Form 1 ISR Specification

Generic Clearance for Census Bureau Field Tests and Evaluations

Attachment 1 - 2023 ISR Specification v3.1_OMB Final

2023 Census Survey

OMB: 0607-0971

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0607-0971 can be found here:

2024-07-02 - Revision of a currently approved collection

Document [docx]

Download: docx | pdf

F Shape2 all 2023 Census Survey Internet Specification

Fall 2023 Census Survey

Internet Specification

Draft v3.0

August 9, 2023

Note: This Fall 2023 Census Survey Internet Specification is a living document. This document reflects the specification baseline as of the date above.

General Information 4

Introduction 4

Standard Fills 4

Global Requirements 5

NONID Address Collection - NEW 8

RESIDENCE_NEW 8

OTHER_ADDRESS_NEW 9

STAN_RESIDENCE_NEW_A 11

STAN_RESIDENCE_NEW_B 12

STAN_OTHER_ADDRESS_NEW_A 13

STAN_OTHER_ADDRESS_NEW_B 13

Verify Address Screens 14

Respondent Demographics 26

SUBMIT Census Questionnaire 42

CONFIRMATION 43

NO_COMPLETE 44

SESSION TIMEOUT 45

General Information

Introduction

This document provides the specifications for the English, self-administered version of the Internet instrument for the 2023 Fall Census Survey.

Translations will be provided in a separate document.

Standard Fills

<ADDRESS>	Street Address, Unit, City, State, Zip
<REFDATE>	November 1, 2023
<OMB STATEMENT>	The U.S. Census Bureau estimates that completing the questionnaire will take 10 minutes on average. Send comments regarding this burden estimate or any other aspect of this burden to: <adrm.pra@census.gov>. Use "Paperwork Reduction Project 0607-0971" as the subject. This collection of information has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number <TBD> confirms this approval.
<WARNING MESSAGE>	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 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 https://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. 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).

Global Requirements

Timeouts

The instrument will time out if a respondent is inactive for 15 minutes.

Languages

There will be a language selection menu allowing users to select either English or Spanish.

Navigation

The respondent will navigate through the instrument using the “Submit”, “Next” or “Previous” buttons located at the bottom of each screen.

URL

For the 2023 Census Survey, the URL will be - <TBD>

LOGIN

Screen Name	LOGIN
Data Needed
Pre-condition
Question Wording
Question Wording Fills	Please Log In Use the materials we mailed to you. All the information that you provide will remain confidential. Please enter the 12-digit Census ID found in the materials we mailed to you. _____-_____-____ (three 4-digit text boxes, separated by a hyphen.) Start Questionnaire The U.S. Census Bureau estimates that completing the questionnaire will take 10 minutes on average. Send comments regarding this burden estimate or any other aspect of this burden to: <adrm.pra@census.gov >. Use "Paperwork Reduction Project 0607-0971" as the subject. This collection of information has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number <TBD> confirms this approval. 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 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 https://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. 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). OMB No. <TBD>: Approval Expires 12/31/2025
Response Options
Response Options Fills
Edits/Errors	N/A
Post-condition	If an invalid ID is entered display: “Login failed. Please try again.”
Special Instructions	If valid Census ID, go to RESIDENCE_NEW If the user exceeds 3 login attempts, go to NO_COMPLETE
	The LOGIN button will not be enabled until 12 digits are entered.

NONID Address Collection - NEW

RESIDENCE_NEW

Screen Name	RESIDENCE_NEW
Data Needed
Pre-condition	Respondent enters a valid user ID on LOGIN screen
Question Wording Before REFDATE	Please provide a street address for this residence. Provide the street address you would use to have a package delivered directly to this residence, not a Rural Route or P.O. Box address used for mailing purposes. A street address is the most helpful for processing your response.
Question Wording On or After REFDATE	Please provide a street address for this residence. Provide the street address you would use to have a package delivered directly to this residence, not a Rural Route or P.O. Box address used for mailing purposes. A street address is the most helpful for processing your response.
Response Options	Street Address Ex: 101 N Main St 100-character text box Apt/Unit Ex: Apt 23 50-character text box City 100-character text box State Drop down menu with alphabetical 50 states and District of Columbia ZIP Code 5-digit text box A user may also select the “I do not have a street address” option.
Edits/Errors	Required Fields: Street Address AND City AND State AND Zip If the respondent does not provide the required fields and selects next: First time: “Please provide a street address, city, state and ZIP code.” Second time: “In order to continue, you must provide a street address, city, state and ZIP code.” Third time: End the questionnaire and display NO_COMPLETE.
Post-condition	If the respondent provides a valid address and selects “Next”, go to STAN_RESIDENCE_NEW_A If “I do not have a street address,” is checked, go to OTHER_ADDRESS_NEW. Else, if “Next” is selected for the third time and any required address field is blank, go to NO_COMPLETE.
Special Instructions	There will only be a “Next” (No “Previous”) button on this screen.

OTHER_ADDRESS_NEW

Screen Name	OTHER_ADDRESS_NEW
Data Needed
Pre-condition	Respondent selects “I do not have a street address” on RESIDENCE_NEW
Question Wording Before REFDATE	Please describe the physical location of this residence. Also provide a city, state and ZIP Code.
Question Wording On or After REFDATE	Please describe the physical location of this residence. Also provide a city, state and ZIP Code.
Response Options Before REFDATE	Please provide as much information as possible. For example: a rural route address, P.O. Box, or E-911 address or a location description such as “The apartment over the gas station” or “The brick house with the screened porch on the northeast corner of Farm Road and HC 46” or a name of a park, street intersection or shelter, if you will be experiencing homelessness on <REFDATE>, as well as the name of the city and state. For example, “Friendship Park, Anywhere, PA.” Please provide as much information as possible: 250-character text box City 100-character text box State Drop down menu with alphabetical 50 states and District of Columbia ZIP Code 5-digit text box
Response Options On or After REFDATE	Please provide as much information as possible. For example: a rural route address, P.O. Box, or E-911 address or a location description such as “The apartment over the gas station” or “The brick house with the screened porch on the northeast corner of Farm Road and HC 46” or a name of a park, street intersection or shelter, if you will be experiencing homelessness on <REFDATE>, as well as the name of the city and state. For example, “Friendship Park, Anywhere, PA.” Please provide as much information as possible: 250-character text box City 100-character text box State Drop down menu with alphabetical states and District of Columbia ZIP Code 5-digit text box
Edits/Errors	Required Fields: City AND State AND Zip If the respondent does not provide the required fields and selects next: First time: "Please provide as much information as possible. Include a city, state and ZIP Code.” Second time: “You must provide a city, state and ZIP Code.” Third Time: End the questionnaire and display NO_COMPLETE screen.
Post-condition	If the respondent selects “Next”, go to STAN_OTHER_ADDRESS_NEW_A Else, if “Next” is selected for the third time and all address fields are blank or an invalid address is provided, go to NO_COMPLETE.
Special Instructions

STAN_RESIDENCE_NEW_A

Screen Name	STAN_RESIDENCE_NEW_A
Data Needed	Respondent provided address from RESIDENCE_NEW.
Pre-condition	All Respondents who provided a valid address on RESIDENCE_NEW.
Question Wording	Please review your address. Here is the address you submitted using standard abbreviations and formatting. <Street Address space delimiter Apt/Unit #> <City comma delimiter State space delimiter ZIP Code> Is the address correct?
Response Options	Respondent will only be able to select one of the following: Yes No
Edits/Errors	Required Fields: Yes No If required fields are left blank and the next button is selected, display the following edit message: “Please answer this question.”
Post-condition	If the respondent selects “No”, go to STAN_RESIDENCE_NEW_B. If “Yes”, go to VERIFY_ADDRESS.
Special Instructions	Respondent cannot move to the next screen until required fields are provided. There will only be a “Next” (No “Previous”) button on this screen.

STAN_RESIDENCE_NEW_B

Screen Name	STAN_RESIDENCE_NEW_B
Data Needed	Respondent provided address from RESIDENCE_NEW.
Pre-condition	Respondent selects “No” on STAN_RESIDENCE_NEW_A
Question Wording	Please make the necessary changes in the fields below.
Response Options	Street Address Ex: 101 N Main St 100-character text box Apt/Unit Ex: Apt 23 50-character text box City 100-character text box State Drop down menu with alphabetical 50 states and District of Columbia ZIP Code 5-digit text box
Edits/Errors	Required Fields: Street Address AND City AND State AND Zip If required fields are left blank and the “Submit” button is selected, display the following edit message next to the blank field: “Please answer this question.”
Post-condition	Go to VERIFY_ADDRESS.
Special Instructions	Respondent cannot move to the next screen until required fields are provided.

STAN_OTHER_ADDRESS_NEW_A

Screen Name	STAN_OTHER_ADDRESS_NEW_A
Data Needed	Respondent provided address from OTHER_ADDRESS_NEW
Pre-condition	All Respondents who provided a valid address on OTHER_ADDRESS_NEW
Question Wording	Please review your address. Here is the address you submitted using standard abbreviations and formatting. <Description> <City comma delimiter State space delimiter ZIP Code> Is the address correct?
Response Options	Respondent will only be able to select one of the following: Yes No
Edits/Errors	Required Fields: Yes No If required fields are left blank and the next button is selected, display the following edit message: “Please answer this question.”
Post-condition	If the respondent selects “No”, go to STAN_OTHER_ADDRESS_NEW_B. If “Yes”, go to VERIFY_ADDRESS.
Special Instructions	Respondent cannot move to the next screen until required fields are provided. There will only be a “Next” (No “Previous”) button on this screen.

STAN_OTHER_ADDRESS_NEW_B

Screen Name	STAN_OTHER_ADDRESS_NEW_B
Data Needed	Respondent provided address from OTHER_ADDRESS_NEW.
Pre-condition	Respondent selects “No” on STAN_OTHER_ADDRESS_NEW_A
Question Wording	Please make the necessary changes in the fields below.
Response Options	City 100-character text box State Drop down menu with alphabetical 50 states and District of Columbia ZIP Code 5-digit text box
Edits/Errors	Required Fields: City AND State AND Zip If required fields are left blank and the “Submit” button is selected, display the following edit message next to the blank field: “Please answer this question.”
Post-condition	Go to VERIFY_ADDRESS.
Special Instructions	Respondent cannot move to the next screen until required fields are provided.

Verify Address Screens

VERIFY ADDRESS

Screen Name	VERIFY ADDRESS
Data Needed	<ADDRESS> <REFDATE>
Pre-condition	STAN_RESIDENCE_NEW_A = “Yes” or STAN_RESIDENCE_NEW_B or STAN_OTHER_ADDRESS_NEW_A = “Yes” or STAN_OTHER_ADDRESS_NEW_B
Question Wording Before REFDATE	On <REFDATE>, will you be living or staying at <ADDRESS>?
Question Wording On or After REFDATE	On <REFDATE>, were you living or staying at <ADDRESS>?
Response Options	Respondent will only be able to select one of the following: Yes No
Response Options Fills	N/A
Edits/Error
Post-condition	If “Yes”, go to RESPONDENT If “No” or Blank, go to ANYONE
Special Instructions	There will only be a “Next” (No “Previous”) button on this screen.

ANYONE

Screen Name	ANYONE
Data Needed	<ADDRESS> <REFDATE>
Pre-condition	VERIFY ADDRESS = “No” or Blank
Question Wording Before REFDATE	Will anyone be living at <ADDRESS> on <REFDATE>?
Question Wording On or After REFDATE	Did anyone live at <ADDRESS> on <REFDATE>?
Response Options	Respondent will only be able to select one of the following: Yes No Don’t Know
Response Options Fills	N/A
Edits/Errors
Post-condition	If “No”, go to UNIT STATUS Else, go to RESPONDENT
Special Instructions

UNIT STATUS

Screen Name	UNIT STATUS
Data Needed	<ADDRESS> <REFDATE>
Pre-condition	ANYONE = “No”
Question Wording Before REFDATE	Why will no one be living at <ADDRESS> on <REFDATE>?
Question Wording On or After REFDATE	Why was no one living at <ADDRESS> on <REFDATE>?
Response Options	Respondent will only be able to select one of the following: Vacant residence Uninhabitable (under construction, open to elements, condemned, burned out, destroyed, demolished) Nonresidential building Empty lot or empty mobile home site Address does not exist Duplicate address Other (Specify) {Display 30-character text box}
Response Options Fills	N/A
Edits/Errors
Post-condition	If “Vacant residence”, go to VACANCY Else (or Blank), go to RESPONDENT
Special Instructions	“Other (Specify)” response option will auto-select if text is entered into the text box.

VACANCY

Screen Name	VACANCY
Data Needed	<ADDRESS> <REFDATE>
Pre-condition	UNIT STATUS = “Vacant residence”
Question Wording Before REFDATE	What is the primary reason why no one will be living or staying at <ADDRESS> on <REFDATE>? The unit will be –
Question Wording On or After REFDATE	What is the primary reason why no one was living or staying at <ADDRESS> on <REFDATE>? The unit was –
Response Options	Respondent will only be able to select one of the following: For rent Rented, not occupied For sale only Sold, not occupied For seasonal, recreational, or occasional use For migrant workers Other (Specify) {Display 30-character text box}
Response Options Fills	N/A
Edits/Errors
Post-condition	Go to RESPONDENT
Special Instructions	“Other (Specify)” response option will auto-select if text is entered into the text box.

Roster

RESPONDENT

Screen Name	RESPONDENT
Data Needed	None
Pre-condition	If VERIFY ADDRESS = “Yes” or If ANYONE = “Yes”/ “Don’t know”/ Blank or If UNIT STATUS is not “Vacant residence” or VACANCY
Question Wording	What is your name, telephone number, and email address? We will only contact you if needed for official Census Bureau business.
Question Wording Fills	N/A
Response Options	First Name 30-character text box Middle Name 30-character text box Last Name(s) 30-character text box Telephone Number 10-digit text box Email address 50-character text box
Response Options Fills	N/A
Edits/Errors	First Name and Last Name(s) are required fields. If First and Last Names are left blank and the next button is selected, display the following edit message next to the blank field: “Please answer this question.”
Post-condition	If VERIFY ADDRESS = “Yes”, go to POPCOUNT If VERIFY ADDRESS = “No” or Blank, go to OTHER_COMPLETE VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Vacant residence > VACANCY > RESPONDENT VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Else / Blank > RESPONDENT VERIFY ADDRESS = No / Blank > ANYONE = Yes/DK/Blank > RESPONDENT
Special Instructions	This is a force response question. The respondent must provide First and Last Name to continue. There will only be a “Next” (No “Previous”) button on this screen.

OTHER_COMPLETE

Screen Name	OTHER_COMPLETE
Data Needed	<REFDATE> <ADDRESS>
Pre-condition	RESPONDENT and VERIFY ADDRESS = “No” or Blank VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Vacant residence > VACANCY > RESPONDENT VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Else/Blank > RESPONDENT VERIFY ADDRESS = No / Blank > ANYONE = Yes/DK/Blank > RESPONDENT
Question Wording Before REFDATE	Thank you for providing information for <ADDRESS>. Since you will not be living or staying at this address on November 1, 2023, you do not need to provide any additional information for it. You may close the browser.
Question Wording On or After REFDATE	Thank you for providing information for <ADDRESS>. Since you did not live or stay at this address on November 1, 2023, you do not need to provide any additional information for it. You may close the browser.
Response Options
Response Options Fills	N/A
Edits/Errors
Post-condition
Special Instructions

POPCOUNT

Screen Name	POPCOUNT
Data Needed	<ADDRESS> <REFDATE>
Pre-condition	RESPONDENT (where VERIFY ADDRESS = “Yes”)
Question Wording Before REFDATE	Including yourself, how many people will be living or staying at <ADDRESS> on <REFDATE>?
Question Wording On or After REFDATE	Including yourself, how many people were living or staying at <ADDRESS> on <REFDATE>?
Response Options	Number One 2-digit numerical text box.
Response Options Fills	N/A
Edits/Errors	If blank or 0 is entered, display: First time: “Please include yourself when reporting the number of people.” Second time: “Please include yourself when reporting the number of people.” Third time: If the field is blank or zero is entered and “Next” is selected go to NO_COMPLETE
Post-condition	If popcount field is zero or blank and selects “Next” for the third time, go to NO_COMPLETE If POPCOUNT=1, go to UC. If POPCOUNT=2-99, go to PEOPLE.
Special Instructions	Respondents will only be able to enter numbers 0 - 99. Non-numeric characters will not be allowed to be entered. A maximum of 3 edits is shown in any combination. There will only be a “Next” (No “Previous”) button on this screen.

PEOPLE

Screen Name	PEOPLE
Data Needed	<ADDRESS> <REFDATE> Name from RESPONDENT POPCOUNT
Pre-condition	POPCOUNT=2-99
Question Wording Before REFDATE	What is the name of each person who will be living or staying at <ADDRESS> on <REFDATE>? Enter names until you have listed everyone who will be living or staying there, then continue to the next page.
Question Wording On or After REFDATE	What is the name of each person who was living or staying at <ADDRESS> on <REFDATE>? Enter names until you have listed everyone who was living or staying there, then continue to the next page.
Response Options	First Name 20-character text box Middle Name 20-character text box Last Name(s) 20-character text box “Remove Row” option “Add another person” option
Response Options Fills	N/A
Edits/Errors
Post-condition	UC
Special Instructions	Display the name from RESPONDENT in the first row of name fields Only a maximum of 10 rows can be displayed.

UC

Screen Name	UC
Data Needed	<ADDRESS> <REFDATE> ROSTER (all names from PEOPLE and RESPONDENT)
Pre-condition	POPCOUNT = 1 or PEOPLE
Question Wording Before REFDATE	We do not want to miss any people who might be staying at <ADDRESS> on <REFDATE>. For example: Children, related or unrelated, such as newborn babies, grandchildren, or foster children Relatives, such as adult children, nieces, nephews, cousins, or in-laws Roommates or other nonrelatives People without a permanent place to live The names listed so far are: <LIST OF HOUSEHOLD MEMBER> Will there be any ADDITIONAL people that you did not already list?
Question Wording On or After REFDATE	We do not want to miss any people who might have stayed at <ADDRESS> on <REFDATE>. For example: Children, related or unrelated, such as newborn babies, grandchildren, or foster children Relatives, such as adult children, nieces, nephews, cousins, or in-laws Roommates or other nonrelatives People without a permanent place to live The names listed so far are: <LIST OF HOUSEHOLD MEMBER> Were there any ADDITIONAL people that you did not already list?
Response Options	Respondent will only be able to select one of the following: Yes No IF YES, display: First Name 30-character text box Middle Name 30-character text box Last Name(s) 30-character text box
Response Options Fills	N/A
Edits/Errors
Post-condition	HOME
Special Instructions	The name boxes will only appear when “Yes” is selected. If the respondent clicks “No” (removing a “Yes” entry), the name boxes will disappear. When “Yes” is selected, only one set of name boxes will appear.

HOME

Screen Name	HOME
Data Needed
Pre-condition	UC
Question Wording Before REFDATE	On <REFDATE>, will the house, apartment, or mobile home at <ADDRESS> be –
Question Wording On or After REFDATE	On <REFDATE>, was the house, apartment, or mobile home at <ADDRESS> –
Response Options	Respondent will only be able to select one of the following: Owned by you or someone in this household with a mortgage or loan (including home equity loans)? Owned by you or someone in this household free and clear (without a mortgage or loan)? Rented? Occupied without payment of rent?
Response Options Fills	N/A
Edits/Errors
Post-condition	If “Occupied without payment of rent” or blank, go to SEX. or If PERSONCOUNT =1, go to SEX. Else, go to OWNER.
Special Instructions	If “Occupied without payment of rent” set <REF NAME> = Person 1. If PERSONCOUNT= (1) set <REF NAME> = Person 1.

OWNER

Screen Name	OWNER
Data Needed	Roster names
Pre-condition	HOME = “Owned by you or someone in this household with a mortgage or loan (including home equity loans)?” or “Owned by you or someone in this household free and clear (without a mortgage or loan)?” or “Rented” and POPCOUNT= (2-99)
Question Wording Before REFDATE	Of the people who will be living at <ADDRESS>, who <FILL2> the house, apartment, or mobile home on <REFDATE>? Select all that apply.
Question Wording On or After REFDATE	Of the people who were living at <ADDRESS>, who <FILL2> the house, apartment, or mobile home on <REFDATE>? Select all that apply.
Question Wording Fills	If current date is before <REFDATE>, then If HOME=Rented, <FILL2> = “will rent” Else, <FILL2> = “will own” If current date is on or after APRIL 1, then If HOME=Rented, <FILL2> = “rented” Else, <FILL2> = “owned”
Response Options	Respondent will be able to select all that apply: A response option for each name from the roster Also, include the response option “None of the above”.
Response Options Fills	N/A
Edits/Errors
Post-condition	SEX
Help Text link	OWNER
Special Instructions	Selecting a response option: A user may select all that apply. The Reference Person will be set as the Respondent. There will only be a “Next” (No “Previous”) button on this screen.

Respondent Demographics

RELATIONSHIP

Screen Name	RELATIONSHIP
Data Needed	RESPONDENT NAME#
Pre-condition	PERSONCOUNT= (2-99) (who is not the Respondent) RACE (if Demo Questions still need to be completed for remaining rostered persons)
Question Wording	How is <NAME#> related to <REF NAME>? <NAME#> is <REF NAME>’s ...
Response Options	Respondent will only be able to select one of the following: Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law Son-in-law or daughter-in-law Other relative Roommate or housemate Foster child Other nonrelative
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, go to SEX. If Answer the Question, go back to response options.
Post-condition	Goto SEX
Help Text link	RELATIONSHIP
Special Instructions	This screen is not displayed for single-person households. This screen is not displayed for the reference person. Previous and Next buttons on screen.

SEX

Screen Name	SEX
Data Needed	NAME#
Pre-condition	HOME = “Occupied without payment of rent” or blank or PERSONCOUNT=1 or OWNER (Person 1) or RELATIONSHIP (Person 2+)
Question Wording	What is <NAME#>’s sex?
Response Options	Respondent will only be able to select one of the following: Male Female
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, go to DOB. If Answer the Question, go back to response options.
Post-condition	Go to DOB
Special Instructions	There will only be a “Next” (No “Previous”) button on this screen.

DOB

Screen Name	DOB
Data Needed	NAME#
Pre-condition	SEX
Question Wording	What is <NAME#>’s date of birth? Verify or enter correct age as of <REFDATE>.
Response Options	A user can select the Month (number - full word), Day, and Year. Only valid dates between January 1, 1897 and Dec. 31, 2023 can be selected. Year drop down box: Starts with <current year> and goes to <current year – 126>. Age: One 3-character numeric only field followed by “years”. I.e.,” ___ years”. Respondent may enter age in the numeric text box.
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, go to HISPANIC ORIGIN. If Answer the Question, go back to response options.
Post-condition	Go to HISPANIC ORIGIN
Special Instructions	Edit Message will only trigger if Month, Day or Year are left blank. If the text box “years” is left blank, the edit message will not trigger.

HISPANIC ORIGIN

Screen Name	HISPANIC ORIGIN
Data Needed	NAME#
Pre-condition	DOB
Question Wording	Is <NAME#> of Hispanic, Latino, or Spanish origin?
Response Options	A user can select either a “No” response or one or more “Yes” responses. No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Enter, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. {Display 200-character text box}
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, go to RACE. If Answer the Question, go back to response options.
Post-condition	Go to RACE
Special Instructions	Check boxes and textboxes are tied to each other; the check box will be automatically checked if something is entered into the corresponding text box.

RACE

Screen Name	RACE
Data Needed	NAME#
Pre-condition	HISPANIC ORIGIN
Question Wording	What is <NAME#>’s race? Select one or more boxes and enter origins. For this survey, Hispanic origins are not races.
Response Options	Respondent may select all that apply: White – Enter, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. {Display 200-character text box} Black or African American – Enter, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. {Display 200-character text box} American Indian or Alaska Native – Enter name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. {Display 200-character text box} Chinese Filipino Asian Indian Vietnamese Korean Japanese Other Asian – Enter, for example, Pakistani, Cambodian, Hmong, etc. {Display 200-character text box} Native Hawaiian Samoan Chamorro Other Pacific Islander – Enter, for example Tongan, Fijian, Marshallese, etc. {Display 200-character text box} Some other race– Enter race or origin. {Display 200-character text box}
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, see post-condition below. If Answer the Question, go back to response options.
Post-condition	If Demo Questions have been completed for the last rostered person: PERSONCOUNT = 1, goto OC PERSONCOUNT= 2-99 , goto OC_HH Else, go to RELATIONSHIP (PERSONCOUNT= (2-99) who aren’t the reference person)
Special Instructions	Check boxes and textboxes are tied to each other; the check box will be automatically checked if something is entered into the corresponding text box.

Coverage

OC

Screen Name	OC
Data Needed	NAME# <ADDRESS>
Pre-condition	RACE has been completed and PERSONCOUNT = (1)
Question Wording	Does <NAME#>’s usually live or stay somewhere else, other than <ADDRESS>? Select all that apply.
Question Wording Fills
Response Options	A respondent may select a “No” response or more than one “Yes” response No Yes, with a parent, grandparent, or other person Yes, while attending college Yes, for a military assignment Yes, to be closer to a job or business Yes, in a nursing home or group home Yes, in a jail or prison Yes, at a seasonal or second residence Yes, for another reason If “Yes, for another reason” is selected: For what reason? {display 250-character textbox}
Edits/Errors
Post-condition	Go to WHOLE/PARTIAL
Special Instructions	Selecting a response option: A respondent can either select “No” OR one or more than one “Yes, …” options.

OC_HH

Screen Name	OC_HH
Data Needed	NAME# <ADDRESS>
Pre-condition	RACE and PERSONCOUNT = (2-99)
Question Wording	We would like to make sure everyone is only counted once. Some people live or stay in more than one place. For example: With a parent, grandparent, or other person While attending college For a military assignment To be closer to a job or business In a nursing home or group home In a jail or prison At a seasonal or second residence Do any of the following people usually live or stay somewhere else, other than <ADDRESS>? Select all that apply.
Question Wording Fills
Response Options	Respondent will be able to select any names from the roster or “None of the above”. <NAMES FROM ROSTER> None of the above
Edits/Errors	If no response, display the following edit only once: “Please provide an answer to the question.”
Post-condition	If one or more <Name #> is selected, go to OC_P screen Else, if POPCOUNT <> PERSONCOUNT go to CD_CHECK Else, if POPCOUNT = PERSONCOUNT go to WHOLE/PARTIAL
Help Text link	OC
Special Instructions	Selecting a response option: If any <NAME#> check box is selected, “None of the above” check box will be grayed out and cannot be selected until all <NAME#> check boxes are unselected. If “None of the above” is selected, and then any other <Name#> is selected, then the “None of the above” check box will be deselected and grayed out. “None of the above” check box option cannot be selected until all <Name#> check boxes are unselected. You will not be able to select a <Name#> check box and “None of the above” check box.

OC_P

Screen Name	OC_P
Data Needed	NAME#
Pre-condition	OC_HH screen for first household member selected or OC_P from previously selected household member from OC_HH
Question Wording	Why does <NAME> usually live or stay somewhere else? Select all that apply. If “For another reason” is selected, display: For what reason?
Question Wording Fills
Response Options	Respondent will be able to select all that apply: To be with a parent, grandparent, or other person To attend college For a military assignment To be closer to a job or business In a nursing home or group home In a jail or prison At a seasonal or second residence For another reason If “For another reason” is selected: {display 250-character textbox}
Edits/Errors	If no response, display the following edit only once: “Please provide an answer to the question.”
Post-condition	If number of persons selected on OC_HH > 1, go to OC_P for the next selected person. If OC_P is the final selected person, and POPCOUNT = PERSONCOUNT, go to WHOLE/PARTIAL If OC_P is the final selected person, and POPCOUNT <> PERSONCOUNT, go to CD_CHECK
Help Text link	OC_P
Special Instructions

CD_CHECK

Screen Name	CD_CHECK
Pre-condition	OC_HH and POPCOUNT <> PERSONCOUNT Or OC_P and POPCOUNT <> PERSONCOUNT
Question Wording Before REFDATE	Earlier, you said that the number of people living or staying at <ADDRESS> will be <POPCOUNT>, but you have listed <PERSONCOUNT> <FILL1>. Including yourself, how many people will be living or staying at <ADDRESS> on <REFDATE>? The names you listed are: <NAMES FROM ROSTER>
Question Wording On or After REFDATE	Earlier, you said that the number of people living or staying at <ADDRESS> was <POPCOUNT>, but you have listed <PERSONCOUNT> <FILL1>. Including yourself, how many people were living or staying at <ADDRESS> on <REFDATE>? The names you listed are: <NAMES FROM ROSTER>
Response Options	Respondent will only be able to select one of the following: Stated popcount Person Count Other If “Other” is selected: {display one 2-digit numeric textbox}
Response Options Fills	N/A
Edits/Errors
Post-condition	WHOLE/PARTIAL
Help Text link
Special Instructions	If PERSONCOUNT = 1, <FILL1> = “person” If PERSONCOUNT = (2-99), <FILL1> = “people” There will only be a “Next” (No “Previous”) button on this screen.

WHOLE/PARTIAL

Screen Name	WHOLE/PARTIAL
Data Needed	<ADDRESS> <REFDATE>
Pre-condition	OC or OC_HH = “None of the Above” or Blank, where POPCOUNT = PERSONCOUNT or OC_P, where POPCOUNT = PERSONCOUNT or CD_CHECK
Question Wording Before REFDATE	Did you list everyone living at <ADDRESS> on your questionnaire, or did you list only some of the people?
Question Wording On or After REFDATE	Did you list everyone living at <ADDRESS> on your questionnaire, or did you list only some of the people?
Response Options	Respondent will only be able to select one of the following: I live alone and only listed myself. I live with others and listed everyone. I live with others but only listed myself. I live with others but only listed some of the people I live with. If “I live with others but only listed myself." or “ I live with others but only listed some of the people I live with." is selected, display the following: The Census Bureau is interested in understanding why some people are not listed on the questionnaire. Please share your reasons for not listing everyone. {250-character textbox}
Response Options Fills	N/A
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, go to VAC_CROWD 1A or 2A If Answer the Question, go back to response options.
Post-condition	Go to VAC_CROWD_1A or VAC_CROWD_2A (based on sample assignment)
Special Instructions	There will only be a “Next” (No “Previous”) button on this screen.

VAC_CROWD_1A

Screen Name	VAC_CROWD_1A
Data Needed
Pre-condition	WHOLE/PARTIAL
Question Wording Before REFDATE	Imagine standing at your front door looking out to your right. Picture your neighbor's house, apartment unit, or mobile home immediately to your right. Is anyone living in that home? Why are we asking this question?
Question Wording On or After REFDATE	Imagine standing at your front door looking out to your right. Picture your neighbor's house, apartment unit, or mobile home immediately to your right. Is anyone living in that home? Why are we asking this question?
Response Options	Respondent will only be able to select one of the following: Yes, someone is living there No, no one is living there I am unsure if someone is living there I am unsure of what home this would be There is no home to my right
Response Options Fills	N/A
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, go to SUBMIT If Answer the Question, go back to response options.
Post-condition	If “No, no one is living there” is selected, go to VAC_CROWD_1B Else, go to SUBMIT
Special Instructions	There will only be a “Next” (No “Previous”) button on this screen.

VAC_CROWD_2A

Screen Name	VAC_CROWD_2A
Data Needed
Pre-condition	WHOLE/PARTIAL
Question Wording Before REFDATE	Do you know the street address of any houses, apartments, or mobile homes that will be vacant on November 1, 2023? This could be homes inside or outside your neighborhood. Please also consider seasonal or vacation homes or Airbnbs where no one is permanently living. Why are we asking this question?
Question Wording On or After REFDATE	Do you know the street address of any houses, apartments, or mobile homes that were vacant on November 1, 2023? This could be homes inside or outside your neighborhood. Please also consider seasonal or vacation homes or Airbnbs where no one is permanently living. Why are we asking this question?
Response Options	Respondent will only be able to select one of the following: Yes No
Response Options Fills	N/A
Edits/Errors	If no response, display the following pop-up modal edit once: “There is 1 unanswered question on this page. Would you like to continue?” Continue without Answering Answer the Question If Continue without Answering, go to SUBMIT If Answer the Question, go back to response options.
Post-condition	If “Yes” is selected, go to VAC_CROWD_2B Else, go to SUBMIT
Special Instructions	There will only be a “Next” (No “Previous”) button on this screen.

VAC_CROWD_1B

Screen Name	VAC_CROWD_1B
Data Needed
Pre-condition	VAC_CROWD_1A = “No, no one is living there”
Question Wording Before REFDATE	What is the address of that vacant home?
Question Wording On or After REFDATE	What is the address of that vacant home?
Response Options	Street Address Ex: 101 N Main St 100-character text box Apt/Unit Ex: Apt 23 50-character text box City 100-character text box State Drop down menu with alphabetical 50 states and District of Columbia ZIP Code 5-digit text box
Response Options Fills	N/A
Edits/Errors
Post-condition	SUBMIT
Special Instructions

VAC_CROWD_2B

Screen Name	VAC_CROWD_2B
Data Needed
Pre-condition	VAC_CROWD_2A = “Yes”
Question Wording Before REFDATE	What is the address of that vacant home? If you know more than one vacant home address, enter only one.
Question Wording On or After REFDATE	What is the address of that vacant home? If you know more than one vacant home address, enter only one.
Response Options	Street Address Ex: 101 N Main St 100-character text box Apt/Unit Ex: Apt 23 50-character text box City 100-character text box State Drop down menu with alphabetical 50 states and District of Columbia ZIP Code 5-digit text box
Response Options Fills	N/A
Edits/Errors
Post-condition	SUBMIT
Special Instructions

SUBMIT Census Questionnaire

Screen Name	SUBMIT Census Questionnaire
Data Needed
Pre-condition	VAC_CROWD_1A = Blank or “Yes, someone is living there”, or “I am unsure if someone is living there”, or “I am unsure of what home this would be”, or “There is no home to my right” Or VAC_CROWD_1B Or VAC_CROWD_2A = Blank or “No” Or VAC_CROWD_2B
Question Wording	You are almost finished and are now ready to send your responses. Once your questionnaire is submitted, you will not be able to access your information or change any of your responses. After you submit your responses and are shown the confirmation page, you may close the web browser. You must select SUBMIT to complete your questionnaire.
Question Wording Fills
Response Options	Submit Questionnaire
Response Options Fills	N/A
Edits/Errors
Post-condition	If Submit Questionnaire, go to CONFIRMATION
Special Instructions	There will only be a “Submit Questionnaire” (No “Edit Questionnaire”) button on this screen.

CONFIRMATION

Screen Name	CONFIRMATION
Data Needed	All submitted cases.
Pre-condition	Cases where the user has selected “Submit Questionnaire” from the SUBMIT Census Questionnaire screen.
Question Wording	Thank you for completing the 2023 Census Survey questionnaire for: <FULL ADDRESS> Date and time of submission If you receive other mail from the Census Bureau about the 2023 Census Survey in the next few days, please disregard it. That mail may have been sent out before today. If you have any questions, please call the phone number printed in your materials. Confirmation #: <Unique Code> You may close the browser.
Question Wording Fills
Response Options
Response Options Fills	N/A
Edits/Errors
Post-condition
Special Instructions

NO_COMPLETE

Screen Name	NO_COMPLETE
Data Needed
Pre-condition	Cases where user exceeds 3 login attempts on the LOGIN screen. Cases where no valid address is provided. Cases where no popcount is provided on the POPCOUNT screen.
Question Wording	Your 2023 Census Survey could not be completed. You must provide a valid address, respondent name and the number of people in the household to complete this questionnaire. Please complete a paper questionnaire, or start over. Thank you. You may close the browser.
Question Wording Fills
Response Options
Response Options Fills	N/A
Edits/Errors
Post-condition
Special Instructions

SESSION TIMEOUT

Screen Name	SESSION TIMEOUT
Data Needed
Pre-condition	Total duration within the instrument reaches 15 minutes
Question Wording	Sessions will display a pop-up window when total duration reaches 14 minutes. It will display the following text for 1 minute. Your session is about to expire. Select Continue to keep working. Su sesión está a punto de terminar. Seleccione Continuar para seguir trabajando. <Exit/Salir> <Continue/Continuar>
Special Instructions	If the respondent selects “Continue/Continuar” the respondent will remain in the instrument. If respondent selects “Exit/Salir” or reaches the maximum duration of 15 minutes (not idle time), the screen display an image file with the following: For security reasons, this session has been terminated. If you think you have reached this screen in error, please start the questionnaire over. You may close the browser.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified	0000-00-00
File Created	0000-00-00