Recruitment Screener

Recruitment Screener – AHS Housing Insecurity

Hello, I’m __________ from the U.S. Census Bureau. Thank you for contacting us about participating in our study. The purpose of this study is to test question wording on a national survey about housing-related topics. Interviews are 1 hour long and we offer $40 for your time. To get started, I just need to ask a few questions to verify if you qualify.

1. Are you 18 or older? [If “No,” ask to speak to someone in the household 18 or older]

• Yes

• No

2. What is your name?

____________________

3. What is your daytime telephone number?

Mobile: ( ) _____ - ________

Home (if not mobile): ( ) _____ - ________

Work (if any): ( ) _____ - ________ Extension: __________

4. In what city, state, and zip code do you currently live?

City: ____________________

State: ____________________

Zip: ____________________

5. Are you male or female?

• Male

• Female

6. In what year were you born?

____________________

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

• Yes

• No

8. What is your race? Please select one or more.

 White

 Black or African-American

 American Indian or Alaska Native

 Asian

 Native Hawaiian or Other Pacific Islander

9. What is the highest grade of school you have completed, or the highest degree you have received?

• 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, Ph. D, JD, etc.)

10. Are you working for pay full-time, part-time, or are you not working for pay at this time?

• Full-Time

• Part-Time

• Not Working for Pay at this Time

11. Are you employed by the Federal Government? [If Federal Contractor, mark “No”]

• Yes

• No

12. Do you speak a language other than English at home?

• Yes

• No

13. How many people age 18 or over currently live in your household, INCLUDING yourself?

__________

14. How many people younger than 18 currently live in your household?

__________

15. How did you hear about this research opportunity?

____________________

16. What is the email address we should use to contact you, should you qualify for this study?

____________________

17. Is your household’s annual income …

• Less than $20,000?

• $20,000 to $35,000?

• $35,000 to $45,000?

• $45,000 to $60,000?

• $60,000 to $75,000?

• $75,000 to $85,000?

• $85,000 to $100,000?

• More than $100,000?

18. Is your current home …

• Owned or being bought by someone in your household?

• Rented?

• Occupied without payment of rent?

19. [If Q18 = Owned or being bought] How many mortgages or loans of any type do you have on this property?

__________

20. When did you move to your current home? [Record month and year]

____________________

21. Do you live with any nonrelatives, such as roommates?

• Yes

• No

22. What days and times would you be available for an in-person interview, should you qualify for this study?

____________________