D-1402 Targeted Coverage Followup (TCFU) Questionnaire

2010 Census Coverage Followup Telephone Operation

Attachment B - TCFU Questionnaire 072710 (09-20-2010 Packet))

Qualitative Research on Methods for Unduplicating People Suspected of Being Counted More Than Once During a Census

OMB: 0607-0946

Document [pdf]
Download: pdf | pdf
OMB 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
ADDRESS INFORMATION #1

House Number

Apt/Unit Number
State

ZIP Code

House Number

Street Name

Apt/Unit Number
State

City

Phone Number

Phone Number

U.S. Census Bureau

ADDRESS INFORMATION #2

Street Name

City

Economics and Statistics Administration

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

PAGE INTENTIONALLY LEFT BLANK

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

PAGE INTENTIONALLY LEFT BLANK

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

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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


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