Demo Questions Focus Group Worksheet

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Enclosure 5 - Demo Questions

Respondent Perceptions of Burden in the American Community Survey (ACS)

OMB: 0690-0030

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OMB Control No. 0690-0030

Expiration Date: 6/30/17

Focus Group Worksheet

Your response to these questions is voluntary.


  1. In what year were you born? __________________ year



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

  • Less than high school

  • Completed high school

  • Some college, no degree

  • Associate’s degree (AA/AS)

  • Bachelor’s degree (BA/BS)

  • Post-bachelor’s degree (for example, MA, MS, PhD, MD)



  1. Are you male or female?



  • Male

  • Female



  1. Are you of Hispanic, Latino, or Spanish origin?



  • Yes

  • No



  1. What is your race? Choose one or more races.



  • White

  • Black or African American

  • American Indian or Alaska Native

  • Asian

  • Native Hawaiian or Other Pacific Islander



  1. How many people age 16 or older currently live in your household, INCLUDING yourself?


_________



  1. How many people younger than age 16 currently live in your household?


_________






  1. Do you currently live with all family members, some family members and some non-family members, or all non-family members?



  • All family members

  • Some family members and some non-family members

  • All non-family members







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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJessica Holzberg (CENSUS/CSM FED)
File Modified0000-00-00
File Created2021-01-22

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