Various Demographic Area Pretesting Activities

Electronic Version 2: Current Day Start

1. I’m here to complete a Census questionnaire for address. It should take about 10 minutes.

2. Do you live or stay at Address now?

   1. Yes – What is your name? Go to 4.

   2. No –

3. Does anyone live or stay at Address now?

   1. Yes – Go to 4

   2. No – Go to 5

4. Please list all the (other) people who live or stay at Address.

5. Please look at this calendar – think back to who was living at ADDRESS on January 15, 2012. Where was each person living or staying on January 15, 2012?

List Roster Here Somewhere else

NAME [] []

6. Were there any OTHER people NOT ALREADY LISTED who were living or staying at ADDRESS on January 15, 2012 who no longer live here?

Yes –What is that person’s name? Anyone else?

No

DK

7. Were there any people NOT ALREADY LISTED who usually live or stay at ADDRESS but were temporarily away on January 15, 2012?

Yes– What is that person’s name? Anyone else?

No – Continue

8. There are certain types of people that are sometimes left off the census. Were there any additional people staying here on January 15^th that you didn’t think of, for example:

   1. Babies? Y N

   2. Foster children? Y N

   3. Any other relatives? Y N

   4. Roommates or people not related to you? Y N

   5. How about anyone staying her who had no permanent place to live? Y N

Yes for any – What is that person’s name? Anyone else?

No for all– Continue

9. Is there anyone who you thought of mentioning but decided not to?

Yes– What is that person’s name? Anyone else?

No – Continue

10. For people who were rostered at 9. When did NAME live or stay here?

    1. Lives /stays here now

    2. Lived/stayed here on January 15

    3. Neither

    4. Both

    5. Other

11. … Demographics…

12. Some people live or stay in more than one place and we would like to make sure everyone is only counted once.

13. People marked “Somewhere else”in 5 – What was your/NAME’s address(es) on January 15?

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)

14. 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 -

15. 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

16. 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 -

17. 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

18. In January, (were you/ was anyone) in a place like a nursing home or a group home?

• Yes – Who was away?

• No

19. In January, was anyone in a jail or prison?

• Yes – Who?

• No

For those with another address:

20. 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)

21. Around January 15, 2012,W where didoes 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

22. On January 15, 2012, where was NAME staying?

• Fill all addresses as choices

• Some other place – Go to 20

23. What address would you/NAME consider your/his/her permanent or official address?

• Fill all addresses as choices

• Some other place – Go to 20

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