Household Roster and Demographics
Case ID ________________ Interviewer Name __________________
| 
			 | 
			 | ||||||||||
| Person line # | 1a 
 
 
 FIRST NAME | 1b 
 
 
 LAST NAME | 2 
			 [Flash A] Relationship to Person 1 | 3 
			 
			 
			 Sex | 4 
			 
			 
			 Age | 5 
			 
			 
			 Hispanic | 6 
			 [Flash B] Race Code(s) | 7 (15+) [Flash C] Educ Code | 8 (15+) Ever in Armed Forces? | 9 (15+) Marital Status Code | |
| 1 | 
			 | 
			 | [Person 1] | M F | 
			 | Y N | 
			 | 
			 | Y N | 
			 | |
| 2 | 
			 | 
			 | 
			 | M F | 
			 | Y N | 
			 | 
			 | Y N | 
			 | |
| 3 | 
			 | 
			 | 
			 | M F | 
			 | Y N | 
			 | 
			 | Y N | 
			 | |
| 4 | 
			 | 
			 | 
			 | M F | 
			 | Y N | 
			 | 
			 | Y N | 
			 | |
| 5 | 
			 | 
			 | 
			 | M F | 
			 | Y N | 
			 | 
			 | Y N | 
			 | |
| 6 | 
			 | 
			 | 
			 | M F | 
			 | Y N | 
			 | 
			 | Y N | 
			 | |
10. Residency
□ DC
□ Maryland
□ Virginia
11. Total annual income [of household]
□ Above $30,000
□ Below $30,000
| File Type | application/msword | 
| File Title | Control card type information necessary for the household at the time of the interview | 
| Author | barte002 | 
| Last Modified By | Bureau Of The Census | 
| File Modified | 2008-05-08 | 
| File Created | 2008-05-08 |