D-1(E)(RI) Enumeratior-NRFU Reinterview

Draft 4 8-28-2008
OMB No. 0607-0919-C: Approval Expires 12/31/2011

H1.

Yes
Yes
Yes
Yes
Yes

Babies?
Foster children?
Any other relatives?
Roommates?
Any other nonrelatives?
How about anyone else staying here on April 1
who had no permanent place to live?

R1.

No
No
No
No
No

R2.

(Ask or verify) What is your name?
Mark I
J
K this box if respondent is the same as
OR1 on the cover page.
MI
First Name

Number

Area Code

–

–

Last Name

No

R3.

Evening

LCO

Unit ID

State

County

–

Either

Respondent Type –
Household member – Lived here on April 1, 2010
Household member – Moved in after April 1, 2010
Neighbor or other proxy

Address of proxy

Last Name

ENUMERATOR REINTERVIEW QUESTIONNAIRE

What is your phone number and best time to call?

If yes to any category, ask: What is that person’s name?
First Name

Economics and Statistics Administration

U.S. CENSUS BUREAU

Day
Yes

U.S. DEPARTMENT OF COMMERCE

REINTERVIEW RESPONDENT INFORMATION

We do not want to miss any people who might have been staying here on April 1.
Were there any additional people that you didn’t mention, for example:

Tract

Block

AA

Map Spot

➤

➤

APPLY LABEL HERE

Anyone else?
Are there any continuation forms for this address?

Last Name

INTERVIEW SUMMARY

H2.

A.

Unit Status on April 1, 2010

Do you or does someone in this household own this (house/apartment/mobile home) with a mortgage or loan,
including home equity loans; own it free and clear; rent it; or occupy it without having to pay rent?

Occupied
Vacant - regular
Vacant - usual home elsewhere
Demolished/burned out/cannot locate
Nonresidential
Empty mobile home/trailer site
Uninhabitable (open to elements,
condemned, under construction)
Duplicate – record ID of Dup. C

Own with a mortgage or loan (including home equity loans)
Own free and clear (without a mortgage or loan)
Rent
Occupy without payment of rent

NOTES

RECORD OF CONTACT
Type

Mo

Day

Time

Personal
Telephone

Outcome
:

Mo

Day

a.m.
p.m.

Personal
Telephone

:

C.

For rent
Rented, not occupied
For sale only
Sold, not occupied
For seasonal, recreational or
occasional use
For migrant workers
Other vacant

Number of people listed on form(s) =
1 - 49 = Total people
00 = Vacant
98 = Delete
99 = POP unknown

Mo

Day

OR5.

What language was the majority of the interview conducted in?
English
Spanish
Other – Specify language number from flashcard ➙

a.m.
p.m.

E.

MOV

F.
CO

I.

Personal
Telephone
Type

:

Mo

Day

Day

Type

G.
REP

J.

Personal
Telephone

Day

H.

Enumerator’s signature

a.m.
p.m.

Employee ID

K.

:

S1.

JIC2

S2.
Crew Leader’s initials

CLD number

OUTCOME CODES: NV = Left Notice of Visit NC = No Contact RE = Refusal CI = Conducted Interview OT = Other

Month
Month

Day

Telephone Number and Best Time to Contact?

(

)

OR4.

Address –

–

Day

Evening

Either

NOTES

Original Interview Language –

Hello, I’m (Name) from the U.S. Census Bureau. (Show ID).
May I speak to (Original respondent’s name)?

S5.

Does someone usually live at this
[house/apartment/mobile home], or is this a vacation
or seasonal home?
Usually lives here - Continue with S6.
Vacation or seasonal home or held for occasional
use - Skip to back page.

S6.

We need to count people where they live
and sleep most of the time.

Yes – Continue with question S2.
No – Confirm address and ask when original respondent is
available. If unable to reinterview the original repsondent,
interview a knowledgeable proxy, starting with S2.

M.

S3.

a.m.
p.m.

OR2.

INTRODUCTION

Outcome

Time

Original Respondent Type –

VDC

Outcome
:

Mo

I certify that the entries I have made on this questionnaire are
true and correct to the best of my knowledge.

Original Respondent’s Name –

English
Spanish
Other – Specify language number from flashcard ➙

REF

CERTIFICATION

a.m.
p.m.

Time

Personal
Telephone

PI

Outcome
:

Mo

L.

a.m.
p.m.

Time

Personal
Telephone
Type

Outcome

Time

OR1.

Household member – Lived here on April 1, 2010
Household member – Moved in after April 1, 2010
Neighbor or other proxy

JIC1
Type

ORIGINAL RESPONDENT INFORMATION

OR3.

UHE

Outcome

Time

If vacant, ask: Which category best
describes this vacant unit as of
April 1, 2010? (Read categories.)

–

D.
Type

B.

Number of forms

I’m here to check on the quality of our census interviews.
This interview should take about 10 minutes. (Hand
respondent Information Sheet.) The first part of this sheet
explains that your answers are confidential. I’ll refer to
the other parts later.
– If talking to someone at original respondent
address – Continue with S3.
– Otherwise – Skip to S4.
Were you or someone in your household recently
interviewed by the Census Bureau about (Address)?
Yes
No

Day

S4.

Did anyone live or stay at (Address) on April 1, 2010?
Yes – Continue with S5.
No – Skip to back page.

USCENSUSBUREAU

Please look at list A. It contains examples of people
who should and should not be counted at this place.
Based on these examples, how many people were
living or staying in this (house/apartment/mobile
home) on April 1, 2010?
= Number of people
ENUMERATOR ITEM: Did the respondent confirm that the
original interview was conducted (S3 = "Yes")?
Yes – Complete only Question 1 for all household
members, then skip to back page
No – Conduct full interview

§k$"¤
740301

Form D-1(E)

RI (8-28-2008)

D-1(E) RI - Tone prints in Green 368 - 10%, 40%, and 65%

Do not list any people recorded for this question on the inside pages or on a continuation form.

Yes ➙
No

D-1(E) RI - Base print in Black ink

First Name

Draft 4 8/28/2008

Person 1
First Name

2.

Please look at list B on the Information
Sheet. How is (Name) related to (Read name
of Person 1)?

3.

Mark I
J
K ONE box.

Mark I
J
K ONE box.

I
J
K Person 1

Is (Name)
male or
female?

Male
Female

MI

4.

What was (Name’s) age on
April 1, 2010? What is
(Name’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
DATE OF BIRTH
Month

Last Name

Day

5.

Please look at List C. Is (Name) of Hispanic, Latino, or
Spanish origin?
Read if necessary:
Examples of another Hispanic, Latino, or Spanish origin include
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran,
Spaniard, and so on.
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin –
What is that origin? C

Year of birth

Person 2
First Name

MI

Last Name

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

Male
Female

Other relative
Roomer or boarder
Housemate
or roommate

Age on
April 1, 2010
DATE OF BIRTH
Month
Day

Unmarried partner
Other nonrelative

First Name

MI

Last Name

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

Male
Female

Other relative
Roomer or boarder
Housemate
or roommate

Age on
April 1, 2010
DATE OF BIRTH
Month
Day

Unmarried partner
Other nonrelative

Please look at List D and choose one or more races. For this census, Hispanic origin is not a race.
What is (Name’s) race?
Read if necessary:
Examples of other Asian groups include Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
Examples of other Pacific Islander groups include Fijian, Tongan, and so on.

White

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan

Some other race — What is that group?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin –
What is that origin? C

Year of birth

Person 3

6.

Year of birth

First Name

MI

Last Name

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

Male
Female

Other relative
Roomer or boarder
Housemate
or roommate

Age on
April 1, 2010
DATE OF BIRTH
Month

Unmarried partner
Other nonrelative

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin –
What is that origin? C

Day
Year of birth

Person 5
First Name

Last Name

MI

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

Male
Female

Age on
April 1, 2010
DATE OF BIRTH
Month
Day
Year of birth

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan

FORM D-1(E) RI (8-28-2008)

Other Asian — What is that group? C

Other Pacific Islander — What is that group?

➙

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian or
Chamorro

Samoan

Other Asian — What is that group? C

Other Pacific Islander — What is that group?

➙

Mark I
J
K all reasons 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

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

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
No

White

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan

Other Asian — What is that group? C

Other Pacific Islander — What is that group?

➙

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
No

White

Black,
African American,
or Negro

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Native
Hawaiian

Guamanian
or Chamorro

Samoan
➙

Read response categories.

No

White

Some other race — What is that group?

Does (Name) sometimes live
or stay somewhere else for
any of these reasons? –

No

American
What is the name of the enrolled or principal tribe? C
Indian or
Alaska Native

Some other race — What is that group?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin –
What is that origin? C

➙

Black,
African American,
or Negro

Some other race — What is that group?

Person 4

Other Pacific Islander — What is that group?

White

Some other race — What is that group?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin –
What is that origin? C

Other Asian — What is that group? C

7.

Other Asian — What is that group? C

Other Pacific Islander — What is that group?

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
No

§k$#¤
740302

D-1(E) RI - Tone prints in Green 368 - 10%, 40, and 65%

Let’s make a list of all those people. Please start with
the name of an owner or renter who was living here
on April 1. Otherwise, start with any adult living here.

D-1(E) RI - Base print in Black ink

1.