D-941 ETLRI-EQ Reinterview Form for [ETL] Enumerator Questionnaire

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-EQ)			U.S. Department of Commerce			TRANSITORY LOCATION (TL) IDENTIFICATION
Economics and Statistics Administration						1. LCO/ST/CO:
U.S. Census Bureau
						2. AA Number:
						3. TL Case ID Number:
						4. TL Name:
Reinterview Form for Enumerator Questionnaires						5. TL Address:
Operation: Enumeration at Transitory Locations
2010 Census						6. EQ Processing ID Number:
						7. Respondent Name:
						8. Respondent Telephone Number:
						QUESTIONNAIRE INFORMATION
						1. Questionnaire Check-in Date [month/day/year]: / /
						2. Enumerator Name/Applicant ID Number:
REINTERVIEW INFORMATION
1. Reinterview Clerk Name:
2. Reinterview Date [month/day/year]: / /
Note: verify that you have transcribed all necessary information onto the reinterview form before contacting respondent!
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 you were recently interviewed by a Census Bureau Enumerator
at the _________________________ (transcribe name of TL from original questionnaire).”
“May I please speak with Mr./Ms. _______________________________?” (Transcribe name from original TL Questionnaire)
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 below:
_________________________________________________
Read the Confidentiality Notice on the D-1(F), Information Sheet, to the respondent!
Ask the respondent:
“Were you (or original respondent) contacted on or about ____/____/____(Transcribe date from original TL Questionnaire) by a census enumerator
1.		Yes - If “Yes”, skip to question D.
2.		No - If “No”, thank respondent, end interview and mark (X) ‘Fail’ (below) as the Final Outcome
3.		I don’t know- If “I don’t know”, thank respondent, end interview and mark (X) ‘Fail’ (below)
as the Final Outcome
D. “In this operation, we want to count people where they usually live and sleep.” “For people with more than
one place to live, this is the place where they sleep most of the time.” “When you were interviewed
at (transcribe name of TL from original questionnaire), did you have another usual residence?”
If “Yes”, thank respondent and end interview
Mark (X) ‘Fail’ (below) as the Final Outcome for the interview
If “No” or “I don’t know”, ask:
E. “Including yourself, how many people were living or staying in this (RV/boat/room/unit) on ____/____/____
(Transcribe date from original TL Questionnaire)?” __________
Thank respondent and end interview
Mark (X) ‘Pass’ (below) as the Final Outcome for the interview

REINTERVIEW FINAL OUTCOME
Determining Final Outcome:
Pass -					If the respondent answers, “No” or “I don’t know”, to the usual home elsewhere
					question (question D), mark the Final Outcome as “Pass”
Fail -					Mark the Final Outcome as, “Fail” for the following reasons:
					If the respondent answers, “No” or “I don’t know”, to the question of whether they were
					contacted, (question C), mark the Final Outcome as “Fail”
					If the respondent answers, “Yes”, to the usual home elsewhere question (question D),
					mark the Final Outcome as “Fail”
Unable to Contact -					Mark the Final Outcome as “Unable to Contact” for the following reasons:
					If you are unable to contact the original respondent or proxy after at least 3 attempts
					If the telephone number provided by the respondent is non-working or incorrect
Final Outcome (also key into OCS)
				Pass
				Fail
				Unable to Contact
PLEASE USE THE SECTION BELOW TO PROVIDE ANY ADDITIONAL INFORMATION