Form DX-1302 Listing Page 1

Hello, I’m (Your name) from the U.S. Census Bureau. Here’s my identification. We are listing addresses as part of the 2008 Census Dress Rehearsal, and I have a few questions to ask you.

Section 4 – LISTING PAGE
(1) Line No.

(2) Block No.

(3) Map Spot No. – Do not fill for Mobile Home Park.

1
(4) House No.

Number

Letter

(5a) Road/Street name

(11a) Is this a single-family
house, multiunit, mobile
home, or trailer?
1

2
(6a) Rural Rte. No.

(6b) Box No.

(7) PO Box No.

(8) ZIP Code

Complete items 9 and 10 for areas with non-city style addresses.
(9) Householder name
First
MI
Last

3

(10) Physical location description or E-911 address
4

Single-family house
(including townhouse,
rowhouse, etc.) – Go to 11b
Multiunit
• Apartments, condominium
• House with attached
apartment (e.g., basement
or attic apartment)
SKIP to 13a
Mobile home or trailer
Not in a park – Go to
a
11b
Park – SKIP to Section
b
6, Mobile Home
Park Page
Other (occupied camper, tent,
van, boat, etc.) – SKIP to 14

(11b) Unit status
1
Occupied or vacant and intended for occupancy – Go to 11c
2
Under construction (foundation and building materials present) . . .
3

Future construction – Mark (X) all that apply.
A sign indicating future construction is planned,
a
A building permit,
b
Stakes in the ground,
c
A zoning change sign from commercial use to residential use
d
e

Other – Specify

4

Unfit for habitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

Boarded up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Storage of household goods – SKIP to 15
Other – Skip to 14

6
8

(13a) Canvass the multiunit and enter the number of units on each floor.

7th floor

8th floor

2nd floor

9th floor

SKIP
(12)
to
14

1

Yes – Specify name if available

2

No

At (address), are there any basement or garage apartments
or other residences, even if no one is living there now?
1

Yes – How many?
Is/Are the other residence(s) attached to the main
residence (e.g., basement apartment) and/or detached
(e.g., mobile home, carriage house)?
Attached – Change item 11a to multiunit, then go to 13a.
Detached – SKIP to 15 then go to the next line number
and record other residence.
No – SKIP to 15

a
b
2

(14) Remarks – Do not use this space for location description.

MULTIUNIT ADDRESS
Basement 1st floor

⎫
⎬
⎭

(11c) Could this place be a group quarters? (Examples include a group home
providing room, board, and supportive services; a residential treatment
center; a migrant farm-work camp; a construction worker camp; etc.)

3rd floor

4th floor

10th floor

11th floor

5th floor

12th floor

(13b) (Ask if an apartment or condominium)
How many apartments,
occupied or vacant, are
there at (address)?

Example: "5 APTS 14th FLR"

6th floor

Total number of Housing
Units (occupied or vacant)

Attic

(15) Information
obtained
from:

OFFICE
USE
ONLY
1

HH member*

3

2

Proxy*

4

*Respondent name

Other –

Manager*
Observation
Telephone No.

If multiunit (answered 13b), then go to Section 5, Multiunit Address Page.

Section 4 – LISTING PAGE
(2) Block No.

(3) Map Spot No. – Do not fill for Mobile Home Park.

2
(4) House No.

Number

Letter

(5a) Road/Street name

(11a) Is this a single-family
house, multiunit, mobile
home, or trailer?
1

2
(6a) Rural Rte. No.

(6b) Box No.

(7) PO Box No.

(8) ZIP Code

Complete items 9 and 10 for areas with non-city style addresses.
(9) Householder name
First
MI
Last

3

(10) Physical location description or E-911 address
4

Single-family house
(including townhouse,
rowhouse, etc.) – Go to 11b
Multiunit
• Apartments, condominium
• House with attached
apartment (e.g., basement
or attic apartment)
SKIP to 13a
Mobile home or trailer
Not in a park – Go to
a
11b
Park – SKIP to Section
b
6, Mobile Home
Park Page
Other (occupied camper, tent,
van, boat, etc.) – SKIP to 14

(11b) Unit status
1
Occupied or vacant and intended for occupancy – Go to 11c
2
Under construction (foundation and building materials present) . . .
3

Future construction – Mark (X) all that apply.
A sign indicating future construction is planned,
a
b
A building permit,
d

Stakes in the ground,
A zoning change sign from commercial use to residential use

e

Other – Specify

c

4

Unfit for habitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

Boarded up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Storage of household goods – SKIP to 15
Other – Skip to 14

6
8

(13a) Canvass the multiunit and enter the number of units on each floor.

Page 7

7th floor

8th floor

2nd floor

9th floor

3rd floor

10th floor

SKIP
(12)
to
14

1

Yes – Specify name if available

2

No

At (address), are there any basement or garage apartments
or other residences, even if no one is living there now?
1

Yes – How many?
Is/Are the other residence(s) attached to the main
residence (e.g., basement apartment) and/or detached
(e.g., mobile home, carriage house)?
Attached – Change item 11a to multiunit, then go to 13a.
Detached – SKIP to 15 then go to the next line number
and record other residence.
No – SKIP to 15

a
b
2

(14) Remarks – Do not use this space for location description.

MULTIUNIT ADDRESS
Basement 1st floor

⎫
⎬
⎭

(11c) Could this place be a group quarters? (Examples include a group home
providing room, board, and supportive services; a residential treatment
center; a migrant farm-work camp; a construction worker camp; etc.)

0001

(1) Line No.

4th floor

11th floor

5th floor

12th floor

Example: "5 APTS 14th FLR"

6th floor

(13b) (Ask if an apartment or condominium)
How many apartments,
occupied or vacant, are
there at (address)?

(15) Information
obtained
from:

*Respondent name
Total number of Housing
Units (occupied or vacant)

Attic

Other –

OFFICE
USE
ONLY
1

HH member*

3

Manager*

2

Proxy*

4

Observation
Telephone No.

If multiunit (answered 13b), then go to Section 5, Multiunit Address Page.

FORM DX-1302 (3-27-2007)

FORM DX-1302, Page 7, prints black ink (30%, 50%, and 100%)

FORM DX-1302, Page 7, Overlay – prints Pantone Cyan (20% and 100%)