The U.S. census is the count of all the people who live in the United States. It happens every 10 years. It
asks how many people live in your household, their age, gender, race, and ethnicity. This survey is not
the census. The next census is in 2020.
1. How familiar are you with the U.S. census?
1) Extremely familiar
2) Very familiar
3) Somewhat familiar
4) Not too familiar
5) Not at all familiar
2. If the census were held today, how likely would you be to fill out the census form?
1) Extremely likely
2) Very likely
3) Somewhat likely
4) Not too likely
5) Not at all likely
3.Thinking about most people you know, if the census were held today how likely would they be to fill
out the census form?
1) Extremely likely
2) Very likely
3) Somewhat likely
4) Not too likely
5) Not at all likely
4. Based on your past experience or just your best guess, how long do you think it would take you
personally to fill out the 2020 Census? Please enter a number.
__________ minutes
5. How likely are you to encourage someone you know to fill out the 2020 Census form?
1) Extremely likely
2) Very likely
3) Somewhat likely
4) Not too likely
5) Not at all likely
6. About how often do you use the internet?
1) Almost constantly
2) Several times a day
3) About once a day
4) Several times a week
5) Once a week
6) Less than once a week
7) Never
7. Which devices do you often use often to access the internet? Please select all that apply.
1) Desktop or laptop computer
2) Smartphone (for example an iPhone, Android, Blackberry)
3) Tablet computer (for example an iPad, Samsung Galaxy Tab, Kindle Fire)
4) I don’t use the internet
8. In 2020, people will be able to complete their census form online. How easy, if at all, do you think it
will be for you personally to complete the 2020 Census online?
1

 1)
2)
3)
4)
5)

Extremely easy
Very easy
Somewhat easy
Not too easy
Not at all easy

The following questions are about the 2020 Census in general. There is no need to look up this
information. Will the 2020 Census be used in any of the following ways or not?
9. Is the census used to decide how much money communities will get from the government, or is it not
used for this?
1) Yes, used for this
2) No, not used
3) Don’t know
10. Is the census used to decide how many representatives each state will have in Congress, or is it not
used for this?
1) Yes, used for this
2) No, not used
3) Don’t know
11. Is the census used to see what changes have taken place in the size, location, and characteristics of
the people in the United States, or is it not used for this?
1) Yes, used for this
2) No, not used
3) Don’t know
12. Is the census used to determine property taxes, or is it not used for this?
1) Yes, used for this
2) No, not used
3) Don’t know
13. Is the census used to help the police and FBI keep track of people who break the law, or is it not used
for this?
1) Yes, used for this
2) No, not used
3) Don’t know
14. Is the census used to locate people living in the country without documentation, or is it not used for
this?
1) Yes, used for this
2) No, not used
3) Don’t know
15. Does the census count both citizens and non-citizens, or not?
1) Yes, used for counting both citizens and non-citizens
2) No, used only for counting citizens
3) Don’t know
16. Is the census used to determine the rate of unemployment, or is it not used for this?
1) Yes, used for this
2) No, not used
3) Don’t know

 17. As far as you know, does the law require you to answer the census questions, or is this not required
by law?
1) Yes, required by law
2) No, not required by law
3) Don’t know
18. As far as you know, is the Census Bureau required by law to keep information confidential, or is this
not required by law?
1) Yes, required by law
2) No, not required by law
3) Don’t know
19. As far as you know, does the U.S. Constitution require that the census be conducted, or is this not
something the Constitution requires?
1) Yes, Constitution requires
2) No, Constitution does not require
3) Don’t know
How important, if at all, are each of these public services to you personally?
20. Daycare for children
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
21. Fire departments
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
22. Police departments
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
23. Hospitals and healthcare
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
24. Job training programs
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important

 25. Roads and highways
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
26. Public transportation
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
27. Schools and the education system
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
How important, if at all, is each of the following to you personally?
28. Showing you’re proud of your cultural heritage
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
29. Contributing to a better future for your community
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
30. Fulfilling your civic duty (for example, voting, jury duty, paying taxes)
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
31. Enforcing civil rights laws
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
Below are some ways in which the 2020 Census will be is used. How important, if at all, are each of these
uses to you personally?

 32. Determining how many elected representatives your state has in Congress
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
33. Providing information for your local government to plan for changes in your community
1) Extremely important
2) Very important
3) Somewhat important
4) Not too important
5) Not at all important
34. Which ONE of the following is the most important reason, to you personally, that you should fill out
the census form? Select only one answer.
1) It helps determine funding for public services in my community, like schools and fire departments
2) It determines how many elected representatives my state has in Congress
3) It is used to enforce civil rights laws
4) It provides information for my local government to plan for changes in my community
5) It shows that I'm proud of my cultural heritage
6) It is my civic duty (along with voting, jury duty, paying taxes)
7) It contributes to a better future for my community
35. How much of the time do you think you can trust the FEDERAL government to do what is right?
1) Just about always
2) Most of the time
3) Only some of the time
4) None of the time
36. How much of the time do you think you can trust your STATE government to do what is right?
1) Just about always
2) Most of the time
3) Only some of the time
4) None of the time
37. How much of the time do you think you can trust your LOCAL government to do what is right?
1) Just about always
2) Most of the time
3) Only some of the time
4) None of the time
38. How concerned are you, if at all, that the Census Bureau will not keep answers to the 2020 Census
confidential?
1) Extremely concerned
2) Very concerned
3) Somewhat concerned
4) Not too concerned
5) Not at all concerned

 39. How concerned are you, if at all, that the Census Bureau will share answers to the 2020 Census with
other government agencies?
1) Extremely concerned
2) Very concerned
3) Somewhat concerned
4) Not too concerned
5) Not at all concerned
40. How concerned are you, if at all, that the answers you provide to the 2020 Census will be used
against you?
1) Extremely concerned
2) Very concerned
3) Somewhat concerned
4) Not too concerned
5) Not at all concerned
41. How much, if at all, do you think it matters if you personally are counted in the 2020 Census?
1) A great deal
2) A lot
3) A moderate amount
4) A little
5) Not at all
42. Do you believe that answering your 2020 Census form could benefit or harm your community in any
way?
1) Benefit
2) Harm
3) Both benefit and harm
4) Neither benefit nor harm
43. Do you believe that answering your 2020 Census form could personally benefit or harm you in any
way?
1) Benefit
2) Harm
3) Both benefit and harm
4) Neither benefit nor harm
44. Which of the following have you ever done, if any? Please select all that apply.
1) Voted in an election
2) Signed a petition (including online petitions)
3) Posted your own thoughts or comments on political or social issues online
4) Volunteered at any organization
5) Worn a button/bracelet/pin for an issue or cause
6) Contacted, or attempted to contact, a politician or civil servant to express your views
7) Attended a neighborhood or community meeting
8) Participated in an organized protest or rally of any kind
9) Donated money or raised funds for social or political activity
10) None of the above
45. Thinking about the 2016 general election for President and other offices, did you happen to vote in
the election, or did things come up that kept you from voting?
1) Yes, voted in 2016 election
2) No, did not vote in 2016 election

 These final questions are for statistical purposes only.
46. What year were you born? Please enter a number.
___ ___ ___ ___
47. Are you…
1) Male
2) Female
48. What is the highest degree or level of school you have completed?
1) No high school
2) Some high school
3) High school graduate or equivalent (for example GED)
4) Some college, but degree not received or is in progress
5) Associate degree (for example AA, AS)
6) Bachelor’s degree (for example BA, BS, AB)
7) Graduate degree (for example Master’s, Professional, Doctorate)
49. Are you of Hispanic, Latino, or Spanish origin?
1) No, not of Hispanic, Latino or Spanish origin
2) Yes, Mexican, Mexican American, Chicano
3) Yes, Puerto Rican
4) Yes, Cuban
5) Yes, another Hispanic, Latino, or Spanish origin (specify origin, for example Argentinian, Colombian,
Nicaraguan, Spaniard, and so on)
______________________________________
50. What is your race? Please select all that apply.
1) White
2) Black, African American
3) American Indian or Alaska Native (specify name of enrolled or principal tribe)
_______________________________________
4) Asian Indian
5) Chinese
6) Filipino
7) Japanese
8) Korean
9) Vietnamese
10) Other Asian (specify race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on)
_______________________________________
11) Native Hawaiian
12) Guamanian or Chamorro
13) Samoan
14) Other Pacific Islanders (specify race, for example Fijian, Tongan, and so on)
_______________________________________
15) Some other race (specify race)
_______________________________________
51. In what country or territory were you born?
1) In the United States
2) Outside of the United States (specify name of country, or Puerto Rico, Guam, etc.)
_______________________________________
52. Do you speak a language other than English at home?
1) Yes
2) No  SKIP to question 68

 Answer questions 53 & 54 if you speak a language other than English at home; otherwise, SKIP to
question 68.
53. What is this language? If more than one, other than English what language do you speak most
often at home?
___________________________________________
54. How well do you speak English?
1) Very well
2) Well
3) Not well
4) Not at all
55. What is your marital status?
1) Now married
2) Divorced
3) Separated
4) Widowed
5) Never married
56. Are there any children 5 years old or younger (including babies) currently living in your household?
1) Yes
2) No
57. Are there any children ages 6 to 17 years old currently living in your household?
1) Yes
2) No
58. How many total people currently live in your household, including yourself (adults and children)?
Please enter a number.
_____________
59. In 2016 what was your total household income before taxes?
1) Less than $25,000
2) $25,000 - $34,999
3) $35,000 - $49,999
4) $50,000 - $74,999
5) $75,000 - $99,999
6) $100,000 - $149,999
7) $150,000 - $199,999
8) $200,000 and above
60. Do you rent or own your house or apartment?
1) Own
2) Rent
3) Occupied without payment of rent
61. Which of the following best represents how you think of yourself?
1) Gay or lesbian
2) Straight (that is, not gay or lesbian)
3) Bisexual
4) Other
5) I don’t know the answer/Prefer not to answer