American Community Survey (ACS) Strategic Framework Mailing Materials Cognitive Interviews

US Census Bureau

Center for Behavioral Science Methodology (CBSM)

Universal Telephone Screener

(for Fiscal Year 2019)

Hello, I’m _____________ from the Census Bureau. Thank you for contacting us about participating in one of our studies. I just need to get a little bit of background information to start.

[Auto filled: ID Number]

[Auto filled: Last Contact Date]

[Auto filled: Eligible Date]

1. What is your name?

First name:_____________________

Last name:_____________________

2. What is your daytime telephone number? [Probe for all 3 phone numbers]

Mobile ([ ]) [ ] – [ ]

Home (if not mobile) ([ ]) [ ] – [ ]

Work (if any) ([ ]) [ ] – [ ] EXT.[ ]

3. In what city, state, and ZIP code do you currently live?

City:_____________________

State:_____________________

Zip code:__________________

4. Are you male or female?

• Male

• Female

5. In what year were you born?

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

• Yes

• No

7. What is your race? Please select one or more. White, Black or African American, American Indian or Alaska Native, Asian, or Native Hawaiian or other Pacific Islander? (Allow up to 3 answers)

• White

• Black or African American

• American Indian or Alaska Native

• Asian

• Native Hawaiian or other Pacific Islander

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

(do not read categories to respondent)

• 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.)

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

• Full-time (ask follow-up questions a and b)

• Part-time (ask follow-up questions a and b)

• Not working for pay at this time (skip to next question)

a. What is your current job title or job description? [open text]

2. Are you employed by the Federal Government? (if federal contractor, mark NO)

• Yes

• No

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

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

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

• Yes (ask follow-up question)

• No (skip to next question)

1. What language or languages do you speak at home? Please select one or more.

[ ] Spanish

[ ] Chinese

[ ] Korean

[ ] Vietnamese

[ ] Arabic

[ ] Russian

[ ] Other - Specify

13. Do you own a cell phone?

• Yes (ask follow-up question)

• No (skip to next question)

1. Some cell phones are called “smartphones” because of certain features they have. Is your cell phone a smartphone, such as an iPhone, Android, Blackberry or Windows phone, or are you not sure?

2. What type of smartphone do you have?

14. Do you own a desktop or laptop computer, or both?

• Desktop computer

• Laptop computer

• Both desktop and laptop computer

• Neither

15. Do you own a tablet computer such as an iPad, Samsung Galaxy Tab, Google Nexus, or Kindle Fire?

• Yes

• No

16. Do you have at least one year of Internet experience?

• Yes (ask follow-up question)

• No (skip to next question)

1. How often do you use the Internet either on a computer or on a mobile device like a smartphone or tablet?...Several times a day, about once a day, a few times a week, a few times a month, or a few times a year?

• Several times a day

• About once a day

• A few times a week

• A few times a month

• A few times a year

• Not at all [do not read to respondent]

2. Name two things you do on the Internet besides e-mail.

Internet Activity #1:

• Research

• Social media/communication (Facebook, Twitter, Craigslist)

• Shopping

• Banking or paying bills online

• Music / movies / videos

• Gaming

• News

• Travel (directions/reservations)

• Employment

• Other

Internet Activity #2:

• Research

• Social media/communication (Facebook, Twitter, Craigslist)

• Shopping

• Banking or paying bills online

• Music / movies / videos

• Gaming

• News

• Travel (directions/reservations)

• Employment

• Other

17. How did you hear about this research opportunity?

• E-mail link

• Census Bureau employee

• Friend or family member (but not a Census Bureau employee)

• Facebook

• Craigslist

• Google advertisement

• Flyer

• Newspaper advertisement

• Other – specify

18. Have you participated in any research studies with the U.S. Census Bureau?

• Yes

• No

19. Would you be willing to come to our office in Suitland, Maryland, to participate in a research study?

• Yes

• No

20. What is the e-mail address we should use when sending directions to our office, should you qualify for a study?

21. Is your household’s annual income …

• Less than $15,000?

• $15,000 to $25,000?

• $25,000 to$50,000?

• $50,000 to $100,000?

• More than $100,000?

22. Are you a United States citizen? You do not have to be a U.S. citizen to participate in our studies.

• Yes

• No

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