DX-1302 Listing Page 3

Generic Clearence for Questionnaire Pretesting Research

ombilb08obsenc3

Respondent Debriefings for CCM Independent Listing Book

OMB: 0607-0725

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Ask the manager of an apartment complex – Do you have any maps of the apartment complex that I can take with me?

Section 5 – MULTIUNIT ADDRESS PAGE
Number

(2) House No.

(8) Map Spot No.

Letter
(3a) Road/street name

(4a) Rural Rte. No.

(4b) Box No.

(5) PO Box No.

(6) ZIP Code

Page 59

Unit designation
(a)

(15) Map Spot No.

Letter
(10a) Road/street name

(11a) Rural Rte. No.

(11b) Box No.

(16) House No.

(12) PO Box No.

(13) ZIP Code

Unit status
(b)

Line
No.

Unit designation
(c)

Unit status
(d)

Line
No.

Unit designation
(e)

Number

Letter
(17a) Road/street name

(18a) Rural Rte. No.

(14) Name of complex (if applicable)

(7) Name of complex (if applicable)

Line
No.

Number

(9) House No.

(18b) Box No.

(19) PO Box No.

(21) Name of complex (if applicable)

Unit status
(f)

Line
No.

Unit designation
(g)

Unit status
(h)

Line
No.

Unit designation
(i)

Unit status
(j)

Line
No.

1

21

1

21

1

21

2

22

2

22

2

22

3

23

3

23

3

23

4

24

4

24

4

24

5

25

5

25

5

25

6

26

6

26

6

26

7

27

7

27

7

27

8

28

8

28

8

28

9

29

9

29

9

29

10

30

10

30

10

30

11

31

11

31

11

31

12

32

12

32

12

32

13

33

13

33

13

33

14

34

14

34

14

34

15

35

15

35

15

35

16

36

16

36

16

36

17

37

17

37

17

37

18

38

18

38

18

38

19

39

19

39

19

39

20

40

20

40

20

40

1 – Occupied or vacant and intended for occupancy

2 – Under construction (started)

UNIT STATUS:

(20) ZIP Code

3 – Future construction (not started)

4 – Unfit for habitation

5 – Boarded up

6 – Storage of household goods

Unit designation
(k)

Unit status
(l)

0003

(1) Map Spot No.

8 – Other

FORM DX-1302 (3-27-2007)

FORM DX-1302, Page 59 Base copy – Prints black ink (30%, 50%, and 100%)

FORM DX-1302, Page 59 Overlay – prints Red PMS 189 (20%)


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