Questionnaire

Enclosure 2: Census Research Panel Survey May 2025 Questionnaire

Introduction

Welcome! Thank you for participating in this survey. This 15-minute survey asks questions on various topics such as employment and retirement, types of appliances in homes, reasons for moving to a new home, etc. We conduct this survey to compare different ways of asking questions, to help determine whether some versions of questions work better than others. 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 Census Research Panel Survey (0607-0978) 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, Special Censuses, Surveys, and Other Studies. 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 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?

Under18_msg [Display if “What year were you born?” Text Response Is Greater Than 2007. Skip to end of survey.]

Thank you for taking our survey. Unfortunately, you are not eligible for this survey.

DEMO_INTRO

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

NAME What is your name?

First Name __________________________________________________

Last Name __________________________________________________

Q2 [ Person column will accommodate up to 12 persons]

The following questions are about everyone who is living or staying at your address.  First, create a list of people. Enter one person on each line. Leave any extra lines blank. Enter names until you have listed everyone who lives or stays there, then click Next.

	First Name	Last Name
Person 1	{Filled with First Name from Name}	{Filled with Last Name from Name}
Person 2

RELATED

How is [Name] related to [respondent’s name]?

Spouse

Unmarried partner

Child

Grandchild

Sibling

Parent

Parent-in-law

Son-in-law or daughter-in-law

Other relative

Roommate or house mate

Other nonrelative

Other (specify)

Age in Months experiment

Programming note: Respondents will randomly receive either AIM2.1 or AIM3 for each person listed on their HH roster (i.e., the same treatment for all their residents).

AIM2.1_1

What is {NAME}'s date of birth and age?

Month/Day/Year of birth Age

__________________ ____ __ If age is in months, check this box.

AIM3

What is {NAME}'s date of birth and age?

Month/Day/Year of birth Age

__________________ ____ __ Less than 1 year old

Programming note: This WORK-ACT is only asked about the respondent and their household members who are ages 15 or older. Respondents will be in two treatment groups: (1) receives “Don’t know” option for the work-related questions and (2) does not receive a “Don’t know” option.

Employment Questions

EMP2

Now, we are going to ask about your and your household members' employment.

WORK

[Are you/Is [Name]] currently working for pay?

Yes

No

Programming note: IF WORK=Yes ask ADD to ACT.

For the next set of questions, please consider {your/Name’s} main job. By main job we mean the job in which {your/Name} works the most hours.

ADD

What is the address of the main location where {you work/ Name works}?

Street __________________________________________________

City __________________________________________________

State __________________________________________________

Zip code __________________________________________________

[X] Don’t know {For half of respondents}

Ask Random 1/4 of Respondents:

JYEAR1.

What year did {you/Name} begin this job?

[XXXX]

Ask Random 1/2 of Respondents: JYEAR2. What year did {you/Name} begin this job?

[XXXX]

[X] Don’t know

Ask Random 1/4 of Respondents: JYEAR3. What year did [you/Name] begin this job? Your best guess is fine.

[XXXX]

OCC

What kind of work did [you/Name] do at [your/their] main job, that is, what is their occupation? If {Name} has more than one job, please answer for the job in which they work the most hours. ________________________________________________________________

[X] Don’t know {For half of the respondents}

ACT

What are [your/ Name’s] usual activities at [your/their] main job?

________________________________________________________________

[X] Don’t know {For half of the respondents}

Programming note: There are two treatments for pension and retirement income received (1) A_SPENQ1 -A_SRETQ17 and (2) Q62Ar to Q98A_other.

DISPLAY TO ALL:
RET_INTRO: Next, we will ask about some questions about retirement for you and other people living with you.

Treatment 1 for Pension and retirement income: A_SPENQ1 to A_SRETQ17:

A_SPENQ1

During 2024 did [you/you or anyone in this household] receive any pension income from a previous employer or union? Do not include Social Security or distributions or withdrawals from IRAs, 401(K)s, or similar accounts.

Yes

No

A_SPENQ2

Who received pension income? Select all that apply

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

A_SPENQ3

What was the source of [your/Name] pension income? Did [you/they] have a pension from a: Select all that apply

Company

Union

Federal Government

State Government

Local Government

U.S. Military

Some other source __________________________________________________

A_SRETQ6

At any time during 2024 did [you/you or anyone in your household] have any retirement accounts such as a 401(k), 403(b), IRA, or other account designed specifically for retirement savings?

Yes

No

A_SRETQ7

Who had such a retirement account? Select all that apply

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

ASK FOR EACH PERSON SELECTED IN A_SRETQ7:

A_SRETQ8

What type of retirement account did [you/Name] have? Select all that apply

401(k)

403(b)

Roth IRA

Traditional IRA

KEOGH plan

SEP plan (Simplified Employee Pension)

Other type of retirement account __________________________________________________

ASK IF A_SRETQ8=401K:

A_SRETQ11

Did [you/Name] withdraw any money or receive a distribution from [your/their] 401(k) account in 2024, including any distributions [you/they] may have been required to take?

Yes

No

ASK IF A_SRETQ8=403B:

A_SRETQ12

Did [you/Name] withdraw any money or receive a distribution from [your/their] 403(b) account in 2024, including any distributions [you/they] may have been required to take?

Yes

No

ASK IF A_SRETQ8=Roth IRA:

A_SRETQ13

Did [you/Name] withdraw any money or receive a distribution from [your/their] Roth IRA account in 2024, including any distributions [you/they]may have been required to take?

Yes

No

ASK IF A_SRETQ8=Traditional IRA:

A_SRETQ14

Did [you/Name] withdraw any money or receive a distribution from [your/their] Traditional IRA account in 2024, including any distributions [you/they]may have been required to take?

Yes

No

ASK IF A_SRETQ8=KEOGH:

A_SRETQ15

Did [you/Name] withdraw any money or receive a distribution from [your/their] KEOGH account in 2024, including any distributions [you/they] may have been required to take?

Yes

No

ASK IF A_SRETQ8=SEP Plan:
A_SRETQ16

Did [you/Name] withdraw any money or receive a distribution from [your/their] SEP plan account in 2024, including any distributions [you/they] may have been required to take?

Yes

No

ASK IF A_SRETQ8=Other:

Q_SRETQ17

Did [you/Name] withdraw any money or receive a distribution from [your/their] ${other specify write-in} account in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Treatment 2 for Retirement and Income: Q62Ar to Q98Ar_other:

Q62Ar

Which types of pension income, if any, did anyone in this household receive in 2024? Do not include Social Security or distributions or withdrawals from IRAs, 401(k)s, or similar accounts. Select all that apply. 

Company

Union

Federal government

State government

Local government

U.S. Military

U.S. Railroad retirement

Other type of pension

⊗None of the above

Q62b_company Who received income from a company pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q62b_union Who received income from a union pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q62b_federal

Who received income from a federal government pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q62b_state

Who received income from a state government pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q62b_local

Who received income from a local government pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q62b_mil Who received income from a U.S. military pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q62b_rail Who received income from a U.S. railroad retirement pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q62b_other Who received income from another type of pension? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Q97Ar In 2024, which types of retirement accounts, if any, did anyone in this household have that were designated specifically for retirement savings? Select all that apply.

401(k)

403(b)

Roth IRA

Traditional IRA

KEOGH plan

SEP plan (Simplified Employee Plan)

Other type of retirement account

⊗None of the above

ASK IF Q97AR=401K:

Q98Br_401k Who had a 401(k)? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

ASK IF Q97AR=403b:

Q97Br_403b Who had a 403(b)? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

ASK IF Q97AR=ROTH:

Q97Br_roth Who had a Roth IRA? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

ASK IF Q97AR=Traditional IRA:

Q97Br_regular Who had a Traditional IRA? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

ASK IF Q97AR=Keogh:

Q97Br_keogh Who had a KEOGH plan? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

ASK IF Q97AR=SEP plan:

Q97Br_SEP Who had a SEP plan (Simplified Employee Pension)? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

ASK IF Q97AR=other:

Q97Br_other Who had another type of retirement account? Select all that apply.

${e://Field/FirstNameFill} ${e://Field/LastNameFill}

${e://Field/FNAME_2} ${e://Field/LNAME_2}

Etc.

Ask about persons who had this type of retirement account:
Q98Ar_401k Did [you/Name] withdraw any money or receive a distribution from [your/their] 401(k) in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Ask about persons who had this type of retirement account:
Q98Ar_401k Did [you/Name] withdraw any money or receive a distribution from [your/their] 403(b) in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Ask about persons who had this type of retirement account:

Q98Ar_roth Did [you/Name] } withdraw any money or receive a distribution from [your/their] Roth IRA in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Ask about persons who had this type of retirement account:
Q98Ar_regular Did [you/Name] withdraw any money or receive a distribution from [your/their] Traditional IRA in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Ask about persons who had this type of retirement account:
Q98Ar_keogh Did [you/Name] withdraw any money or receive a distribution from [your/their] KEOGH plan in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Ask about persons who had this type of retirement account:
Q98Ar_sep Did [you/Name] withdraw any money or receive a distribution from [your/their] SEP plan in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Ask about persons who had this type of retirement account:
Q98Ar_other Did [you/Name] withdraw any money or receive a distribution from [your/their] other type of retirement account in 2024, including any distributions [you/they] may have been required to take?

Yes

No

Programming note: There are two treatment groups for TAX and CREDIT (1) respondents receiving a “Don’t know” option and (2) those who do not receive a “Don’t know” option.

DISPLAY TO ALL:

Next, we will ask you questions about tax credits.

Tax questions

TAX

Did [you/Name] file a federal income tax return in 2025 for the 2024 tax year?

Yes

No

Don’t know {half respondents}

IF YES TO TAX:

CREDIT

Did [you/Name] claim any of the following tax credits on their 2024 tax return...

Earned Income Tax Credit or EITC? The Earned Income Tax Credit helps low-to moderate-income workers and families get a tax break and may reduce the taxes you owe or increase your refund.

Yes

No

Don't know {half respondents}

Child Tax Credit or CTC? The Child Tax Credit helps families with qualifying children get a tax break, even if you don’t normally file a tax return.

Yes

No

Don’t know {half respondents}

Child and Dependent Care Tax Credit or CDCTC? The Child and Dependent Care Tax Credit may help pay for the care of eligible children and other dependents in order for you to work or look for work.

Yes

No

Don’t know {half respondents}

Programming note:– Respondents will be randomly assigned to one of four groups for the main reason they moved to their current residence

Main Reason for Moving experiment: Randomize font and orientation of response choice examples to the right of the subject, beneath the subject, and bolded and non-bolded.

DISPLAY TO ALL:

Next, we will ask you about reasons you may have moved to your current residence.

Group 1

M1rfm_right non-bold

What was the main reason you moved to your current residence? 

Family - For example, birth of a child; to help parent; divorced; death in family

Nonfamily interpersonal - For example, to be with unmarried partner; wanted to live with friend; conflict with roommate

Work - For example, shorter commute; starting new job; unemployed; armed forces; retired

Education or training - For example, college; trade school; unpaid internship

Housing hardship - For example, unaffordable housing costs; foreclosure; eviction; landlord negligence- such as refusal to provide repairs, pest or mold control, or heating; homelessness

Better-suited housing - For example, found less expensive housing; wanted to own home; downsized; amenities such as garage, pool, or yard

Better-suited neighborhood, cultural amenities, or lifestyle - For example, desirable school district; wanted to live in a bigger or smaller city; change of scenery; nightlife

Crime or safety - For example, feeling unsafe in your community; high crime rates

Legal or institutional - For example, re-entry from prison; foster care; court mandated relocation; change in visa or residency requirements

Health - For example, needed home without stairs; injury; assisted living; exited rehabilitation; pollution

Natural disaster or risk of natural disaster - For example, hurricane or tornado damage; flooding; wildfire risk

Better-suited climate or natural environment - For example, warmer temperatures; distinct seasons; proximity to mountains, ocean

Other

Never have moved

Group 2

M1RFM_right_bold

What was the main reason you moved to your current residence? 

Family - For example, birth of a child; to help parent; divorced; death in family

Nonfamily interpersonal - For example, to be with unmarried partner; wanted to live with friend; conflict with roommate

Work - For example, shorter commute; starting new job; unemployed; armed forces; retired

Education or training - For example, college; trade school; unpaid internship

Housing hardship - For example, unaffordable housing costs; foreclosure; eviction; landlord negligence- such as refusal to provide repairs, pest or mold control, or heating; homelessness

Better-suited housing - For example, found less expensive housing; wanted to own home; downsized; amenities such as garage, pool, or yard

Better-suited neighborhood, cultural amenities, or lifestyle - For example, desirable school district; wanted to live in a bigger or smaller city; change of scenery; nightlife

Crime or safety - For example, feeling unsafe in your community; high crime rates

Legal or institutional - For example, re-entry from prison; foster care; court mandated relocation; change in visa or residency requirements

Health - For example, needed home without stairs; injury; assisted living; exited rehabilitation; pollution

Natural disaster or risk of natural disaster - For example, hurricane or tornado damage; flooding; wildfire risk

Better-suited climate or natural environment - For example, warmer temperatures; distinct seasons; proximity to mountains, ocean

Other

Never have moved

Group 3

M1rfm_beneath non-bold

What was the main reason you moved to your current residence?

Family

For example, birth of a child; to help parent; divorced; death in family

Nonfamily interpersonal

For example, to be with unmarried partner; wanted to live with friend; conflict with roommate

Work

For example, shorter commute; starting new job; unemployed; armed forces; retired

Education or training

For example, college; trade school; unpaid internship

Housing hardship

For example, unaffordable housing costs; foreclosure; eviction; landlord negligence- such as refusal to provide repairs, pest or mold control, or heating; homelessness

Better-suited housing

For example, found less expensive housing; wanted to own home; downsized; amenities such as garage, pool, or yard

Better-suited neighborhood, cultural amenities, or lifestyle

For example, desirable school district; wanted to live in a bigger or smaller city; change of scenery; nightlife

Crime or safety

For example, feeling unsafe in your community; high crime rates

Legal or institutional

For example, re-entry from prison; foster care; court mandated relocation; change in visa or residency requirements

Health

For example, needed home without stairs; injury; assisted living; exited rehabilitation; pollution

Natural disaster or risk of natural disaster

For example, hurricane or tornado damage; flooding; wildfire risk

Better-suited climate or natural environment

For example, warmer temperatures; distinct seasons; proximity to mountains, ocean

Other

Never have moved

Group 4

M1rfm_beneath bold

What was the main reason you moved to your current residence?

Family

For example, birth of a child; to help parent; divorced; death in family

Nonfamily interpersonal

For example, to be with unmarried partner; wanted to live with friend; conflict with roommate

Work

For example, shorter commute; starting new job; unemployed; armed forces; retired

Education or training

For example, college; trade school; unpaid internship

Housing hardship

For example, unaffordable housing costs; foreclosure; eviction; landlord negligence- such as refusal to provide repairs, pest or mold control, or heating; homelessness

Better-suited housing

For example, found less expensive housing; wanted to own home; downsized; amenities such as garage, pool, or yard

Better-suited neighborhood, cultural amenities, or lifestyle

For example, desirable school district; wanted to live in a bigger or smaller city; change of scenery; nightlife

Crime or safety

For example, feeling unsafe in your community; high crime rates

Legal or institutional

For example, re-entry from prison; foster care; court mandated relocation; change in visa or residency requirements

Health

For example, needed home without stairs; injury; assisted living; exited rehabilitation; pollution

Natural disaster or risk of natural disaster

For example, hurricane or tornado damage; flooding; wildfire risk

Better-suited climate or natural environment

For example, warmer temperatures; distinct seasons; proximity to mountains, ocean

Other

Never have moved

Programming Note: All participants will see the intro and filter questions. This is a 3x3 experiment with 9 groups. Participants receive either 3, 5, or 7 appliance questions in either a grayed out, unfolded, or single page layout.

Intro

The next questions are about appliances in your home.

Filter

Do you have more than one appliance in your home? For example, washing machine, refrigerator, dishwasher, crockpot, coffee maker, toaster, vacuum.

Yes

No

Branching Questions

Appliances

How many appliances do you have at home?

________________________________________________________________

Kitchen

How many of your appliances are mainly used in the kitchen?

________________________________________________________________

Outside_Kitchen

How many of your appliances are mainly used outside of the kitchen?

________________________________________________________________

Electricity

How many of your appliances use electricity?

________________________________________________________________

Range_cook

Is your range/cooktop electric or gas-operated?

Electric

Gas-operated

I do not have a range/cooktop

Small_app

How many small appliances do you have at home? (for example: blender, mixer, toaster)

________________________________________________________________

Large_app

How many large appliances do you have at home? (for example: refrigerator, washer, dryer)

________________________________________________________________

Demographic questions

We're almost done with the survey. We just have a few questions about you before we end.

If respondent and EMP2=Yes:

FT_PT Previously you told us you were working. Are you working full-time or part-time?

Full-time

Part-time

If respondent and EMP2=Yes:

EMP3

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

If respondent and EMP2=Yes:

FED_EMPLOYEE

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

Yes

No

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 – Randomize order of female and male answer option.

What is your sex?

Female

Male

RACE

What is your race and/or ethnicity? Select all that apply.

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.

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

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

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

Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

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

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

LANG Do you speak a language other than English at home?

Yes

No

IF LANG=Yes:

LANG_SPECIFY

What is that language? If you speak more than one language other than English, select the language you speak best.

Spanish

Chinese

Vietnamese

French

Arabic

Korean

Russian

German

Haitian

Hindi

Portuguese

Italian

Other, please specify: __________________________________________________

If LANG=Yes and selects language in LANG_SPECIFY:
SPEAK_LANG

How well do you speak that language?

Very well

Well

Not well

Not at all

If LANG=Yes and selects language in LANG_SPECIFY:
LANG_ANS

Could you answer a survey in that language?

Yes

No

If LANG=Yes and selects language in LANG_SPECIFY:

SPEAK_Eng

How well do you speak English?

Very well

Well

Not well

Not at all

Contact Info/future research questions

ENUM

Have you ever been a Census enumerator?

Yes

No

PROM Did you help promote the 2020 Census?

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

HHINCOME In 2024 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

ZIP

What is your ZIP code?

ZIP Code __________________________________________________

CONT_TEXT

We send survey invitations via 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. Would you like us to contact you by text message?

Yes

No

BESTCELL

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

Cell phone __________________________________________________

DEV

What device are you using to complete this survey?

Phone

Laptop or Desktop computer

Tablet

DEV_OWN Which of the following devices do you own? Select all that apply.

Smartphone

Desktop

Laptop

Tablet

IF DEV_OWN=Smartphone:
SMARTPHONE What type of smartphone do you have? Select all that apply.

iPhone

Android

Other, please specify:

IF DEV_OWN=Tablet:
TABLET What type of tablet do you have? Select all that apply.

iPad

Samsung Galaxy Tab

Kindle Fire

Other, please specify: __________________________________________________

FEEDBACK

Is there anything else you'd like to tell us?

__________________________________________________

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