SC-3(RI) Enumeration Reinterview Form

Attachment E
OMB No. XXXX-XXXX
FORM SC-3(RI)
(01-13-2012) Draft 5

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

ENUMERATION
REINTERVIEW FORM
Special Census
APPLY REINTERVIEW ADDRESS LABEL HERE

THIS LISTING CONTAINS INFORMATION,
THE RELEASE OF WHICH IS PROHIBITED
BY TITLE 13, U.S.C.
ORIGINAL RESPONDENT’S INFORMATION

OR1.

Original respondent’s name

OR2.

OR3.

Telephone number and the best time
to call?

Area code

Original respondent
type —

OR4.

Address

Lived here on
Special Census
Date

Telephone number

Moved in after
Special Census
Date
Day

Evening

Either

Is neighbor or
other proxy

RECORD OF CONTACT
First and last name

Interview type

Month

Day

Time

Personal

Telephone

/

:

a.m.

p.m.

2.

Personal

Telephone

/

:

a.m.

p.m.

3.

Personal

Telephone

/

:

a.m.

p.m.

4.

Personal

Telephone

/

:

a.m.

p.m.

1.

INTRODUCTION

§!/++¤

S2.

Hello, I’m (Name) from the U.S. Census Bureau.
(Show ID). May I speak to (Original respondent’s name)?

S4.

Yes – Continue with question S2

Yes – Continue to S5

No – Ask when the original respondent will be available.
If unable to reinterview the original respondent,
interview a knowledgeable proxy, starting with S2.
Write the knowledgeable proxy’s name in the
Record of Contact.

No – Skip to S6.

S5.

I’m inquiring about the quality of our Special Census
interview. It should take about 10 minutes. (Hand
respondent an Information Sheet.) The first part explains
that your answers are confidential. I’ll refer to the
other parts later.

Based on these examples, how many people were living
or staying at (Reinterview Address on label) on (Special Census
Date)?
Number of people – SKIP to S7 on back of page to list the
names of those people.

– Otherwise, skip to S4.
Were you or someone in your household recently
interviewed by the Census Bureau about (Reinterview
Address on label)?
Yes – Continue to S4
No – Conduct a full interview using the SC-1
Enumerator Questionnaire

We need to count people where they live and sleep most
of the time.
Please look at list A. It contains examples of people who
should and should not be counted at this place.

– If talking to someone at the original respondent address,
continue to S3.

S3.

Did anyone live or stay at (Reinterview Address on label) on
(Special Census Date)?

S6.

Check box if Reinterview Address on label was vacant on
Special Census Date and End interview.
Vacant

00141010

S1.

S7.

Let’s make a list of all those people. Please start with the name of an owner or renter who was living at (Reinterview Address on label)
on (Special Census Date). Otherwise, start with any adult living in the (house/apartment/mobile home).

HOUSEHOLD ROSTER
Person

Record the name of those persons living at the Reinterview Address (on label) on (Special Census Date)

1
2
3
4
5
6
7
8
9
10
NOTES

I certify that the entries I have made on this questionnaire are true and correct to the best of my knowledge.

Crew Leader’s Initials

CLD #

Month Day

Year

00141028

§!/+=¤

CERTIFICATION

For Office Use Only

RI STATUS
If you select "Defer to Supervisor" write a detailed reason for deferring this RI in the NOTES section of this form.
Reviewing Clerk’s Initials

Clerk
completes
RI-Initial ➞

Pass

Defer to Supervisor

Supervisor
completes
➞
RI-Final

Pass

Soft-Fail

Form SC-3(RI) (01-13-2012)

Hard-Fail

Non-Interview

Date of Review (MM/DD/YYYY)