FBA Lineage Pilot Questionnaire

Stage 0 Internal Test — Questionnaire v0.9 / Consent v0.9

This questionnaire implements the FBA Lineage Pilot Study Protocol. It tests definition comprehension, genealogy progress, the Documented FBA Lineage Anchor method, terminology preferences, and an experimental federal-question concept.

You do not have to trace your family back to slavery to participate.

Do not submit Social Security numbers, government IDs, financial information, passwords, raw DNA data, or sensitive records about living people. This phase does not accept document uploads.

Working FBA definition used in this test:
Foundational Black American (FBA) is a lineage-based identity for descendants of the historic Black American population established in the United States. This population includes the historic Free Black American population and descendants of people enslaved in the United States. An individual does not have to trace an ancestor back to slavery to establish FBA lineage; a documented ancestral connection to the historic U.S. Black population can establish the lineage.

Consent and eligibility I confirm that I am at least 18 years old. I voluntarily consent to my responses being used in anonymized or aggregate FBA lineage research. I understand this is an independent research project and not an official Census Bureau or OMB submission. I understand participation does not create a legal or federal status, benefit, or certification.

1. Do you currently identify as Foundational Black American (FBA)? Yes No Unsure / researching

2. Before today, had you heard the term Foundational Black American? Yes No Unsure

3. In your own words, who does the FBA definition above describe?

4. Based on the definition above, must a person trace an ancestor all the way back to slavery to be FBA? Yes No Unsure

5. How far have you traced at least one Black American family line? Parents Grandparents Great-grandparents Before 1900 1870–1899 Before 1870 Unsure

6. Earliest year for which you currently have a reliable record

7. State or U.S. jurisdiction associated with that ancestor

County / parish / locality (if known)

8. Name or initials of the earliest documented ancestor you are comfortable reporting (optional)

9. What classification appears in the historical record? Black Colored Negro Mulatto African American Another classification No classification shown Unsure Exact wording if “Another classification”:

10. What type of record is it? Select all that apply. Federal census State census Birth record Death record Marriage record Military record Pension record Freedmen’s Bureau Freedman’s Bank Probate / estate Property / deed / tax Church / cemetery Newspaper / obituary Court record Manumission record Slave schedule Other slavery-era record Family record Other

Brief description of the earliest record or evidence

11. Was this ancestor born in the United States? Yes No Unknown

12. Where were the ancestor’s parents born, if known?

13. Does this family line show immigration into the United States in the generations you have researched? Yes No Unknown

14. Which terms do you personally use for this lineage? Select all that apply. Foundational Black American African American Black American American Freedman American Descendant of Slavery Negro / American Negro Other None of these

15. If a federal form allowed ONE detailed term under Black or African American, which term would you most prefer for this lineage? Foundational Black American African American Black American American Freedman American Descendant of Slavery Negro / American Negro Other No preference

16. Why do you prefer that term? (optional)

RESEARCH EXAMPLE — NOT AN OFFICIAL CENSUS FORM

What is your race and/or ethnicity? Select all that apply and enter additional details below.

☐ Black or African American
Detailed identity example: Foundational Black American

17. Would you select Foundational Black American for yourself in the research example above? Yes No Unsure

18. Was the meaning of the FBA option clear? Very clear Somewhat clear Somewhat unclear Very unclear

19. What, if anything, was confusing?

Follow-up and recruitment Yes, I would consider follow-up research Maybe No

How did you hear about this pilot? (optional)

Name or alias (optional)

Email for project contact (optional)

If I provided an email address, I consent to being contacted about this research project.

Additional research note (optional — no sensitive information)

Do not enter Social Security numbers, government ID numbers, financial information, passwords, raw DNA data, or unnecessary private information about living people.