D-1380 U.S. Initial Housing Unit Followup Quality Control Form

Attachment C

Put Block Cluster Bar Code here

Note: Bar code is the same layout and information as on HUFU packet sheet.

FORM D-1380 (08/25/2008) U.S. DEPARTMENT OF COMMERCE

OMB No. XXXX-XXXX: Economics and Statistics Administration

Approval Expires XX/XX/20XX U.S. CENSUS BUREAU

Census Coverage Measurement (CCM)

Initial Housing Unit Followup (IHUFU) Quality Control (QC) Form

2010 Census

Page XX of XX

INTRODUCTION – Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. Recently, Census employees checked addresses in this area as part of the 2010 Decennial Census. I am here to check the quality of their work. My questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it).

Section A: Identification

1. Cluster No.: XXXXXXXX

2. LCO Name: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

3. LCO Code: XXXX

Section B: Assignment Information

Position (a)

Name (b)

FR Code (c)

Dates

Assigned (d)

Completed (e)

Month

Day

Month

Day

1. QC Crew Leader

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2. QC Checker

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3. QC Checker

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Section C: QC Check

Followup Cases Selected for QC Check

QC Check Results

Page # (a)

CCM

Census

Followup Code (h)

Case Correct (No Critical Errors)* (i)

Case Incorrect (One or More Critical Errors) (j)

Block (b)

MSN (c)

WMSN (d)

Block (e)

Census ID (f)

MSN (g)

XXXXXXX

XXXXXX

XXXX

XXXXXXX

XXXXXXXXX

XXXXX

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(Note: Listing of sample continues as needed, possibly causing section to scroll to second page.)

1. Total Number of Cases Selected for QC Check: XX

2. Acceptance Number - Cluster passes if Total Incorrect is less than or equal to: XX

3. Total Correct

4. Total Incorrect

5. QC Check Outcome (Mark (X) one):  Pass  Fail – Rectify

Notes

Section D: Rectification

1. Total Number of Followup Cases in Cluster

XXXXX

2. Total Number of Incorrect Cases in Cluster (Cases with One or More Critical Errors)

*List of Noncritical Errors:

• Spelling errors

• Street-type errors

• For a GQ, one of the fields for facility name or description is filled and correct, but the other is either incorrect or blank.

CENSUS CONFIDENTIAL: RESTRICTED DATA FOR OFFICIAL USE ONLY. Information contained in this report is for use by the Census Bureau and is confidential by law (Title 13, U.S.C.). It may be seen only by sworn Census employees and may be used only for statistical purposes.