The American Community Survey

Your Guide for

THE

American
Community
Survey

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

USCENSUSBUREAU

ACS-30(2008)
(5-2007)

This guide gives helpful information on
completing your survey form. If you need
more help, call 1-800-354-7271. The
telephone call is free. After you have
completed your survey form, please return
it in the postage-paid envelope we have
provided.

Page
Your
answers are confidential

4

How
to fill out the survey form

4

Examples
of printed and marked entries

4

Instructions
for the survey questions

5

What
the survey is about

16

Why
the Census Bureau asks certain questions

16

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YOUR ANSWERS ARE CONFIDENTIAL AND REQUIRED BY LAW
The law, Title 13, Sections 141, 193, and 221 of the U.S. Code,
authorizing the American Community Survey, also provides that your
answers are confidential. No one except Census Bureau employees
may see your completed form and they can be fined and imprisoned
for any disclosure of your answers.
The same law that protects the confidentiality of your answers
requires that you provide the information asked in this survey to the
best of your knowledge.

HOW TO FILL OUT THE AMERICAN COMMUNITY
SURVEY FORM
Please mark the category or categories as they apply to your household.
Some questions ask you to print the information. See Examples below.
Make sure you answer questions for each person in this household. If
anyone in the household, such as a roomer or boarder, does not want to
give you his or her personal information, print at least the person’s name
and answer questions 2 and 3. An interviewer will telephone to get
the information from that person.
There may be a question you cannot answer exactly. For example, you
may not know the age of an elderly person or the price for which your
house would sell. Ask someone else in your household; if no one knows,
give your best estimate.
Follow the steps through the questionnaire and read the instructions.
Instructions for completing the individual questions begin on page 5 of
this guide. These instructions will help you understand the questions and
to answer them correctly. If you need assistance, call 1-800-354-7271. The
telephone call is free.

EXAMPLES OF PRINTED AND MARKED ENTRIES
3

When did PERSON 1 (listed on page 2)
move into this house, apartment, or
mobile home?
Month

Year

10 200 5
6

Is there a business (such as a store or
barber shop) or a medical office on
this property?
Yes
No

7

Where was this person born?
In the United States – Print name of state.

OHIO
Outside the United States – Print name of
foreign country, or Puerto Rico, Guam, etc.

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INSTRUCTIONS FOR THE SURVEY QUESTIONS
List the name of each person who lives at this address. If you are not sure if
you should list a person, see the guidelines on the front page of the form.
If you are still not sure, call 1-800-354-7271 for help.
In the space labeled Person 1, print the name of the household member
living or staying here in whose name the house or apartment is owned,
being bought, or rented.
If there is no such person, any adult household member can be Person 1.
If there are more than 5 people in your household, please provide the
name of each additional person on page 4. For each additional person
listed on page 4, you should also provide this person’s sex and age.
Complete this form for the first five people listed on pages 2, 3, and 4, and
mail it back in the enclosed envelope as soon as possible. An interviewer
may telephone to obtain information for the additional persons.
ANSWER PERSON QUESTIONS 1 THROUGH 6 FOR THE FIRST FIVE
PEOPLE LISTED ON PAGES 2, 3, AND 4 OF THE QUESTIONNAIRE.
2. If the person is related to Person 1 by birth, marriage, or adoption,
but is not the 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, of Person 1, mark the "Other relative" box.
Therefore, a niece or nephew of person 1 would be categorized as
"Other relative."
If a person is not related to Person 1, mark the applicable box. A
"Roomer or boarder" is someone renting a room/space in the
house. A "Housemate or roommate" is someone sharing the house/
apartment (but who is not romantically involved) with Person 1. An
"Unmarried partner," also known as a domestic partner, is a person
who shares a close personal relationship with Person 1. Mark the
"Other nonrelative" box for a foster child or foster adult, that is
someone who is involved in the formal foster care system. For all
other people who are not related to person 1 mark "Other
nonrelative".
3. Mark one box to indicate whether the person is male or female.
4. For each person, print the age at last birthday (print "0" for babies
less than 1 year old). Also print the month, day, and year of birth.
5. Please answer BOTH Question 5 about Hispanic origin and Question 6
about race. For this survey, Hispanic origins are not races. A person is of
Hispanic, Latino, or Spanish origin if the person’s origin (ancestry) is
Mexican, Mexican American, Chicano, Puerto Rican, Cuban,
Argentinean, Colombian, Costa Rican, Dominican, Ecuadoran,
Guatemalan, Honduran, Nicaraguan, Peruvian, Salvadoran, from other
Spanish-speaking countries of the Caribbean or Central or South
America, or from Spain.
The term Mexican Am. refers to persons of Mexican-American origin or
ancestry.
If you mark the "Yes, another Hispanic, Latino, or Spanish origin"
box, print the name of the specific group.
If a person is not of Hispanic, Latino, or Spanish origin, answer this
question by marking the "No, not of Hispanic, Latino, or Spanish
origin" box.
This question should be answered for ALL persons, regardless of
citizenship status.
6. Please answer BOTH Question 5 about Hispanic origin and Question 6
about race. For this survey, Hispanic origins are not races. Mark one or
more race categories.
If you mark the "American Indian or Alaska Native" box, also
print the name of the tribe(s) in which the person is enrolled. If the
person is not enrolled in a tribe, print the name of the principal tribe.
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If you mark the "Other Asian" or the "Other Pacific Islander" box,
print the name of the specific race(s) or group(s) in the space provided.
The category Other Asian includes persons who identify themselves
as Burmese, Hmong, Indonesian, Laotian, Pakistani, Thai, Cambodian,
Sri Lankan, and so on.
The category Other Pacific Islander includes persons who identify
themselves as Fijian, Tongan, Polynesian, Tahitian, and so on.
If you mark the "Some other race" box, print the race(s) or group(s)
in the space provided.
This question should be answered for ALL persons, regardless of
citizenship status.
ANSWER HOUSING QUESTIONS 1 THROUGH 21 FOR THE
ADDRESS ON THE MAILING LABEL.
1.

Mark only one category.
Count both occupied and vacant apartments in the house or
building. Do not count stores or office space.
Detached means there is open space on all sides, or the house is
joined only to a shed or garage. Attached means that the house is
joined to another house or building by at least one wall that goes
from ground to roof. An example of A one-family house attached
to one or more houses is a house in a row of houses attached to
one another, sometimes referred to as a townhouse.
A mobile home that has had one or more rooms added or built onto
it should be considered as A one-family house detached from any
other house. If only a porch or shed has been added to a mobile
home, it should be considered as a mobile home.
Towable RVs, such as travel trailers or fifth-wheel trailers, should be
considered as A mobile home. Self-propelling RVs or motorhomes
should be considered as a Boat, RV, van, etc.

2.

Mark the box that corresponds to the year in which the original
construction was completed, not the time of any later remodeling,
additions, or conversions. If the building was first built in 2000 or
later, enter the exact year it was built.
If the building was first built in 2000 or later, enter the exact year
it was built.
If you live on a boat or in a mobile home, enter the year corresponding
to the model year in which it was manufactured.
If you do not know the year the building was first built, enter your
best estimate.

3.

Enter the month and year that Person 1 listed on page 2 last moved
into this house, apartment, or mobile home.

4.

Complete this question only if you live in a one-family house or
in a mobile home; include only land that you own or rent.
The number of acres is the acreage on which the house or mobile
home is located; include adjoining land you rent for your use.

5.

Complete this item only if this one-family house or mobile home
is on 1 or more acres of land.

6.

Complete this question only if you live in a one-family house or
mobile home. A business, such as a grocery store or barber shop,
is easily recognized from the outside and usually has a separate
entrance. A medical office is a doctor’s or dentist’s office
regularly visited by patients.

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7a. Count rooms in your house, apartment, or mobile home separated by
built-in archways or walls that extent out six inches, go from floor to
ceiling, and are used for living purposes, such as living rooms, dining
rooms, kitchens, bedrooms, finished recreation rooms, family rooms,
etc. DO NOT count bathrooms, kitchenettes, strip or pullman kitchens,
utility rooms, foyers, halls, porches, balconies, unfinished attics,
unfinished basements, or other unfinished space used for storage.
7b. Include all rooms intended to be used as bedrooms in this house,
apartment, or mobile home, even if they are currently being used for
other purposes.
Print "0" for an efficiency or studio apartment that does not have a
separate bedroom. Your response to this question (7b) should be
smaller than the number of rooms reported in question 7a.
8a. Mark "Yes" to "hot and cold running water" even if the unit has
hot water only part of the time.
8d. Mark "Yes" to "sink with a faucet" if the sink is inside the house,
apartment or mobile home and the water can be turned on and off
with a faucet.
8e. Mark "Yes" to "a stove or range" if the stove or range is inside
the house, apartment or mobile home. Portable cooking equipment
is not considered a stove or range.
8g. Mark "Yes" to "telephone service ..." if (1) there is a telephone in
working order, and someone receives service at this house,
apartment, or mobile home; or (2) if someone has a cell phone from
which you can both make and receive calls. If service has been
discontinued because of nonpayment or any other reason, mark the
"No" box.
9.

10.

Include company cars, vans or SUVs (including police cars and
taxicabs) and company trucks of one-ton (2,000 pounds) capacity or
less that are regularly kept at home and used by household members
for nonbusiness purposes. DO NOT count (1) cars or trucks
permanently out of working order, or (2) motorcycles or other
recreational vehicles.
Mark the ONE category for the fuel used most to heat this house,
apartment, or mobile home. In buildings containing more than one
apartment, you may obtain this information from the owner,
manager, or janitor.
Solar energy is provided by a system that collects, stores, and
distributes heat from the sun. Other fuel includes any fuel not
listed separately, such as purchased steam, fuel briquettes, and
waste material.

11a-11d.
If your house, apartment, or mobile home is rented, enter the costs
for utilities and fuels only if you pay for them in addition to the
monthly rent.
If you live in a condominium, enter the costs for utilities and fuels
only if you pay for them in addition to your condominium fee.
If your fuel and utility costs are included in your rent or condominium
fee, mark the "Included in rent or condominium fee" box.
DO NOT enter any dollar amounts.
For items 11a and 11b, report last month’s costs. For items 11c and
11d, report total costs for the past 12 months.
Estimate as closely as possible if you do not know exact costs. If you
have lived in this house, apartment, or mobile home less than one
year, estimate the costs for the past 12 months in 11c and 11d.

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Report amounts even if your bills are unpaid or paid by someone
else. If the bills include utilities or fuel used also by another
apartment or a business establishment, estimate the amounts for
your house or apartment only. If gas and electricity are billed
together, enter the combined amount in 11a and mark the
"Included in electricity payment entered above" box in
item 11b.
13.

A condominium is housing in which the apartments, houses, or
mobile homes in a building or development are individually owned,
but the common areas, such as lobbies and halls, are jointly owned.
Occupants of a cooperative should mark the "No" box.
A condominium fee is normally assessed by the condominium
owners’ association for the purpose of improving and maintaining
the common areas. Enter a monthly amount even if it is unpaid or
paid by someone else. If the amount is paid on some other periodic
basis, see the instruction for question 15a on how to change it to a
monthly amount.

14.

Housing is owned if the owner or co-owner lives in it.
If the house, apartment, or mobile home is mortgaged or there is a
contract to purchase, mark the "Owned by you or someone in this
household with a mortgage or loan? Include home equity
loans." box. If there is no mortgage or other debt, mark the
"Owned by you or someone in this household free and clear
(without a mortgage or loan)?" box. If the house, apartment, or
mobile home is owned but the land is rented, mark one of the
"owned" categories. If the mobile home is owned without an
installment loan, but there is a mortgage on the land, mark the
"Owned by you or someone in this household with a mortgage
or loan? Include home equity loans." box.
If any money rent is paid, even if the rent is paid by people who are
not members of your household, or paid by a Federal, state, or local
government agency, mark the "Rented?" box.
If the unit is not owned or being bought by the occupants and if
money rent is not paid or contracted, mark the "Occupied
without payment of rent?" box. The unit may be owned by
friends or relatives who live elsewhere and who allow you to occupy
this house, apartment, or mobile home without charge. A house or
apartment may be provided as part of wages or salary. Examples
are: caretaker’s or janitor’s house or apartment; parsonages; tenant
farmer or sharecropper houses for which the occupants do not pay
rent; or military housing.

15a. Report the rent agreed to or contracted for, even if the rent for your
house, apartment, or mobile home is unpaid or paid by someone else.
Divide
Multiply
rent by:
rent by:
If rent is paid:
If rent is paid:
By the day . . . . . . . . 30
By the week . . . . . . . 4
Every other week . . . . 2

4 times a year . . . . . . . 3
2 times a year . . . . . . 6
Once a year . . . . . . . . 12

15b. If meals are included in the monthly rent payment, or you must
contract for meals or a meal plan in order to live in this house,
apartment, or mobile home, mark the "Yes" box.
ANSWER HOUSING QUESTIONS 16 THROUGH 21 IF YOU OR ANY
MEMBER OF THIS HOUSEHOLD OWNS OR IS BUYING THIS HOUSE.
16. Enter your best estimate of the value of the property; that is, how
much you think the property would sell for if it were on the market.
If this is a house, include the value of the house, the land it is on,
and any other sturctures on the same property. If the house is
owned but the land is rented, estimate the combined value of the
house and the land, If this is a condominium unit, estimate the value
for the condominium, including your share of the common
elements. If this is a mobile home, include the value of the mobile
home and the value of the land only if you own the land.

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17.

Report taxes for all taxing jurisdictions (city or town, county,
state, school district, etc.) even if they are included in your
mortgage payment; not yet paid or paid by someone else; or are
delinquent. DO NOT include taxes past due from previous years.

18.

When premiums are paid other than on a yearly basis, convert to
a yearly basis. Enter the yearly amount even if no payment was
made during the past year.

19a. The word mortgage indicates all types of loans secured by real
estate.
19b. Enter a monthly amount even if it is unpaid or paid by someone
else. If the amount is paid on some other periodic basis, see the
instructions for 15a to change it to a monthly amount.
Include payments on first mortgages and contracts to purchase only.
Report payments for second or junior mortgages and home equity
loans in 20b.
If this is a mobile home, report payments on installment loans but
do not include personal property taxes, site rent, registration fees,
and license fees on the mobile home and site. Report these fees in
item 21.
20a. A second mortgage or home equity loan is also secured by real estate.
You must have a first mortgage in order to have a second mortgage.
You may have a home equity loan and other mortgages on the
property or the home equity loan may be the only mortgage.
20b. Enter a monthly amount even if it is unpaid or paid by someone
else. If the amount is paid on some other periodic basis, see
instructions for 15a to change it to a monthly amount. Include
payments on all second or junior mortgages or home equity loans.
ANSWER HOUSING QUESTION 21 ONLY IF THIS IS A MOBILE HOME
THAT YOU OWN OR ARE BUYING.
21.

Report an amount even if your bills are unpaid or paid by
someone else.
Include payments for personal property taxes, land or site rent,
registration fees and license fees. DO NOT include real estate taxes
already reported in 20. Report the total annual amount even if you
make it in two or more installments. Estimate as closely as possible
when you don’t know exact costs.

ANSWER PERSON QUESTIONS 7 THROUGH 16 FOR ALL PERSONS
ON PAGES 2, 3, AND 4.
Questions 7-47 are a continuation of the questions for each person.
(Questions 1-6 appear on pages 2, 3, and 4 of the questionnaire.)
7. For people born in the United States:
Mark the "In the United States" box and then print the name of
the state in which the person was born. If the person was born in
Washington, D.C., print District of Columbia.
For people born outside the United States:
Mark the "Outside the United States" box, and then print the
name of the foreign country or area where the person was born. Use
current boundaries, not boundaries at the time of the person’s birth.
For example, specify whether Northern Ireland or the Republic of
Ireland (Eire); North or South Korea; England, Scotland, or Wales (not
Great Britain or United Kingdom). Specify the particular country or
island in the Caribbean (for example, Jamaica, not West Indies).

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8. If the person was born in the United States (50 states and District of
Columbia), mark the "Yes, born in the United States" box. If the
person was born in Puerto Rico, Guam, the U.S. Virgin Islands, Northern
Marianas, or American Samoa, mark the "Yes, born in Puerto Rico,
Guam, the U.S. Virgin Islands, or Northern Marianas" box. If the
person was born outside the United States (50 states and District of
Columbia) or at sea and had at least one parent who was a U.S. citizen
at the time of the person’s birth, mark the "Yes, born abroad of U.S.
citizen parent or parents" box. Mark the "Yes, a U.S. citizen by
naturalization" box only if this person was born outside the United
States (50 states and District of Columbia) and has completed the
naturalization process and is now a United States citizen. In the boxes
below "Print year of naturalization," print the four-digit year this
person completed the formal naturalization process. If this person is not
a U.S. citizen, mark the "No, not a U.S. citizen" box. Legal Permanent
Residents (LPRs) or "green card" holders, or other non-naturalized
immigrants or visitors to the U.S. are not citizens of the United States
and therefore should mark the "No, not a U.S. citizen" box.
9. If the person entered the United States (that is, the 50 states and the
District of Columbia) more than once, enter the latest year he or she
came to live in the United States.
10a. A public school is any school or college that is controlled and
supported primarily by a local, county, state, or Federal government.
Schools are private if supported and controlled primarily by religious
organizations or other private groups. Home school applies to parental
guided education outside of a public or private school for grades 1–12.
10b. Answer this question if the person attended regular school, college, or
home school in the last three months. Mark the box that corresponds
to the grade level or college level the person was attending.
11. Mark only one box to indicate the highest grade or level of schooling
the person has completed or the highest degree the person received.
Report schooling completed in foreign or ungraded schools as the
equivalent level of schooling in the regular American school system.
For persons who attended 12th grade but did not receive a diploma or
GED, mark the "12th grade – NO DIPLOMA" box.
For persons who completed high school by passing an equivalency test,
such as the General Educational Development (GED) examination, and
did not attend college, mark the "GED or alternative credential" box.
For persons who completed some college credits but did not complete
enough credits to be counted as a sophomore, mark the "Some
college credit, but less than 1 year of college credit" box.
Some of the examples of Professional school degrees include medicine,
dentistry, chiropractic, optometry, osteopathic medicine, pharmacy,
podiatry, veterinary medicine, law, and theology.
For the "Professional degree beyond a bachelor’s degree"
category, DO NOT include certificates or diplomas for training on
specific trades such as computer and electronics technology, auto
repair, medical assistant, cosmetology, and other fields at vocational,
technical or business schools.
DO NOT include honorary degrees awarded by colleges and universities
to individuals for their accomplishments. Include only "earned" degrees.
12. Print the ancestry group(s). Ancestry refers to the person’s ethnic
origin or descent, "roots," or heritage. Ancestry also may refer to the
country of birth of the person or the person’s parents or ancestors
before their arrival in the United States. Answer this question for ALL
persons, regardless of citizenship status.
Persons who have more than one origin and cannot identify with a
single ancestry group may report two ancestry groups (for example,
German-Irish).
Do not report a religious group as a person’s ancestry.
13a. Mark the"Yes" box if the person sometimes or always speaks a
language other than English at home.
Mark the "No" box if the person speaks only English, or if a non-English
language is spoken only at school or is limited to a few expressions or slang.
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13b. Print the name of the language spoken at home. If this person speaks
more than one non-English language and cannot determine which is
spoken more often, report the one the person first learned to speak.
14a. If the person is a baby under one year of age, mark the "Person
is under 1 year old" box. Then SKIP to the question 15.
If the person lived in the same house or apartment one year ago, mark
the "Yes, this house" box and then SKIP to question 15.
If the person did not live in the United States or Puerto Rico one year
ago, mark the "No, outside the United States and Puerto Rico"
box and print the name of the foreign country, or U.S. Virgin Islands,
Guam, etc., where the person lived. Be specific when printing the
name of foreign countries, for example, specify whether Northern
Ireland or the Republic of Ireland (Eire); North or South Korea;
England, Scotland or Wales (not Great Britain or United Kingdom).
Specify the particular country or island in the Caribbean (not, for
example, West Indies). Then SKIP to question 15.
If the person lived somewhere else in the United States or Puerto Rico
one year ago, mark the "No, different house in the United States
or Puerto Rico" box. Then in item 14b provide the house number
and street name, the name of the city, town, or post office, the name
of the U.S. county or municipio in Puerto Rico, the U.S. state or Puerto
Rico, and the ZIP Code where the person lived one year ago.
14b. Include the house or structure number; street name; street type (for
example, St., Road, Ave.); and the street direction (if a direction such
as "North" is part of the address). For example, print 1239 N. Main St.
or 1239 Main St., N.W., not just 1239 Main. If the person lived in
Puerto Rico, the address should also include the name of the
development or condominium.
If the only known address is a post office box, give a description of the
residence location. For example, print the name of the building where
the person lived, the nearest intersection, the name of a military base
or installation, or the nearest street where the residence was located,
etc. DO NOT GIVE A POST OFFICE BOX NUMBER.
Print the name of the U.S. county name or municipio if in Puerto Rico.
If the person lived in Louisiana, print the parish name in the "Name
of U.S. county or municipio in Puerto Rico" space. If the person
lived in Alaska, print the borough or census area name, if known. If
the person lived in New York City and the county name is not known,
print the borough name. If the person lived in an independent city
(not in any county) or in Washington, D.C., leave the "Name of U.S.
county or municipio in Puerto Rico" space blank.
15. Mark the "Yes" or "No" box for each part of question 15. Mark
"Yes" if this person currently has the type of health insurance or
health coverage listed. Mark "No" if this person does not have the
type of health insurance or health coverage listed.
These categories include health insurance obtained through a job, an
insurance company, or government health care plans such as Medicaid,
Medicare, VA, and military health programs.
If the person reports any other type of coverage plan in 15h, specify
the type of coverage or name of the plan in the write-in box. DO NOT
include plans that cover only one type of health care (such as dental
plans) or plans that only cover a person in case of an accident or
disability.
16a. Mark the "Yes" or "No" box to indicate if the person is deaf or has
serious difficulty hearing.
16b. Mark the "Yes" or "No" box to indicate if the person is blind or has
serious difficulty seeing even when wearing glasses.
ANSWER PERSON QUESTIONS 17a THROUGH 17c IF THIS PERSON
IS 5 YEARS OLD OR OVER.
17. Mark the "Yes" or "No" box to indicate if the person has serious
diffuclty with any of the activities listed in parts a, b, and c because of
a physical, mental or emotional condition.
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ANSWER PERSON QUESTIONS 18 THROUGH 47 IF THIS PERSON IS 15
YEARS OLD OR OVER.
18. Mark the "Yes" or "No" box if the person has any difficulty doing
errands by himself or herself due to a physical, mental, or emotional
condition.
19. Mark the "Now married" box for a married person regardless of
whether his or her spouse is living in the household unless they are
separated. If the person’s only marriage was annulled, mark the
"Never married" box.
20. Mark the "Yes" or "No" box for parts a through c of question 20.
21. Indicate whether this person has been married once, twice, or three
or more times. Do not count marriages that ended in annulment.
22. Write the four-digit year when the person last got married, even if
the person is now widowed, divorced, or separated.
23. Answer this question if the person is a female who is at least 15 years
old and younger than 51 years old. Mark the "Yes" box if the person
has given birth to at least one child born alive in the past 12 months,
even if the child died or no longer lives with the mother. Do not
consider miscarriages, or stillborn children, or any adopted, foster, or
step children.
24a. Mark the "Yes" box if the person has at least one of his or her own
grandchildren, who is under 18 years of age, living in the house,
apartment, or mobile home.
24b. Answer this question if the person has at least one of his or her
own grandchildren living in the house, apartment, or mobile home.
Mark the "Yes" box if the person is currently responsible for the
basic needs of the grandchild or grandchildren.
24c. Mark one box to indicate the length of time the person has been
providing for the basic needs of his or her grandchild or
grandchildren.
25. For a person with service in the National Guard or military Reserves,
mark a Yes category only if the person has ever been called up for
active duty other than for training. For a person whose only service
was as a civilian employee or civilian volunteer for the Red Cross,
USO, Public Health Service, or War or Defense Department, mark the
"No, never served in the military" box. Count World War II
Merchant Marine service as active duty; DO NOT count other
Merchant Marine service as active duty.
26. Mark a box for EACH period served, even if service in the period was
brief, or did not include the entire period of time in the response
category. Enter as many responses as apply.
27a. If this person has a Department of Veteran Affairs (VA)
service-connected disability ranting, mark the "Yes" box.
27b. Mark one box that shows the person’s service-connected disability
rating. Mark the "0 percent" box if the person has received a
service-connected disability rating of zero. Do not mark the box
showing "0 percent" to indicate no rating.
28a. Count as work – Mark the "Yes" box if this person performed:
• Work for someone else for wages, salary, piece rate,
commission, tips, or payments "in kind" (for example, food or
lodging received as payment for work performed).
• Work in own business, professional practice, or farm.
• Any work in a family business or farm, paid or not.
• Any part-time work including babysitting, paper routes, etc.
• Active duty in the Armed Forces.
Do not count as work – Mark the "No" box if
this person performed:
• Housework or yard work at home.
• Unpaid volunteer work.
• School work done as a student.
• Work done as a resident of an institution.

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28b. Mark the "Yes" box if this person did any work and received any
amount pay for that work, even if the person worked for as little as
one hour.
29. Include the house or structure number; street name; street type (for
example, St., Road, Ave.); and the street direction (if a direction such
as "North" is part of the address). For example, print 1239 N. Main St.
or 1239 Main St., N.W., not just 1239 Main.
If the only known address is a post office box, give a description of
the work location. For example, print the name of the building or
shopping center where the person works, the nearest intersection,
or the nearest street where the workplace is located, etc. DO NOT
GIVE A POST OFFICE BOX NUMBER.
If the person worked at a military installation or military base that
has no street address, report the name of the military installation or
base, and a description of the work location (such as building
number, building name, nearest street or intersection).
If the person worked at several locations, but reported to the same
location each day to begin work, print the street address of the
location where he or she reported. If the person did not report to
the same location each day to begin work, print the address of the
location where he or she worked most of the time last week.
If the person’s employer operates in more than one location (such as
a grocery store chain or public school system), print the street address
of the location or branch where the person worked. If the street
address of a school is not known, print the name of the school, and a
description of the location (such as nearest street or intersection).
If the person worked on a college or university campus and the street
address of the workplace is not known, print the name of the building
where he or she worked, and a description of the location (such as
nearest street or intersection).
If the person worked in a foreign country or Puerto Rico, Guam, etc.,
print the name of the country on the state or foreign country line and
then go to question 30.
30. If the person usually used more than one type of transportation
to get to work (for example, drove to public transportation), mark
the category of the one method of transportation that he or she
used for most of the distance during the trip.
31. If the person was driven to work by someone who then drove back
home or to a non-work destination, enter 1 in the box labeled
Person(s).
DO NOT include persons who rode to school or some other non-work
destination in the count of persons who rode in the vehicle.
32. Give the time of day the person usually left home to go to work.
DO NOT give the time that the person usually began his or her work.
If the person usually left home to go to work sometime between
12:00 o’clock midnight and 12:00 o’clock noon, mark a.m.
If the person usually left home to go to work sometime between
12:00 o’clock noon and 12:00 o’clock midnight, mark p.m.
33. Travel time is from door to door. Include time waiting for public
transportation or picking up passengers in a carpool.
ANSWER PERSON QUESTIONS 34a THROUGH 37 IF THE PERSON DID
NOT WORK LAST WEEK.
34a. Persons are on layoff if they are waiting to be recalled to a job
from which they were temporarily separated for business-related
reasons.
34b. If the person works only during certain seasons or on a day-by-day
basis when work is available, mark the "No" box.
34c. If the person was informed by his or her employer, either formally
or informally, that they will be recalled within the next 6 months,
mark the "YES" box. Also mark the "YES" box if the person has
been given, formally or informally, a specific date to return to
work, even if that date is more than 6 months away.

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35. Mark the "Yes" box if the person tried to get a job or start a
business or professional practice at any time in the last 4 weeks; for
example, registered at a public or private employment office, went
to a job interview, placed or answered employment ads, or did
anything toward starting a business or professional practice.
36. If the person was expecting to report to a job within 30 days,
mark the "Yes, could have gone to work" box.
Mark the "No, because of own temporary illness" box only if the
person expects to be able to work within 30 days.
If the person could not have gone to work because he or she
was going to school, taking care of children, etc., mark the
"No, because of all other reasons (in school, etc.)" box.
37. Refer to the instructions for question 28 to determine what to count
as work. Mark the "Over 5 years ago or never worked" box if the
person: (1) never worked at any kind of job or business, either full or
part time, (2) never worked, with or without pay, in a family business
or farm, and (3) never served on active duty in the Armed Forces.
38. Refer to the instructions for question 28 to determine what to count
as work. Include paid vacation, paid sick leave, and military service.
Count every week in which the person worked at all, even for an hour.
39. If the hours worked each week varied considerably in the past 12
months, give an approximate average of the hours worked each week.
ANSWER PERSON QUESTIONS 40 THROUGH 45 IF THE PERSON
WORKED IN THE PAST 5 YEARS.
40. Mark the "An employee of a PRIVATE NOT FOR PROFIT, . . .
organization" box if the person worked for a cooperative, credit
union, mutual insurance company, or similar organization.
Employees of foreign governments, the United Nations, and other
international organizations should mark the "Federal
GOVERNMENT employee" box.
If the person worked at a public school, college or university, mark
the appropriate government category; for example, mark the
"a state GOVERNMENT employee" box for a state university, or
mark the "a local GOVERNMENT employee?" box for a county-run
community college or a city-run public school.
41. If the person worked for a company, business, or government agency,
print the name of the company, not the name of the person’s
supervisor. If the person worked for an individual or a business that
had no company name, print the name of the individual worked for.
If the person worked in his or her own un-named business, print
"self-employed."
42. Print one or more words to describe the business, industry, or
individual employer named in question 41. If there is more than one
activity, describe only the major activity at the place where the person
worked. Enter what is made, what is sold, or what service is given.
Enter descriptions like the following: Metal furniture
manufacturing, Retail grocery store, Petroleum refining, Cattle ranch
Do not enter: Furniture company, Grocery store, Oil company, Ranch
44. Print one or more words to describe the kind of work the person did. If
the person was a trainee, apprentice, or helper, include that in the
description.
Enter descriptions like the following: Registered nurse,
Personnel manager, High school teacher.
Do not enter single words such as: Nurse, Manager, Teacher
ANSWER PERSON QUESTIONS 46 THROUGH 47 ONLY IF THIS PERSON
IS 15 YEARS OLD OR OVER.
Mark the "Yes" or "No" box for each part, and enter the amount received
in the past 12 months for each "Yes" response.
If income from any source was received jointly by household members,
report, if possible, the appropriate share for each person; otherwise, report
the whole amount for only one person and mark the "No" box for the
other person.
When reporting income received jointly, DO NOT include the amount for a
person not listed on pages 2, 3, and 4.
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46a. Include wages and salaries before deductions from ALL jobs. Be
sure to include any tips, commissions, or bonuses. Owners of
incorporated businesses should enter their salary here. Military
personnel should include base pay plus cash housing and/or
subsistence allowance, flight pay, uniform allotments,
reenlistment bonuses.
b. Include NONFARM profit (or loss) from self-employment in sole
proprietorships and partnerships. Exclude profit (or loss) of
incorporated businesses you own.
Include FARM profit (or loss) from self-employment in sole
proprietorships and partnerships. Exclude profit (or loss) of
incorporated farm businesses you own. Also exclude amounts from
land rented for cash but include amounts from land rented for
shares.
c. Include interest received or credited to checking and saving
accounts, money market funds, certificates of deposit (CDs),
IRAs, KEOGHs, and government bonds.
Include dividends received, credited, or reinvested from ownership of
stocks or mutual funds.
Include profit (or loss) from royalties and the rental of land, buildings
or real estate, or from roomers or boarders. Income received by
self-employed persons whose primary source of income is from
renting property or from royalties should be included in question 46b
above. Include regular payments from an estate or trust fund.
d. Include amounts, before Medicare deductions, of Social Security
and/or Railroad Retirement payments to retired persons, to
dependents of deceased insured workers, and to disabled
workers.
e. Include Supplemental Security Income (SSI) received by elderly,
blind, or disabled persons.
f. Include any public assistance or welfare payments the person
receives from the state or county welfare office. Do not include
assistance received from private charities. Do not include
assistance to pay heating or cooling costs.
g. Include retirement, survivor or disability benefits received from
companies and unions, Federal, state, and local governments,
and the U.S. military. Include regular income from annuities
and IRA or KEOGH retirement plans.
h. Include Veterans’ (VA) disability compensation and educational
assistance payments (VEAP); unemployment compensation,
child support or alimony; and all other regular payments such
as Armed Forces transfer payments, assistance from private
charities, regular contributions from persons not living in the
household.
Do Not include the following as income in any item:
• Refunds or rebates of any kind
• Withdrawals from savings of any kind
• Capital gains or losses from the sale of homes, shares of stock, etc.
• Inheritances or insurance settlements
• Any type of loan
• Pay in-kind such as food, free rent
47. Add the total entries (subtracting losses) for 46a through 46h
for the past 12 months and enter that number in the space
provided.

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What the Survey Is About -Some Questions and Answers
Why are we taking a survey?
The Census Bureau is conducting the American Community Survey to
provide more timely data than data we typically collect only once every
10 years during the decennial census.
What does the Census Bureau do with the information you provide?
The American Community Survey will be the source of summarized data
that we make available to federal, state, and local governments, and
also to the public. The data will enable your community leaders from
government, business, and non-profit organizations to plan more
effectively.
How was this address selected?
Your address was scientifically selected to represent a cross section of
other households in your community. Households in the sample are
required to complete the survey form. Please return it in the
postage-paid envelope as soon as possible.

Why the Census Bureau Asks Certain
Questions -Here are reasons we ask some of the questions on the survey.
Name
Names help make sure that everyone in a household is included on the
List of Residents, but that no one is listed twice.
Value or rent
Government and planning agencies use answers to these questions in
combination with other information to develop housing programs to
meet the needs of people at different economic levels.
Plumbing and Kitchen facilities
This question helps provide information on the quality of housing. The
data are used with other statistics to show how the "level of living"
compares in various areas and how it changes over time.
Place of birth
This question provides information used to study long-term trends about
where people move and to study migration patterns and differences in
growth patterns.
Job
Answers to the questions about the jobs people hold provide information
on the extent and types of employment in different areas of the country.
From this information, communities can develop training programs, and
business and local governments can determine the need for new
employment opportunities.
Income
Income helps determine how well families or persons live. Income
information makes it possible to compare the economic levels of different
areas, and how economic levels for a community change over time.
Funding for many government programs is based on the answers to these
questions.
Education
Responses to the education questions in the survey help to determine the
number of public schools, education programs, and daycare services
required in a community.
Disability
Questions about disability provide the means to allocate Federal funding
for healthcare services and new hospitals in many communities.
Journey to work
Answers to these questions help communities plan road improvements,
develop public transportation services, and design programs to ease traffic
problems.

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