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Form analysis
1 forms found in the DOM

Name: INTWEB — GET https://ness.norc.org/SE/

<form name="INTWEB" method="GET" action="https://ness.norc.org/SE/"><!-- PROD -->
  <!-- 	<FORM NAME="INTWEB" METHOD=GET action="https://atest-cawi.norc.org/SE/"> --><!-- TEST -->
  <div class="row whiterow">
    <table style="width:100%">
      <tbody>
        <tr>
          <th>
            <div id="headerbar">
              <div style="text-align: left;"><!--<img src="/Media/1/norclogo2.jpg">--></div>
            </div>
          </th>
          <th>
            <div style="text-align: center;"><img src="https://static-tst.norc.org/sp/_assets/survey-templates/SP_A4S_BaseCode/NORCLogo_516x75.jpg"></div>
          </th>
        </tr>
      </tbody>
    </table>
    <!--<div style="width: 100%; margin: 0 auto; text-align: center;">
					<span id="welcome"><strong><h3>California Health Coverage Survey</h3></strong></span>
				</div>-->
    <div style="text-align: center;">
      <!--<p><br/></p>
					<p Style="font-weight:bold;">Si prefiere completar la encuesta en español, por favor haga clic en "Español" abajo:<p></p>-->
      <input type="button" value="Español" onclick="changeText(this.value);">
      <input type="button" value="English" onclick="window.location.href=window.location.href">
      <p></p>
    </div>
    <div class="col-sm-12" style="text-align: center;">
      <div id="consentpadding" style="padding-top:6px;padding-bottom:4px;">
        <p id="chcsText">You should have received a PIN by mail or email that will give you access to the survey.</p>
      </div>
      <p id="chcsText_2">Please enter your PIN below, and click “Start Survey”.</p>
      <p id="chcsText_7">Note: Please utilize Firefox, Chrome or Edge as your browser for this survey.</p>
      <div class="pinerror">
        <div class="alert alert-danger" role="alert">
          <center>
            <p id="chcsText_3">Please enter a valid six digit PIN.</p>
          </center>
        </div>
      </div>
      <p class="pinform">
        <input type="hidden" name="st" value="IV7AYkmxUbkvsBrOvLoZ9%2FRxTa3O7UubZKpvjfhKofw%3D"><!-- Update Survey Token -->
        <strong>PIN:&nbsp;</strong><input id="pin" name="p" value="" maxlength="6">
        <input id="submitText" class="btn-responsive" style="font-weight:bold;" type="submit" value="Start Survey" <p="">
      </p><br>
      <p></p>
      <p id="chcsText_4" style="text-align: center;">Please email us at <a href="mailto:CAInsuranceSurvey@norc.org">CAInsuranceSurvey@norc.org</a> or call us 800-483-2565 if you have misplaced your PIN or have any technical problems accessing the
        survey.</p>
      <div align="center">
        <input type="HIDDEN" id="LANG" name="lang" value="EN">
        <input type="HIDDEN" id="CCALANG" name="CCALANG" value="EN">
        <input type="HIDDEN" id="SRC" name="SRC" value="2">
        <input type="HIDDEN" name="urlimport" value="1">
        <input type="HIDDEN" name="questlist" value="lang;CCALANG;SRC">
      </div>
      <div class="col-sm-12">
        <div id="footerbar">
          <div id="footertechassist" class="footerdisplayrow">
            <div id="assistText" style="text-align:center; font-size: .8em;">
              <p id="chcsText_5">This survey is being conducted by NORC at the University of Chicago.</p>
            </div>
            <div style="text-align:center; font-size: .8em;">
              <p id="chcsText_6"></p>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

You should have received a PIN by mail or email that will give you access to the
survey.

Please enter your PIN below, and click “Start Survey”.

Note: Please utilize Firefox, Chrome or Edge as your browser for this survey.

Please enter a valid six digit PIN.

PIN: 




Please email us at CAInsuranceSurvey@norc.org or call us 800-483-2565 if you
have misplaced your PIN or have any technical problems accessing the survey.



This survey is being conducted by NORC at the University of Chicago.