D-941 ETLRI-TL Reinterview Form for Transitory Locations

This listing contains confidential information, including Title 13 and Personally Identifiable Information (PII), the release of which is protected by the Privacy Act of 1974. OMB No. 0607-0919-C. Approval Expires 12/31/2011.

Form D-941 (ETLRI-TL)

U.S. Department of Commerce

TRANSITORY LOCATION (TL) IDENTIFICATION

Economics and Statistics Administration

1. LCO/ST/CO:

2. AA Number:

U.S. Census Bureau

3. TL Case ID Number:

4. TL Name:

Reinterview Form for Transitory Locations

5. TL Address:

Operation: Enumeration at Transitory Locations

2010 Census

6. TL Contact Name:

7. TL Contact Telephone Number:

TL BINDER INFORMATION

1. TL Binder Check-in Date [month/day/year]: / /

2. Crew Leader or Lead Enumerator Name/Applicant ID Number:

REINTERVIEW INFORMATION

1. Reinterview Clerk Name:

2. Reinterview Date [month/day/year]: ____/____/____

3. Reinterview Type:

Random or

Supplemental

Note: Verify that you have transcribed all necessary information onto the reinterview form before contacting the TL!

Read verbatim below:

A. “Hello, my name is (your name). I work for the U.S. Census Bureau.” “As part of our quality control

procedures, I would like to verify that a Census Bureau Enumerator visited your facility/site recently.”

“May I please speak with Mr./Ms. _______________________________?” (Transcribe name from TL Binder)

If “Yes”, skip to line C  If “No”, read line B

B. “May I speak with someone else who can answer my questions?”

If “Yes”, Enter respondent’s name below:

________________________________________________

If respondent is available, read line C

If a respondent is not immediately available, ask when they would be available for a call back.

Write call back time and date here___________________________________________

Ask the respondent:

“Our records show census staff visited your facility/site on or about ____/____/____ (Transcribe date from TL Binder) to enumerate your units.” “Is this correct?”

1.

Yes

2.

No

Before you accept a response of ‘No’ or ‘I don’t know’, ask respondent if

3.

I don’t know

there is anyone else who might have talked to an enumerator.

Thank respondent and end interview

Mark (X) a Final Outcome for the interview below

REINTERVIEW FINAL OUTCOME

Determining Final Outcome:

Pass -

If the respondent answers, “Yes” or “I don’t know”, mark the Final Outcome as “Pass”

Unable to Contact -

If unable to reach original respondent or a proxy, mark the Final Outcome as “Unable to Contact”,

after consulting with AMQA regarding final status

Soft Fail -

If the respondent answers, “No” and an investigation indicates respondent error or honest

enumerator error, mark the Final Outcome as “Soft Fail”.

Hard Fail -

If the respondent answers, “No” and an investigation indicates enumerator falsification, consult

with AMQA. If AMQA recommends “Hard Fail”, do so below.

Final Outcome (also key into OCS)

Pass

Unable to Contact (Mark only if directed by AMQA or QA OOS)

Soft Fail (Mark only if directed by AMQA or QA OOS)

Hard Fail (Mark based on AMQA Recommendation)

PLEASE USE THE SECTION BELOW TO PROVIDE ANY ADDITIONAL INFORMATION