Form D-1340(EVAL) AFAQ Form (Round 1)
2010 Census Coverage Measurement Final Housing Unit Followup and Address Frame Accuracy & Quality Evaluation
AFAQ Forms for Delete-Duplicate Operation
Address Frame Accuracy and Quality Evaluation
OMB: 0607-0962
FORM D-1340(EVAL) OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx |
U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU
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Evaluation of Address Frame Accuracy and Quality
Final Housing Unit Followup (FHUFU) Packet Cover Page
2010 Census
A. Cluster Identification B. Followup Units in Packet
1. Cluster No.
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2. LCO name |
3. Code |
4. County |
5. Code |
6. State |
7. Code |
8. TEA |
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9. City |
10. ZIP |
Block Number |
Number of Followup Units per Block |
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Total Number of Followup Units______ |
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C. Field Staff Identification
Position (a) |
CLD (b) |
Name (c) |
FR Code (d) |
Dates |
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Assigned (e) |
Completed (f) |
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Month |
Day |
Month |
Day |
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1. Crew leader |
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2. Interviewer |
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3. Interviewer |
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Total # Maps:
CENSUS CONFIDENTIAL: RESTRICTED DATA FOR OFFICIAL USE ONLY. Information contained in this report is for use by the Census Bureau and is confidential by law (Title 13, U.S.C.). It may be seen only by persons sworn to protect the confidentiality of the data and may be used only for statistical purposes. Access restricted to authorized CCM staff.
NOTICE TO FINDER: If found, please either call 1-301-763-3301 to arrange for pickup OR mail to: Field Division, U.S. Census Bureau, 4600 Silver Hill Road, Washington, DC 20233-5700, Attn: Coverage Measurement Branch.
Possible CCM-Census Match (P)
The CCM and Census addresses are possible matches. Determine if the CCM and Census addresses are the same.
CCM Address |
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Census Address |
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Block |
MSN |
WMSN |
TOA |
Unit Status |
# Units |
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Block |
Census ID |
MSN |
XXXXXXX |
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YYYYYYY |
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CCM ADDRESS |
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CENSUS ADDRESS |
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Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. We are checking some addresses in this area as part of the 2010 Census. The questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it.)
(If you cannot locate the address, ask a neighbor, apartment manager, or mail carrier) I’m trying to find (address). Did or does the house/apartment at (address) ever use a different address?
1. [Go to next question. /Fill question or note from analyst beginning with: Special question: _______________________ (M)
_______________________________________________________________________________________________
_______________________________________________________________________________________________ ]
2. Do CCM Address and Census Address refer to the same housing unit? (C1)
Yes a. What is the correct address?
CCM ADDRESS
CENSUS ADDRESS
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX
YYYYYYY
Other __________________________________________________
No Skip to Question 5
3. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
___________________________________________________________________________
___________________________________________________________________________
4. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
STOP if you answered “Yes” to Question 2
CCM ADDRESS |
5. Was there a housing unit at CCM ADDRESS on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CCM ADDRESS
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down……………………………………………………………………………………….
Boarded up…………………………………………………………………………………………………..……….
Unit used for storage of non-household goods…………………………………………………………….……. Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………….. Question 9
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business…………………………………………………………………………………………………………. …
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 10
6. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
7. Look at the Census column of the Housing Unit Reference List. Do any addresses in that column refer to the same (E) housing unit as CCM ADDRESS?
Yes Enter Census ID:
No
8. Look at the CCM column of the Housing Unit Reference List. Do any other addresses in that column refer to the same (F1)
housing unit as CCM ADDRESS?
Yes Enter CCM MSN and WMSN
No
9. Is CCM ADDRESS located in block XXXXXXX? (B)
Yes
No In what block number is CCM ADDRESS?
CENSUS ADDRESS |
10. Was there a housing unit at CENSUS ADDRESS on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 14
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 15
11. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
12. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the same (D)
housing unit as CENSUS ADDRESS?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit , then enter the map
spot number here:
13. Look at the Census column of the Housing Unit Reference List. Do any other addresses in that column refer to the (G1)
same housing unit as CENSUS ADDRESS?
Yes Enter Census ID:
No
14. Is CENSUS ADDRESS located in block YYYYYYY? (B)
Yes
No In what block number is CENSUS ADDRESS?
15. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
STOP – Go to Next Form
FOR QC USE ONLY |
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CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
CCM-Census Match/Duplicate Census Address (M/DE)
The CCM and Census address match. The Census address is a possible duplicate with another Census address. Determine if the addresses on the Census list are the same.
CCM Address(es) |
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Census Address(es) |
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Block |
MSN |
WMSN |
TOA |
Unit Status
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# Units |
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Block |
Census ID |
MSN |
XXXXXXX |
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XXXXXXX |
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CCM ADDRESS |
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CENSUS ADDRESS 1 |
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YYYYYYY |
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CENSUS ADDRESS 2 |
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Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. We are checking some addresses in this area as part of the 2010 Census. The questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it.)
(If you cannot locate the address, ask a neighbor, apartment manager, or mail carrier) I’m trying to find (address). Did or does the house/apartment at (address) ever use a different address?
1. [Go to next question. /Fill question or note from analyst beginning with: Special question: _______________________ (M)
_______________________________________________________________________________________________
_______________________________________________________________________________________________ ]
CENSUS DUPLICATE ADDRESS |
2. Do CCM Address and Census Address refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 2
Neither address is correct
What is the correct address? __________________________________________________
b. What is the correct block? (C2)
XXXXXXX
YYYYYYY
Other _________________________________________________
No ® Skip to Question 5
3. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
4. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
STOP if you answered “Yes” to Question 2
SECOND CENSUS ADDRESS |
5. Was there a housing unit at CENSUS ADDRESS 2 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 2
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….………....Future construction…………………………………………………………………………………………………
Unfit for habitation (condemned or open to the elements) and unoccupied………………………………….
Demolished or burned down……………………………………………………………………………………….
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 9
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 10
6. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
7. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the same (D)
housing unit as CENSUS ADDRESS 2?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map spot
number here:
8. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1, do any other (G2)
addresses in that column refer to the same housing unit as CENSUS ADDRESS 2?
Yes Enter Census ID:
No
9. Is CENSUS ADDRESS 2 located in block YYYYYYY? (B)
Yes
No In what block number is CENSUS ADDRESS 2?
10. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
STOP – Go to Next Form
FOR QC USE ONLY |
||||
CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
CCM-Census Match/Two Duplicate Census Addresses (M/DE/DE)
The CCM and Census address match. The Census addresses are possible duplicates with other Census addresses. Determine if the addresses on the Census list are the same.
CCM Address(es) |
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Census Address(es) |
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Block |
MSN |
WMSN |
TOA |
Unit Status |
# Units |
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Block |
Census ID |
MSN |
XXXXXXX |
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XXXXXXX |
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CCM ADDRESS |
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CENSUS ADDRESS 1 |
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XXXXXXX |
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CENSUS ADDRESS 2 |
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XXXXXXX |
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CENSUS ADDRESS 3 |
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Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. We are checking some addresses in this area as part of the 2010 Census. The questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it.)
(If you cannot locate the address, ask a neighbor, apartment manager, or mail carrier) I’m trying to find (address). Did or does the house/apartment at (address) ever use a different address?
1. [Go to next question. /Fill question or note from analyst beginning with: Special question: _______________________ (M)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
FIRST CENSUS DUPLICATE ADDRESS |
2. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 2 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 2
Neither address is correct
What is the correct address? _________________________________________________
b. What is the correct block? (C2)
XXXXXXX
Other _________________________________________________
No ® Skip to Question 4
3. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
SKIP to Question 9 if you answered “Yes” to Question 2
SECOND CENSUS ADDRESS |
4. Was there a housing unit at CENSUS ADDRESS 2 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 2
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….……..….Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 8
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 9
5. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
6. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 2?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the
map spot number here:
7. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1 (G3)
and CENSUS ADDRESS 3 do any other addresses in that column refer to the same housing unit
as CENSUS ADDRESS 2?
Yes Enter Census ID:
No
8. Is CENSUS ADDRESS 2 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 2?
SECOND CENSUS DUPLICATE ADDRESS |
9. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 3 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 3
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX
Other __________________________________________________
No Skip to Question 11
10. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
SKIP to Question 16 if you answered “Yes” to Question 9
THIRD CENSUS ADDRESS |
11. Was there a housing unit at CENSUS ADDRESS 3 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 3
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…….
….Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 15
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 16
12. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
13. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 3?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
14. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1 (G3)
and CENSUS ADDRESS 2, do any other addresses in that column refer to the same housing unit
as CENSUS ADDRESS 3?
Yes Enter Census ID:
No
15. Is CENSUS ADDRESS 3 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 3?
16. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
STOP – Go to Next Form
FOR QC USE ONLY |
||||
CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
Census Nonmatched and Duplicate Address (NE/DE)
The Census listed an address that CCM did not. The Census address is a possible duplicate with another Census address. Determine if the Census address is a housing unit and if the addresses on the Census list are the same.
CCM Address(es) |
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Census Address(es) |
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Block |
MSN |
WMSN |
TOA |
Unit Status
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# Units |
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Block |
Census ID |
MSN |
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XXXXXXX |
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CENSUS ADDRESS 1 |
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XXXXXXX |
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CENSUS ADDRESS 2 |
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Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. We are checking some addresses in this area as part of the 2010 Census. The questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it.)
(If you cannot locate the address, ask a neighbor, apartment manager, or mail carrier) I’m trying to find (address). Did or does the house/apartment at (address) ever use a different address?
1. [Go to next question. /Fill question or note from analyst beginning with: Special question: _______________________ (M)
_______________________________________________________________________________________________
_______________________________________________________________________________________________ ]
CENSUS DUPLICATE ADDRESS |
2. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 2 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 2
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX Skip to Question 8
Other __________________________________ Skip to Question 8
No
SECOND CENSUS ADDRESS |
3. Was there a housing unit at CENSUS ADDRESS 2 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 2
U
nder
construction (doors, windows, or floors NOT in
place)………………………………………………….Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 7
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
__________________________________________________
Business………………………………………………………………………………………………………….….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
______________________________________________________________________ Skip to Question 8
4. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
5. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 2?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
6. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1, do any other (G2)
addresses in that column refer to the same housing unit as CENSUS ADDRESS 2?
Yes Enter Census ID:
No
7. Is CENSUS ADDRESS 2 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 2?
CENSUS NONMATCH ADDRESS |
8. Was there a housing unit at CENSUS ADDRESS 1 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 1
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….……..….Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 12
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
__________________________________________________
Business…………………………………………………………………………………………………………. ….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 13
9. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
10. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 1?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
11. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 2, do any other (G2)
addresses in that column refer to the same housing unit as CENSUS ADDRESS 1?
Yes Enter Census ID:
No
12. Is CENSUS ADDRESS 1 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 1?
13. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
STOP – Go to Next Form
FOR QC USE ONLY |
||||
CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
Census Nonmatched/Two Duplicate Census Addresses (NE/DE/DE)
The Census listed an address that CCM did not. The Census addresses are possible duplicates with other Census addresses. Determine if the Census address is a housing unit and if the addresses on the Census list are the same.
CCM Address(es) |
|
Census Address(es) |
|||||||
Block |
MSN |
WMSN |
TOA |
Unit Status
|
# Units |
|
Block |
Census ID |
MSN |
|
|
|
|
|
|
|
XXXXXXX |
|
|
|
|
CENSUS ADDRESS 1 |
|||||||
|
|
|
|
|
|
XXXXXXX |
|
|
|
|
|
CENSUS ADDRESS 2 |
|||||||
|
|||||||||
|
|
|
|
|
|
XXXXXXX |
|
|
|
|
CENSUS ADDRESS 3 |
||||||||
|
|||||||||
Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. We are checking some addresses in this area as part of the 2010 Census. The questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it.)
(If you cannot locate the address, ask a neighbor, apartment manager, or mail carrier) I’m trying to find (address). Did or does the house/apartment at (address) ever use a different address?
1. [Go to next question. /Fill question or note from analyst beginning with: Special question: _______________________ (M)
_______________________________________________________________________________________________
_______________________________________________________________________________________________ ]
FIRST CENSUS DUPLICATE ADDRESS |
2. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 2 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 2
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX Skip to Question 8
Other __________________________________ Skip to Question 8
No
SECOND CENSUS ADDRESS |
3. Was there a housing unit at CENSUS ADDRESS 2 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 2
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 7
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
______________________________________________________________________ Skip to Question 8
4. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
5. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 2?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
6. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1 and (G3)
CENSUS ADDRESS 3, do any other addresses in that column refer to the same housing unit as
CENSUS ADDRESS 2?
Yes Enter Census ID:
No
7. Is CENSUS ADDRESS 2 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 2?
SECOND CENSUS DUPLICATE ADDRESS |
8. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 3 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 3
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX Skip to Question 14
Other __________________________________ Skip to Question 14
No
THIRD CENSUS ADDRESS |
9. Was there a housing unit at CENSUS ADDRESS 3 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 3
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….………….Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 13
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 14
10. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
11. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 3?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
12. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1 and (G3)
CENSUS ADDRESS 2, do any other addresses in that column refer to the same housing unit as CENSUS ADDRESS 3?
Yes Enter Census ID:
No
13. Is CENSUS ADDRESS 3 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 3?
CENSUS NONMATCH ADDRESS |
14. Was there a housing unit at CENSUS ADDRESS 1 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 1
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 18
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 19
15. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
16. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 1?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
17. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 2 and (G3)
CENSUS ADDRESS 3, do any other addresses in that column refer to the same housing unit as
CENSUS ADDRESS 1?
Yes Enter Census ID:
No
18. Is CENSUS ADDRESS 1 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 1?
19. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
STOP – Go to Next Form
FOR QC USE ONLY |
||||
CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
Group Quarters (GQ)
CCM listed the address as a housing unit, but Census listed it as a group quarters. Determine if the CCM address is a housing unit or a group quarters.
CCM Address |
|
Census Address |
|||||||
Block |
MSN |
WMSN |
TOA |
Unit Status |
# Units |
|
Block |
Census ID |
MSN |
XXXXXXX |
|
|
|
|
|
|
YYYYYYY |
|
|
CCM ADDRESS |
|
CENSUS ADDRESS |
|||||||
Hello my name is (your name). I’m from the U.S. Census Bureau (show your identification badge). I’d like to speak with (H)
someone who can answer questions about this place. Would that be you, or should I speak with someone else?
(Continue, or if referred to another respondent, re-read paragraph above).
We are checking addresses in this area as part of the 2010 Census. The questions should take about 3 minutes. This notice explains that your answers are confidential. (Hand the person the Confidentiality Notice and allow time for the person to read it.)
READ IF NECESSARY: I won’t need to interview residents here; I just want to ask some very basic questions about this place.
1. [Go to next question./Fill question or note from analyst beginning with: Special question:________________________ (M)
______________________________________________________________________________________________
______________________________________________________________________________________________ ]
Do CCM ADDRESS 1 and CENSUS ADDRESS refer to the same housing unit? (C1)
Yes a. What is the correct address?
CCM ADDRESS 1
CENSUS ADDRESS
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX
Other __________________________________
No
2. Next I’m going to show you a list [HAND FLASHCARD TO RESPONDENT]. Which of these best describes (I)
this place (CCM Address)?
A: Boarding school (except for schools for people with disabilities)….………………………………………… Skip to Question 9
B: Correctional facility for adults or juveniles……………………………………………………………………… Skip to Question 9
C: Fraternity or sorority house for students at a college, university, or seminary.……………………….….... Skip to Question 9
D: Group home (non-correctional) or residential treatment center (non-correctional)………………….…… Skip to Question 9
E: Health care facility (e.g., skilled nursing facility, nursing facility, hospital, hospice)…………………….. ...Skip to Question 9
F: Hotel, motel, hostel, single-room occupancy units, inn, resort, lodge, or bed & breakfast…………………Skip to Question 9
G: Independent living or assisted living facility……………………………………………………………………..Skip to Question 4
H: Military quarters (e.g., barrack/dormitory, disciplinary barrack/jail, military treatment facility)…………..…Skip to Question 9
I: Recreational vehicle (RV) park, campground, marina, or racetrack…………………………………...……...Skip to Question 5
J: Religious group living quarters intended to house members living in a group situation (e.g., convent,
monastery, or abbey)………………………………………………………………………………………….…...Skip to Question 9
K: Residence hall or dormitory for students that is owned, leased, or managed either by a college,
university or seminary, or by a private entity or organization…….……………………………..……...…… Skip to Question 9
L: Schools for people with disabilities (e.g., schools for the physically or developmentally disabled)….…… Skip to Question 9
M: Soup kitchen, a facility that operates a regularly schedule mobile food van, or shelter for people
experiencing homelessness……………………………………………………………………………………... Skip to Question 9
N: Workers’ group living quarters or group housing at Job Corps centers (e.g., migratory farm worker quarters, ranch
housing, vocational training facilities, or housing for staff)………………………………….………………...Skip to Question 9
O: None of the above………………………………………………………………………………………..…….…. Skip to Question 3
3. Is this a private residence? (J)
Yes Skip to Question 5
No Go to Question 4
4. Please describe this place: _________________________________________________________________________ (K)
_________________________________________________________________________
5. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
6. Is CCM ADDRESS located in block XXXXXXX? (B)
Yes
No In what block number is CCM ADDRESS?
7. Look at the Census column of the Housing Unit Reference List. Do any addresses in that column refer to the same (E) housing unit as CCM ADDRESS?
Yes Enter Census ID:
No
8. Look at the CCM column of the Housing Unit Reference List. Do any other addresses in that column refer to the same (F1)
housing unit as CCM ADDRESS?
Yes Enter CCM MSN and WMSN
No
9. Main source of information you used to fill out questions: (N)
NOTE: You cannot complete this case by observation.
Household member
Building manager or landlord
Proxy
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
FOR QC USE ONLY |
||||
CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
Possible CCM-Census Match/Duplicate Census Address (P/DE)
The CCM and Census addresses are possible matches. The Census address is a possible duplicate with another census address. Determine if the CCM and Census addresses are the same and if the addresses on the Census list are the same.
CCM Address(es) |
|
Census Address(es) |
|||||||
Block |
MSN |
WMSN |
TOA |
Unit Status
|
# Units |
|
Block |
Census ID |
MSN |
XXXXXXX |
|
|
|
|
|
|
XXXXXXX |
|
|
CCM ADDRESS |
|
CENSUS ADDRESS 1 |
|||||||
|
|
|
|
|
|
|
YYYYYYY |
|
|
|
|
CENSUS ADDRESS 2 |
|||||||
Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. We are checking some addresses in this area as part of the 2010 Census. The questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it.)
(If you cannot locate the address, ask a neighbor, apartment manager, or mail carrier) I’m trying to find (address). Did or does the house/apartment at (address) ever use a different address?
1. [Go to next question. /Fill question or note from analyst beginning with: Special question: _______________________ (M)
_______________________________________________________________________________________________
_______________________________________________________________________________________________ ]
2. Do CCM ADDRESS and CENSUS ADDRESS 1 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CCM ADDRESS
CENSUS ADDRESS 1
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX
Other __________________________________
No Skip to Question 4
3. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
___________________________________________________________________________
___________________________________________________________________________
SKIP to Question 14 if you answered “Yes” to Question 2
CCM ADDRESS |
4. Was there a housing unit at CCM ADDRESS on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CCM ADDRESS
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 8
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 9
5. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
6. Look at the Census column of the Housing Unit Reference List. Do any addresses in that column refer to the same (E) housing unit as CCM ADDRESS?
Yes Enter Census ID:
No
7. Look at the CCM column of the Housing Unit Reference List. Do any other addresses in that column refer to the same (F1)
housing unit as CCM ADDRESS?
Yes Enter CCM MSN and WMSN
No
8. Is CCM ADDRESS located in block XXXXXXX? (B)
Yes
No In what block number is CCM ADDRESS?
FIRST CENSUS ADDRESS |
9. Was there a housing unit at CENSUS ADDRESS 1 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 1
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….………….Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 13
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 14
10. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
11. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the same (D)
housing unit as CENSUS ADDRESS 1?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
12. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 2, do any other (G2)
addresses in that column refer to the same housing unit as CENSUS ADDRESS 1?
Yes Enter Census ID:
No
13. Is CENSUS ADDRESS 1 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 1?
CENSUS DUPLICATE ADDRESS |
14. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 2 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 2
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX Skip to Question 20
YYYYYYY Skip to Question 20
Other __________________________________ Skip to Question 20
No
SECOND CENSUS ADDRESS |
15. Was there a housing unit at CENSUS ADDRESS 2 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 2
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 19
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 20
16. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
17. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the same (D)
housing unit as CENSUS ADDRESS 2?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit , then enter the map
spot number here:
18. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1, do any other (G2)
addresses in that column refer to the same housing unit as CENSUS ADDRESS 2?
Yes Enter Census ID:
No
19. Is CENSUS ADDRESS 2 located in block YYYYYYY? (B)
Yes
No In what block number is CENSUS ADDRESS 2?
20. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
STOP – Go to Next Form
FOR QC USE ONLY |
||||
CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
Possible CCM-Census Match/Two Duplicate Census Addresses (P/DE/DE)
The CCM and Census addresses are possible matches. The Census addresses are possible duplicates with other census addresses. Determine if the CCM and Census addresses are the same and if the addresses on the Census list are the same.
CCM Address(es) |
|
Census Address(es) |
|||||||
Block |
MSN |
WMSN |
TOA |
Unit Status
|
# Units |
|
Block |
Census ID |
MSN |
XXXXXXX |
|
|
|
|
|
|
XXXXXXX |
|
|
CCM ADDRESS |
|
CENSUS ADDRESS 1 |
|||||||
|
|
|
|
|
|
XXXXXXX |
|
|
|
|
|
CENSUS ADDRESS 2 |
|||||||
|
|||||||||
|
|
|
|
|
|
XXXXXXX |
|
|
|
|
CENSUS ADDRESS 3 |
||||||||
|
|||||||||
Hello. I am (your name) from the U.S. Census Bureau. Here is my identification. We are checking some addresses in this area as part of the 2010 Census. The questions should only take 3 minutes. This notice explains that your answers are confidential. (Hand the respondent a Confidentiality Notice and allow time for him or her to read it.)
(If you cannot locate the address, ask a neighbor, apartment manager, or mail carrier) I’m trying to find (address). Did or does the house/apartment at (address) ever use a different address?
1. [Go to next question. /Fill question or note from analyst beginning with: Special question: _______________________ (M)
_______________________________________________________________________________________________
_______________________________________________________________________________________________ ]
2. Do CCM ADDRESS and CENSUS ADDRESS 1 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CCM ADDRESS
CENSUS ADDRESS 1
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX
Other __________________________________
No Skip to Question
4. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
___________________________________________________________________________
___________________________________________________________________________
SKIP to Question 14 if you answered “Yes” to Question 2
CCM ADDRESS |
4. Was there a housing unit at CCM ADDRESS on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CCM ADDRESS
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 8
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
______________________________________________________________________ Skip to Question 9
5. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
6. Look at the Census column of the Housing Unit Reference List. Do any addresses in that column refer to the same (E) housing unit as CCM ADDRESS?
Yes Enter Census ID:
No
7. Look at the CCM column of the Housing Unit Reference List. Do any other addresses in that column refer to the same (F1)
housing unit as CCM ADDRESS?
Yes Enter CCM MSN and WMSN
No
8. Is CCM ADDRESS located in block XXXXXXX? (B)
Yes
No In what block number is CCM ADDRESS?
FIRST CENSUS ADDRESS |
9. Was there a housing unit at CENSUS ADDRESS 1 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 1
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 13
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 14
10. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
11. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the same (D)
housing unit as CENSUS ADDRESS 1?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the
map spot number here:
12. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 2 and CENSUS (G3)
ADDRESS 3, do any other addresses in that column refer to the same housing unit as CENSUS ADDRESS 1?
Yes Enter Census ID:
No
13. Is CENSUS ADDRESS 1 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 1?
FIRST CENSUS DUPLICATE ADDRESS |
14. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 2 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 2
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX Skip to Question 20
Other __________________________________ Skip to Question 20
No
SECOND CENSUS ADDRESS |
15. Was there a housing unit at CENSUS ADDRESS 2 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 2
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 19
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 20
16. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
17. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the same (D)
housing unit as CENSUS ADDRESS 2?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
18. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1 and CENSUS (G3)
ADDRESS 3, do any other addresses in that column refer to the same housing unit as CENSUS ADDRESS 2?
Yes Enter Census ID:
No
19. Is CENSUS ADDRESS 2 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 2?
SECOND CENSUS DUPLICATE ADDRESS |
20. Do CENSUS ADDRESS 1 and CENSUS ADDRESS 3 refer to the same housing unit? (C1)
Yes a. What is the correct address?
CENSUS ADDRESS 1
CENSUS ADDRESS 3
Neither address is correct
What is the correct address? ___________________________________________________
b. What is the correct block? (C2)
XXXXXXX Skip to Question 26
Other __________________________________ Skip to Question 26
No
THIRD CENSUS ADDRESS |
21. Was there a housing unit at CENSUS ADDRESS 3 on April 1st, 2010? (A)
Yes, and address is correct
Yes, but address needs correction
(Write correct address here): ____________________________________________________________________
No Please describe the status of CENSUS ADDRESS 3
U
nder
construction (doors, windows, or floors NOT in
place)……………………………………….…………Future construction………………………………………………………………………………………………….
Unfit for habitation (condemned or open to the elements) and unoccupied…………………………………..
Demolished or burned down………………………………………………………………………………………..
Boarded up…………………………………………………………………………………………………..………
Unit used for storage of non-household goods…………………………………………………………….…… Skip to
Empty trailer lot/site or trailer/house has been moved………………………………………………………… Question 25
Group quarters Enter facility name: __________________________________________________
Describe facility: __________________________________________________
_________________________________________________
Business………………………………………………………………………………………………………….
Other Explain what is on the ground; continue on back and draw sketch map if needed
________________________________________________________________________________
Cannot locate Explain what is on the ground; continue on the back and draw a sketch map if needed.
________________________________________________________________________________________
_____________________________________________________________________ Skip to Question 26
22. How many housing units were at this basic street address on April 1st, 2010? (L)
One
More than one How many? ____________
List all unit designations (e.g., Apt. 12A, 12B, or for several units list ranges of all units,
e.g., Apts. 101-106, 201-206, 301-306) continue in Notes and on the back if necessary:
______________________________________________________________________
______________________________________________________________________
23. Look at the CCM column of the Housing Unit Reference List. Do any addresses in that column refer to the (D)
same housing unit as CENSUS ADDRESS 3?
Yes Enter CCM MSN and WMSN
No Add new map spot to the CCM Block Map ONLY if this address is a housing unit, then enter the map
spot number here:
24. Look at the Census column of the Housing Unit Reference List. Aside from CENSUS ADDRESS 1 (G3)
and CENSUS ADDRESS 2, do any other addresses in that column refer to the same housing unit
as CENSUS ADDRESS 3?
Yes Enter Census ID:
No
25 Is CENSUS ADDRESS 3 located in block XXXXXXX? (B)
Yes
No In what block number is CENSUS ADDRESS 3?
26. Main source of information you used to fill out questions: (N)
Household member
Building manager or landlord
Proxy
Observation
Notes: _____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
STOP – Go to Next Form
FOR QC USE ONLY |
||||
CL |
QC Correct |
QC Incorrect |
QC CL |
QC OE |
FORM D-1340.REF(EVAL) OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx |
U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU
|
Evaluation of Address Frame Accuracy and Quality
Final Housing Unit Reference List
Cluster: 12345678 Page xxx of xxx
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Census Column |
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# Units |
TOA
Unit Status |
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Location Description |
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CENSUS CONFIDENTIAL: RESTRICTED DATA FOR OFFICIAL USE ONLY. Information contained in this report is for use by the Census Bureau and is confidential by law (Title 13, U.S.C.). It may be seen only by sworn Census employees and may be used only for statistical purposes. Access is limited to CCM staff.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | johns022 |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |
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