Demographic
EXCEL DEMOGRAPHIC QUESTIONNAIRE
[PDF DOWNLOAD]International Communications Research
Media, Pennsylvania
December, 2008
(ASK EVERYONE)
And finally, just a few questions for classification purposes only. . .
Z 1. Is your home owned or rented?
1 Owned
2 Rented
D Don’t Know
R Refused
Z 2. Are you: (READ LIST)
1 Single, that is never married
2 Single, living with a partner
3 Married
4 Separated
5 Widowed, or
6 Divorced
R (DO NOT READ) Refused
(ASK MALES)
Z 3. Would you consider yourself to be the male head of this household?
1 Yes
2 No
D Don’t Know
R Refused
(SKIP TO Q.Z 4)
(ASK FEMALES)
Z 3. Would you consider yourself to be the female head of this household?
1 Yes
2 No
D Don’t Know
R Refused
Z 4. Currently, are you yourself employed full time, part time, or not at all?
1 Full time (SKIP TO Q.Z 6)
2 Part time (SKIP TO Q.Z 6)
3 Not employed (GO TO Q.Z 5)
R Refused (SKIP TO Q.Z 6)
(ASK IF NOT EMPLOYED IN Q.Z 4)
Z 5. Are you: (READ LIST)
1 Retired
2 A homemaker
3 A student, or
4 Temporarily unemployed
5 (DO NOT READ) Disabled/handicapped
0 (DO NOT READ) Other
D (DO NOT READ) Don’t Know
R (DO NOT READ) Refused
Z 6. Including yourself, how many people are there living in your household?
(RECORD SINGLE DIGIT NUMBER)
____________________
8 Eight or more people
R Refused
(IF 1 OR IF REFUSED, SKIP TO Q.Z 7)
Z 6A. How many of these are adults, 18 or older?
(RECORD SINGLE DIGIT NUMBER)
____________________
8 Eight or more people
R Refused
(IF 1 AND IF NUMBER IN Q.Z 6A IS LESS THAN Q.Z 6, SKIP TO Q.Z 6B)
Z 6AA. How many of these adults are male?
(RECORD SINGLE DIGIT NUMBER)
____________________
0 None
8 Eight or more people
R Refused
Z 6AB. How many of these adults are female?
(RECORD SINGLE DIGIT NUMBER)
____________________
0 None
8 Eight or more people
R Refused
Z 6B. How many are children 12 to 17?
(RECORD SINGLE DIGIT NUMBER)
____________________
0 None
8 Eight or more people
R Refused
Z 6C. How many are children 6 to 11?
(RECORD SINGLE DIGIT NUMBER)
____________________
0 None
8 Eight or more people
R Refused
Z 6D. How many are children under 6?
(RECORD SINGLE DIGIT NUMBER)
____________________
0 None
8 Eight or more people
R Refused
IF TOTAL NUMBER OF ADULTS AND CHILDREN DO NOT EQUAL NUMBER IN Z-6,
RE-ASK Z-6 THROUGH Z-6D
DI-22A. You mentioned there is (a) child(ren) between the ages of 12 and 17. Could
you please me give me the age and gender of (the first/next) child?
ENTER AGE OF FIRST/NEXT CHILD
ENTER GENDER OF FIRST/NEXT CHILD
(ASK FOR FIRST EIGHT (8) CHILDREN IN THIS AGE GROUP)
DI-22B. You mentioned there is (a) child(ren) between the ages of 6 and 11. Could
you please me give me the age and gender of (the first/next) child?
ENTER AGE OF FIRST/NEXT CHILD
ENTER GENDER OF FIRST/NEXT CHILD
(ASK FOR FIRST EIGHT (8) CHILDREN IN THIS AGE GROUP)
DI-22C. You mentioned there is (a) child(ren) under the age of 6. Could you please
me give me the age and gender of (the first/next) child?
ENTER AGE OF FIRST/NEXT CHILD
ENTER GENDER OF FIRST/NEXT CHILD
(ASK FOR FIRST EIGHT (8) CHILDREN IN THIS AGE GROUP)
Z 7. What is your age?
(RECORD 2 DIGIT NUMBER)
____________________
RR Refused
Z 8. What is the last grade of school you completed?
(DO NOT READ LIST)
1 Less than high school graduate
2 High school graduate
3 Some college
4 Graduated college
5 Graduate school or more
6 Technical school/Other
R Refused
Z 9. Is your total annual household income from all sources, and before taxes:
(READ LIST)
1 Less than $10,000 (SKIP TO Q.Z 10)
2 $10,000 but less than $15,000 (SKIP TO Q.Z 10)
3 $15,000 but less than $20,000 (SKIP TO Q.Z 10)
4 $20,000 but less than $25,000 (SKIP TO Q.Z 10)
5 $25,000 but less than $30,000 (SKIP TO Q.Z 10)
6 $30,000 but less than $35,000 (SKIP TO Q.Z 10)
7 $35,000 but less than $40,000 (SKIP TO Q.Z 10)
8 $40,000 but less than $50,000 (SKIP TO Q.Z 10)
9 $50,000 but less than $75,000 (SKIP TO Q.Z 10)
10 $75,000 but less than $100,000, or (SKIP TO Q.Z 10)
11 $100,000 and over (SKIP TO Q.Z 10)
D (DO NOT READ) Don’t Know (ASK Q.Z 9A)
R (DO NOT READ) Refused (ASK Q.Z 9A)
Z 9A. Is your total annual household income from all sources and before taxes under or over $50,000?
1 $50,000 and over, or
2 Under $50,000
D Don’t Know
R Refused
Z 10. Are you of Hispanic origin or background?
1 Yes (CONTINUE)
2 No (SKIP TO Q.Z 11)
D Don’t Know (SKIP TO Q.Z 11)
R Refused (SKIP TO Q.Z 11)
Z 10A. Are you White Hispanic or Black Hispanic?
1 White
2 Black
D Don’t Know
R Refused
(SKIP TO Q.Z 11A)
Z 11. Would you consider yourself to be White, Black or of some other race?
If “other” say: “I’m not referring to your nationality. I just want to know if you
consider yourself white or black.”
1 White
2 Black or African American
3 Asian/Oriental/Chinese/Japanese
4 Native American/American Indian/Alaska Native
5 Native Hawaiian and Other Pacific Islander
0 Other (SPECIFY)________________
Z 11A. Generally speaking, do you usually think of yourself as:
If respondent gives answer such as: “conservative, liberal, vote for best man”
Probe: Would that be Republican, Democrat, or independent?
1 A Republican
2 A Democrat, or
3 An independent
7 (DO NOT READ) Other (SPECIFY) ____________________
D (DO NOT READ) Don’t Know
R (DO NOT READ) Refused
Z 11B. Are you registered to vote at your present address?
1 Yes
2 No
D Don’t Know
R Refused
Z-12. Besides the telephone number I reached you on, how many other telephone
numbers, if any, does your household have that I could have reached you on?
An interviewer note will be on the screen instructing them not to count phone
lines such as those dedicated to a fax or modem.
(RECORD SINGLE DIGIT NUMBER)
____________________
0 None
R Refused