FSA Research Participant Recruiting Questionnaire w burden statement

Federal Student Aid

Digital & Customer Care Platform & Services Design Research Screener Question Pool

OMB Control Number: 1845-0159

Demographic questions

First name

[text entry]

Last name

[text entry]

Email

[text entry]

Phone number

[number entry]

State or territory of residence

[text entry]

Age group

• Under 18

• 18-24 years old

• 25-34 years old

• 35-44 years old

• 45-54 years old

• 55-64 years old

• 65-74 years old

• 75 years or older

Can you claim anyone as a dependent?

• Yes

• No

What is your dependent’s education level(s)? (Check all that apply)

• Less than High School

• High School or GED

• Vocational or other

• Some college, no degree

• Associate degree

• Bachelor’s degree

• Other: [text entry]

Are you currently in the armed forces?

• Yes

• No

Have you ever served in the military?

• Yes

• No

Are you of Hispanic or Latino descent?

• Yes

• No

What race do you most identify with? (Check all that apply)

• Native American or Alaska Native

• Asian

• Black or African American

• Native Hawaiian or Other Pacific Islander

• White

• Prefer not to answer

What is your parents’ education level?

• Neither parent completed college

• One parent completed college

• Both parents completed college

What is your marital status?

• Single

• Married

• Divorced

• Other: [text entry]

• Prefer not to answer

How would you rate your fluency in English?

• Native

• Fluent

• Conversational

• Beginner

• I don’t speak English

Would you consider yourself an English learner?

• Yes

• No

Would you or anyone in your family consider themselves an English learner?

• Yes

• No

How would you rate your fluency in Spanish?

• Native

• Fluent

• Conversational

• Beginner

• I don’t speak Spanish

Are you a native or fluent speaker of any other languages? If so, please specify.

[text entry]

What is your household income?

• $0 - 25,000

• $26,000- $50,000

• $51,000 - $75,000

• $76,000 - $125,000

• $126,000 - $150,000

• $150,000+

• Don’t know/Not sure

• Prefer not to answer

Education

What is the highest level of education you have completed?

• Some high school

• High school graduate

• Professional or career school

• Some college

• Associate’s degree

• Bachelor’s degree

• Some graduate school

• Master’s degree

• Doctoral degree

What best describes your current situation in regard to college or career school?

• I attend in-person

• I am an online student

• I attend both online and in-person

• I deferred my acceptance

• I took a leave of absence

• I withdrew

• I graduated

• I will be attending school

• I don’t plan to attend school

• Other: [text entry]

Are you a first-generation college student?

• Yes

• No

• Don’t know/Not sure

What is your current enrolment status?

• Part time

• Full time

What degree are you pursuing?

• Certificate

• Associate’s degree

• Bachelor’s degree

• Master’s degree

• Doctoral degree

• Undecided

When did you graduate from your most recent schooling?

• 0–5 months ago

• 6–12 months ago

• 1–2 years ago

• 2-5 years ago

• 5+ years ago

• I’m currently in school

• Don’t know/Not sure

Do you have any dependents currently enrolled in a post-secondary school (college or career school)?

• Yes

• No

What type of college or career school is/are your dependent(s) attending? (check all that apply)

• Two-year Public

• Four-year Public

• Two-year Private

• Four-year Private

• Proprietary

• Vocational

Federal Student Aid: Student Loans and grants

Have you received financial aid from the federal government to help pay for school? (Check all that apply)

• Direct subsidized loan

• Direct unsubsidized loan

• Direct Parent PLUS loan

• Direct Grad PLUS loan

• Federal Perkins loan

• Federal Family Education Loan (FFEL)

• Direct Consolidated loan

• Pell Grant

• ISAG Grant

• FSEOG Grant

• TEACH Grant

• Work-study program

• I have not received any financial aid from the federal government

• Don’t know/Not sure

How much federal student loan debt do you have?

• < $10,000

• $10,001–$25,000

• $25,001–$75,000

• $75,001–$100,000

• $100,000+

• Prefer not to say

• Don’t know/Not sure

Have you started paying back your loans?

• Yes

• No

• Don’t know/Not sure

Which of the following best describes your situation in regard to making payments on your student loans?

• I am in a grace period

• I am making payments on time

• I am behind on my payments

• My loans are in default

• My loans are in deferment or forbearance

• I completed my payments

• Other: [text entry]

What repayment plan are you on?

• Standard Repayment Plan

• Graduated Repayment Plan

• Extended Repayment Plan

• Income-driven Repayment Plan

• Don’t know/Unsure

Which Income-Driven Repayment Plan are you on?

• Revised Pay As You Earn Repayment Plan (REPAYE)

• Pay As You Earn Repayment Plan (PAYE)

• Income-Based Repayment Plan (IBR)

• Income-Contingent Repayment Plan (ICR)

• Income-Sensitive Repayment Plan

• Don’t know/Not sure

Have you ever defaulted on your federal student loans?

• Yes

• No

• Don’t know/Unsure

Are any of your current student loans in delinquent status or have defaulted?

• Yes

• No

• Don’t know/Unsure

Have you ever participated in a user research activity, market research discussion group, or individual interview with the Department of Education or Federal Student Aid before?

• Yes

• No

When was the last time you participated in a user research activity, market research discussion group, or individual interview?

• Within the past three months

• 3-12 months

• Over a year ago

Employment

Which of the following best describes your current employment situation?

• Employed full time

• Employed part time

• Not employed, seeking work

• Not employed, not seeking work

What is your current job?

[text entry]

Which of the following best describes your employer?

• Government organizations (federal, state, local, or tribe)

• Not-for-profit organizations

• Private business

• Other: [text entry]

• Don’t know/Not sure

Do your work for an institution of higher education?

• Yes

• No

Do you work at a college financial aid office?

• Yes

• No

What is your job within your college’s financial aid office?

[text entry]

Do you work in a nonprofit that focuses on higher education?

• Yes

• No

Do you work at a secondary school (high school)?

• Yes

• No

Are you a secondary school (high school) counselor?

• Yes

• No

Are you a post-secondary school (college) counselor?

• Yes

• No

Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number.  The valid OMB control number for this information collection is 1845-0159.  Public reporting burden for this collection of information is estimated to average 6 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  The obligation to respond to this collection is voluntary.  If you have any comments concerning the accuracy of the time estimate, suggestions for improving this individual collection, or if you have comments or concerns regarding the status of your individual form, application or survey, please contact FSA.brand@ed.gov or 1-800-433-3243 directly.