Form 1 Questionnaire

Affinity Panel November 2024 Questionnaire

Introduction

Welcome! Thank you for participating in this survey. This 15-minute survey asks questions that will help the U.S. Census Bureau improve the way we conduct our surveys. The survey will also collect information about you and your household to determine your eligibility for future research studies.

The authority for the collection of this information for Opt-in Affinity Panel Web Probing Survey (0607-0978) the Census Research Panel is provided under Title 13, United States Code, Sections 141 and 182. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.

The purpose of collecting this information is to help improve Census Bureau survey methods. Personally identifiable information collected includes name, address, telephone/cell phone number, date of birth or age, email address, and race or ethnicity.

Your privacy is protected by the Privacy Act (Title 5, U.S. Code, Section 552a). Access to PII/BII is restricted to authorized personnel only and with staff that have a need to know. Routine uses of these data are limited to those identified in the Privacy Act System of Record Notice titled, COMMERCE/ Census-3 Demographic Survey Collection (Census Bureau Sampling Frame). The Census Bureau can use your responses only to produce statistics and is not permitted to publicly release your responses in a way that could identify you. Furnishing this information is voluntary. Failure to do so will produce no consequences but will limit the Census Bureau’s attempts to improve survey methods.

Federal law protects your privacy and keeps your answers confidential (Title 13, United States Code, Section 9). We estimate that this survey will take 15 minutes on average. Send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey to adrm.pra@census.gov. This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-0978, confirms this approval and expires on 01/31/2027. We are required to display this number to conduct this survey.

BIRTHYEAR

What year were you born? ____

EMP2

First, we are going to ask about your employment.

WORK

Are you currently working?

Yes

No

FT_PT – If WORK = yes.

Are you working full-time or part-time?

Full-time

Part-time

EMP3 – If WORK = yes.

Are you employed by the government, by a private company, a nonprofit organization or are you self-employed or working in a family business? Select only one answer.

Government

Private company

Non-profit organization including tax exempt and charitable organizations

Self-employed

Working in a family business

FED_EMPLOYEE – If EMP3 = 1.

Are you employed by the Federal government? If federal contractor, select NO.

Yes

No

JOB_DESC

What is your current job title or job description? ____________________________________

STUD

Are you currently a student?

Yes

No

DEV

What device are you using to complete this survey?

Phone

Laptop or desktop computer

Tablet

COMP

How often do you use a laptop or desktop computer?

Daily

A few times a week

Once a week

A few times a month

Once a month

A few times a year

Never

DEMO_INTRO

Now we have a few questions about you and your household.

NAME

What is your name?

First Name __________________

Last Name __________________

EDUCATION

What is the highest degree or level of school you have completed? Select only one answer.

Less than high school

Some high school

High school graduate or equivalent (for example GED)

Some college, but degree not received or is in progress

Associate’s degree (for example AA, AS)

Bachelor's degree (for example BA, BS, AB)

Graduate degree (for example master's, professional, doctorate)

SEX

What sex were you assigned at birth, on your original birth certificate?

Male

Female

GENID

How do you currently describe yourself? Select all that apply.

Male

Female

Transgender

Nonbinary

I use a different term – Please specify: ___________________

ORIENTATION

Which of the following best represents how you think of yourself?

Gay or lesbian

Straight, that is not gay or lesbian

Bisexual

I use a different term – Please specify: ___________________

CONFIRM – Present this question if SEX ne GENID. Fill with responses from SEX and GENID.

Just to confirm, you were assigned [SEX] at birth, and now you describe yourself as [GEN_ID]. Is that correct?

Yes

No

SEX_CONF – If CONFIRM = no.

What sex were you assigned at birth, on your original birth certificate?

Male

Female

GENID_CONF – If CONFIRM = no.

How do you currently describe yourself? Select all that apply.

Male

Female

Transgender

Nonbinary

I use a different term – Please specify: ________________

RACE

What is your race and/or ethnicity? Select all that apply and enter additional details in the spaces below.

White – Provide details below.

English

German

Irish

Italian

Polish

Scottish

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

Hispanic or Latino – Provide details below.

Mexican

Puerto Rican

Salvadoran

Cuban

Dominican

Guatemalan

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

Black or African American – Provide details below.

African American

Jamaican

Haitian

Nigerian

Ethiopian

Somali

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

Asian – Provide details below.

Chinese

Asian Indian

Filipino

Vietnamese

Korean

Japanese

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

American Indian or Alaska Native – 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. _____

Middle Eastern or North African – Provide details below.

Lebanese

Iranian

Egyptian

Syrian

Iraqi

Israeli

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

Native Hawaiian or Pacific Islander – Provide details below.

Native Hawaiian

Samoan

Chamorro

Tongan

Fijian

Marshallese

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

ZIPCODE

What is your ZIP code? _____

HHINTRO

Next, we would like to learn more about your household.

HHSIZE_TOTAL

How many total people – adults and children – currently live in your household, including yourself? ________

LIVE_STAY

Who lives or stays with you? Please select all that apply.

No one - I live alone

Parent(s) or Parent(s)-in-law

Grandparent(s)

Husband/wife/spouse

Unmarried partner

Adult children, son-in-law, daughter-in-law

Children under age 18

Grandchildren

Other relative(s)

Roommates

Friends

Other: Please specify – __________________________________________________

HHSIZE_CHILDREN – If LIVE_STAY “children under 18” was selected.

How many children under 18 years-old currently live in your household? ______

OTHR_CHILD

Do you have any children under 18 who live outside of your household?

Yes

No

NICK – If HHSIZE_CHILDREN =/> 1, or LIVEWITH_CHLU18 > 0. Provide number of fields based on HHSIZE_CHILDREN.

Please provide a nickname or initials for each child under 18 living in your household so that we can refer to them in the next few questions.

First child: _________________

Second child: _________________

Etc.

Age in Months experiment – If HHSIZE_CHILDREN = >1, or LIVEWITH_CHLU18 > 0. Provide a question for each child reported in NICK. Randomly assign AIM1 / AIM2, and use the same version for each child reported in NICK.

AIM1

What is [NICK first child]’s age and date of birth? To report a baby’s age in months, print “M” after age; for example: for 1 month old, print “1M.”

Print numbers in boxes.

Age Month Day Year of birth

_ _ _ _ _ _ _ _ _ _ _

AIM2

What is [NICK first child]’s age and date of birth?

Print numbers in boxes.

Age Month Day Year of birth

_ _ _ ↘ _ _ _ _ _ _ _ _

__ Check this box if age is in months.

School Lunch experiment – If HHSIZE_CHILDREN = >1 or LIVEWITH_CHLU18 > 0. Randomly assign to two treatment groups: C-L and D-L.

Group C-L – LNCH_C

LNCH_C

Do any of these children usually eat a complete breakfast and/or lunch prepared by the school?

Yes- Breakfast Yes- Lunch No- no school meals

[NICK-1] [ ] [ ] [ ]

[NICK-2] [ ] [ ] [ ]

Etc.

Group D-L – LNCH_D1 – LNCH_D2

LNCH_D1

Which of these children usually eats a complete breakfast and/or lunch prepared by the school?

[NICK-1]

[NICK-2]

Etc.

[ ] None of these children

LNCH_D2 – If Group D-L and LNCH_D1 >= 1 but ne “none of these”

Which meals prepared by the school do these children usually eat?

Breakfast Lunch

[Child from LNCH_D1] [ ] [ ]

[Child from LNCH_D1] [ ] [ ]

Etc.

Incentives questions – Randomize order of REST, CONV, and GROC.

INC_INTRO

Next we’d like to ask you some questions about how you pay for things.

REST

When eating out at a restaurant, how do you usually pay?

Cash

Credit card

Debit card

Phone (e.g., Apple Pay, Google Wallet)

Check

SNAP EBT card

CONV

When buying a couple of inexpensive items at a convenience store or grocery store, how do you usually pay?

Cash

Credit card

Debit card

Phone (e.g., Apple Pay, Google Wallet)

Check

SNAP EBT card

GROC

When buying a large amount of groceries, how do you usually pay?

Cash

Credit card

Debit card

Phone (e.g., Apple Pay, Google Wallet)

Check

SNAP EBT card

SNAP – If R selected SNAP for REST, CONV, or GROC.

How do you pay for food or other items when you do not use a SNAP EBT card? Select all that apply.

Cash

Credit card

Debit card

Phone (e.g., Apple Pay, Google Wallet)

Check

OWE

If a friend owes you $40, how do you prefer that they pay you back?

Cash

Payment app (e.g., Venmo, Zelle, Paypal)

Check

Gift card

VIN1 – Randomize the fill for 5 or 40.

Imagine that you just completed a survey online that took an hour. The last question of the survey asks how you would like to receive your $[5/40] payment. Which method would you choose?

Cash, mailed to your house

Digital gift card, emailed

Physical gift card, mailed to your house

Check, mailed to your house

Electronic transfer to your bank account

I wouldn’t take the payment

VIN2 – Fill with the filled value that was NOT used in VIN1.

Would your answer change if the payment was $[5/40]?

Yes

No

VIN2a – If VIN2 = yes. Fill with same value used in VIN2.

If you completed a survey online that took an hour, how would you want to receive the $[5/40] payment?

Cash, mailed to your home

Digital gift card, emailed

Physical gift card, mailed to your home

Check, mailed to your home

Electronic transfer to your bank account

I wouldn’t take the payment

INCIMP1 – If VIN1 = 1, 2, 3, 4, or 5. First fill, use response for VIN1. Second fill, use value filled in VIN1.

Randomize order of response options.

When you selected “[response for VIN1]” for your $[5/40] payment, which was more important?

Received quickly

Payment easy to use

Payment is secure

INCIMP2 – If VIN2a = 1, 2, 3, 4, or 5. First fill, use response for VIN2a. Second fill, use value filled in VIN2a. Randomize order of response options.

When you selected “[response for Vin2a]” for your $[filled amount in Vin2a] payment, which was more important?

Received quickly

Payment easy to use

Payment is secure

CHK. When you receive a check in the mail, how do you usually cash or deposit the check?

ATM

In-person at the bank

Bank’s app on my phone

Payment app (e.g., Venmo)

Store that cashes checks

Sign it over to someone else

APBA

Do you ever use an app to do your banking?

Yes

No

APPA

Do you ever use an app to pay people?

Yes

No

CAHAV

How often do you have cash?

Always

Most of the time

Sometimes

Rarely

Never

I only have cash for emergencies

CAUSE

How often do you use cash to pay for things?

Always

Most of the time

Sometimes

Rarely

Never

CASPND – If CAUSE ne “Never” or if R skipped CAUSE.

If you use cash, of any amount, which of these things do you use it for?

(select all that apply; do not randomize)

Tips

Groceries

Gas

Purchases under $20

Parking or Public Transportation

Dining out or Take out

Market or vendor stalls (e.g., farmers market, concession stand)

Businesses that have credit card fees or minimums

Children’s activities

Personal care services (e.g., haircut)

Freelance services (e.g., dog walker, fitness trainer)

CASPEND – If CAUSE ne “Never” or if R skipped CAUSE.

When you spend cash, how much do you spend in a single transaction? Select all that apply.

Less than $5

$5 to $20

$21 - $50

$51 -$100

More than $100

Utilities test questions – Randomly assign to three treatment groups: C1, C2, and D.

TEN

Is your house or apartment…? Select only one answer.

Owned by you or someone in this household free and clear?

Owned by you or someone in this household with a mortgage or loan (including home equity loans)?

Rented?

Occupied without payment of rent?

SEP_UTL – If TEN = “Rented”.

Do you pay for any utilities separately from your rent?

Yes

No

Group C1 – UTL1 – UTL1_D3c

UTL1 – If SEP_UTL = Yes or TEN = 1,2,3

How much did this household pay for electricity, gas, basic telephone service, and other utilities in October?

Other common example of utilities include water, heating oil and wood, trash or recycling, and mobile telephone service (excluding data plans, applications, games, and ringtones.) Do not include cable TV or internet.

$_____.00

UTL1_D1 – If SEP_UTL=Yes or TEN=1,2,3) AND UTIL not empty

Which of the following types of utilities did you include in your response of {fill}?

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

Internet

Cable or Satellite TV

Other, specify – _______________________

UTL1_D2 – If SEP_UTL=Yes or or TEN=1,2,3) AND UTIL not empty

Which of the following types of utilities do you have in your home?

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

Internet

Cable or Satellite TV

Other, specify – _____________________

UTL1_D3a

Which utilities do you pay on a monthly basis? Select all that apply.

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

Internet

Cable or Satellite TV

Other, specify – _____________________

UTL1_D3b

Which utilities do you pay on a quarterly or annual basis? Select all that apply.

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

Internet

Cable or Satellite TV

Other, specify – _____________________

None of these

UTL1_D3c – If UTL1_D3b = 1 to 9. Fill with response(s) from UTL_D3b.

Did you calculate estimated amounts for any of the utilities you pay on a quarterly or annual basis in your response of “[Fill]”?

Yes

No

Group C2 – UTL2 – UTL2_D3c

UTL2 – (IF GROUP C2 AND (SEP_UTL=Yes or TEN=1,2,3))

Which of the following types of utilities does your household pay {if rent: separately from rent}? Select all that apply.

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

UTL2a – UTL2f – If SEP_UTL = Yes or TEN = 1,2,3. Present questions based on responses selected in UTL2. Present all on the same screen.

UTL2a

How much did this household pay for electricity in October?

$_____.00

UTL2b

How much did this household pay for natural gas in October?

$_____.00

UTL2c

How much did this household pay for water and sewer in October?

$_____.00

UTL2d

How much did this household pay for basic or mobile telephone service in October? Exclude amounts for data plans, applications, and ringtones.

$_____.00

UTL2e

How much did this household pay for heating oil or wood in October?

$_____.00

UTL2f

How much did this household pay for trash and recycling in October?

$_____.00

UTL2_D3a

Which utilities do you pay on a monthly basis?

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

UTL2_D3b

Which utilities do you pay on a quarterly or annual basis?

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

None of these

UTL2_D3c. – If UTL2_D3b =1 to 6.

Did you calculate estimated amounts for any of the utilities you pay on a quarterly or annual basis?

Yes

No

Group D – UTL3 – UTL3_D3c

UTL3 – If SEP_UTL = Yes or TEN = 1,2,3.

Which of the following types of utilities does your household pay {if rent: separately from rent}? Select all that apply.

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

UTL3a – If SEP_UTL=Yes or TEN=1,2,3. Present only items selected in UTL3.

Please enter how much this household paid for each of the following types of utilities in October.

Electricity $_____.00

Natural gas $_____.00

Water and sewer $_____.00

Basic or mobile telephone service. Exclude amounts for data plans, applications, and ringtones. $_____.00

Heating oil or wood $_____.00

Trash and recycling $_____.00

UTL3_D3a. Which utilities do you pay on a monthly basis?

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

UTL3_D3b

Which utilities do you pay on a quarterly or annual basis?

Electricity

Natural gas

Water and sewer

Basic or mobile telephone service

Heating oil or wood

Trash and recycling

None of these

UTL3_D3c. – If UTL3_D3b = 1 to 6.

Did you calculate estimated amounts for any of the utilities you pay on a quarterly or annual basis?

Yes

No

Rental Income test questions – Randomly assign cases to three treatment groups: C1-RR, C2-RR, D-RR

Group C1-RR – RRR_C1a – RRR_C1DB

RRR_C1a

At any time during 2024, did you receive income from rent, roomers or boarders, estates, trusts, or royalties?

Yes

No

RRR_C1b – If RRR_C1a = Y.

How much did you receive in income from rent, roomers or boarders, estates, trusts, or royalties after expenses this year?

If you broke even or lost money, enter 0.

$______

RRR_C1DB – If RRR_C1b not blank

Which of these types of income did you include in your response to the previous question? Select all that apply.

Royalties

Rented property

Roomers/ Boarders

Estates or Trusts

None of the above

Group C2-RR – RRR_C2a – RRR_C2b

RRR_C2a

Which of the types of income did you received in 2024? Select all that apply.

Royalties

Rented property

Roomers/ Boarders

Estates or Trusts

None of the above

RRR_C2b – If RRR_C2a = 1,2,3, or 4. Fill with responses selected in RRR_C2a.

Enter the amount of income and expenses for 2024.

Income per Expenses per

[RRR_C2a_1] $______ [dropdown: $_____ [dropdown:

month, quarter, year] month, quarter, year]

[RRR_C2a_2] $______ [dropdown: $_____ [dropdown:

month, quarter, year] month, quarter, year]

Etc.

Group D-RR – RRR_Da – RRR_Dc

RRR_Da

Did you receive income from any of these sources in 2024?

Yes No

Royalties

Rented property

Roomers/ Boarders

Estates or Trusts

RRR_Db – If RRR_Da 1,2,3, or 4 = Y. Fill with responses selected in RRR_Da.

Enter the amount of income you received for 2024, before expenses.

Income

[RRR_DA_1] $______

[RRR_DA_2] $______

Etc.

RRR_Dc – If RRR_Da 1,2,3, or 4 = Y, even if skip RRR _Db. Fill with responses selected in RRR_Da and values reported in RRR_Db.

Enter your expenses for 2024.

Income Expenses

[RRR_DA_1] $[RRRE_DB_1] $____

[RRR_DA_2] $[RRRE_DB_2] $____

Etc.

HHINCOME

In 2023, what was your total household income before taxes?

Less than $25,000

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $149,999

$150,000 to $199,999

$200,000 and above

Contact info/future research

CON3B

We usually send updates, notifications, and survey links via text message. Would you like us to contact you by text message?

Message and data rates may apply, depending on your mobile phone service plan. Message frequency varies. You can opt out of these messages at any time by replying STOP or reply HELP for more assistance.

Yes

No

CON4 – If CON3B = yes.

What is the best cell phone number for us to reach you?

Cell phone __________________________________________________

PROMOTE_2020

Did you help promote the 2020 Census?

Yes

No

ENUMERATOR

Have you ever been a Census enumerator?

Yes

No

INPERSON_RESEARCH

Thank you for opting in to participate in online Census Bureau research studies. Sometimes, the Census Bureau conducts one-on-one studies or focus groups where you would work directly with a researcher.

Some of our studies are conducted in person. Would you be willing to participate in an in-person research study if the location was convenient for you?

Yes

No

REMOTE_RESEARCH

Some of our one-on-one studies are conducted remotely with a researcher. Would you be willing to use your computer, tablet, or phone to participate in a research study?

Yes

No

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