Electronic Version 1: Census Day Start
I’m here to complete a Census questionnaire for address. It should take about 10 minutes. We need to count everyone where they were living or staying on Census Day, which was January 15, 2012.
Please look at this calendar, on January 15, 2012 were you living or staying at this address?
Yes – What is your name? Was there anyone else living or staying at this address on January 15, 2010? What is his/her name? Anyone else? Go to 3.
No - Go to c.
Did anyone live at this address on January 15?
[] Yes - Do you know who lived here?
Yes - ? What is his/her name? Anyone else? Complete this interview for those people if possible (going to 3), if not, go to d.
No – Go to d.
[] No – Go to d.
[] Don’t know – Go to d.
Where did you live on January 15, 2012? Get address. Complete this interview for that address.
There are certain types of people that are sometimes left off the census. Were there any additional people staying here on January 15th that you didn’t think of, for example:
Babies? Y N
Foster children? Y N
Any other relatives? Y N
Roommates or people not related to you? Y N
Yes for any – What is that person’s name? Anyone else?
No for all– Continue
Was there anyone else staying here on January 15st who had no permanent place to live?
Yes– What is that person’s name? Anyone else?
No – Continue
Was there anyone else who usually lives or stays here but was away on January 15, 2012?
Yes– What is that person’s name? Anyone else?
No – Continue
Was there anyone else living or staying here on January 15st who is no longer here?
Yes – What is that person’s name? Anyone else?
No – Continue
… Demographics…
Some people live or stay in more than one place and we would like to make sure everyone is only counted once.
If there are people 18 or under Do you/anyone sometimes live or stay somewhere else with a parent, grandparent or other person?
Yes – if more than one person in household – Who sometimes lives or stays somewhere else?
No -
Do you/anyone sometimes live or stay at another home, like a seasonal or second residence?
-Yes – if more than one person in household – Who sometimes lives or stays somewhere else?
-No
If there are people ages 18-25 In January, (Were you/ was anyone) living in college housing - on or off campus?
Yes – if more than one person in household – Who was living in college housing?
No -
If there are people ages 18-60 In January, (Were you/ Was anyone) living or staying away for the military or for a job?
Yes – if more than one person in household – Who was living or staying away?
No
In January, (were you/ was anyone) in a place like a nursing home or a group home?
Yes – Who was away?
No
In January, was anyone in a jail or prison?
Yes – Who?
No
For those with another address:
What was your/NAME’s other address(es)? (Get as many addresses as they need to provide
Address (Number and street name)
____________________________ (45-character write-in box)
City
______________ (30-character write-in box)
State
________ (drop-down menu with state names in alphabetical order)
Zip Code
______ (5-character write-in box)
If there is no street address or if this is a facility, please type a description in the box below.
(250-character text box)
Around January 15, 2012, wWhere doesid NAME live and sleep most of the time?
Fill all addresses as choices
Equal time at both/all places
Some other place – Go to 20
On January 15, 2012, where was NAME staying?
Fill all addresses as choices
Some other place – Go to 20
What address would you/NAME consider your/his/her permanent or official address?
Fill all addresses as choices
Some other place – Go to 20
| File Type | application/msword |
| Author | nathanjurgenson |
| Last Modified By | demai001 |
| File Modified | 2011-12-21 |
| File Created | 2011-12-21 |