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pdfTargeted Coverage Followup (TCFU)
Phone Interview
ADDRESS INFORMATION #1
Block
LCO
House No, Street Name
Unit
House No, Street Name
Physical Location Description
City
Zip
City
Phone Number
1
2
3
4
5
6
7
8
CaseID
Unit
Physical Location Description
State
Phone
number
ADDRESS INFORMATION #2
Block
LCO
State
ZIP
Phone Number
Respondent /Contact
Date
Time
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Interviewer
ID No.
Call Outcome
Phone number
Respondent
/Contact
Date
Time
Interviewer
ID No.
Call
Outcome
9
10
11
12
13
14
15
16
Final Outcome Code
Office Processing
BARCODE
August 28, 2009
1
Section A – Same Phone # - Whole Household or Partial Household -- Contacting The Household
1.
Hello my name is (Specify name) and I’m from the U.S. Census Bureau. Have I reached the
household?
[ ] Yes – Go to 3 Î
[ ] No – Continue to 2
2.
Have I reached either or ?
[ ] Yes, Which address?
[ ] ADDR1 – Go to Section B
[ ] ADDR2 – Go to Section B
[ ] Neither – Go to Section End
3.
May I speak to , , ….
[ ] Dup #1 – Go to Section C
[ ] Dup #2
[ ] Dup #3
[ ] Dup #4
[ ] Dup #5
[ ] Dup #6
[ ] Dup #7 – Go to Section C
[ ] No, person(s) no longer live here. – Go to 5
[ ] No, person(s) will be gone for an extended period of time. - Go to 5
[ ] No, person is currently not available. – Continue to 4
4.
What is the best time to reach one of the people I just mentioned?
Who
Date
Time
a.m.
p.m.
a.m.
p.m.
Thank you, we will try back then.
5.
6.
Is there an adult member of the
household who I can speak to now?
[ ] Yes – Continue to 6
[ ] No – Thank you for your time – Go to the front of the questionnaire and record the result.
As needed, Hello my name is (Specify name) and I’m from the U.S. Census Bureau.
What is your name:
[ ] Person 1
[ ] Person 5
[ ] Person 2
[ ] Person 6
[ ] Person 3
[ ] Person 7
[ ] Person 4
[ ] Person 8
[ ] Someone else: __________________________________________
GO TO Section C
August 28, 2009
2
Section B – Same Phone # - Whole Household or Partial Household -- Wrong HH, Correct Address
The purpose of my call is to help the Census Bureau take the most accurate census. We are doing
research to help improve future censuses.
5.
I am required by law to tell you that this survey is authorized by Title 13, Section 182, of the United
States Code. This survey is mandatory and your cooperation is very important. All the information
you provide will remain completely confidential. Our approval number from the Office of
Management and Budget is XXXX-XXXX. The interview will take approximately 10 minutes and
may be monitored to evaluate my performance.
6. What is their phone number and address?
Phone number:
1.
2.
3.
Do you know the household?
[ ] Yes – Continue to 2
[ ] No – Go to 7
House number:
Did they move out, are they neighbors, or do you know them some other way?
[ ] Moved out – Continue to 3
[ ] Neighbors – Go to 5 Æ
[ ] Other – Please specify:____________________________________ Go to 5 Æ
Apt/Unit Number:
When did they move out?
Month
Day
Street name:
Year
City
7.
During 2009, did YOUR household move?
[ ] Yes – Continue to 8
[ ] No – Go to Section END
[ ] DK – Go to Section END
8.
When did your household move?
Month
Day
- Go to 5
[ ] DK – Continue to 4
4.
Do you know how to contact the household?
[ ] Yes – Continue to 6
[ ] No – go to 7
[ ] DK – Go to 7
Did the household move out before, on, or after April 1, 2009?
[ ] Before April 1 – Go to 5
[ ] On April 1 – Go to 5
[ ] After April 1 – Go to 5
[ ] DK – Go to 5
State
Year
ZIP Code
- Go to 5
[ ] DK Æ [ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
9.
(ask or verify) Was your household there on Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Go to Section END
August 28, 2009
3
Section C – Same Phone # - Whole Household or Partial Household -- Right HH, Have Respondent
The purpose of my call is to help the Census Bureau take the most accurate census. We are doing
research to help improve future censuses.
I am required by law to tell you that this survey is authorized by Title 13, Section 182, of the United
States Code. This survey is mandatory and your cooperation is very important. All the information
you provide will remain completely confidential. Our approval number from the Office of
Management and Budget is XXXX-XXXX. The interview will take approximately 10 minutes and
may be monitored to evaluate my performance.
1.
Have I reached either or ?
[ ] Yes, Which address?
[ ] ADDR1 – Continue to 2
[ ] ADDR2 – Continue to 2
[ ] Neither – Go to 3, next page
2.
Do you recognize the other address?
[ ] Yes – Is that address…
[ ] One that / moved from? – Go to Q7
[ ] A second home?
[ ] A vacation home?
[ ] A seasonal home?
[ ] A place / sometimes stays for school?
[ ] A place / sometimes stays for the military?
[ ] A place / sometimes stays for work?
[ ] A relatives house, apt, or mobile home, such as:
[ ] A parent’s
[ ] A grandparent’s
[ ] A son or daughter’s
[ ] A brother or sister’s
[ ] Some other relative, please specify: _____________________
[ ] A nonrelatives house, apt, or mobile home, such as:
[ ] A boyfriend, girlfriend, significant other, or companion.
[ ] Roommate, old or new.
[ ] Landlord
[ ] Some other nonrelative, please specify: _____________________
[ ] A place / sometimes stays for health care purposes?
[ ] A place / sometimes stays to care for someone else?
[ ] Something else?, please specify:______________________________________________
[ ] DK – Go to Q7
[ ] No – Go to Section P
[ ] DK – Go to Section P
August 28, 2009
4
Section C2 – Same P# - Whole Household or Partial Household --Right HH, Neither Address
6.
Do you recognize ?
[ ] Yes – Is that address…
[ ] One that / moved from? – Go to Q7
[ ] A second home?
[ ] A vacation home?
[ ] A seasonal home?
[ ] A place / sometimes stays for school?
[ ] A place / sometimes stays for the military?
[ ] A place / sometimes stays for work?
[ ] A relatives house, apt, or mobile home, such as:
[ ] A parent’s
[ ] A grandparent’s
[ ] A son or daughter’s
[ ] A brother or sister’s
[ ] Some other relative, please specify: _____________________
[ ] A nonrelatives house, apt, or mobile home, such as:
[ ] A boyfriend, girlfriend, significant other, or companion.
[ ] Roommate, old or new.
[ ] Landlord
[ ] Some other nonrelative, please specify: _____________________
[ ] A place / sometimes stays for health care purposes?
[ ] A place / sometimes stays to care for someone else?
[ ] Something else?, please specify:______________________________________________
[ ] DK – Go to Q7
[ ] No - Go to Section P
[ ] DK - Go to Section P
August 28, 2009
5
3. What is / current address?
House number:
Street name:
Apt/Unit Number:
City
State
ZIP Code
[ ] DK – Probe for street, city, state
4.
When did the / move into this address?
Month
Day
Year
[ ] DK
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
5.
Do you recognize ?
[ ] Yes – Is that address… - Go to Q6
[ ] One that / moved from? – Go to Q6
[ ] A second home?
[ ] A vacation home?
[ ] A seasonal home?
[ ] A place / sometimes stays for school?
[ ] A place / sometimes stays for the military?
[ ] A place / sometimes stays for work?
[ ] A relatives house, apt, or mobile home, such as:
[ ] A parent’s
[ ] A grandparent’s
[ ] A son or daughter’s
[ ] A brother or sister’s
[ ] Some other relative, please specify: _____________________
[ ] A nonrelatives house, apt, or mobile home, such as:
[ ] A boyfriend, girlfriend, significant other, or companion.
[ ] Roommate, old or new.
[ ] Landlord
[ ] Some other nonrelative, please specify: _____________________
[ ] A place / sometimes stays for health care purposes?
[ ] A place / sometimes stays to care for someone else?
[ ] Something else?, please specify:______________________________________________
[ ] DK – Go to Q6
[ ] No - Section P
[ ] DK - Section P
7. Now I’m going to ask you questions about when each person was living or staying at . – Go to B1
B1. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C1. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B2. During 2010, when did live or stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or more
places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
B4. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C4. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B5. During 2010, when did live or stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or more
places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C2. (ask or verify) Were you/Was he/she there on Wednesday,
April 1st?
[ ] Yes [ ] No [ ] DK
C5. (ask or verify) Were you/Was he/she there on Wednesday,
April 1st?
[ ] Yes [ ] No [ ] DK
B3. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C3. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B6. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C6. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Interviewer, Continue to Next Page for the next Address.
August 28, 2009
6
8. Now I’m going to ask you questions about when each person was living or staying at . – Go to B7
B7. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C7. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B10. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C10. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B8. During 2010, when did live or stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or more
places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C8. (ask or verify) Were you/Was he/she there on Wednesday,
April 1st?
[ ] Yes [ ] No [ ] DK
B11. During 2010, when did live or stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or more
places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C11. (ask or verify) Were you/Was he/she there on Wednesday,
April 1st?
[ ] Yes [ ] No [ ] DK
B9. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C9. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B12. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C12. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Interviewer, Continue to the next page if you collected a new address from the respondent, otherwise go to Section END.
August 28, 2009
7
9. Now I’m going to ask you questions about when each person was living or staying at the current address– Go to B13
B13. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C13. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B16. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C16. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B14. During 2010, when did live or stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or more
places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C14. (ask or verify Were you/Was he/she there on Wednesday,
April 1st?
[ ] Yes [ ] No [ ] DK
B17. During 2010, when did live or stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or more
places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C17. (ask or verify) Were you/Was he/she there on Wednesday,
April 1st?
[ ] Yes [ ] No [ ] DK
B15. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C15. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B18. During 2010, when did live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C18. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Go to Section END
August 28, 2009
8
Section A – Different Phone # - Whole Household or Partial Household - Identifying The Household
1.
Hello my name is (Specify name) and I’m from the U.S. Census Bureau. Have I reached the
household?
[ ] Yes – Go to 3
[ ] No – Continue to 2
2.
Have I reached ?
[ ] Yes - Go to Section B
[ ] No – Go to Section End
3.
May I speak to , , ….
[ ] Dup #1 – Go to Section C
[ ] Dup #2
[ ] Dup #3
[ ] Dup #4
[ ] Dup #5
[ ] Dup #6
[ ] Dup #7 – Go to Section C
[ ] No, person(s) no longer live here. – Go to 5
[ ] No, person(s) will be gone for an extended period of time. - Go to 5
[ ] No, person is currently not available. – Continue to 4
4.
What is the best time to reach one of the people I just mentioned?
Who
Date
Time
a.m.
p.m.
a.m.
p.m.
Thank you, we will try back then.
5.
6.
Is there an adult member of the
household who I can speak to now?
[ ] Yes – Continue to 6
[ ] No – Thank you for your time – Go to the front of the questionnaire and record the result.
As needed, Hello my name is (Specify name) and I’m from the U.S. Census Bureau.
What is your name:
[ ] Person 1
[ ] Person 5
[ ] Person 2
[ ] Person 6
[ ] Person 3
[ ] Person 7
[ ] Person 4
[ ] Person 8
[ ] Someone else: __________________________________________
GO TO Section C
August 28, 2009
9
Section B – Different Phone # - Whole Household or Partial Household - Wrong HH, Right ADDR
The purpose of my call is to help the Census Bureau take the most accurate census. We are doing
research to help improve future censuses.
5.
I am required by law to tell you that this survey is authorized by Title 13, Section 182, of the United
States Code. This survey is mandatory and your cooperation is very important. All the information
you provide will remain completely confidential. Our approval number from the Office of
Management and Budget is XXXX-XXXX. The interview will take approximately 10 minutes and
may be monitored to evaluate my performance.
6. What is the phone number and address?
Phone number:
1.
2.
3.
Do you know the household?
[ ] Yes – Continue to 2
[ ] No – Go to 5
House number:
Did they move out, are they neighbors, or do you know them some other way?
[ ] Moved out – Continue to 3
[ ] Neighbors – Continue to 5 Æ
[ ] Other – Please specify:____________________________________ Continue to 5 Æ
Apt/Unit Number:
When did they move out?
Month
Day
Street name:
Year
City
7.
During 2009, did YOUR household move?
[ ] Yes – Continue to 8
[ ] No – Go to Section END
[ ] DK – Go to Section END
8.
When did your household move?
Month
Day
- Go to 5
[ ] DK – Continue to 4
4.
Do you know how to contact the household?
[ ] Yes – Continue to 6
[ ] No – go to 7
[ ] DK – Go to 7
Did the household move out before, on, or after April 1, 2009?
[ ] Before April 1
[ ] On April 1
[ ] After April 1
[ ] DK
State
Year
ZIP Code
- Go to 5
[ ] DK Æ [ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
9.
(ask or verify) Was your household there on Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Go to Section END
August 28, 2009
10
Section C – Different Phone # - Whole Household - Right HH, Have Respondent
The purpose of my call is to help the Census Bureau take the most
accurate census. We are doing research to help improve future
censuses.
I am required by law to tell you that this survey is authorized by Title
13, Section 182, of the United States Code. This survey is mandatory
and your cooperation is very important. All the information you
provide will remain completely confidential. Our approval number
from the Office of Management and Budget is XXXX-XXXX. The
interview will take approximately 10 minutes and may be monitored
to evaluate my performance.
1. Have I reached ?
[ ] Yes - Continue to 2
[ ] No – Go to 6
A1. What was/is the address of that
place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
B1. Thinking of the time that the
NAMES household spent at those
two places, did everyone in your
household go from place to place at
the same time or different times?
[] Yes, same time - Answer the next
question thinking of your entire
household.
[] No, different times - Answer the
next question just thinking of
yourself.
Address collected from Question:_____
2.
During 2009, did the
NAME household move?
[ ] Yes – Go to A1
[ ] No – Go to 3
[ ] DK – Go to 3
During 2009, Did the
NAME household have a
second home?
[ ] Yes – Go to A1 or A2
[ ] No – Go to 4
[ ] DK – Go to 4
D1. (ask or verify) Was the NAME household there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
3.
4.
During 2009, Did the
NAME household have a
vacation or seasonal home?
[ ] Yes – Go to A1 or A2
[ ] No – Go to 5
[ ] DK – Go to 5
5.
During 2009, Did the
NAME household stay
anywhere for any other
reason?
[ ] Yes – Go to A1 or A2
[ ] No – Go to Section P/GQ
[ ] DK – Go to Section P/GQ
C1. During 2009, when did the NAME household live or
stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did the household move or go back and forth
between 2 or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
A2. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
August 28, 2009
B2. Thinking of the time that the
NAMES household spent at those
two places, did everyone in your
household go from place to place at
the same time or different times?
[] Yes, same time - Answer the next
question thinking of your entire
household.
[] No, different times - Answer the
next question just thinking of
yourself.
C2. During 2009, when did the NAME household live or
stay at that place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did the household move or go back and forth
between 2 or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights.
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
D2. (ask or verify) Was the NAME household there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
11
Section C2 – Different Phone # - Whole Household - Housing Unit Questions
9.
6. What address have I reached?
House number:
Situation: Did he/she move or go back and forth between 2 or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
Street name:
Apt/Unit Number:
City
During 2009, when did the household live or stay at ?
From
To
State
ZIP Code
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
[ ] DK – Probe for street, city, state
7.
8.
Do you recognize ?
[ ] Yes – Is that address…
[ ] One that your household moved from? - Go to Q8
[ ] A second home?
[ ] A vacation home?
[ ] A seasonal home?
[ ] A place your household sometimes stays for work?
[ ] Something else?, please specify:______________________________________________
[ ] DK – Go to Q8
[ ] No – Go to Section P/GQ
[ ] DK – Go to Section P/GQ
10. (ask or verify) Was the household there on Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
GO TO Section P/GQ
Thinking of the time that the NAMES household spent at those two places, did everyone in your
household go from place to place at the same time or different times?
[] Same time - Answer the next question thinking of your entire household. -- Continue to 9
[] Different times - Answer the next question just thinking of yourself. -- Continue to 9
August 28, 2009
12
Section C – Different Phone # - Partial Household -Housing Unit Questions
The purpose of my call is to help the Census Bureau take the most accurate census. We are doing
research to help improve future censuses.
I am required by law to tell you that this survey is authorized by Title 13, Section 182, of the United
States Code. This survey is mandatory and your cooperation is very important. All the information
you provide will remain completely confidential. Our approval number from the Office of
Management and Budget is XXXX-XXXX. The interview will take approximately 10 minutes and
may be monitored to evaluate my performance.
1.
4.
Thinking of the time that NAMES spent at those two places, did NAMES go from place to place
at the same time or different times?
[] Yes, same time - Answer the next question thinking of everyone.
[] No, different times - Answer the next question just thinking of yourself.
5.
During 2009, when did you/ live or stay at ?
From
mm/dd/2009
To mm/dd/2009
Have I reached
[ ] Yes – Go to Section P
[ ] No – Continue to 2
Situation: Did you/NAMES move or go back and forth between 2 or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
2. What address have I reached?
House number:
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
Street name:
Apt/Unit Number:
City
State
ZIP Code
[ ] DK – Probe for street, city, state
6.
3.
Do you recognize ?
[ ] Yes – Is that address…
[ ] One that moved from? - Go to Q4
[ ] A second home?
[ ] A vacation home?
[ ] A seasonal home?
[ ] A place sometimes stays for work?
[ ] Something else?, please specify:______________________________________________
[ ] DK – Go to Q4
[ ] No – Go to Section P/GQ
[ ] DK – Go to Section P/GQ
(ask or verify) Were you/NAMES there on Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Go to Intro/Section P/GQ
August 28, 2009
13
Children often have more than one place to stay. The next series of questions asks about the {child/children} in this
household and where they might have stayed this year, that is, during the calendar year 2009. Let’s start with .
1. During 2009, did
A1. What is the address of that place?
B1. During 2009, when did you/he/she live or stay at that
[ ] Same as _______________________
stay part of
place?
From
mm/dd/2009
To mm/dd/2009
the time with another
House Number _____________________
Situation: Did he/she move or go back and forth between 2
parent, or
Street Name________________________
or more places?
grandparent?
[ ] Yes – Go to A1
Apt/Unit Number___________________
[ ] Move – was the move
[ ] No – Go to 2
City______________________________
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] DK – Go to 2
State______________ Zip_____________
[ ] Back and forth
[ ] Not in U.S.
How often he/she stay at that place:Mark (X) all that apply.
[ ] DK/REF -- Probe for street, city, state.
[ ] Most of the time?
[ ] Did not stay?
2. During 2009, Did
[ ] Half of the time?
stay part of
Address collected from Question:_____
[ ] Less than half of the time?
the time with another
[ ] Short Stays?
relative like an aunt
[ ] Daytime only, didn’t spend nights?
or cousin?
[ ] Yes – Go to A1 or A2
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] No – Go to 3
[ ] Th [ ] F [ ] Sa
[ ] DK – Go to 3
C1. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
3. During 2009, Did
[ ] Yes [ ] No [ ] DK
have a
different address for
school?
[ ] Yes – Go to A1 or A2
[ ] No – Go to 4, next page
[ ] DK – Go to 4, next page
A2. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B2. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C2. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
August 28, 2009
Section P - Kids Series
D1. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E1. Who usually lives at
that place?
D2. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E2. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
14
Section P - Kids Series
During 2009, did
ever stay
overnight somewhere
for child care
purposes?
[ ] Yes – Go to 4a Æ
[ ] No – Go to 5
[ ] DK – Go to 5
A3. What is the address of that place?
[ ] Same as _______________________
4.
During 2009, Did
ever stay
with a friend,
neighbor, or legal
guardian?
[ ] Yes – Go to 5a Æ
[ ] No – Go to 6
[ ] DK – Go to 6
4a. Did stay
there more than 7 nights
in the past year?
[ ] Yes - Go to A3 or A4
[ ] No – Go to 5
[ ] DK – Go to 5
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
5.
Is NAME a foster
child?
[ ] Yes – Go to 6a Æ
[ ] No – Go to 7
[ ] DK – Go to 7
5a. Did stay
there more than 7 nights
in the past year?
[ ] Yes - Go to A3 or A4
[ ] No – Go to 6
[ ] DK – Go to 6
6.
6a. During 2009, did
stay
somewhere else?
[ ] Yes - Go to A3 or A4
[ ] No – Go to 7
[ ] DK – Go to 7
B3. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C3. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
A4. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B4. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C4. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
August 28, 2009
D3. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E3. Who usually lives at
that place?
D4. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E4. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
15
Section P - Kids Series
7.
During 2009, has
NAME stayed
anywhere else for any
of the following
reasons:
Education or training?
[ ] Yes [ ] No [ ] DK
Athletics or sports?
[ ] Yes [ ] No [ ] DK
Hobbies?
[ ] Yes [ ] No [ ] DK
Camps or lessons?
[ ] Yes [ ] No [ ] DK
Vacation or retreats?
[ ] Yes [ ] No [ ] DK
To care for someone?
[ ] Yes [ ] No [ ] DK
Because of financial
problems?
[ ] Yes [ ] No [ ] DK
Conferences or
conventions?
[ ] Yes [ ] No [ ] DK
Because of health
problems, either yours or
theirs?
[ ] Yes [ ] No [ ] DK
INT CHECK: Did you
answer “Yes” to any of the
above?
[ ] Yes – Go to 7a Æ
[ ] No – Continue to 8
8.
Did stay
anywhere else, even
for just one night or
on the weekend?
[ ] Yes – Go to 8a Æ
[ ] No – Go to 9
[ ] DK – Go to 9
A5. What was the address of each place
that he/she stayed more than 7 nights?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
Facility Name_______________________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B5. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C5. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
7a. For that/those
reason(s), did he/she
stay at any one place
more than 7 nights in
the past year?
[ ] Yes – Go to A5 or A6
[ ] No – Go to 8
[ ] DK – Go to 8
8a. Did he/she stay there
more than 7 nights in
the past year?
[ ] Yes – Go to A5
[ ] No – Go to 9
[ ] DK – Go to 9
A6. What was the address of each place
that he/she stayed more than 7 nights?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
Facility Name_______________________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B6. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C6. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
August 28, 2009
D5. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E5. Who usually lives at
that place?
D6. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E6. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
16
Section P – Kid Series
9.
(ask or verify) What is
your/NAME’s current
address?
[ ] ADDR1 – Go to B7
[ ] ADDR2 – Go to B7
[ ] Other address – Go to A7
A7. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B7. During 2009, when did you/he/she live or stay at
your/his/her current address?
From
mm/dd/2009
To mm/dd/2009
Situation: Did you/he/she move or go back and forth
between 2 or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C7. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
- Go to Next person OR Section END
August 28, 2009
17
The following questions will ask you about activities you/NAME may have done this year, that is, during the
calendar year 2009. If you’ve done these things this year, please say “yes”, even if you aren’t still doing them.
A1. What is the address of that place?
[ ] Same as _______________________
1. During 2009, have
you/has NAME
House Number _____________________
moved?
[ ] Yes – Go to 1a Æ
Street Name________________________
1a. Did you/he/she move
[ ] No – Go to 2
Apt/Unit Number___________________
once or more than once?
[ ] Once – Go to A1 or A2
[ ] DK – Go to 2
City______________________________
[ ] More than once
State______________ Zip_____________
[ ] Not in U.S.
How many places, not
[ ] DK/REF -- Probe for street, city, state.
counting you’re your
current address?
2. During 2009, Have
_____
If college, probe for
you/Has NAME
Collect all addresses
University Name___________________
attended college, grad
Dorm Name_______________________
school, or any
training program?
[ ] Yes – Go to 2a Æ
If military, probe for, is it:
2a. Did you/he/she have
[ ] No – Go to 3
[ ] A barracks _____________________
another place to stay for 2b. Did you/he/she have
[ ] DK – Go to 3
[ ] A ship _________________________
school?
one place or more than
[ ] Yes – Go to 2b Æ
one place?
[ ] No – Go to 3
Address collected from Question:_____
[ ] One – Go to A1 or A2
[ ] DK – Go to 3
[ ] More than one
How many?_____
A2. What is the address of that place?
Collect all addresses
[ ] Same as _______________________
3. During 2009, Have
you/Has NAME been
House Number _____________________
in the military?
Street Name________________________
[ ] Yes – Go to 3a Æ
3a. Did you/he/she stay
Apt/Unit Number___________________
[ ] No – Go to 4
at another place in 2009, 3b. Did you/he/she have
City______________________________
[ ] DK – Go to 4
because of the military?
one place or more than
State______________ Zip_____________
[ ] Yes – Go to 3b Æ
one place?
[ ] Not in U.S.
[ ] No – Go to 4
[ ] One – Go to A1 or A2
[ ] DK/REF -- Probe for street, city, state.
[ ] DK – Go to 4
[ ] More than one
How many?_____
If college, probe for
Collect all addresses
University Name___________________
4. During 2009, Have
Dorm Name_______________________
you/Has NAME had
a job?
If military, probe for, is it:
[ ] Yes – Go to 4a Æ
4a. Did you/he/she have
4b. Did you/he/she have
[ ] A barracks _____________________
[ ] No – Go to 5
another place to stay
one place or more than
[ ] A ship _________________________
[ ] DK – Go to 5
because of your job?
one place?
[ ] Yes – Go to 4b Æ
[ ] One – Go to A1 or A2
Address collected from Question:_____
[ ] No – Go to 5
[ ] More than one
[ ] DK – Go to 5
How many?_____
Collect all addresses
August 28, 2009
Section P – Young Adults
B1. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Half of the time
[ ] Less than half of the time?
[ ] Short Stays
[ ] Daytime only, didn’t spend nights
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
E1. Who else stays at
that place?
C1. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Name 8: __________
B2. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Half of the time
[ ] Less than half of the time?
[ ] Short Stays
[ ] Daytime only, didn’t spend nights
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C2. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
E2. Who else stays at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
18
Section P - Young Adults
During 2009, have
you/has NAME had a
seasonal or vacation
home?
[ ] Yes – Go to 5a Æ
[ ] No – Go to 6
[ ] DK – Go to 6
A3. What is the address of that place?
[ ] Same as _______________________
5.
5a. Did you/he/she have
one place or more than
one place?
[ ] One – Go to A3
[ ] More than one
How many?_____
Collect all addresses
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
If college, probe for
University Name___________________
Dorm Name_______________________
6.
During 2009, Have
you/Has NAME had
another residence
that you owned or
rented?
[ ] Yes – Go to 6a Æ
[ ] No – Go to 7
[ ] DK – Go to 7
5a. Did you/he/she have
one place or more than
one place?
[ ] One – Go to A3 or A4
[ ] More than one
How many?_____
Collect all addresses
If military, probe for, is it:
[ ] A barracks _____________________
[ ] A ship _________________________
Address collected from Question:_____
A4. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B3. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C3. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B4. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C4. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
August 28, 2009
D3. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E3. Who usually lives at
that place?
D4. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E4. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
19
Section P - Young Adults
People stay with friends
and relatives for many
different reasons. We are
interested in whether
you/NAME stayed with
anyone any time this
year, that is during 2009.
Please say "yes" even if
you/NAME have/has only
stayed with someone on
weekends, for a few
weeks, or off-and-on
throughout the year.
During 2009, have
you/has NAME
stayed at a different
address with a
relative, such as a
parent, grandparent,
aunt or cousin?
[ ] Yes – Go to A5
[ ] No – Go to 8
[ ] DK – Go to 8
A5. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
7.
8.
During 2009, Have
you/Has NAME
stayed with a
boyfriend or
girlfriend,?
[ ] Yes – A5 or A6
[ ] No – Go to 9
[ ] DK – Go to 9
B5. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C5. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
A6. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B6. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C6. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
August 28, 2009
D5. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E5. Who usually lives at
that place?
D6. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E6. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
20
Section P - Young Adults
9.
During 2009, have
you/has NAME
stayed anywhere for
any of the following
reasons:
Education or training?
[ ] Yes [ ] No [ ] DK
Athletics or sports?
[ ] Yes [ ] No [ ] DK
Hobbies?
[ ] Yes [ ] No [ ] DK
Camps or lessons?
[ ] Yes [ ] No [ ] DK
Vacation or retreats?
[ ] Yes [ ] No [ ] DK
To care for someone?
[ ] Yes [ ] No [ ] DK
Because of financial
problems?
[ ] Yes [ ] No [ ] DK
Conferences or
conventions?
[ ] Yes [ ] No [ ] DK
Because of health
problems, either yours or
someone else’s?
[ ] Yes [ ] No [ ] DK
INT CHECK: Did you
answer “Yes” to any of the
above?
[ ] Yes – Go to 9a Æ
[ ] No – Continue to 10
10. Did you/
stay anywhere else,
even for just one
night or on the
weekend?
[ ] Yes – Go to 10a Æ
[ ] No – Go to 11
[ ] DK – Go to 11
A7. What was the address of each place
that he/she stayed more than 7 nights?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
Facility Name_______________________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state,
facility name.
Address collected from Question:_____
B7. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C7.(ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
A8. What was the address of each place
that he/she stayed more than 7 nights?
[ ] Same as _______________________
9a. For that/those
reason(s), did you/he/she
stay at any one place
more than 7 nights in
the past year?
[ ] Yes – Go to A7
[ ] No – Go to 10
[ ] DK – Go to 10
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
Facility Name_______________________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state,
facility name.
Address collected from Question:_____
10a. Did you/he/she stay
there more than 7 nights
in the past year?
[ ] Yes – Go to A7 or A8
[ ] No – Go to 11
[ ] DK – Go to 11
B8. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C8. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
August 28, 2009
D7. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E7. Who usually lives at
that place?
D8. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E8. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
21
Section P – Young Adults
11. (ask or verify) What is
your/NAME’s current
address?
[ ] ADDR1 – Go to B9
[ ] ADDR2 – Go to B9
[ ] Other address – Go to A9
A9. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B9. During 2009, when did you/he/she live or stay at
your/his/her current address?
From
mm/dd/2009
To mm/dd/2009
Situation: Did you/he/she move or go back and forth
between 2 or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that
apply.
[ ] Most of the time?
[ ] Did not
stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C9. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
- Go to Next person OR Section END
August 28, 2009
22
The following questions will ask you about activities you/NAME may have done this year, that is, during the
calendar year 2009. If you’ve done these things this year, please say “yes”, even if you aren’t still doing them.
A1. What is the address of that place?
[ ] Same as _______________________
1. During 2009, have
you/has NAME
House Number _____________________
moved?
[ ] Yes – Go to 1a Æ
Street Name________________________
1a. Did you/he/she move
[ ] No – Go to 2
Apt/Unit Number___________________
once or more than once?
[ ] Once – Go to A1 or A2
[ ] DK – Go to 2
City______________________________
[ ] More than once
State______________ Zip_____________
[ ] Not in U.S.
How many places, not
[ ] DK/REF -- Probe for street, city, state.
counting you’re your
current address?
2. During 2009, Have
Collect all addresses
If college, probe for
you/Has NAME
University Name___________________
attended college, grad
Dorm Name_______________________
school, or any
training program?
[ ] Yes – Go to 2a Æ
If military, probe for, is it:
2a. Did you/he/she have
[ ] No – Go to 3
[ ] A barracks _____________________
another place to stay for 2b. Did you/he/she have
[ ] DK – Go to 3
[ ] A ship _________________________
school?
one place or more than
[ ] Yes – Go to 2b Æ
one place?
[ ] No – Go to 3
Address collected from Question:_____
[ ] One – Go to A1 or A2
[ ] DK – Go to 3
[ ] More than one
How many?_____
A2. What is the address of that place?
Collect all addresses
[ ] Same as _______________________
3. During 2009, Have
you/Has NAME been
House Number _____________________
in the military?
Street Name________________________
[ ] Yes – Go to 3a Æ
3a. Did you/he/she stay
Apt/Unit Number___________________
[ ] No – Go to 4
at another place in 2009, 3b. Did you/he/she have
City______________________________
[ ] DK – Go to 4
because of the military?
one place or more than
State______________ Zip_____________
[ ] Yes – Go to 3b Æ
one place?
[ ] Not in U.S.
[ ] No – Go to 4
[ ] One – Go to A1 or A2
[ ] DK/REF -- Probe for street, city, state.
[ ] DK – Go to 4
[ ] More than one
How many?_____
If college, probe for
Collect all addresses
University Name___________________
4. During 2009, Have
Dorm Name_______________________
you/Has NAME had
4a. Did you/he/she have
a job?
If military, probe for, is it:
[ ] Yes – Go to 4a Æ
another place to stay
4b. Did you/he/she have
[ ] A barracks _____________________
[ ] No – Go to 5
because of your job?
one place or more than
[ ] A ship _________________________
[ ] Yes – Go to 4b Æ
[ ] DK – Go to 5
one place?
[ ] No – Go to 5
[ ] One – Go to A1 or A2
Address collected from Question:_____
[ ] DK – Go to 5
[ ] More than one
How many?_____
Collect all addresses
August 28, 2009
Section P – Stable Adults
B1. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
E1. Who else stays at
that place?
C1. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Name 8: __________
B2. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2 or
more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C2. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
E2. Who else stays at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
23
Section P - Stable Adults
During 2009, have
you/has NAME had
a seasonal or
vacation home?
[ ] Yes – Go to 5a Æ
[ ] No – Go to 6
[ ] DK – Go to 6
A3. What is the address of that place?
[ ] Same as _______________________
5.
During 2009, Have
you/Has NAME had
another residence
that you owned or
rented?
[ ] Yes – Go to 6a Æ
[ ] No – Go to 7
[ ] DK – Go to 7
5a. Did you/he/she have
one place or more than
one place?
[ ] One – Go to A3 or A4
[ ] More than one
How many?_____
Collect all addresses
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
If college, probe for
University Name___________________
Dorm Name_______________________
6.
If military, probe for, is it:
[ ] A barracks _____________________
[ ] A ship _________________________
6a. Did you/he/she have
one place or more than
one place?
[ ] One – Go to A3 or A4
[ ] More than one
How many?_____
Collect all addresses
Address collected from Question:_____
A4. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
If college, probe for
University Name___________________
Dorm Name_______________________
If military, probe for, is it:
[ ] A barracks _____________________
[ ] A ship _________________________
B3. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C3. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B4. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C4. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Address collected from Question:_____
August 28, 2009
D3. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E3. Who usually lives at
that place?
D4. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E4. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
24
Section P - Stable Adults
People stay with friends
and relatives for many
different reasons. We are
interested in whether
you/NAME stayed with
anyone any time this
year, that is during 2009.
Please say "yes" even if
you/NAME have/has only
stayed with someone on
weekends, for a few
weeks, or off-and-on
throughout the year.
During 2009, have
you/has NAME
stayed with a parent,
even just for a night
or weekend?
[ ] Yes – Go to A5
[ ] No – Go to 8
[ ] DK – Go to 8
A5. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
7.
8.
During 2009, have
you/has NAME
stayed with a son or
daughter?
[ ] Yes – Go to A5 or A6
[ ] No – Go to 9
[ ] DK – Go to 9
B5. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C5. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
A6. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
Address collected from Question:_____
B6. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C6. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
August 28, 2009
D5. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E5. Who usually lives at
that place?
D6. Does (name) also
sometimes stay at/use
that address?
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
[ ] Yes [ ] No [ ] DK
E6. Who usually lives at
that place?
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
Name 1:___________
Name 2: __________
Name 3:___________
Name 4: __________
Name 5:___________
Name 6: __________
Name 7:___________
Name 8: __________
[ ] DK
[ ] No one
25
Section P - Stable Adults
A7. What is the address of that place?
[ ] Same as _______________________
9.
During 2009, have
you/has NAME
stayed with a brother
or sister?
[ ] Yes – Go to A7
[ ] No – Go to 10
[ ] DK – Go to 10
10. During 2009, Have
you/has NAME
stayed with any other
relatives, like a
grandparent, aunt or
cousin?
[ ] Yes – Go to A7 or A8
[ ] No – Go to 11
[ ] DK – Go to 11
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
If college, probe for
University Name___________________
Dorm Name_______________________
If military, probe for, is it:
[ ] A barracks _____________________
[ ] A ship _________________________
Address collected from Question:_____
11. During 2009, Have
you/Has NAME
stayed with a
boyfriend, girlfriend,
or significant other,
even if just on
weekends?
[ ] Yes – Go to A7 or A8
[ ] No – Go to 12
[ ] DK – Go to 12
A8. What is the address of that place?
[ ] Same as _______________________
House Number _____________________
Street Name________________________
Apt/Unit Number___________________
City______________________________
State______________ Zip_____________
[ ] Not in U.S.
[ ] DK/REF -- Probe for street, city, state.
If college, probe for
University Name___________________
Dorm Name_______________________
If military, probe for, is it:
[ ] A barracks _____________________
[ ] A ship _________________________
B7. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C7. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
B8. During 2009, when did you/he/she live or stay at that
place?
From
mm/dd/2009
To mm/dd/2009
Situation: Did he/she move or go back and forth between 2
or more places?
[ ] Move – was the move
[ ] Before 4/1 [ ] On 4/1 [ ] After 4/1
[ ] Back and forth
How often he/she stay at that place:Mark (X) all that apply.
[ ] Most of the time?
[ ] Did not stay?
[ ] Half of the time?
[ ] Less than half of the time?
[ ] Short Stays?
[ ] Daytime only, didn’t spend nights?
[ ] Certain days of the week [ ] Su [ ] M [ ] Tu [ ] W
[ ] Th [ ] F [ ] Sa
C8. (ask or verify) Were you/Was he/she there on
Wednesday, April 1st?
[ ] Yes [ ] No [ ] DK
Address collected from Question:_____
August 28, 2009
D7. Does (name) also
sometimes stay at/use
that address?