Participants will be recruited by telephone and via Qualtrics for the focus groups, per the criteria in Appendix B. Participants may choose to self-respond using the Qualtrics link provided in the advertisements. For those that choose to contact the recruiter to be screened, the recruiter will screen potential participants over the phone to meet the desired audience composition for each focus group. The project lead will choose participants for each focus group. The recruiter will call the selected participants to schedule them for the focus group.
RECRUITER-ADMINISTERED SCREENING QUESTIONNAIRE
Introduction
/* DISPLAY */ Hello, my name is ______ and I work at the U.S. Census Bureau. We are conducting focus groups in person, [IF AN OUTGOING CALL: and you have previously indicated a desire to participate in focus groups].
The focus group will take about 90 minutes, and you will receive $75 for your time. If you are still interested in participating, I will ask you a few questions to see if you qualify. The questions I will ask on this call will take about five to 10 minutes.
May we proceed? /*If yes, proceed*/ If no, thank and end call*/
Before we start, I want to tell you a few things about the focus group and the questions I will be asking you now. Your participation is voluntary, but your responses are important. You can choose not to answer any or all questions. The questions I am about to ask you and the focus group itself have been authorized for collection by U.S. Office of Management and Budget, approval number [XXXX-XXXX], expiring on [DATE].
Are you willing to participate? [IF YES] Great, I have a few questions to see if you qualify for this study.
CBSM UNIVERSAL Screener Questions
What is your name?
First name:_____________________
Last name:_____________________
What is your daytime telephone number? [Probe for all 3 phone numbers]
Mobile ([ ]) [ ] – [ ]
Home (if not mobile) ([ ]) [ ] – [ ]
Work (if any) ([ ]) [ ] – [ ] EXT.[ ]
In what City and State code do you currently live?
City:_____________________
State:_____________________
When, if ever, was the last time you participated in a marketing research study, such as a consumer interview or a group discussion? DO NOT READ LIST
Within the past three months [ ] > INELIGIBLE
Over three months ago [ ] > CONTINUE
Never [ ] > CONTINUE
How old are you? (DO NOT READ ANSWER CHOICES)
17 or younger ## ASK FOR ANOTHER PERSON, THEN END CALL ##
18–24
25-34
35-54
55+
What sex were you assigned at birth, on your original birth certificate?
1) Male
2) Female
Do you currently describe yourself as female, male, or transgender, non-binary, or another gender?
1) Female
2) Male
3) Transgender, non-binary, or another gender
4) Prefer not to answer
/* QRaceEthnicity */ What is your race and/or ethncity? You may provide more than one group. /* MULTIPLE RESPONSES PERMITTED */
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
/* QNativity*/ In what country or territory were you born? [DON’T READ CHOICES, CIRCLE RESPONSE.]
In the United States
Other /* SPECIFY */
/* QAge_At_Immigration */ ## IF QNATIVITY=C2 ## How old were you when you first came to the United States? (IF ASKED: this information is being asked to ensure a broad range of experiences are represented in the discussion. Answers will not be shared for marketing or any other purpose.)
17 or older ## 1st Generation ##
16 or younger ## 1.5 Generation, meaning more acculturation ##
Do you speak a language other than English at home?
o Yes (ask follow-up question 12a) ( score 1 point)
o No (skip to next question) a. What language or languages do you speak at home? Please select one or more.
[ ] Spanish
[ ] Chinese
[ ] Korean
[ ] Vietnamese
[ ] Arabic
[ ] Russian
[ ] Other - Specify
/* QLanguage Preference*/ ## IF QLANGUAGE = NOT ENGLISH ## When both are available, do you prefer to complete forms in English or [LANGUAGE]? (EXAMPLES IF CONFUSED: government forms, questionnaires, school forms, medical forms)
English
[LANGUAGE]
Either way
/*QEDU */ What is the highest grade or year of schooling you have completed?
High school or Less
Some college
College graduate or postgraduate degree
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 9a and 9b)
Part-time (ask follow-up questions 9a and 9b)
Not working for pay at this time (skip to next question)
a. What is your current job title or job description? [open text]
b. Are you employed by the Federal Government? (if federal contractor, mark NO)
• Yes
• No
What is your marital status?
Married
Widowed
Divorced
Separated
Never married
What is your total annual household income?
Less than $15,000
$15,000 to $24,999
$25,000 to $49,999
$50,000 to $99,999
More than $100,000
How many people age 18 or older currently live in your household, INCLUDING yourself?
( score 1 point for each person)
How many people younger than 18 currently live in your household?
( score 1 point for each person)
Do you own a cell phone?
o Yes
o No (skip to next question)
a. 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?
b. What type of smartphone do you have?
Do you own a desktop or laptop computer, or both?
o Desktop computer
o Laptop computer
o Both desktop and laptop computer
o Neither
Do you own a tablet computer such as an iPad, Samsung Galaxy Tab, Google Nexus, or Kindle Fire?
o Yes
o No
Do you have at least one year of Internet experience?
o Yes (ask follow-up questions 16a and 16b)
o No (skip to next question) d. 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?
o Several times a day
o About once a day
o A few times a week
o A few times a month
o A few times a year
o Not at all [do not read to respondent]
How did you hear about this research opportunity?
o E-mail link
o Census Bureau employee
o Friend or family member (but not a Census Bureau employee)
o Facebook
o Craigslist
o Google advertisement
o Flyer
o Newspaper advertisement
o Other – specify
What is the e-mail address we should use when sending directions to our office, should you qualify for a study? __________________
UNDERCOUNT OF YOUNG CHILDREN
SUPPLEMENTAL SCREENer QUESTIONS
Is your home owned, rented or occupied without payment of rent?
a. owned
b. rented ( score 1 point)
c. occupied without payment of rent ( score 1 point)
d. Don’t know/Refused ( score 1 point)
What type of home do you live in?
a. House, townhouse or condo
b. Apartment ( score 1 point)
c. Something else ( score 1 point)
d. Don’t know/Refused ( score 1 point)
Do any children under age 5 live in your household?
a. Yes ( score 2 points) 3b. How many?____( score 1 point for each person)
b. No
c. Don’t know/refused ( score 2 points)
Do any children under age 5 stay at your household, even if it’s just for a night or two?
Yes ( score 4 points)
No
Don’t know/refused ( score 4 points)
Do any foster children live or stay at your household, even if it’s just for a night or two?
Yes ( score 4 points)
No
Don’t know/refused ( score 4 points)
Is everyone who lives or stays at your household related to each other?
Yes
No ( score 4 points)
Don’t know/Refused ( score 4 points)
Has anyone moved in or out of your household recently – say in the last year or so?
Yes ( score 4 points)
No
Don’t know/Refused ( score 4 points)
Is anyone in your household the grandparent of a child who lives or stays there sometimes?
Yes ( score 2 points)
No
Don’t know/Refused ( score 2 points)
Is anyone in your household the mother of a child who lives or stays there sometimes?
Yes ( score 1 point) 9a. How old is the mother? ____(if under 30 score 1 pt)
9b. Is the mother…
married
divorced or separated ( score 1 point)
widowed or ( score 1 point)
never married? ( score 1 point)
No
Don’t know/refused ( score 1 point)
Is anyone in your household the father of a child who lives or stays there sometimes?
Yes ( score 1 point) 10a. How old is the father? ____(if under 30 score 1 pt)
10b. Is the father…
married
divorced or separated ( score 1 point)
widowed or ( score 1 point)
never married? ( score 1 point)
No
Don’t know/Refused ( score 1 point)
Is anyone living or staying at your household temporarily while they find another place to live?
Yes ( score 4 points)
No
Don’t know/Refused ( score 4 points)
If the census were held today, how likely would you be to fill out the census form?
Extremely likely ( score 1 point)
Very likely ( score 1 point)
Somewhat likely ( score 1 point)
Not too likely
Not at all likely
/* DISPLAY */Thank you. You may be eligible to participate in the focus group on XX/XX. If you are chosen to participate, a member of the team will contact you to provide more information and schedule you for the focus group. If you have any questions or comments about this study, you may send them to rodney.terry@census.gov.
[END OF RECRUITER-ADMINISTERED SCREENER]
SELF-ADMINSTERED SCREENING QUESTIONNAIRE
Available at www.XXXXXXXX.com
The U.S. Census Bureau is conducting research to understand how people make decisions about responding to the U.S. census. Selected participants will be asked for their thoughts and opinions about some topics related to the U.S. Census Bureau. If you are eligible, we will invite you to a 90-minute focus group which will be conducted in person at [Location]. You will receive $75 for participating in the focus group.
To determine if you are eligible for the focus group, we must ask you a few screening questions about your background. Your participation in the eligibility screening is completely voluntary. You may stop at any time or skip questions that you do not want to answer.
The U.S. Census Bureau is required by law to protect your information. The Census Bureau is not permitted to publicly release your responses in a way that could identify you. We are conducting this voluntary survey under the authorizing legislation for the questionnaire being tested. Federal law keeps your answers confidential (Title 13, United States Code, Section 9). Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.
Your privacy is protected by the Privacy Act, Title 5 U.S. Code. There are a limited number of uses of your data permitted under the Privacy Act. You can find a list of these uses in the System of Records Notice named “SORN COMMERCE/Census-7, Demographic Survey Collection (non-Census Bureau Sampling Frame).”
We estimate that completing the screening questions will take 10 minutes on average. This information collection has been approved by the Office of Management and Budget (OMB). You can validate that this survey is a legitimate federally-approved information collection using the Office of Management and Budget's approval number [XXXX-XXXX], which expires on [DATE]. We are required to tell you this number to conduct this survey. Send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey to adrm.pra@census.gov.
If you have questions, please contact Rodney Terry, U.S. Census Bureau, Center for Behavioral Science Methods, 301-763-5475.
If you are eligible for the study, we will call or email you to schedule a time for the focus group. By proceeding, you give your consent to participate in these screening questions.
CBSM UNIVERSAL Screener Questions
What is your name?
First name:_____________________
Last name:_____________________
What is your daytime telephone number? [Probe for all 3 phone numbers]
Mobile ([ ]) [ ] – [ ]
Home (if not mobile) ([ ]) [ ] – [ ]
Work (if any) ([ ]) [ ] – [ ] EXT.[ ]
In what City and State code do you currently live?
City:_____________________
State:_____________________
When, if ever, was the last time you participated in a marketing research study, such as a consumer interview or a group discussion? DO NOT READ LIST
Within the past three months [ ] > INELIGIBLE
Over three months ago [ ] > CONTINUE
Never [ ] > CONTINUE
How old are you? (DO NOT READ ANSWER CHOICES)
17 or younger
18–24
25-34
35-54
55+
CHECK: If Q2 = 1, END SURVEY AND DISPLAY: You must be at least 18 years old to participate in the focus group. We thank you for your time spent taking this survey. Your response has been recorded
Are you…
Female
Male
Transgender, non-binary, or another gender
Prefer not to answer
/* QRaceEthnicity */ What is your race and/or ethncity? You may provide more than one group. /* MULTIPLE RESPONSES PERMITTED */
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
/* QNativity*/ In what country or territory were you born? [DON’T READ CHOICES, CIRCLE RESPONSE.]
In the United States
Other /* SPECIFY */
/* QAge_At_Immigration */ ## IF QNATIVITY=C2 ## How old were you when you first came to the United States? (IF ASKED: this information is being asked to ensure a broad range of experiences are represented in the discussion. Answers will not be shared for marketing or any other purpose.)
17 or older ## 1st Generation ##
16 or younger ## 1.5 Generation, meaning more acculturation ##
Do you speak a language other than English at home?
o Yes (ask follow-up question 12a) ( score 1 point)
o No (skip to next question) a. What language or languages do you speak at home? Please select one or more.
[ ] Spanish
[ ] Chinese
[ ] Korean
[ ] Vietnamese
[ ] Arabic
[ ] Russian
[ ] Other - Specify
/* QLanguage Preference*/ ## IF QLANGUAGE = NOT ENGLISH ## When both are available, do you prefer to complete forms in English or [LANGUAGE]? (EXAMPLES IF CONFUSED: government forms, questionnaires, school forms, medical forms)
English
[LANGUAGE]
Either way
/*QEDU */ What is the highest grade or year of schooling you have completed?
High school or Less
Some college
College graduate or postgraduate degree
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 9a and 9b)
Part-time (ask follow-up questions 9a and 9b)
Not working for pay at this time (skip to next question)
a. What is your current job title or job description? [open text]
b. Are you employed by the Federal Government? (if federal contractor, mark NO)
• Yes
• No
What is your marital status?
Married
Widowed
Divorced
Separated
Never married
What is your total annual household income?
Less than $15,000
$15,000 to $24,999
$25,000 to $49,999
$50,000 to $99,999
More than $100,000
How many people age 18 or older currently live in your household, INCLUDING yourself?
( score 1 point for each person)
How many people younger than 18 currently live in your household?
( score 1 point for each person)
Do you own a cell phone?
o Yes
o No (skip to next question)
a. 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?
b. What type of smartphone do you have?
Do you own a desktop or laptop computer, or both?
o Desktop computer
o Laptop computer
o Both desktop and laptop computer
o Neither
Do you own a tablet computer such as an iPad, Samsung Galaxy Tab, Google Nexus, or Kindle Fire?
o Yes
o No
Do you have at least one year of Internet experience?
o Yes (ask follow-up questions 16a and 16b)
o No (skip to next question) d. 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?
o Several times a day
o About once a day
o A few times a week
o A few times a month
o A few times a year
o Not at all [do not read to respondent]
How did you hear about this research opportunity?
o E-mail link
o Census Bureau employee
o Friend or family member (but not a Census Bureau employee)
o Facebook
o Craigslist
o Google advertisement
o Flyer
o Newspaper advertisement
o Other – specify
What is the e-mail address we should use when sending directions to our office, should you qualify for a study? __________________
UNDERCOUNT OF YOUNG CHILDREN
SUPPLEMENTAL SCREENer QUESTIONS
Is your home owned, rented or occupied without payment of rent?
a. owned
b. rented ( score 1 point)
c. occupied without payment of rent ( score 1 point)
d. Don’t know/Refused ( score 1 point)
What type of home do you live in?
a. House, townhouse or condo
b. Apartment ( score 1 point)
c. Something else ( score 1 point)
d. Don’t know/Refused ( score 1 point)
Do any children under age 5 live in your household?
a. Yes ( score 2 points) 3b. How many?____( score 1 point for each person)
b. No
c. Don’t know/refused ( score 2 points)
Do any children under age 5 stay at your household, even if it’s just for a night or two?
Yes ( score 4 points)
No
Don’t know/refused ( score 4 points)
Do any foster children live or stay at your household, even if it’s just for a night or two?
Yes ( score 4 points)
No
Don’t know/refused ( score 4 points)
Is everyone who lives or stays at your household related to each other?
Yes
No ( score 4 points)
Don’t know/Refused ( score 4 points)
Has anyone moved in or out of your household recently – say in the last year or so?
Yes ( score 4 points)
No
Don’t know/Refused ( score 4 points)
Is anyone in your household the grandparent of a child who lives or stays there sometimes?
Yes ( score 2 points)
No
Don’t know/Refused ( score 2 points)
Is anyone in your household the mother of a child who lives or stays there sometimes?
Yes ( score 1 point) 9a. How old is the mother? ____(if under 30 score 1 pt)
9b. Is the mother…
married
divorced or separated ( score 1 point)
widowed or ( score 1 point)
never married? ( score 1 point)
No
Don’t know/refused ( score 1 point)
Is anyone in your household the father of a child who lives or stays there sometimes?
Yes ( score 1 point) 10a. How old is the father? ____(if under 30 score 1 pt)
10b. Is the father…
married
divorced or separated ( score 1 point)
widowed or ( score 1 point)
never married? ( score 1 point)
No
Don’t know/Refused ( score 1 point)
Is anyone living or staying at your household temporarily while they find another place to live?
Yes ( score 4 points)
No
Don’t know/Refused ( score 4 points)
If the census were held today, how likely would you be to fill out the census form?
Extremely likely ( score 1 point)
Very likely ( score 1 point)
Somewhat likely ( score 1 point)
Not too likely
Not at all likely
/* DISPLAY */ Thank you. You may be eligible to participate in a focus group. If you are chosen to participate, a member of the team will contact you to provide more information and schedule you for the focus group. If you have any questions or comments about this study, you may send them to rodney.terry@census.gov.
[END OF SELF-ADMINISTERED SCREENER]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Heskamp, Paige |
| File Modified | 0000-00-00 |
| File Created | 2024-07-19 |