Various Pretesting Activities (see attached list)

C

U.S. Department of Commerce
Economics and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47144

C

OFFICIAL BUSINESS
Penalty for Private Use $300
D-8C(AZ) (7-2008)

To return your census form, please
make sure the BAR CODE ABOVE YOUR
ADDRESS appears in this window.

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 16081

WASHINGTON DC

POSTAGE WILL BE PAID BY U.S. CENSUS BUREAU

2010 CENSUS DATA CAPTURE CENTER
4722 BUCKEYE ROAD
PHOENIX AZ 85043-XXXX
|8504300000|

7/30/2008 - Size 9-7/16 x 5-11/16" Covered window 5 x 1-1/16"

8504300000

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

To return your census form, please make sure the BAR CODE
ABOVE YOUR ADDRESS appears in the window of this envelope.
Thank you for participating in the 2008 Census Dress Rehearsal.

7-30-2008

D-8C(AZ) (BACK)

Draft 5 8/26/2008

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

April 6, 2010

Dear Resident:
A few weeks ago, the U.S. Census Bureau sent your
household an official 2010 Census form. U.S. law requires
you to respond. If you have not yet responded, we
encourage you to do so immediately.
Return your form today. This is your last chance to respond
by mail before a Census Bureau Representative contacts you.
It is important that each household respond only once. If you
have already provided your census information, we thank
you – there is no need to provide it again.
Your answers are confidential. This means the Census Bureau
cannot give out information that identifies you or your
household. Your answers will only be used for statistical
purposes, and for no other purpose. The back of this letter
contains more information about protecting your data.
Sincerely,

Steve H. Murdock
Director, U.S. Census Bureau

USCENSUSBUREAU
D-17(L) (8-26-2008)

Base copy prints black ink
Overlay prints Pantone Cyan – 10% and 100%

Your Answers Are Confidential
Federal law protects your privacy and keeps your answers
confidential (Title 13, United States Code, Sections 9 and
214). The answers you give on the census form cannot be
obtained by law enforcement or tax collection agencies.
Your answers cannot be used in court. They cannot be
obtained with a Freedom of Information Act (FOIA) request.
As allowed by law, census data become public after
72 years (Title 44, United States Code, Section 2108).
This information can be used for family history and
other types of historical research.
Please visit our Web site at
and click on "Protecting Your Answers" to learn more about
our privacy policy and data protection.

D-17(L) (8-26-2008)

Base copy prints black ink
Overlay prints Pantone Cyan - 10% and 100%

Draft 2 (8-5-2008)

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➞

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➞
U.S. DEPARTMENT OF COMMERCE

First Name

5. Please provide information for each person living here. Start with a

Use a blue or black pen.

MI

person living here who owns or rents this house, apartment, or mobile
home. If the owner or renter lives somewhere else, start with any adult
living here. This will be Person 1.
What is Person 1’s name? Print name below.

Start here
Age on April 1, 2010

Sex
Male
Female

Person 8

Sex

Month

Last Name

Age on April 1, 2010

Male
Female

Person 9

Fold Line

Sex

Related to Person 1?

Date of Birth
Day

Year

First Name

Day

Related to Person 1?
Year

• Do not count anyone living away either at college or in the
Armed Forces.
• Do not count anyone in a nursing home, jail, prison,
detention facility, etc., on April 1, 2010.
• Leave these people off your form, even if they will return to
live here after they leave college, the nursing home, the
military, jail, etc. Otherwise, they may be counted twice.

Yes
No

Last Name

Age on April 1, 2010

Male

First Name

MI

Date of Birth
Month

Day

Related to Person 1?
Year

Female

The Census must also include people without a permanent
place to stay, so:

Yes

• If someone who has no permanent place to stay is staying
here on April 1, 2010, count that person. Otherwise, he or
she may be missed in the census.

No

Last Name

First Name

MI

1. How many people were living or staying in this house,

Last Name
MI

First Name

6. What is Person 1’s sex? Mark I
J
K ONE box.
Male

Female

7. What is Person 1’s age and what is Person 1’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

Month

Day

Year of birth

➜ NOTE: Please answer BOTH Question 8 about Hispanic origin and

Question 9 about race. For this census, Hispanic origins are not races.

8. Is Person 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. C

apartment, or mobile home on April 1, 2010?
Age on April 1, 2010

Sex
Male

Month

Day

Year

Female

Person 11

Yes
No

First Name

Last Name

2. Were there any additional people staying here
April 1, 2010 that you did not include in Question 1?
Mark I
J
K all that apply.
Children, such as newborn babies or foster children
Relatives, such as adult children, cousins, or in-laws
Nonrelatives, such as roommates or live-in baby sitters
People staying here temporarily
No additional people

MI

If you need help completing this form, call 1-866-872-6868 between 8:00 a.m. and 9:00 p.m.,
7 days a week. The telephone call is free.
Sex

Age on April 1, 2010

Month

Male

Related to Person 1?

Date of Birth
Day

Year

Sex

Last Name

Age on April 1, 2010

Male

3. Is this house, apartment, or mobile home —
Mark I
J
K ONE box.

No

Female

Person 12

TDD — Telephone display device for the hearing impaired. Call 1-866-783-2010 between
8:00 a.m. and 9:00 p.m., 7 days a week. The telephone call is free.

Yes

First Name

Day

Year

Female

Yes
No

JIC1

4. What is your telephone number? We may call if we
don’t understand an answer.
Area Code + Number
–

Respondents are not required to respond to any information collection unless it displays a valid approval
number from the Office of Management and Budget.

FOR OFFICIAL USE ONLY

Thank you for completing your official
2010 Census form.

Owned by you or someone in this household with a
mortgage or loan? Include home equity loans.
Owned by you or someone in this household free and
clear (without a mortgage or loan)?
Rented?
Occupied without payment of rent?

The U.S. Census Bureau estimates that, for the average household, this form will take about 10 minutes to
complete, including the time for reviewing the instructions and answers. Send comments regarding this burden
estimate or any other aspect of this burden to: Paperwork Reduction Project 0607-0919-C, U.S. Census
Bureau, AMSD-3K138, 4600 Silver Hill Road, Washington, DC 20233. You may e-mail comments to
< [email protected] >; use "Paperwork Project 0607-0919-C" as the subject.

Related to Person 1?

Date of Birth
Month

¿NECESITA AYUDA? Si usted necesita ayuda para completar este cuestionario, llame al
1-866-928-2010 entre las 8:00 a.m. y 9:00 p.m., 7 días a la semana. La llamada telefónica
es gratis.

MI

9. What is Person 1’s race? Mark I
J
K one or more boxes.

Number of people =

If your enclosed postage-paid envelope is missing, please mail your completed form to:
U.S. Census Bureau
National Processing Center
1201 East 10th Street
Jeffersonville, IN 47132

Related to Person 1?

Date of Birth

JIC2

–

OMB No. 0607-0725: Approval Expires 8/30/2010.
Form

§,,"¤
111101
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➞

DY-1(X) (8-5-2008)

USCENSUSBUREAU

Fold line

➞

White
Black, African Am., or Negro
American Indian or Alaska Native — Print name of enrolled or principal tribe. C

Japanese
Asian Indian
Chinese
Korean
Filipino
Vietnamese
Other Asian — Print race, for
example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on. C

Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander — Print
race, for example, Fijian, Tongan,
and so on. C

Some other race — Print race. C

10. Does Person 1 sometimes live or stay somewhere else?
No

Yes — Mark I
J
K all that apply.
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

➜ If more people were counted in Question 1, continue with Person 2.

➞

➞

Person 10

• Count all people, including babies, who live and sleep here
most of the time.
The Census Bureau also conducts counts in institutions
and other places, so:

MI

Date of Birth
Month

The Census must count every person living in the United
States on April 1, 2010.
Before you answer Question 1, count the people living in
this house, apartment, or mobile home using our guidelines.

Yes
No

Fold Line

Last Name

U.S. CENSUS BUREAU

DY-1(X) - Base prints in BLACK DY-1(X) - Prints Pantone PROCESS CYAN (10%. 20%, 25%,50% and 100%)

Person 7

Economics and Statistics Administration

This is the official form for all the people at this address.
It is quick and easy, and your answers are protected by law.

Use this section to complete information for the rest of the people you counted in Question 1 on the
front page. We may call for additional information about them.

Last Name

Last Name

First Name

First Name

MI

J
K ONE box.
2. How is this person related to Person 1? Mark I
Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

2. How is this person related to Person 1? Mark I
J
K ONE box.
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

J
K ONE box.
3. What is this person’s sex? Mark I

3. What is this person’s sex? Mark I
J
K ONE box.

Female

Male

4. What is this person’s age and 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

Month

Day

Year of birth

Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Female

Male

Fold Line ➞

3. What is this person’s sex? Mark I
J
K ONE box.

Female

Male

4. What is this person’s age and what is this person’s date of birth?

Female

4. What is this person’s age and 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.

Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

Age on April 1, 2010

Age on April 1, 2010

Age on April 1, 2010

Age on April 1, 2010

Month

Day

Year of birth

Month

Day

Year of birth

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. C

Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. C

6. What is this person’s race? Mark I
J
K one or more boxes.

Month

Day

Year of birth

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

Question 6 about race. For this census, Hispanic origins are not races.
5. Is this person of Hispanic, Latino, or Spanish origin?

Day

Year of birth

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

Question 6 about race. For this census, Hispanic origins are not races.

5. Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. C

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. C

6. What is this person’s race? Mark I
J
K one or more boxes.

Month

6. What is this person’s race? Mark I
J
K one or more boxes.

White
Black, African Am., or Negro
American Indian or Alaska Native — Print name of enrolled or principal tribe. C

White
Black, African Am., or Negro
American Indian or Alaska Native — Print name of enrolled or principal tribe. C

White
Black, African Am., or Negro
American Indian or Alaska Native — Print name of enrolled or principal tribe. C

White
Black, African Am., or Negro
American Indian or Alaska Native — Print name of enrolled or principal tribe. C

White
Black, African Am., or Negro
American Indian or Alaska Native — Print name of enrolled or principal tribe. C

Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian — Print race, for
example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on. C

Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian — Print race, for
example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on. C

Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian — Print race, for
example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on. C

Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian — Print race, for
example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on. C

Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian — Print race, for
example, Hmong, Laotian, Thai,
Pakistani, Cambodian, and so on. C

Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander — Print
race, for example, Fijian, Tongan,
and so on. C

Some other race — Print race. C

7. Does this person sometimes live or stay somewhere else?
No

No
For child custody
In jail or prison
In a nursing home
For another reason

If more people were counted in Question 1 on the front page,
continue with Person 3.

➜

No
For child custody
In jail or prison
In a nursing home
For another reason

➜

If more people were counted in Question 1 on the front page,
continue with Person 4.

No
For child custody
In jail or prison
In a nursing home
For another reason

If more people were counted in Question 1 on the front page,
continue with Person 5.

➜

7. Does this person sometimes live or stay somewhere else?

Yes — Mark I
J
K all that apply.
In college housing
In the military
At a seasonal
or second residence

Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander — Print
race, for example, Fijian, Tongan,
and so on. C

Some other race — Print race. C

7. Does this person sometimes live or stay somewhere else?

Yes — Mark I
J
K all that apply.
In college housing
In the military
At a seasonal
or second residence

Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander — Print
race, for example, Fijian, Tongan,
and so on. C

Some other race — Print race. C

7. Does this person sometimes live or stay somewhere else?

Yes — Mark I
J
K all that apply.
In college housing
In the military
At a seasonal
or second residence

Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander — Print
race, for example, Fijian, Tongan,
and so on. C

Some other race — Print race. C

7. Does this person sometimes live or stay somewhere else?

Yes — Mark I
J
K all that apply.
In college housing
In the military
At a seasonal
or second residence

Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander — Print
race, for example, Fijian, Tongan,
and so on. C

No
For child custody
In jail or prison
In a nursing home
For another reason

Yes — Mark I
J
K all that apply.
In college housing
In the military
At a seasonal
or second residence

➜

If more people were counted in Question 1 on the front page,
continue with Person 6.

For child custody
In jail or prison
In a nursing home
For another reason

If more than six people were counted in Question 1 on
the front page, turn the page and continue.
Form DY-1(X) (8-5-2008)

Fold Line ➞

§,,#¤
111102

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

Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

6. What is this person’s race? Mark I
J
K one or more boxes.

Some other race — Print race. C

➜

Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and
➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and
Question 6 about race. For this census, Hispanic origins are not races.
Question 6 about race. For this census, Hispanic origins are not races.
Question 6 about race. For this census, Hispanic origins are not races.
5. Is this person of Hispanic, Latino, or Spanish origin?
5. Is this person of Hispanic, Latino, or Spanish origin?
5. Is this person of Hispanic, Latino, or Spanish origin?

6. What is this person’s race? Mark I
J
K one or more boxes.

MI

2. How is this person related to Person 1? Mark I
J
K ONE box.

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

3. What is this person’s sex? Mark I
J
K ONE box.
Male

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin — Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. C

Husband or wife
Biological son or daughter
Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Female

4. What is this person’s age and what is this person’s date of birth?

First Name

MI

2. How is this person related to Person 1? Mark I
J
K ONE box.

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

3. What is this person’s sex? Mark I
J
K ONE box.

4. What is this person’s age and what is this person’s date of birth?

First Name

MI

2. How is this person related to Person 1? Mark I
J
K ONE box.

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

Last Name

Last Name

First Name

MI

1. Print name of Person 6

Fold Line ➞

➜ If more people
live here, turn
the page and
continue.

Fold Line ➞

Last Name

1. Print name of Person 5

1. Print name of Person 4

DY-1(X) - Pantone PROCESS CYAN (10%, 25%, 50% and 100%)

1. Print name of Person 3

DY-1(X) - Base prints BLACK

1. Print name of Person 2

Male

Fold Line ➞

Fold Line ➞

Draft 2 (8-5-2008)

C

U.S. Department of Commerce
Economics and Statistics Administration
U.S. Census Bureau
1201 E 10th Street
Jeffersonville IN 47144

C

OFFICIAL BUSINESS
Penalty for Private Use $300
D-8C(AZ) (7-2008)

To return your census form, please
make sure the BAR CODE ABOVE YOUR
ADDRESS appears in this window.

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 16081

WASHINGTON DC

POSTAGE WILL BE PAID BY U.S. CENSUS BUREAU

2010 CENSUS DATA CAPTURE CENTER
4722 BUCKEYE ROAD
PHOENIX AZ 85043-XXXX
|8504300000|

7/30/2008 - Size 9-7/16 x 5-11/16" Covered window 5 x 1-1/16"

8504300000

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

To return your census form, please make sure the BAR CODE
ABOVE YOUR ADDRESS appears in the window of this envelope.
Thank you for participating in the 2008 Census Dress Rehearsal.

7-30-2008

D-8C(AZ) (BACK)