Questionnaire Text

SESTAT NSCG 2013 SESTAT NSRCG 2008 SESTAT NSCG 1999 SESTAT SDR 1995
SESTAT SDR 2013 SESTAT NSCG 2006 SESTAT SDR 1999 SESTAT NSRCG 1995
SESTAT NSCG 2010 SESTAT SDR 2006 SESTAT NSRCG 1999 SESTAT NSCG 1993
SESTAT SDR 2010 SESTAT NSRCG 2006 SESTAT NSCG 1997 SESTAT SDR 1993
SESTAT NSRCG 2010 SESTAT NSCG 2003 SESTAT SDR 1997 SESTAT NSRCG 1993
SESTAT NSCG 2008 SESTAT SDR 2003 SESTAT NSRCG 1997
SESTAT SDR 2008 SESTAT NSRCG 2003 SESTAT NSCG 1995
top
SESTAT NSCG 2013
Questionnaire form view entire document:  text  image
E20.

Are you of Hispanic, Latino, or Spanish origin?
Mark one answer.
0[ ] No, not of Hispanic, Latino, or Spanish origin
1[ ] Yes, Mexican, Mexican American, or Chicano
2[ ] Yes, Puerto Rican
3[ ] Yes, Cuban
4[ ] Yes, another Hispanic, Latino, or Spanish origin – Specify_______________________
E21.

What is your race?
Mark one or more.
1[ ] American Indian or Alaska Native – Specify tribal affiliation(s)
__________________________________________
2[ ] Native Hawaiian or other Pacific Islander
3[ ] Asian
4[ ] Black or African American
5[ ] White

top
SESTAT SDR 2013

No questionnaire text is available for this sample.


top
SESTAT NSCG 2010
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT SDR 2010
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT NSRCG 2010
Questionnaire form view entire document:  text  image
D20.
Are you of Hispanic, Latino, or Spanish origin?
Mark one answer.
0 [ ] No, not of Hispanic, Latino, or Spanish origin
1 [ ] Yes, Mexican, Mexican American, or Chicano
2 [ ] Yes, Puerto Rican
3 [ ] Yes, Cuban
4 [ ] Yes, another Hispanic, Latino, or Spanish origin – Specify _________
D21.
What is your race?
Mark one or more.
1 [ ] American Indian or Alaska Native – specify tribal affiliations ___________
2 [ ] Native Hawaiian or other Pacific Islander
3 [ ] Asian
4 [ ] Black or African American
5 [ ] White

top
SESTAT NSCG 2008
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT SDR 2008
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT NSRCG 2008
Questionnaire form view entire document:  text  image
D14.
Are you Hispanic or Latino
1 [ ] Yes
2 [ ] No (Go to question D16)
D15.
(If Yes) Which of the following best describes your Hispanic origin or descent?
Mark one answer.
1 [ ] Mexican or Chicano
2 [ ] Puerto Rican
3 [ ] Cuban
4 [ ] Other Hispanic – Specify
_______________________
D16.
What is your racial background?
Mark one or more.
1 [ ] American Indian or Alaska Native – specify tribal affiliations ___________
2 [ ] Native Hawaiian or other Pacific Islander
3 [ ] Asian
4 [ ] Black or African American
5 [ ] White

top
SESTAT NSCG 2006
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT SDR 2006
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT NSRCG 2006
Questionnaire form view entire document:  text  image
D13.
Are you Hispanic or Latino
1 [ ] Yes
2 [ ] No (Go to question D15)
D14.
(If Yes) Which of the following best describes your Hispanic origin or descent?
Mark one answer.
1 [ ] Mexican or Chicano
2 [ ] Puerto Rican
3 [ ] Cuban
4 [ ] Other Hispanic – Specify
_______________________
D15.
What is your racial background?
Mark one or more.
1 [ ] American Indian or Alaska Native – specify tribal affiliations ___________
2 [ ] Native Hawaiian or other Pacific Islander
3 [ ] Asian
4 [ ] Black or African American
5 [ ] White

top
SESTAT NSCG 2003
Questionnaire form view entire document:  text  image
E19.
Are you Hispanic or Latino?
1 [ ] Yes
2 [ ] No (Go to question E21)
E20.
(If Yes) Which of the following best describes your Hispanic origin or descent?
Mark (X) one answer.
1 [ ] Mexican or Chicano
2 [ ] Puerto Rican
3 [ ] Cuban
4 [ ] Other Hispanic – Specify ___________
E21.
What is your racial background?
Mark (X) one or more.
1 [ ] American Indian or Alaska Native - Specify tribal affiliation(s) ___________
2 [ ] Native Hawaiian or other Pacific Islander
3 [ ] Asian
4 [ ] Black or African-American
5 [ ] White

top
SESTAT SDR 2003
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT NSRCG 2003
Questionnaire form view entire document:  text  image
D21.
Are you Hispanic or Latino
1 [ ] Yes
2 [ ] No (Go to question D23)
D22.
(If Yes) Which of the following best describes your Hispanic origin or descent?
Mark one answer.
1 [ ] Mexican or Chicano
2 [ ] Puerto Rican
3 [ ] Cuban
4 [ ] Other Hispanic – Specify
_______________________
D23.
What is your racial background?
Mark one or more.
1 [ ] American Indian or Alaska Native – specify tribal affiliations ___________
2 [ ] Native Hawaiian or other Pacific Islander
3 [ ] Asian
4 [ ] Black or African American
5 [ ] White

top
SESTAT NSCG 1999
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT SDR 1999
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT NSRCG 1999
Questionnaire form view entire document:  text  image
D7.
Are you . . .
Mark (X) ONLY one
1 [ ] White
2 [ ] Black or African American
3 [ ] Asian or Pacific Islander
4 [ ] American Indian or Alaskan Native (e.g., Eskimo, Aleut)
91 [ ] Other – Specify: __________________________

top
SESTAT NSCG 1997
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT SDR 1997
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT NSRCG 1997
Questionnaire form view entire document:  text  image
D7.
Are you . . .
Mark (X) ONLY one
1 [ ] White
2 [ ] Black or African American
3 [ ] Asian or Pacific Islander
4 [ ] American Indian or Alaskan Native (e.g., Eskimo, Aleut)
91 [ ] Other – Specify: ______________________________

top
SESTAT NSCG 1995
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT SDR 1995
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT NSRCG 1995
Questionnaire form view entire document:  text  image
D7.
Are you:
Mark (X) one
1 [ ] White
2 [ ] Black/African American
3 [ ] Asian or Pacific Islander
4 [ ] American Indian or Alaskan Native (Eskimo, Aleut)
5 [ ] Other – Specify: ________________________________

top
SESTAT NSCG 1993
Questionnaire form view entire document:  text  image
Derived within SESTAT from reported information.

top
SESTAT SDR 1993
Questionnaire form view entire document:  text  image
E7.
Are you:
MARK ONE
1 [ ] White
2 [ ] Black/African American
3 [ ] Asian or Pacific Islander
4 [ ] American Indian, Alaskan Native (Eskimo, Aleut)
5 [ ] Other (Specify:)

top
SESTAT NSRCG 1993
Questionnaire form view entire document:  text  image
D7.
Are you:
MARK (X) ONE
1 [ ] White
2 [ ] Black/African American
3 [ ] Asian or Pacific Islander
4 [ ] American Indian or Alaskan Native (Eskimo, Aleut)
5 [ ] Other (Specify:)