Form 1 CBAMS Mindset Instrument

2020 Mindset Panel Online Questionnaire
November 11, 2019

QUESTIONNAIRE (ENGLISH)
Page Title: Autocode
Section Code Answer Order (QORDER)
## THIS QUESTION WILL RANDOMLY ASSIGN PARTICIPANTS TO SEE UNIPOLAR SCALES IN THE ORDER
THEY ARE WRITTEN IN THESE REQUIREMENTS (CHOICE 1 TO CHOICE 5), OR TO SEE THEM IN REVERSE
ORDER (CHOICE 5 TO CHOICE 1) ##
1) ## WRITTEN ## Show unipolar scales as they are written
2) ## REVERSE ## Show unipolar scales in reverse order
## HEADER TO BE DISPLAYED ON EVERY PAGE AFTER WELCOME PAGE##
## ENGLISH ##
AN OFFICIAL WEBSITE OF THE UNITED STATES GOVERNMENT
Unites States Census Bureau Logo
2020 Census Planning Survey
English | Español | Logout
## SPANISH ##
UN SITIO WEB OFICIAL DEL GOBIERNO DE LOS EE.UU.
Unites States Census Bureau Logo
Encuesta de Planificación del Censo del 2020
English | Español | Salir
## FOOTER TO BE DISPLAYED ON EVERY PAGE ##
## ENGLISH ##
OMB No.: 0607-0978 Approval Expires: 08/31/2020
Accessibility – Linked to webpage https://www.census.gov/about/policies/privacy/privacypolicy.html#par_textimage_1 with the following language:
The Census Bureau is committed to making online forms and other public documents on its Internet
server accessible to all. Currently, we are reviewing our web sites and making modifications to those
pages, which are not in compliance with the Americans with Disabilities Act. We use Hypertext Markup
Language (HTML) to create pages that are generally accessible to persons using screen-reading devices,
and we are careful in our construction of HTML documents to ensure maximum accessibility. We include
alternate text describing graphics.
Many Census Bureau Internet documents are in ASCII or HTML formats. These documents are accessible
to persons using screen-reading software. We also have a large number of documents in Adobe Acrobat
PDF (Portable Document Format) files. Currently, many people using screen-reading devices cannot read
documents in PDF format, specifically those that were created from a scanned hard copy.

1

Adobe Systems, Inc. is producing various products designed to make Adobe Acrobat documents
accessible to persons using screen-reading software. Adobe's accessibility web pages describe their
efforts.
To allow us to better serve those with visual disabilities who are having difficulty accessing PDF
documents; you may contact us directly for further assistance at 301-763-INFO (4636), 800-923-8282, or
by submitting a request at ask.census.gov.
Privacy – Linked to webpage https://www.census.gov/privacy/ with the following language:
We are committed to handling your information responsibly. Your information is kept confidential. This
commitment applies to the individuals, households, and businesses that answer our surveys, and to
those browsing our website.
Security – Linked to webpage [URL] with the following language:
Data are Encrypted at all Times
Our secure servers use Hypertext Transfer Protocol over Secure Socket Layer (HTTPS) to ensure the
encrypted transmission of data between your browser and the U.S. Census Bureau. This means that
instead of sending readable text over the Internet, both your browser and our servers encode
(scramble) all text using a security key. That way, personal data sent to your browser and data you send
back are extremely difficult to decode in the unlikely event of interception by an unauthorized party. As
a result of this, your browser must be capable of using the required encryption protocol and strength in
order to connect to our servers. If you cannot connect to our secure servers, please upgrade to a newer
browser.
Third Party Identity Proofing
Our secure servers use a digital certificate (digital ID) issued by a trusted, third party Certificate
Authority (CA) as proof of identity. The only way to be sure of a web site's authenticity is to view their
digital ID. In this way, you can be assured that you are not being "spoofed" or tricked by an imposter.
The digital ID will contain information such as the name of the organization that owns the web site, the
site's registered internet name/address, and the name of the Certification Authority under which the
digital ID was issued. The method for viewing a web site's Digital Certificate/ID varies depending on the
web browser. Please see your browser's "Help" information for instructions on how to verify a web site's
identity.
Burden – Linked to webpage [URL] with the following language:
How long will this survey take?
The Census Bureau estimates that, for the average household, this survey will take about 15
minutes to complete, including the time for reviewing the instructions and answers.
## SPANISH ##
Núm. de OMB: 0607-0978 Aprobado hasta: 08/31/2020
Accesibilidad – Linked to webpage [URL] with the following language:
Privacidad – Linked to webpage [URL] with the following language:
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Seguridad – Linked to webpage [URL] with the following language:
Tiempo y esfuerzo – Linked to webpage [URL] with the following language:
¿Cuánto tiempo va a tomar esta encuesta?
La Oficina del Censo calcula que al hogar típico le tomará como promedio aproximadamente 15 minutos
completar esta encuesta, incluyendo el tiempo que toma repasar las instrucciones y revisar las
respuestas.
/* START PAGE */
Page Title: Welcome_Page
Section Welcome Page (display_Welcome)
Welcome! Thank you for participating in this survey sponsored by the U.S. Department of Commerce,
U.S. Census Bureau. This survey is available in another language.Please use the drop down menu in the
upper right corner of each page to select the language in which you prefer to complete the survey.
¡Bienvenido(a)! Gracias por participar en esta encuesta de la Oficina del Censo y el Departamento de
Comercio de los Estados Unidos. Esta encuesta está disponible en otro idioma. Por favor seleccione el
idioma de su preferencia para contestar la encuesta.

Logic:
• Ask this question for all respondents
• Only one response permitted here, and respondents will be able to toggle between languages in
the remaining of the survey
/* END PAGE */
/* START PAGE */
Page Title: Login
Section Splash Page (display_Information)
Thank you for participating. Completing this short 15-minute survey will help the U.S. Census Bureau
conduct the 2020 Census This survey is not the census.

Here is some helpful information:
•
•
•

We will keep your answers confidential.
You can validate that this survey is a legitimate federally-approved information collection using
the U.S. Office of Management and Budget approval number 0607-0978, expiring on
08/31/2020. Federal agencies may not sponsor surveys without a valid control number.
To learn more about this survey go to: www.census.gov/plan.

** U.S. Census Bureau Notice and Consent Warning **
You are accessing a United States Government computer network. Any information you enter into this
system is confidential. It may be used by the Census Bureau for statistical purposes and to improve the
3

website. If you want to know more about the use of this system, and how your privacy is protected, visit
our online privacy webpage at http://www.census.gov/about/policies/privacy/privacy-policy.html.
Use of this system indicates your consent to collection, monitoring, recording, and use of the
information that you provide for any lawful government purpose. 1 So that our website remains safe
and available for its intended use, network traffic is monitored to identify unauthorized attempts to
access, upload, change information, or otherwise cause damage to the web service. Use of the
government computer network for unauthorized purposes is a violation of Federal law and can be
punished with fines or imprisonment (PUBLIC LAW 99-474).
Section Splash Page Spanish (display_Information)
Gracias por participar. Completar esta breve encuesta de 15 minutos ayudará a la Oficina del Censo de
los Estados Unidos a realizar el próximo censo en el 2020. Esta encuesta debe ser completada por la
persona que generalmente abre la correspondencia en su hogar. Esta encuesta no es el censo.
A continuación alguna información útil:
•
•

•

Mantendremos sus respuestas confidenciales.
Puede validar que esta encuesta es una recopilación de información legítima aprobada por el
gobierno federal utilizando el número de aprobación 0607-0978 de la Oficina de Administración
y Presupuesto de los Estados Unidos, que vence el 08/31/2020. Las agencias federales no
pueden patrocinar encuestas sin un número de control válido.
Para obtener más información sobre esta encuesta, visite: www.census.gov/plan.

** Aviso de la Oficina del Censo de los EE. UU. y Advertencia sobre el consentimiento **
Usted está accediendo a una red de computación del gobierno de los Estados Unidos. Toda la
información que escriba en este sistema es confidencial. La Oficina del Censo puede usar dicha
información para propósitos estadísticos y para mejorar el sitio web. Si desea conocer más acerca del
uso de este sistema y cómo se protege su privacidad, visite nuestra página web.
El uso de este sistema indica su consentimiento a que recopilemos, monitoreemos, registremos y
usemos la información que usted proporcione para cualquier propósito legal del gobierno. Con el fin de
que nuestro sitio web siga siendo seguro y que siga disponible para el uso al que está destinado,
monitoreamos el tráfico en la red para identificar los intentos no autorizados de acceder, subir o
cambiar información, o de dañar de alguna otra manera el servicio del sitio web. El uso de la red de
computación del gobierno para fines no autorizados se trata de una violación de las leyes federales y
puede ser penalizado con multas o encarcelamiento (LEY PÚBLICA 99-474).
/* END PAGE */
/* START PAGE */
Page Title: Census_Introduction
Section Display Q1 (display_Q1)

4

The U.S. census is the count of all the people who live in the United States. It happens every 10 years. It
asks questions such as how many people live in your household, their age, race, and ethnicity. This
survey is not the census. The next census is in 2020.
Section Display Q1 (display_Q1)
El Censo de los EE. UU. es el conteo de todas las personas que viven en los Estados Unidos. Se realiza
cada 10 años. Este pregunta cuántas personas viven en su hogar, su edad, raza, y origen étnico. Esta
encuesta no es el censo. El próximo censo se llevará a cabo en el 2020.
Section Q1 (familiarity)
How familiar are you with the U.S. census? Select only one answer.
1) Extremely familiar
2) Very familiar
3) Somewhat familiar
4) Not too familiar
5) Not at all familiar
Section Q1 Spanish (familiarity)
¿Qué tan familiarizado(a) está con el censo de los Estados Unidos? Seleccione solo una respuesta.
1) Extremadamente familiarizado(a)
2) Muy familiarizado(a)
3) Algo familiarizado(a)
4) No muy familiarizado(a)
5) Nada familiarizado(a)
Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q2 (participation1)
If the census were held today, how likely would you be to fill out the census form? Select only one
answer.
1) Extremely likely
2) Very likely
3) Somewhat likely
4) Not too likely
5) Not at all likely
Section Q2 Spanish (participation1)
Si el censo se llevara a cabo hoy, ¿qué tan probable sería que usted llenara el formulario del censo?
Seleccione solo una respuesta.
1) Extremadamente probable
2) Muy probable
3) Algo probable
5

4) No muy probable
5) Nada probable
Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END PAGE */
/* START PAGE */
Page Title: Census_Participation
Section Q3 (participation2)
Thinking about most people you know, if the census were held today how likely would they be to fill out
the census form? Select only one answer.
1) Extremely likely
2) Very likely
3) Somewhat likely
4) Not too likely
5) Not at all likely
Section Q3 Spanish (participation2)
Si el censo se llevara a cabo hoy, ¿qué tan probable sería que la mayoría de las personas que usted
conoce llenaran el formulario del censo? Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente probable
Muy probable
Algo probable
No muy probable
Nada probable

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q4 (participation3)
Based on your past experience or just your best guess, how long do you think it would take you
personally to fill out the 2020 Census? Please enter a number in minutes.
________ minutes
Section Q4 Spanish (participation3)
De acuerdo con su experiencia anterior o simplemente según sus cálculos, ¿cuánto tiempo cree que le
tomaría a usted llenar el Censo del 2020? Anote el número de minutos.
__________ minutos
Logic:
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•
•
•

Open end numeric
Range: 0 to 500
If a respondent enters a number that falls outside of the above range, display the following
message (soft edit):
o For English: “Please enter a number between 0 and 500.”
o For Spanish: “Por favor ingrese un número entre 0 y 500.”

Section Q5 (participation4)
How likely are you to encourage someone you know to fill out the 2020 Census form? Select only one
answer.
1) Extremely likely
2) Very likely
3) Somewhat likely
4) Not too likely
5) Not at all likely
Section Q5 Spanish (participation4)
¿Qué tan probable es que usted anime a algún conocido a que llene el formulario del Censo del 2020?
Seleccione solo una respuesta.
1) Extremadamente probable
2) Muy probable
3) Algo probable
4) No muy probable
5) Nada probable
Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END PAGE */
/* START PAGE */
Page Title: Internet_Usage1
Section Q6 (internet1)
About how often do you use the internet? Select only one answer.
1) Almost constantly
2) Several times a day
3) About once a day
4) Several times a week
5) Once a week
6) Less than once a week
7) Never
Section Q6 Spanish (internet1)
Aproximadamente, ¿con qué frecuencia usa usted internet? Seleccione solo una respuesta.
1) Casi constantemente

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2)
3)
4)
5)
6)
7)

Varias veces al día
Alrededor de una vez al día
Varias veces a la semana
Una vez a la semana
Menos de una vez a la semana
Nunca

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q7 (internet2)
Which devices do you often use to access the internet? Please select all that apply.
1) Desktop or laptop computer
2) Smartphone (for example an iPhone, Android, Blackberry)
3) Tablet computer (for example an iPad, Samsung Galaxy Tab, Kindle Fire)
4) I don’t use the internet /* EXCLUSIVE */
Section Q7 Spanish (internet2)
¿Qué aparatos usa con mayor frecuencia para acceder a internet? Seleccione todas las que
correspondan.
1)
2)
3)
4)

Computadora de escritorio o computadora portátil
Teléfono inteligente (Smartphone como iPhone, Android, Blackberry)
Tableta (como iPad, Samsung Galaxy Tab, Kindle Fire)
No uso internet /* EXCLUSIVE */

Logic:
• Multiple responses permitted
• Do NOT rotate answer choices
• If respondents select response 4 (“I don’t use the internet”/ “No uso internet”), other responses
would be grayed out.
/* END PAGE */
/* START PAGE */
Page Title: Internet_Usage2
Section Q8 (internet3)
Which of the following comes closest to your view? Select only one answer.
1) I prefer to fill out paper forms instead of online forms
2) I prefer to fill out online forms instead of paper forms
3) I have no preference between completing online or paper forms /* DO NOT ROTATE */
Section Q8 Spanish (internet3)
¿Cuál de las siguientes frases se acerca más a su punto de vista? Seleccione solo una respuesta.
1) Prefiero llenar formularios impresos en vez de formularios por internet
8

2) Prefiero llenar formularios por internet en vez de formularios impresos
3) No tengo preferencia entre llenar formularios por internet o impresos /* DO NOT ROTATE
*/
Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END PAGE */
/* START PAGE */
Page Title: Use_of_Census1
Section Display Q9 (display_Q9)
The following questions are about the 2020 Census in general. There is no need to look up this
information. As you understand it, will the 2020 Census be used in any of the following ways or not?
Section Display Q9 Spanish (display_Q9)
Las siguientes preguntas son sobre el Censo del 2020 en general. No es necesario que busque esta
información. Según lo que usted entiende, ¿el Censo del 2020 se usará de algunas de las siguientes
maneras o no?
/* RANDOM ROTATE SERIES */
Section Q9 (use1)
Is the census used to decide how much money communities will get from the government, or is it not
used for this? Select only one answer.
1) Yes, used for this
2) No, not used
3) Don't know
Section Q9 Spanish (use1)
¿El censo se usa para decidir cuánto dinero del gobierno recibirán las comunidades, o no se usa para
este fin? Seleccione solo una respuesta.
1) Sí, se usa para esto
2) No, no se usa para esto
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q16 (use8)
Is the census used to determine the rate of unemployment, or is it not used for this? Select only one
answer.
1) Yes, used for this
2) No, not used
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3) Don't know
Section Q16 Spanish (use8)
¿El censo se usa para determinar la tasa de desempleo, o no se usa para este fin? Seleccione solo una
respuesta.
1) Sí, se usa para esto
2) No, no se usa para esto
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q15 (use7)
Does the census count both citizens and non-citizens, or only citizens? Select only one answer.
1) Yes, used for counting both citizens and non-citizens
2) No, used only for counting citizens
3) Don't know
Section Q15 Spanish (use7)
¿El censo cuenta tanto a los ciudadanos como a quienes no son ciudadanos, o solo a los ciudadanos?
Seleccione solo una respuesta.
1) Sí, se usa para contar tanto a los ciudadanos como a quienes no son ciudadanos
2) No, se usa para contar solo a los ciudadanos
3) No lo sé
Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q12 (use4)
Is the census used to determine property taxes, or is it not used for this? Select only one answer.
1) Yes, used for this
2) No, not used
3) Don't know
Section Q12 Spanish (use4)
¿El censo se usa para determinar los impuestos a la propiedad, o no se usa para este fin? Seleccione solo
una respuesta.
1) Sí, se usa para esto
2) No, no se usa para esto
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
10

/* END SERIES */
/* END PAGE */
/* START PAGE */
/* RANDOM ROTATE SERIES */
Page Title: Use_of_Census2
Section Q10 (use2)
Is the census used to decide how many representatives each state will have in Congress, or is it not used
for this? Select only one answer.
1) Yes, used for this
2) No, not used
3) Don't know
Section Q10 Spanish (use2)
¿El censo se usa para decidir cuántos representantes tendrá cada estado en el Congreso, o no se usa
para este fin? Seleccione solo una respuesta.
1) Sí, se usa para esto
2) No, no se usa para esto
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q13 (use5)
Is the census used to help the police and FBI keep track of people who break the law, or is it not used for
this? Select only one answer.
1) Yes, used for this
2) No, not used
3) Don't know
Section Q13 Spanish (use5)
¿El censo se usa para ayudar a la policía y al FBI a mantener un registro de las personas que no cumplen
la ley, o no se usa para este fin? Seleccione solo una respuesta.
1) Sí, se usa para esto
2) No, no se usa para esto
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q14 (use6)
Is the census used to locate people living in the country without documentation, or is it not used for this?
Select only one answer.
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1) Yes, used for this
2) No, not used
3) Don't know
Section Q14 Spanish (use6)
¿El censo se usa para ubicar a las personas indocumentadas que viven en el país, o no se usa para este
fin? Seleccione solo una respuesta.
1) Sí, se usa para esto
2) No, no se usa para esto
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q11 (use3)
Is the census used to see what changes have taken place in the size, location, and characteristics of the
people in the United States, or is it not used for this? Select only one answer.
1) Yes, used for this
2) No, not used
3) Don't know
Section Q11 Spanish (use3)
¿El censo se usa para ver qué cambios han ocurrido en el tamaño, la ubicación y las características de la
población en los Estados Unidos, o no se usa para este fin? Seleccione solo una respuesta.
1) Sí, se usa para esto
2) No, no se usa para esto
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
/* END SERIES */
/* END PAGE */
/* START PAGE */
Page Title: Legal_Requirements
Section Q17 (legal1)
Does the law require you to answer the census questions, or is this not required by law? Select only one
answer.
1) Yes, required by law
2) No, not required by law
3) Don't know
Section Q17 Spanish (legal1)
12

¿La ley exige que conteste las preguntas del censo, o no lo exige? Seleccione solo una respuesta.
1) Sí, la ley lo exige
2) No, la ley no lo exige
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q18 (legal2)
Is the Census Bureau required by law to keep information confidential, or is this not required by law?
Select only one answer.
1) Yes, required by law
2) No, not required by law
3) Don't know
Section Q18 Spanish (legal2)
¿La ley exige que la Oficina del Censo mantenga la información confidencial, o no lo exige? Seleccione
solo una respuesta.
1) Sí, la ley lo exige
2) No, la ley no lo exige
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q19 (legal3)
Does the U.S. Constitution require that the census be conducted, or is this not something the
Constitution requires? Select only one answer.
1) Yes, Constitution requires
2) No, Constitution does not require
3) Don't know
Section Q19 Spanish (legal3)
¿La Constitución de los Estados Unidos exige que el censo se lleve a cabo, o no es algo que exija la
Constitución? Seleccione solo una respuesta.
1) Sí, la Constitución lo exige
2) No, la Constitución no lo exige
3) No lo sé

Logic:
• Only one response permitted
• Do NOT rotate answer choices
/* END PAGE */
13

/* START PAGE */
Page Title: Attitudinal_Motivators1
Section Display before Q20 (display_Q20)
How important, if at all, is each of the following programs and services to you personally?
Section Display before Q20 Spanish (display_Q20)
¿Qué importancia tienen para usted personalmente, si tienen alguna importancia, cada uno de estos
programas y servicios?
/* RANDOM ROTATE SERIES */
Section Q20 (a_motivator1)
Daycare for children. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q20 Spanish (a_motivator1)
Guarderías para niños. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q21 (a_motivator2)
Fire departments. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q21 Spanish (a_motivator2)
Estaciones de bomberos. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante
14

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q22 (a_motivator3)
Police departments. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q22 Spanish (a_motivator3)
Departamentos de policía. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q23 (a_motivator4)
Hospitals and healthcare. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q23 Spanish (a_motivator4)
Hospitales y cuidado de salud. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
15

/* END SERIES */
/* END PAGE */
/* START PAGE */
Page Title: Attitudinal_Motivators2
Section Display before Q24 (display_Q24)
How important, if at all, is each of the following programs and services to you personally?
Section Display before Q24 Spanish (display_Q24)
¿Qué importancia tienen para usted personalmente, si tienen alguna importancia, cada uno de estos
programas y servicios?
/* RANDOM ROTATE SERIES */
Section Q24 (a_motivator5)
Job training programs. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q24 Spanish (a_motivator5)
Programas de capacitación laboral. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q25 (a_motivator6)
Roads and highways. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q25 Spanish (a_motivator6)
Carreteras y autopistas. Seleccione solo una respuesta.
1) Extremadamente importante
2) Muy importante

16

3) Algo importante
4) No muy importante
5) Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q26 (a_motivator7)
Public transportation. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q26 Spanish (a_motivator7)
Transporte público. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q27 (a_motivator8)
Schools and the education system. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q27 Spanish (a_motivator8)
Escuelas y el sistema educativo. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
17

•
•
•

Only one response permitted
If QORDER = C1 then show written order of answer choices
If QORDER = C2 then show reversed order of answer choices

/* END SERIES */
/* END PAGE */
/* START PAGE */
Page Title: Personal_Motivators
Section Display Q28 (display_Q28)
How important, if at all, is each of the following to you personally?
Section Display Q28 Spanish (display_Q28)
¿Qué importancia tienen para usted personalmente, si tienen alguna importancia, cada una de las
siguientes cosas?
/* RANDOM ROTATE SERIES */
Section Q28 (p_motivator1)
Showing you are proud of your cultural heritage. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q28 Spanish (p_motivator1)
Demostrar que está orgulloso(a) de su herencia cultural. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q29 (p_motivator2)
Contributing to a better future for your community. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
18

Section Q29 Spanish (p_motivator2)
Contribuir a un mejor futuro para su comunidad. Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q30 (p_motivator3)
Fulfilling your civic duty (for example, voting, jury duty, paying taxes). Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q30 Spanish (p_motivator3)
Cumplir con su deber cívico (por ejemplo, votar, cumplir con el deber de servir en un jurado, pagar
impuestos). Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q31 (p_motivator4)
That civil rights laws are enforced. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q31 Spanish (p_motivator4)
Hacer que se cumplan las leyes de derechos civiles. Seleccione solo una respuesta.
19

1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END SERIES */
/* END PAGE */
/* START PAGE */
Page Title: Use_of_Census3
Section Display Q32 (display_Q32)
The following are some ways in which the 2020 Census will be used. How important, if at all, is each of
these uses to you personally?
Section Display Q32 Spanish (display_Q32)
A continuación se presentan algunas de las formas en las que se usará el Censo del 2020. ¿Qué
importancia tiene cada uno de estos usos para usted personalmente, si tienen alguna importancia?
/* RANDOM ROTATE SERIES */
Section Q32 (use9)
Determining how many elected representatives your state has in Congress. Select only one answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q32 Spanish (use9)
Determinar cuántos representantes electos tiene su estado en el Congreso. Seleccione solo una
respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
20

Section Q33 (use10)
Providing information for your local government to plan for changes in your community. Select only one
answer.
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Section Q33 Spanish (use10)
Proporcionar información a su gobierno local para planificar cambios en su comunidad. Seleccione solo
una respuesta.
1)
2)
3)
4)
5)

Extremadamente importante
Muy importante
Algo importante
No muy importante
Nada importante

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END SERIES */
/* END PAGE */
/* START PAGE */
Page Title: All_Motivators
Section Q34 (all_motivators)
Which ONE of the following is the most important reason, to you personally, that you should fill out the
census form? Select only one answer.
1) It helps determine funding for public services in my community, like schools and fire
departments
2) It determines how many elected representatives my state has in Congress
3) It is used to enforce civil rights laws
4) It provides information for my local government to plan for changes in my community
5) It shows that I am proud of my cultural heritage
6) It is my civic duty (along with voting, jury duty, paying taxes)
7) It contributes to a better future for my community
Section Q34 Spanish (all_motivators)
¿CUÁL de las siguientes razones es la más importante para usted personalmente por la que debería
llenar el formulario del censo? Seleccione solo una respuesta.
1) Ayuda a determinar el financiamiento para servicios públicos en mi comunidad, como
escuelas y estaciones de bomberos
2) Determina cuántos representantes electos tiene mi estado en el Congreso
21

3)
4)
5)
6)

Se usa para hacer cumplir las leyes de derechos civiles
Proporciona información a mi gobierno local para planificar cambios en mi comunidad
Demuestra que estoy orgulloso(a) de mi herencia cultural
Es mi deber cívico (como votar, cumplir con el deber de servir en un jurado, pagar
impuestos)
7) Contribuye a un mejor futuro para mi comunidad
Logic:
• Only one response permitted
• Random rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Trust_in_Government
Section Q35 (trust_federal)
How much of the time do you think you can trust the FEDERAL government to do what is right? Select
only one answer.
1) Just about always
2) Most of the time
3) Only some of the time
4) None of the time
Section Q35 Spanish (trust_federal)
¿Con qué frecuencia puede confiar en que el gobierno FEDERAL hará lo correcto? Seleccione solo una
respuesta.
1)
2)
3)
4)

Casi siempre
La mayor parte del tiempo
Solo parte del tiempo
En ningún momento

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q36 (trust_state)
How much of the time do you think you can trust your STATE government to do what is right? Select
only one answer.
1) Just about always
2) Most of the time
3) Only some of the time
4) None of the time

22

Section Q36 Spanish (trust_state)
¿Con qué frecuencia puede confiar en que su gobierno ESTATAL hará lo correcto? Seleccione solo una
respuesta.
1)
2)
3)
4)

Casi siempre
La mayor parte del tiempo
Solo parte del tiempo
En ningún momento

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q37 (trust_local)
How much of the time do you think you can trust your LOCAL government to do what is right? Select
only one answer.
1) Just about always
2) Most of the time
3) Only some of the time
4) None of the time
Section Q37 Spanish (trust_local)
¿Con qué frecuencia puede confiar en que su gobierno LOCAL hará lo correcto? Seleccione solo una
respuesta.
1) Casi siempre
2) La mayor parte del tiempo
3) Solo parte del tiempo
4) En ningún momento
Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END PAGE */
/* START PAGE */
Page Title: Confidentiality
Section Q38 (concern1)
How concerned are you, if at all, that the Census Bureau will not keep answers to the 2020 Census
confidential? Select only one answer.
1) Extremely concerned
2) Very concerned
3) Somewhat concerned
4) Not too concerned
5) Not at all concerned
23

Section Q38 Spanish (concern1)
¿Qué tan preocupado(a) está, si está preocupado(a), de que la Oficina del Censo no mantenga las
respuestas al Censo del 2020 confidenciales? Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente preocupado(a)
Muy preocupado(a)
Algo preocupado(a)
No muy preocupado(a)
Nada preocupado(a)

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q39 (concern2)
How concerned are you, if at all, that the Census Bureau will share answers to the 2020 Census with
other government agencies? Select only one answer.
1) Extremely concerned
2) Very concerned
3) Somewhat concerned
4) Not too concerned
5) Not at all concerned
Section Q39 Spanish (concern2)
¿Qué tan preocupado(a) está, si está preocupado(a), de que la Oficina del Censo comparta las
respuestas al Censo del 2020 con otras agencias gubernamentales? Seleccione solo una respuesta.
1) Extremadamente preocupado(a)
2) Muy preocupado(a)
3) Algo preocupado(a)
4) No muy preocupado(a)
5) Nada preocupado(a)
Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
Section Q40 (concern3)
How concerned are you, if at all, that the answers you provide to the 2020 Census will be used against
you? Select only one answer.
1) Extremely concerned
2) Very concerned
3) Somewhat concerned
4) Not too concerned
5) Not at all concerned
Section Q40 Spanish (concern3)
24

¿Qué tan preocupado(a) está, si está preocupado(a), de que las respuestas que usted le proporcione al
Censo del 2020 se usen en su contra? Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Extremadamente preocupado(a)
Muy preocupado(a)
Algo preocupado(a)
No muy preocupado(a)
Nada preocupado(a)

Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END PAGE */
/* START PAGE */
Page Title: Efficacy
Section Q41 (efficacy)
How much, if at all, do you think it matters if you personally are counted in the 2020 Census? Select only
one answer.
1) A great deal
2) A lot
3) A moderate amount
4) A little
5) Not at all
Section Q41 Spanish (efficacy)
¿Cuánta importancia cree que tiene, si tiene importancia, el que usted personalmente sea contado(a) en
el Censo del 2020? Seleccione solo una respuesta.
1) Muchísima importancia
2) Mucha importancia
3) Una cantidad moderada de importancia
4) Un poco de importancia
5) Nada de importancia
Logic:
• Only one response permitted
• If QORDER = C1 then show written order of answer choices
• If QORDER = C2 then show reversed order of answer choices
/* END PAGE */
Section Code Insert for Community Question (qinsert1)
## CODES THE QUESTION TEXT INSERT FOR NEXT QUESTION ##
1) benefit or harm
2) harm or benefit
25

Section Code Insert for Community Question in Spanish (qinsert1)
## CODES THE QUESTION TEXT INSERT FOR NEXT QUESTION ##
1) beneficiar o perjudicar
2) perjudicar o beneficiar
Logic:
• Do NOT ask respondents
• Randomly assign one option to respondents
/* START PAGE */
Page Title: Community_Benefits
Section Q42 (benefit_harm_community)
Do you believe that answering your 2020 Census form could /* [INSERT QINSERT1: benefit or harm
(harm or benefit)] */ YOUR COMMUNITY in any way? Select only one answer.
1) Benefit
2) Harm
3) Both benefit and harm /* DO NOT ROTATE */
4) Neither benefit nor harm /* DO NOT ROTATE */
Section Q42 Spanish (benefit_harm_community)
¿Cree que llenar el formulario del Censo del 2020 podría /* [INSERT QINSERT1: beneficiar o perjudicar
(perjudicar o beneficiar)] */ a SU COMUNIDAD de algún modo? Seleccione solo una respuesta.
1) Beneficiar
2) Perjudicar
3) Tanto beneficiar como perjudicar /* DO NOT ROTATE */
4) Ni beneficiar ni perjudicar /* DO NOT ROTATE */
Logic:
• Only one response permitted
• Make sure order of answer choice matches order of question text:
o If QINSERT1 = C1 then show answer choices as below:
 For English:
1) Benefit
2) Harm
3) Both benefit and harm /* DO NOT ROTATE */
4) Neither benefit nor harm /* DO NOT ROTATE */
 For Spanish:
1) Beneficiar
2) Perjudicar
3) Tanto beneficiar como perjudicar /* DO NOT ROTATE */
4) Ni beneficiar ni perjudicar /* DO NOT ROTATE */
o If QINSERT1 = C2 then show answer choices as below:
 For English:
1) Harm
2) Benefit
3) Both harm and benefit /* DO NOT ROTATE */
26



4) Neither harm nor benefit /* DO NOT ROTATE */
For Spanish:
1) Perjudicar
2) Beneficiar
3) Tanto perjudicar como beneficiar /* DO NOT ROTATE */
4) Ni perjudicar ni beneficiar /* DO NOT ROTATE */

/* END PAGE */
Section Code Insert for Personal Question (qinsert2)
## CODES THE QUESTION TEXT INSERT FOR NEXT QUESTION ##
1) benefit or harm
2) harm or benefit
Section Code Insert for Personal Question in Spanish (qinsert2)
## CODES THE QUESTION TEXT INSERT FOR NEXT QUESTION ##
1) beneficiarlo(a) o perjudicarlo(a)
2) perjudicarlo(a) o beneficiarlo(a)
Logic:
• Do NOT ask respondents
• Make sure order of QINSERT2 matches order of QINSERT1:
o If QINSERT1 = C1 then QINSERT2 =C1
o If QINSERT1 = C2 then QINSERT2 =C2
/* START PAGE */
Page Title: Personal_Benefits
Section Q43 (benefit_harm_personal)
Do you believe that answering your 2020 Census form could personally /* [INSERT QINSERT2: benefit or
harm (harm or benefit)] */ YOU in any way? Select only one answer.
1) Benefit
2) Harm
3) Both benefit and harm
4) Neither benefit nor harm
Section Q43 Spanish (benefit_harm_personal)
¿Cree que llenar el formulario del Censo del 2020 podría /* [INSERT QINSERT2: beneficiarlo(a) o
perjudicarlo(a) (perjudicarlo(a) o beneficiarlo(a)) ] */ a USTED personalmente de alguna forma?
Seleccione solo una respuesta.
1) Beneficiarme
2) Perjudicarme
3) Tanto beneficiarme como perjudicarme
4) Ni beneficiarme ni perjudicarme
Logic:
• Only one response permitted
27

•

Make sure order of answer choice matches order of question text:
o If QINSERT1 = C1 then show answer choices as below:
 For English:
1) Benefit
2) Harm
3) Both benefit and harm
4) Neither benefit nor harm
 For Spanish:
1) Beneficiarme
2) Perjudicarme
3) Tanto beneficiarme como perjudicarme
4) Ni beneficiarme ni perjudicarme
o If QINSERT1 = C2 then show answer choices as below:
 For English:
1) Harm
2) Benefit
3) Both harm and benefit
4) Neither harm nor benefit
 For Spanish:
1) Perjudicarme
2) Beneficiarme
3) Tanto perjudicarme como beneficiarme
4) Ni perjudicarme ni beneficiarme

/* END PAGE */
/* START PAGE */
Page Title: Civic_Participation
Section Q44 (civic_participation)
Which of the following have you ever done, if any? Please select all that apply.
1) Voted in an election
2) Signed a petition (including online petitions)
3) Posted your own thoughts or comments on political or social issues online
4) Volunteered at any organization
5) Worn a button/bracelet/pin for an issue or cause
6) Contacted, or attempted to contact, a politician or civil servant to express your views
7) Attended a neighborhood or community meeting
8) Participated in an organized protest or rally of any kind
9) Donated money or raised funds for social or political activity
10) None of the above /* EXCLUSIVE */ /* DO NOT ROTATE */
Section Q44 Spanish (civic_participation)
¿Cuál de las siguientes acciones ha realizado usted, si ha realizado alguna? Seleccione todas las que
correspondan.
1) Voté en una elección
2) Firmé una petición (incluyendo peticiones por internet)

28

3)
4)
5)
6)
7)
8)
9)
10)

Publiqué mis propias ideas o comentarios sobre asuntos políticos o sociales por internet
Trabajé como voluntario(a) en una organización
Usé una insignia/brazalete/prendedor a favor de una causa
Me comuniqué o intenté comunicarme con un político o funcionario público para expresar
mis puntos de vista
Asistí a una reunión de mi vecindario o de la comunidad
Participé en algún tipo de protesta o manifestación organizada
Doné dinero o recaudé fondos para una actividad social o política
Ninguna de las anteriores /* EXCLUSIVE */ /* DO NOT ROTATE */

Logic:
• Multiple responses permitted
• Random rotate answer choices
• If respondents select response 10 (“None of the above”/ “Ninguna de las anteriores”), other
responses would be grayed out.
Section Q45 (election2016)
Thinking about the 2016 general election for President and other offices, did you happen to vote in the
election, or did things come up that kept you from voting? Select only one answer.
1) Yes, voted in 2016 election
2) No, did not vote in 2016 election
Section Q45 Spanish (election2016)
Piense en las elecciones generales del 2016 para presidente y otros cargos. ¿Votó usted en las
elecciones o surgió algo que le impidió votar? Seleccione solo una respuesta.
1) Sí, voté en las elecciones del 2016
2) No, no voté en las elecciones del 2016
Logic:
• Only one response permitted
• Do NOT rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Age_Gender
Section Display before Q46 (display_Q46)
These final questions are for statistical purposes only.
Section Display before Q46 Spanish (display_Q46)
Estas últimas preguntas se hacen solo con propósitos estadísticos.
Section Q46 (birth_year)
What year were you born? Please enter a number.
____

29

Section Q46 Spanish (birth_year)
¿En qué año nació usted? Por favor ingrese un número.
____
Logic:
• Open end numeric
• Range: 1900 to 2017
• If a respondent enters a number that falls outside of the above range, display the following
message (soft edit):
o For English: “Please enter a number between 1900 and 2017.”
o For Spanish: “Por favor ingrese un número entre 1900 y 2017.”
Section Q47 (gender)
Are you… Select only one answer.
1) Male
2) Female
Section Q47 Spanish (gender)
Usted es… Seleccione solo una respuesta.
1) Hombre
2) Mujer

Logic:
• Only one response permitted
• Do NOT rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Education
Section Q48 (education)
What is the highest degree or level of school you have completed? Select only one answer.
1) No high school
2) Some high school
3) High school graduate or equivalent (for example GED)
4) Some college, but degree not received or is in progress
5) Associate degree (for example AA, AS)
6) Bachelor's degree (for example BA, BS, AB)
7) Graduate degree (for example master's, professional, doctorate)
Section Q48 Spanish (education)
¿Cuál es el grado o nivel de educación más alto que ha completado? Seleccione solo una respuesta.
1) No fui a la escuela secundaria o preparatoria (high school)
2) Algo de escuela secundaria o preparatoria (high school)
3) Graduado(a) de escuela secundaria o preparatoria (high school) o equivalente (por ejemplo,
GED)
30

4)
5)
6)
7)

Algo de universidad, pero no recibí un título o todavía estoy estudiando
Título de asociado universitario (por ejemplo, AA, AS)
Título de licenciatura universitaria (por ejemplo, BA, BS, AB)
Título de posgrado (por ejemplo, título de maestría, título profesional, doctorado)

Logic:
• Only one response permitted
• Do NOT rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Race_Ethnicity
Section Q49 (hispanics)
Are you of Hispanic, Latino, or Spanish origin?
1) No, not of Hispanic, Latino, or Spanish origin
2) Yes, Mexican, Mexican American, Chicano
3) Yes, Puerto Rican
4) Yes, Cuban
5) Yes, another Hispanic, Latino, or Spanish origin (specify origin, for example, Argentinian,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on) /* SPECIFY */ ##
OPEN-ENDED RESPONSE UP TO 60 CHARACTERS ##
Section Q49 Spanish (hispanics)
¿Es usted de origen hispano, latino, o español?
1)
2)
3)
4)
5)

No, no soy de origen hispano, latino, o español
Sí, mexicano, mexicanoamericano, chicano
Sí, puertorriqueño
Sí, cubano
Sí, de otro origen hispano, latino, o español (especifique el origen, por ejemplo, argentino,
colombiano, dominicano, nicaragüense, salvadoreño, español, etc.) /* SPECIFY */ ## OPENENDED RESPONSE UP TO 60 CHARACTERS ##

Logic:
• Only one response permitted
• Do NOT rotate answer choices
• If respondents choose any answer choices other than 5 (“Yes, another Hispanic, Latino, or
Spanish origin”/ “Sí, de otro origen hispano, latino, o español”), remove and/or disable text field
for answer choice 5.
Section Q50 (race)
What is your race? Please select all that apply.
1) White
2) Black or African American
3) American Indian or Alaska Native (specify name of enrolled or principal tribe) /* SPECIFY */
## OPEN-ENDED RESPONSE UP TO 60 CHARACTERS ##
31

4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)

Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian (specify race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so
on) /* SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60 CHARACTERS ##
Native Hawaiian
Chamorro
Samoan
Other Pacific Islanders (specify race, for example, Fijian, Tongan, and so on) /* SPECIFY */
## UP TO 60 CHARACTERS ##
Some other race (specify race) /* SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60
CHARACTERS ##

Section Q50 Spanish (race)
¿Cuál es su raza? Seleccione todas las que correspondan.
1) Blanca
2) Negra o afroamericana
3) Indígena de las Américas o nativa de Alaska (especifique el nombre de la tribu en la cual está

4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)

inscrito[a] o la tribu principal) /* SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60
CHARACTERS ##
India asiática
China
Filipina
Japonesa
Coreana
Vietnamita
Otra asiática (especifique la raza, por ejemplo, hmong, laosiana, tailandesa, paquistaní,
camboyana, etc.) /* SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60 CHARACTERS ##
Nativa de Hawái
Chamorra
Samoana
Otra de las islas del Pacífico (especifique raza, por ejemplo, fiyiana, tongana, etc.) /* SPECIFY
*/ ## OPEN-ENDED RESPONSE UP TO 60 CHARACTERS ##
Alguna otra raza (especifique la raza) /* SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60
CHARACTERS ##

Logic:
• Multiple responses permitted
• Do NOT rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Language1
32

Section Q51 (country_of_birth)
In what country or territory were you born? Select only one answer.
1) In the United States
2) Outside of the United States (specify name of country, or Puerto Rico, Guam, etc.) /*
SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60 CHARACTERS ##
Section Q51 Spanish (country_of_birth)
¿En qué país o territorio nació? Seleccione solo una respuesta.
1) En los Estados Unidos
2) Fuera de los Estados Unidos (especifique el nombre del país o Puerto Rico, Guam, etc.) /*

SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60 CHARACTERS ##

Logic:
• Only one response permitted
• Do NOT rotate answer choices
• If respondents choose answer choice 1, remove and/or disable text field for answer choice 2.
Section Q52 (language1)
Do you speak a language other than English at home? Select only one answer.
1) Yes
2) No
Section Q52 Spanish (language1)
¿Habla algún otro idioma que no sea inglés en su casa? Seleccione solo una respuesta.
1) Sí
2) No

Logic:
•
•
•
•

Only one response permitted
Do NOT rotate answer choices
Go to question 53 (language2) if respondents choose answer choice 1 (Yes)
Skip to question 55 (marital_status) if respondents choose answer choice 2 (No) or skip this
question

/* END PAGE */
/* START PAGE */
Page Title: Language2
Section Q53 (language2)
What is this language? If more than one, other than English what language do you speak most often at
home? Specify language.
______________________________
Section Q53 Spanish (language2)
¿Qué idioma? Si es más de uno, ¿además del inglés, qué idioma habla con mayor frecuencia en su casa?
Especifique el idioma.
______________________________
33

Logic:
• Display this question only to respondents who choose answer choice 1 (Yes) in Q52 (language1)
• Open end
• Limit to 30 characters
Section Q54 (language3)
How well do you speak English? Select only one answer.
1) Very well
2) Well
3) Not well
4) Not at all
Section Q54 Spanish (language3)
¿Qué tan bien habla usted inglés? Seleccione solo una respuesta.
1)
2)
3)
4)

Hablo muy bien
Hablo bien
No hablo bien
Nada

Logic:
• Display this question only to respondents who choose answer choice 1 (Yes) in Q52 (language1)
• Only one response permitted
• Do NOT rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Household
Section Q55 (marital_status)
What is your marital status? Select only one answer.
1) Now married
2) Divorced
3) Separated
4) Widowed
5) Never married
Section Q55 Spanish (marital_status)
¿Cuál es su estado civil? Seleccione solo una respuesta.
1)
2)
3)
4)
5)

Casado(a) actualmente
Divorciado(a)
Separado(a)
Viudo(a)
Nunca me he casado

Logic:
34

•
•

Only one response permitted
Do NOT rotate answer choices

Section Q56 (household1)
Are there any children 5 years old or younger (including babies) currently living in your household?
Select only one answer.
1) Yes
2) No
Section Q56 Spanish (household1)
¿Actualmente viven en su hogar niños de 5 años de edad o menores (incluyendo bebés)? Seleccione solo
una respuesta.
1) Sí
2) No
Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q57 (household2)
Are there any children ages 6 to 17 years old currently living in your household? Select only one answer.
1) Yes
2) No
Section Q57 Spanish (household2)
¿Actualmente viven en su hogar niños de 6 a 17 años de edad? Seleccione solo una respuesta.
1) Sí
2) No
Logic:
• Only one response permitted
• Do NOT rotate answer choices
Section Q58 (household3)
How many total people – adults and children – currently live in your household, including yourself? Please
enter a number.
____
Section Q58 Spanish (household3)
¿Cuántas personas en total – adultos y niños – viven actualmente en su hogar, incluyéndose a sí mismo(a)?
Por favor ingrese un número.
____
Logic:
• Open end numeric
• Range: 1 to 40
35

•

If a respondent enters a number that falls outside of the above range, display the following
message (soft edit):
o For English: “Please enter a number between 1 and 40.”
o For Spanish: “Por favor ingrese un número entre 1 y 40.”

/* END PAGE */
/* START PAGE */
Page Title: Rent
Section Q59 (rent)
Do you rent or own your house or apartment? Select only one answer.
1) Own
2) Rent
3) Occupied without payment of rent
Section Q59 Spanish (rent)
¿Usted alquila su casa o apartamento o es dueño(a)? Seleccione solo una respuesta.
1) Dueño(a)
2) Alquilo
3) Ocupo la vivienda sin pagar alquiler

Logic:
• Only one response permitted
• Do NOT rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Sexual_Orientation
Section Q60 (sexual_orientation)
Which of the following best represents how you think of yourself? Select only one answer.
1) Lesbian or gay
2) Straight, that is not lesbian or gay
3) Bisexual
4) Something else (please specify) /* SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60
CHARACTERS ##
5) I don't know the answer
Section Q60 Spanish (sexual_orientation)
¿Cuál de las siguientes describe cómo usted se identifica a sí mismo(a)? Seleccione solo una respuesta.
1)
2)
3)
4)

Lesbiana o gay
Heterosexual, es decir ni lesbiana ni gay
Bisexual
Otro (Por favor, especifique) /* SPECIFY */ ## OPEN-ENDED RESPONSE UP TO 60
CHARACTERS ##
5) No sé la respuesta
36

Logic:
• Only one response permitted
• Do NOT rotate answer choices
• If respondents choose any answer choices other than 4 (“Something else”/“Otro”), remove
and/or disable text field for answer choice 4.
/* END PAGE */
/* START PAGE */
Page Title: Income
Section Q61 (income)
In 2018 what was your total household income before taxes? Select only one answer.
1) Less than $25,000
2) $25,000 - $34,999
3) $35,000 - $49,999
4) $50,000 - $74,999
5) $75,000 - $99,999
6) $100,000 - $149,999
7) $150,000 - $199,999
8) $200,000 and above
Section Q61 Spanish (income)
En el 2017, ¿cuál fue el ingreso total de su hogar antes de que le descontaran los impuestos? Seleccione
solo una respuesta.
1)
2)
3)
4)
5)
6)
7)
8)

Menos de $25,000
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 y más

Logic:
• Only one response permitted
• Do NOT rotate answer choices
/* END PAGE */
/* START PAGE */
Page Title: Address_Page
Section Address
*SEE APPENDED ISR NON-ID ADDRESS ITEMS, WHICH WILL APPEAR HERE*

/* START PAGE */
Page Title: Submit_Page
37

Section Submit Page (Submit)
That concludes the survey. Please click on the “Submit” button when you are finished.
Section Submit Page Spanish (Submit)
Con esto terminamos la encuesta. Haga clic en el botón “Enviar” cuando haya terminado.
## SUBMIT BUTTON DISPLAYED HERE ##
Logic:
• Users can still use the “Previous” navigator to go back to the survey before clicking the Submit
button.
/* END PAGE */
/* START PAGE */
Page Title: Thank_You_Page
Section Thank You Page (display_ThankYou)
Thank you for participating in the 2020 Census Planning Survey.
If you have any questions about this survey please visit www.census.gov/plan. You can validate that this
survey is a legitimate federally-approved information collection using the U.S. Office of Management
and Budget approval number 0607-0978, expiring on 08/31/2020.
Section Thank You Page Spanish (display_ThankYou)
Gracias por participar en la Encuesta de Planificación del Censo del 2020.
Si tiene alguna pregunta sobre esta encuesta, visite www.census.gov/plan. Puede confirmar que esta
encuesta es una recopilación de información legítima aprobada por el gobierno federal usando el
número de aprobación 0607-0978 de la Oficina de Administración y Presupuesto de los Estados Unidos,
que vence el 08/31/2020.
/* END PAGE */

38

Residence

If valid address is provided, end address collection
If “I do not have a street address” is selected, got to Rural_Route

Rural_Route

If “Yes”, go to RR_Address
If “No”, go to Homeless

RR_Address

If valid address is provided, end address collection

Homeless

Goto “Other_Address”

Other_Address

If valid address is provided, end address collection

RESIDENCE
Screen Name
Help Text link
Help Text
Before REFDATE

RESIDENCE
RESIDENCE
Please type in the street address of the place where you will be living on
.
If you have more than one address associated with your residence, please
provide the street address if available.
For example, if you normally use a P.O. Box or Rural Route address for
mailing purposes, please enter a physical street address, such as what you
would give to a shipping company to have a package delivered to your
home. In addition, some P.O. Box addresses look like street addresses,
but are actually the addresses for private mailboxes at a business or the
Post Office.
We only want the street address of where you will be living or staying on
.
For Street Addresses, such as 5007 N Maple Ave, you can enter your
address into the address fields.
•
•
•

•

Help Text
On or After
REFDATE

Address Number is the numeric or alphanumeric identifier from
your street address, for example 5007 or 5007-A.
Street Name is the name of your street, for example N Maple
Ave.
Apt/Unit refers to any unit information that is part of your
address, such as an apartment number, unit number, or lot. You
will need to enter both the unit type and number. For example,
enter “Apt A” or “Lot 3” or “Unit 2-H” or “Room 12”.
If you share the same address with other living quarters, such as a
basement or garage apartment, or even a separate structure on the
same lot (e.g., a trailer behind the main house), please provide
this in the Apt/Unit.

Please type in the street address of the place where you were living on
.
If you have more than one address associated with your residence, please
provide the street address if available.
For example, if you normally use a P.O. Box or Rural Route address for
mailing purposes, please enter a physical street address, such as what you
would give to a shipping company to have a package delivered to your
home. In addition, some P.O. Box addresses look like street addresses,

but are actually the addresses for private mailboxes at a business or the
Post Office.
We only want the street address of where you were living or staying on
.
For Street Addresses, such as 5007 N Maple Ave, you can enter your
address into the address fields.
•
•
•

•

RURAL ROUTE
Screen Name
Help Text link
Help Text

RR_ADDRESS
Screen Name
Help Text link
Help Text
Before REFDATE

Address Number is the numeric or alphanumeric identifier from
your street address, for example 5007 or 5007-A.
Street Name is the name of your street, for example N Maple
Ave.
Apt/Unit refers to any unit information that is part of your
address, such as an apartment number, unit number, or lot. You
will need to enter both the unit type and number. For example,
enter “Apt A” or “Lot 3” or “Unit 2-H” or “Room 12”.
If you share the same address with other living quarters, such as a
basement or garage apartment, or even a separate structure on the
same lot (e.g., a trailer behind the main house), please provide
this in the Apt/Unit.

RURAL_ROUTE
RURAL_ROUTE
You have previously indicated that you do not have a street address.
Please let us know if you have a Rural Route address, such as RR 101
Box 2 Suitland, MD 20746.

RR_ADDRESS
RR_ADDRESS
If you normally use a Rural Route address for mailing purposes, you will
need to enter your Rural Route address.
If you have a Street Address, such as what you would give to a shipping
company to have a package delivered to your home, please use the
“Previous” buttons to take you to that address collection screen.
Otherwise, enter your Rural Route address into the address fields.
• Use the drop-down menu to select the Rural Route Descriptor, such
as:
o RR – Rural Route

o HC – Contract Delivery Service Route (formerly Highway
Contract Route)
o SR – Star Route
o PS – Postal Service
o RTE – Route
• Provide the number of the Rural Route
• Provide the number of the Box
• Provide a city, state, and ZIP Code
You may also describe the physical location of where you will be living
on in the “Physical Location Description” box. Please
provide as much information as possible.
Help Text
On or After
REFDATE

If you normally use a Rural Route address for mailing purposes, you will
need to enter your Rural Route address.
If you have a Street Address, such as what you would give to a shipping
company to have a package delivered to your home, please use the
“Previous” buttons to take you to that address collection screen.
Otherwise, enter your Rural Route address into the address fields.
• Use the drop-down menu to select the Rural Route Descriptor, such
as:
o RR – Rural Route
o HC – Contract Delivery Service Route (formerly Highway
Contract Route)
o SR – Star Route
o PS – Postal Service
o RTE – Route
• Provide the number of the Rural Route
• Provide the number of the Box
• Provide a city, state, and ZIP Code
You may also describe the physical location of where you were living on
in the “Physical Location Description” box. Please
provide as much information as possible.

HOMELESS
Screen Name
Help Text link
Help Text
Before REFDATE

HOMELESS
HOMELESS
You have previously indicated that you do not have a street address or a
Rural Route address. Answer "Yes" if you will be experiencing
homelessness or will not have a permanent place to live on
.

Help Text
On or After
REFDATE

OTHER_ADDRESS
Screen Name
Help Text link
Help Text
Before REFDATE

You have previously indicated that you do not have a street address or a
Rural Route address. Answer "Yes" if you were experiencing
homelessness or did not have a permanent place to live on .

OTHER_ADDRESS
OTHER_ADDRESS
If you have a Street Address, such as what you would give to a shipping
company to have a package delivered to your home, please use the
“Previous” buttons to take you to that address collection screen.
Otherwise, please provide a city and state, OR ZIP Code into the address
fields.

Help Text
On or After
REFDATE

You may also describe the physical location of where you will be living
on in the “Physical Location Description” box. Please
provide as much information as possible.
If you have a Street Address, such as what you would give to a shipping
company to have a package delivered to your home, please use the
“Previous” buttons to take you to that address collection screen.
Otherwise, please provide a city and state, OR ZIP Code into the address
fields.
You may also describe the physical location of where you were living on
in the “Physical Location Description” box. Please
provide as much information as possible.