Form 1 Internet Instrument

Generic Clearance for Census Bureau Field Tests and Evaluations

Attachment 01 - 2024 National Census Survey Online Questionnaire Specification (abbreviated)

2024 National Census Survey

OMB: 0607-0971

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2024 National Census Survey Internet Specification



2024 National Census Survey

Internet Self-Response Instrument

Specification



Draft v2.0

July 3, 2024



Note: This 2024 SmaRT Internet Self-Response automated data collection test specification is a living document. This document reflects the specification baseline as of the date above.
















General Information



Introduction

This document provides the specifications for the English, self-administered version of the Internet instrument for the 2024 National Census Survey.

Translations will be provided in a separate document.

Standard Fills

<ADDRESS>

Street Address, Unit, City, State, Zip

<REFDATE>

October 1, 2024

<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 0607-0971 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 2024 National Census Survey, the URL will be <TBD>



LOGIN

Screen Name

LOGIN

Variable Names

CENSUS_ID: NUM 12

Data Needed


Pre-condition

Question Wording



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 0607-0971 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. 0607-0971: Approval Expires 12/31/2025

Question Wording Fills






Response Options


Response Options Fills

N/A

Edits/Errors

If an invalid ID is entered display:

“Login failed. Please try again.”

Post-condition

If valid Census ID, go to RESIDENCE_NEW.

If the user exceeds 3 login attempts, goto NO_COMPLETE_AUTH

Special Instructions

The LOGIN button will be enabled at all times.







NONID Address Collection

RESIDENCE

Screen Name

RESIDENCE

Variable Names

Respondent-Provided Street Address Fields
ADR_STREET_TEXT: VARCHAR2 (100)

ADR_UNIT_TEXT: VARCHAR2 (50)
ADR_CITY_TEXT: VARCHAR2 (100)
ADR_STATE_TEXT: VARCHAR2 (2)
ADR_ZIP_TEXT: NUM (5)

ADR_NO_STREET_ADDRESS_IND: ‘No address’

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

43-character text box


Apt/Unit Ex: Apt 23

15-character text box


City

30-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:

  1. First time: “Please provide a street address, city, state and ZIP code.”

  2. Second time: “In order to continue, you must provide a street address, city, state and ZIP code.”

  3. Third time: End the questionnaire and display NO_COMPLETE.

Post-condition

  • If the respondent provides a valid address and selects “Next”, goto STAN_RESIDENCE_A

  • If “I do not have a street address,” is checked, goto OTHER_ADDRESS.

  • Else, if “Next” is selected for the third time and any required address field is blank, goto NO_COMPLETE.

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.



OTHER_ADDRESS

Screen Name

OTHER_ADDRESS

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: NUM2 (5)


Physical Description Field

ADR_LOC_DESC_TEXT: VARCHAR2 (250)


Checkbox Fields

ADR_RURAL_IND

ADR_PO_BOX_IND

ADR_VEHICLE_IND

ADR_TENT_IND

ADR_UNHOUSED_IND

Data Needed

Pre-condition

Respondent selects “I do not have a street address” on RESIDENCE

Question Wording

Before REFDATE

Please provide a City, State and ZIP code and a physical location of this residence. Also select any of the checkboxes at the bottom of the screen if they apply to your situation.

Question Wording

On or After REFDATE

Please provide a City, State and ZIP code and a physical location of this residence. Also select any of the checkboxes at the bottom of the screen if they apply to your situation.

Response Options

Before REFDATE

For example:

  • a rural route address or E-911 address

  • coordinates (longitude and latitude)

  • 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”

  • the closest street intersection and/or the name of a park, homeless shelter, or nearby business if you will be unhoused or living in an unconventional type of shelter, such as a vehicle, tent, shed, or storage unit. For example, “A car in the Moondance Supermarket parking lot near intersection of Main St and Silver Ave.”


Please provide as much information as possible.


City

30-character text box

State

Drop down menu with alphabetical 50 states and District of Columbia

ZIP Code

5-digit text box


Please select any of the following that apply to your situation:

  • I provided a rural route address, E-911 address or coordinates in the box above

  • I live in a vehicle, such as a car, van, bus, or semi-truck

  • I live in a tent, shed, storage unit, or other unconventional type of shelter

  • I am unhoused or living outdoors

Response Options

On or After REFDATE

For example:

  • a rural route address or E-911 address

  • coordinates (longitude and latitude)

  • 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”

  • the closest street intersection and/or the name of a park, homeless shelter, or nearby business if you will be unhoused or living in an unconventional type of shelter, such as a vehicle, tent, shed, or storage unit. For example, “A car in the Moondance Supermarket parking lot near intersection of Main St and Silver Ave.”

Please provide as much information as possible.


City

30-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 any of the following checkboxes:

  • I provided a rural route address, E-911 address or coordinates in the box above

  • I live in a vehicle, such as a car, van, bus, or semi-truck

  • I live in a tent, shed, storage unit, or other unconventional type of shelter

  • I am unhoused or living outdoors

Edits/Errors

Required Fields:

City AND State AND Zip

If the respondent does not provide the required fields and selects next:

  1. First time: "Please provide as much information as possible. Include a city, state and ZIP Code.”

  2. Second time: “You must provide a city, state and ZIP Code.”

  3. Third Time: End the questionnaire and display NO_COMPLETE screen.

Post-condition

  • If the respondent selects “Next”, goto 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, goto NO_COMPLETE.

Special Instructions



STAN_RESIDENCE _A

Screen Name

STAN_RESIDENCE _A

Variable Names

Respondent-Provided Street Address Fields

ADR_NEW_STAN_YES_IND: 1

ADR_NEW_STAN_NO_IND: 2

Data Needed

Respondent provided address from RESIDENCE.

Pre-condition

All Respondents who provided a valid address on RESIDENCE.

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 or No

If required fields 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 the respondent selects “No”, goto STAN_RESIDENCE_B.

If “Yes”, goto 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.

NOTE: Here we are using Census' Geocoder API to check the entered address. If the displayed address is in all UPPERCASE then the entered address is valid, if returned as it was typed then the address was not found by API.











STAN_RESIDENCE _B

Screen Name

STAN_RESIDENCE _B

Variable Names

Respondent-Provided Street Address Fields
ADR_STREET_TEXT: VARCHAR2 (100)
ADR_UNIT_TEXT: VARCHAR2 (50)
ADR_CITY_TEXT: VARCHAR2 (100)
ADR_STATE_TEXT: VARCHAR2 (2)
ADR_ZIP_TEXT: NUM (5)

Data Needed

Respondent provided address from RESIDENCE.

Pre-condition

Respondent selects “No” on STAN_RESIDENCE_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

30-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

Goto VERIFY_ADDRESS.

Special Instructions

Respondent cannot move to the next screen until required fields are provided.



STAN_OTHER_ADDRESS _A

Screen Name

STAN_OTHER_ADDRESS _A

Variable Names

ADR_NEW_STAN_YES_IND: 1

ADR_NEW_STAN_NO_IND: 2

Data Needed

Respondent provided address from OTHER_ADDRESS

Pre-condition

All Respondents who provided a valid address on OTHER_ADDRESS

Question Wording

Please review your address. Here is the address you submitted using standard abbreviations and formatting.

<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 next to the blank field:



“Please answer this question.”

Post-condition

If the respondent selects “No”, goto STAN_OTHER_ADDRESS_B.

If “Yes”, goto 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.

NOTE: Here we are using Census' Geocoder API to check the entered address. If the displayed address is in all UPPERCASE then the entered address is valid, if returned as it was typed then the address was not found by API.



STAN_OTHER_ADDRESS _B

Screen Name

STAN_OTHER_ADDRESS _B

Variable Names

Respondent-Provided General Address Fields

ADR_CITY_TEXT: VARCHAR2 (100)

ADR_STATE_TEXT: VARCHAR2 (2)

ADR_ZIP_TEXT: NUM (5)

Data Needed

Respondent provided address from OTHER_ADDRESS.

Pre-condition

Respondent selects “No” on STAN_OTHER_ADDRESS _A

Question Wording

Please make the necessary changes in the fields below.

Response Options

City

30-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

Goto 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

Variable Names

H_OCC_YES_IND: 1

H_OCC_NO_IND: 2

Data Needed

<ADDRESS>

<REFDATE>

Pre-condition

STAN_RESIDENCE_A = “Yes”

or

STAN_RESIDENCE_B

or

STAN_OTHER_ADDRESS_A = “Yes”

or

STAN_OTHER_ADDRESS_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

Variable Names

H_OCC_YES_PRX_IND: 1

H_OCC_NO_PRX_IND: 2

H_OCC_DK_PRX_IND: 3

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”, goto UNIT STATUS

Else, goto RESPONDENT

Special Instructions




UNIT STATUS

Screen Name

UNIT STATUS

Variable Names

H_US_VAC_IND: 1

H_US_UNINHAB_IND: 2

H_US_NONRES_IND: 3

H_US_EMPTY_IND: 4

H_US_ADDRESS_NOEXIST_IND: 5

H_US_DUPLICATE_IND: 6

H_US_OTHER_IND: 7

H_US_OTHER_TEXT: 8

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

Variable Names

H_VAC_FORRENT_IND: 1

H_VAC_RENTNOTOCC_IND: 2

H_VAC_FORSALE_IND: 3

H_VAC_SOLDNOTOCC_IND: 4

H_VAC_SEASON_IND: 5

H_VAC_MIGRANT_IND: 6

H_VAC_OTHER_IND: 7

H_VAC_OTHER_TEXT

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 at <ADDRESS> on <REFDATE>? The unit will be –

Question Wording

On or After REFDATE

What is the primary reason why no one was living 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

Variable Names

P_RESP_FIRST_NAME: CHAR 30

P_RESP_MIDDLE_NAME: CHAR 30

P_RESP_LAST_NAME: CHAR 30

RESP_PH_NUM_ID: NUM 10

RESP_EMAIL_TEXT: CHAR 50

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, goto OTHER_COMPLETE

  • VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Vacant > VACANCY > RESPONDENT

  • VERIFY ADDRESS = No / Blank > ANYONE = No > UNIT STATUS = Else > 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

Variable Names


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 <REFDATE>, 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 <REFDATE>, 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

Variable Names

H_SIZE_STATED_CNT: NUM 2 [1-99]

H_PC_EDIT1_IND: 1

H_PC_EDIT2_IND: 2

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 goto NO_COMPLETE

Post-condition

If popcount field is zero or blank and selects “Next” for the third time, goto NO_COMPLETE

If POPCOUNT=1, goto UC. In Qualtrics POPCOUNT = numpeople

If POPCOUNT=2-99, goto 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

Variable Names

P_FIRST_NAME: CHAR 20

P_MIDDLE_NAME: CHAR 20

P_LAST_NAME: CHAR 20

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

Variable Names

H_UC_ADD_YES_IND: 0,1

H_UC_ADD_NO_IND: 0,1

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 anyone.



For example:

  • Children, related or unrelated, such as newborns, babies, grandchildren, or foster children

  • Relatives, such as adult children, nieces, nephews, cousins, or in-laws

  • Roommates or other nonrelatives, and their children

  • People who live or stay in more than one place

  • People who have no place to live



The names listed so far are:

<LIST OF HOUSEHOLD MEMBER>



Will there be any ADDITIONAL people sleeping at <ADDRESS> on <REFDATE> who are not listed above??

Question Wording

On or After REFDATE

We do not want to miss anyone.



For example:

  • Children, related or unrelated, such as newborns, babies, grandchildren, or foster children

  • Relatives, such as adult children, nieces, nephews, cousins, or in-laws

  • Roommates or other nonrelatives, and their children

  • People who live or stay in more than one place

  • People who have no place to live



The names listed so far are:

<LIST OF HOUSEHOLD MEMBER>



Were there any ADDITIONAL people sleeping at <ADDRESS> on <REFDATE> who are not listed above??

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, goto HOME.

If Answer the Question, go back to response options.

Post-condition

If “Yes”, goto UC_YES_NAMES

If “No”, goto 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. But there will be an option to add more sets of name boxes for additional people (similar to PEOPLE screen).

Create UC_COUNT variable and fill it with the number of person names added from UC, TARGETED_UC and ALTERNATE_UC.



UC_YES_NAMES

Screen Name

UC_ YES_NAMES

Variable Names

P_FIRST_NAME: CHAR 30

P_MIDDLE_NAME: CHAR 30

P_LAST_NAME: CHAR 30

Data Needed


Pre-condition

UC = “Yes”

Question Wording

Before REFDATE

Please enter the name of each additional person that you did not already list.

Question Wording

On or After REFDATE

Please enter the name of each additional person that you did not already list.

Response Options

This screen will display 4 rows of name fields:



First Name

30-character text box



Middle Name

30-character text box



Last Name(s)

30-character text box



An “Add another person” option



A “Remove row” option

Response Options Fills

N/A

Edits/Errors


Post-condition

HOME

Special Instructions

Four sets of name boxes will be shown. But there will be an option to add more sets of name boxes for additional people (similar to PEOPLE screen).

For Mobile view, the name label will display as: “First, middle, last name(s)”





HOME

Screen Name

HOME

Variable Names

H_TENURE_OWNED_MORT_IND: 1

H_TENURE_OWNED_FREE_IND: 2

H_TENURE_RENTED_IND: 3

H_TENURE_OCC_NOPAY_IND: 4

Data Needed


Pre-condition

UC or UC_YES_NAMES

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, goto SEX.

or

If PERSONCOUNT =1, goto SEX.

Else, goto 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

Variable Names

For each person selected P_OWNER_RENTER_IND: 0,1

H_OWNER_RENTER_NONE_IND: 0,1

P_REFERENCE_PERSON_IND: 0,1

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 <REFDATE>, 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

Variable Names

P_REL_SPOUSE_OPP_IND: 0,1

P_REL_PARTNER_OPP_IND: 0,1

P_REL_SPOUSE_SAME_IND: 0,1

P_REL_PARTNER_SAME_IND: 0,1

P_REL_CHILD_BIO_IND: 0,1

P_REL_CHILD_ADOPTED_IND: 0,1

P_REL_CHILD_STEP_IND: 0,1

P_REL_SIBLING_IND: 0,1

P_REL_PARENT_IND: 0,1

P_REL_GRANDCHILD_IND: 0,1

P_REL_INLAW_PARENT_IND: 0,1

P_REL_INLAW_CHILD_IND: 0,1

P_REL_OTHER_REL_IND: 0,1

P_REL_HOUSEROOMMATE_IND: 0,1

P_REL_CHILD_FOSTER_IND: 0,1

P_REL_OTHER_NONREL_IND: 0,1

Data Needed

RESPONDENT

NAME#

Pre-condition

PERSONCOUNT= (2-99) (who is not the Respondent)

OC = “No” (if Demo Questions still need to be completed for remaining rostered persons)

or

WHERE (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, goto SEX.

If Answer the Question, go back to response options.

Post-condition

Goto SEX

Help Text link

RELATIONSHIP

Special Instructions

  1. This screen is not displayed for single-person households.

  2. This screen is not displayed for the reference person.

  3. There will only be a “Next” (No “Previous”) button on this screen

SEX

Screen Name

SEX

Variable Names

P_SEX_MALE_IND: 1

P_SEX_FEMALE_IND: 2

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




DOB

Screen Name

DOB

Variable Names

P_BIRTH_MONTH_INT: NUM 2

P_BIRTH_DAY_INT: NUM 2

P_BIRTH_YEAR_INT: NUM 4

P_AGE_INT: NUM 3

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 (full word), Day, and Year.



Only valid dates between January 1, 1898 and Dec. 31, 2024 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. Only allow entries up to 126.

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

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.

RACE

Screen name

RACE

Previous screen(s) and response option(s)

DOB

Data needed

NAME#

Question wording

Before REFDATE

What is <NAME#>’s race and/or ethnicity? (Help)

Select all that apply.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

White

For example, English, German, Irish, Italian, Polish, Scottish, etc.

P_RACE_WHITE_IND

1

Hispanic or Latino

For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.

P_RACE_HISPANIC_IND

1

Black or African American

For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

P_RACE_BLACK_IND

1

Asian

For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

P_RACE_ASIAN_IND

1

American Indian or Alaska Native

For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

P_RACE_AIAN_IND

1

Middle Eastern or North African

For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

P_RACE_MENA_IND

1

Native Hawaiian or Pacific Islander

For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

P_RACE_NHPI_IND

1

Some other race and/or ethnicity

P_RACE_SOR_IND

1

Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “White”, go to WHITE

Else if RACE = “Hispanic or Latino”, go to HISPANIC

Else if RACE = “Black or African American”, go to BLACK

Else if RACE = “Asian”, go to ASIAN

Else if RACE = “American Indian or Alaska Native”, go to AIAN

Else if RACE = “Middle Eastern or North African”, go to MENA

Else if RACE = “Native Hawaiian or Pacific Islander”, go to NHPI

Else if RACE = “Some other race and/or ethnicity”, go to SOR

If more than one race is selected, the instrument should branch to the screen associated with the first checkbox selected. Additional branching will occur as described in the specification for each screen.


Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If no response, display the following edit only once:

“Please provide an answer to the question.”




Top of the screen? ☐

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.

Exit Survey option




WHITE

Screen name

WHITE

Previous screen(s) and response option(s)

RACE

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s WHITE details?

Select all that apply and enter additional details in the space below.



Enter, for example, French, Swedish, Norwegian, etc.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

English

P_RACE2_ENGLISH_IND

1

German

P_RACE2_GERMAN_IND

1

Irish

P_RACE2_IRISH_IND

1

Italian

P_RACE2_ITALIAN_IND

1

Polish

P_RACE2_POLISH_IND

1

Scottish

P_RACE2_SCOTTISH_IND

1

[write-in]

P_RACE2_WHITE_TEXT

CHAR 200

Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “Hispanic or Latino”, go to HISPANIC

Else if RACE = “Black or African American”, go to BLACK

Else if RACE = “Asian”, go to ASIAN

Else if RACE = “American Indian or Alaska Native”, go to AIAN

Else if RACE = “Middle Eastern or North African”, go to MENA

Else if RACE = “Native Hawaiian or Pacific Islander”, go to NHPI

Else if RACE = “Some other race and/or ethnicity”, go to SOR

Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.


Textboxes should always be displayed and initially shaded white. Text can be entered into a textbox without a checkbox being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted yellow.



The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option




HISPANIC

Screen name

HISPANIC

Previous screen(s) and response option(s)

RACE

WHITE (if “White” was selected on RACE)

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s HISPANIC OR LATINO details?

Select all that apply and enter additional details in the space below.



Enter, for example, Colombian, Honduran, Spaniard, etc.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

Mexican

P_RACE2_MEXICAN_IND

1

Puerto Rican

P_RACE2_PUERTORICAN_IND

1

Salvadoran

P_RACE2_SALVADORAN_IND

1

Cuban

P_RACE2_CUBAN_IND

1

Dominican

P_RACE2_DOMINICAN_IND

1

Guatemalan

P_RACE2_GUATEMALAN_IND

1

[write-in]

P_RACE2_HISPANIC_TEXT

CHAR 200

Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “Black or African American”, go to BLACK

Else if RACE = “Asian”, go to ASIAN

Else if RACE = “American Indian or Alaska Native”, go to AIAN

Else if RACE = “Middle Eastern or North African”, go to MENA

Else if RACE = “Native Hawaiian or Pacific Islander”, go to NHPI

Else if RACE = “Some other race and/or ethnicity”, go to SOR

Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.


Textboxes should always be displayed and initially shaded white. Text can be entered into a textbox without a checkbox being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted yellow.


The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option




BLACK

Screen name

BLACK

Previous screen(s) and response option(s)

RACE

WHITE (if “White” was selected on RACE)
HISPANIC (if “Hispanic or Latino” was selected on RACE)

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s BLACK OR AFRICAN AMERICAN details?

Select all that apply and enter additional details in the space below.



Enter, for example, Trinidadian and Tobagonian, Ghanaian, Congolese, etc.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

African American

P_RACE2_AFRICANAMERICAN_IND

1

Jamaican

P_RACE2_JAMAICAN_IND

1

Haitian

P_RACE2_HAITIAN_IND

1

Nigerian

P_RACE2_NIGERIAN_IND

1

Ethiopian

P_RACE2_ETHIOPIAN_IND

1

Somali

P_RACE2_SOMALI_IND

1

[write-in]

P_RACE2_BLACK_TEXT

CHAR 200

Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “Asian”, go to ASIAN

Else if RACE = “American Indian or Alaska Native”, go to AIAN

Else if RACE = “Middle Eastern or North African”, go to MENA

Else if RACE = “Native Hawaiian or Pacific Islander”, go to NHPI

Else if RACE = “Some other race and/or ethnicity”, go to SOR

Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.



Textboxes should always be displayed and initially shaded white. Text can be entered into a textbox without a checkbox being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted yellow.



The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option




ASIAN

Screen name

ASIAN

Previous screen(s) and response option(s)

RACE

WHITE (if “White” was selected on RACE)
HISPANIC (if “Hispanic or Latino” was selected on RACE)

BLACK (if “Black or African American” was selected on RACE)

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s ASIAN details?

Select all that apply and enter additional details in the space below.



Enter, for example, Pakistani, Hmong, Afghan, etc.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

Chinese

P_RACE2_CHINESE_IND

1

Asian Indian

P_RACE2_ASIANINDIAN_IND

1

Filipino

P_RACE2_FILIPINO_IND

1

Vietnamese

P_RACE2_VIETNAMESE_IND

1

Korean

P_RACE2_KOREAN_IND

1

Japanese

P_RACE2_JAPANESE_IND

1

[write-in]

P_RACE2_ASIAN_TEXT

CHAR 200

Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “American Indian or Alaska Native”, go to AIAN

Else if RACE = “Middle Eastern or North African”, go to MENA

Else if RACE = “Native Hawaiian or Pacific Islander”, go to NHPI

Else if RACE = “Some other race and/or ethnicity”, go to SOR

Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.


The write-in boxes are initially shaded white. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted in yellow.



Textboxes should always be displayed; text can be entered into a textbox without a check box being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed.



The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option




AIAN

Screen name

AIAN

Previous screen(s) and response option(s)

RACE

WHITE (if “White” was selected on RACE)
HISPANIC (if “Hispanic or Latino” was selected on RACE)

BLACK (if “Black or African American” was selected on RACE)

ASIAN (if “Asian” was selected on RACE)

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s AMERICAN INDIAN OR ALASKA NATIVE details?


Enter, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

[write-in]

P_RACE2_AIAN_TEXT

CHAR 200



















Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “Middle Eastern or North African”, go to MENA

Else if RACE = “Native Hawaiian or Pacific Islander”, go to NHPI

Else if RACE = “Some other race and/or ethnicity”, go to SOR

Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.


Textboxes should always be displayed and initially shaded white. Text can be entered into a textbox without a checkbox being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted yellow.



The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option




MENA

Screen name

MENA

Previous screen(s) and response option(s)

RACE

WHITE (if “White” was selected on RACE)
HISPANIC (if “Hispanic or Latino” was selected on RACE)

BLACK (if “Black or African American” was selected on RACE)

ASIAN (if “Asian” was selected on RACE)

AIAN (if “American Indian or Alaska Native” was selected on RACE)

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s MIDDLE EASTERN OR NORTH AFRICAN details?

Select all that apply and enter additional details in the space below.



Enter, for example, Moroccan, Yemeni, Kurdish, etc.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

Lebanese

P_RACE2_LEBANESE_IND

1

Iranian

P_RACE2_IRANIAN_IND

1

Egyptian

P_RACE2_EGYPTIAN_IND

1

Syrian

P_RACE2_SYRIAN_IND

1

Iraqi

P_RACE2_IRAQI_IND

1

Israeli

P_RACE2_ISRAELI_IND

1

[write-in]

P_RACE2_MENA_TEXT

CHAR 200

Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “Native Hawaiian or Pacific Islander”, go to NHPI

Else if RACE = “Some other race and/or ethnicity”, go to SOR

Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.


Textboxes should always be displayed and initially shaded white. Text can be entered into a textbox without a checkbox being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted yellow.



The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option




NHPI

Screen name

NHPI

Previous screen(s) and response option(s)

RACE

WHITE (if “White” was selected on RACE)
HISPANIC (if “Hispanic or Latino” was selected on RACE)

BLACK (if “Black or African American” was selected on RACE)

ASIAN (if “Asian” was selected on RACE)

AIAN (if “American Indian or Alaska Native” was selected on RACE)

MENA (if “Middle Eastern or North African” was selected on RACE)

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s NATIVE HAWAIIAN OR PACIFIC ISLANDER details?

Select all that apply and enter additional details in the space below.


Enter, for example, Chuukese, Palauan, Tahitian, etc.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

Native Hawaiian

P_RACE2_NATIVEHAWAIIAN_IND

1

Samoan

P_RACE2_SAMOAN_IND

1

Chamorro

P_RACE2_CHAMORRO_IND

1

Tongan

P_RACE2_TONGAN_IND

1

Fijian

P_RACE2_FIJIAN_IND

1

Marshallese

P_RACE2_MARSHALLESE_IND

1

[write-in]

P_RACE2_NHPI_TEXT

CHAR 200

Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

If RACE = “Some other race and/or ethnicity”, go to SOR

Else if RACE is blank, go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.


Textboxes should always be displayed and initially shaded white. Text can be entered into a textbox without a checkbox being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted yellow.



The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option


SOR

Screen name

SOR

Previous screen(s) and response option(s)

RACE

WHITE (if “White” was selected on RACE)
HISPANIC (if “Hispanic or Latino” was selected on RACE)

BLACK (if “Black or African American” was selected on RACE)

ASIAN (if “Asian” was selected on RACE)

AIAN (if “American Indian or Alaska Native” was selected on RACE)

MENA (if “Middle Eastern or North African” was selected on RACE)

NHPI (if “Native Hawaiian or Pacific Islander” was selected on RACE)

Data needed

NAME#

Question wording

Before REFDATE

What are <NAME>’s SOME OTHER RACE AND/OR ETHNICITY details?

Enter details in the space below.

On or After REFDATE


Response options and Variables

Response Option

Variable Name

Value

[write-in]

P_RACE2_SOR_TEXT

CHAR 200



















Need Don’t Know, Refused options? Please click the checkbox in the next column and provide any additional instructions in the Special Instructions field.

☐

Branching/Skip Patterns

Go to OC

Help text

Before REFDATE

Race and/or Ethnicity

An individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the question generally reflect sociopolitical definitions recognized in this country and do not attempt to define groups biologically or genetically.


The following descriptions define each of the categories:


White

The category “White” includes individuals with origins in any of the original peoples of Europe. Examples of these groups include, but are not limited to, English, German, Irish, Italian, Polish, and Scottish. The category also includes groups such as French, Swedish, Norwegian, Russian, Cajun, Roma, etc. Individuals should select all that apply and report the person’s additional detailed White group or groups in the space provided.


Hispanic or Latino

The category “Hispanic or Latino” includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin. The category also includes groups such as Colombian, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should select all that apply and report the person’s additional detailed Hispanic or Latino group or groups in the space provided.



Black or African American

The category “Black or African American” includes individuals with origins in any of the Black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Trinidadian and Tobagonian, Ghanaian, Congolese, Kenyan, Cameroonian, Barbadian, etc. Individuals should select all that apply and report the person’s additional detailed Black or African American group or groups in the space provided.


Asian

The category “Asian” includes individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia. Examples of these groups include, but are not limited to, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Hmong, Afghan, Cambodian, Taiwanese, Thai, etc. Individuals should select all that apply and report the person’s additional detailed Asian group or groups in the space provided.


American Indian or Alaska Native

The category “American Indian or Alaska Native” includes individuals with origins in any of the original peoples of North, Central, and South America. Examples of these groups include, but are not limited to, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya. The category also includes groups such as The Muscogee (Creek) Nation, The Chickasaw Nation, Central Council of the Tlingit and Haida Indian Tribes, Native Village of Kotzebue, Taino, Inca, etc. Individuals should report the person’s detailed American Indian or Alaska Native tribe or tribes in the space provided.


Middle Eastern or North African
The category “Middle Eastern or North African” includes individuals with origins in any of the original peoples of the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli. The category also includes groups such as Moroccan, Yemeni, Kurdish, Palestinian, Chaldean, Assyrian, etc. Individuals should select all that apply and report the person’s additional detailed Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Pacific Islander

The category “Native Hawaiian or Pacific Islander” includes individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Chuukese, Palauan, Tahitian, Māori, Pohnpeian, Kosraean, etc. Individuals should select all that apply and report the person’s additional detailed Native Hawaiian or Pacific Islander group or groups in the space provided.


Some Other Race and/or Ethnicity

“Some Other Race and/or Ethnicity” includes all other responses not included in the categories above. Individuals should report the person’s detailed group or groups in the space provided.

How are race and/or ethnicity data used?

Questions about race and/or ethnicity are asked because these data are required for federal and state programs and are critical factors in the basic research behind numerous policies, particularly for civil rights. These data are also used to promote equal employment opportunities and to address disparities in health and environmental risks.


By law, the Census Bureau can only use your responses to produce statistics. The Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your household. Your answers cannot be used against you by any government agency or court.

On or After REFDATE


Soft Edit

1st soft edit

In-line? ☐ If yes, for which response option?

If nothing is checked or written into the box, display: “Please provide a response. If this person does not have an answer, continue to the next page.”

Top of the screen? ☒

2nd soft edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Hard Edit

1st hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

2nd hard edit

In-line? ☐ If yes, for which response option?


Top of the screen? ☐

Special instructions

Are electronic versions of field materials needed on this screen? ☐

If yes, what material is needed on this screen?

Please provide any additional special instructions below.


Textboxes should always be displayed and initially shaded white. Text can be entered into a textbox without a checkbox being selected. If there is a write-in response but none of the boxes are checked, an edit will not be triggered. No message is needed. When an edit is rendered for a missing response in the write-in box, the write-in box should be highlighted yellow.



The system will only allow the following special characters for write-ins on WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHPI and SOR screens:


Alphanumeric and , (comma), - (dash), ; (semicolon), / (forward slash), \ (back slash), & (ampersand), Á (A with an accent), á (a with an accent), É (E with an accent), é (e with an accent), Í (I with an accent), í (i with an accent), Ó (O with an accent), ó (o with an accent), Ú (U with an accent), ú (u with an accent), Ü (U with an umlaut), ü (u with an umlaut), Ý (Y with an accent), ý (y with an accent), Ñ (N with tilde(~)), and ñ (n with tilde(~)).


There should be a 200 character limit for write-ins.

Exit Survey option






OC

Screen Name

OC

Variable Names

P_LOC_ELSE_NO_IND: 1

P_LOC_ELSE_RELATIVES_IND: 2

P_LOC_ELSE_COLLEGE_IND: 3

P_LOC_ELSE_MILITARY_IND: 4

P_LOC_ELSE_JOB_IND: 5

P_LOC_ELSE_NURSINGHOME_IND: 6

P_LOC_ELSE_JAIL_IND: 7

P_LOC_ELSE_SEASONAL_IND: 8

P_LOC_ELSE_OTHER_IND: 9

Data Needed

NAME#

<ADDRESS>

Pre-condition

RACE

WHITE (if “White” was selected on RACE)
HISPANIC (if “Hispanic or Latino” was selected on RACE)

BLACK (if “Black or African American” was selected on RACE)

ASIAN (if “Asian” was selected on RACE)

AIAN (if “American Indian or Alaska Native” was selected on RACE)

MENA (if “Middle Eastern or North African” was selected on RACE)

NHPI (if “Native Hawaiian or Pacific Islander” was selected on RACE)

SOR (if “Some other race and/or ethnicity” was selected on RACE)

Question Wording

Does <NAME#> often sleep somewhere else, other than <ADDRESS>?

If <NAME> stays at more than one other place, select the response that applies to where they stay most often.

Question Wording Fills


Response Options

Respondent will only be able to select one of the following:


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

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 any of the Yes options are selected, go to ALTERNATE_ADDRESS.

If “No” was selected:

  • AND if Demographic Questions have not been asked for all people listed on roster, goto RELATIONSHIP for next person on roster.

or

  • Else, if POPCOUNT <> PERSONCOUNT, go to CD_CHECK

or

Else, goto VAC_CROWD_A

Special Instructions




ALTERNATE_ADDRESS

Screen Name

ALTERNATE_ADDRESS

Variable Names

P_ALT_ADR_STNM_TEXT: VARCHAR2 (100)

P_ALT_ADR_UNIT_TEXT: VARCHAR2 (50)
P_ALT_ADR_CITY_TEXT: VARCHAR2 (100)
P_ALT_ADR_STATE_TEXT: VARCHAR2 (2)
P_ALT_ADR_ZIP_TEXT: VARCHAR2 (5)
P_ALT_ADR_NO_STR_ADR_IND: ‘The place does not have a street address’

Data Needed

NAME#

Pre-condition

Any of the “Yes” options selected on OC

Question Wording

What is the street address of the other place where <NAME#> often sleeps?


Provide the street address you would use to have a package delivered directly to that residence, not a Rural Route or P.O. Box address that is used only for mailing purposes. A street address is the most helpful for processing your response.

Question Wording Fills


Response Options

Street Address

Ex: 101 N Main St

(100-character text box)


Apt/Unit

Ex: Apt 23

(50-character text box)


City

(30-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 “The place does not have a street address” option.

Edits/Errors


Post-condition

  • If the respondent provides the preferred address fields and selects “Next”, goto MOST

  • If “The place does not have a street address,” is checked, goto ALTERNATE_ADDRESS_OTHER.

Special Instructions

No soft edit



ALTERNATE_ADDRESS_OTHER

Screen Name

ALTERNATE_ADDRESS_OTHER

Variable Names

P_ALTOTH_ADR_CITY_TEXT: VARCHAR2 (100)
P_ALTOTH_ADR_STATE_TEXT: VARCHAR2 (2)
P_ALTOTH_ADR_ZIP_TEXT: VARCHAR2 (5)

P_ALTOTH_ADR_LOC_DESC_TEXT: VARCHAR2 (250)

Data Needed

Pre-condition

Respondent selects “The place does not have a street address” on ALTERNATE_ADDRESS

Question Wording

Please describe the physical location of the other place where <NAME#> often sleeps. Also provide a city, state, and ZIP Code.

Response Options

Please provide as much information as possible.

For example:

  • a rural route address or E-911 address

  • 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”

Physical Location Description:

(250-character text box)


City

(30-character text box)


State

(Drop down menu with alphabetical 50 states and District of Columbia)


ZIP Code

(5-digit text box)

Edits/Errors


Post-condition

MOST

Special Instructions

No soft edit

MOST

Screen Name

MOST

Variable Names

P_LOC_MOST_RFN_ADR_IND: 1

P_LOC_MOST_OTHER_IND: 2

P_LOC_MOST_REFANDALT_IND: 3

P_LOC_MOST_ELSEWHERE_IND: 4

Data Needed

NAME#

<ADDRESS>

<ALTERNATE ADDRESS> = Street Address, Unit, City, State, Zip provided on ALTERNATE ADDRESS screen

Pre-condition

ALTERNATE_ADDRESS

Or

ALTERNATE_ADDRESS_OTHER

Question Wording

Where does <NAME#> sleep most often?

Question Wording Fills


Response Options

Respondent will only be able to select one of the following:


  • <ADDRESS>

  • <ALTERNATE ADDRESS> (or “The other place where they sometimes live or stay” when address was not provided on the ALTERNATE_ADDRESS screen)

  • Equal time at both places

  • Some other place


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, goto WHERE.

If Answer the Question, go back to response options.

Post-condition

Goto WHERE

Special Instructions




WHERE

Screen Name

WHERE

Variable Names

P_LOC_OCD_RFN_ADR_IND: 1

P_LOC_OCD_OTHER_IND: 2

P_LOC_OCD_ELSEWHERE_IND: 3

P_LOC_OCD_DK_IND: 4

Data Needed

NAME#

<REFDATE>

<ADDRESS>

<ALTERNATE ADDRESS>

Pre-condition

MOST

Question Wording

Before REFDATE

On <REFDATE>, where will <NAME#> be sleeping overnight?

Question Wording

On or After REFDATE

On <REFDATE>, where was <NAME#> sleeping overnight?

Question Wording Fills


Response Options

Respondent will only be able to select one of the following:


  • <ADDRESS>

  • <ALTERNATE ADDRESS> (or “The other place where they sometimes live or stay” if a valid address was not provided on the ALTERNATE_ADDRESS screen)

  • Some other place

  • Don’t Know

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, goto next screen (following Post-condition criteria for this screen).

If Answer the Question, go back to response options.

Post-condition

  • If Demographic Questions have not been asked for all people listed on roster, goto RELATIONSHIP for next person on roster.

or

  • Else, if POPCOUNT <> PERSONCOUNT, go to CD_CHECK

or

  • Else, goto VAC_CROWD_A

Special Instructions


Coverage



CD_CHECK

Screen Name

CD_CHECK

Variable Names

H_SIZE_STATED_CNT: NUM 2 [1-99]

H_SIZE_CALCULATED_INT: NUM 2 [1-99]

H_SIZE_CHECK_CODE: 0,1,2,3

H_SIZE_CHECK_CNT: NUM 2 [1-99]

Pre-condition

OC and POPCOUNT <> PERSONCOUNT

Or

WHERE 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>.

The names you listed are:

<NAMES FROM ROSTER>



Including yourself, how many people will be living or staying at <ADDRESS> on <REFDATE>?

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>.

The names you listed are:

<NAMES FROM ROSTER>

Including yourself, how many people were living or staying at <ADDRESS> on <REFDATE>?

Response Options

Respondent will only be able to select one of the following:

  • <POPCOUNT>

  • <PERSONCOUNT>

  • Other



If “Other” is selected:

{display one 2-digit numeric 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, goto next screen (following Post-condition criteria for this screen).


If Answer the Question, go back to response options.

Post-condition

VAC_CROWD_1A or VAC_CROWD_2A (based on sample assignment)

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.



VAC_CROWD_1A

Screen Name

VAC_CROWD_1A

Variable Names

h_vc1_someone_ind

h_vc1_noone_ind

h_vc1_unsure_ind

h_vc1_whathome_ind

h_vc1_nohome_ind

Data Needed


Pre-condition

CD_CHECK

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 TIME_CAPSULE

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 TIME_CAPSULE

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.



VAC_CROWD_1B

Screen Name

VAC_CROWD_1B

Variable Names


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

TIME_CAPSULE

Special Instructions




VAC_CROWD_2A

Screen Name

VAC_CROWD_2A

Variable Names


Data Needed


Pre-condition

CD_CHECK

Question Wording

Before REFDATE

Do you know the street address of any houses, apartments, or mobile homes that will be vacant on <REFDATE>? This could be homes inside or outside your neighborhood.

Please also consider seasonal or vacation homes or short-term rentals 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 <REFDATE>? This could be homes inside or outside your neighborhood.

Please also consider seasonal or vacation homes or short-term rentals 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 TIME_CAPSULE

If Answer the Question, go back to response options.

Post-condition

If “Yes” is selected, go to VAC_CROWD_2B

Else, go to TIME_CAPSULE

Special Instructions

There will only be a “Next” (No “Previous”) button on this screen.



VAC_CROWD_2B

Screen Name

VAC_CROWD_2B

Variable Names


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

TIME_CAPSULE

Special Instructions


TIME_CAPSULE 

Screen Name 

TIME_CAPSULE 

Variable Names 

 

Data Needed 

 

Pre-condition 

 VAC_CROWD_B 


or


VAC_CROWD_A=”No” or Blank

 

Question Wording 

Before REFDATE 

Before you submit your responses, you have an opportunity to write a message for future generations. For example, you can write about what your life is like in 2024. Your message will be released by the National Archives and Records Administration to the public in 2102, as part of the release of census records.

The message you share in this question can be used by future generations and historians to gain a perspective about this time in history or to learn more about you. Submitting a message is voluntary. By participating, you are helping to create a collection of stories to study, use, and enjoy. 

This opportunity is only available in the online questionnaire. Sessions close after 15 minutes of inactivity.

 

Question Wording  

On or After REFDATE 

Before you submit your responses, you have an opportunity to write a message for future generations. For example, you can write about what your life is like in 2024. Your message will be released by the National Archives and Records Administration to the public in 2102, as part of the release of census records.

The message you share in this question can be used by future generations and historians to gain a perspective about this time in history or to learn more about you. Submitting a message is voluntary. By participating, you are helping to create a collection of stories to study, use, and enjoy. 

This opportunity is only available in the online questionnaire. Sessions close after 15 minutes of inactivity.

 

Response Options 

Display 1000-character text field with the following header above the response box: Message for Future Generations - Optional

 

Response Options Fills 

N/A 

Edits/Errors 

 

Post-condition 

SUBMIT 

Special Instructions 

 

SUBMIT Census Questionnaire

Screen Name

SUBMIT Census Questionnaire

Variable Names

RESP_SUBMIT_IND:

Data Needed


Pre-condition

TIME_CAPSULE

Question Wording

You are almost finished with the survey. To submit your responses, click the button below. Once you see 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 2024 National Census Survey questionnaire for:

<FULL ADDRESS>

Date and time of submission

If you receive other mail from the Census Bureau about the 2024 National 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 2024 National 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


NO_COMPLETE_AUTH

Screen Name

NO_COMPLETE_AUTH

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 2024 National Census Survey could not be completed. 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 Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKristen A Hearns(CENSUS/DCMD FED)
File Modified0000-00-00
File Created2024-09-09
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