research.rm.census.gov
Open in
urlscan Pro
92.123.149.145
Public Scan
Submitted URL: http://safelinks.protection.outlook.com/?url=https%3A%2F%2Fresearch.rm.census.gov%2Fjfe%2Fform%2FSV_ebxqQBxRMilt3eu&data=05%7C01...
Effective URL: https://research.rm.census.gov/jfe/form/SV_ebxqQBxRMilt3eu
Submission: On June 14 via api from US — Scanned from FI
Effective URL: https://research.rm.census.gov/jfe/form/SV_ebxqQBxRMilt3eu
Submission: On June 14 via api from US — Scanned from FI
Form analysis
1 forms found in the DOMName: Page —
<form id="Page" name="Page" class="Page ActivePage" data-testid="page-ready">
<meta name="HandheldFriendly" content="true">
<meta name="viewport" content="user-scalable = yes, maximum-scale=10, minimum-scale=1, initial-scale = 1, width = device-width">
<div class="Skin">
<div id="Overlay"></div>
<div id="Wrapper">
<div class="SkinInner">
<div id="LogoContainer">
<div id="Logo"></div>
</div>
<div id="HeaderContainer">
<div id="Header" role="banner"></div>
</div>
<div id="SkinContent">
<div id="Questions" role="main">
<div id="QID19259496Separator" class="Separator" data-runtime-show="runtime.SeparatorDisplayed"></div>
<div class="QuestionOuter BorderColor DB QID19259496" id="QID19259496" questionid="QID19259496" posttag="QID19259496" data-runtime-remove-class-hidden="runtime.Displayed">
<div id="QR~QID19259496~VALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.ErrorMsg" data-runtime-html="runtime.ErrorMsg" style="display: none;"></div>
<div id="QR~QID19259496~SDPVALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.PDPErrorMsg" data-runtime-html="runtime.PDPErrorMsg" style="display: none;"></div>
<div class="Inner BorderColor GRB">
<div class="InnerInner BorderColor WOTXB">
<div class="QuestionBody"><img border="0" src="https://research.rm.census.gov/WRQualtricsControlPanel/Graphic.php?IM=IM_elYvzq6vksmHIK9" alt="Consent header" data-image-state="ready"><br></div>
</div>
</div>
</div>
<div id="QID19259497Separator" class="Separator" data-runtime-show="runtime.SeparatorDisplayed"></div>
<div class="QuestionOuter BorderColor DB QID19259497" id="QID19259497" questionid="QID19259497" posttag="QID19259497" data-runtime-remove-class-hidden="runtime.Displayed">
<div id="QR~QID19259497~VALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.ErrorMsg" data-runtime-html="runtime.ErrorMsg" style="display: none;"></div>
<div id="QR~QID19259497~SDPVALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.PDPErrorMsg" data-runtime-html="runtime.PDPErrorMsg" style="display: none;"></div>
<div class="Inner BorderColor TB">
<div class="InnerInner BorderColor">
<div class="QuestionText BorderColor">
<p><strong>CONSENT FORM</strong></p>
<p><span style="font-size: 16px;">The U.S. Census Bureau routinely conducts research on how we, and our partners, collect information in order to produce the best statistics possible. You have volunteered to take part in a
study of data collection procedures.<br>
<br> We plan to use your feedback to improve the design and layout of the form for future data collections. Only staff involved in this product design research will have access to any responses you provide. This collection has
been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-0978, confirms this approval and expires on 12/31/2023. Without this approval, we could not conduct this study.</span></p>
<p><strong><span style="font-family: "Arial",sans-serif; font-size: 11pt;">You have volunteered to take part in a study of data collection procedures. In order to have a complete record of your comments, your interview
will be recorded (e.g., audio and screen ). We plan to use your feedback to improve the design and layout of survey forms for future data collections. Only staff involved in this product design research will have access to
the recording. </span></strong></p>
<p> </p>
</div>
<div class="QuestionBody"></div>
</div>
</div>
</div>
<div id="QID19259498Separator" class="Separator" data-runtime-show="runtime.SeparatorDisplayed"></div>
<div class="QuestionOuter BorderColor DB QID19259498" id="QID19259498" questionid="QID19259498" posttag="QID19259498" data-runtime-remove-class-hidden="runtime.Displayed">
<div id="QR~QID19259498~VALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.ErrorMsg" data-runtime-html="runtime.ErrorMsg" style="display: none;"></div>
<div id="QR~QID19259498~SDPVALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.PDPErrorMsg" data-runtime-html="runtime.PDPErrorMsg" style="display: none;"></div>
<div class="Inner BorderColor TB">
<div class="InnerInner BorderColor">
<div class="QuestionText BorderColor">
<p><strong>AUTHORITY AND CONFIDENTIALITY</strong></p>
<p><span style="font-size: 16px;">This collection is authorized under Title 13 U.S. Code, Sections 131 and 182. The U.S. Census Bureau is required by Section 9 of the same law to keep your information confidential and can use your
responses only to produce statistics. Your privacy is protected by the Privacy Act, Title 5 U.S. Code, Section 552a. The uses of these data are limited to those identified in the Privacy Act System of Record Notice titled
“COMMERCE/CENSUS-4, Economic Survey Collection.” The Census Bureau is not permitted to publicly release your responses in a way that could identify you, your business, organization, or institution. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.</span><br> </p>
<p><strong>BURDEN ESTIMATE </strong></p>
<p><span style="font-size: 16px;">We estimate that completing this interview will take 60 minutes on average, including the time for reviewing instructions, searching existing data sources (if necessary), gathering and maintaining
the data needed (if necessary), and completing and reviewing the collection of information. You may send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes
to complete this survey to <span
style="font-family: "Arial",sans-serif; mso-fareast-font-family: Cambria; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">ewd.surveys@census.gov</span>.</span></p>
</div>
<div class="QuestionBody"></div>
</div>
</div>
</div>
<div id="QID19259499Separator" class="Separator" data-runtime-show="runtime.SeparatorDisplayed"></div>
<div class="QuestionOuter BorderColor MC QID19259499" id="QID19259499" questionid="QID19259499" posttag="QID19259499" data-runtime-remove-class-hidden="runtime.Displayed">
<div id="QR~QID19259499~VALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.ErrorMsg" data-runtime-html="runtime.ErrorMsg" style="display: none;"></div>
<div id="QR~QID19259499~SDPVALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.PDPErrorMsg" data-runtime-html="runtime.PDPErrorMsg" style="display: none;"></div>
<div class="Inner BorderColor MAVR">
<div class="InnerInner BorderColor TX">
<fieldset aria-describedby="QR~QID19259499~VALIDATION QR~QID19259499~SDPVALIDATION"> <!-- BEGIN PARTIALS --><!-- Partial for defining the ControlContainerContent --><!-- END PARTIALS -->
<legend>
<div class="QuestionText BorderColor">Click here to participate in this research.</div>
</legend>
<div class="QuestionBody">
<ul class="ChoiceStructure">
<li class="Selection reg"> <input choiceid="1" class="checkbox QR-QID19259499-1 QWatchTimer" type="checkbox" name="QR~QID19259499~1" id="QR~QID19259499~1" value="Selected" data-runtime-checked="runtime.Choices.1.Selected"
aria-labelledby="QID19259499-1-label"><label for="QR~QID19259499~1" class="q-checkbox" aria-hidden="true" data-runtime-class-q-checked="runtime.Choices.1.Selected"></label> <span class="LabelWrapper"> <label
for="QR~QID19259499~1" id="QID19259499-1-label" class="MultipleAnswer ChoiceTextPositionLeft" data-runtime-class-q-checked="runtime.Choices.1.Selected"><span>I agree to participate in this research</span></label></span>
<div class="clear"></div>
</li>
</ul>
<div class="clear zero"></div>
</div>
</fieldset>
</div>
</div>
</div>
<div id="QID19259500Separator" class="Separator" data-runtime-show="runtime.SeparatorDisplayed"></div>
<div class="QuestionOuter BorderColor TE QID19259500" id="QID19259500" questionid="QID19259500" posttag="QID19259500" data-runtime-remove-class-hidden="runtime.Displayed">
<div id="QR~QID19259500~VALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.ErrorMsg" data-runtime-html="runtime.ErrorMsg" style="display: none;"></div>
<div id="QR~QID19259500~SDPVALIDATION" class="ValidationError" role="alert" data-runtime-show="runtime.PDPErrorMsg" data-runtime-html="runtime.PDPErrorMsg" style="display: none;"></div>
<div class="Inner BorderColor FORM">
<div class="InnerInner BorderColor">
<fieldset aria-describedby="QR~QID19259500~VALIDATION QR~QID19259500~SDPVALIDATION">
<!-- BEGIN PARTIALS --><!-- Partial for defining the ControlContainerContent --><!-- Partial for defining the LabelContainerContent --><!-- END PARTIALS -->
<legend> <label class="QuestionText BorderColor">Enter your information below:</label></legend>
<div class="QuestionBody">
<div class="ChoiceStructure">
<table role="presentation" cellpadding="0" cellspacing="0">
<tbody>
<tr class="">
<td> <span class="LabelWrapper"><label id="QR~QID19259500~1~label" for="QR~QID19259500~1"><span>First Name:</span></label></span> </td>
<td class="ControlContainer"> <input autocomplete="off" class="Medium InputText QR-QID19259500-1 QWatchTimer" id="QR~QID19259500~1" name="QR~QID19259500~1~TEXT" style="width:251px;" type="text" value=""
data-runtime-textvalue="runtime.Choices.1.Text" aria-labelledby="QR~QID19259500~1~label"> <span class="ValidationError Sub TE" data-runtime-html="runtime.Choices.1.ErrorMsg"
data-runtime-show="runtime.Choices.1.ErrorMsg" style="display: none;"></span> <br data-runtime-show="runtime.Choices.1.PDPErrorMsg" style="display: none;"> <span class="ValidationError Sub TE"
data-runtime-html="runtime.Choices.1.PDPErrorMsg" data-runtime-show="runtime.Choices.1.PDPErrorMsg" style="display: none;"></span> </td>
</tr>
<tr class="ReadableAlt">
<td> <span class="LabelWrapper"><label id="QR~QID19259500~2~label" for="QR~QID19259500~2"><span>Last Name:</span></label></span> </td>
<td class="ControlContainer"> <input autocomplete="off" class="Medium InputText QR-QID19259500-2 QWatchTimer" id="QR~QID19259500~2" name="QR~QID19259500~2~TEXT" style="width:250px;" type="text" value=""
data-runtime-textvalue="runtime.Choices.2.Text" aria-labelledby="QR~QID19259500~2~label"> <span class="ValidationError Sub TE" data-runtime-html="runtime.Choices.2.ErrorMsg"
data-runtime-show="runtime.Choices.2.ErrorMsg" style="display: none;"></span> <br data-runtime-show="runtime.Choices.2.PDPErrorMsg" style="display: none;"> <span class="ValidationError Sub TE"
data-runtime-html="runtime.Choices.2.PDPErrorMsg" data-runtime-show="runtime.Choices.2.PDPErrorMsg" style="display: none;"></span> </td>
</tr>
</tbody>
</table>
</div>
</div>
</fieldset>
</div>
</div>
</div>
</div>
<div id="Buttons" role="navigation"><input id="NextButton" class="NextButton Button" title="→" type="button" name="NextButton" value="→" data-runtime-disabled="runtime.Disabled" data-runtime-aria-label="runtime.ariaLabel"
data-runtime-hide="runtime.Hide" page-id="P_1686764198592" aria-label="Next"></div>
</div>
<div id="ProgressBar"></div>
</div>
<div id="Footer" role="contentinfo"></div>
<div id="PushStickyFooter"></div>
</div>
<div id="Plug" style="display:block !important;">
<a href="https://www.qualtrics.com/powered-by-qualtrics/?utm_source=internal%2Binitiatives&utm_medium=survey%2Bpowered%2Bby%2Bqualtrics&utm_content=uscensusbureau&utm_survey_id=SV_ebxqQBxRMilt3eu" target="_blank" aria-label="Powered by Qualtrics: Learn more about Qualtrics in a new tab">Powered by Qualtrics</a>
</div>
</div>
</form>
Text Content
Javascript is required to load this page. Page Loaded CONSENT FORM The U.S. Census Bureau routinely conducts research on how we, and our partners, collect information in order to produce the best statistics possible. You have volunteered to take part in a study of data collection procedures. We plan to use your feedback to improve the design and layout of the form for future data collections. Only staff involved in this product design research will have access to any responses you provide. This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-0978, confirms this approval and expires on 12/31/2023. Without this approval, we could not conduct this study. You have volunteered to take part in a study of data collection procedures. In order to have a complete record of your comments, your interview will be recorded (e.g., audio and screen ). We plan to use your feedback to improve the design and layout of survey forms for future data collections. Only staff involved in this product design research will have access to the recording. AUTHORITY AND CONFIDENTIALITY This collection is authorized under Title 13 U.S. Code, Sections 131 and 182. The U.S. Census Bureau is required by Section 9 of the same law to keep your information confidential and can use your responses only to produce statistics. Your privacy is protected by the Privacy Act, Title 5 U.S. Code, Section 552a. The uses of these data are limited to those identified in the Privacy Act System of Record Notice titled “COMMERCE/CENSUS-4, Economic Survey Collection.” The Census Bureau is not permitted to publicly release your responses in a way that could identify you, your business, organization, or institution. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data. BURDEN ESTIMATE We estimate that completing this interview will take 60 minutes on average, including the time for reviewing instructions, searching existing data sources (if necessary), gathering and maintaining the data needed (if necessary), and completing and reviewing the collection of information. You may send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey to ewd.surveys@census.gov. Click here to participate in this research. * I agree to participate in this research Enter your information below: First Name: Last Name: Powered by Qualtrics