Q- Bank

User's Manual

Self-Administered Population & Establishment Questionnaires

Version 1.7

8/15/08

The Q-Bank database is an interagency activity, supported by the U.S.
Bureau of the Census, the National Science Foundation, the National
Cancer Institute of the National Institutes of Health, and the Bureau of
Labor Statistics. Q-Bank is managed and hosted by the National Center
for Health Statistics (NCHS).

Any questions regarding the preparation and submission of reports to
Q-Bank should be directed to the Q-Bank administrator at qbank@cdc.gov.

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|     |                                                            |   |
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| 1\. | Survey                                                     | 8 |
|     | Title........................                              |   |
|     | .......................................................... |   |
+-----+------------------------------------------------------------+---+
| 2\. | Survey Year                                                | 9 |
|     | ...\.....................                                  |   |
|     | ......................................................\... |   |
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| 3\. | Testing Agency                                             | 1 |
|     | ....................                                       | 0 |
|     | ......................................................\... |   |
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| 4\. | Test Date                                                  | 1 |
|     | ...........................                                | 1 |
|     | ......................................................\... |   |
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| 5\. | Principal Investigator                                     | 1 |
|     | \..............                                            | 2 |
|     | .................................................\...\.... |   |
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| 6\. | Sponsor                                                    | 1 |
|     | ............................                               | 3 |
|     | .......................................................... |   |
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| 7\. | Universe                                                   | 1 |
|     | ..................................                         | 4 |
|     | ......................................\...\...\...\...\... |   |
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| 8\. | Evaluation                                                 | 1 |
|     | Type.....................                                  | 5 |
|     | ................................................\...\..... |   |
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| 9\. | Documentation.....................                         | 1 |
|     | ......................................................\... | 6 |
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| 1   | Pre-testing Mode                                           | 1 |
| 0\. | ................                                           | 7 |
|     | .......................................................... |   |
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| 1   | Field                                                      | 1 |
| 1\. | Mode..................................                     | 8 |
|     | ................................\...\...\...\...\...\..... |   |
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| 1   | Global                                                     | 1 |
| 2\. | Instructions...................                            | 9 |
|     | ............................................\...\...\..... |   |
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| 1   | Introductory Text (Overall Question or                     | 2 |
| 3\. | Instructions)..............................                | 1 |
|     |                                                            |   |
|     | Core                                                       |   |
|     | Question.............................                      |   |
|     | ..................................\...\...\...\...\...\... |   |
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| 1   |                                                            | 2 |
| 4\. |                                                            | 2 |
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| 1   | Objects -- Matrix                                          | 2 |
| 5\. | only...............                                        | 3 |
|     | ................................................\...\..... |   |
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| 1   | Instructions Following Core                                | 2 |
| 6\. | Question................................................   | 4 |
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| 1   | Response Option                                            | 2 |
| 7\. | Text..........                                             | 5 |
|     | .......................................................... |   |
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| 1   | Instructions Following Response                            | 2 |
| 8\. | Options...........................................         | 6 |
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| 1   | Information                                                | 2 |
| 9\. | Type.......................                                | 7 |
|     | ........................................\...\...\...\..... |   |
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| 2   | Response                                                   | 3 |
| 0\. | Category.................                                  | 1 |
|     | ..............................................\...\...\... |   |
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| 2   | Target                                                     | 3 |
| 1\. | Population......................                           | 3 |
|     | .........................................\...\...\...\.... |   |
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| 2   | Sequence                                                   | 3 |
| 2\. | Number...................                                  | 4 |
|     | ............................................\...\...\..... |   |
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| 2   | Response Error -- Population                               | 3 |
| 3\. | Surveys...............................................     | 7 |
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| 2   | Response Error -- Establishment                            | 4 |
| 4\. | Surveys..........................................          | 6 |
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| 2   | Where Error                                                | 5 |
| 5\. | Occurs.................                                    | 0 |
|     | ..............................................\...\...\... |   |
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| 2   | Respondent                                                 | 5 |
| 6\. | Role......................                                 | 1 |
|     | .........................................\...\...\...\.... |   |
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| 2   | Index                                                      | 5 |
| 7\. | Status.................................                    | 2 |
|     | ..............................\...\...\...\...\...\...\... |   |
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| 2   | Question                                                   | 5 |
| 8\. | Topic...........................                           | 3 |
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| 2   | Page                                                       | 5 |
| 9\. | Number..............................                       | 6 |
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| 3   | Layout of Questions and Response                           | 5 |
| 0\. | Options.......................................             | 7 |
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| 3   | Location of                                                | 5 |
| 1\. | Question...............                                    | 8 |
|     | ................................................\...\..... |   |
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| 3   | Response Option Text                                       | 5 |
| 2\. | Location.....                                              | 9 |
|     | .....................................\...\...\...\...\.... |   |
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| 3   | Separate                                                   | 6 |
| 3\. | Instructions..............                                 | 1 |
|     | .................................................\...\.... |   |
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| 3   | Core Question                                              | 6 |
| 4\. | Format..........                                           | 2 |
|     | .......................................................... |   |
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| 3   | Introductory Text                                          | 6 |
| 5\. | Format.......                                              | 3 |
|     | .......................................................... |   |
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| 3   | Matrix                                                     | 6 |
| 6\. | Status..........................                           | 4 |
|     | .....................................\...\...\...\...\.... |   |
|     | ...                                                        |   |
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| 3   | Orientation of Core                                        | 6 |
| 7\. | Questions                                                  | 5 |
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| 3   | Using the Self Administered Population and Establishment   | 6 |
| 8\. | Coding                                                     | 6 |
|     | Templates..........................                        |   |
|     | .......................................................... |   |
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| 3   | Self Administered Population                               | 6 |
| 9\. | Template..............................................     | 8 |
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| 4   | Self Administered Establishment                            | 7 |
| 0\. | Template.........................................          | 0 |
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INTRODUCTION: Q-BANK SUBMISSION GUIDELINES

Q-Bank is an interagency activity designed to improve the quality of
survey data by facilitating the sharing of knowledge about survey
questions. Most agencies conduct research to test questions within their
data collection programs, but the results of these tests are often not
shared. Q-Bank is a database consisting of questions that have been
evaluated for federal surveys. The database catalogues survey questions
and links each question to its test findings. The primary, but not
exclusive, method of question evaluation is cognitive testing.

Questions in Q-Bank are searchable by content or subject matter (e.g.
income, demographic, health conditions), as well as by type of
information (e.g. objective characteristics, behaviors, attitudes),
response category type (e.g. yes/no, open-ended, mark all that apply),
and response error type (e.g. problems with terms, recall problems).

An interagency steering committee consisting of members from the
Interagency Response Error Group (IREG), a federal group addressing
question response error in surveys, oversees the operation of Q-Bank.
Members of the steering committee include: The U.S. Bureau of the
Census, The National Science Foundation, The National Cancer Institute
of the National Institutes of Health, and the Bureau of Labor
Statistics. Q-Bank is managed and hosted by the National Center for
Health Statistics (NCHS).

Evaluation reports must be submitted to Q-Bank through one of the
sponsoring agencies and submissions must be formatted according to the
outline below.

Before posting, reports receive two tiers of review: 1) from the
sponsoring agency and 2) from the Q-Bank administrator. The Q-Bank
administrator makes the final decision as to what is included in Q-Bank
with input from the steering committee. The report analyst will be
contacted by the Q-Bank administrator if any of the following
requirements are not met.

Inclusion into Q-Bank will require that:

1.  Reports are coded consistently according to the Q-Bank
    categorization schema

2.  Reports are properly formatted and include a fully developed methods
    section

3.  Reports provide enough detail so that conclusions are sufficiently
    illustrated with empirically-based evidence

Submission packages must include a full report, which includes a
methodology section, question by question review, and the actual
questionnaire that was tested, as well as any associated instructions.
Please note a coding document should be submitted separate from the
actual report. See the SA and establishment templates for instructions.
In addition, please include contact information in case questions arise.

The Q-Bank steering committee is dedicated to making pre-test results
public so that data users are more fully aware of data quality issues as
well as the substance constituting their data. It is also dedicated to
the advancement of pre-test methodologies and, therefore, encourages
replication as well as the reporting of alternative findings.

The following document provides detailed descriptions of all information
contained in the Q-Bank database. The manual is divided up into three
sections. The first section outlines general information that is
required in all reports. The second section contains information on the
question specific coding fields. Finally, the last section contains
instructions on how to format reports, as well as the coding templates.
Please take some time to familiarize yourself with the codes before
beginning to code your reports.

** Part 1: Questionnaire-Level Fields and Categories **

This section outlines general information that is required in all
reports. All information described in this section can be found within
the report, and will be entered into Q-Bank following submission. The
units of analysis for the fields located in this section are at the
questionnaire level.

Survey Title

The field denotes the survey for which the question was tested. Please
note that this field represents the survey which was tested and not the
program which produced the survey. If possible, select a category from
the list below. New survey titles may be added to the database as well.
Sometimes new questions are tested that are not yet associated with a
particular survey. In this case, you may use the category "Not
Applicable". Please include in your report both the full title of survey
as well as the associated acronym if available.

Categories: 2005 National Census Test

ACS (American Community Survey)

AHS (American Housing Survey)

ATUS (American Time Use Survey)

> AWTS/AGBR (Annual Wholesale Trade Survey/Agents, Brokers and
> Electronic Markets)

BE-605 (Bureau of Economic Analysis Quarterly Report)

CE (Consumer Expenditure Survey)

CPS (Current Population Survey)

Econ Census (Economic Census)

HINTS (Health Information National Trends Survey)

LSS (Living Situation Survey)

MA-10000 (Annual Survey of Manufactures)

NCVS (National Crime Victimization Survey)

NHANES (National Health and Nutrition Examination Survey)

NHIS (National Health Interview Survey)

NIS (National Immunization Survey)

NRFU (Decennial Census Nonresponse Follow Up)

NSFG (National Survey of Family Growth)

> Provider Patient Communication about Prostate Specific Antigen
>
> Test
>
> Report of Organization

SA-42 (Annual Trade Survey)

SIPP (Survey of Income and Program Participation)

SLAITS (State and Local Area Integrated Telephone Survey)

SM-42 (Current Trade Report)

Not Applicable

Please note, due to limited space survey title acronyms will be entered
into the Q-Bank database when available. A glossary is provided in the
help menu, which will display the full survey titles with their
associated acronyms.

Survey Year

This field represents the year in which the question is or was expected
to be fielded in the survey. This information may be unknown. In this
case, please enter "unknown" rather than leaving the field blank.

Categories: \[year\]

Example: 2002

Testing Agency

This field specifies the agency that conducted the evaluation work. If
testing was conducted by more than one agency, please list all agencies
that apply. For certain agencies the testing agency may be a department
within the agency, for example "Census- SRD". Please note, due to
limited space testing agency acronyms will be entered into the Q-Bank
database when available. A glossary is provided in the help menu, which
will display the full name of the testing agencies with their associated
acronyms.

Categories: BLS

Census

Census -- CSMR

Census -- ESMS\
Census -- SRD

NCHS

NCI

NSF

Westat

Example: Census-SRD, NCHS

Test Date

This field indicates the month and year that the initial project of
testing interviews *began*.

Categories: Month/Year

Example: March/2002

Principal Investigator

The field denotes the *lead* investigator of the cognitive testing
project.

Categories: \[Full Name\]

Example: Kristen Miller

Sponsor

This field specifies the agency/program requesting or sponsoring the
question testing. If the project was sponsored by multiple agencies,
please list all agencies that apply. For certain agencies the sponsor
may be a department within the agency, for example "Census- DMD".

Please note, due to limited space sponsor acronyms will be entered into
the Q-Bank database when available. A glossary is provided in the help
menu, which will display the full name of the sponsor with their
associated acronyms.

Categories: BEA

CDC

Census -- DMD

Census -- POP

EPA

FDA

HHS/ASPE

NCCDPH-Division of Oral Health

NCHS

NIH

NIMH

SAMHSA

Example: CDC, NIH

Universe

This field specifies whether the question derives from an establishment
survey or a population (household) survey. Establishment surveys include
surveys of organizations such as for-profit businesses, non-profit
organizations, educational institutions, and associations. Population
surveys include both interviewer-administered and self-administered
surveys of individuals or households.

These categories should be mutually exclusive. Please list only one
category.

Categories: Population

Establishment

Evaluation Type

This field denotes the type of documented evaluation conducted on the
question.

Please indicate all methods used.

Categories: Cognitive Interview

Focus Group

Split Sample Test

Respondent Debriefing

Behavior Coding

Expert Review

Other

Example: Cognitive Interview, Focus Group

Documentation

This field provides information on the type of documentation used in
conducting the evaluation of the questionnaire. If multiple modes of
documentation were used, please indicate all that apply.

Categories: Final Report

Audio Tapes

Video Tapes

Transcriptions

Video Library

Interview Summaries

Pilot Test

Example: Video tapes, interview summaries, final report

Pre-Testing Mode

This field represents the mode in which the question was evaluated.
Please be sure to enter the method that was used for testing. For
example, if you tested a self-administered survey, please indicate this,
even though it may have also been a cognitive interview.

Also, if the survey is a CATI or CAPI survey, but you pre-tested it
using a paper and pencil version of the survey, please indicate the
pre-testing mode as PAPI. This will more accurately reflect the
instrument that was tested.

If the question was evaluated using multiple modes, please indicate all
that apply. Please note that evaluations done using M-CAPI (Mobile
Computer-Assisted Personal Interviewer Instrument) the pre-testing mode
should be documented as CAPI.

If the question was evaluated using multiple modes, please indicate all
that apply.

Categories: CAPI (Computer-Assisted Personal Interviewing)

CATI (Computer-Assisted Telephone Interviewing)

PAPI (Paper and Pencil Interviewing)

SAQ (Self-Administered Questionnaire)

Web Survey (Self-Administered Web Questionnaire)

CASI (Computer-Assisted Self-Administered Interviewing)

ACASI (Audio Computer-Assisted Self-Administered Interviewing)

IVR/TDE (Interactive Voice Response/Touchtone Data Entry)

Other electronic surveys (CD, E-mail, download)

Other

Example: SAQ

Field Mode

This field refers to the mode in which the survey will be administered
when it goes into the field.

If more that one field mode will be used, please indicate all modes that
apply. Please note that if the field mode expected to be used is M-CAPI
(Mobile Computer-Assisted Personal Interviewer Instrument) the field
mode should be documented as CAPI. If the field mode is unknown, please
indicate this by entering "unknown."

Categories: CAPI (Computer-Assisted Personal Interviewing)

CATI (Computer-Assisted Telephone Interviewing)

PAPI (Paper and Pencil Interviewing)

SAQ (Self-Administered Questionnaire)

Web Survey (Self-Administered Web Questionnaire)

CASI (Computer-Assisted Self-Administered Interviewing)

ACASI (Audio Computer-Assisted Self-Administered Interviewing)

IVR/TDE (Interactive Voice Response/Touchtone Data Entry)

Other electronic surveys (CD, E-mail, download)

Other

Unknown

Example: Web

Global Instructions

This field provides the instructions that appear at the start of the
questionnaire, which apply to all or to the majority of questions.
Please include the global instructions in your report as they appear in
the questionnaire.

In some cases, a questionnaire may have two different versions of global
instructions depending on the intended respondent. Both versions of the
global instructions should be included in data entry form.

Category: Verbatim Text

Example: "Start here. Use a blue or black pen."

"Please center numbers in their respective boxes"

**Figure 1: Census 2000 Questionnaire---Global Instructions Example**

![](media/image1.jpeg){width="6.1097222222222225in"
height="3.1041666666666665in"}

**Part II: Question-Level Fields and Categories **

This section contains information on the question-specific coding
fields. These fields contain information that is applicable to the
question, not necessarily the whole questionnaire. Some fields describe
the physical layout of the question, while other fields describe the
information contained within the question, as well as the error(s) that
occurred (if any) when the question was tested. The units of analysis
for the fields located in this section are at the question level.

Introductory Text

(Matrix: Overall Question or Instructions)

This field contains, if applicable, the text that occurs before the
actual question. The introductory text provides the context for a coming
set of questions, and is likely to contain a description of the subject
matter, or specific instructions including the response categories for
the series of questions or the time frame to consider. In the case of a
matrix, this may appear as a heading, instructions, or question that
apply to the overall matrix. Please include in your report the
introductory text as it appears on the survey.

Categories: Verbatim Text

Example: "In this next set of questions, I will ask about INJURIES AND
POISONINGS that happened in the PAST THREE MONTHS that REQUIRED MEDICAL
ADVICE OR TREATMENT, including call to a poison control center."

**Figure 2: 2003 Annual Survey of Foreign Direct Investment in the
United States---Introductory Text Example**

![](media/image2.jpeg){width="5.860416666666667in"
height="2.1868055555555554in"}

**Figure 3: 2004 National Census Test---Introductory Text Example**

![](media/image3.jpeg){width="6.002083333333333in"
height="1.8604166666666666in"}

Core Question

This field contains the core text of the question. Please include in
your report every part of the question (except the response categories)
so that it makes sense on its own. Therefore, if the front part of the
question is broken apart and used for several questions, then that first
part must be included when recording each question. Include definitions
when they are embedded in the question (not as instructions but as
definitions).

Categories: Verbatim Text

Example: Have you ever eaten.....

....lobster? Y/N

....steak tartar? Y/N

....sea urchin? Y/N

Record As: Have you ever eaten....steak tartar?

In forms that contain a matrix it may be more difficult to identify the
core question or the item for an individual question. In a matrix, a
series of questions are asked about a series of objects. The core
question for a matrix is the question or statement that tells the
respondent the topic of interest. The object is the person, place or
thing that the question asks about, in relation to the topic of
interest. In a matrix, core questions are either in the rows or columns.
The core question solicits information across several objects. The core
question is the type of information being solicited while the object is
the dimension that is being measured.

**Figure 4: 2005 American Community Survey---Core Question Example**

![](media/image4.jpeg){width="5.983333333333333in"
height="1.8083333333333333in"}

Objects

(Applies to Matrix only)

This is a list of the persons, places or things that the question asks
about. Write them verbatim with semicolons separating them.

**Figure 5: BE-605, Transactions of a U.S. Affiliate...with a Foreign
Parent---Object Example**

![](media/image5.jpeg){width="6.007638888888889in"
height="2.2090277777777776in"}

Objects: Canada; United Kingdom; Netherlands

**Figure 6: 2005 American Community Survey---Object Example**

![](media/image4.jpeg){width="5.983333333333333in"
height="2.6659722222222224in"}

Objects: Person 1; Person 2

Instructions Following Core Question

In self-administered surveys, instructions not only precede questions,
but they often follow them as well. This field provides the instructions
that appear immediately after a question, which apply to that question.
Please include any instructions following a core question as they appear
in the survey.

Categories: Verbatim Text

Example: "If the grandparent is financially responsible for more than
one grandchild, answer the question for the grandchild for whom the
grandparent has been responsible for the longest period of time."

**Figure 9: 2005 American Community Survey---Instructions Following Core
Question Example**

![](media/image4.jpeg){width="5.8625in" height="1.5263888888888888in"}

**Figure 10: 2003 Annual Survey of Foreign Direct Investment in the
United States---Instructions Following Core Question Example**

![](media/image2.jpeg){width="6.121527777777778in"
height="1.9277777777777778in"}

Response Option Text

This field contains the response options given with the question. Please
include in your report the verbatim text of the response options. If
there is no text associated with the answer space, please indicate this
using N/A.

Categories: Verbatim Text or N/A

Example: Yes

No

**Figure 7: 2004 National Census Test---Response Option Text Example**

![](media/image3.jpeg){width="5.250694444444444in"
height="2.0444444444444443in"}

**Figure 8: 2004 National Census Test---Response Option Text Example**

![](media/image3.jpeg){width="5.250694444444444in"
height="1.9826388888888888in"}

Instructions Following Response Options

Instructions may also follow the response options in self-administered
surveys. This field provides the instructions that follow response
options or the answer space. These instructions are often follow-up
question or are skip instructions for the next question. Please include
any instructions that follow response options as they appear in the
survey and the response options they follow.

Categories: Verbatim Text

Example: "Yes -- Mark X all reasons that apply."

**Figure 11: 2003 Annual Survey of Foreign Direct Investment in the
United States---Instructions Following Response Options Example**

![](media/image2.jpeg){width="6.108333333333333in"
height="2.3159722222222223in"}

**Figure 12: Census 2000 questionnaire---Instructions Following Response
Options Example**

![](media/image1.jpeg){width="5.372916666666667in"
height="1.7638888888888888in"}

Information Type

The information type field is designed to distinguish between broad
types of information that are often elicited through survey questions.
The first category in this field is "**events, actions, and
behaviors**," which is assigned to questions about past or present
behaviors or activities that respondents engage in. This type of
question can generally be distinguished from a question about an
"**objective characteristic**"---i.e., a non-behavioral attribute that
describes a person or object. Questions such as "do you own a car" and
"do you have diabetes" are examples. Objective characteristics are
theoretically observable by an outsider, whereas the next category
-"**subjective characteristic**"- refers to attributes that are not. An
example of a subjective characteristic question would be "how healthy do
you feel today" or other states of feeling. Another distinctive category
is "**attitudes/opinions**" which call for evaluative judgments. Less
common but still distinctive categories of questions ask for respondent
"**speculations**" (e.g., whether they believe something will happen) or
"**knowledge tests**" (e.g. questions which test respondents'
knowledge). These categories are designed to be mutually exclusive and
as comprehensive as possible, capturing meaningful distinctions in
relatively few broad categories. For question types that do not fit any
of the above categories, please use the information type of "**other**".

Categories: Events, Actions Behaviors

Objective Characteristics

Subjective Characteristics

Speculations

Attitudes/Opinions

Knowledge Tests

Other

Example: Objective Characteristics

Description of Information Types: (listed on next page)

Description of Information Types

+---------------+---------------------------+--------------------------+
| ## TYPE       | ## DEFINITION             | **EXAMPLES**             |
+---------------+---------------------------+--------------------------+
| **Events,     | -   **Describes an action | # Have you ever s        |
| Actions, and  |     or event**            | moked a whole cigarette? |
| Behaviors**   |                           |                          |
|               | -   **Includes reports of | When did your            |
|               |     past and present      | injury/poisoning happen? |
|               |     actions, habits,      |                          |
|               |     behaviors, events and | Did you ever have a      |
|               |     practices**           | heart attack?            |
|               |                           |                          |
|               | These reports are         | Do you currently take    |
|               | externally observable.    | insulin for your         |
|               | They are not              | diabetes?                |
|               | characteristics of        |                          |
|               | people, households, or    | In the past 12 months,   |
|               | institutions, but         | how many times have you  |
|               | represent some action     | seen or talked to a      |
|               | that was taken. This      | nurse for care or        |
|               | category includes         | advice?                  |
|               | non-event questions, that |                          |
|               | is, when a respondent is  | In the last 12 months,   |
|               | asked to report whether   | have you had surgery?    |
|               | an action or event did    |                          |
|               | *not* take place. It also | In the last 12 months,   |
|               | includes the naming of    | have your tonsils been   |
|               | something related to an   | removed?                 |
|               | event.                    |                          |
|               |                           | What type of vehicle     |
|               |                           | struck your vehicle?     |
|               |                           |                          |
|               |                           | During the past 12       |
|               |                           | months, has medical care |
|               |                           | been delayed because of  |
|               |                           | worry about the cost?    |
|               |                           |                          |
|               |                           | Are you paying an        |
|               |                           | additional premium for a |
|               |                           | supplemental health      |
|               |                           | insurance plan?          |
|               |                           |                          |
|               |                           | Has a doctor ever told   |
|               |                           | you that you have        |
|               |                           | asthma?                  |
+---------------+---------------------------+--------------------------+
| **Objective** | -   **Describes           | Do you have diabetes?    |
|               |     characteristics of    |                          |
| **Char        |     the respondent,       | Do you have insurance    |
| acteristics** |     household, household  | that you purchase        |
|               |     member,               | directly?                |
|               |     establishment,        |                          |
|               |     employee or some      | Do you have any type of  |
|               |     other group**         | government-sponsored     |
|               |                           | insurance such as        |
|               | -   **Is verifiable       | Medicare, Medicaid,      |
|               |     information**         | Medi-GAP, or CHIP?       |
|               |                           |                          |
|               | Objective characteristics | How old are you?         |
|               | are traits of             |                          |
|               | individuals, households,  | How old were you when    |
|               | or institutions. It can   | you first started to     |
|               | include something they    | smoke fairly regularly?  |
|               | have, received, are aware |                          |
|               | of, or were told about.   | What is your weight?     |
|               | For example, questions    |                          |
|               | fitting into this         | Because of a health      |
|               | category would include    | problem, are you unable  |
|               | questions about whether   | to walk without using    |
|               | people "have" a chronic   | any special equipment?   |
|               | condition, health         |                          |
|               | insurance plan or whether | What herbs are included  |
|               | they are aware of another | in \[combination herb    |
|               | kind of condition that    | pill#1\]?                |
|               | they might have.          |                          |
|               | Question coding is        |                          |
|               | assessing whether the     |                          |
|               | question content is       |                          |
|               | objective, regardless of  |                          |
|               | question design intent.   |                          |
+---------------+---------------------------+--------------------------+
| *             | -   **Describes           | In general, how would    |
| *Subjective** |     characteristics of    | you rate your health     |
|               |     the respondent,       | today?                   |
| **Char        |     household, household  |                          |
| acteristics** |     member,               | Do you consider yourself |
|               |     establishment,        | to have a disability?    |
|               |     employee or some      |                          |
|               |     other group**         | Do you need the help of  |
|               |                           | another person with      |
|               | -   **Is                  | preparing meals? *(as    |
|               |     [not]{.underline}     | opposed to: Does another |
|               |     verifiable            | person prepare your      |
|               |     information**         | meals for you?)*         |
|               |                           |                          |
|               | A subjective              | By yourself, and without |
|               | characteristic is a       | using any special        |
|               | personal state that is a  | equipment, how difficult |
|               | matter of perception.     | is it for you to stand   |
|               | Even if these             | or be on your feet for   |
|               | characteristics were      | about 2 hours?           |
|               | well-defined, they could  |                          |
|               | not be externally         | Overall in the last 30   |
|               | verified, and there is no | days, how much distress, |
|               | "true" answer. Question   | sadness or worry did you |
|               | coding is assessing       | experience?              |
|               | whether the question      |                          |
|               | content is subjective,    | Because of a health      |
|               | regardless of question    | problem, do you have     |
|               | design intent.            | difficulty walking       |
|               |                           | without using any        |
|               |                           | special equipment?       |
+---------------+---------------------------+--------------------------+
| **S           | > **Ask about intentions, | Do you plan to visit the |
| peculations** | > predictions or          | dentist in the next six  |
|               | > hypothetical            | months?                  |
|               | > situations**            |                          |
|               |                           | How likely are you to    |
|               | Speculative questions are | lose 10 pounds over the  |
|               | about events, behaviors,  | next year?               |
|               | practices that have not   |                          |
|               | yet occurred, or they     | If you were in a car     |
|               | present hypothetical      | accident, who would you  |
|               | situations to which the   | call first?              |
|               | respondent must evaluate  |                          |
|               | or provide prediction.    | John cannot wash, groom  |
|               | Unlike "report" questions | or dress himself without |
|               | that inquire into past or | personal help. He has no |
|               | present events, the tense | problems with feeding.   |
|               | of speculations is future | How would you rate his   |
|               | or subjunctive.           | difficulty with          |
|               |                           | self-care?               |
|               |                           |                          |
|               |                           | What are your chances of |
|               |                           | getting HIV?             |
+---------------+---------------------------+--------------------------+
| **Attitud     | **Ask about Attitudes and | On a scale from 0 to 5   |
| es/Opinions** | opinions**                | (with 0 being not at all |
|               |                           | and 5 being very         |
|               | The general format of     | strong), how strongly do |
|               | these questions is to ask | you believe that         |
|               | for an opinion, a         | children should be       |
|               | preference, or a          | immunized?               |
|               | particular position. The  |                          |
|               | response options          | Do you believe that      |
|               | generally appear in the   | immunizations are        |
|               | form of a scale.          | harmful to children      |
|               |                           | under 2 years old?       |
|               | []{.mark}                 |                          |
|               |                           | Would you like to weigh  |
|               |                           | more?                    |
|               |                           |                          |
|               |                           | Do you believe that you  |
|               |                           | are identified more      |
|               |                           | often by other people as |
|               |                           | belonging to only one of |
|               |                           | these groups?            |
+---------------+---------------------------+--------------------------+
| **Knowledge   | **Tests respondents'      | Does trans fat raise     |
| Tests**       | knowledge**               | blood cholesterol, lower |
|               |                           | it or have no effect on  |
|               | Knowledge questions       | blood cholesterol?       |
|               | verify the level of       |                          |
|               | knowledge respondents     | Can you name the mayor   |
|               | have regarding a          | of Baltimore?            |
|               | particular subject        |                          |
|               | matter. They ask about    | Have you ever heard of   |
|               | externally verifiable     | Medicare?                |
|               | facts, where some outside |                          |
|               | source of information     |                          |
|               | will be considered as a   |                          |
|               | "gold standard" and the   |                          |
|               | point of the question is  |                          |
|               | to see how well           |                          |
|               | respondent knowledge      |                          |
|               | compares to that standard |                          |
|               |                           |                          |
|               | Include awareness about   |                          |
|               | events or questions       |                          |
|               | asking if someone has     |                          |
|               | ever "heard of" a         |                          |
|               | particular program.       |                          |
+---------------+---------------------------+--------------------------+
| **Other**     | **Question types that do  |                          |
|               | not fit any of the above  |                          |
|               | categories.**             |                          |
+---------------+---------------------------+--------------------------+

Response Category

The response category type field refers specifically to the format of
information that a question is attempting to capture. For example, many
questions solicit a "yes/no" response. Others questions ask respondents
to select one answer from a list of responses---this could include
questions with a list of response options and also scales (either
numeric "from 1 to 10" or verbal, such as "excellent, good, fair,
poor"). Other questions allow for multiple responses (i.e. "check all
that apply"). A less common response category type is an allocation
(e.g., assigning percentages across various categories).

Other questions ask respondents to provide numeric or textual responses
in an open-ended manner, such as reporting the number of times that an
event happened to them, the date of an event, or the name of their usual
care provider. Responses to questions may also appear to be in both
numeric and textual form. The following question provides an example.

How long has it been since you last visited a dentist or dental clinic?

-   within in the past year (1 to 12 months ago)

-   within the past 2 years (1 to 2 years)

-   within 5 years (2 to 5 years)

-   five or more years

-   Don't know/never/refuse

In this case, the response category would be select one numeric because
the type of information the question is attempting to capture is numeric
(how many years).

In self-administered surveys information is often provided to
demonstrate how respondents should record their response. An open-ended
textual or number delineated response category would provide markings to
tell the respondent where each number or letter of their response should
go (e.g., phone number: \_ \_ \_-\_ \_ \_ -\_ \_ \_ \_). See other
examples of delineated and non-delineated fields below.

These categories are intended to be mutually exclusive. Please indicate
one response category that best fits the information presented in the
question.

Periodically, a questionnaire will have questions which appear to have
multiple response category types. See example below.

What is your race? (Please mark one or more races)

-   White

-   Black

-   Indian -- Print name of tribe \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_
    \_

-   Asian

```{=html}
<!-- -->
```
-   Other -- Please specify \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_

Here the response category could appear to be both mark all that apply
as well as open ended textual delineated. In these cases, please code
the main response category. For this question, the response category
would be mark all that apply.

Categories: Yes/No

Select one textual

Select one numeric

Mark all that apply

Allocation

Open-ended textual -- Delineated

Open-ended textual -- Non Delineated

Open-ended numeric -- Delineated

Open-ended numeric -- Non Delineated

Other

**Figure 17: 2005 American Community Figure 18: 2005 American**

**Survey--- Open-Ended Textual, Non Community Survey---Open-ended**

**Delineated Example Numeric, Delineated Example**

![](media/image4.jpeg){width="2.859722222222222in"
height="1.6555555555555554in"}
![](media/image4.jpeg){width="2.6069444444444443in"
height="1.667361111111111in"}

Target Population

This field specifies who the question is inquiring about -- the
individual, household, or another type of establishment.

For population surveys the target population categories should be
mutually exclusive. However, for establishment surveys, if the question
is inquiring about more than one type of establishment, please indicate
all that apply. Additional target population categories may be added for
establishment surveys only. If possible, please select a category from
the list below. If none of the categories are applicable you may
indicate a new category to be added to the database.

Categories:

[Population]{.underline}: Individual

Household

[Establishment]{.underline}: School/Educational Institution

Farm

Hospital

Business

Other\_\_\_\_\_\_\_\_

Sequence Number

This field denotes the number of the question within one introductory
phrase or number of the question in a matrix. For example, if there are
four core questions in a matrix, they would be numbered 1, 2, 3 or 4 for
this field. The sequence number field is used only when the
questionnaire contains introductory text. If there is no introductory
text preceding the question, please write N/A in the sequence number
field. Please note that sequence number starts over after new
introductory text is presented (see example 3).

Category: Number (1 of 6) or N/A

**Example 1:**

Have you ever eaten.....

....lobster? Y/N

....steak tartar? Y/N

....sea urchin? Y/N

The question which asks about steak tartar would be recorded as 2 of 3,
as it is question number 2 out of the series of 3 questions within one
introductory phrase.

**Example 2:**

In this next set of questions, you will be asked about INJURIES AND
POISONINGS that happened in the PAST THREE MONTHS that REQUIRED MEDICAL
ADVICE OR TREATMENT, including calls to a poison control center.

> \(1\) DURING THE PAST THREE MONTHS, that is, since May 1^st^ 2006,
> were you injured or poisoned seriously enough that you got medical
> advice or treatment?
>
> \(2\) How many different times in the PAST 3 MONTHS were you injured
> or poisoned seriously enough to seek medical advice or treatment?
>
> \(3\) When did your injury/poisoning happen?

The first question in the series following the introductory text would
be labeled sequence 1 of 3, the second question would be labeled
sequence 2 of 3, and the third question would be labeled sequence 3 of
3.

**Example 3:**

Now we'd like to know what recommendations you may have heard regarding
physical activity, nutrition, and protecting oneself from the sun.

> 1\) What is the recommended minimum number of days per week an average
> adult should be physically active to achieve a health benefit?
>
> 2\) What is the recommended minimum number of minutes an average adult
> needs to be physically active during most days of the week in order to
> achieve a health benefit?

I'm going to read you three statements concerning physical activity. For
each, just tell me if you think it's true, false, or you don't know.

> 3\) The first statement is: The average adult must exercise
> *vigorously* to achieve a health benefit. (Would you say that is true,
> false, or you don't know.)

The sequence number for question 1 would be 1 of 2 and the sequence
number for question 2 would be 2 of 2. However, the sequence number for
question #3 would 1 because of the second set of introductory text
preceding question 3.

**Example 4:**

The following questions are about discussions doctors may have with
their patients about the PSA test that is used to look for prostate
cancer.

1.  *Discussion of clinical issue or nature of decision*

> Have you and a doctor ever talked about the PSA test?

2.  *Discussion of pros and cons of alternatives*

> Which of the following topics about PSA tests have you ever talked
> about with a doctor? Have you talked about:
>
> 2\. 1 the PSA test's effect on your peace of mind?
>
> 2\. 2 the PSA test's chances for giving wrong results?

3.  *Discussion of uncertainty*

> Has a doctor ever mentioned to you that experts have different
> opinions about the PSA test?

For this set of questions the sequence numbering would begin with the
first question following the introductory text marked as sequence number
1 or 4. Question 2.1 would be entered as sequence number 2 of 4 and
question 2.2 would be entered as sequence number 3 of 4. Finally,
question number 3 would be entered as sequence number 4 of 4.

**Figure 19: BE-605, Transactions of a U.S. Affiliate...with a Foreign
Parent---Sequence Number Example**

![](media/image5.jpeg){width="5.990972222222222in"
height="1.3701388888888888in"}

**Figure 20: 2005 American Community Survey---Sequence Number Example**

![](media/image4.jpeg){width="5.9944444444444445in"
height="3.828472222222222in"}

Response Error

(Self-Administered [Population]{.underline} Questionnaires)

The response error field denotes the type of question design error(s)
identified in the cognitive testing. This field provides information on
the types of error occurring within the question itself. All questions
that are coded for response error must include empirical evidence in the
report, which provides a convincing argument and enough description to
show that the error exists. Please code response errors based *only* on
the information provided in the evaluation summary for that question. Do
*not* code potential problems identified based solely on expert review.
If more than one error is found during the evaluation of question,
please mark all the response errors that apply. However, only one
response error code can be used per problem. If it appears as if two
different response error codes could be applied to a single problem,
please select the response error that emerges as the root of the
problem. . If results from multiple rounds of testing are presented in
one report please code all versions of the questions that elicited
sufficient evidence to support a code. If the same question was tested
during multiple rounds, please code all errors that were elicited in all
rounds.

Response error may appear in the introductory text, the question itself,
or in the response errors. Please indicate error if it occurs in any of
these parts of the question. Please note however, introductory text
cannot be entered into Q-Bank without a corresponding question.

The response error field denotes the type(s) of error(s) identified in
the questionnaire evaluation. The first few categories of the taxonomy
cover problems with terms or concepts. The first category is
**"problematic terms".** This response error occurs when the question
contains inappropriate or unfamiliar terms. For example, respondents who
answered a question about the use of dosimeters did in fact use such a
device, but did not recognize it by that name. A related category
focuses on **"ambiguous concepts"**. This category contains response
errors that occur due to unclear and vague concepts. One such example is
a question about whether a respondent works near a large electrical
machine. The words utilized in the question are readily familiar, but
the term "large electrical machine" is considered an ambiguous concept.
This is evidenced by four respondents who worked near a drill press
answering yes because they thought that the machine qualified as large.
But, three other respondents, who also worked near a drill press, saw
the machine as relatively small, therefore, responded no to the
question. As a result, respondents in exactly the same situation
characterized themselves differently due to this ambiguous term.

A third conceptual problem, **"assumption/double barrel"** include
questions that make an assumption that may be false or only apply to a
subset of respondents, or questions that ask about two different topics
but assume a single answer. The following question is an example of a
question that elicits an assumption response error.

(Would/Do) any of these affect whether or not you use acupuncture?

\(a\) Friends or family recommended it? Yes no don't know

\(b\) A medical doctor recommended it? Yes no don't know

\(c\) Insurance paid for it? Yes no don't know

When tested, it was shown that this question made an implicit assumption
that respondents did not *want* to use acupuncture and therefore, would
have to be persuaded by somebody (or something) in order to do so. This
was a faulty assumption for those respondents who wanted to use
acupuncture, but in their words, simply "haven't gotten around to it."
Because the question makes a faulty assumption, an answer of "no" isn't
exactly correct. Double barrel questions ask respondents about two
different concepts but assume a single answer. The following question is
an example of a question which elicited a double barrel response error.

As a result of this injury/poisoning, how much work did (you/participant
name) miss?

1)  Not employed at the time of the injury/poisoning

2)  None

3)  Less than 1 day

4)  One to five days

5)  Six or more days

6)  Refused

7)  Don't know

This question attempts to find out if the respondent was employed at the
time of the injury (via the response option "not employed at the time of
the injury," as well as the number of days missed. From the respondents
point of view, it was shown that the question itself assumed that the
he/she was employed at the time of the injury, and occurred that the
unemployed or retired respondent answered "none" (because, indeed, they
did not miss any days of work)---this error especially occurred if they
answered before hearing the response categories. The two categories
"assumption" and "double barrel" have been combined as it is often
difficult to distinguish between the two.

Two categories were designed to indicate various recall or judgment
problems in the response process. One of these categories,
**"recall/estimation difficulty"**, reflects a variety of situations
where respondents have difficulty remembering information or might not
know it at all. For example, a question that asked whether respondents
experienced symptoms of asthma before they were two years old, presented
a situation in which respondents could not remember firsthand and did
not know at all unless someone told them. Another category was created
for "**biased/sensitive"** questions, used to denote unintentional
influences on response accuracy that might suggest a particular answer
was more correct or desirable than others.

Some other categories focus more on structural problems with the
questions. The **"overly complex"** category is used to denote questions
that are long, complex, grammatically twisted, or overly laden with
clauses. Another category, **"inadequate response options"** is largely
self-explanatory. This category applies when important response options
are missing from the question, the provided response units don't make
sense, or related problems. **"Not seen/read"** deals with the
perception problem that precedes the comprehension stage in which the
respondent either does not see, or chooses not to attend to a piece of
the item, which could be the instruction, part of the question text or
the response text.

Finally, additional problems may occur as a result of the formatting of
the questionnaire. **"Questionnaire effects"** is used *not* to denote
problems with particular questions, but rather problems emerging from a
particular juxtaposition of questions. Examples could include bad flow,
apparent context effects, skip problems, and so on. **"Problematic
answer space"** deals with any difficulty the respondent could have
entering their chosen answer onto the space provided on the form.
**"Problematic visual cues"** include any visual stimulus that could
mislead the respondent. These could be inadequate or ambiguous visual or
navigational cues, such as skip patterns that are not easily followed,
directional symbols that are not well understood, or misuse of italics.
Problematic visual cues could also be cues that are inconsistent, for
example, using the phrase "skip to" sometimes and "go to" other times
within a questionnaire to indicate a skip pattern or using the bolding
and italics interchangeably throughout the questionnaire.

There may be cases where it is difficult to select a response error code
based on the way the errors emerged in the evaluation or based on the
way the evaluation results are summarized. For instance, older reports
may be written in a way that does not fit the Q-Bank response error
coding scheme. Also, there may be cases where no response category will
fully capture the response error occurring in the question evaluation.
In these instances please use the response error category "**response
error N.E.C. (not elsewhere coded)**." If no errors were discovered
during the question evaluation please indicate this using the category
**"none as tested**.**"**

Errors that occur as a result of problematic instructions or
introductory text may be coded as well. However, when instructions are
provided in a separate booklet or document, they may not be coded as
eliciting a response error. The following questions provide examples of
items where the instructions are embedded within the question, as
opposed to being placed in a separate document.

[Example:]{.underline}

What kind of health insurance or health care coverage do you have?
Include those that pay for only one type of service (nursing home care,
accidents, or dental care). Exclude private plans that only provide
extra cash while hospitalized.

During testing respondents reported having trouble with the overuse of
qualifiers, which led to misreporting of their health insurance/health
care coverage. The type of error occurring in this question would be
"overly complex."

[Example:]{.underline}

INTRO:

I am going to ask you about the time you spent being physically active
in the last 7 days. Please answer each question even if you do not
consider yourself to be an active person. Think about the activities you
do at work, as part of your house and yard work, to get from place to
place, and in your spare time for recreation, exercise or sport.

First, think about all the [vigorous activities]{.underline} which take
[hard physical effort]{.underline} that you did in the last 7 days.
Vigorous activities make you breathe much harder than normal and may
include heavy lifting, digging, aerobics, or fast bicycling. Think only
about those physical activities that you did *for* [at least 10 minutes
at a time]{.underline}

> PAB1. During the [last 7 days]{.underline}, on how many days did you
> do [vigorous]{.underline} physical activities?

During cognitive testing the introductions and instructions were found
to be very long and often had to be repeated. Details contained in these
introductions often got lost. The type of error occurring in this
question would be "overly complex."

If multiple errors were discovered during the pre-testing of the
questions, please indicate all that apply. However, if you use the
category "none as tested" no other response errors may be applied to
that question.

Categories:

1.  Problematic Visual Cues

2.  Not Seen/Read

3.  Problematic Terms

4.  Ambiguous Concepts

5.  Overly Complex

6.  Assumption/Double Barrel

7.  Questionnaire Effects

8.  Recall /Estimation Difficulty

9.  Biased/Sensitive

10. Inadequate Response Options

11. Problematic Answer Space

12. Response Error N.E.C

13. None as Tested

Example: ambiguous concept, not seen/read

Response Error Indicators, Self-Administered Questionnaires: (listed on
next page)

**Response Error Indicators (For Self-Administered Questionnaires)**

The following table provides definitions of the response error
categories and examples of questions which may elicit these types of
errors. Remember it is important that all response error codes be
applied based on problems that were identified during the question
evaluation. A question that has not been adequately tested cannot be
labeled as containing an error based on the question text alone**.**

+----------------+------------------------+----------------------------+
| **ERROR TYPE** | **DEFINTION**          | **EXAMPLE**                |
+----------------+------------------------+----------------------------+
| COMPREHENSION  |                        |                            |
+----------------+------------------------+----------------------------+
| 1\.            | **Contains             | Have you ever used a       |
| Problematic    | inappropriate or       | dental sealant?            |
| Terms          | unfamiliar terms**     | (respondents did not know  |
|                |                        | term 'dental sealant')     |
|                | -   Unknown terms      |                            |
|                |                        |                            |
|                | -   Terms used out of  |                            |
|                |     context or         | How often do you use a     |
|                |     inappropriately    | dosimeter? (respondents    |
|                |                        | did not know term          |
|                | -   Overly technical   | 'dosimeter')               |
|                |     language/jargon    |                            |
+----------------+------------------------+----------------------------+
| 2\. Ambiguous  | **Contains vague or    | How many hours a week do   |
| Concepts       | ambiguous concepts**   | you [work                  |
|                |                        | near]{.underline} a [large |
|                | -   Ambiguous or vague | electrical                 |
|                |     concepts or terms  | machine]{.underline}? (A   |
|                |                        | respondent constantly      |
|                | -   missing reference  | passed by a machine for a  |
|                |     period             | few seconds, and was       |
|                |                        | unsure whether that was    |
|                | -   concepts with      | considered *working near*? |
|                |     multiple           | *Large* is vague; some     |
|                |     interpretations -  | respondents categorized a  |
|                |     answer could vary  | drill press as large,      |
|                |     depending upon     | while other respondents    |
|                |     which              | did not.)                  |
|                |     interpretation was |                            |
|                |     taken              | Do you need the help of    |
|                |                        | other persons in handling  |
|                | -   Instructions or    | personal care needs?       |
|                |     definitions are    | (Respondent did "get help" |
|                |     missing or         | but did not "need help";   |
|                |     inadequate         | they were unsure which     |
|                |                        | answer was most            |
|                |                        | appropriate.)              |
|                |                        |                            |
|                |                        | Did you have sex with your |
|                |                        | current partner?           |
|                |                        | (Respondents did not know  |
|                |                        | what the term sex was      |
|                |                        | referring toCould refer   |
|                |                        | to intercourse or other    |
|                |                        | forms of intimate contact; |
|                |                        | their answers varied       |
|                |                        | depending upon             |
|                |                        | interpretation.)           |
|                |                        |                            |
|                |                        | What is the recommended    |
|                |                        | SPF number in sunscreen    |
|                |                        | that you should use to     |
|                |                        | prevent skin cancer? (The  |
|                |                        | subject in this question,  |
|                |                        | "you", is ambiguous        |
|                |                        | because respondents were   |
|                |                        | unsure whether they should |
|                |                        | be responding for          |
|                |                        | themselves or for a people |
|                |                        | in general.)               |
+----------------+------------------------+----------------------------+
| 3\. Overly     | **Question is long or  | Do you have any            |
| Complex        | overly complex  **     | [difficulty]{.underline}   |
|                |                        | hearing, seeing,           |
|                | -   Respondents are    | communicating, walking,    |
|                |     unable to remember | climbing stairs, bending,  |
|                |     or synthesize the  | learning or doing any      |
|                |     details in the     | similar activities?        |
|                |     question because   | (Respondents had trouble   |
|                |     of the length      | remembering examples)      |
|                |                        |                            |
|                | -   Overuse of         | What kind of health        |
|                |     qualifiers, such   | insurance or health care   |
|                |     as "including" and | coverage do you have?      |
|                |     "not counting"     | Include those that pay for |
|                |                        | only one type of service   |
|                | -   Important ideas    | (nursing home care,        |
|                |     are missed because | accidents, or dental       |
|                |     they are buried    | care). Exclude private     |
|                |     within the         | plans that only provide    |
|                |     question           | extra cash while           |
|                |                        | hospitalized. (Respondents |
|                | -   Unnecessary        | had trouble with use of    |
|                |     grammatical        | qualifiers and             |
|                |     complications      | misreported)               |
|                |     (e.g.              |                            |
|                |     double-negatives)  | In the past 12 months, how |
|                |     or awkward         | many times have you seen   |
|                |     structure          | or talked on the telephone |
|                |                        | about your physical,       |
|                |                        | emotional or mental health |
|                |                        | with a family doctor or    |
|                |                        | general practitioner?      |
|                |                        | (Many did not hear "seen"  |
|                |                        | and responded with only    |
|                |                        | the number of times spoken |
|                |                        | on the telephone)          |
+----------------+------------------------+----------------------------+
| 4\.            | **Question makes       | When did you stop beating  |
| Assumption/    | inaccurate assumption  | your wife? (Assumed the    |
| Double Barrel  | about respondents'     | respondent has done this.) |
|                | experiences**          |                            |
|                |                        | When riding in the back    |
|                | **Question asks about  | seat of a car, how often   |
|                | two different          | do you wear a seat belt?   |
|                | concepts, but assumes  | (Assumed that the          |
|                | a single answer**      | respondent ever rides in   |
|                |                        | the back seat of a car.)   |
|                |                        |                            |
|                |                        | Do you think women and     |
|                |                        | children should have       |
|                |                        | universal health care      |
|                |                        | coverage? (Respondents who |
|                |                        | thought children should,   |
|                |                        | but not necessarily women, |
|                |                        | were unsure how to         |
|                |                        | answer.)                   |
|                |                        |                            |
|                |                        | As a result of this        |
|                |                        | injury/poisoning, how much |
|                |                        | work did you miss?         |
|                |                        | (Respondents who were      |
|                |                        | jobless misreported by     |
|                |                        | saying that they did not   |
|                |                        | miss any workthey had no  |
|                |                        | work to miss)              |
+----------------+------------------------+----------------------------+
| RETRIEVAL      |                        |                            |
+----------------+------------------------+----------------------------+
| 1\.            | **Respondent does not  | What is the dosage of your |
| Rec            | know or has difficulty | asthma medication?         |
| all/Estimation | recalling              | (respondents had           |
| Difficulty     | information.**         | difficulty estimating      |
|                |                        | response)                  |
|                | **Response is subject  |                            |
|                | to error because of    | In your lifetime, with how |
|                | calculation or         | many people have you had   |
|                | estimation             | sex? (respondents had      |
|                | difficulty.**          | difficulty calculating     |
|                |                        | response)                  |
|                | The difficulty may be  |                            |
|                | because of memory      | Do you think the Lt.       |
|                | trouble or because the | Governor of Delaware has   |
|                | respondent never knew  | been doing a good job?     |
|                | the information to     | (respondents had           |
|                | begin with.            | difficulty because they    |
|                |                        | did not know information)  |
|                | -   Topic is of low    |                            |
|                |     salience to R      | * *                        |
|                |     (especially for    |                            |
|                |     attitude           | On what date did you first |
|                |     questions)         | ride a bicycle?            |
|                |                        |                            |
|                | ```{=html}             | (respondents had           |
|                | <!-- -->               | difficulty due to recall   |
|                | ```                    | issues)                    |
|                | -   Question asks      |                            |
|                |     about information  | In the past three years,   |
|                |     the respondent is  | how many times did you     |
|                |     unlikely to know   | visit a doctor?            |
|                |                        | (respondents had           |
|                | -   Telescoping:       | difficulty estimating      |
|                |     Specific recall    | response)                  |
|                |     problem where      |                            |
|                |     events before the  | In your lifetime, how many |
|                |     reference period   | cigarettes have you        |
|                |     are recalled as    | smoked? (respondents had   |
|                |     being within the   | difficulty calculating     |
|                |     reference period.  | response)                  |
|                |                        |                            |
|                | -   Requires broad     | Asking floor manager about |
|                |     reliance on        | hours that the office      |
|                |     estimation (a wild | staff works. (respondent   |
|                |     guess is the best  | did not have enough        |
|                |     possible result).  | information to answer      |
|                |                        | question)                  |
|                | -   Guessing or        |                            |
|                |     assuming the       | Asking proxy for           |
|                |     answer -- ball     | information proxy is not   |
|                |     parking            | likely to have.            |
|                |                        | (respondent did not have   |
|                | -   Trouble making     | enough information to      |
|                |     calculations in    | answer question)           |
|                |     head               |                            |
+----------------+------------------------+----------------------------+
| JUDGEMENT      |                        |                            |
+----------------+------------------------+----------------------------+
| 1\.            | **Response process is  | Are you in favor of        |
| Bi             | influenced by either   | allowing the interests of  |
| ased/Sensitive | the sensitive or       | big business to dominate   |
|                | social context of the  | the Congressional agenda,  |
|                | question topic.**      | or are you in favor of     |
|                |                        | sensible legislation to    |
|                | **The format of the    | moderate the influence of  |
|                | question text or       | outside lobbyists?         |
|                | response options       | (respondents felt          |
|                | produces unintentional | pressured to select second |
|                | influences on the      | option)                    |
|                | response process.**    |                            |
|                |                        | With how many men have you |
|                |                        | had sex?                   |
|                |                        |                            |
|                |                        | (respondents felt          |
|                |                        | uncomfortable with         |
|                |                        | answering this question)   |
|                |                        |                            |
|                |                        | People in the United       |
|                |                        | States are from many       |
|                |                        | countries, tribes and      |
|                |                        | cultural groups. What is   |
|                |                        | YOUR/NAME'S ancestry or    |
|                |                        | tribe? For example,        |
|                |                        | Italian, African American, |
|                |                        | Dominican, Aleut,          |
|                |                        | Jamaican, Chinese,         |
|                |                        | Pakistani, Salvadoran,     |
|                |                        | Rosebud Sioux, Nigerian,   |
|                |                        | Samoan, Russian, etc.      |
|                |                        |                            |
|                |                        | (Rather than viewing the   |
|                |                        | list of ancestries as      |
|                |                        | examples, respondents      |
|                |                        | viewed the list as an      |
|                |                        | exhaustive list of         |
|                |                        | choices)                   |
+----------------+------------------------+----------------------------+
| STRUCTURAL     |                        |                            |
+----------------+------------------------+----------------------------+
| 1\. Inadequate | **Response options are | Do you NOW smoke           |
| Response       | incomplete, inadequate | cigarettes every day, some |
| Options        | or overlapping**       | days or not at all? (Many  |
|                |                        | people wanted to report    |
|                | -   R cannot           | "many days" because "some  |
|                |     adequately express | days" seemed like not      |
|                |     their response     | enough)                    |
|                |     given the          |                            |
|                |     categories         | What was the reason that   |
|                |     provided           | you had a mammogram?\[Pick |
|                |                        | one: Regular check up,     |
|                | -   Non-mutually       | doctor suggested it, had   |
|                |     exclusive response | concern that there was a   |
|                |     options; two       | problem, thought it was    |
|                |     categories could   | time to get one.\]         |
|                |     apply, but only    | (respondents felt the list |
|                |     one can be         | of reasons were            |
|                |     selected           | inadequate)                |
|                |                        |                            |
|                | -   Response options   | Does a long-term physical  |
|                |     do not fit the     | condition or mental        |
|                |     question           | condition or health        |
|                |                        | problem, reduce the amount |
|                | -   Response units are | or the kind of activity    |
|                |     inappropriate      | you can do at home?        |
|                |                        | Sometimes. Often or Never. |
|                | -   Response           |                            |
|                |     categories include | (respondents felt response |
|                |     a problematic      | options were               |
|                |     term, are          | inappropriate)             |
|                |     ambiguous, or are  |                            |
|                |     overly complex     | How many canisters of      |
|                |                        | asthma medications do you  |
|                | -   Length of response | use per month?             |
|                |     options places     |                            |
|                |     burden on          | \_\_\_\_\_\_ Number of     |
|                |     respondent,        | canisters                  |
|                |     causing            |                            |
|                |     respondents to     | (Most respondents used no  |
|                |     overlook           | more than one canister per |
|                |     appropriate        | month)                     |
|                |     responses or to    |                            |
|                |     choose the first   |                            |
|                |     response that      |                            |
|                |     appears to be      |                            |
|                |     appropriate        |                            |
|                |     without            |                            |
|                |     considering        |                            |
|                |     subsequent         |                            |
|                |     responses          |                            |
+----------------+------------------------+----------------------------+
| 2\. Not        | **Respondent either    |                            |
| Seen/Not Read  | does not see or        |                            |
|                | chooses not to attend  |                            |
|                | to a piece of the      |                            |
|                | item, which could be   |                            |
|                | an instruction, part   |                            |
|                | of the question text   |                            |
|                | or the response        |                            |
|                | text.**                |                            |
+----------------+------------------------+----------------------------+
| 3\.            | **Question problem     | Do you have chronic        |
| Questionnaire  | related to the         | bronchitis?                |
| Effects        | questionnaire**        |                            |
|                |                        | Do you have coronary heart |
|                | Question would not     | disease?                   |
|                | necessarily have a     |                            |
|                | problem independently, | What was you total         |
|                | but there is a problem | household income before    |
|                | related to the entire  | taxes in 2002?             |
|                | questionnaire.         |  (respondents were         |
|                |                        | confused by illogical      |
|                | -   Illogical          | flow)                      |
|                |     juxtaposition of   |                            |
|                |     topics/awkward     | Series of questions about  |
|                |     flow               | exercise where "no"        |
|                |                        | responses started to       |
|                | -   Response of        | create an image of         |
|                |     question is        | inactivity which made the  |
|                |     impacted by        | respondent uncomfortable;  |
|                |     previous questions | questions that respondents |
|                |     (i.e. context or   | seem reluctant to answer   |
|                |     order effects)     |                            |
|                |                        | Most questions in the      |
|                | -   Inconsistent       | series ask                 |
|                |     verbal format      | "agree/disagree," but then |
|                |     across similar or  | a few switches to          |
|                |     related questions  | "true/false"(confused      |
|                |                        | respondent)                |
|                | -   Questions are      |                            |
|                |     perceived to be    | In the 2 years before your |
|                |     repetitive         | first positive HIV test,   |
|                |                        | how many times were you    |
|                | -   Burdensome length  | tested for HIV?            |
|                |     of the             |                            |
|                |     questionnaire      | How often did you get      |
|                |                        | tested for HIV in the 2    |
|                | -   Apparent omissions | years before your first    |
|                |     that confuse or    | positive HIV test?         |
|                |     irritate           |                            |
|                |     respondents.       | (respondents were confused |
|                |                        | due to the repetitiveness  |
|                |                        | of questions)              |
|                |                        |                            |
|                |                        | R complains about length   |
|                |                        | or does not concentrate to |
|                |                        | provide accurate           |
|                |                        | information                |
|                |                        |                            |
|                |                        | In a questionnaire for     |
|                |                        | truck drivers about toxic  |
|                |                        | exposures, R comments that |
|                |                        | there were no questions    |
|                |                        | about exhaust from other   |
|                |                        | cars, which is one of the  |
|                |                        | worst problems.            |
+----------------+------------------------+----------------------------+
| 4\.            | **Any difficulty       |                            |
| Problematic    | experienced by the     |                            |
| Answer Space   | respondent when        |                            |
|                | attempted to record    |                            |
|                | their response onto    |                            |
|                | the form.**            |                            |
+----------------+------------------------+----------------------------+
| 5\.            | **Any visual stimulus  |                            |
| Problematic    | that could mislead the |                            |
| Visual Cues    | respondent. These      |                            |
|                | include:**             |                            |
|                |                        |                            |
|                | -   Inadequate or      |                            |
|                |     ambiguous visual   |                            |
|                |     or navigational    |                            |
|                |     cues, such as skip |                            |
|                |     patterns,          |                            |
|                |     directional        |                            |
|                |     symbols that are   |                            |
|                |     not well           |                            |
|                |     understood or      |                            |
|                |     misuse of italics  |                            |
|                |                        |                            |
|                | -   Cues that are      |                            |
|                |     inconsistent, such |                            |
|                |     as using skip to   |                            |
|                |     and go to within   |                            |
|                |     same questionnaire |                            |
|                |     or using bolding   |                            |
|                |     and italics        |                            |
|                |     interchangeably    |                            |
+----------------+------------------------+----------------------------+
| OTHER          |                        |                            |
+----------------+------------------------+----------------------------+
| 1.Response     | **Use for problems     |                            |
| Error N.E.C.   | where it is difficult  |                            |
|                | to select a response   |                            |
|                | error code based on    |                            |
|                | the way the errors     |                            |
|                | emerged in the         |                            |
|                | evaluation or based on |                            |
|                | the way the evaluation |                            |
|                | results are            |                            |
|                | summarized.**          |                            |
+----------------+------------------------+----------------------------+
| 2\. None as    | **No errors were       |                            |
| Tested         | detected during the    |                            |
|                | pre-testing of the     |                            |
|                | question.**            |                            |
+----------------+------------------------+----------------------------+

Response Error

(Additional [Establishment]{.underline} Response Errors)

In addition to the self-administered response errors listed in the
previous page, establishment surveys elicit a set of unique response
errors as a result of the reporting process. The following response
error indicators appear only when questions from establishment surveys
are being entered into the database or are the topic of a search.

Retrieval from records encompasses five potential response error
indicators. A **"mismatch between reporting and organizational unit"**
occurs when the reporting unit for which data are requested does not
match the respondent's organizational or accounting structure. A
**"mismatch between requested data and records"** occurs when the data
for the topic of interest exists in records, but not in the manner
requested. **"Requested data not kept in records"** happens when a
survey asks for information that is not tracked in records at all.
**"Lack of access to requested data"** indicates that the data exists in
records, but the respondent has not been granted access to that
information. **"Decentralized data"** signifies that the requested data
does not reside in one location or with one respondent. It is necessary
to consult multiple sources to retrieve information.

Additionally, in establishments, when a respondent makes a judgment
about how to report something, they are not only making a personal
judgment (i.e. should I estimate, or try to calculate the answer?), but
they are also considering authority and policies concerning reporting
company data to an external entity. For this reason, we differentiate
between personal judgment errors and policy imposed judgment errors.

Personal judgment errors are broken down further into three categories
that were created to reflect errors that occur at the level of the
respondent as an individual, not the establishment as a whole. The first
category, **"estimation"** represents errors that occur based on
respondent's error in estimating rather than errors in the actual
figures. Note this category replaces the recall/estimation category used
for self-administered population surveys. **"Calculation/transformation
of data"** type errors may occur when a respondent commits an error when
asked to calculate figures that could be calculated on the processing
side of data collection. (e.g., asking respondents to sum figures in a
table). **"Perpetuating prior incorrect reporting strategy"** occur when
the respondent uses an erroneous strategy that had been used in the past
for reporting this type of data, instead of reading instructions and
generating the requested data.

Finally, response errors may occur as a direct result of policy imposed
judgments. There are three different reasons for why data is not
released. The **"release of data is prohibited"**, the establishment is
**"Not willing to divulge propriety information"** or the **"release of
data conditional upon authorization"**.

For establishment surveys, please use any of the response errors listed
under population self-administered surveys in addition to these response
errors for establishment surveys.

Categories:

1.  Problematic Visual Cues

2.  Not Seen/Read

3.  Problematic Terms

4.  Ambiguous Concepts

5.  Overly Complex

6.  Assumption/Double Barrel

7.  Questionnaire Effects

8.  Biased/Sensitive

9.  Inadequate Response Options

10. Problematic Answer Space

11. Mismatch between reporting unit and org unit

12. Mismatch between requested data and records

13. Requested data not kept in records

14. Lack of access to requested data

15. Decentralized data

16. Release of data prohibited

17. Not willing to divulge proprietary information

18. Release of data conditional upon authorization

19. Estimation

20. Calculation/transformation of data

21. Perpetuating prior incorrect reporting strategy

22. Response Error N.E.C

23. None as Tested

Example: Release of data is prohibited

Response Error Indicators, Additional Establishment Questionnaire
Response Errors: (listed on next page)

**Response Error Indicators (Additional Establishment Questionnaire
Response Errors)**

+-----------------------------------+-----------------------------------+
| # ERROR TYPE                      | **DEFINTION**                     |
+-----------------------------------+-----------------------------------+
| #                                 |                                   |
|                                   |                                   |
| # RETRIEVAL ERROR                 |                                   |
+-----------------------------------+-----------------------------------+
| 1\. Mismatch between reporting    | The structural unit for which     |
| and organizational unit           | data are requested does not match |
|                                   | the respondent's natural or       |
|                                   | structural way of organizing      |
|                                   | information.                      |
+-----------------------------------+-----------------------------------+
| 2\. Mismatch between requested    | The data for the topic of         |
| data and records                  | interest exists in records, but   |
|                                   | not in the manner requested.      |
+-----------------------------------+-----------------------------------+
| 3\. Requested data not kept in    | The survey asks for information   |
| records                           | that is not tracked in records at |
|                                   | all.                              |
+-----------------------------------+-----------------------------------+
| 4\. Lack of access to requested   | Data exists in records, but the   |
| data                              | respondent has not been granted   |
|                                   | access to that information        |
+-----------------------------------+-----------------------------------+
| 5\. Decentralized data            | The requested data does not       |
|                                   | reside in one location or with    |
|                                   | one respondent. It is necessary   |
|                                   | to consult multiple sources to    |
|                                   | retrieve information              |
+-----------------------------------+-----------------------------------+
| #                                 |                                   |
|                                   |                                   |
| # PERSONAL JUDGMENT               |                                   |
+-----------------------------------+-----------------------------------+
| 1\. Estimation                    | Errors that occur based on        |
|                                   | respondent's error in estimating  |
|                                   | rather than errors in the actual  |
|                                   | figures.                          |
+-----------------------------------+-----------------------------------+
| 2\. Calculation/transformation of | A respondent commits an error     |
| data                              | when asked to calculate figures   |
|                                   | that could be calculated on the   |
|                                   | processing side of data           |
|                                   | collection. (e.g., asking         |
|                                   | respondents to sum figures in a   |
|                                   | table                             |
+-----------------------------------+-----------------------------------+
| 3\. Perpetuating prior incorrect  | Respondent uses an erroneous      |
| reporting strategy                | strategy that had been used in    |
|                                   | the past for reporting this type  |
|                                   | of data, instead of reading       |
|                                   | instructions and generating the   |
|                                   | requested data.                   |
+-----------------------------------+-----------------------------------+
| POLICY IMPOSED JUDGMENTS          |                                   |
+-----------------------------------+-----------------------------------+
| 1\. Release of data is prohibited | Release of the data is prohibited |
|                                   | due to establishment policy.      |
+-----------------------------------+-----------------------------------+
| 2\. Not willing to divulge        | Respondent is not willing to      |
| propriety information             | divulge proprietary information   |
|                                   | due to establishment policy.      |
+-----------------------------------+-----------------------------------+
| 3\. Release of data conditional   | Establishment policy states that  |
| upon authorization                | the release of data is            |
|                                   | conditional upon proper           |
|                                   | authorization.                    |
+-----------------------------------+-----------------------------------+

Where the Error Occurs

This field denotes where an error occurs in the questionnaire. For
self-administered surveys it is important to determine whether the error
occurred in the question itself or in the heading or label, the
contextual instructions, the navigational direction, the response
options, or in non-verbal components of the questionnaire. Non-verbal
components are defined as including the "numeric, symbolic and graphic
information (color brightness, shape and location of information). If
error occurs in multiple locations, please indicate all that apply. If
no response error is identified during testing please indicate not
applicable.

Category: Heading/Label

Question/Item

Contextual Instruction

Navigational Direction

Response Option

Non-Verbal Components

Not applicable

Example: Heading/label, non-verbal components

**Figure 16: 2004 National Census Test---Where an Error Could Occur
Example**

![](media/image3.jpeg){width="6.002083333333333in"
height="2.611111111111111in"}

Respondent Role

This field specifies who is responding to the question -- whether the
report is for the self, another person (proxy), or both for a household
survey, or the job title of the person targeted in an establishment
survey. Respondent role may change throughout a questionnaire. Please
indicate the respondent role for each question.

Additional respondent role categories may be added for establishment
surveys only. If possible, please select a category from the list below.
If none of the categories are applicable you may indicate a new category
to be added to the database. Multiple respondent roles may be selected
for a question.

Categories:

[Population:]{.underline}

Self

Proxy

Self and Proxy

[Establishment:]{.underline}

Accountant

Dean

Principal

President

Other\_\_\_\_\_\_\_

Index Status

The field denotes whether or not the question is part of an index or a
mathematically linked set of questions. These include items that are
used to calculate a figure outside of the survey instrument. It does not
include items that could possibly be used to calculate an indicator. If
you are unsure as to whether or not a question is part of an index,
please mark no.

Categories: Yes

No

[Example of a series of questions are considered to be part of an
index:]{.underline}

1\. Including yourself, how many people live here and have no other
place they live?

2\. Besides those counted in Question 1, how many other people have more
than one place they live, but sleep here more often than anywhere else?

3\. Besides those counted in Question 1 or 2, how many other people were
staying here temporarily on January 3, 2005 and had no other place where
they live?

These questions would all be considered to be part of an index because
the summation of the responses given to each question is used by the
Census Bureau to calculate the total number of people living in the
household.

[Example of a series of questions that are *NOT* considered to be part
of an index:]{.underline}

A. What were the total receipts and other operating revenues for the
locations identified in item 2?

\> Note the sum of items 3A1 and 3A2 should equal item 3A.

A1. What were commissions and selling or listing fees?

A2. What were product sales on your own account and other operating
revenue?

While the summation of answers to question A1 and A2 should equal the
answer given in 3A, these questions are not considered part of an index.

Question Topic

This field indicates the general topic of the question. The question
topic is sometimes determined by the section in which it appears in the
survey.

The *question topic* field assigns one of several broad categories
(e.g., demographics, health insurance, income) to each question. Thus, a
user could use this field to identify all questions about, say, health
insurance, that are in the database. The categories to be included in
this field are designed to be specific enough to provide meaningful
distinctions without being so narrow that very few questions would ever
fit under the category. Thus, a category such as "health" is far too
broad, but "HMO use" is too narrow. Rather than attempt to define all
possible categories in advance, this field is open to change as new
reports are coded into the database.

If possible, please select a category from the list below. If none of
the categories are applicable you may indicate a new category to be
added to the database.

Category: (listed on next page)

+---------------------------------+------------------------------------+
| **Question Topic -- Population  |                                    |
| Surveys**                       |                                    |
+---------------------------------+------------------------------------+
| **Crime**                       | Poisoning                          |
|                                 |                                    |
| Assault                         | Prescription Medicine              |
|                                 |                                    |
| Burglary                        | Prostate Health                    |
|                                 |                                    |
| Computer Crime                  | Rectal Health                      |
|                                 |                                    |
| Domestic Violence               | Self Rated Health                  |
|                                 |                                    |
| Identity theft                  | Sexual Behavior                    |
|                                 |                                    |
| Property Crime                  | Skin Cancer                        |
|                                 |                                    |
| Rape                            | Sleep                              |
|                                 |                                    |
| Robbery                         | Vaccinations                       |
|                                 |                                    |
| Theft                           | **Income Sources and Assets**      |
|                                 |                                    |
| Weapons                         | Home Ownership                     |
|                                 |                                    |
| **Demographics**                | Household Income                   |
|                                 |                                    |
| Age                             | Earnings                           |
|                                 |                                    |
| Ancestry                        | Interest and Dividends             |
|                                 |                                    |
| Date of Birth                   | Child Support and Alimony          |
|                                 |                                    |
| Educational Status              | **Public Assistance Programs**     |
|                                 |                                    |
| Employment Status               | Child Care Subsidies               |
|                                 |                                    |
| Ethnicity                       | Food Stamps                        |
|                                 |                                    |
| Gender or Sex                   | Job Training Programs              |
|                                 |                                    |
| Household Roster & Composition  | SSI                                |
|                                 |                                    |
| Marital Status                  | TANF (formerly AFDC)               |
|                                 |                                    |
| Military Service                | Transportation Subsidies           |
|                                 |                                    |
| Race                            | **Social Problems**                |
|                                 |                                    |
| Relationship                    | Discrimination                     |
|                                 |                                    |
| Residency                       | Substance Use                      |
|                                 |                                    |
| Sexual Identity                 | **Catastrophic Events**            |
|                                 |                                    |
| **Education**                   | Disaster                           |
|                                 |                                    |
| Extracurricular Activities      | Terrorism                          |
|                                 |                                    |
| School Environment              |                                    |
|                                 |                                    |
| Student Performance             |                                    |
|                                 |                                    |
| Truancy                         |                                    |
|                                 |                                    |
| Drug/Alcohol Education          |                                    |
|                                 |                                    |
| **Heath**                       |                                    |
|                                 |                                    |
| Access to Health Care           |                                    |
|                                 |                                    |
| Alternative Medicine            |                                    |
|                                 |                                    |
| Children's Mental Health        |                                    |
|                                 |                                    |
| Disability                      |                                    |
|                                 |                                    |
| Erectile Dysfunction            |                                    |
|                                 |                                    |
| Health Conditions               |                                    |
|                                 |                                    |
| Health Information              |                                    |
|                                 |                                    |
| Health Insurance                |                                    |
|                                 |                                    |
| Health Recommendations          |                                    |
|                                 |                                    |
| HIV/AIDS                        |                                    |
|                                 |                                    |
| Hospitalization                 |                                    |
|                                 |                                    |
| Hypertension                    |                                    |
|                                 |                                    |
| Injury                          |                                    |
|                                 |                                    |
| Injury and/or Poisoning         |                                    |
|                                 |                                    |
| Mental Health                   |                                    |
|                                 |                                    |
| Nutrition                       |                                    |
|                                 |                                    |
| Oral Health                     |                                    |
|                                 |                                    |
| Physical Health                 |                                    |
+---------------------------------+------------------------------------+

+---------------------------------+------------------------------------+
| **Question Topic -              |                                    |
| Establishment Surveys**         |                                    |
+---------------------------------+------------------------------------+
| **Assets -- Monetary**          | **Identification**                 |
|                                 |                                    |
| **Assets -- Physical**          | **Imported goods / services**      |
|                                 |                                    |
| Building(s)                     | **Inventory**                      |
|                                 |                                    |
| Equipment                       | **Lease/rental**                   |
|                                 |                                    |
| Inventory                       | **Liabilities/Debts**              |
|                                 |                                    |
| Land                            | **Orders**                         |
|                                 |                                    |
| **Assets -- Nonphysical**       | **Organizational change**          |
|                                 |                                    |
| Copyright                       | **Owner/stockholder equity**       |
|                                 |                                    |
| Trademark                       | **Payroll**                        |
|                                 |                                    |
| Patent                          | **Production**                     |
|                                 |                                    |
| **Business owner(s)**           | Actual operations                  |
|                                 |                                    |
| Demographic characteristics     | Full production                    |
|                                 |                                    |
| Role in business                | Market value                       |
|                                 |                                    |
| **Contact information**         | Work patterns                      |
|                                 |                                    |
| **Contractors**                 | **Public services**                |
|                                 |                                    |
| **Contracts**                   | **Reporting period**               |
|                                 |                                    |
| **Customer Type**               | **Sales/Receipts/Revenues**        |
|                                 |                                    |
| **Depreciation**                | Source (of                         |
|                                 | sales/receipts/revenues)           |
| **E-commerce**                  |                                    |
|                                 | Volume (of                         |
| **E-government**                | sales/receipts/revenues)           |
|                                 |                                    |
| **Employment/Employees**        | **Services**                       |
|                                 |                                    |
| Education level                 | Interest                           |
|                                 |                                    |
| Full-time/part-time             | Research & development             |
|                                 |                                    |
| Full-time equivalents (FTEs)    | Utilities                          |
|                                 |                                    |
| Gender                          | Administrative                     |
|                                 |                                    |
| Hours worked                    | **Shipments**                      |
|                                 |                                    |
| Leased employees                | **Structure/characteristics of     |
|                                 | enterprise/establishment**         |
| Number                          |                                    |
|                                 | Business type                      |
| Temporary employees             |                                    |
|                                 | Franchise status                   |
| Type of employees               |                                    |
|                                 | Industry                           |
| Visa status                     |                                    |
|                                 | Legal form of organization         |
| **Expenses**                    |                                    |
|                                 | Number of establishments           |
| Administrative                  |                                    |
|                                 | Physical location / geography      |
| Equipment / supplies            |                                    |
|                                 | Reporting unit                     |
| Interest                        |                                    |
|                                 | **Taxes/fees collected**           |
| Research & development          |                                    |
|                                 | Income taxes                       |
| Services                        |                                    |
|                                 | License taxes                      |
| Software                        |                                    |
|                                 | Other taxes                        |
| Structures                      |                                    |
|                                 | Property taxes                     |
| Utilities                       |                                    |
|                                 | Sales taxes                        |
| **Exported goods / services**   |                                    |
|                                 | **Taxes/fees paid**                |
| **Fiscal year**                 |                                    |
|                                 | Income taxes                       |
| **Foreign Operations**          |                                    |
|                                 | License taxes                      |
| **Fringe Benefits**             |                                    |
|                                 | Other taxes                        |
| Health insurance                |                                    |
|                                 | Property taxes                     |
| Life insurance                  |                                    |
|                                 | Sales taxes                        |
| Medicare                        |                                    |
|                                 | **Vehicle(s)**                     |
| Other fringe benefits           |                                    |
|                                 | **Website**                        |
| Stock option                    |                                    |
|                                 |                                    |
| Retirement                      |                                    |
+---------------------------------+------------------------------------+

Page Number

This field denotes the number of the page in which the question appears
within the questionnaire.

Categories: Page [X]{.underline} of [Y]{.underline}

Example: [2]{.underline} of [10]{.underline}

Layout of Questions and Response Options

This field denotes the location of the question in relation to the
response options. If there is only one response option, then two
possibilities exist: the question is either located above or to the left
of the one option. However, if there is more than one set of response
options, the question may be located above the response options or to
the left, and response options can either be aligned horizontally or
vertically. For an example, see box below.

+---------------+-------------------------+-------------+-------------+
| Response      | Question Above          | Question    |             |
| Options       |                         | Left        |             |
+---------------+-------------------------+-------------+-------------+
| Horizontal    | What is your sex?       | What is     |             |
|               |                         | your sex?   |             |
|               |  M F                  | M  F      |             |
+---------------+-------------------------+-------------+-------------+
| Vertical      | What is your sex?       | What is     |  M  F     |
|               |                         | your sex?   |             |
|               | M                      |             |             |
|               |                         |             |             |
|               |  F                     |             |             |
+---------------+-------------------------+-------------+-------------+

Also, the question many appear above or to the left and the response
options can be aligned both horizontally and vertically.

+--------------+----------------------+------------+-------+----------+
| Response     | Question Above       | Question   |       |          |
| Options      |                      | Left       |       |          |
+--------------+----------------------+------------+-------+----------+
| Horizontal & | What is your race?   | What is    |      | Black   |
| Vertical     |                      | your race? | White |          |
|              |  White  Black      |            |       | Am.     |
|              |                      |            |      | Indian   |
|              | Asian Am. Indian   |            | Asian |          |
+--------------+----------------------+------------+-------+----------+

The categories are intended to be mutually exclusive. Please select the
category that best fits the format of the question.

Categories:

[Question Above Response Options]{.underline}

One RO

Vertical ROs

Horizontal ROs

Vertical and Horizontal ROs

[Question Left of Response Options]{.underline}

One RO

Vertical ROs

Horizontal ROs

Vertical and Horizontal ROs

Location of Question

The field is intended to indicate the location of the question on the
page. Please code only the questions in the extreme positions of the
page as top or bottom. Only the first question on the page in the left
column is to be coded "top left" Similarly, only the last question at
the bottom of the left column should be coded as "bottom left." All
other questions should be coded as "middle." If there are two columns of
a page, please indicate if the question appears in the "middle left"
side of the page or the "middle right" side of the page.

Categories: Top

Top Left

Top Right

Middle

Middle Left

Middle Right

Bottom

Bottom Left

Bottom Right

Example: Top Left

**Figure 21: Census 2000 questionnaire---Location of Question Example**

![](media/image1.jpeg){width="5.749305555555556in"
height="2.876388888888889in"}

Response Option Text Location

This field denotes the location of the response options text in relation
to the response box or answer space. Response options may appear to the
right of, left of, below or above the response space. See examples below

+-----------------+-----------------+-----------------+-----------------+
| Right           | Left            | Above           | Below           |
+-----------------+-----------------+-----------------+-----------------+
| \_\_\_\_\_ Year | Year \_\_\_\_\_ | Year            | \_\_\_\_\_      |
|                 |                 |                 |                 |
|                 |                 | \_\_\_\_\_      | Year            |
+-----------------+-----------------+-----------------+-----------------+

In addition, the response option text can appear in the response space.
See examples below.

![](media/image6.png){width="2.7402777777777776in"
height="2.0833333333333335in"}

![](media/image7.png){width="2.0097222222222224in"
height="0.37083333333333335in"}

Periodically, a questionnaire will have questions which ask respondents
to select an answer from a list, as well as a field where text may be
entered in. See example below.

What is your race? (Please mark one or more races)

 White

 Black

 Indian -- Print name of tribe \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_
\_

 Asian

Other -- Please specify \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_ \_

Here the response option location could appear to be the right or the
left of the answer box/space. In cases such as these please code the
main response option text location. For this question, the response
option location would be to the right.

These categories are considered to be mutually exclusive. Please select
the category that best fits the location of the response option text. .
If there is no text association with the answer space please indicate
this using N/A.

Categories: Right

Left

Above

Below

In response space

Not Applicable

Separate Instructions

This field indicates whether the form, in which the question is found,
has separate instructions from the rest of the survey. Also, this field
indicates instructions that are not near the associated question but are
item-by-item in nature. Separate instructions may appear at the
beginning of the questionnaire, at the end, or in a separate booklet. An
example of separate instructions would the IRS form guide, which is
provided in a separate booklet from the actual form. Please indicate
whether there are separate instructions associated with the question and
be sure to include the separate instructions with your report.

Categories: Yes

No

Core Question Format

This field denotes the format of the 'core question' text. More
specifically, it denotes whether the text appear as a question, as a
single word or phrase (i.e., heading/label), or as some kind of
instructions or directions.

These categories should be considered mutually exclusive, please select
one only.

Categories: Heading/Label

Instruction/Statement

Question

Example: Instruction: Enter this person's sex. Enter this person's age.

**Figure 23: 2003 Annual Survey of Foreign Direct Investment in the
United States---Core Question Format Example, Heading/label**

![](media/image2.jpeg){width="4.876388888888889in"
height="1.1881944444444446in"}

**Figure 24: 2005 National Census Test---Core Question Format Example,
Instruction**

![](media/image8.jpeg){width="4.872222222222222in"
height="1.4270833333333333in"}

**Figure 25: 2004 National Census Test---Core Question Format Example,
Question**

![](media/image3.jpeg){width="4.127777777777778in"
height="1.5770833333333334in"}

Introductory Text Format

This field denotes the format of the introductory text. This field
describes whether the introductory text takes the form of a heading or
label, contextual instructions navigational directions or some
combination. Headings or labels are basically sentence fragments or
phrases. Contextual instructions provide respondents with instructions
that are necessary to answer the question correctly, and navigational
directions tell respondents how to move through the questionnaire.

Introductory text may include multiple formats. Please indicate all that
apply. If there is no introductory text associated with the question
please indicate not applicable.

Categories: Heading/label

Instruction

Navigational Direction

Question

Not Applicable

Example:

Heading: Part 1 Identification of U.S. Affiliate --Continued

Instruction: Industry classification of fully consolidated U.S.
affiliate (based on sales or gross operating revenues)---Enter the
4-digit International Surveys Industry (ISI) code(s) and the sales (as
defined in item 55 on page 6) and employment associated with each code.

Question: What amounts were paid to FAFPs (or were entered into
inter-company accounts, whichever came first) during the quarter, by
country, and what were the debt balances with the FAFP at the beginning
and end of the quarter, by country?

**Figure 22: 2004 National Census Test---Introductory Text Format
Example**

![](media/image3.jpeg){width="6.002083333333333in"
height="2.611111111111111in"}

Matrix Status

This field denotes whether or not the question is part of a matrix. A
matrix is a grid in which a series of questions are asked about a series
of objects, where one must look at the row and column, in deciding what
to place into the answer cell.

Categories: Yes

No

**Figure 13: Alternative Design of Form BE-605---Matrix Example**

![](media/image9.png){width="6.011805555555555in"
height="3.8784722222222223in"}

Orientation of Core Questions

This field denotes the location of the core question within the matrix.
In a matrix, core questions are either positioned in rows or columns.
The core question solicits information across several objects. The
difference between the question and the object is where the most focus
goes. The core question is the topic of the question. The object is the
dimension that is being measured of that topic.

Please select only one.

Categories: Rows

Columns

**Figure 14: BE-605, Transactions of a U.S. Affiliate...with a Foreign
Parent---Orientation of Core Questions Example (column)**

![](media/image5.jpeg){width="5.876388888888889in"
height="1.8763888888888889in"}

**Figure 15: BE-605, Transactions of a U.S. Affiliate...with a Foreign
Parent---Orientation of Core Questions Example (row)**

![](media/image9.png){width="5.879861111111111in"
height="2.438888888888889in"}

** Part III: Preparing Reports for Q-Bank **

Evaluation reports must be submitted to Q-Bank through one of the
sponsoring agencies and submissions must be formatted according to the
outline below. Submission packages must include a final report, which
includes a methodology section, question by question review and the
actual questionnaire that was tested, as well as any associated
instructions, forms, or flashcards. The final report should include the
following a detailed methods section, which, outlines the pre-testing
methods used and sample characteristics. Please include the sample size
and characteristics, the amount of remuneration provided, pre-testing
mode and a description of the probing methods used. In addition final
reports should include the full question for each question that was
tested, which includes the question itself, any instructions or
introductory text and response options.

In addition, a data entry document should be submitted separate from the
actual report. Information on how to format the data entry document is
provided below. Finally, please include contact information in case
questions arise. The author of the report will be contacted regarding
formatting questions, regardless of who prepared the report for Q-Bank.

**[Using the Self-Administered Population and Establishment Information
Templates]{.underline}**

Due to the large amount of information that needs to be documented for
self-administered reports, a data entry document should be created and
submitted to the Q-Bank administrator in addition to the evaluation
report. Two data entry documents are provided at the end of this manual,
one for preparing self-administered population reports and one for
preparing self-administered establishment reports. You are required to
provide information in each field. Please do not leave any fields blank.
Detailed information regarding each of these fields is provided in the
User Manual. All self- administered population and establishment data
entry documents submitted to Q-Bank should be formatted in the following
manner:

1\. *General Information* -- Copy and paste the report title, the
general information table, and the global instructions into your coding
document. Under report title, please indicate the title of the report
for which the data entry document pertains. The first table collects
general information about the questionnaire evaluation. The general
information table contains text fields in which data can be directly
entered. Next, you are required to enter any global instructions that
are provided with the questionnaire that was evaluated.

2\. *Question Specific Information -* You will then need to copy and
paste as many question specific coding boxes as needed into your data
entry document. Introductory text, core question, objects, instructions
following core question, response option text and instructions following
response options are all text fields in which information can be
directly entered. Please provide information in each field. If the
information required in any of the fields is not applicable, please
enter N/A. Please fill out the question specific coding table based on
the information provided in your summary of the results, which were
found during the evaluation of the question. To mark an item simply
select the box you wish to check with your mouse and type "X".

PLEASE NOTE:

Evaluation reports are sometimes formatted in a manner that is
incompatible with the Q-Bank formatting guidelines. For example,
summaries may not be written in a question by question format, making it
difficult to determine where to place the question specific coding
tables and when to apply codes (i.e. a summary may pertain to all
questions in a series and not to a specific question). In these cases,
please do the best you can, using the materials available. Please
contact the Q-Bank administrator if you have any questions regarding
report formatting.

**SELF-ADMINSTERED, POPULATION TEMPLATE**

**(manual page numbers in parentheses)**

**REPORT TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

General Information

  ----------------------------------- -----------------------------------
  **Survey Title** (8):               **Universe** (14):

  **Survey Year** (9):                **Evaluation Type** (15):

  **Testing Agency** (10):            **Documentation** (16):

  **Test Date** (11):                 **Pre-Testing Mode** (17):

  **Principal Investigator** (12):    **Field Mode** (18):

  **Sponsor** (13):                   
  ----------------------------------- -----------------------------------

**Global Instructions (19)**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

Question Specific Coding Tables

**Introductory Text (21)**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Core Question (22)**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Objects (Matrix only) (23)**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Instructions Following Core Question (24)**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Response Option Text (25)**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Instructions Following Response Options (26)**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| **Separate Instructions** (61)                                        |
|                                                                       |
| Yes No                                                              |
+-----------------------------------------------------------------------+

Question Characteristics and Response Error

+---------------------+------------------------------+-----------------+
| **Information       | **Response Error** (37):     | **Target        |
| Type** (27):        |                              | Population**    |
|                     | Problematic Visual Cues     | (33):           |
| Event, Action &    |                              |                 |
| Behavior            | Not Seen/Read               | Individual     |
|                     |                              |                 |
| Objective          | Problematic Term            | Household      |
| Characteristics     |                              |                 |
|                     | Ambiguous Concept           |                 |
| Subjective         |                              |                 |
| Characteristics     | Overly Complex              |                 |
|                     |                              |                 |
| Speculations       | Assumption/Double Barrel    |                 |
|                     |                              |                 |
| Attitudes/Opinions | Questionnaire Effect        |                 |
|                     |                              |                 |
| Knowledge Test     | Recall/Estimation           |                 |
|                     |                              |                 |
| Other              | Biased/Sensitive            |                 |
|                     |                              |                 |
|                     | Inadequate Response Options |                 |
|                     |                              |                 |
|                     | Problematic Answer Space    |                 |
|                     |                              |                 |
|                     | Response Error N.E.C.       |                 |
|                     |                              |                 |
|                     | None As Tested              |                 |
+---------------------+------------------------------+-----------------+
|                     |                              | **Respondent    |
|                     |                              | Role** (51):    |
|                     |                              |                 |
|                     |                              | Self           |
|                     |                              |                 |
|                     |                              | Proxy          |
|                     |                              |                 |
|                     |                              | Self and Proxy |
+---------------------+------------------------------+-----------------+
|                     |                              | **Index         |
|                     |                              | Status** (52):  |
|                     |                              |                 |
|                     |                              | Yes            |
|                     |                              |                 |
|                     |                              |  No            |
+---------------------+------------------------------+-----------------+
| **Response          |                              |                 |
| Category** (31):    |                              |                 |
|                     |                              |                 |
| Yes/No             |                              |                 |
|                     |                              |                 |
| Select One Numeric |                              |                 |
|                     |                              |                 |
| Select One Textual |                              |                 |
|                     |                              |                 |
| Mark All That      |                              |                 |
| Apply               |                              |                 |
|                     |                              |                 |
| Allocation         |                              |                 |
|                     |                              |                 |
| Open-Ended Textual  |                              |                 |
|                     |                              |                 |
| Delineated         |                              |                 |
|                     |                              |                 |
| Non-Delineated     |                              |                 |
|                     |                              |                 |
| Open-Ended Numeric  |                              |                 |
|                     |                              |                 |
| Delineated         |                              |                 |
|                     |                              |                 |
| Non-Delineated     |                              |                 |
|                     |                              |                 |
| Other              |                              |                 |
+---------------------+------------------------------+-----------------+
|                     | **Where Error Occurs** (50): | **Page Number** |
|                     |                              | (56):           |
|                     | Heading/Label               |                 |
|                     |                              | Number \_\_\_\_ |
|                     | Question/Item               | of \_\_\_\_\_   |
|                     |                              |                 |
|                     | Contextual Instruction      |                 |
|                     |                              |                 |
|                     | Navigational Direction      |                 |
|                     |                              |                 |
|                     | Response Options            |                 |
|                     |                              |                 |
|                     | Non-Verbal Components       |                 |
|                     |                              |                 |
|                     | Not Applicable              |                 |
+---------------------+------------------------------+-----------------+
|                     |                              | **Sequence      |
|                     |                              | Number** (34):  |
|                     |                              |                 |
|                     |                              | Number \_\_\_\_ |
|                     |                              | of \_\_\_\_\_   |
+---------------------+------------------------------+-----------------+
| **Question Topic**  |                              |                 |
| (53):               |                              |                 |
|                     |                              |                 |
| **Main:**           |                              |                 |
|                     |                              |                 |
| **Sub:**            |                              |                 |
+---------------------+------------------------------+-----------------+

Question Formatting

+-------------------+--------------------+-----------+----------------+
| **Intro Text      | **Layout of Qs and | *         | **RO Text      |
| Format** (63):    | ROs** (57):        | *Location | Location**     |
|                   |                    | of        | (59):          |
| Heading/Label    | Q Above ROs        | Q         |                |
|                   |                    | uestion** | (does not      |
| Instruction      | One RO            | (58):     | apply to       |
|                   |                    |           | matrix)        |
| Navigational     | Vertical ROs      | Top      |                |
| Direction         |                    |           | Right         |
|                   | Horizontal ROs    | Top Left |                |
| Question         |                    |           | Left          |
|                   | Vertical and      | Top      |                |
| Not Applicable   | horizontal ROs     | Right     | Above         |
|                   |                    |           |                |
|                   | Q Left of ROs      | Middle   | Below         |
|                   |                    |           |                |
|                   | One RO            | Middle   | In Response   |
|                   |                    | Left      | Space          |
|                   | Vertical ROs      |           |                |
|                   |                    | Middle   | Not           |
|                   | Horizontal ROs    | Right     | Applicable     |
|                   |                    |           |                |
|                   | Vertical and      | Bottom   |                |
|                   | horizontal ROs     |           |                |
|                   |                    | Bottom   |                |
|                   |                    | Left      |                |
|                   |                    |           |                |
|                   |                    | Bottom   |                |
|                   |                    | Right     |                |
+-------------------+--------------------+-----------+----------------+
| **Core Question   |                    |           |                |
| Format** (62):    |                    |           |                |
|                   |                    |           |                |
| Headings/Label   |                    |           |                |
|                   |                    |           |                |
| Inst             |                    |           |                |
| ruction/Statement |                    |           |                |
|                   |                    |           |                |
| Question         |                    |           |                |
+-------------------+--------------------+-----------+----------------+

Matrix Forms

+-------------------------------------+--------------------------------+
| **Matrix Status** (64):             | **Orientation of Core Qs**     |
|                                     | (65):                          |
| Yes                                |                                |
|                                     | Rows                          |
|  No                                |                                |
|                                     | Columns                       |
+-------------------------------------+--------------------------------+

**SELF-ADMINSTERED ESTABLISHMENT QUESTIONNAIRE TEMPLATE**

**(manual page numbers in parentheses):**

**REPORT TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**General Information:**

  ----------------------------------- -----------------------------------
  **Survey Title** (8):               **Universe** (14):

  **Survey Year** (9):                **Evaluation Type** (15):

  **Testing Agency** (10):            **Documentation** (16):

  **Test Date** (11):                 **Pre-Testing Mode** (17):

  **Principal Investigator** (12):    **Field Mode** (18):

  **Sponsor** (13):                   
  ----------------------------------- -----------------------------------

**Global Instructions** (19)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

Question Specific Coding Tables

**Introductory Text** (21)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Core Question** (22)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Objects (Matrix only)** (23)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Instructions Following Core Question** (24)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Response Option Text** (25)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

**Instructions Following Response Options** (26)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| **Separate Instructions** (61)                                        |
|                                                                       |
| Yes No                                                              |
+-----------------------------------------------------------------------+

Question Characteristics and Response Error

+------------------+-------------------------------+-------------------+
| **Information    | **Response Error** (37):      | **Target          |
| Type** (27):     |                               | Population**      |
|                  | Problematic Visual Cues      | (33):             |
| Event, Action & |                               |                   |
| Behavior         | Not Seen/Read                | S                |
|                  |                               | chool/Educational |
| Objective       | Problematic Term             | Institution       |
| Characteristics  |                               |                   |
|                  | Ambiguous Concept            | Farm             |
| Subjective      |                               |                   |
| Characteristics  | Overly Complex               | Hospital         |
|                  |                               |                   |
| Speculations    | Assumption/ Double Barrel    | Business         |
|                  |                               |                   |
| At              | Questionnaire Effect         |  Other           |
| titudes/Opinions |                               | \_\               |
|                  | Biased/Sensitive             | _\_\_\_\_\_\_\_\_ |
| Knowledge Test  |                               |                   |
|                  | Inadequate Response Options  |                   |
| Other           |                               |                   |
|                  | Problematic Answer Space     |                   |
|                  |                               |                   |
|                  | Mismatch Between Reporting   |                   |
|                  | Unit & Org Unit               |                   |
|                  |                               |                   |
|                  | Mismatch Between Requested   |                   |
|                  | Data & Records                |                   |
|                  |                               |                   |
|                  | Requested Data Not Kept In   |                   |
|                  | Records                       |                   |
|                  |                               |                   |
|                  | Lack Of Access To Requested  |                   |
|                  | Data                          |                   |
|                  |                               |                   |
|                  | Decentralized Data           |                   |
|                  |                               |                   |
|                  | Release Of Data Prohibited   |                   |
|                  |                               |                   |
|                  | Not Willing To Divulge       |                   |
|                  | Proprietary Info              |                   |
|                  |                               |                   |
|                  | Release Of Data Conditional  |                   |
|                  | Upon Auth.                    |                   |
|                  |                               |                   |
|                  | Estimation                   |                   |
|                  |                               |                   |
|                  | Calculation Transformation   |                   |
|                  | Of Data                       |                   |
|                  |                               |                   |
|                  | Perpetuating Prior Incorrect |                   |
|                  | Reporting Strategy            |                   |
|                  |                               |                   |
|                  | Response Error N.E.C.        |                   |
|                  |                               |                   |
|                  | None As Tested               |                   |
+------------------+-------------------------------+-------------------+
| **Response       |                               | **Respondent      |
| Category** (31): |                               | Role** (51):      |
|                  |                               |                   |
| Yes/No          |                               | Accountant       |
|                  |                               |                   |
| Select One      |                               | Dean             |
| Numeric          |                               |                   |
|                  |                               | Principal        |
| Select One      |                               |                   |
| Textual          |                               | President        |
|                  |                               |                   |
| Mark All That   |                               |  Other           |
| Apply            |                               | \_\               |
|                  |                               | _\_\_\_\_\_\_\_\_ |
| Allocation      |                               |                   |
|                  |                               |                   |
| Open-Ended       |                               |                   |
| Textual          |                               |                   |
|                  |                               |                   |
| Delineated      |                               |                   |
|                  |                               |                   |
| Non-Delineated  |                               |                   |
|                  |                               |                   |
| Open-Ended       |                               |                   |
| Numeric          |                               |                   |
|                  |                               |                   |
| Delineated      |                               |                   |
|                  |                               |                   |
| Non-Delineated  |                               |                   |
|                  |                               |                   |
| Other           |                               |                   |
+------------------+-------------------------------+-------------------+
|                  |                               | **Index Status**  |
|                  |                               | (52):             |
|                  |                               |                   |
|                  |                               | Yes              |
|                  |                               |                   |
|                  |                               |  No              |
+------------------+-------------------------------+-------------------+
|                  |                               | **Page Number**   |
|                  |                               | (56):             |
|                  |                               |                   |
|                  |                               | Number \_\_\_\_   |
|                  |                               | of \_\_\_\_\_     |
+------------------+-------------------------------+-------------------+
| **Question       | **Where Error Occurs** (50):  | **Sequence        |
| Topic** (53):    |                               | Number** (34):    |
|                  | Heading/Label                |                   |
| **Main:**        |                               | Number \_\_\_\_   |
|                  | Question/Item                | of \_\_\_\_\_     |
| **Sub:**         |                               |                   |
|                  | Contextual Instruction       |                   |
|                  |                               |                   |
|                  | Navigational Direction       |                   |
|                  |                               |                   |
|                  | Response Options             |                   |
|                  |                               |                   |
|                  | Non-Verbal Components        |                   |
|                  |                               |                   |
|                  | Not Applicable               |                   |
+------------------+-------------------------------+-------------------+

Question Formatting

+-------------------+--------------------+-----------+----------------+
| **Intro Text      | **Layout of Qs and | *         | **RO Text      |
| Format** (63):    | ROs** (57):        | *Location | Location**     |
|                   |                    | of        | (59):          |
| Heading/Label    | Q Above ROs        | Q         |                |
|                   |                    | uestion** | (does not      |
| Instruction      | One RO            | (58):     | apply to       |
|                   |                    |           | matrix)        |
| Navigational     | Vertical ROs      | Top      |                |
| Direction         |                    |           | Right         |
|                   | Horizontal ROs    | Top Left |                |
| Question         |                    |           | Left          |
|                   | Vertical and      | Top      |                |
| Not Applicable   | horizontal ROs     | Right     | Above         |
|                   |                    |           |                |
|                   | Q Left of ROs      | Middle   | Below         |
|                   |                    |           |                |
|                   | One RO            | Middle   | In Response   |
|                   |                    | Left      | Space          |
|                   | Vertical ROs      |           |                |
|                   |                    | Middle   | Not           |
|                   | Horizontal ROs    | Right     | Applicable     |
|                   |                    |           |                |
|                   | Vertical and      | Bottom   |                |
|                   | horizontal ROs     |           |                |
|                   |                    | Bottom   |                |
|                   |                    | Left      |                |
|                   |                    |           |                |
|                   |                    | Bottom   |                |
|                   |                    | Right     |                |
+-------------------+--------------------+-----------+----------------+
| **Core Question   |                    |           |                |
| Format** (62):    |                    |           |                |
|                   |                    |           |                |
| Headings/Label   |                    |           |                |
|                   |                    |           |                |
| Inst             |                    |           |                |
| ruction/Statement |                    |           |                |
|                   |                    |           |                |
| Question         |                    |           |                |
+-------------------+--------------------+-----------+----------------+

Matrix Forms

+-------------------------------------+--------------------------------+
| **Matrix Status** (64):             | **Orientation of Core Qs**     |
|                                     | (65):                          |
| Yes                                |                                |
|                                     | Rows                          |
|  No                                |                                |
|                                     | Columns                       |
+-------------------------------------+--------------------------------+