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OMB No. 0607-0368: Approval Expires 05/31/2005
NOTES
TRANSCRIBE FROM THE ADDRESS LABEL ON FORM SC-1
SC ID
State
SCO
AA
Map Spot
County
Tract
Block
Unit ID
Form
House No.
Street name, Rural route and box, or PO box
of
Form(s)
Apt. No. or Location
Location description
ZIP Code
FORM SC-1(SUPP)
(6-24-2002)
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
CONTINUATION FORM
FOR ENUMERATOR
QUESTIONNAIRE
Special Census
001101
SC-1(SUPP) - Page 1 and 4 - Prints Yellow, Pantone 129
SC-1(SUPP) - Page 1 and 4 - Base prints Black
⊕
⊕
person’s sex?
Mark ✗ ONE box.
Person No.
6
First Name
MI
Last Name
Cancel
Person No.
NONRELATIVE:
Roomer/boarder
Housemate/roommate
Add
7
MI
Last Name
⊕
Person No.
Add
8
MI
Add
9
MI
Female
What is this person’s
date of birth?
Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister
NONRELATIVE:
Roomer/boarder
Housemate/roommate
Add
10
MI
Last Name
Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister
Unmarried partner
Foster child
Other
nonrelative
Add
5. Are any of the persons that I have listed Mexican, Puerto
Rican, Cuban, or of another Hispanic or Latino group?
No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?
Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.
Male
Age
Female
What is this person’s
date of birth?
No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?
Day
Unmarried partner
Foster child
Other
nonrelative
Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.
Male
Age
Female
What is this person’s
date of birth?
Other
nonrelative
Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.
No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?
Male
Age
Female
What is this person’s
date of birth?
Other
nonrelative
Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.
Other
nonrelative
Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?
Native Hawaiian
Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race
Male
Age
Female
What is this person’s
date of birth?
White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?
Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?
Native Hawaiian
Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race
White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?
Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?
Native Hawaiian
Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race
No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?
White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?
Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?
Native Hawaiian
Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race
No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?
White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?
Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?
Native Hawaiian
Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race
⊕
Year of
birth
FORM SC-1(SUPP) (6-24-2002)
001103
⊕
⊕
Year of
birth
Day
Unmarried partner
Foster child
White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?
Year of
birth
Day
Unmarried partner
Foster child
does each person consider himself/herself to be?
Year of
birth
Day
Unmarried partner
Foster child
6. Now choose one or more races for each person. Which race or races
Year of
birth
Month
NONRELATIVE:
Roomer/boarder
Housemate/roommate
ENUMERATOR NOTE: It is important to ask BOTH questions 5 and 6 and show Cards B and C.
Day
Month
First Name
Cancel
Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister
NONRELATIVE:
Roomer/boarder
Housemate/roommate
Last Name
Person No.
Age
Month
First Name
Cancel
Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister
NONRELATIVE:
Roomer/boarder
Housemate/roommate
Last Name
Person No.
Male
Month
First Name
Cancel
Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.
What was each person’s
age on (Special Census date)?
Print numbers in boxes.
Month
First Name
Cancel
Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister
4.
Fold line
SC-1(SUPP) - Page 2 and 3 - Prints YELLOW, Pantone 129
related to (Read name of Person 1)?
3
SC-1(SUPP) - Page 2 and 3 - Base prints BLACK
2
ENUMERATOR NOTE: For questions 2 through 6, prompt respondent with names if needed, for example, "Let’s start with Bob."
1. Who else lived here on (Special Census date)?
2. (Show Card A.) Which of these categories best describes how each person is
3. What is each
| File Type | application/pdf |
| File Modified | 2002-12-09 |
| File Created | 2002-12-09 |