Maricopa County - Evaluation Follow Up

19

Questionnaire Content Document for the Enumerator Instrument

for the 2015 Evaluation Followup

Question name	ATTEMPT TYPE
Question wording for in person housing unit respondent	Describe this contact attempt for <address>.
Response options	Personal visit Outbound call attempt Inbound call received Message received Not Attempted/Quit before dialing

Question name	RESP LOCATION
Question wording for in person housing unit respondent	Are you attempting to contact <partial address> or a proxy?
Response options	Attempting address Attempting proxy

Question name	DATE OF CONTACT
Question wording for in person housing unit respondent	Enter the month and day of the contact attempt.
Response options	Capture date. Possibly use wheels for each component or whatever method is consistent with other screens. Default to the current date.

Question name	TIME OF CONTACT
Question wording for in person housing unit respondent	Enter the time when you made the contact attempt.
Response options	Capture time. Possibly use wheels for each component or whatever method is consistent with other screens. Include an AM/PM choice.

Question name	RESULT OF MESSAGE
Question wording for in person housing unit respondent	Result of voice or text message received:
Response options	Requests appointment; specifies date and time All other

Question name	NUMBER CALLED
Question wording for in person housing unit respondent	N/A
Response options	Allow the enumerator to select from the case phones or add a phone number not on the list. If new phone is added then have a label field for the enumerator to identify if the Phone number is for the Household or the Proxy.

Question name	DIAL OUTCOME
Question wording for in person housing unit respondent	N/A
Response options	Someone Answers Ring no answer Answering machine/service – Message left Answering machine/service – No message left New number from recording Normal busy/circuits busy Fast or WATTS/FTS busy Fax machine reached, no message sent Number could not be completed as dialed No signal or funny signal Number not in service Number changed, no new number given Bad connection Temporarily not in service TDD or TYY reached Number not dialed/Number misdialed Other noncontact If Other noncontact selected, display a write-in field with the label Specify.

Question name	VERIFY DIALED NUMBER
Question wording for in person housing unit respondent	Hello. My name is (your name) and I am from the U.S. Census Bureau. Have I reached <insert phone number selected from NUMBER CALLED>?
Response options	Yes No

Question name	INTRO PHONE
Question wording for in person housing unit respondent	IF OUTBOUND CALL DISPLAY: I am calling about a very important survey. IF INBOUND CALL DISPLAY: Thank you for returning my call. My name is <fill enumerator name> from the U.S. Census Bureau. I contacted your household concerning a very important survey. Both: Are you the lady or gentleman of the house? May I speak with someone at least 15 years old who lives here and knows about the people in the household? Would that be you?
Response options	Yes, Continue someone is available No, Eligible person is not home now or not available now No, Other outcome or problem interviewing household

Question name	ADDRESS VERIFY
Question wording for in person housing unit respondent	I’m calling to complete a Census questionnaire for <partial address>. This survey is authorized by Title 13 of the United States Code and your response is required by law. Our approval number from the Office of Management and Budget is XXXX-XXXX. All of the information you provide will remain confidential. The interview will take about 15 minutes. Is this: <fill CENSUSADDRESS>?
Response options	Yes No

Question name	KNOW ADDRESS
Question wording for in person housing unit respondent	Do you know where <FULLCENSUSADDRESS> is?
Response options	Yes No If “Yes” then display a 125 character text box with the label Specify.

Question name	PHONE INBOUND
Question wording for in person housing unit respondent	In case we get disconnected, what phone number are you calling from?
Response options	Phone Number (separate by a hyphen with auto-tabbing) Area code: 3-digit text box Number: 3-digit text box Exchange: 4-digit text box Radio button: Continue with interview

Question name	INTRO EFU
Question wording for in person housing unit respondent	Hello, I’m (your name) from the U.S. Census Bureau. Here is my identification. As part of the census, we are contacting households to make sure we counted everyone correctly. Here is a letter explaining our interview and information we will refer to later. (Hand respondent letter.) Is this <partial address>? May I speak with someone at least 15 years old who lives here and knows about the people in the household? Would that be you?
Response options	Yes No, not correct address No contact with anyone No, Eligible person is not home now or not available now

Screen name	INTRO PROXY EFU
Question wording for in person housing unit respondent	In person: Hello, I’m (your name) from the U.S. Census Bureau. Here is my identification. As part of the census, we are contacting households to make sure we counted everyone correctly. Here is a letter explaining our interview and information we will refer to later. (Hand respondent letter.) May I ask you some questions about <partial address>?
Response options	Yes No, address does not exist No contact with proxy

Question name	INTRO PARTIAL
Question wording for in person housing unit respondent	Hello, I’m (your name) from the U.S. Census Bureau. (Show ID). May I speak to <RESP NAME>?
Response options	<RESP NAME> available Contact made - <RESP NAME> unavailable <RESP NAME> doesn’t exist/Respondent doesn’t know <RESP NAME> No contact with anyone

Question name	PARTIAL REVIEW
Question wording for in person housing unit respondent	We previously completed some of the Census questionnaire for <PARTIAL CENSUS ADDRESS>. So far you have told me about: <List each person on the roster>. We will now resume where we left off.
Response options	(Radio button) Resume

Question name	ADDRESS
Question wording for in person housing unit respondent	On <CENSUSDAY>, were you living or staying at <partial address>?
Response options	Yes No

Screen name	RESP NAME
Question wording for in person housing unit respondent	What is your name?
Response options	Name: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box Nickname: 20-character text box Maiden Name: 20-character text box

Screen name	RESP PHONE
Question wording for in person housing unit respondent	What is the best phone number to reach you?
Response options	Allow the enumerator to select from all phones number with PHONEASSOC=HH or the ability to add a phone number with the label “Phone Number” if the option “Other” is selected.

Screen name	ANYONE
Question wording for in person housing unit respondent	Did anyone live at this address on <CENSUSDAY>?
Response options	Yes No

Question name	OCCUPANCY
Question wording for in person housing unit respondent	On <CENSUSDAY>, was this unit vacant or occupied by a different household?
Response options	Vacant Occupied by a different household Not a housing unit

Question name	SPECIFIC UNIT STATUS
Question wording for in person housing unit respondent	Unit status on <CENSUSDAY>
Response options	Vacant – regular Vacant – usual home elsewhere Demolished/burned out Cannot locate Nonresidential Empty mobile home/trailer site Uninhabitable (open to elements, condemned, under construction) Duplicate

Question name	VACANT DESCRIPTION EFU
Question wording for in person housing unit respondent	Now look at the calendar. Which category best describes this vacant unit as of <CENSUSDAY>?
Response options	For rent Rented, not occupied For sale Sold, not occupied For seasonal, recreational, or occasional use For migrant workers Other

Question name	A6
Question wording for in person housing unit respondent	Was <partial address> vacant or not occupied at anytime during 2015?
Response options	Yes, <partial address> was vacant or not occupied in 2015 No, someone always lived at <partial address> in 2015

Question name	A7
Question wording for in person housing unit respondent	Please look at the calendar. When was <partial address> vacant or not occupied in 2015?
Response options	We need a From: and a To: response. Prefill the year with 2015. For user selectable elements, the default text before an answer is selected is left blank. Month user selectable element containing only the name of the month (i.e., January, February, etc.) in chronological order (starts with December and goes to January). User selectable elements containing: 01-31 as the default if no month is selected 01-30 if month = April, June, September, or November 01-31 if month = January, March, May, July, August, October, December 01-28 if month = February and year is 1900 or not divisible by 4 01-29 if month = February and year is divisible by 4 and not 1900 Year drop down box: Starts with 2015 and ends with 2015

Screen name	WHO
Question wording for in person housing unit respondent	Do you know who lived at <partial address> on <CENSUS DAY>?
Response options	Yes No

Screen name	OTHERS
Question wording for in person housing unit respondent	On <CENSUS DAY>, was there anyone else living or staying at <partial address>?
Response options	Yes No

Screen name	PEOPLE EFU
Question wording for in person housing unit respondent	Besides you, what are the names of the other people who were living or staying here on <CENSUSDAY>? Enter a name on each screen until you have listed everybody everyone who was living or staying there.
Response options	Text boxes: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box Nickname: 20-character text box Maiden Name: 20-character text box If one person is added then prompt resident for another name. with this question: "Were there any other people living or staying <here/there> on <CENSUS DAY>? If a second person is added then prompt resident for another name. with this question: Any other person? Enter a name on each screen until response to “Any other person?” is “No”

Screen name	B4
Question wording for in person housing unit respondent	Was there anyone who had another place to live but stayed <here/there> often aroud April 1, 2015? So far you have told me about the following people: <List of names>
Response options	Yes No If “Yes”, prompt respondent for a name. Text boxes: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box Nickname: 20-character text box Maiden name: 20-character text box Then ask “Any more people?” If yes, prompt respondent for another name. Ask for another name until the response to “Any more people?” is “No”

Screen name	B5
Question wording for in person housing unit respondent	Around April 1, 2015, was there anyone who was staying <here/there> until they found a place to live? So far you have told me about the following people: <List of names>
Response options	Yes No If “Yes”, prompt respondent for a name. Text boxes: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box Nickname: 20-character text box Maiden name: 20-character text box Then ask “Any more people?” If yes, prompt respondent for another name. Ask for another name until the response to “Any more people?” is “No”

Screen name	B6
Question wording for in person housing unit respondent	Were there any babies, foster children, or other children who stayed here around April 1, 2015 that you did not mention yet? So far you have told me about the following people: <List of names>
Response options	Yes No If “Yes”, prompt respondent for a name. Text boxes: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box Nickname: 20-character text box Maiden name: 20-character text box Then ask “Any more people?” If yes, prompt respondent for another name. Ask for another name until the response to “Any more people?” is “No”

Screen name	B7
Question wording for in person housing unit respondent	Have I missed any relatives or unrelated people who lived or stayed <here/there> around April 1, 2015? So far you have told me about the following people: <List of names>
Response options	Yes No If “Yes”, prompt respondent for a name. Text boxes: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box Nickname: 20-character text box Maiden name: 20-character text box Then ask “Any more people?” If yes, prompt respondent for another name. Ask for another name until the response to “Any more people?” is “No”

Screen name	E1
Question wording for in person housing unit respondent	Was there anyone else living or staying at <partial address> during January, February, or March 2015 who is no longer living <here/there>? So far you have told me about the following people: <List of names>
Response options	Yes No If “Yes”, prompt respondent for a name. Text boxes: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box Nickname: 20-character text box Maiden name: 20-character text box Then ask “Any more people?” If yes, prompt respondent for another name. Ask for another name until the response to “Any more people?” is “No”

Screen name	ROSTER_REVIEW
Question wording for in person housing unit respondent	Based on what you’ve told me so far, the names I have listed are: <names> Is this list correct? You will not be able to change this list later.
Response options	Yes No

Screen name	ROSTER_EDIT
Question wording for in person housing unit respondent	What type of correction needs to be made? You can change spelling, add additional people, or remove someone from the list.
Response options	(Check boxes) Change spelling Add additional people Remove someone

Screen name	ROSTER_REVIEW2
Question wording for in person housing unit respondent	Based on what you’ve told me so far, the names I have listed are: <names> Is this updated list correct? You will not be able to change this list later.
Response options	Yes No

Question name	SEX
Question wording for in person housing unit respondent	Are you male or female?
Response options	Male Female

Question name	DATE OF BIRTH
Question wording for in person housing unit respondent	What is <your/ roster name’s> date of birth?
Response options	For user selectable elements, the default text before an answer is selected is left blank. Month user selectable element containing only the name of the month (i.e., January, February, etc.) in chronological order (starts with December and goes to January). User selectable elements containing: 01-31 as the default if no month is selected 01-30 if month = April, June, September, or November 01-31 if month = January, March, May, July, August, October, December 01-28 if month = February and year is 1900 or not divisible by 4 01-29 if month = February and year is divisible by 4 and not 1900 Year drop down box: Starts with 2015 and goes to 1889.

Question name	AGE
Question wording for in person housing unit respondent	What was <your/roster name’s> age on <CENSUSDAY>? If you don’t know the exact age, please estimate. Make sure the respondent gives the age in completed years as of <CENSUSDAY>. Do not round up. Do not enter age in months. For babies less than 1 year old enter 0 as the age.
Response options	Write-in Box: [3] [this screen should only allow numeric entries.] Label above the write-in box that reads “Age on <CENSUSDAY>”

Question name	CONFIRM AGE
Question wording for in person housing unit respondent	For the Census, we need to record age as of <CENSUSDAY>. So, just to confirm <you were/ ROSTER NAME was> <AGE/less than one year old> on <CENSUSDAY>?
Response options	Yes No

Question name	CHANGE AGE
Question wording for in person housing unit respondent	What was <your/ROSTERNAME’s> age on <CENSUSDAY>? If you don’t know the exact age, please estimate. Enter CORRECT age. Make sure the respondent gives the CORRECT age in completed years as of <CENSUSDAY>. Do not round up. Do not enter age in months. For babies less than 1 year old enter 0 as the age.
Response options	Write-in Box: [3] Label above the write-in box that reads “Age on <CENSUSDAY>”
Question name		CHANGE DATE OF BIRTH
Question wording for in person housing unit respondent		Since <your/ROSTERNAME’s> age as of <CENSUSDAY> was <CHANGE AGE>, can you help me correct <your/ROSTERNAME’s> date of birth? I have <DOB – Convert to Month Day, Year>. What should it be? Enter CORRECT date of birth.
Response options		Example: [ Month] [Day] [ Year] Month user selectable element containing only the name of the month (i.e., January, February, etc.) in chronological order. Day drop down box containing: 01-31 as the default if no month is selected 01-30 if month = April, June, September, or November 01-31 if month = January, March, May, July, August, October, December 01-28 if month = February and year is 1900 or not divisible by 4 01-29 if month = February and year is divisible by 4 and not 1900 Year user selectable element: Starts with 2015 and goes to 1889.

Question name	BABY FLAG
Question wording for in person housing unit respondent	For the Census, we need to record age as of <CENSUSDAY>. So, just to confirm, <ROSTER NAME> was born after <CENSUSDAY>?
Response options	Yes No

Question name	C4
Question wording for in person housing unit respondent	Please look at the calendar on the back of the letter. During 2015, when did <you/<name>> live or stay at <partial address>?
Response options	We need a From: and a To: response. Prefill the year with 2015. For user selectable elements, the default text before an answer is selected is left blank. Month user selectable element containing only the name of the month (i.e., January, February, etc.) in chronological order (starts with December and goes to January). User selectable elements containing: 01-31 as the default if no month is selected 01-30 if month = April, June, September, or November 01-31 if month = January, March, May, July, August, October, December 01-28 if month = February and year is 1900 or not divisible by 4 01-29 if month = February and year is divisible by 4 and not 1900 Year drop down box: Starts with 2015 and ends with 2015

Question name	C5
Question wording for in person housing unit respondent	(Ask or Verify) During 2015, did <you/<name>> live at <partial address> all year, move, or go back and forth between addresses?
Response options	All year Go back and forth Move – was the move: Before 4/1 On 4/1 After 4/1

Question name	C6
Question wording for in person housing unit respondent	(Ask or Verify) During 2015, did <you/<name>> stay at <partial address>?
Response options	Most of the time? Half of the time? Less than half of the time? Short stays? Daytime only, didn’t spend nights? Certain days of the week?: Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Question name	C7
Question wording for in person housing unit respondent	(Ask or Verify) <Were you/Was <name>> staying at <partial address> on Wednesday, April 1st?
Response options	Yes No

Screen name	RELATIVES
Question wording for in person housing unit respondent	Some people live or stay in more than one place and we would like to make sure everyone is only counted once. Around <CENSUS DAY>, did you <,NAME2, NAME3, or NAME4, ETC.> sometimes live or stay somewhere else with a parent, grandparent, or other person?
Response options	Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	COLLEGE HOUSING
Question wording for in person housing unit respondent	Around <CENSUSDAY>, were you <, NAME2, NAME3, or NAME4, etc.> living or staying somewhere else while attending college?
Response options	Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	JOB
Question wording for in person housing unit respondent	Around <CENSUSDAY>, were you <, name2, name3, or name4 etc> sometimes living or staying somewhere else to be closer to a job (including military assignments)?
Response options	Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	NURSING/GROUP HOME
Question wording for in person housing unit respondent	Around <CENSUSDAY>, did you <name2, name3, or name4 etc> sometimes stay in a place like a nursing home or a group home?
Response options	Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	JAIL/PRISON
Question wording for in person housing unit respondent	Around <CENSUSDAY>, were you, < name2, name3, or name4 etc> staying in a jail or prison?
Response options	Yes No [Note: If “Yes, display the following] Who? Check all that apply. <roster name 1> <roster name 2-n (if applicable)>

Screen name	SEASONAL
Question wording for in person housing unit respondent	Do you <, name2, name3, or name4, etc > sometimes live or stay at another home, like a seasonal or second residence? < Read if necessary> Do not include situations you have already told me about related to stays with parents, grandparents, or other persons, college housing, jobs, military service, or staying at nursing homes, prisons, or jails.
Response options	Yes No [Note: If “Yes”, display the following] Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	ANOTHER REASON
Question wording for in person housing unit respondent	Around <CENSUSDAY>, did you <name2, name3, name4, etc> sometimes live somewhere elsefor any reason other than those just mentioned? < Read if necessary> Do not include situations you have already told me about related to, stays with parents, grandparents, or other persons, college housing, jobs, military service, seasonal or second residences, or staying at nursing homes, prisons, or jails.
Response options	Yes No [Note: If “Yes, display the following] Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name

FULLSTAY (D2)

Question wording for in person housing unit respondent

Please provide the full address <flag_location1> where <name> sometimes lived or stayed around April 1^st <flag_location2>. Fill in as much information as the respondent can provide.

Response options

Address Type:

• City Style

• P.O. Box

• Rural Route

If City Style is selected, then display:

House Number: 20-character text box

Street Name: 100-Character text box

Apt/Unit #: 52-character text box

City: 20-character text box

State: drop down menu with alphabetical states and District of Columbia

Zip: 5-character text box

If P.O. Box is selected:

P.O. Box #: 10-character text box

City: 20-character text box

State: drop down menu with alphabetical states and District of Columbia

Zip: 5-character text box

Please provide a physical address such as:

• An address you would give to a shipping company if you wanted a package delivered to your home, or

• An address you would provide if you were requesting emergency services such as a 911 call, or

• A location description such as “The apartment over the Post Office on County Road 5” or “The blue house on the northeast corner of Main Street and First Avenue”.

Location Description: 250-character text box

If Rural Route is selected:

Rural Route Descriptor: drop down menu with the following options

• RR

• HC

• SR

• PSC

• RTE

Rural Route #: 10-character text box

Box ID: 10-character text box

City: 20-character text box

State: drop down menu with alphabetical states and District of Columbia

Zip: 5-character text box

Please provide a physical address such as:

• An address you would give to a shipping company if you wanted a package delivered to your home, or

• An address you would provide if you were requesting emergency services such as a 911 call, or

• A location description such as “The apartment over the Post Office on County Road 5” or “The blue house on the northeast corner of Main Street and First Avenue”.

Location Description: 250-character text box

• If this is a 1-person household use “you” in the question stem instead of <person>.

• Use the location flags (flag_location1 and flag_location2) from the Table below. Only one flag will be used for each person.

Location Flags

Response Option	flag_location1	flag_location2	flag_location3
Seasonal	of the seasonal or second residence	N/A	seasonal or second residence
Relatives	N/A	for the relatives address	Relatives address
College housing	of the college housing	N/A	college housing address
Job	N/A	for the job	job address
Nursing home	of the nursing home	N/A	nursing home
Prison or jail	of the prison or jail	N/A	prison or jail
Another reason	N/A	for another reason	other place

Note: Due to the wording of the question stem in FULL STAY, different flags are needed for some of the location types so we create two flags for this screen (flag_location1 and flag_location2).

Question name	D3
Question wording for in person housing unit respondent	Is that place a house or apartment or another type of place like those show on List B on the back of the letter?
Response options	House/apartment/mobile home/condo/townhouse College dorm/residence hall/sorority/fraternity house Military barracks Nursing home Skilled nursing unit in assisted living Independent/assisted living Correctional facility Group home Other If Other place is selected, display a write-in field with the label Specify.

Question name	D4
Question wording for in person housing unit respondent	Please look at the calendar on the back of the letter. During 2015, when did <you/<name>> live or stay at <newly collected ADDRESS>?
Response options	We need a From: and a To: response. Prefill the year with 2015. For user selectable elements, the default text before an answer is selected is left blank. Month user selectable element containing only the name of the month (i.e., January, February, etc.) in chronological order (starts with December and goes to January). User selectable elements containing: 01-31 as the default if no month is selected 01-30 if month = April, June, September, or November 01-31 if month = January, March, May, July, August, October, December 01-28 if month = February and year is 1900 or not divisible by 4 01-29 if month = February and year is divisible by 4 and not 1900 Year drop down box: Starts with 2015 and ends with 2015

Question name	D5
Question wording for in person housing unit respondent	(Ask or Verify) During 2015, did <you/<name>> live at that address all year, move, or go back and forth between addresses?
Response options	All year Go back and forth Move – was the move: Before 4/1 On 4/1 After 4/1

Question name	D6
Question wording for in person housing unit respondent	(Ask or Verify) During 2015, did <you/<name>> stay at that address?
Response options	Most of the time? Half of the time? Less than half of the time? Short stays? Daytime only, didn’t spend nights? Certain days of the week?: Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Question name	D7
Question wording for in person housing unit respondent	(Ask or Verify) Where <were you/was <name>> staying on Wednesday, April 1st?
Response options	<partial address> <newly collected ADDRESS> Some other place

Question name	ADDRESS CHECK
Question wording for in person housing unit respondent	How are you familiar with <FULLCENSUSADDRESS>?
Response options	Respondent used to live at address Respondent knows someone who lives at address Address needs a slight correction Use this address for billing and shipping purposes Not familiar

Question name	NO COMPLETE
Question wording for in person housing unit respondent	Thank you for your time. Why are you exiting this interview?
Response options	Eligible respondent not available Inconvenient time – Need to set an appointment Inconvenient time – No appointment made Language Barrier Hearing Barrier Refusal by Respondent Other If other selected, display 200-character text box

Question name	APPOINTMENT TYPE
Question wording for in person housing unit respondent	Would you like me to call on the phone or come back in person?
Response options	Telephone appointment In person appointment

Question name	WHO TO CALL
Question wording for in person housing unit respondent	Whom should I ask for when I call back?
Response options	Allow enumerator to select from a dropdown of roster entries or to add a new name (within a 42-character text box)

Question name	APPOINTMENT PHONE
Question wording for in person housing unit respondent	What is the best number for me to call back on?
Response options	Allow the enumerator to select from the case phones or add a phone number not on the list with the label “Phone Number”. If new phone is added then have a label field for the enumerator to identify if the Phone number is for the Household or the Proxy.

Question name	APPOINTMENT DATE
Question wording for in person housing unit respondent	What is the best date and time <fill>?
Response options	Capture date (month and day) using a calendar.

Question name	APPOINTMENT TIME
Question wording for in person housing unit respondent	What is the best date and time <fill>? Display date selected from APPOINTMENT DATE and any appointments scheduled for that day

Question name	Language Barrier phone
Question wording for in person housing unit respondent	Please give me your phone number and someone may contact you?
Response options	(numeric keypad should be available to enter a phone number) Phone Number (separate by a hyphen with auto-tabbing) Area Code: 3-digit text box Prefix: 3-digit text box Suffix: 4-digit text box

Question name	Language Barrier
Question wording for in person housing unit respondent	In which language was the interview attempted?
Response options	(drop down box of languages with other option without text box)

Question name	Language BARRIER RESP
Question wording for in person housing unit respondent	What language does the respondent speak?
Response options	(drop down box of languages with other option without text box)

Question name	Refusal Reason
Question wording for in person housing unit respondent	What reasons were given for the refusal, if known?
Response options	Respondent too busy / doesn’t have time Not interested / Does not want to be bothered Survey is a waste of taxpayer money Done enough other surveys Claims they already completed questionnaire Questions legitimacy of questionnaire Privacy concerns Scheduling difficulties Survey is voluntary / Claims does not have to do questionnaire Does not understand the questionnaire / Asks questions about the questionnaire Anti-government concerns Hang-up / Slammed door Hostile Resp / dangerous situation / threatened enumerator Breaks appointment (puts off enumerator indefinitely) Other If “other” selected, display a 200-character text box.

Question name	PERSONAL NON-CONTACT
Question wording for in person housing unit respondent	Select the best category to describe the personal visit.
Response options	No one home No one home – appointment broken No one home – Notice of Visit removed from last contact attempt No one home appears vacant Household does not answer door – evidence that someone is home Unable to reach / locked gate / physical access denied Not a housing unit/Away for duration of operation Other If “Other” is selected, display a 100-character text box with the label Specify.

Question name	PROXY NAME
Question wording for in person housing unit respondent	My final questions are about you, in case I or someone else from the Census Bureau needs to contact you again for additional information. Ask or confirm. What is your name?
Response options	Name: First Name: 20-character text box Middle Name: 20-character text box Last Name: 20-character text box

Question name	PROXY PHONE
Question wording for in person housing unit respondent	N/A
Response options	If ATTEMPT TYPE=Outbound call attempt and RESP_TYPE=proxy: Yes No If no, then the following question should be displayed as well as the text boxes to collect the phone number: Ask or confirm. What is the best phone number to reach you? If ATTEMPT TYPE=Inbound call received and RESP_TYPE=proxy: Phone Number (separate by a hyphen with auto-tabbing) Area Code: 3-digit text box Prefix: 3-digit text box Suffix: 4-digit text box

Question name	LOCATION OF PROXY
Question wording for in person housing unit respondent	N/A
Response options	Address Type: City Style Rural Route If City Style is selected, then display: [ ] <house number + street name + (unit designation) + city + state + zip> {get this data from input files. Unit designation is not necessary but if it’s filled on input, then it should be used here. If the enumerator checks this box, then these address parts should be filled in the proxy address fields (PROXY_*) and PROXY_ADDRTYPE = CITY STYLE.} House Number: 20-character text box Street Name: 100-character text box Apt/Unit #: 52-character text box City: 20-character text box State: drop down menu with alphabetical states and District of Columbia Zip: 5-character numeric text box Please provide a physical address such as: An address you would give to a shipping company if you wanted a package delivered to your home, or An address you would provide if you were requesting emergency services such as a 911 call, or A location description such as “The apartment over the Post Office on County Road 5” or “The blue house on the northeast corner of Main Street and First Avenue”. Location Description: 250-character text box If Rural Route is selected: Rural Route Descriptor: drop down menu with the following options RR HC SR PSC RTE Rural Route #: 10-character text box Box ID: 10-character text box City: 20-character text box State: drop down menu with alphabetical states and District of Columbia Zip: 5-character numeric text box Please provide a physical address such as: An address you would give to a shipping company if you wanted a package delivered to your home, or An address you would provide if you were requesting emergency services such as a 911 call, or A location description such as “The apartment over the Post Office on County Road 5” or “The brick house with the screened porch on the northeast corner of Main Street and First Avenue”. Location Description: 250-character text box

Question name	TYPE OF PROXY
Question wording for in person housing unit respondent	N/A
Response options	Neighbor Landlord or Property Manager (Owner, Rental Office Manager, etc.) Real Estate Agent/Office Relative of Household Member Caregiver or Health Provider In mover (moved in after <CENSUSDAY>) Government Office or Worker (Tax Assessor, Letter Carrier, etc.) Utility Worker (Meter Reader, Telephone Repair, Cable/Satellite, etc.) Enumerator Personal Knowledge Other If Other, display a 125-character text box with the label Specify.

Question name	GOOD BYE
Question wording for in person housing unit respondent	That completes the interview. Thank you for your time and cooperation.

Question name	TRANSLATOR
Question wording for in person housing unit respondent	Was there a translator present?
Response options	Yes No

Question name	ID TRANSLATOR
Question wording for in person housing unit respondent	Who was the translator?
Response options	<Insert all household members> Another Enumerator Neighbor Local community member Other If “other” selected, display a 100-character text box with the label Specify.

Question name	LANGUAGE
Question wording for in person housing unit respondent	If TRANSLATOR= no: What language was the interview conducted in? If TRANSLATOR= yes: What language was the interview translated from?
Response options	(drop down box of languages with other option with text box) If “other” selected, display 35-character text box with the label Specify.

Question name	UNABLE TO INTERVIEW
Question wording for in person housing unit respondent	Select the best category to describe why an interview cannot be conducted at the census address for the length of the operation.
Response options	Demolished/burned out Cannot locate Nonresidential Empty mobile home/trailer site Uninhabitable (open to elements, condemned, under construction) Address does not exist Household away for duration of operation

Question name	STRATEGIES
Question wording for in person housing unit respondent	Did you leave a Notice of Visit? Respondent’s User ID for this case is <CASE ID (formatted as XXXX-XXXX-XXXX)>.
Response options	Yes No

Question name	UNSUCCESSFUL PROXY
Question wording for in person housing unit respondent	N/A
Response options	Neighbor Landlord or Property Manager (Owner, Rental Office Manager, etc.) Real Estate Agent/Office Relative of Household Member Caregiver or Health Provider In mover (moved in after <CENSUS DAY>) Government Office or Worker (Tax Assessor, Letter Carrier, etc.) Utility Worker (Meter Reader, Telephone Repair, Cable/Satellite, etc.) Other If “other” is selected, display a 125-character text box with the label Specify.

Question name	CASE NOTES
Question wording for in person housing unit respondent	Enter any notes about the case in the text box.
Response options