Form DY-1(E) Census 2010 Enumerator Questionnaire

Draft 1 6/12/2008
OMB No. 0607-0725: Approval Expires 8/30/2010

RESPONDENT INFORMATION

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

We do not want to miss any people who might have been staying here on April 1.
Were there any additional people that you didn’t mention, for example:
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No

Yes

No

R2.

(Ask or verify) What is your name?
First Name

MI

Area Code

Day

Address of proxy

R3.

State

County

Tract

Block

AA

Map Spot

A.

Unit Status on April 1, 2010
Occupied
Vacant - regular
Vacant - usual home elsewhere
Demolished/burned out/cannot locate
Nonresidential
Empty mobile home/trailer site
Uninhabitable (open to elements,
condemned, under construction)
Duplicate – record ID of Dup. C

B.

For rent
For sale only
Rented, not occupied
Sold, not occupied
For seasonal, recreational
or occasional use
For migrant workers
Other vacant

Number of people listed on form(s) =
1 - 49 = Total people
00 = Vacant
98 = Delete
99 = POP unknown

Yes ➙

Type
I
J
K Personal

UHE

D.

E.

What language was the majority of the interview conducted in?
English

MOV

F.
CO

PI

G.
REP

REF

H.
VDC

Spanish

I.

Other – Specify language number from flashcard ➙

J.

L.

I certify that the entries I have made on this questionnaire are
true and correct to the best of my knowledge.
Enumerator’s signature

Mo

S1.

JIC2

M.

S2.

Employee ID

Month

Day

:

a.m.
p.m.

:

a.m.
p.m.

:

a.m.
p.m.

Outcome

Time

Time

Outcome

Hello, I’m (name) from the U.S. Census Bureau.
(show ID). Is this (Address)?

S4.

Yes - Continue with question S2
No - Ask: Can you tell me where to find (Address)?
END INTERVIEW

Crew Leader’s initials

Day

Day

Type
Mo
Personal
Telephone
Mo
Personal
Telephone
Mo
Personal
Telephone

Outcome

Time

Personal
Telephone

CLD number

Month

Day

Personal
Telephone

CERTIFICATION
NOTES

Mo

Day

Day

Outcome

Time
:

a.m.
p.m.

:

a.m.
p.m.

:

a.m.
p.m.

Outcome

Time

Time

Outcome

Day

I’m here to complete a Census questionnaire for this
address. It should take about 10 minutes. (Hand
respondent Information Sheet.) The first part explains
that your answers are confidential. We will be referring
to this handout throughout the interview. Did you or
anyone in this household live here on April 1, 2010?

S5.

Yes - Continue with question S3
No - Skip to question S4

S3.

We need to count people where they live and sleep
most of the time.
Please look at list A. It contains examples of
people who should and should not be counted at
this place.

Is this (house/apartment/mobile home) a vacation or
seasonal home, or does someone in this household
usually live here?

USCENSUSBUREAU

(Only ask if no household member lived here on April 1.)
On April 1, was this unit vacant, or occupied by a
different household?
Vacant - Skip to "Respondent Information" on back page
Occupied by a different household - Using a
knowledgeable respondent, complete this
questionnaire for the Census Day household.
Not a housing unit – Skip to "Respondent Information"
on back page.

Based on these examples, how many people were
living or staying in this (house/apartment/mobile
home) on April 1?

Vacation or seasonal home or held for occasional use Skip to "Respondent Information" on back page
Usually lives here - Skip to question S5

PID Barcode

Day

OUTCOME CODES: NV = Left Notice of visit NC = No contact RE = Refusal CI=Conducted Interview OT = Other

K.

JIC1

ZIP Code

Go to respondent Information on back page.

Number of forms

No

Mo

Apartment number

State

Are there any continuation forms for this address?

RECORD OF CONTACT

If there is not an address label affixed, or if the address label includes only a location description, ask –
What is the address of this unit?
Street name or rural route address

C.

If vacant, ask: Which category best
describes this vacant unit as of
April 1, 2010? (Read categories.)

➤

APPLY LABEL HERE

= Number of People

770101

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Form DY-1(E)(6-12-2008)

DY-1(E) - Tone prints in Pantone Process Cyan - 10%, 15%, 25% and 50%

Last Name

Owned free and clear (without a mortgage or loan),
Rented, or
Occupied without payment of rent?

City

LCO

–

INTERVIEW SUMMARY

Is this (house/apartment/mobile home) –

House number

Either

Respondent Type –

Last Name

Owned by you or someone else in this household with a mortgage or loan
(including home equity loans),

H3.

Evening

Household member – Lived here on April 1, 2010
Household member – Moved in after April 1, 2010
Neighbor or other proxy

Do not list any people recorded for this question on the inside pages or on a continuation form.

H2.

–
Unit ID

Last Name

Anyone else?
First Name

Number
–

If yes to any category, ask: What is that person’s name?
First Name

ENUMERATOR QUESTIONNAIRE

What is your phone number and best time to call?

DY-1(E) - Base print in Black ink

Babies?
Foster children?
Any other relatives?
Roommates?
Any other nonrelatives?
How about anyone else staying here on April 1
who had no permanent place to live?

R1.

➤

H1.

Draft 1 6/12/2008

Person 1
First Name

2.

Please look at list B on the Information
Sheet. How is (Name) related to (Read name
of Person 1)?

3.

Mark I
J
K ONE box.

Mark I
J
K ONE box.

I
J
K Person 1

Is (Name)
male or
female?

Male
Female

MI

4.

What was (Name’s) age on
April 1, 2010? What is this
person’s date of birth?
Please report babies as age 0
when the child is less than 1
year old.
Print numbers in boxes.
Age on
April 1, 2010
DATE OF BIRTH
Month

Last Name

Day

5.

Please look at List C. Is (Name) of Hispanic, Latino, or
Spanish origin?
Read if necessary:
Examples of another Hispanic, Latino, or Spanish origin include
Argentinean, Columbian, Dominican, Nicaraguan, Salvadoran,
Spaniard, and so on.
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin —
What is that origin? C

Year of birth

Person 2
First Name

MI

Last Name

Person 3
First Name

MI

Last Name

Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild
Parent-in-law

Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild
Parent-in-law

Son-in-law or
daughter-in-law

Male
Female

Other relative
Roomer or boarder
Housemate
or roommate

DATE OF BIRTH
Month
Day

Unmarried partner
Other nonrelative

Son-in-law or
daughter-in-law

Age on
April 1, 2010

Other relative
Roomer or boarder
Housemate
or roommate

Age on
April 1, 2010
DATE OF BIRTH
Month
Day

Unmarried partner
Other nonrelative

Please look at List D and choose one or more races. For this census, Hispanic origins are not races.
What is (Name’s) race?

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin —
What is that origin? C

White

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan

Year of
birth

First Name

MI

Last Name

Person 5
First Name

Last Name

MI

Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild
Parent-in-law

Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild
Parent-in-law

Son-in-law or
daughter-in-law

Male
Female

Other relative
Roomer or boarder
Housemate
or roommate

DATE OF BIRTH
Month

Unmarried partner
Other nonrelative

Son-in-law or
daughter-in-law
Other relative
Roomer or boarder
Housemate
or roommate
Unmarried partner
Other nonrelative

Age on
April 1, 2010

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin —
What is that origin? C

Day
Year of
birth

Male
Female

Age on
April 1, 2010

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan

DATE OF BIRTH
Month
Day
Year of
birth

FORM DY-1(E) (6-12-2008)

PID Barcode

Other Asian — What is that group? C

Other Pacific Islander — What is that group?

White

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian or
Chamorro

Samoan

In college housing
In the military
At a seasonal or
second residence
For child custody
In jail or prison
In a nursing home
For another reason
No

Other Asian — What is that group? C

Other Pacific Islander — What is that group?
➙

White

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan

In college housing
In the military
At a seasonal or
second residence
For child custody
In jail or prison
In a nursing home
For another reason
No

Other Asian — What is that group? C

Other Pacific Islander — What is that group?
➙

White

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan

Some other race — What is that group?

In college housing
In the military
At a seasonal or
second residence
For child custody
In jail or prison
In a nursing home
For another reason
No

➙

Some other race — What is that group?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin —
What is that origin? C

In college housing
In the military
At a seasonal or
second residence
For child custody
In jail or prison
In a nursing home
For another reason
No

Other Pacific Islander — What is that group?

Black,
African American,
or Negro

Some other race — What is that group?

Person 4

Mark I
J
K all reasons that apply.

Other Asian — What is that group? C

White

Does (Name) sometimes live
or stay somewhere else for
any of these reasons? —
Read response categories.

➙

Some other race — What is that group?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin —
What is that origin? C

7.

Read if necessary:
Examples of other Asian groups include Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
Examples of other Pacific Islander groups include Fijian, Tongan, and so on.

Some other race — What is that group?

Year of
birth

Male
Female

6.

In college housing
In the military
At a seasonal or
second residence
For child custody
In jail or prison
In a nursing home
For another reason
No

Other Asian — What is that group? C

Other Pacific Islander — What is that group?
➙
770102

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DY-1(E) - Tone prints in Pantone Process Cyan - 10%, 15, 25% and
50%

Let’s make a list of all those people. Please start with
the name of an owner or renter who was living here
on April 1. Otherwise, start with any adult living here.

DY-1(E) - Base print in Black ink

1.