2008 Census Dress Rehearsal

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

List A

INFORMATION SHEET
2008 Census Dress Rehearsal

PRIVACY NOTICE
Your Answers Are Confidential
Your answers are confidential and protected by
law. All Census Bureau employees have taken an
oath and are subject to a jail term, a fine, or both
if they disclose ANY information that could
identify you or your household. Your survey
answers will only be used to produce statistics,
and for no other purpose. You are required by
law to provide the information requested. These
federal laws are found in Title 13, U.S. Code,
Sections 9, 141, 193, 214, and 221.
Thank you for your cooperation. The Census
Bureau appreciates your help.

If you have any comments concerning the time it takes to
complete this form or any other aspect of the collection, send it
to: Paperwork Project 0607-0919-DR, U.S. Census Bureau,
4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233.
You may e-mail comments to [email protected]; use
"Paperwork Project 0607-0919-DR" as the subject.

RELATIONSHIP
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
Other relative
Roomer or boarder
Housemate or roommate
Unmarried partner
Other nonrelative

Respondents are not required to respond to any information
collection unless a valid approval number has been assigned by
the Office of Management and Budget. The approval number for
the 2008 Census Dress Rehearsal is: OMB No. 0607-0919-DR;
Approval Expires 08/30/2010.
DX-1(F) (2-23-2007)

USCENSUSBUREAU

DX-1(F) - Base prints Black Ink

DX-1(F) - TOne prints Pantone Process Cyan 10% and 20%

List B

List C

HISPANIC, LATINO, OR
SPANISH ORIGIN

RACE
(Choose one or more races)

No, not of Hispanic, Latino, or
Spanish origin
Yes, Mexican, Mexican American, or
Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, of another Hispanic, Latino, or
Spanish origin – For example, Argentinean,
Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, and so on

White
Black, African American, or Negro
American Indian or Alaska Native
Asian – includes:
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian – For example, Hmong,
Laotian, Thai, Pakistani, Cambodian,
and so on
Native Hawaiian or Other Pacific Islander –
includes:
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander – For example,
Fijian, Tongan, and so on
Some other race

DX-1(F) (2-23-2007)

DX-1(F) - Base prints Black Ink

DX-1(F) - TOne prints Pantone Process Cyan 10% and 20%