counting bathrooms, porches, balconies, foyers, halls or unfinished basements?

INCLUDE BEDROOMS, KITCHENS, ETC.









6c. Did you include bedrooms?


Yes Go to 6d

No Go to 6e




6d. How many of the <number of rooms from question 6b> rooms would you list as bedrooms if this <house/apartment/mobile home/unit > were for sale or rent?



ENTER NUMBER OF BEDROOMS





 Go to 7a



6e. How many rooms would you list as bedrooms if this <house/apartment/mobile home/unit > were for sale or rent?



ENTER NUMBER OF BEDROOMS








7a. Does this <house/apartment/mobile home/unit > have hot and cold running water?





Yes

No




7b. Does this <house/apartment/mobile home/unit > have a bathtub or shower?





Yes

No




7c. Does this <house/apartment/mobile home/unit > have a sink with a faucet?



Yes

No




7d. Does this <house/apartment/mobile home/unit > have a stove or range?



Yes

No




7e. Does this <house/apartment/mobile home/unit > have a refrigerator?





Yes

No


(COMPUTER AND INTERNET: 8a – 10f)

*8a. At this <house/apartment/mobile home/unit>, do you or any member of this household own or use a desktop, laptop, or a tablet?



Yes

No



*8b. At this <house/apartment/mobile home/unit>, do you or any member of this household own or use a smartphone?



Yes Go to 9

No Go to 10a




*9. Do any of the smartphones owned or used by you or any member of this household have a paid cellular data plan for accessing the Internet?



Yes Go to 10b

No Go to 10a




*10a. Do you or any member of this household pay for access to the Internet using a cellular data plan for a mobile device?



Yes

No




*10b. Do you or any member of this household pay for access to the Internet using a broadband or high speed Internet service such as cable, fiber optic, or DSL service installed in this <house/apartment/mobile home/unit >?



Yes

No




*10c. Do you or any member of this household pay for access to the Internet using a satellite Internet service installed in this <house/apartment/mobile home/unit >?



Yes

No




*10d. Do you or any member of this household pay for access to the Internet using a dial-up Internet service installed in this <house/apartment/mobile home/unit >?



Yes

No




*10e. Do you or any member of this household pay for access to the Internet using some other service?



Yes Go to10f

No Go to Instruction B




*10f. What is this other type of Internet service?





Instruction B

IF YES TO QUESTION 9 (PAID CELLULAR DATA PLAN), SKIP TO INSTRUCTION C.

OTHERWISE, GO TO QUESTION 11.


(TELEPHONE SERVICE: 11)

*11. Can you or any member of this household both make and receive phone calls when at this <house/apartment/mobile home/unit>? Include calls using cell phones, land lines, or other phone devices.



Yes

No


INSTRUCTION C

CONTINUE WITH DETAILED QUESTIONS FOR PERSON 1 ON PAGE 6 .



DETAILED QUESTIONS—PERSON 1

(CONTAINS YEAR OF NATURALIZATION AND YEAR OF ENTRY MODULES)



NAME ____________________


7a. I will now be asking a series of questions about you.

The next few questions deal with your place of birth and citizenship...

Where were you born?


ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER U.S.




_______ State Go to INSTRUCTION E

OR

Not born in the US Go to 7b



7b. In what country were you born?


___________ Country


INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a. OTHERWISE GO TO QUESTION 8a.


8a. Are you a citizen of the United States?

Yes Go to 8b

No Go to 9a


8b. Were you born abroad of U.S. citizen parent or parents, or did you become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents Go to 9a

Citizen by naturalization Go to 8c

(YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*8c. In what year did you become a naturalized citizen of the United States? Was it between 1995 and 1999, between 2000 and 2004, or 2005 or later?




Before 1985 Go to 9a

1985 – 1989 Go to 9a

1990 – 1994 Go to 9a

1995 – 1999 Go to 9a

2000 – 2004 Go to 9a

2005 or later Go to 8d


*8d. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.



Year

(YEAR OF ENTRY: 9a – 9b)


IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did you come to live in the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*9a. In what year did you come to live in the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*9a. In what year did you come to live in the United States? Was between 1990 and 1994, 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*9a. In what year did you come to live in the United States? Was between 1995 and 1999, between 2000 and 2004, or 2005 or later? If you came to live in the United States more than once, give the latest year.




Before 1985 Go to INSTRUCTION E

1985 - 1989 Go to INSTRUCTION E

1990 - 1994 Go to INSTRUCTION E

1995 - 1999 Go to INSTRUCTION E

2000 - 2004 Go to INSTRUCTION E

2005 or later Go to 9b



*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


Year

INSTRUCTION E


If there is another person to collect detailED person data for, Continue to person 2.

Otherwise, end interview.






DETAILED QUESTIONS—PERSON 2

(CONTAINS YEAR OF NATURALIZATION AND YEAR OF ENTRY MODULES)



NAME ____________________


7a. I will now be asking a series of questions about <Name>.

The next few questions deal with <Name’s> place of birth and citizenship...

Where was <Name> born?


ENTER STATE, IF KNOWN. IF STATE NOT KNOWN, ENTER US




_______ State Go to INSTRUCTION E

OR

Not born in the US Go to 7b




7b. In what country was <Name> born?


___________ Country


INSTRUCTION D

IF COUNTRY IN 7b IS PUERTO RICO, GUAM, THE U.S. VIRGIN ISLANDS, OR NORTHERN MARIANAS, GO TO QUESTION 9a. OTHERWISE GO TO QUESTION 8a.


8a. Is <Name> a citizen of the United States?

Yes Go to 8b

No Go to 9a


8b. Was <Name> born abroad of U.S. citizen parent or parents, or did <Name> become a citizen by naturalization?


Born abroad of U.S. citizen parent or parents Go to 9a

Citizen by naturalization Go to 8c

(YEAR OF NATURALIZATION: 8c – 8d)



IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 1995 and 1999, between 2000 and 2004, or 2005 or later?


IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS:

*8c. In what year did <Name> become a naturalized citizen of the United States? Was it between 2000 and 2004, or 2005 or later?



Before 1985 Go to 9a

1985 – 1989 Go to 9a

1990 – 1994 Go to 9a

1995 – 1999 Go to 9a

2000 – 2004 Go to 9a

2005 or later Go to 8d


8d. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON BECAME A NATURALIZED CITIZEN IN 2005 OR LATER.



Year

(YEAR OF ENTRY: 9a – 9b)


IF THIS PERSON WAS BORN BEFORE 1985, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it before 1985, between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1985 AND 1989, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was it between 1985 and 1989, between 1990 and 1994, between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1990 AND 1994, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 1990 and 1994, 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 1995 AND 1999, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 1995 and 1999, between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.


IF THIS PERSON WAS BORN BETWEEN 2000 AND 2004, READ THIS:

*9a. In what year did <Name> come to live in the United States? Was between 2000 and 2004, or 2005 or later? If <Name> came to live in the United States more than once, give the latest year.



Before 1985 Go to INSTRUCTION E

1985 - 1989 Go to INSTRUCTION E

1990 - 1994 Go to INSTRUCTION E

1995 - 1999 Go to INSTRUCTION E

2000 - 2004 Go to INSTRUCTION E

2005 or later Go to 9b



*9b. In what year was that?


ENTER SPECIFIC YEAR THIS PERSON CAME TO LIVE IN THE US IN 2005 OR LATER.


Year

INSTRUCTION E


end interview.




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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleHOUSING QUESTIONS
Authoremcfarlane
File Modified0000-00-00
File Created2021-01-28

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