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pdfOMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx
D-1402
U.S. DEPARTMENT OF COMMERCE
FORM
(7-23-10) Draft 8
Targeted Coverage Followup (TCFU)
Phone Interview
Economics and Statistics Administration
U.S. Census Bureau
Attachment B
ADDRESS INFORMATION #1
House Number
ADDRESS INFORMATION #2
Street Name
Apt/Unit Number
City
State
ZIP Code
Street Name
Apt/Unit Number
State
City
Phone Number
Phone Number
House Number
ZIP Code
Phone Number
Respondent/Contact
Contact
Date
Contact
Time
Call Outcome
Appointment
Respondent
Appointment
Date
Appointment
Time
1
a.m.
p.m.
a.m.
p.m.
2
a.m.
p.m.
a.m.
p.m.
3
a.m.
p.m.
a.m.
p.m.
4
a.m.
p.m.
a.m.
p.m.
5
a.m.
p.m.
a.m.
p.m.
6
a.m.
p.m.
a.m.
p.m.
7
a.m.
p.m.
a.m.
p.m.
8
a.m.
p.m.
a.m.
p.m.
Case ID
USCENSUSBUREAU
Final Outcome Code
James Bond
ID Number
Notes
Office Processing
1
Targeted Coverage Followup (TCFU)
Phone Interview
Phone Number
Respondent/Contact
Contact
Date
Contact
Time
Call Outcome
Appointment
Respondent
Appointment
Date
Appointment
Time
9
a.m.
p.m.
a.m.
p.m.
10
a.m.
p.m.
a.m.
p.m.
11
a.m.
p.m.
a.m.
p.m.
12
a.m.
p.m.
a.m.
p.m.
13
a.m.
p.m.
a.m.
p.m.
14
a.m.
p.m.
a.m.
p.m.
15
a.m.
p.m.
a.m.
p.m.
16
a.m.
p.m.
a.m.
p.m.
James Bond
ID Number
Notes
2
Section A1
1. Hello my name is (Specify name) and I’m from the U.S. Census Bureau. Have I reached the
household?
3. Is there an adult member of the
household who I can speak with who can answer questions about
Yes – Skip to 2
➤
No
1a. Have I reached either
Yes – Continue to 4
No – Thank you for your time. We will try back later. Goodbye.
Yes – Which address?
– Go to the front of the questionnaire and record the result.
Skip to Section B, Question 1
Skip to Section B, Question 1
4. Hello my name is (Specify name) and I’m from the U.S. Census Bureau. Who am I speaking with?
Neither – Skip to Section S
2. May I speak with
➤
Someone else – Specify
Yes – Who may I speak with?
⎫
⎬
Skip to 5
(next column)
⎭
No
5. Hello my name is (Specify name) and I’m from the U.S. Census Bureau. The purpose of my call is
to help the Census Bureau take the most accurate census. The Census Bureau is doing research
to help improve future censuses.
This survey is authorized by law, Title 13, Sections 193 and 141, of the United States Code. This
survey is required by law. Your cooperation is very important. All the information you provide will
remain confidential by the same law. Our approval number from the Office of Management and
Budget is (xxxx-xxxx) and this approval expires {expiration date}. Without that number we could
not conduct this survey or require your participation. The interview will take approximately 10
minutes and may be monitored to evaluate my performance.
Person(s) is currently not available – Continue to 2a
Person(s) no longer live here – Skip to 3
Person(s) gone for an extended period of time – Skip to 3
6. Have I reached either
Person(s) deceased – Skip to 3
2a. What is the best time to reach (name/him/her/one of the people I just mentioned)?
Who
Date
Yes – Which address have I reached?
Time
a.m.
p.m.
a.m.
p.m.
Thank you. We will try back then. Goodbye.
– Go to the front of the questionnaire and record the result.
Skip to Section D, Question 1
Skip to Section D, Question 2
Neither – Skip to Section C, Question 1
3
PAGE INTENTIONALLY LEFT BLANK
6
Section A2
1. Hello my name is (Specify name) and I’m from the U.S. Census Bureau. Have I reached the
household?
3. Is there an adult member of the
household who I can speak with who can answer questions about
Yes – Skip to 3
➤
No
Yes – Continue to 4
1a. Have I reached
No – Thank you for your time. We will try back later. Goodbye.
Yes – Skip to Section B, Question 1
– Go to the front of the questionnaire and record the result.
No – Skip to Section S
4. Hello my name is (Specify name) and I’m from the U.S. Census Bureau. Who am I speaking with?
2. May I speak with
➤
Someone else – Specify
Yes – Who may I speak with?
⎫
⎬
Skip to 5
(next column)
⎭
No
5. Hello my name is (Specify name) and I’m from the U.S. Census Bureau. The purpose of my call is
to help the Census Bureau take the most accurate census. The Census Bureau is doing research
to help improve future censuses.
This survey is authorized by law, Title 13, Sections 193 and 141, of the United States Code. This
survey is required by law. Your cooperation is very important. All the information you provide will
remain confidential by the same law. Our approval number from the Office of Management and
Budget is (xxxx-xxxx) and this approval expires {expiration date}. Without that number we could
not conduct this survey or require your participation. The interview will take approximately 10
minutes and may be monitored to evaluate my performance.
Person(s) is currently not available – Continue to 2a
Person(s) no longer live here – Skip to 3
Person(s) gone for an extended period of time – Skip to 3
Person(s) deceased – Skip to 3
6. Have I reached
2a. What is the best time to reach (name/him/her/one of the people I just mentioned)?
Who
Date
Yes – Skip to Section D, Question 1
Time
a.m.
p.m.
No – Skip to Section C, Question 1
a.m.
p.m.
Thank you. We will try back then. Goodbye.
– Go to the front of the questionnaire and record the result.
4
PAGE INTENTIONALLY LEFT BLANK
6
Section B
1. Hello my name is (Specify name) and I’m from the U.S. Census Bureau. 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. Do you know how to contact the
household?
Yes – Continue to 6
No – Skip to 7
This survey is authorized by law, Title 13, Sections 193 and 141, of the United States Code. This
survey is required by law. Your cooperation is very important. All the information you provide will
remain confidential by the same law. Our approval number from the Office of Management and
Budget is (xxxx-xxxx) and this approval expires {expiration date}. Without that number we could
not conduct this survey or require your participation. The interview will take approximately 10
minutes and may be monitored to evaluate my performance.
2. Do you know the
household?
Yes – Continue to 3
DK – Skip to 7
6. What is their phone number and address?
Phone Number
(
)
House Number
Street Name
Apt/Unit Number
No – Skip to 7
City
3. Did they move out, are they friends, neighbors, relatives, or do you know them some other way?
State
Moved out – Continue to 4
Friends – Skip to 5 (next column)
ZIP Code
County
Neighbors – Skip to 5 (next column)
Relatives – Skip to 5 (next column)
DK – Probe for street, city, state, county.
➤
Other – Specify
7. When did your household move into this address?
Month
Day
Year
Skip to 5 (next column)
4. When did they move out?
Month
Day
DK
Year
8. Was your household living at this address on Thursday, April 1st, 2010?
Skip to 5
Yes
DK – Continue to 4a
No
4a. Did the
or after April 1st, 2010?
Before April 1
On April 1
After April 1
DK
household move out before, on,
DK
⎫
⎬
⎭
Skip to Section S
⎫
⎬
Continue to 5 (next column)
⎭
5
PAGE INTENTIONALLY LEFT BLANK
6
Section C
3. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
1. What is
Month
current address?
House Number
Month
Month
Year
2010
To
Year
2010
Day
Month
Day
2010
To
Month
Day
Year
2010
From
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6
DK – Probe for months
City
Month
Day
Day
Year
2010
To
Year
2010
From
Month
Month
Day
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12
DK – Probe for months
ZIP Code
County
DK – Probe for street, city, state, county.
2. Now I’m going to ask you questions about when (each person/
you) lived or stayed at that address, since January 1st of this
year.
Continue to 3
Day
From
Apt/Unit Number
Year
2010
From
Street Name
State
Day
9. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
4. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
10. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Sa
5. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
Yes
6. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Day
Month
Day
Year
2010
From
2010
From
Month
Day
Month
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9
DK – Probe for months
Certain days of the week
Su M Tu W Th F
8. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
DK
Month
Day
Month
Day
Year
2010
Day
Month
Day
Year
2010
To
Year
2010
From
Month
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to 15
DK – Probe for months
7. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
No
From
Year
2010
To
Sa
12. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
To
Year
Certain days of the week
Su M Tu W Th F
11. (Were you/Was he/she) there on Thursday, April 1st, 2010?
DK
Month
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
13. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Sa
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
14. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
7
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6
Section C
16. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Year
2010
From
Month
Day
Day
Year
2010
To
Year
2010
From
Month
Month
Day
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to 18
DK – Probe for months
17. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
18. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
INTERVIEWER INSTRUCTION:
Skip to Section D, Question 2
19. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Month
Day
Year
2010
From
Day
Month
Day
To
Year
2010
To
Year
2010
From
Month
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to Section D, Question 2
DK – Probe for months
20. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
21. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
8
PAGE INTENTIONALLY LEFT BLANK
6
Section D
1. Now I’m going to ask you questions about when
4. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
lived or stayed at
Day
2010
From
These questions are about this year, that is, during the calendar
year 2010. Let’s start with
Month
Day
2. Are you familiar with
Yes – Continue to 3
No – Skip to Section D, Interviewer Check on next page
DK – Skip to Section D, Interviewer Check on next page
3. Can you tell me about that place? Is it, for example, one that
moved from, a second home, a relative’s home,
a place for school, or some other place?
Read as necessary and check all that apply.
➤
Moved from?
Second home?
Vacation or seasonal home?
Place for school?
Place for the military?
Place for work?
Relative’s home, such as:
Parent’s?
Grandparent’s?
Son or daughter’s?
Brother or sister’s?
Some other relative?
Nonrelative’s home, such as:
Boyfriend, girlfriend, significant other?
Friend?
Roommate?
Landlord?
Some other nonrelative?
A place for health care purposes?
A place to care for someone else?
Something else? Please specify
DK
Continue to 4
Month
Day
Year
2010
To
Year
2010
From
➤
Skip to 4
Year
10. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7
DK – Probe for months
No
Certain days of the week
Su M Tu W Th F
Sa
Month
Day
Year
2010
From
2010
From
Month
Day
Month
Day
2010
2010
To
Certain days of the week
Su M Tu W Th F
9. (Were you/Was he/she) there on Thursday, April 1st, 2010?
No
DK
No
Day
Year
2010
To
Certain days of the week
Su M Tu W Th F
Sa
DK
Month
Day
Month
Day
Year
2010
From
Year
Day
Month
Day
Year
2010
To
Year
2010
From
Month
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to 16
DK – Probe for months
8. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Yes
Month
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10
DK – Probe for months
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
2010
2010
To
Year
Year
13. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
To
Year
Day
From
Yes
7. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Day
Month
Day
12. (Were you/Was he/she) there on Thursday, April 1st, 2010?
DK
Month
2010
Month
11. During those dates, how often did (you/he/she) stay there?
Read as necessary.
6. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13
DK – Probe for months
5. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
From
Year
2010
To
Month
14. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Sa
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
15. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
9
PAGE INTENTIONALLY LEFT BLANK
6
Section D
16. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Year
2010
From
Month
Day
Day
Year
2010
To
Year
2010
From
Month
{Different Phone Number Fill}
Month
Day
INTERVIEWER CHECK:
Do not read – Continue to next page
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to 19
DK – Probe for months
17. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
18. (Were you/Was he/she) there on Thursday, April 1st , 2010?
Yes
No
DK
19. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Year
2010
From
Month
Day
Day
To
Year
2010
From
Month
{Same Phone Number Fill}
Month
Day
Year
INTERVIEWER CHECK:
2010
Do not read – Which address did the respondent indicate had been
reached?
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to Interviewer Check
DK – Probe for months
Skip to Section E, Question 1 (next page)
Neither – Skip to Section E, Question 2 (next page)
20. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Skip to Section E, Question 2 (next page)
Sa
21. (Were you/Was he/she) there on Thursday, April 1st , 2010?
Yes
No
DK
10
PAGE INTENTIONALLY LEFT BLANK
6
Section E
4. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
1. Now I’m going to ask you questions about when
Month
lived or stayed at
Day
2010
From
These questions are about this year, that is, during the calendar
year 2010. Let’s start with
Month
Day
2. Are you familiar with
Yes – Continue to 3
No – Skip to Section D, Interviewew Check on next page
DK – Skip to Section D, Interviewer Check on next page
3. Can you tell me about that place? Is it, for example, one that
moved from, a second home, a relative’s home,
a place for school, or some other place?
Read as necessary and check all that apply.
➤
Moved from?
Second home?
Vacation or seasonal home?
Place for school?
Place for the military?
Place for work?
Relative’s home, such as:
Parent’s?
Grandparent’s?
Son or daughter’s?
Brother or sister’s?
Some other relative?
Nonrelative’s home, such as:
Boyfriend, girlfriend, significant other?
Friend?
Roommate?
Landlord?
Some other nonrelative?
A place for health care purposes?
A place to care for someone else?
Something else? Please specify
DK
Continue to 4
Month
Day
Year
2010
To
Year
2010
From
➤
Skip to 4
Year
10. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7
DK – Probe for months
No
Certain days of the week
Su M Tu W Th F
Sa
Month
Day
Year
2010
From
2010
From
Month
Day
Month
Day
2010
2010
To
Certain days of the week
Su M Tu W Th F
9. (Were you/Was he/she) there on Thursday, April 1st, 2010?
No
DK
No
Day
Year
2010
To
Certain days of the week
Su M Tu W Th F
Sa
DK
Month
Day
Month
Day
Year
2010
From
Year
Day
Month
Day
Year
2010
To
Year
2010
From
Month
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to 16
DK – Probe for months
8. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Yes
Month
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10
DK – Probe for months
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
2010
2010
To
Year
Year
13. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
To
Year
Day
From
Yes
7. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Day
Month
Day
12. (Were you/Was he/she) there on Thursday, April 1st, 2010?
DK
Month
2010
Month
11. During those dates, how often did (you/he/she) stay there?
Read as necessary.
6. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13
DK – Probe for months
5. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
From
Year
2010
To
Month
14. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Sa
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
15. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
11
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6
Section E
The questions on this page refer to the following address:
INTERVIEWER CHECK:
16. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Year
2010
From
Month
Day
Day
Year
2010
To
Year
2010
From
Month
Do not read – Was the respondent familiar with
Month
Day
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 – Skip to 19
DK – Probe for months
Yes – Continue
No – Skip to next page.
Do not read – Was the respondent familiar with
Yes – Skip to Section S.
No – Continue to next page.
17. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
18. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
19. During 2010, when did
live or stay at that address?
Please provide as specific dates as possible.
Month
Day
Month
Day
Year
2010
From
Day
Month
Day
Year
2010
To
Year
2010
From
Month
Year
2010
To
Off and on during all of 2010
Did not stay there during 2010 Skip to Interviewer Check
DK – Probe for months
20. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Certain days of the week
Su M Tu W Th F
Sa
21. (Were you/Was he/she) there on Thursday, April 1st, 2010?
Yes
No
DK
12
PAGE INTENTIONALLY LEFT BLANK
6
Section F
1. Now let’s talk about (you/
). The following questions
will ask about activities (you/he/she) may have done this year, that is, during the
calendar year 2010. If (you/he/she) did these things this year, please answer “yes”,
even if (you aren’t/ he/she isn’t) still doing them.
1.1. During 2010, (have you/has has he/she) moved?
Yes – Continue to 1.2a
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.2a. In January 2010, what was the first address where
(you/he/she) lived?
1.2b.
Please provide as specific dates as possible.
Month
Same
as
Day
Street Name
Year
2010
From
House Number
1.2d.
During 2010, when did (you/he/she) live at that place?
Month
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.2e.
No
DK
What are the names of the people who
usually lived at that place in 2010?
1.2f. INTERVIEWER NOTE:
Go to 1.3a, and collect
the next address.
Year
Name 1
Apt/Unit Number
2010
From
City
State
2010
To
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
ZIP Code
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.3a. What was the address of the next place
(you/he/she) lived in 2010?
1.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.3b.
During 2010, when did (you/he/she) live at that place?
Month
Day
Street Name
Year
2010
From
Month
Day
Month
Day
1.3e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
Apt/Unit Number
From
City
State
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Same
as
House Number
1.3d.
ZIP Code
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
1.3f. Was there another
address where
(you/he/she) lived in
2010?
Yes – Continue to 1.4a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Name 2
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
13
Section F
1.4a. What was the address of the next place
(you/he/she) lived in 2010?
1.4b.
During 2010, when did (you/he/she) live at that place?
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.4e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Month
Same
as
Day
Street Name
Year
2010
From
House Number
1.4d.
Month
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
2010
From
City
State
2010
To
DK – Skip to 2 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
ZIP Code
Yes – Continue to 1.5a
No – Skip to 2 (next page)
Name 1
Apt/Unit Number
1.4f. Was there another
address where
(you/he/she) lived
in 2010?
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.5a. What was the address of the next place
(you/he/she) lived in 2010?
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.5b.
During 2010, when did (you/he/she) live at that place?
Month
Day
Street Name
Year
2010
From
Month
Day
Month
Day
1.5e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
From
City
ZIP Code
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
1.5f. Was there another
address where
(you/he/she) lived
in 2010?
Yes – Skip to 2 (next page)
No – Skip to 2 (next page)
Name 1
Apt/Unit Number
State
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Same
as
House Number
1.5d.
DK – Skip to 2 (next page)
Name 2
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
14
Section F
2. During 2010, (have you/has
graduate school?
2.1. Other than places you already mentioned, did (you/he/she) have
another place to stay for school?
) attended a college, university, or
Yes – Continue to 2.1
Yes – Continue to 2.2a
No – Skip to 3 (next page)
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
DK – Skip to 3 (next page)
2.2a. What was the address of the other place?
2.2b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Same
as
House Number
Month
Month
Day
State
ZIP Code
County
Day
Month
Day
What are the names of the people who
usually lived at that place in 2010?
Yes
No
DK
Year
2010
To
2.2e.
Year
2010
To
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2.2f. Was there another
school address where
(you/he/she) stayed
in 2010?
Yes – Continue to 2.3a
No – Skip to 3 (next page)
Name 1
DK – Skip to 3 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.2e
DK – Probe for months
DK
REF
No one else lived there
2.2c. Which semesters or terms did (you/he/she) have or use that
address? Read as necessary.
College/University Name
Dorm Name
Not in United States
DK/REF – Probe for street, city, state, county,
college/university and dorm name
2.3a. What was the address of the other place?
Winter semester/term 2009
Spring semester/term 2010
Summer semester/term 2010
Fall semester/term 2010
Winter semester/term 2010
Month
Day
Month
Apt/Unit Number
From
City
ZIP Code
County
College/University Name
Dorm Name
Not in United States
DK/REF – Probe for street, city, state, county,
college/university and dorm name
Sa
DK
Year
2010
From
Street Name
Certain days of the week
Su M Tu W Th F
2.3b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Same
as
State
Month
Year
2010
From
City
Year
2010
From
Street Name
Apt/Unit Number
House Number
Day
2.2d.
Day
Month
Month
Day
2.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
No
DK
Year
2010
To
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Year
2010
To
Year
2010
Day
2.3d.
Name 1
2.3f. Was there another
school address where
(you/he/she) stayed
in 2010?
Yes – Continue to 2.4a (on
back)
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.3e
DK – Probe for months
DK
REF
No one else lived there
2.3c. Which semesters or terms did (you/he/she) have or use that
address? Read as necessary.
Winter semester/term 2009
Spring semester/term 2010
Summer semester/term 2010
Fall semester/term 2010
Winter semester/term 2010
Certain days of the week
Su M Tu W Th F
Sa
DK
15
Section F
2.4a. What was the address of the other place?
2.4b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Same
as
House Number
Month
Month
Day
State
ZIP Code
County
Day
Month
Day
What are the names of the people who
usually lived at that place in 2010?
Yes
No
DK
Year
2010
To
2.2e.
Year
2010
To
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2.4f. Was there another
school address where
(you/he/she) stayed
in 2010?
Yes – Continue to 2.5a
No – Skip to 3 (next page)
Name 1
DK – Skip to 3 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.4e
DK – Probe for months
DK
REF
No one else lived there
2.4c. Which semesters or terms did (you/he/she) have or use that
address? Read as necessary.
College/University Name
Dorm Name
Not in United States
DK/REF – Probe for street, city, state, county,
college/university and dorm name
2.5a. What was the address of the other place?
Winter semester/term 2009
Spring semester/term 2010
Summer semester/term 2010
Fall semester/term 2010
Winter semester/term 2010
Month
Day
Month
Apt/Unit Number
From
City
ZIP Code
County
College/University Name
Dorm Name
Not in United States
DK/REF – Probe for street, city, state, county,
college/university and dorm name
Sa
DK
Year
2010
From
Street Name
Certain days of the week
Su M Tu W Th F
2.5b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Same
as
State
Month
Year
2010
From
City
Year
2010
From
Street Name
Apt/Unit Number
House Number
Day
2.4d.
Day
Month
Month
Day
2.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
No
DK
Year
2010
To
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Year
2010
To
Year
2010
Day
2.5d.
2.5f. Was there another
school address where
(you/he/she) stayed
in 2010?
Yes – Skip to 3 (next page)
No – Skip to 3 (next page)
Name 1
DK – Skip to 3 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.5e
DK – Probe for months
DK
REF
No one else lived there
2.5c. Which semesters or terms did (you/he/she) have or use that
address? Read as necessary.
Winter semester/term 2009
Spring semester/term 2010
Summer semester/term 2010
Fall semester/term 2010
Winter semester/term 2010
Certain days of the week
Su M Tu W Th F
Sa
DK
16
Section F
3. During 2010, (have you/has
2.1. Other than places you already mentioned, did (you/he/she) stay
at another place in 2010, because of the military?
) been in the military?
Yes – Continue to 3.1
Yes – Continue to 3.2a
No – Skip to 4 (next page)
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
DK – Skip to 4 (next page)
3.2a. What was the address of the other place?
3.2d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
3.2e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
3.2b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
3.3a. What was the address of the other place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.2e
DK – Probe for months
DK
REF
No one else lived there
3.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
3.3b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
DK – Skip to 4 (next page)
2010
To
3.3d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
3.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
2010
From
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
From
City
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
Yes – Continue to 3.3a
No – Skip to 4 (next page)
Year
Name 1
City
3.2f. Was there another
military address where
(you/he/she) stayed
in 2010?
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.3e
DK – Probe for months
3.3f. Was there another
military address where
(you/he/she) stayed
in 2010?
Yes – Continue to 3.4a (on
back)
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
Name 2
DK
REF
No one else lived there
3.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
17
Section F
3.4a. What was the address of the other place?
3.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
3.4e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
3.4b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
3.5a. What was the address of the other place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.4e
DK – Probe for months
DK
REF
No one else lived there
3.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
3.5b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
DK – Skip to 4 (next page)
2010
To
3.5d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
3.5e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
2010
From
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
From
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
2010
To
DK – Skip to 4 (next page)
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.5e
DK – Probe for months
3.5f. Was there another
military address where
(you/he/she) stayed
in 2010?
Yes – Skip to 4 (next page)
No – Skip to 4 (next page)
Year
Name 1
City
Yes – Continue to 3.5a
No – Skip to 4 (next page)
Year
Name 1
City
3.4f. Was there another
military address where
(you/he/she) stayed
in 2010?
Name 2
DK
REF
No one else lived there
3.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
18
Section F
4. During 2010, (have you/has
had a job?
4.1. Other than places you already mentioned, did (you/he/she) have
another place to stay because of (your/his/her) job?
)
4.2. Did (you/he/she) stay at any one place more
than 7 nights total for that job?
Yes – Continue to 4.1
Yes – Continue to 4.2
Yes – Continue to 4.3a
No – Skip to 5 (next page)
No – Skip to 5 (next page)
No – Skip to 5 (next page)
DK – Skip to 5 (next page)
DK – Skip to 5 (next page)
DK – Skip to 5 (next page)
4.3a. What was the address of the other place?
4.3d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
4.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
4.3b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Yes – Continue to 4.4a
Name 1
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
4.4a. What was the address of the other place?
2010
To
No – Skip to 5 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.3e
DK – Probe for months
DK
4.4b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
REF
No one else lived there
Day
Month
Apt/Unit Number
Year
2010
From
4.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Day
4.4e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.4e
DK – Probe for months
4.4f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for work
purposes?
Yes – Continue to 4.5a (on
back)
No – Skip to 5 (next page)
Name 1
From
City
DK – Skip to 5 (next page)
4.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Su M Tu W Th F Sa
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Please provide as specific dates as possible.
Same
as
House Number
2010
From
City
4.3f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for work
purposes?
Name 2
DK
REF
No one else lived there
DK – Skip to 5 (next page)
4.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
19
Section F
4.5a. What was the address of the other place?
4.5d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
4.5e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
4.5b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Yes – Continue to 4.6a
Name 1
2010
From
City
State
ZIP Code
County
Facility Name
2010
To
DK
Not in United States
DK/REF – Probe for street, city, state, county
4.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
4.6a. What was the address of the other place?
4.6b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
No one else lived there
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
4.6e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
2010
To
REF
4.6d.
Please provide as specific dates as possible.
Same
as
House Number
No – Skip to 5 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.5e
DK – Probe for months
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.6e
DK – Probe for months
DK – Skip to 5 (next page)
4.6f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for work
purposes?
Yes – Skip to 5 (next page)
Name 1
From
City
4.5f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for work
purposes?
No – Skip to 5 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 5 (next page)
4.6c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
20
Section F
5. Other than places you already mentioned, during 2010, (have you/
has
) had a seasonal or vacation home?
Yes – Continue to 5.1a
No – Skip to 6 (next page)
DK – Skip to 6 (next page)
5.1a. What was the address of that place?
During 2010, when did (you/he/she) stay at or visit that place?
5.1d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
5.1e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
5.1b.
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
County
Not in United States
DK/REF – Probe for street, city, state, county
5.2a. What was the address of that place?
DK
5.2b.
During 2010, when did (you/he/she) stay at or visit that place?
Month
Street Name
REF
No one else lived there
5.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
5.2d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
5.2e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
DK – Skip to 6 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.1e
DK – Probe for months
ZIP Code
Facility Name
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes – Continue to 5.2a
No – Skip to 6 (next page)
Name 1
2010
From
City
5.1f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.2e
DK – Probe for months
5.2f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
Yes – Continue to 5.3a (on
back)
No – Skip to 6 (next page)
DK – Skip to 6 (next page)
Name 2
DK
REF
No one else lived there
5.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
21
Section F
5.3a. What was the address of that place?
During 2010, when did (you/he/she) stay at or visit that place?
5.3d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
5.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
5.3b.
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
County
Not in United States
DK/REF – Probe for street, city, state, county
5.4a. What was the address of that place?
DK
5.4b.
During 2010, when did (you/he/she) stay at or visit that place?
Month
Street Name
REF
No one else lived there
5.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
5.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
5.4e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
DK – Skip to 6 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.3e
DK – Probe for months
ZIP Code
Facility Name
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.4e
DK – Probe for months
5.4f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
Yes – Skip to 6 (next page)
No – Skip to 6 (next page)
Name 1
City
Yes – Continue to 5.4a
No – Skip to 6 (next page)
Name 1
2010
From
City
5.3f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
DK – Skip to 6 (next page)
Name 2
DK
REF
No one else lived there
5.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
22
Section F
6. Other than places you already mentioned, during 2010, (have you/has
had another residence that (you/he/she) owned or rented?
)
Yes – Continue to 6.1a
No – Skip to 7 (next page)
DK – Skip to 7 (next page)
6.1a. What was the address of that place?
6.1d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
6.1e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
6.1b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
No – Skip to 7 (next page)
Year
Name 1
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
6.2a. What was the address of that place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.1e
DK – Probe for months
DK
REF
No one else lived there
6.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
6.2b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
DK – Skip to 7 (next page)
2010
To
6.2d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
6.2e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
2010
From
City
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
6.1f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
Yes – Continue to 6.2a
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.2e
DK – Probe for months
6.2f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
Yes – Continue to 6.3a (on
back)
No – Skip to 7 (next page)
DK – Skip to 7 (next page)
Name 2
DK
REF
No one else lived there
6.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
23
Section F
6.3a. What was the address of that place?
6.3d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
6.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
6.3b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
No – Skip to 7 (next page)
Year
Name 1
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
6.4a. What was the address of that place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.3e
DK – Probe for months
DK
REF
No one else lived there
6.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
6.4b. During 2010, when did (you/he/she) live or stay at that address?
Month
Street Name
DK – Skip to 7 (next page)
2010
To
6.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
6.4e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
2010
From
City
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
DK – Skip to 7 (next page)
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.4e
DK – Probe for months
6.4f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
Yes – Skip to 7 (next page)
No – Skip to 7 (next page)
Year
Name 1
City
6.3f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
Yes – Continue to 6.4a
Name 2
DK
REF
No one else lived there
6.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
24
Section F
7. People stay with friends and relatives for many different reasons. The following
questions will ask whether (you/
) stayed
with any friends or relatives at any time this year, that is, during the calendar year
2010. Please answer "yes" even if (you/he/she) only stayed with someone on
weekends, for a few weeks, or off and on throughout the year.
7.1.
Other than places you already mentioned, during
2010, (have you/has he/she) stayed with a parent?
Yes – Continue to 7.2a
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
7.2a. What was the address of that place?
Same
as
House Number
7.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
7.3a. What was the address of that place?
Same
as
Year
2010
To
7.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
7.2f. Was there another
parent’s address where
(you/he/she) stayed in
2010?
Yes – Continue to 7.3a
No – Skip to 8 (next page)
Name 1
DK – Skip to 8 (next page)
Name 2
REF
No one else lived there
7.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
7.2e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.2e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
7.2d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
7.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
7.3d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.3e
DK – Probe for months
No
DK
Name 1
7.3f. Was there another
parent’s address where
(you/he/she) stayed in
2010?
Yes – Continue to 7.4a (on
back)
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
Name 2
DK
REF
No one else lived there
7.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
25
Section F
7.4a. What was the address of that place?
Same
as
House Number
7.4b.
During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
Not in United States
DK/REF – Probe for street, city, state, county
7.5a. What was the address of that place?
Same
as
Year
2010
To
7.5b.
During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
Day
Year
2010
From
Apt/Unit Number
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
No – Skip to 8 (next page)
Name 1
DK – Skip to 8 (next page)
Name 2
DK
Month
Day
Year
Street Name
ZIP Code
What are the names of the people who
usually lived at that place in 2010?
7.4f. Was there another
parent’s address
where (you/he/she)
stayed in 2010?
Yes – Continue to 7.5a
REF
No one else lived there
7.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Month
City
7.4e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.4e
DK – Probe for months
County
Facility Name
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
7.4d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
7.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
7.5d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.5e
DK – Probe for months
No
DK
7.5f. Was there another
parent’s address
where (you/he/she)
stayed in 2010?
Yes – Skip to 8 (next page)
No – Skip to 8 (next page)
Name 1
DK – Skip to 8 (next page)
Name 2
DK
REF
No one else lived there
7.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
26
Section F
8. Other than places you already mentioned, during 2010, (have you/has
stayed with a son or daughter?
)
Yes – Continue to 8.1a
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
8.1a. What was the address of that place?
Same
as
House Number
8.1b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
8.2a. What was the address of that place?
Same
as
Year
2010
To
8.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
8.1f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 8.2a
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
Name 2
REF
No one else lived there
8.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
8.1e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.1e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
8.1d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
8.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
8.2d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.2e
DK – Probe for months
No
DK
Name 1
Name 2
8.2f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 8.3a (on
back)
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
DK
REF
No one else lived there
8.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
27
Section F
8.3a. What was the address of that place?
Same
as
House Number
8.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
8.4a. What was the address of that place?
Same
as
Year
2010
To
8.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
8.3f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 8.4a
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
Name 2
REF
No one else lived there
8.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
8.3e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.3e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
8.3d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
8.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
8.4d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.4e
DK – Probe for months
No
DK
Name 1
8.4f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Skip to 9 (next page)
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
Name 2
DK
REF
No one else lived there
8.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
28
Section F
9. Other than places you already mentioned, during 2010, (have you/has
stayed with a brother or sister?
)
Yes – Continue to 9.1a
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
9.1a. What was the address of that place?
Same
as
House Number
9.1b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.2a. What was the address of that place?
Same
as
Year
2010
To
9.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
9.1f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 9.2a
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
Name 2
REF
No one else lived there
9.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
9.1e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.1e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
9.1d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
9.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
9.2d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.2e
DK – Probe for months
No
DK
Name 1
Name 2
9.2f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 9.3a (on
back)
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
DK
REF
No one else lived there
9.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
29
Section F
9.3a. What was the address of that place?
Same
as
House Number
9.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.4a. What was the address of that place?
Same
as
Year
2010
To
9.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
9.3f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 9.4a
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
Name 2
REF
No one else lived there
9.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
9.3e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.3e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
9.3d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
9.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
9.4d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.4e
DK – Probe for months
No
DK
Name 1
9.4f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Skip to 10 (next page)
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
Name 2
DK
REF
No one else lived there
9.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
30
Section F
10. Other than places you already mentioned, during 2010, (have you/has
stayed with any other relatives, like a grandparent, aunt or cousin?
)
Yes – Continue to 10.1a
No – Skip to 11 (next page)
DK – Skip to 11 (next page)
10.1a. What was the address of that place?
Same
as
House Number
10.1b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
10.2a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
10.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
10.1f. Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Continue to 10.2a
No – Skip to 11 (next page)
DK – Skip to 11 (next page)
Name 2
REF
No one else lived there
10.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
10.1e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.1e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
10.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.2e
DK – Probe for months
10.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
10.2e. What are the names of the people who
usually lived at that place in 2010?
Name 1
10.2f. Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Continue to 10.3a (on
back)
No – Skip to 11 (next page)
DK – Skip to 11 (next page)
Name 2
DK
REF
No one else lived there
10.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
31
Section F
10.3a. What was the address of that place?
Same
as
House Number
10.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
10.4a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
10.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
10.3f. Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Continue to 10.4a
No – Skip to 11 (next page)
DK – Skip to 11 (next page)
Name 2
REF
No one else lived there
10.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
10.3e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.3e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
10.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.4e
DK – Probe for months
10.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
10.4e. What are the names of the people who
usually lived at that place in 2010?
10.4f. Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Skip to 11 (next page)
No – Skip to 11 (next page)
Name 1
DK – Skip to 11 (next page)
Name 2
DK
REF
No one else lived there
10.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
32
Section F
11. Other than the places you already mentioned, during 2010, (have you/has
stayed with a boyfriend, girlfriend, or significant other, even if just on weekends?
)
Yes – Continue to 11.1a
No – Skip to 12 (next page)
DK – Skip to 12 (next page)
11.1a. What was the address of that place?
Same
as
House Number
11.1b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
11.2a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
11.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
11.1f. Was there another
place where
(you/he/she) stayed
with a significant other
in 2010?
Yes – Continue to 11.2a
No – Skip to 12 (next page)
DK – Skip to 12 (next page)
Name 2
REF
No one else lived there
11.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
11.1e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.1e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
11.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.2e
DK – Probe for months
11.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
11.2e. What are the names of the people who
usually lived at that place in 2010?
Name 1
Name 2
11.2f. Was there another
place where
(you/he/she) stayed
with a significant other
in 2010?
Yes – Continue to 11.3a (on
back)
No – Skip to 12 (next page)
DK – Skip to 12 (next page)
DK
REF
No one else lived there
11.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
33
Section F
11.3a. What was the address of that place?
Same
as
House Number
11.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
11.4a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
11.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
11.3f. Was there another
place where
(you/he/she) stayed
with a significant other
in 2010?
Yes – Continue to 11.4a
No – Skip to 12 (next page)
DK – Skip to 12 (next page)
Name 2
REF
No one else lived there
11.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
11.3e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.3e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
11.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.4e
DK – Probe for months
11.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
11.4e. What are the names of the people who
usually lived at that place in 2010?
Name 1
11.4f. Was there another
place where
(you/he/she) stayed
with a significant other
in 2010?
Yes – Skip to 12 (next page)
No – Skip to 12 (next page)
DK – Skip to 12 (next page)
Name 2
DK
REF
No one else lived there
11.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
34
Section F
12. Other than the places you already mentioned, during 2010, (have you/has
stayed with any other people, such as friends?
12.1. Did (you/he/she) stay at any one place for
more than 7 nights total in 2010?
)
Yes – Continue to 12.1
Yes – Continue to 12.2a
No – Skip to 13 (next page)
No – Skip to 13 (next page)
DK – Skip to 13 (next page)
DK – Skip to 13 (next page)
12.2a What was the address of that place?
Same
as
House Number
12.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
12.3a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
12.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
12.2f
Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Continue to 12.3a
No – Skip to 13 (next page)
Name 2
REF
No one else lived there
DK – Skip to 13 (next page)
12.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
12.2e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.2e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
12.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.3e
DK – Probe for months
12.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
12.3e. What are the names of the people who
usually lived at that place in 2010?
12.3f. Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Continue to 12.4a (on
back)
No – Skip to 13 (next page)
Name 1
Name 2
DK
REF
No one else lived there
DK – Skip to 13 (next page)
12.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
35
Section F
12.4a. What was the address of that place?
Same
as
House Number
12.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
12.5a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
12.5b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
12.4f. Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Continue to 12.5a
No – Skip to 13 (next page)
Name 2
REF
No one else lived there
DK – Skip to 13 (next page)
12.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
12.4e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.4e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
12.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.5e
DK – Probe for months
12.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
12.5e. What are the names of the people who
usually lived at that place in 2010?
12.5f. Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Skip to 13 (next page)
Name 1
No – Skip to 13 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 13 (next page)
12.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
36
Section F
INTERVIEWER CHECK:
13. Other than places you already mentioned, during 2010, did (you/he/she) stay anywhere for any of the following reasons:
a. Training or internships?
Yes
No
DK
b. A vocational program?
Yes
No
DK
c. Athletics or sports?
Yes
No
d. Hobbies?
Yes
g. To care for someone else?
No
DK
e. Camps or lessons?
Yes
No
Yes
13.2a. What was the address of that place?
Same
as
No
DK
Yes
i.
DK
DK
No
DK
Because of health problems,
either (yours/his/hers) or
someone else’s?
Yes
No
Do not read – Did the respondent
answer "Yes" to any of those
reasons, 13a through 13j?
DK
Yes – Continue to 13.1
Conferences or conventions?
Yes
No
No – Skip to 14 (next page)
DK
13.2b. During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
Month
House Number
No
h. Because of financial problems?
f. Vacations or retreats?
DK
Yes
j.
Day
Year
Month
Day
Year
2010
To
13.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
2010
13.2e. What are the names of the people who
usually lived at that place in 2010?
Year
Name 1
Street Name
From
13.1. For (that/those) reason(s) (specify
as needed), did (you/he/she) stay
at any one place for more than 7
nights total in 2010?
Yes – Continue to 13.2a
No – Skip to 14 (next page)
DK – Skip to 14 (next page)
Apt/Unit Number
Month
City
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
13.3a. What was the address of that place?
Same
as
Month
Day
2010
To
DK
13.3b. During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
No one else lived there
No – Skip to 14 (next page)
13.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Month
Day
Month
Day
Year
2010
From
ZIP Code
REF
DK – Skip to 14 (next page)
Month
Day
Month
Day
Year
Street Name
City
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.2e
DK – Probe for months
Apt/Unit Number
State
Year
2010
From
State
House Number
Day
13.2f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the
reason(s) mentioned
before (specify as
needed)?
Yes – Continue to 13.3a
2010
2010
To
Year
To
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.3e
DK – Probe for months
13.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
13.3e. What are the names of the people who
usually lived at that place in 2010?
Name 1
Name 2
DK
REF
No one else lived there
13.3f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the
reason(s) mentioned
before (specify as
needed)?
Yes – Continue to 13.4a (on
back)
No – Skip to 14 (next page)
DK – Skip to 14 (next page)
13.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
37
Section F
13.4a. What was the address of that place?
Same
as
House Number
13.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
13.5a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
13.5b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
13.4f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the reason(s)
mentioned before
(specify as needed)?
Yes – Continue to 13.5a
Name 2
No – Skip to 14 (next page)
REF
No one else lived there
DK – Skip to 14 (next page)
13.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
13.5f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the reason(s)
mentioned before
(specify as needed)?
13.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
13.4e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.4e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
13.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.5e
DK – Probe for months
Yes
No
DK
13.5e. What are the names of the people who
usually lived at that place in 2010?
Name 1
Yes – Skip to 14 (next page)
Name 2
No – Skip to 14 (next page)
DK
REF
No one else lived there
DK – Skip to 14 (next page)
13.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
38
Section F
14. Other than the places you already mentioned, during 2010, (have you/has
stayed anywhere else, even for just one night or on the weekend?
14.1. Did (you/he/she) stay at any one place for
more than 7 nights total in 2010?
)
Yes – Continue to 14.1
Yes – Continue to 14.2a
No – Skip to 1 (next page)
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
DK – Skip to 1 (next page)
14.2a What was the address of that place?
Same
as
House Number
14.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
14.3a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
14.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
14.2f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Continue to 14.3a
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
Name 2
REF
No one else lived there
14.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
14.2e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.2e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
14.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.3e
DK – Probe for months
14.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
14.3e. What are the names of the people who
usually lived at that place in 2010?
14.3f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Continue to 14.4a (on
back)
No – Skip to 1 (next page)
Name 1
Name 2
DK
REF
No one else lived there
DK – Skip to 1 (next page)
14.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
39
Section F
14.4a. What was the address of that place?
Same
as
House Number
14.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
14.5a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
14.5b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
14.4f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Continue to 14.5a
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
Name 2
REF
No one else lived there
14.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
14.4e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.4e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
14.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.5e
DK – Probe for months
14.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
14.5e. What are the names of the people who
usually lived at that place in 2010?
14.5f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Skip to 1 (next page)
Name 1
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
Name 2
DK
REF
No one else lived there
14.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
40
Section G
1. Now let’s talk about (you/
). People stay with friends and
relatives for many different reasons. The following questions will ask whether (you/he/she) stayed
with friends or relatives any time this year, that is, during the calendar year 2010. Please answer
"yes" even if (you/he/she) only stayed with someone on weekends, for a few weeks, or off and on
throughout the year.
1.1. During 2010, (have you/has he/she) stayed with
a son or daughter?
Yes – Continue to 1.2a
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.2a. What was the address of that place?
Same
as
House Number
1.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.3a. What was the address of that place?
Same
as
Year
2010
To
1.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
1.2f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 1.3a
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Name 2
REF
No one else lived there
1.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
1.2e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
1.2d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
1.3d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
No
DK
Name 1
Name 2
1.3f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 1.4a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
DK
REF
No one else lived there
1.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
41
Section G
1.4a. What was the address of that place?
Same
as
House Number
1.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.5a. What was the address of that place?
Same
as
Year
2010
To
1.5b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
1.4f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 1.5a
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Name 2
REF
No one else lived there
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
1.4e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
1.4d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
1.5d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
No
DK
Name 1
1.5f. Was there another
son or daughter’s
address where
(you/he/she) stayed
in 2010?
Yes – Skip to 2 (next page)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Name 2
DK
REF
No one else lived there
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
42
Section G
2. Other than the places you already mentioned, during 2010, (have you/has
stayed with a brother or sister?
)
Yes – Continue to 2.1a
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
2.1a. What was the address of that place?
Same
as
House Number
2.1b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2.2a. What was the address of that place?
Same
as
Year
2010
To
2.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
2.1f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 2.2a
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Name 2
REF
No one else lived there
2.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
2.1e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.1e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
2.1d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
2.2d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.2e
DK – Probe for months
No
DK
Name 1
Name 2
2.2f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 2.3a (on
back)
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
DK
REF
No one else lived there
2.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
43
Section G
2.3a. What was the address of that place?
Same
as
House Number
2.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2.4a. What was the address of that place?
Same
as
Year
2010
To
2.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Name 1
2.3f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Continue to 2.4a
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Name 2
REF
No one else lived there
2.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
2.3e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.3e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
2.3d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
2.4d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.4e
DK – Probe for months
No
DK
Name 1
2.4f. Was there another
brother or sister’s
address where
(you/he/she) stayed
in 2010?
Yes – Skip to 3 (next page)
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Name 2
DK
REF
No one else lived there
2.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
44
Section G
3. Other than the places you already mentioned, during 2010, (have you/has
stayed with any other relatives, like a parent, aunt or cousin?
)
Yes – Continue to 3.1a
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
3.1a. What was the address of that place?
Same
as
House Number
3.1b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
3.2a. What was the address of that place?
Same
as
Year
2010
To
3.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Continue to 3.2a
3.1f.
No – Skip to 4 (next page)
Name 1
DK – Skip to 4 (next page)
Name 2
REF
No one else lived there
3.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
3.1e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.1e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
3.1d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
3.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
3.2d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.2e
DK – Probe for months
No
DK
Name 1
3.2f.
Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Continue to 3.3a (on
back)
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
Name 2
DK
REF
No one else lived there
3.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
45
Section G
3.3a. What was the address of that place?
Same
as
House Number
3.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
3.4a. What was the address of that place?
Same
as
Year
2010
To
3.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Continue to 3.4a
3.3f.
No – Skip to 4 (next page)
Name 1
DK – Skip to 4 (next page)
Name 2
REF
No one else lived there
3.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
3.3e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.3e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
3.3d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
3.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
3.4d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.4e
DK – Probe for months
No
DK
3.4f.
Was there another
relative’s address
where (you/he/she)
stayed in 2010?
Yes – Skip to 4 (next page)
No – Skip to 4 (next page)
Name 1
DK – Skip to 4 (next page)
Name 2
DK
REF
No one else lived there
3.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
46
Section G
4. Other than the places you already mentioned, during 2010, (have you/has
stayed with a companion or significant other?
)
Yes – Continue to 4.1a
No – Skip to 5 (next page)
DK – Skip to 5 (next page)
4.1a. What was the address of that place?
Same
as
House Number
4.1b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
4.2a. What was the address of that place?
Same
as
Year
2010
To
4.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
DK
4.1f. Was there another
place where
(you/he/she) stayed
with a companion or
significant other
in 2010?
Yes – Continue to 4.2a
Name 1
No – Skip to 5 (next page)
Name 2
REF
No one else lived there
DK – Skip to 5 (next page)
4.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
4.1e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.1e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
4.1d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
4.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
4.2d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.2e
DK – Probe for months
No
DK
4.2f. Was there another
place where
(you/he/she) stayed
with a companion or
significant other
in 2010?
Yes – Continue to 4.3a (on
back)
No – Skip to 5 (next page)
Name 1
Name 2
DK
REF
No one else lived there
DK – Skip to 5 (next page)
4.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
47
Section G
4.3a. What was the address of that place?
Same
as
House Number
4.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
4.4a. What was the address of that place?
Same
as
Year
2010
To
4.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
4.3f.
DK
Was there another
place where
(you/he/she) stayed
with a companion or
significant other
in 2010?
Yes – Continue to 4.4a
Name 1
No – Skip to 5 (next page)
Name 2
REF
No one else lived there
DK – Skip to 5 (next page)
4.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
4.3e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.3e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
4.3d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
4.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
4.4d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.4e
DK – Probe for months
No
DK
4.4f.
Was there another
place where
(you/he/she) stayed
with a companion or
significant other
in 2010?
Yes – Skip to 5 (next page)
Name 1
No – Skip to 5 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 5 (next page)
4.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
48
Section G
5. Other than the places you already mentioned, during 2010, (have you/has
stayed with any other people, such as friends?
5.1. Did (you/he/she) stay at any one place for
more than 7 nights total in 2010?
)
Yes – Continue to 5.1
Yes – Continue to 5.2a
No – Skip to 6 (next page)
No – Skip to 6 (next page)
DK – Skip to 6 (next page)
DK – Skip to 6 (next page)
5.2a. What was the address of that place?
Same
as
House Number
5.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
5.3a. What was the address of that place?
Same
as
Year
2010
To
5.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
5.2f.
DK
Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Continue to 5.3a
Name 1
No – Skip to 6 (next page)
Name 2
REF
No one else lived there
DK – Skip to 6 (next page)
5.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
5.2e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.2e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
5.2d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
5.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
5.3d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.3e
DK – Probe for months
No
DK
5.3f.
Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Continue to 5.4a (on
back)
No – Skip to 6 (next page)
Name 1
Name 2
DK
REF
No one else lived there
DK – Skip to 6 (next page)
5.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
49
Section G
5.4a. What was the address of that place?
Same
as
House Number
5.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
5.5a. What was the address of that place?
Same
as
Year
2010
To
5.5b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes
No
5.4f.
DK
Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Continue to 5.5a
Name 1
No – Skip to 6 (next page)
Name 2
REF
No one else lived there
DK – Skip to 6 (next page)
5.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Month
Day
Year
Street Name
ZIP Code
5.4e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.4e
DK – Probe for months
Month
City
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
5.4d.
Day
2010
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
5.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
2010
To
Year
5.5d.
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.5e
DK – Probe for months
No
DK
5.5f.
Was there another
place where
(you/he/she) stayed
with friends for more
than 7 nights total
in 2010?
Yes – Skip to 6 (next page)
Name 1
No – Skip to 6 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 6 (next page)
5.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
50
Section G
6. People sometimes stay at different places to receive care or services. The next
series of questions will ask if (you/
)
stayed at certain places to receive care or services this year, that is, during
the calendar year 2010, even if only for one night.
6.3a. What was the address of that place?
Street Name
Day
DK – Skip to 7 (next page)
DK – Continue to 6.3a
Month
Apt/Unit Number
Year
2010
From
Day
Yes – Continue to 6.3a
No – Continue to 6.3a
6.3b. During 2010, when did (you/he/she) live or stay at that place?
Month
6.2. Did the facility provide 24 hour care
by a skilled professional or nurse?
No – Skip to 7 (next page)
6.3d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
6.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
6.1. During 2010, (have you/has he/she) stayed in a nursing
home, assisted living facility or an independent living
facility?
Yes – Continue to 6.2
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
6.4a. What was the address of that place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.3e
DK – Probe for months
DK
REF
No one else lived there
6.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
6.4b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
Month
Apt/Unit Number
Year
2010
From
6.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Day
6.4e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes – Continue to 6.4a
DK – Skip to 7 (next page)
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Was there another
place like this where
(you/he/she) stayed
in 2010?
No – Skip to 7 (next page)
Name 1
2010
From
City
6.3f.
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.4e
DK – Probe for months
6.4f.
Was there another
place like this where
(you/he/she) stayed
in 2010?
Yes – Continue to 6.5a (on
back)
No – Skip to 7 (next page)
DK – Skip to 7 (next page)
Name 2
DK
REF
No one else lived there
6.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
51
Section G
6.5a. What was the address of that place?
6.5d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
6.5e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
6.5b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
6.6a. What was the address of that place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.5e
DK – Probe for months
DK
REF
No one else lived there
6.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
6.6b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
Month
Apt/Unit Number
Year
2010
From
6.6d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Day
6.6e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.6e
DK – Probe for months
6.6f.
Was there another
place like this where
(you/he/she) stayed
in 2010?
Yes – Skip to 7 (next page)
No – Skip to 7 (next page)
Name 1
City
Yes – Continue to 6.6a
DK – Skip to 7 (next page)
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Was there another
place like this where
(you/he/she) stayed
in 2010?
No – Skip to 7 (next page)
Name 1
2010
From
City
6.5f.
DK – Skip to 7 (next page)
Name 2
DK
REF
No one else lived there
6.6c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
52
Section G
7. Other than the places you already mentioned, during 2010, (have you/has
stayed in a rehabilitation hospital or facility?
)
Yes – Continue to 7.1a
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
7.1a. What was the address of that place?
7.1d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
7.1e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
7.1b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
7.2a. What was the address of that place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.1e
DK – Probe for months
DK
REF
No one else lived there
7.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
7.2b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
Month
Apt/Unit Number
Year
2010
From
7.2d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Day
7.2e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes – Continue to 7.2a
DK – Skip to 8 (next page)
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Was there another
rehabilitation place
where (you/he/she)
stayed in 2010?
No – Skip to 8 (next page)
Name 1
2010
From
City
7.1f.
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.2e
DK – Probe for months
7.2f.
Was there another
rehabilitation place
where (you/he/she)
stayed in 2010?
Yes – Continue to 7.3a (on
back)
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
Name 2
DK
REF
No one else lived there
7.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
53
Section G
7.3a. What was the address of that place?
7.3d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
7.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
7.3b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
7.4a. What was the address of that place?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.3e
DK – Probe for months
DK
REF
No one else lived there
7.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
7.4b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
Month
Apt/Unit Number
Year
2010
From
7.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Day
7.4e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.4e
DK – Probe for months
7.4f.
Was there another
rehabilitation place
where (you/he/she)
stayed in 2010?
Yes – Skip to 8 (next page)
No – Skip to 8 (next page)
Name 1
City
Yes – Continue to 7.4a
DK – Skip to 8 (next page)
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Was there another
rehabilitation place
where (you/he/she)
stayed in 2010?
No – Skip to 8 (next page)
Name 1
2010
From
City
7.3f.
DK – Skip to 8 (next page)
Name 2
DK
REF
No one else lived there
7.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
54
Section G
8. Other than the places you already mentioned, during 2010, did (you/he/she)
stay anywhere because of health problems, either (yours/his/hers) or someone else’s?
Yes – Continue to 7.1a
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
8.1a. What was the address of that place?
8.1d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
8.1e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
8.1b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
8.2a. What was the address of that place?
DK – Skip to 9 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.1e
DK – Probe for months
DK
REF
No one else lived there
8.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
8.2b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
No – Skip to 9 (next page)
2010
To
8.2d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
8.2e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
2010
From
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.2e
DK – Probe for months
8.2f.
Was there another
place where
(you/he/she) stayed
for health reasons
in 2010?
Yes – Continue to 8.3a (on
back)
No – Skip to 9 (next page)
Year
Name 1
City
Was there another
place where
(you/he/she) stayed
for health reasons
in 2010?
Yes – Continue to 8.2a
Year
Name 1
City
8.1f.
Name 2
DK
REF
No one else lived there
DK – Skip to 9 (next page)
8.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
55
Section G
8.3a. What was the address of that place?
8.3d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
8.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
8.3b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
8.4a. What was the address of that place?
DK – Skip to 9 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.3e
DK – Probe for months
DK
REF
No one else lived there
8.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
8.4b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
No – Skip to 9 (next page)
2010
To
8.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
8.4e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
2010
From
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
Was there another
place where
(you/he/she) stayed
for health reasons
in 2010?
No – Skip to 9 (next page)
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.4e
DK – Probe for months
8.4f.
Yes – Skip to 9 (next page)
Year
Name 1
City
Was there another
place where
(you/he/she) stayed
for health reasons
in 2010?
Yes – Continue to 8.4a
Year
Name 1
City
8.3f.
DK – Skip to 9 (next page)
Name 2
DK
REF
No one else lived there
8.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
56
Section G
9. The next series of questions will ask about activities
(you/
) may have
done this year, that is, during the calendar year 2010.
If (you/he/she) did any of the following things this year,
please answer “yes”, even if (you aren’t/ he/she isn’t)
still doing them.
9.1. Other than places you already mentioned, during 2010,
(have you/has
)
moved?
Yes – Continue to 9.2a
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
9.2a. In January 2010, what was the first address where
(you/he/she) lived?
9.2b. During 2010, when did (you/he/she) live at that place?
Please provide as specific dates as possible.
Month
Same
as
Day
Street Name
Year
2010
From
House Number
9.2d.
Month
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
9.2e.
No
DK
What are the names of the people who
usually lived at that place in 2010?
9.2f. INTERVIEWER NOTE:
Go to 9.3a, and collect
the next address.
Year
Name 1
Apt/Unit Number
2010
From
City
State
ZIP Code
2010
To
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.2e
DK – Probe for months
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.3a. What was the address of the next place
(you/he/she) lived in 2010?
9.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
9.3b. During 2010, when did (you/he/she) live at that place?
Month
Day
Street Name
Year
2010
From
Month
Day
Month
Day
9.3e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
Apt/Unit Number
From
City
State
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Same
as
House Number
9.3d.
ZIP Code
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.3e
DK – Probe for months
9.3f. Was there another
address where
(you/he/she) lived in
2010?
Yes – Continue to 9.4a (on
back)
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
Name 2
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
57
Section G
9.4a. What was the address of the next place
(you/he/she) lived in 2010?
9.4b. During 2010, when did (you/he/she) live at that place?
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
9.4e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Month
Same
as
Day
Street Name
Year
2010
From
House Number
9.4d.
Month
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
2010
From
City
State
ZIP Code
2010
To
Yes – Continue to 9.5a
No – Skip to 10 (next page)
Name 1
Apt/Unit Number
9.4f. Was there another
address where
(you/he/she) lived in
2010?
DK – Skip to 10 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.4e
DK – Probe for months
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.5a. What was the address of the next place
(you/he/she) lived in 2010?
9.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
9.5b. During 2010, when did (you/he/she) live at that place?
Month
Day
Street Name
Year
2010
From
Month
Day
Month
Day
9.5e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
From
City
ZIP Code
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.5e
DK – Probe for months
9.5f. Was there another
address where
(you/he/she) lived in
2010?
Yes – Skip to 10 (next page)
No – Skip to 10 (next page)
Name 1
Apt/Unit Number
State
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Same
as
House Number
9.5d.
DK – Skip to 10 (next page)
Name 2
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
58
Section G
10. During 2010, (have you/has
in the military?
) been
10.1. Other than places you already mentioned, did (you/he/she) stay at
another place in 2010, because of the military?
Yes – Continue to 10.1
Yes – Continue to 10.2a
No – Skip to 11 (next page)
No – Skip to 11 (next page)
DK – Skip to 11 (next page)
DK – Skip to 11 (next page)
10.2a. What was the address of the other place?
Same
as
House Number
10.2b. During 2010, when did (you/he/she) live or stay at that address? 10.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
10.2e. What are the names of the people who
usually lived at that place in 2010?
No – Skip to 11 (next page)
Year
Name 1
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
10.3a. What was the address of the other place?
Same
as
House Number
2010
From
City
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.2e
DK – Probe for months
DK
REF
No one else lived there
10.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
10.3b. During 2010, when did (you/he/she) live or stay at that address? 10.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Month
Street Name
DK – Skip to 11 (next page)
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
10.3e. What are the names of the people who
usually lived at that place in 2010?
Year
Name 1
From
City
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
10.2f. Was there another
military address
where (you/he/she)
stayed in 2010?
Yes – Continue to 10.3a
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.3e
DK – Probe for months
10.3f. Was there another
military address
where (you/he/she)
stayed in 2010?
Yes – Continue to 10.4a (on
back)
No – Skip to 11 (next page)
DK – Skip to 11 (next page)
Name 2
DK
REF
No one else lived there
10.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
59
Section G
10.4a. What was the address of the other place?
Same
as
House Number
10.4b. During 2010, when did (you/he/she) live or stay at that address? 10.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
10.4e. What are the names of the people who
usually lived at that place in 2010?
No – Skip to 11 (next page)
Year
Name 1
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
10.5a. What was the address of the other place?
Same
as
House Number
2010
From
City
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.4e
DK – Probe for months
DK
REF
No one else lived there
10.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
10.5b. During 2010, when did (you/he/she) live or stay at that address? 10.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Month
Street Name
DK – Skip to 11 (next page)
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
10.5e. What are the names of the people who
usually lived at that place in 2010?
From
State
ZIP Code
County
Facility Name (such as fort, base, barrack, ship)
Not in United States
DK/REF – Probe for street, city, state, county, facility
2010
To
DK – Skip to 11 (next page)
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.5e
DK – Probe for months
10.5f. Was there another
military address
where (you/he/she)
stayed in 2010?
Yes – Skip to 11 (next page)
No – Skip to 11 (next page)
Year
Name 1
City
10.4f. Was there another
military address
where (you/he/she)
stayed in 2010?
Yes – Continue to 10.5a
Name 2
DK
REF
No one else lived there
10.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
60
Section G
11. During 2010, (have you/has
a job?
) had
11.1. Other than places you already mentioned, did (you/he/she)
have another place to stay because of (your/his/her) job?
11.2. Did (you/he/she) stay at any one place
more than 7 nights total for that job?
Yes – Continue to 11.1
Yes – Continue to 11.2
Yes – Continue to 11.3a
No – Skip to 12 (next page)
No – Skip to 12 (next page)
No – Skip to 12 (next page)
DK – Skip to 12 (next page)
DK – Skip to 12 (next page)
DK – Skip to 12 (next page)
11.3a. What was the address of the other place?
Same
as
House Number
11.3b. During 2010, when did (you/he/she) live or stay at that address? 11.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
11.3e. What are the names of the people who
usually lived at that place in 2010?
Year
Yes – Continue to 11.4a
Name 1
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
11.4a. What was the address of the other place?
Same
as
House Number
2010
From
City
No – Skip to 12 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.3e
DK – Probe for months
DK
REF
No one else lived there
11.4b. During 2010, when did (you/he/she) live or stay at that address? 11.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
11.4e. What are the names of the people who
usually lived at that place in 2010?
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.4e
DK – Probe for months
11.4f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for
work purposes?
Yes – Continue to 11.5a (on
back)
No – Skip to 12 (next page)
Name 1
From
City
DK – Skip to 12 (next page)
11.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Month
Street Name
2010
To
11.3f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for
work purposes?
Name 2
DK
REF
No one else lived there
DK – Skip to 12 (next page)
11.4c During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
61
Section G
11.5a. What was the address of the other place?
Same
as
House Number
11.5b. During 2010, when did (you/he/she) live or stay at that address? 11.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
11.5e. What are the names of the people who
usually lived at that place in 2010?
Year
Yes – Continue to 11.6a
Name 1
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
11.6a. What was the address of the other place?
Same
as
House Number
2010
From
City
No – Skip to 12 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.5e
DK – Probe for months
DK
REF
No one else lived there
11.6b. During 2010, when did (you/he/she) live or stay at that address? 11.6d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Please provide as specific dates as possible.
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
11.6e. What are the names of the people who
usually lived at that place in 2010?
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 11.6e
DK – Probe for months
11.6f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for
work purposes?
Yes – Skip to 12 (next page)
Name 1
From
City
DK – Skip to 12 (next page)
11.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Month
Street Name
2010
To
11.5f. Was there another
address where
(you/he/she) stayed
more than 7 nights
total in 2010 for
work purposes?
No – Skip to 12 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 12 (next page)
11.6c During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
62
Section G
12. Other than places you already mentioned, during 2010,
(have you/has
)
had a seasonal or vacation home?
Yes – Continue to 12.1a
No – Skip to 13 (next page)
DK – Skip to 13 (next page)
12.1a. What was the address of that place?
Please provide as specific dates as possible.
Same
as
House Number
12.1b. During 2010, when did (you/he/she) stay or visit that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
12.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
12.1e. What are the names of the people who
usually lived at that place in 2010?
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
12.2a. What was the address of that place?
DK
REF
No one else lived there
12.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
12.2b. During 2010, when did (you/he/she) stay or visit that place?
Month
Street Name
DK – Skip to 13 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.1e
DK – Probe for months
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
12.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
12.2e. What are the names of the people who
usually lived at that place in 2010?
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes – Continue to 12.2a
No – Skip to 13 (next page)
Name 1
2010
From
City
12.1f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.2e
DK – Probe for months
12.2f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
Yes – Continue to 12.3a (on
back)
No – Skip to 13 (next page)
DK – Skip to 13 (next page)
Name 2
DK
REF
No one else lived there
12.2c During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
63
Section G
12.3a. What was the address of that place?
Please provide as specific dates as possible.
Same
as
House Number
12.3b. During 2010, when did (you/he/she) stay or visit that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
12.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
12.3e. What are the names of the people who
usually lived at that place in 2010?
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
12.4a. What was the address of that place?
DK
REF
No one else lived there
12.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
12.4b. During 2010, when did (you/he/she) stay or visit that place?
Month
Street Name
DK – Skip to 13 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.3e
DK – Probe for months
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
12.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
12.4e. What are the names of the people who
usually lived at that place in 2010?
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
12.4f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
Yes – Skip to 13 (next page)
Year
Name 1
From
City
Yes – Continue to 12.4a
No – Skip to 13 (next page)
Name 1
2010
From
City
12.3f. Did (you/he/she) have
another vacation or
seasonal home in
2010?
No – Skip to 13 (next page)
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 12.4e
DK – Probe for months
DK – Skip to 13 (next page)
Name 2
DK
REF
No one else lived there
12.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
64
Section G
13. Other than places you already mentioned, during 2010,
(have you/has
)
had another residence that (you/he/she) owned or rented?
Yes – Continue to 13.1a
No – Skip to 14 (next page)
DK – Skip to 14 (next page)
13.1a. What was the address of that place?
Please provide as specific dates as possible.
Same
as
House Number
13.1b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
13.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
13.1e. What are the names of the people who
usually lived at that place in 2010?
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
13.2a. What was the address of that place?
DK
REF
No one else lived there
13.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
13.2b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
DK – Skip to 14 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.1e
DK – Probe for months
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
13.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
13.2e. What are the names of the people who
usually lived at that place in 2010?
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes – Continue to 13.3a
No – Skip to 14 (next page)
Name 1
2010
From
City
13.1f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.2e
DK – Probe for months
13.2f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
Yes – Continue to 13.3a (on
back)
No – Skip to 13 (next page)
DK – Skip to 13 (next page)
Name 2
DK
REF
No one else lived there
13.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
65
Section G
13.3a. What was the address of that place?
Please provide as specific dates as possible.
Same
as
House Number
13.3b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
13.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
13.3e. What are the names of the people who
usually lived at that place in 2010?
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
13.4a. What was the address of that place?
DK
REF
No one else lived there
13.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
13.4b. During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
DK – Skip to 14 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.3e
DK – Probe for months
Please provide as specific dates as possible.
Same
as
House Number
2010
To
Day
Month
Apt/Unit Number
Year
2010
From
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
13.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
No
DK
13.4e. What are the names of the people who
usually lived at that place in 2010?
Year
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 13.4e
DK – Probe for months
13.4f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
Yes – Skip to 14 (next page)
No – Skip to 14 (next page)
Name 1
City
Yes – Continue to 13.4a
No – Skip to 14 (next page)
Name 1
2010
From
City
13.3f. Was there another
residence that
(you/he/she) owned
or rented in 2010?
DK – Skip to 14 (next page)
Name 2
DK
REF
No one else lived there
13.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
66
Section G
14. Other than places you already mentioned, during 2010, (have you/has he/she) stayed anywhere for any of the following reasons:
a. Education or training?
Yes
No
DK
b. Athletics or sports?
Yes
No
DK
c. Hobbies?
Yes
DK
Yes
Yes
Same
as
No
No
DK
Yes
No
Month
Day
No
DK
Month
Day
DK
Yes
Year
2010
City
No
Month
Day
Month
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
14.3a. What was the address of that place?
Same
as
Year
Year
2010
To
Day
Year
2010
Month
From
Not in United States
DK/REF – Probe for street, city, state, county
No
DK
Name 1
Yes – Continue to 14.3a
Name 2
REF
No one else lived there
No – Skip to 15 (next page)
DK – Skip to 15 (next page)
14.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
From
Facility Name
Yes
14.2e. What are the names of the people who
usually lived at that place in 2010?
14.2f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the
reason(s) mentioned
before (specify as
needed)?
14.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
County
14.1. For (that/those) reason(s) (specify
as needed), did (you/he/she) stay
at any one place for more than 7
nights total in 2010?
Yes – Continue to 14.2a
No – Skip to 15 (next page)
DK – Skip to 15 (next page)
14.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
DK
Month
Day
Year
Street Name
ZIP Code
No – Skip to 15 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.2e
DK – Probe for months
Month
City
Yes – Continue to 14.1
DK
2010
To
Year
2010
From
State
Do not read – Did the respondent
answer "Yes" to any of those
reasons, 14a through 14h?
h. Conferences or conventions?
Street Name
From
State
Yes
14.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
House Number
g. Because of financial problems?
DK
f. To care for someone?
d. Camps or lessons?
14.2a. What was the address of that place?
House Number
e. Vacations or retreats?
No
INTERVIEWER CHECK:
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.3e
DK – Probe for months
14.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
14.3e. What are the names of the people who
usually lived at that place in 2010?
Name 1
Name 2
DK
REF
No one else lived there
14.3f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the
reason(s) mentioned
before (specify as
needed)?
Yes – Continue to 14.4a (on
back)
No – Skip to 15 (next page)
DK – Skip to 15 (next page)
14.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
67
Section G
14.4a. What was the address of that place?
Same
as
House Number
14.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
14.5a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
Day
Year
2010
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Yes – Continue to 14.5a
Name 2
REF
No one else lived there
No – Skip to 15 (next page)
DK – Skip to 15 (next page)
14.5b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
From
County
DK
14.4f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the
reason(s) mentioned
before (specify as
needed)?
14.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
14.4e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.4e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
14.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 14.5e
DK – Probe for months
14.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
14.5e. What are the names of the people who
usually lived at that place in 2010?
Name 1
14.5f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total for the
reason(s) mentioned
before (specify as
needed)?
Yes – Skip to 15 (next page)
Name 2
DK
REF
No one else lived there
No – Skip to 15 (next page)
DK – Skip to 15 (next page)
14.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
68
Section G
15. Other than the places you already mentioned, during 2010,
(have you/has
) stayed
anywhere else, even for just one night or on the weekend?
15.1. Other than the places you already mentioned, did (you/he/she)
stay at any one place for more than 7 nights total in 2010?
Yes – Continue to 15.1
Yes – Continue to 15.2a
No – Skip to 1 (next page)
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
DK – Skip to 1 (next page)
15.2a. What was the address of that place?
Same
as
House Number
15.2b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
15.3a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Year
2010
To
15.3b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Day
Year
2010
From
Month
From
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
DK
15.2f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Continue to 15.3a
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
Name 2
REF
No one else lived there
15.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Apt/Unit Number
ZIP Code
No
Name 1
DK
Month
Day
Year
Street Name
City
Yes
15.2e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 15.2e
DK – Probe for months
Month
State
Month
Street Name
Apt/Unit Number
House Number
Year
15.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 15.3e
DK – Probe for months
15.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
15.3e. What are the names of the people who
usually lived at that place in 2010?
15.3f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Continue to 15.4a (on
back)
Name 1
No – Skip to 1 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 1 (next page)
15.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
69
Section G
15.4a. What was the address of that place?
Same
as
House Number
15.4b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
Year
Month
Day
Month
Day
Year
Street Name
2010
From
Apt/Unit Number
City
2010
From
State
ZIP Code
2010
To
Year
Year
2010
To
15.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
15.4e. What are the names of the people who
usually lived at that place in 2010?
15.4f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Continue to 15.5a
Name 1
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
Name 2
Off
on during
of 2010
Did and
not stay
there all
during
2010 – Skip to 15.4e
DK
REF
No one else lived there
County
DK – Probe for months
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
15.5a. What was the address of that place?
Same
as
15.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
15.5b. During 2010, when did (you/he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
House Number
Day
Month
Day
Year
Street Name
2010
From
Apt/Unit Number
Month
City
State
Year
From
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 15.5e
DK – Probe for months
15.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
15.5e. What are the names of the people who
usually lived at that place in 2010?
15.5f. Was there another
place where
(you/he/she) stayed
more than 7 nights
total in 2010?
Yes – Skip to 1 (next page)
Name 1
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
Name 2
DK
REF
No one else lived there
15.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
70
Section H
1.1.
1. Now let’s talk about
. Children often have more than one place
to stay. The next series of questions will ask about places where (children in this household/
) might have stayed this year, that is, during the calendar year
2010. Please answer "yes" even if (they/he/she) only stayed at that place on the weekends, for a
few weeks, or off and on throughout the year. Let’s start with
.
During 2010, has
stayed part of the time with another parent or grandparent?
Yes – Continue to 1.2a
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.2a. What was the address of that place?
Same
as
1.2b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
House Number
Day
2010
From
Month
City
Day
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.3a. What was the address of that place?
Same
as
Month
Day
Year
2010
To
1.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 1.3a
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Name 2
REF
No one else lived there
1.3d.
Was (he/she) there on Thursday, April 1st,
2010?
1.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
1.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
1.2f. Was there another
address where (he/she)
stayed with a parent
or grandparent in 2010?
Sa
1.3b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
1.2e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
1.2d.
No
DK
Name 1
1.3f. Was there another
address where (he/she)
stayed with a parent
or grandparent in 2010?
Yes – Continue to 1.4a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Name 2
DK
REF
No one else lived there
Sa
71
Section H
1.4a. What was the address of that place?
Same
as
1.4b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
House Number
Day
2010
From
Month
City
Day
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
1.5a. What was the address of that place?
Same
as
Month
Day
Year
2010
To
1.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 1.5a
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Name 2
REF
No one else lived there
1.5d.
Was (he/she) there on Thursday, April 1st,
2010?
1.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
1.5c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
1.4f. Was there another
address where (he/she)
stayed with a parent
or grandparent in 2010?
Sa
1.5b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
1.4e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
1.4d.
No
DK
1.5f. Was there another
address where (he/she)
stayed with a parent
or grandparent in 2010?
Yes – Skip to 2 (next page)
No – Skip to 2 (next page)
Name 1
DK – Skip to 2 (next page)
Name 2
DK
REF
No one else lived there
Sa
72
Section H
2. Other than the places you already mentioned, during 2010, has
stayed part of the time with another relative like an aunt or cousin?
Yes – Continue to 2.1a
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
2.1a. What was the address of that place?
Same
as
2.1b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
House Number
Day
2010
From
Month
City
Day
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2.2a. What was the address of that place?
Same
as
Month
Day
Year
2010
To
2.1c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 2.2a
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Name 2
REF
No one else lived there
2.2d.
Was 9he/she) there on Thursday, April 1st,
2010?
2.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.2e
DK – Probe for months
2.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
2.1f. Was there another
relative’s address
where (he/she) stayed
in 2010?
Sa
2.2b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
2.1e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.1e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
2.1d.
No
DK
Name 1
2.2f. Was there another
relative’s address
where (he/she) stayed
in 2010?
Yes – Continue to 2.3a (on
back)
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Name 2
DK
REF
No one else lived there
Sa
73
Section H
2.3a. What was the address of that place?
Same
as
2.3b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
House Number
Day
2010
From
Month
City
Day
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2.4a. What was the address of that place?
Same
as
Month
Day
Year
2010
To
2.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 2.4a
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Name 2
REF
No one else lived there
2.4d.
Was (he/she) there on Thursday, April 1st,
2010?
2.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.4e
DK – Probe for months
2.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
2.3f. Was there another
relative’s address
where (he/she) stayed
in 2010?
Sa
2.4b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
2.3e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.3e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
2.3d.
No
DK
2.4f. Was there another
relative’s address
where (he/she) stayed
in 2010?
Yes – Skip to 3 (next page)
No – Skip to 3 (next page)
Name 1
DK – Skip to 3 (next page)
Name 2
DK
REF
No one else lived there
Sa
74
Section H
3. Other than the places you already mentioned, during 2010, has
had a different address for school?
Yes – Continue to 3.1a
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
3.1a. What was the address of that place?
Same
as
House Number
3.1b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
3.2a. What was the address of that place?
Same
as
Year
2010
To
3.1c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
2010
Month
To
Day
Yes – Continue to 3.2a
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
Name 2
REF
No one else lived there
3.2d.
Was (he/she) there on Thursday, April 1st,
2010?
3.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.2e
DK – Probe for months
3.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
Year
No
3.1f. Did (he/she) have
another school
address in 2010?
Sa
3.2b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
3.1e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.1e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
3.1d.
No
DK
Name 1
3.2f. Did (he/she) have
another school
address in 2010?
Yes – Continue to 3.3a (on
back)
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
Name 2
DK
REF
No one else lived there
Sa
75
Section H
3.3a. What was the address of that place?
Same
as
House Number
3.3b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
3.4a. What was the address of that place?
Same
as
Year
2010
To
3.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
2010
Month
To
Day
Yes – Continue to 3.4a
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
Name 2
REF
No one else lived there
3.4d.
Was (he/she) there on Thursday, April 1st,
2010?
3.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.4e
DK – Probe for months
3.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
Year
No
3.3f. Did (he/she) have
another school
address in 2010?
Sa
3.4b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
3.3e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.3e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
3.3d.
No
DK
3.4f. Did (he/she) have
another school
address in 2010?
Yes – Skip to 4 (next page)
No – Skip to 4 (next page)
DK – Skip to 4 (next page)
Name 1
Name 2
DK
REF
No one else lived there
Sa
76
Section H
4. Other than the places you already mentioned, during 2010, has
stayed overnight somewhere for child care purposes?
4.1. Did (he/she) stay at any one place
more than 7 nights total in 2010?
Yes – Continue to 4.1a
Yes – Continue to 4.2a
No – Skip to 5 (next page)
No – Skip to 5 (next page)
DK – Skip to 5 (next page)
DK – Skip to 5 (next page)
4.2a. What was the address of that place?
Same
as
House Number
4.2b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
4.3a. What was the address of that place?
Same
as
Year
2010
To
4.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 4.3a
No – Skip to 5 (next page)
DK – Skip to 5 (next page)
Name 2
REF
No one else lived there
4.3d.
Was (he/she) there on Thursday, April 1st,
2010?
4.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.3e
DK – Probe for months
4.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
4.2f. Was there another
place where (he/she)
stayed for child care
purposes more than
7 nights total in 2010?
Sa
4.3b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
4.2e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.2e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
4.2d.
No
DK
4.3f. Was there another
place where (he/she)
stayed for child care
purposes more than
7 nights total in 2010?
Yes – Continue to 4.4a (on
back)
No – Skip to 5 (next page)
Name 1
Name 2
DK
REF
No one else lived there
DK – Skip to 5 (next page)
Sa
77
Section H
4.4a. What was the address of that place?
Same
as
House Number
4.4b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
4.5a. What was the address of that place?
Same
as
Year
2010
To
4.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 4.5a
No – Skip to 5 (next page)
DK – Skip to 5 (next page)
Name 2
REF
No one else lived there
4.5d.
Was (he/she) there on Thursday, April 1st,
2010?
4.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.5e
DK – Probe for months
4.5c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
4.4f. Was there another
place where (he/she)
stayed for child care
purposes more than
7 nights total in 2010?
Sa
4.5b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
4.4e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 4.4e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
4.4d.
No
DK
4.5f. Was there another
place where (he/she)
stayed for child care
purposes more than
7 nights total in 2010?
Yes – Skip to 5 (next page)
Name 1
No – Skip to 5 (next page)
DK – Skip to 5 (next page)
Name 2
DK
REF
No one else lived there
Sa
78
Section H
5. Is
5.1. Other than the places you already mentioned, during 2010,
has (he/she) stayed somewhere else for foster care?
a foster child?
Yes – Continue to 5.1
Yes – Continue to 5.2a
No – Skip to 6 (next page)
No – Skip to 6 (next page)
DK – Skip to 6 (next page)
DK – Skip to 6 (next page)
5.2a. What was the address of that place?
Same
as
5.2b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
House Number
Day
2010
From
Month
City
Day
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
5.3a. What was the address of that place?
Same
as
Month
Day
Year
2010
To
5.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 5.3a
No – Skip to 6 (next page)
DK – Skip to 6 (next page)
Name 2
REF
No one else lived there
5.3d.
Was (he/she) there on Thursday, April 1st,
2010?
5.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.3e
DK – Probe for months
5.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
5.2f. Was there another
place where (he/she)
stayed for foster care
in 2010?
Sa
5.3b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
5.2e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.2e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
5.2d.
No
DK
Name 1
5.3f. Was there another
place where (he/she)
stayed for foster care
in 2010?
Yes – Continue to 5.4a (on
back)
No – Skip to 6 (next page)
DK – Skip to 6 (next page)
Name 2
DK
REF
No one else lived there
Sa
79
Section H
5.4a. What was the address of that place?
Same
as
5.4b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
House Number
Day
2010
From
Month
City
Day
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
5.5a. What was the address of that place?
Same
as
Month
Day
Year
2010
To
5.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 5.5a
No – Skip to 6 (next page)
DK – Skip to 6 (next page)
Name 2
REF
No one else lived there
5.5d.
Was (he/she) there on Thursday, April 1st,
2010?
5.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.5e
DK – Probe for months
5.5c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
5.4f. Was there another
place where (he/she)
stayed for foster care
in 2010?
Sa
5.5b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
5.4e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 5.4e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
5.4d.
No
DK
5.5f. Was there another
place where (he/she)
stayed for foster care
in 2010?
Yes – Skip to 6 (next page)
No – Skip to 6 (next page)
Name 1
DK – Skip to 6 (next page)
Name 2
DK
REF
No one else lived there
Sa
80
Section H
6. Other than the places you already mentioned, during 2010, has
stayed overnight with a friend,
neighbor, or legal guardian?
6.1. Did (he/she) stay at any one place
more than 7 nights total in 2010?
Yes – Continue to 6.2a
Yes – Continue to 6.1
No – Skip to 7 (next page)
No – Skip to 7 (next page)
DK – Skip to 7 (next page)
DK – Skip to 7 (next page)
6.2a. What was the address of that place?
Same
as
House Number
6.2b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
6.3a. What was the address of that place?
Same
as
Year
2010
To
6.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 6.3a
No – Skip to 7 (next page)
Name 2
No one else lived there
DK – Skip to 7 (next page)
6.3d.
Was (he/she) there on Thursday, April 1st,
2010?
6.3e.
What are the names of the people who
usually lived at that place in 2010?
6.3f. Was there another
place where (he/she)
stayed with a friend,
neighbor, or guardian
more than 7 nights
total in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.3e
DK – Probe for months
6.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
6.2f. Was there another
place where (he/she)
stayed with a friend,
neighbor, or guardian
more than 7 nights
total in 2010?
REF
Sa
6.3b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
6.2e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.2e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
6.2d.
No
DK
Name 1
Yes – Continue to 6.4a (on
back)
No – Skip to 7 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 7 (next page)
Sa
81
Section H
6.4a. What was the address of that place?
Same
as
House Number
6.4b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
2010
From
City
Day
Month
Day
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
6.5a. What was the address of that place?
Same
as
Year
2010
To
6.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Yes – Continue to 6.5a
No – Skip to 7 (next page)
Name 2
No one else lived there
DK – Skip to 7 (next page)
6.5d.
Was (he/she) there on Thursday, April 1st,
2010?
6.5e.
What are the names of the people who
usually lived at that place in 2010?
6.5f. Was there another
place where (he/she)
stayed with a friend,
neighbor, or guardian
more than 7 nights
total in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.5e
DK – Probe for months
6.5c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
6.4f. Was there another
place where (he/she)
stayed with a friend,
neighbor, or guardian
more than 7 nights
total in 2010?
REF
Sa
6.5b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
6.4e.
Yes
Year
Off and on during all of 2010
Did not stay there during 2010 – Skip to 6.4e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
2010
From
State
State
Month
Street Name
Apt/Unit Number
House Number
Year
6.4d.
No
DK
Name 1
Yes – Skip to 7 (next page)
No – Skip to 7 (next page)
Name 2
DK
REF
No one else lived there
DK – Skip to 7 (next page)
Sa
82
Section H
7. Other than the places you already mentioned, during 2010, has
) moved?
Yes – Continue to 7.1a
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
7.1a. In January 2010, what was the first address where
(he/she) lived?
7.1b. During 2010, when did (he/she) live at that place?
Please provide as specific dates as possible.
Month
Same
as
Day
Street Name
Year
2010
From
House Number
7.1d.
Month
Day
Month
Day
Year
Month
Day
Yes
Year
2010
To
Was (he/she) there on Thursday, April 1st,
2010?
7.1e.
No
DK
What are the names of the people who
usually lived at that place in 2010?
7.1g. INTERVIEWER NOTE:
Go to 7.2a, and collect
the next address.
Year
Name 1
Apt/Unit Number
2010
From
City
State
ZIP Code
2010
To
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.1e
DK – Probe for months
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
7.2a. What was the address of the next place (he/she)
lived in 2010?
7.1c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
7.2b. During 2010, when did (he/she) live at that place?
Month
Day
Street Name
Year
2010
From
Month
Was (he/she) there on Thursday, April 1st,
2010?
Day
Month
Day
7.2e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
Apt/Unit Number
From
City
State
7.2d.
Please provide as specific dates as possible.
Same
as
House Number
Sa
ZIP Code
2010
To
7.2g. Was there another
address (he/she)
lived in 2010?
Yes – Continue to 7.3a (on
back)
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
2010
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.2e
DK – Probe for months
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
7.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Sa
83
Section H
7.3a. What was the address of the next place (he/she)
lived in 2010?
7.3b. During 2010, when did (he/she) live at that place?
Was (he/she) there on Thursday, April 1st,
2010?
7.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Month
Same
as
Day
Street Name
Year
2010
From
House Number
7.3d.
Month
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
Name 1
Apt/Unit Number
2010
From
City
State
ZIP Code
Yes – Continue to 7.4a (on
back)
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
2010
To
7.3f. Was there another
address (he/she)
lived in 2010?
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.3e
DK – Probe for months
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
7.4a. What was the address of the next place (he/she)
lived in 2010?
7.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
7.4b. During 2010, when did (he/she) live at that place?
Month
Day
Street Name
Year
2010
From
Month
Was (he/she) there on Thursday, April 1st,
2010?
Day
Month
Day
7.4e.
What are the names of the people who
usually lived at that place in 2010?
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
From
City
ZIP Code
2010
To
7.4f. Was there another
address (he/she)
lived in 2010?
Yes – Skip to 8 (next page)
No – Skip to 8 (next page)
DK – Skip to 8 (next page)
Name 1
Apt/Unit Number
State
7.4d.
Please provide as specific dates as possible.
Same
as
House Number
Sa
2010
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 7.4e
DK – Probe for months
DK
REF
No one else lived there
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
7.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Sa
84
Section H
8. Other than the places you already mentioned, during 2010, has
stayed at a seasonal or
vacation home?
Yes – Continue to 8.1a
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
8.1a. What was the address of that place?
8.1d.
Was (he/she) there on Thursday, April 1st,
2010?
8.1e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
8.1b. During 2010, when did (he/she) stay or visit that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
8.2a. What was the address of that place?
DK – Skip to 9 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.1e
DK – Probe for months
DK
8.1c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
8.2b. During 2010, when did (he/she) stay or visit that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
No one else lived there
8.2d.
Was (he/she) there on Thursday, April 1st,
2010?
8.2e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
2010
To
REF
Sa
Please provide as specific dates as possible.
Same
as
House Number
2010
To
No
DK
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
Yes – Continue to 8.2a
No – Skip to 9 (next page)
Name 1
2010
From
City
8.1f. Was there another
seasonal or vacation
home where (he/she)
stayed in 2010?
2010
8.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Yes – Continue to 8.3a (on
back)
No – Skip to 9 (next page)
DK – Skip to 9 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.2e
DK – Probe for months
8.2f. Was there another
seasonal or vacation
home where (he/she)
stayed in 2010?
DK
REF
No one else lived there
Sa
85
Section H
8.3a. What was the address of that place?
8.3d.
Was (he/she) there on Thursday, April 1st,
2010?
8.3e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
8.3b. During 2010, when did (he/she) stay or visit that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
DK
Year
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
8.4a. What was the address of that place?
DK – Skip to 9 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.3e
DK – Probe for months
DK
8.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
8.4b. During 2010, when did (he/she) stay or visit that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
No one else lived there
8.4d.
Was (he/she) there on Thursday, April 1st,
2010?
8.4e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
2010
To
REF
Sa
Please provide as specific dates as possible.
Same
as
House Number
2010
To
No
DK
Year
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
Yes – Skip to 9 (next page)
DK – Skip to 9 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 8.4e
DK – Probe for months
8.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
8.4f. Was there another
seasonal or vacation
home where (he/she)
stayed in 2010?
No – Skip to 9 (next page)
Name 1
City
Yes – Continue to 8.4a
No – Skip to 9(next page)
Name 1
2010
From
City
8.3f. Was there another
seasonal or vacation
home where (he/she)
stayed in 2010?
DK
REF
No one else lived there
Sa
86
Section H
INTERVIEWER CHECK:
9. Other than places you already mentioned, during 2010, has (he/she) stayed anywhere for any of the following reasons:
a. Training or internships?
Yes
No
DK
b. Athletics or sports?
Yes
No
Yes
DK
DK
Yes
No
Yes
No
No
DK
Yes
Same
as
DK
Yes
No
No
Yes
No
DK
Yes – Continue to 9.1
No – Skip to 10 (next page)
9.2b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Month
Day
Month
Day
Year
Month
Day
2010
Month
Day
City
2010
From
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.3a. What was the address of that place?
Same
as
Year
2010
To
9.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Day
Year
Month
Day
2010
From
Month
From
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
Day
Was there another
place where (he/she)
stayed more than 7
nights total for the
reason(s) mentioned
before (specify as
needed)?
Yes – Continue to 9.3a
Name 2
No – Skip to 10 (next page)
REF
No one else lived there
9.3d.
Was (he/she) there on Thursday, April 1st,
2010?
9.3e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.3e
DK – Probe for months
9.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK
Name 1
2010
To
No
9.2f.
DK – Skip to 10 (next page)
Sa
9.3b. During 2010, when did (he/she) live at, stay at or visit that
place?
Please provide as specific dates as possible.
Apt/Unit Number
County
What are the names of the people who
usually lived at that place in 2010?
DK
Street Name
ZIP Code
9.2e.
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.2e
DK – Probe for months
Month
City
Was (he/she) there on Thursday, April 1st,
2010?
2010
To
Year
9.1. For (that/those) reason(s) (specify
as needed), did (he/she) stay at
any one place for more than 7
nights total in 2010?
Yes – Continue to 9.2a
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
9.2d.
Yes
Year
Street Name
From
State
DK
Do not read – Did the respondent
answer "Yes" to any of those
reasons, 9a through 9i?
DK
Apt/Unit Number
House Number
DK
h. Because of someone’s job?
i. Because of health
problems, either theirs
or someone else’s?
f. To care for someone?
9.2a. What was the address of that place?
House Number
No
g. Because of financial problems?
e. Vacations or retreats?
c. Hobbies?
Yes
d. Camps or lessons?
No
DK
Name 1
9.3f.
Was there another
place where (he/she)
stayed more than 7
nights total for the
reason(s) mentioned
before (specify as
needed)?
Yes – Continue to 9.4a (on
back)
Name 2
DK
REF
No one else lived there
No – Skip to 10 (next page)
DK – Skip to 10 (next page)
Sa
87
Section H
9.4a. What was the address of that place?
9.4d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
9.4e.
What are the names of the people who
usually lived at that place in 2010?
Please provide as specific dates as possible.
Same
as
House Number
9.4b. During 2010, when did (he/she) live, stay or visit that place?
Month
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
2010
To
Year
Month
Day
Yes
Year
No
9.4f.
DK
Year
Name 1
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
9.5a. What was the address of that place?
2010
To
Yes – Continue to 9.5a
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.4e
DK – Probe for months
9.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Street Name
Day
2010
From
Month
Apt/Unit Number
Year
Day
Month
Day
Year
Month
Day
No one else lived there
9.5d.
(Were you/Was he/she) there on Thursday,
April 1st, 2010?
9.5e.
What are the names of the people who
usually lived at that place in 2010?
Yes
Year
2010
To
REF
No
DK
Year
Name 1
From
City
State
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
2010
To
2010
9.5f.
Was there another
place where (he/she)
stayed more than 7
nights total for the
reason(s) mentioned
before (specify as
needed)?
Yes – Skip to 10 (next page)
Name 2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 9.5e
DK – Probe for months
9.5c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
DK – Skip to 10 (next page)
Sa
9.5b. During 2010, when did (he/she) live, stay or visit that place?
Month
No – Skip to 10 (next page)
DK
Please provide as specific dates as possible.
Same
as
House Number
2010
From
City
Was there another
place where (he/she)
stayed more than 7
nights total for the
reason(s) mentioned
before (specify as
needed)?
No – Skip to 10 (next page)
DK
REF
No one else lived there
DK – Skip to 10 (next page)
Sa
88
Section H
10. Other than the places you already mentioned, during 2010,
has (he/she) stayed anywhere else, even for just one night
or on the weekend?
10.1. Did (he/she) stay at any one place
for more than 7 nights total in 2010?
Yes – Continue to 10.2a
Yes – Continue to 10.1
No – Skip to 1 (next page)
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
DK – Skip to 1 (next page)
10.2a. What was the address of that place?
Same
as
Month
House Number
Day
2010
From
Month
City
Day
Month
Day
Yes
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
10.3a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Month
Day
Year
2010
To
Year
Month
Day
2010
From
Month
City
From
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
No – Skip to 1 (next page)
Name 2
Yes
Year
2010
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.3e
DK – Probe for months
10.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Yes – Continue to 10.3a
DK – Skip to 1 (next page)
REF
No one else lived there
10.3d. Was (he/she) there on Thursday, April 1st,
2010?
Street Name
Apt/Unit Number
10.2f. Was there another
place where (he/she)
stayed more than 7
nights total in 2010?
Sa
10.3b. During 2010, when did (he/she) live at, stay at, or visit that
place?
Please provide as specific dates as possible.
Day
DK
Name 1
DK
10.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
No
10.2e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.2e
DK – Probe for months
Month
State
Year
Street Name
Apt/Unit Number
House Number
10.2d. Was (he/she) there on Thursday, April 1st,
2010?
10.2b. During 2010, when did (he/she) live at, stay at, or visit that
place?
Please provide as specific dates as possible.
No
DK
10.3e. What are the names of the people who
usually lived at that place in 2010?
Name 1
10.3f. Was there another
place where (he/she)
stayed more than 7
nights total in 2010?
Yes – Continue to 10.4a (on
back)
No – Skip to 1 (next page)
DK – Skip to 1 (next page)
Name 2
DK
REF
No one else lived there
Sa
89
Section H
10.4a. What was the address of that place?
Same
as
Month
House Number
Day
2010
From
Month
City
Day
Month
Day
Yes
Year
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
10.5a. What was the address of that place?
Same
as
2010
To
Year
2010
From
State
Month
Day
Year
2010
To
Year
Month
Day
2010
From
Month
City
From
ZIP Code
County
Facility Name
Not in United States
DK/REF – Probe for street, city, state, county
Day
Year
2010
Month
To
No – Skip to 1 (next page)
Name 2
Yes
Year
2010
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.5e
DK – Probe for months
10.5c. During those dates, how often did (he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Yes – Continue to 10.5a
DK – Skip to 1 (next page)
REF
No one else lived there
10.5d. Was (he/she) there on Thursday, April 1st,
2010?
Street Name
Apt/Unit Number
10.4f. Was there another
place where (he/she)
stayed more than 7
nights total in 2010?
Sa
10.5b. During 2010, when did (he/she) live at, stay at, or visit that
place?
Please provide as specific dates as possible.
Day
DK
Name 1
DK
10.4c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
No
10.4e. What are the names of the people who
usually lived at that place in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 10.4e
DK – Probe for months
Month
State
Year
Street Name
Apt/Unit Number
House Number
10.4d. Was (he/she) there on Thursday, April 1st,
2010?
10.4b. During 2010, when did (he/she) live at, stay at, or visit that
place?
Please provide as specific dates as possible.
No
DK
10.5e. What are the names of the people who
usually lived at that place in 2010?
10.5f. Was there another
place where (he/she)
stayed more than 7
nights total in 2010?
Yes – Skip to 1 (next page)
No – Skip to 1 (next page)
Name 1
DK – Skip to 1 (next page)
Name 2
DK
REF
No one else lived there
Sa
90
Section I
1. The following questions will ask
1.1. During 2010, (have you/has he/she) stayed, even for just one night, in any of the following places: INTERVIEWER CHECK: 1.2. During 2010, were
you about places where (you/
a. Military barracks?
Yes
No
DK
b. Military ship?
Yes
No
DK
c. On-base housing?
Yes
No
DK
might have stayed this year, that
is, during the calendar year 2010.
If (you/he/she) stayed at one of
these places this year, please
answer "yes" even if (you/he/she)
did not stay there for long.
1.4a. What was the first military address where
(you/he/she) stayed in 2010?
Facility Name (such as fort, base, barrack, ship):
d. Off-base housing?
Yes
No
DK
e. Military academy dormitory?
Yes
No
DK
f. Military treatment facility?
Yes
No
DK
Street Name
Month
City
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.5a. What was the next military address where
(you/he/she) stayed in 2010?
Facility Name (such as fort, base, barrack, ship):
Street Name
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
Yes
No
DK
Year
Yes – Continue to 1.5a
2010
Month
Day
1.4e. Was there another
military address where
(you/he/she) stayed in
2010?
No – Skip to 2 (next page)
Year
DK – Skip to 2 (next page)
2010
To
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.5b. During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
From
ZIP Code
Day
To
Year
2010
Month
Day
Month
Day
Year
2010
From
City
Month
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.3. During 2010 did (you/
he/she) stay anywhere
else because of (your/
his/her) military service,
even just for one night?
Yes–Continue to 1.4a
No–Skip to 2 (next page)
DK–Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
Apt/Unit Number
State
Day
From
State
Year
2010
From
Apt/Unit Number
House Number
Day
(you/he/she) in the
military?
Yes–Continue to 1.3
No–Skip to 2 (next page)
DK–Skip to 2 (next page)
Do not read – Did the
respondent answer "Yes"
to any of those reasons,
1.1a through 1.1g?
Yes–Skip to 1.4a
No–Continue to 1.2
1.4b. During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
Month
House Number
g. Military disciplinary
barracks or jail?
Yes
No
DK
Day
Month
Day
Year
2010
To
Year
2010
Month
To
Year
2010
1.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.5e. Was there another
military address where
(you/he/she) stayed in
2010?
Yes – Continue to 1.6a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
91
Section I
1.6a. What was the next military address where
(you/he/she) stayed in 2010?
Facility Name (such as fort, base, barrack, ship):
1.6b. During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
Month
House Number
Street Name
Month
City
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.7a. What was the next military address where
(you/he/she) stayed in 2010?
Facility Name (such as fort, base, barrack, ship):
Street Name
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
Yes
No
DK
Year
Yes – Continue to 1.7a
2010
Month
Day
No – Skip to 2 (next page)
Year
DK – Skip to 2 (next page)
2010
To
1.6c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.7b. During 2010, when did (you/he/she) live at, stay at, or visit
that place?
Please provide as specific dates as possible.
From
ZIP Code
Day
To
Year
2010
Month
Day
Month
Day
Year
2010
From
City
Month
1.6e. Was there another
military address where
(you/he/she) stayed in
2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.6e
DK – Probe for months
Apt/Unit Number
State
Day
From
State
Year
2010
From
Apt/Unit Number
House Number
Day
1.6d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Day
Year
2010
To
Year
2010
Month
To
Year
1.7d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.7e. Was there another
military address where
(you/he/she) stayed in
2010?
Yes – Skip to 2 (next page)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.7e
DK – Probe for months
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
92
Section J
1. The following questions will ask you
about places where (you/
)
might have stayed this year, that is,
during the calendar year 2010. If
(you/he/she) stayed at one of these
places this year, please answer “yes”
even if (you/he/she) did not stay
there for long.
1.1. During 2010, (have you/has he/she) stayed in any of the following places:
a. College dorm or residence hall?
Yes
No
Yes
DK
b. Sorority or fraternity house?
Yes
No
Yes
College/University
No
DK
Yes
Yes
Month
ZIP Code
County
Not in United States
DK/REF – Probe for college/university/dorm, street, city,
state, county
1.5a. What was the name and address of that place?
College/University
From
County
Not in United States
DK/REF – Probe for college/university/dorm, street, city,
state, county
DK
Month
Day
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
2010
To
Year
Year
Month
Day
To
1.4e. Was there another
college address where
(you/he/she) stayed in
2010?
Yes – Continue to 1.5a
Year
No – Skip to 2 (next page)
2010
DK – Skip to 2 (next page)
1.5b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Day
Year
2010
Month
ZIP Code
No
1.4c. Which semesters or terms did (you/he/she) have or use that
address?
Read as necessary.
Certain days of the week
Winter semester/term 2010
Spring semester/term 2010
Su M Tu W Th F Sa
Summer semester/term 2010
Fall semester/term 2010
DK
From
City
DK
INTERVIEWER CHECK: 1.2. During 2010, did
1.3. Did (you/he/she) have
(you/he/she) take any
a room at college
Do not read – Did the
college classes?
assigned to (you/him/her),
respondent answer "Yes"
even if (you/he/she)
to any of those reasons,
Yes–Continue to 1.3
didn’t stay there?
1.1a through 1.1f?
Yes–Continue to 1.4a
No–Skip to 2 (next page)
Yes–Skip to 1.4a
No–Skip to 2 (next page)
DK–Skip to 2 (next page)
DK–Skip to 2 (next page)
No–Continue to 1.2
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
Street Name
Apt/Unit Number
State
Day
2010
Month
Facility Name (such as dorm, building, complex):
Year
2010
From
State
House Number
Day
From
City
No
1.4b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Street Name
Apt/Unit Number
DK
f. Hotel for college living?
DK
Month
Facility Name (such as dorm, building, complex):
No
e. Study abroad program?
c. On-campus college apartment or suite?
1.4a. What was the name and address of that place?
House Number
d. Off-campus college apartment or suite?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
1.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.5e. Was there another
college address where
(you/he/she) stayed in
2010?
Yes – Continue to 1.6a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
1.5c. Which semesters or terms did (you/he/she) have or use that
address?
Read as necessary.
Certain days of the week
Winter semester/term 2010
Spring semester/term 2010
Su M Tu W Th F Sa
Summer semester/term 2010
Fall semester/term 2010
DK
93
Section J
1.6a. What was the name and address of that place?
College/University
1.6b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Month
Facility Name (such as dorm, building, complex):
House Number
Month
State
ZIP Code
County
Not in United States
DK/REF – Probe for college/university/dorm, street, city,
state, county
1.7a. What was the name and address of that place?
College/University
From
County
Not in United States
DK/REF – Probe for college/university/dorm, street, city,
state, county
Yes
No
DK
2010
To
Month
Day
To
Yes – Continue to 1.7a
Year
No – Skip to 2 (next page)
2010
DK – Skip to 2 (next page)
1.7b. During 2010, when did (you/he/she) have or use that address?
Please provide as specific dates as possible.
Day
Year
2010
Month
ZIP Code
Year
1.6c. Which semesters or terms did (you/he/she) have or use that
address?
Read as necessary.
Certain days of the week
Winter semester/term 2010
Spring semester/term 2010
Su M Tu W Th F Sa
Summer semester/term 2010
Fall semester/term 2010
DK
From
City
Day
1.6e. Was there another
college address where
(you/he/she) stayed in
2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.6e
DK – Probe for months
Street Name
Apt/Unit Number
Month
Year
2010
Month
Facility Name (such as dorm, building, complex):
State
Day
From
City
Year
2010
From
Street Name
Apt/Unit Number
House Number
Day
1.6d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
1.7d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.7e. Was there another
college address where
(you/he/she) stayed in
2010?
Yes – Skip to 2 (next page)
Year
No – Skip to 2 (next page)
2010
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.7e
DK – Probe for months
1.7c. Which semesters or terms did (you/he/she) have or use that
address?
Read as necessary.
Certain days of the week
Winter semester/term 2010
Spring semester/term 2010
Su M Tu W Th F Sa
Summer semester/term 2010
Fall semester/term 2010
DK
94
Section K
1. The next series of questions will ask you about places
where (you/
) might
have stayed this year, that is, during the calendar year
2010. If (you/he/she) stayed at one of these places this
year, please answer “yes” even if (you/he/she) did not
stay there for long. During 2010, (have you / has he/she)
spent even one night:
During 2010, did (you/he/she) spend even one night:
1.2a. What was the name and address of that place?
a. In a correctional facility,
like a jail or prison?
Yes
DK
b. In a detention center?
Yes
No
DK
No–Skip to 2 (next page)
No–Continue to 1.1
DK–Skip to 2 (next page)
1.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
Month
Day
Year
Yes
No
DK
Street Name
2010
From
Apt/Unit Number
Month
City
Day
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.3a. What was the name and address of that place?
2010
To
Year
2010
From
State
Month
Day
To
Yes – Continue to 1.3a
2010
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
1.2c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Sa
1.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.3b. During 2010, when did (you/he/she) stay at that place?
Month
Day
Year
Month
Day
Year
Street Name
2010
From
Apt/Unit Number
Month
City
From
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
Day
2010
2010
To
Year
Month
To
1.2e. Was there another
correctional facility or
detention center where
(you/he/she) stayed in
2010?
Year
Please provide as specific dates as possible.
Facility Name
State
Yes–Continue to 1.2a
Yes–Skip to 1.2a
1.2b. During 2010, when did (you/he/she) stay at that place?
Month
House Number
Do not read – Did the
respondent answer "Yes"
to either of those reasons?
Please provide as specific dates as possible.
Facility Name
House Number
No
1.1. During 2010, did
(you/he/she) spend even
one night under arrest?
INTERVIEWER CHECK:
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
1.3c. During those dates, how often did (he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Yes
No
DK
1.3e. Was there another
correctional facility or
detention center where
(you/he/she) stayed in
2010?
Yes – Continue to 1.4a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Sa
95
Section L
1.4a. What was the name and address of that place?
Please provide as specific dates as possible.
Facility Name
Month
House Number
Day
2010
From
Month
City
Day
Month
Day
Year
Yes
No
DK
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.5a. What was the name and address of that place?
2010
To
Year
2010
From
State
Month
Day
To
Yes – Continue to 1.5a
2010
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.5b. During 2010, when did (you/he/she) stay at that place?
Month
Day
Year
Month
Day
Year
Street Name
2010
From
Apt/Unit Number
Month
City
From
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.4e. Was there another
correctional facility or
detention center where
(you/he/she) stayed in
2010?
Year
Please provide as specific dates as possible.
Facility Name
State
Year
Street Name
Apt/Unit Number
House Number
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
1.4b. During 2010, when did (you/he/she) stay at that place?
Day
Year
2010
2010
To
Month
To
Day
Yes
No
DK
1.5e. Was there another
correctional facility or
detention center where
(you/he/she) stayed in
2010?
Year
Yes – Skip to 2 (next page)
2010
No – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
DK – Skip to 2 (next page)
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
96
Section L
Yes
Yes
No
1.1b.
No
DK
DK
Yes
No
DK
Day
DK
Yes
Year
Yes
No
INTERVIEWER CHECK:
DK
h. Any other type of
juvenile facility?
Yes
No
DK
f. Boarding school?
No
Month
Day
Do not read – Did the
respondent answer "Yes"
to any of those reasons,
1a through 1h?
Yes – Continue to 1.1a
No – Skip to 2 (next page)
DK
1.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
During 2010, when did (you/he/she) stay at that place?
Year
Yes
No
DK
Street Name
2010
From
Apt/Unit Number
Month
City
Day
ZIP Code
1.2a. What was the address of that place?
Month
Day
To
No – Skip to 2 (next page)
2010
DK – Skip to 2 (next page)
1.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.2b.
1.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
During 2010, when did (you/he/she) stay at that place?
Month
Day
Year
Month
Day
Year
Street Name
2010
From
Apt/Unit Number
Month
City
From
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
Yes – Continue to 1.2a
Year
Please provide as specific dates as possible.
Facility Name (such as fort, base, barrack, ship):
1.1e. Was there another
facility where
(you/he/she) stayed
in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.1e
DK – Probe for months
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
2010
To
Year
2010
From
State
State
No
e. Training school or
farm?
c. Juvenile correctional facility?
Month
House Number
Yes
Please provide as specific dates as possible.
Facility Name
House Number
DK
b. Residential school for
people with disabilities?
Yes
1.1a. What was the name and address of that place?
No
g. Treatment center?
d. Boot camp?
a. Group home?
1. The next series of questions will ask you about places
where (you/
) might
have stayed this year, that is, during the calendar year
2010. If (you/he/she) stayed at one of these places this
year, please answer “yes” even if (you/he/she) did not
stay there for long. During 2010, (have you/has he/she)
spent even one night in any of the following places:
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Yes
No
DK
1.2e. Was there another
facility where
(you/he/she) stayed
in 2010?
Yes – Continue to 1.3a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
1.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Most of the time
Certain days of the week
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
97
Section L
1.4a. What was the name and address of that place?
1.4b. During 2010, when did (you/he/she) stay at that address?
Please provide as specific dates as possible.
Facility Name
Month
House Number
Day
2010
From
Month
City
Day
Day
Year
Yes
No
DK
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.5a. What was the name and address of that place?
2010
To
Year
2010
From
State
Month
Day
To
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.5b. During 2010, when did (you/he/she) stay at that address?
Month
Day
Year
2010
From
Apt/Unit Number
Month
From
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
Yes – Continue to 1.5a
2010
Month
Day
Year
Street Name
City
1.4e. Was there another
facility where
(you/he/she) stayed
in 2010?
Year
Please provide as specific dates as possible.
Facility Name
State
Month
Street Name
Apt/Unit Number
House Number
Year
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
1.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.5e. Was there another
correctional facility or
detention center where
(you/he/she) stayed in
2010?
Year
Yes – Skip to 2 (next page)
2010
No – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
DK – Skip to 2 (next page)
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
98
Section M
1. People sometimes stay places to receive care or
services. For the following places, we would like to
know if (you/
)
stayed there at any time this year, that is, during the
calendar year 2010. During 2010, (have you/has
he/she) spent even one night in any of the following
places:
1.1a. What was the name and address of the first place
where (you/he/she) stayed in 2010?
a. Nursing home?
Yes
Yes
Yes
1.1b.
County
1.2b.
Day
From
Not in United States
DK/REF – Probe for facility, street, city, state, county
Month
Day
Do not read – Did the
respondent answer "Yes"
to any of those reasons,
1a through 1h?
DK
h. Residential school for
people with disabilities?
Yes
No
Yes – Continue to 1.1a
No – Skip to 2 (next page)
DK
Year
1.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
2010
To
Year
No
DK
Month
Day
No – Skip to 2 (next page)
2010
To
1.1e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
Yes – Continue to 1.2a
Year
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
Day
Year
2010
Month
County
Year
2010
From
ZIP Code
No
During 2010, when did (you/he/she) live or stay at that place?
Apt/Unit Number
State
Day
2010
Month
City
Yes
Yes
INTERVIEWER CHECK:
1.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Su M Tu W Th F Sa
Half of the time
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Facility Name (such as fort, base, barrack, ship):
Street Name
DK
g. Residential
treatment facility?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.1e
DK – Probe for months
ZIP Code
1.2a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
No
f. Group home?
DK
From
Not in United States
DK/REF – Probe for facility, street, city, state, county
Yes
Please provide as specific dates as possible.
Month
State
DK
e. Skilled nursing facility?
DK
No
No
During 2010, when did (you/he/she) live or stay at that place?
Apt/Unit Number
House Number
No
From
City
Yes
c. Rehabilitation hospital?
Month
Street Name
d. General or specialized
hospital?
DK
b. Assisted living facility?
Facility Name
House Number
No
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
1.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.2e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
Yes – Continue to 1.3a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
99
Section M
1.3a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.3b. During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Facility Name
House Number
Month
State
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.4a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
From
Not in United States
DK/REF – Probe for facility, street, city, state, county
Month
Day
No
DK
To
Year
Yes – Continue to 1.4a
2010
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
Day
Year
2010
Month
County
Yes
2010
1.4b. During 2010, when did (you/he/she) live or stay at that place?
Apt/Unit Number
ZIP Code
Year
1.3e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
1.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
From
City
Day
To
Year
2010
Month
Street Name
Month
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
Facility Name
State
Day
From
City
Year
2010
From
Street Name
Apt/Unit Number
House Number
Day
1.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.4e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
Year
Yes – Skip to 2 (next page)
2010
No – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
DK – Skip to 2 (next page)
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
100
Section N
a. Group home?
1. People sometimes stay places to receive care or
services. For the following places, we would like to
know if (you/
)
stayed there at any time this year, that is, during the
calendar year 2010. During 2010, (have you / has
he/she) spent even one night in any of the following
places:
Yes
No
Yes
b. Residential
treatment facility?
Yes
No
No
Yes
No
1.1b.
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.2a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.2b.
Day
Day
No
Yes – Continue to 1.1a
No – Skip to 2 (next page)
DK
1.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.1e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
Yes – Continue to 1.2a
Year
No – Skip to 2 (next page)
2010
To
From
Year
2010
Month
Not in United States
DK/REF – Probe for facility, street, city, state, county
Month
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
Apt/Unit Number
County
Year
During 2010, when did (you/he/she) live or stay at that place?
From
ZIP Code
DK
2010
To
Year
2010
Month
City
Yes
DK
Day
No
1.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Facility Name
Street Name
Month
Do not read – Did the
respondent answer "Yes"
to any of those reasons,
1a through 1h?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.1e
DK – Probe for months
ZIP Code
County
State
Day
From
State
Year
2010
Month
Apt/Unit Number
House Number
Day
INTERVIEWER CHECK:
DK
h. Skilled nursing facility?
Please provide as specific dates as possible.
From
City
Yes
DK
During 2010, when did (you/he/she) live or stay at that place?
Month
Street Name
No
No
g. General or specialized
hospital?
DK
e. Assisted living facility?
Facility Name
House Number
Yes
d. Nursing home?
DK
Yes
1.1a. What was the name and address of the first place
where (you/he/she) stayed in 2010?
f. Rehabilitation hospital?
c. Residential school for
people with disabilities?
DK
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
1.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.2e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
Yes – Continue to 1.3a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
101
Section N
1.3a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.3b. During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Facility Name
House Number
Month
State
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.4a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
From
Not in United States
DK/REF – Probe for facility, street, city, state, county
Month
Day
No
DK
To
Year
Yes – Continue to 1.4a
2010
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
Day
Year
2010
Month
County
Yes
2010
1.4b. During 2010, when did (you/he/she) live or stay at that place?
Apt/Unit Number
ZIP Code
Year
1.3e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
1.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
From
City
Day
To
Year
2010
Month
Street Name
Month
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
Facility Name
State
Day
From
City
Year
2010
From
Street Name
Apt/Unit Number
House Number
Day
1.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.4e. Was there another
place where
(you/he/she) stayed to
receive care or services
in 2010?
Year
Yes – Skip to 2 (next page)
2010
No – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
DK – Skip to 2 (next page)
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
102
Section O
1. People sometimes receive care or services from different
types of places. For the following places, we would like to
know if (you/
) went there
to use their services at any time this year, that is, during the
calendar year 2010, even if (you/he/she) only went once.
1.1. During 2010, (have you/has he/she) used services from
any of the following types of places:
a. Soup kitchen?
Yes
No
c. Shelter?
DK
Yes
1.2a. What was the name and address of that place?
Day
DK
No
Year
Month
Day
Year
DK
Do not read – Did the
respondent answer "Yes"
to any of those reasons,
1.1a through 1.1d?
Yes–Continue to 1.2a
No–Skip to 2 (next page)
1.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
Street Name
2010
From
Apt/Unit Number
Month
City
Day
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.3a. What was the name and address of that place?
2010
To
Year
2010
From
State
Month
Day
To
Yes – Continue to 1.3a
2010
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.2e
DK – Probe for months
1.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.3b. During 2010, when did (you/he/she) stay at or use that place?
Month
Day
Year
Month
Day
Year
Street Name
2010
From
Apt/Unit Number
Month
City
From
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.2e. Was there another
place where
(you/he/she) visited to
receive care or services
in 2010?
Year
Please provide as specific dates as possible.
Facility Name
State
Yes
1.2b. During 2010, when did (you/he/she) stay at or use that place?
Month
House Number
DK
Please provide as specific dates as possible.
Facility Name
House Number
No
No
d. Hotel or motel?
b. Mobile food van?
Yes
INTERVIEWER CHECK:
Day
Year
2010
2010
To
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
1.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.3e. Was there another
place where
(you/he/she) visited to
receive care or services
in 2010?
Yes – Continue to 1.4a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
103
Section O
1.4a. What was the name and address of that place?
1.4b. During 2010, when did (you/he/she) stay at or use that place?
Please provide as specific dates as possible.
Facility Name
Month
House Number
Day
2010
From
Month
City
Day
Day
Year
Yes
No
DK
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.5a. What was the name and address of that place?
2010
To
Year
2010
From
State
Month
Day
To
Yes – Continue to 1.5a
2010
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
1.5b. During 2010, when did (you/he/she) stay at or use that place?
Month
Day
Year
Month
Day
Year
Street Name
2010
From
Apt/Unit Number
Month
City
From
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.4e. Was there another
place where
(you/he/she) visited to
receive care or services
in 2010?
Year
Please provide as specific dates as possible.
Facility Name
State
Month
Street Name
Apt/Unit Number
House Number
Year
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Year
2010
2010
To
Month
To
Day
1.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.5e. Was there another
place where
(you/he/she) visited to
receive care or services
in 2010?
Year
Yes – Skip to 2 (next page)
2010
No – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
DK – Skip to 2 (next page)
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
104
Section P
1. The following questions will ask you about places
where (you/
)
might have stayed this year, that is, during the
calendar year 2010. If (you/he/she) stayed at one of
these places this year, please answer “yes” even if
(you/he/she) did not stay there for long.
1.4a. What was the name and address of the first place
where (you/he/she) stayed in 2010?
1.1. During 2010, (have you/has he/she) had
a job where your employer provided
housing for you?
1.4b.
Yes – Skip to 1.4a
Yes – Continue to 1.4a
No – Continue to 1.2
No – Continue to 1.3
No – Skip to 2 (next page)
DK – Continue to 1.2
DK – Continue to 1.3
DK – Skip to 2 (next page)
During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
State
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.5a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.5b.
Day
Apt/Unit Number
From
Not in United States
DK/REF – Probe for facility, street, city, state, county
To
Year
2010
Month
County
Day
Yes
No
DK
Yes – Continue to 1.5a
Year
No – Skip to 2 (next page)
2010
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
From
ZIP Code
Month
During 2010, when did (you/he/she) live or stay at that place?
Month
City
Year
2010
To
Year
2010
Day
1.4e. Was there another
place where
(you/he/she) stayed for
work purposes in 2010?
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Facility Name (such as fort, base, barrack, ship):
Street Name
Month
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
ZIP Code
County
State
Day
From
City
Year
2010
Month
Apt/Unit Number
House Number
Day
From
Street Name
1.3. During 2010, (have you/has he/she)
had a job that involved living
somewhere other than here?
Yes – Skip to 1.4a
Facility Name
House Number
1.2. During 2010, (have you/has he/she)
stayed in a place with other people that
(you/he/she) worked with?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
1.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.5e. Was there another
place where
(you/he/she) stayed for
work purposes in 2010?
Yes – Continue to 1.6a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
105
Section P
1.6a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.6b.
During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Facility Name
House Number
Month
State
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.7a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.7b.
Day
Apt/Unit Number
From
Not in United States
DK/REF – Probe for facility, street, city, state, county
To
Year
2010
Month
County
Day
Yes
No
DK
Yes – Continue to 1.7a
Year
No – Skip to 2 (next page)
2010
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
From
ZIP Code
Month
During 2010, when did (you/he/she) live or stay at that place?
Month
City
Year
2010
To
Year
2010
Day
1.6c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Facility Name
Street Name
Month
1.6e. Was there another
place where
(you/he/she) stayed for
work purposes in 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.6e
DK – Probe for months
ZIP Code
County
State
Day
From
City
Year
2010
From
Street Name
Apt/Unit Number
House Number
Day
1.6d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
1.7d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.7e. Was there another
place where
(you/he/she) stayed for
work purposes in 2010?
Yes – Skip to 2 (next page)
Year
No – Skip to 2 (next page)
2010
DK – Skip to 2 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.7e
DK – Probe for months
1.7c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
106
Section Q
1.1. During 2010, (have you/has he/she)
stayed somewhere for religious or
spiritual reasons?
1.2. What type of place was it?
Read as necessary.
Yes – Continue to 1.2
No – Skip to 2 (next page)
1.3b.
ZIP Code
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.4a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.4b.
Day
Month
Day
No
DK
Year
Yes – Continue to 1.4a
2010
To
From
Year
2010
Month
Not in United States
DK/REF – Probe for facility, street, city, state, county
Yes
2010
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
Apt/Unit Number
County
Year
During 2010, when did (you/he/she) live or stay at that place?
From
ZIP Code
Day
To
Year
2010
Month
City
Month
1.3e. Was there another
place where
(you/he/she) stayed
for religious or
spiritual reasons in
2010?
1.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
Facility Name
Street Name
Year
1.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.3e
DK – Probe for months
County
State
Day
From
State
Yeshiva
2010
Month
Apt/Unit Number
House Number
Day
From
City
Other – Please specify
Please provide as specific dates as possible.
Month
Street Name
Monastery
During 2010, when did (you/he/she) live or stay at that place?
Facility Name
House Number
Commune
Rectory
DK – Skip to 2 (next page)
1.3a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
Convent
➤
1. The following questions will ask you about places
where (you/
)
might have stayed this year, that is, during the
calendar year 2010. If (you/he/she) stayed at one of
these places this year, please answer “yes” even if
(you/he/she) did not stay there for long.
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.4e
DK – Probe for months
1.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.4e. Was there another
place where
(you/he/she) stayed
for religious or
spiritual reasons in
2010?
Yes – Continue to 1.5a (on
back)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
107
Section Q
1.5a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
1.5b. During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Facility Name
House Number
Month
State
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
1.6a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
From
Not in United States
DK/REF – Probe for facility, street, city, state, county
Month
Day
No
DK
Year
Yes – Continue to 1.5a
2010
To
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
Please provide as specific dates as possible.
Day
Year
2010
Month
County
Yes
2010
1.6b. During 2010, when did (you/he/she) live or stay at that place?
Apt/Unit Number
ZIP Code
Year
1.5e. Was there another
place where
(you/he/she) stayed
for religious or
spiritual reasons in
2010?
1.5c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
From
City
Day
To
Year
2010
Month
Street Name
Month
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.5e
DK – Probe for months
Facility Name
State
Day
From
City
Year
2010
From
Street Name
Apt/Unit Number
House Number
Day
1.5d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 1.6e
DK – Probe for months
1.6d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
1.6e. Was there another
place where
(you/he/she) stayed
for religious or
spiritual reasons in
2010?
Yes – Skip to 2 (next page)
No – Skip to 2 (next page)
DK – Skip to 2 (next page)
1.6c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
108
Section R
2. The Census Bureau does a special count of people in places that house groups of people, such
as nursing homes, jails and emergency shelters. Other than places that you have already told me
about, even if (you/
) did not live there, (have you/has he/she)
spent even one night in any of those types of places in 2010?
Yes – Continue to 2.1a
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
2.1a. What was the name and address of the first place
where (you/he/she) stayed in 2010?
2.1b. During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Same
as
Day
Year
2010
From
Month
Day
Year
2.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
2010
To
Yes – Continue to 2.2a
Facility Name
Month
House Number
Street Name
Day
2010
From
Apt/Unit Number
Year
Month
Day
To
Year
No – Skip to 3 (next page)
2010
DK – Skip to 3 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.1e
DK – Probe for months
City
State
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
2.2a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
2.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
2.2b. During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Same
as
Day
Year
2010
From
Month
Day
Year
2010
To
Facility Name
Month
House Number
Street Name
From
Apt/Unit Number
Day
Year
2010
Month
To
Day
Year
2010
2.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
2.2e. Was there another
facility where
(you/he/she) stayed
in 2010?
Yes – Continue to 2.3a (on
back)
No – Skip to 3 (next page)
DK – Skip to 3 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.2e
DK – Probe for months
City
State
2.1e. Was there another
facility where
(you/he/she) stayed
in 2010?
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
2.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
109
Section R
2.3a. What was the name and address of the first place
where (you/he/she) stayed in 2010?
2.3b. During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Same
as
Day
Year
2010
From
Month
Day
Year
2.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
2010
To
Yes – Continue to 2.4a
Facility Name
Month
House Number
Street Name
Day
2010
From
Apt/Unit Number
Year
Month
Day
To
Year
No – Skip to 3 (next page)
2010
DK – Skip to 3 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.3e
DK – Probe for months
City
State
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
2.4a. What was the name and address of the next place
where (you/he/she) stayed in 2010?
2.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
2.4b. During 2010, when did (you/he/she) live or stay at that place?
Please provide as specific dates as possible.
Month
Same
as
Day
Year
2010
From
Month
Day
Year
2010
To
Facility Name
Month
House Number
Street Name
From
Apt/Unit Number
Day
Year
2010
Month
To
Day
2.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
2.4e. Was there another
facility where
(you/he/she) stayed
in 2010?
Yes – Skip to 3 (next page)
Year
No – Skip to 3 (next page)
2010
DK – Skip to 3 (next page)
Off and on during all of 2010
Did not stay there during 2010 – Skip to 2.4e
DK – Probe for months
City
State
2.3e. Was there another
facility where
(you/he/she) stayed
in 2010?
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
2.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
110
Section R
3. Other than places that you have already mentioned, during 2010, (have you/
has he/she) stayed somewhere else for an extended time or lived part of
the time at another place?
Yes – Continue to 3.1a
No – Skip to Section S (next page)
DK – Skip to Section S (next page)
3.1a. What was the address of that place?
Please provide as specific dates as possible.
Same
as
Month
Facility Name
House Number
Day
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
3.2a. What was the address of that place?
Month
Day
Year
Month
Day
Day
From
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
Year
2010
Month
ZIP Code
Yes – Continue to 3.2a
No – Skip to Section S
(next page)
2010
To
DK – Skip to Section S
(next page)
3.2b. During 2010, when did (you/he/she) live or stay at that place?
Street Name
City
DK
3.1e. Was there another
place where
(you/he/she) stayed
in 2010?
3.1c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
From
Apt/Unit Number
No
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.1e
DK – Probe for months
Month
Facility Name
Yes
Year
Please provide as specific dates as possible.
Same
as
3.1d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
Year
2010
Month
Street Name
City
State
Day
From
Apt/Unit Number
House Number
3.1b. During 2010, when did (you/he/she) live or stay at that place?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.2e
DK – Probe for months
3.2d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
3.2e. Was there another
place where
(you/he/she) stayed
in 2010?
Yes – Continue to 3.3a (on
back)
No – Skip to Section S
(next page)
DK – Skip to Section S
(next page)
3.2c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
111
Section R
3.3a. What was the address of that place?
Please provide as specific dates as possible.
Same
as
Month
Facility Name
House Number
Day
ZIP Code
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
3.4a. What was the address of that place?
Month
Day
Year
Month
Day
Day
From
County
Not in United States
DK/REF – Probe for facility, street, city, state, county
Year
2010
Month
ZIP Code
Yes – Continue to 3.4a
No – Skip to Section S
(next page)
2010
To
DK – Skip to Section S
(next page)
3.4b. During 2010, when did (you/he/she) live or stay at that place?
Street Name
City
DK
3.3e. Was there another
place where
(you/he/she) stayed
in 2010?
3.3c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
From
Apt/Unit Number
No
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.3e
DK – Probe for months
Month
Facility Name
Yes
Year
Please provide as specific dates as possible.
Same
as
3.3d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
2010
To
Year
2010
From
State
Year
2010
Month
Street Name
City
State
Day
From
Apt/Unit Number
House Number
3.3b. During 2010, when did (you/he/she) live or stay at that place?
Day
Month
Year
2010
To
Year
2010
Day
Month
To
Day
Year
2010
Off and on during all of 2010
Did not stay there during 2010 – Skip to 3.4e
DK – Probe for months
3.4d. (Were you/Was he/she) there on Thursday,
April 1st, 2010?
Yes
No
DK
3.4e. Was there another
place where
(you/he/she) stayed
in 2010?
Yes – Skip to Section S
(next page)
No – Skip to Section S
(next page)
DK – Skip to Section S
(next page)
3.4c. During those dates, how often did (you/he/she) stay there?
Read as necessary.
Certain days of the week
Most of the time
Half of the time
Su M Tu W Th F Sa
Less than half of the time
DK – Probe for most, half, or
less than half of the time
112
Section S
Closing Remarks
1. Those are all the questions that I have. If you have any comments about the amount of time we
estimate to complete the survey or any other aspect of this survey, I can give you an address
where you can write to express your comments. Would you like the address?
(READ ONLY IF NECESSARY)
INTERVIEWER FINAL CHECKS
While collecting addresses, did you mark any "Same as
"?
Yes – Go back and finish completing the information.
No – Closeout the case.
Associate Director for Administration
Paperwork Project 0607-0725
U.S. Census Bureau
Room 31043
Washington, D.C. 20233
You may also email comments to [email protected], use “Paperwork Project – XXXX-XXXX
as the subject.
Thank you for your time and cooperation. You’ve been very helpful.
113
| File Type | application/pdf |
| File Title | d1402_p001.g |
| File Modified | 2011-06-23 |
| File Created | 2010-07-27 |