SC-116 Group Quarters Enumeration Control Record

Sheet _____ of _____ sheets
FORM SC-116
(11-12-2002)

OMB No. 0607-0368: Approval Expires 05/31/2005
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU

SC ID

SCO

AA

GQ ENUMERATION
CONTROL RECORD

State

Map Spot

County

Tract

Block

Unit ID

➤

➤

APPLY LABEL HERE

GQ name

Special Census

GQ type

House No.

THIS LISTING CONTAINS INFORMATION, THE
RELEASE OF WHICH IS PROHIBITED BY
TITLE 13, U.S.C.

Street name, Rural route and box, or PO box

City

ZIP Code

State

1. Name/Address/Changes
GQ name

GQ type

House No.

Street name, Rural route and box, or PO box

City

State

ZIP Code

2. Contact name
4. Delete reason

3. Contact telephone number
D1

Not a GQ

D2

Does not exist

D3

No LQ

Administrative records
Resident listing

D4

Duplicate

D5

GEO Change

6. FOR OFFICE
USE ONLY
Total forms

5. Listing used for completion
Other – Specify

Unit
designation

Person
number

Name

Complete

(a)

(b)

(c)

(d)



011601

Unit
designation

Person
number

Name

Complete

(a)

(b)

(c)

(d)

FORM SC-116 (11-12-2002)


011602