Population Questions

Attachment Rpt3 -- Population Questions.pdf

The American Community Survey

Population Questions

OMB: 0607-0810

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0607-0810 can be found here:

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American Community Survey
Administrative Questions

form and return
after receiving

mation about
g or staying at
ng label and
ment, or mobile
dress on the

StartQuestions
Hereas they appear in the questionnaire.
➜

Please print today’s date.
Month Day
Year

➜

Please print the name and telephone number of the person who is
filling out this form. We may contact you if there is a question.
Last Name

First Name

—

➜

(TDD):
ne call is free.

abla español y
cuestionario,
33-5625.
stionario en
por teléfono
pañol.

se (Black)

Area Code + Number

ave questions
s form, please call
elephone call is free.

merican
site at:

for use in the ACS

How many people are living or staying at this address?
● INCLUDE everyone who is living or staying here for more than 2 months.
● INCLUDE yourself if you are living here for more than 2 months.
● INCLUDE anyone else staying here who does not have another place to
stay, even if they are here for 2 months or less.
● DO NOT INCLUDE anyone who is living somewhere else for more than
2 months, such as a college student living away or someone in the
Armed Forces on deployment.
Person 1
Number of people

1 What is Person 2’s name?

➜

(Person 1 is the person living or staying here in whose name this house
Fill
out pagesis2,owned,
3, andbeing
4 forbought,
everyone,
including
yourself,
who is
or apartment
or rented.
If there
is no such
living
orstart
staying
address
for more
2 months.
person,
with at
thethis
name
of any adult
livingthan
or staying
here.)Then
complete the rest of the form.

ACS-1(2009)KFI

2 How is this person related

OMB No. 0607-0810

FORM
(05-22-2008)

Last Name (Please print)

Husband or wife
Biological son or daughter

What is Person 1’s name?

Adopted son or daughter

Last Name (Please print)

First Name

Stepson or stepdaughter
Brother or sister

ACS-1(2009)KFI, Page 1, Green Pantone 354 (20 and 40%)
How is this person related to Person 1?
2 ACS-1(2009)KFI
Source:
X

Person 1

Grandchild
Parent-in-law

What is Person
1’s sex? Mark
(X) ONE box. NEEDS
MEETING
FEDERAL
Male

Father or mother

Female

3 What is Person 2’s sex? Ma
Male

Femal

The Census Bureau uses this information to ensure response accuracy and completeness,
is Person 1’s
age
and what is
1’s
date of birth?
4 What
4 What is Person 2’s age and
and for contacting
respondents
with
incomplete
orPerson
missing
information.
Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

Please report babies as age 0
Print

Age (in years)

Month

Day

Year of birth

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

Question 6 about race. For this survey, Hispanic origins are not races.

Is Person 1 of Hispanic, Latino, or Spanish origin?

Month

➜ NOTE: Please answer BO

Question 6 about race. For

5 Is Person 2 of Hispanic, La

No, not of Hispanic, Latino, or Spanish origin

No, not of Hispanic, Latino

Yes, Mexican, Mexican Am., Chicano

Yes, Mexican, Mexican Am

Yes, Puerto Rican

Yes, Cuban

13199021

American Community Survey

Person 2

Population: Question on Relationship
1 What is Person 2’s name?

1 in whose name this house
ere
ented. If there is no such
ving or staying here.)

Last Name (Please print)

13199021

PersonFirst2Name

Question as it appears in the questionnaire.
1 What is Person 2’s name?
(Please
print)related to Person
First
HowName
is this
person
1? Name
Mark (X) ONE box.
2 Last

ere in whose name this house
ented. If there is no such
ving or staying here.)

Husband or wife

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter
Husband or wife
Stepson or stepdaughter
Biological son or daughter
Brother or sister
Adopted son or daughter
Father or mother
Stepson or stepdaughter
Grandchild
Brother or sister
Parent-in-law
Father or mother

Roomer or boarder
Son-in-law or daughter-in-law
Housemate or roommate
Other relative
Unmarried partner
Roomer or boarder
Foster child
Housemate or roommate
Other nonrelative
Unmarried partner

Grandchild
Male
Parent-in-law

Other nonrelative

2 How is this person related to Person 1? Mark (X) ONE box.

st Name

Source:
ACS-1(2009)KFI
is Person
3 What

ox.
1?

2’s sex? Mark (X) ONE box.

Foster child

Female

rson
What is
is Person
Person
2’s sex?
age and
what
is Person
2’s date of birth?
4 What
MEETING
FEDERAL
ox. 1’s date of birth?
2’s
Mark
(X) ONE
box.NEEDS
3
ild is less than 1 year old.
Please report babies as age 0 when the child is less than 1 year old.
Male relationship Print
Female
boxes.
numbersfor
in boxes.
The census subject about
is essential
classifying the population into families

ear of birth

Age (in years)

Month

Day

Year of birth

other groups.
Information
changes
in is
the
composition
American family,
rson 1’s date of and
birth?
is Personabout
2’s age
and what
Person
2’s date of
of the
birth?
4 What
ild is less than 1 year
old.
report
babies
as age
when
the child
less than living
1 year old.
from
the number Please
of people
living
alone
to0the
number
ofischildren
with only one parent,
boxes.
Printanumbers
is essential for planning and carrying out
numberinofboxes.
federal programs. In federally funded

ear
of birth
(in years)
Month
Day
of birth
and education
programs,
how
the money
isYear
spent
hinges,
at origin
least partially,
on
5 about
Hispanicnutrition
origin and
NOTE:
Please answer
BOTH
Question
5 about
Hispanic
and
➜Age
, Hispanic originsdecennial
are not races.
Question
6
about
race.
For
this
survey,
Hispanic
origins are not races.
census program data about relationship.

5 about Hispanic origin and
rigin

5 Is Person 2 of Hispanic, Latino, or Spanish origin?
Please
answer
BOTH
5 about Hispanic origin and
➜ NOTE:
No, not
of Hispanic,
Latino,
or Question
Spanish origin

nish origin?

5 Is Person 2 of Hispanic, Latino, or Spanish origin?

nish origin?

, Hispanic origins are not races.

Question 6 about race. For this survey, Hispanic origins are not races.

rigin

origin – Print origin, for example,
araguan, Salvadoran, Spaniard,

Government

Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican
No, not of Hispanic, Latino, or Spanish origin
Yes, Cuban
Yes, Mexican, Mexican Am., Chicano
Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Yes,
Puerto Rican
Argentinean,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
and so on.
Education
Yes, Cuban

COMMUNITY BENEFITS

Federal agencies use
about
rela-Latino, or Spanish
Dataorigin
about
relationship
are used to
Yes, data
another
Hispanic,
– Print
origin, for example,
origin – Print origin, for example,
Argentinean,
Colombian, Dominican,allocate
Nicaraguan,
Salvadoran,
Spaniard,
araguan, Salvadoran, Spaniard,
tionship for a variety
of programmatic
funds
to states
and counties
and so on.

or more boxes.

to
or morethe
boxes.
purposes. 6 What is Person 2’s race? Mark (X) one
improve
education of children in lowincome families.
White
Black, African Am., or Negro

Housing 6 What is Person 2’s race? Mark (X) one or more boxes.
t name of enrolled or principal tribe.
American Indian or Alaska Native — Print
name
of enrolled or principal tribe.
Social
Services
White
Data about families
in poverty are used
to distribute fundsBlack,
for housing
toorlocal
Local health agencies plan and administer
African Am.,
Negro
governments.
programs promoting the well-being of
t name of enrolled or principal tribe.
American Indian or Alaska Native — Print name of enrolled or principal tribe.
Japanese
Asian Indian
Native Hawaiian
Hawaiian
families andNative
children
using information on
relationship.Guamanian or Chamorro
Korean
Chinese
Guamanian or Chamorro

or more boxes.

Samoan
Native Hawaiian
Other Pacific Islander –
Guamanian
orexample,
Chamorro
Print race, for
Fijian, Tongan, and
Samoan
so on.

Filipino
Asian Indian
Other Asian – Print race,
Chinese
for example, Hmong,
Laotian, Thai, Pakistani,
Filipino
Cambodian, and so on.

Other Pacific Islander –
Print race, for example,
Fijian, Tongan, and
so on.

Other Asian – Print race,
for example, Hmong,
Laotian, Thai, Pakistani,
Cambodian, and so on.
Some other race – Print race.

Some other race – Print race.

Vietnamese
Japanese
Korean
Vietnamese

Samoan
www.census.gov
Native Hawaiian
Other Pacific Islander –
Guamanian
orexample,
Chamorro
Print race, for
Fijian, Tongan, and
Samoan
so on.
Other Pacific Islander –
Print race, for example,
Fijian, Tongan, and
so on.

2 How is this per

Husband or w

Biological so

American Community Survey
1

What is Person 1’s name?

Adopted son

Last Name (Please print)

First Name

Population: Question on Sex

Brother or si

Father or mo

2 How is this person related to Person 1?
Question
as it1 appears in the questionnaire.
X Person
3

Grandchild

Parent-in-law

3 What is Person

What is Person 1’s sex? Mark (X) ONE box.
Male

Stepson or s

Female

Male

Source:
What is Person
4 ACS-1(2009)KFI

1’s age and what is Person 1’s date of birth?
Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.
Age (in years)

Month Day
Year of birth
MEETING FEDERAL
NEEDS

4 What is Person

Please report bab
Age (in years)

Census data about sex are critical because so many federal programs must differentiate
between males and females.
The U.S.Please
Departments
of Education
and
Health
and origin
Human
answer BOTH
Question 5
about
Hispanic
and
➜ NOTE:
➜ NOTE: Please
Question
aboutdata
race.to
For
this survey,
Hispanic
are not
races.
Question 6 abo
Services are required by statute
to use6these
fund,
implement,
andorigins
evaluate
various
social and welfare programs,
as 1the
Supplemental
Food Program
Person
of Special
Hispanic,
Latino, or Spanish
origin? for Women,
5 Issuch
5 Is Person 2 of H
Infants, and Children (WIC) or theNo,
Low-Income
Home
Energy
Assistance
Program
(LIHEAP).
Laws
No, not of H
not of Hispanic, Latino, or Spanish origin
to promote equal employment opportunity for women also require census data on sex. The
Yes, Mexican
Yes, Mexican, Mexican Am., Chicano
U.S. Department of Veterans Affairs must use census data to develop its state projections of
Yes, Puerto R
veterans’ facilities and benefits. Yes, Puerto Rican
Yes, Cuban

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
and so on.

Yes, another
Argentinean,
and so on.

COMMUNITY BENEFITS
Planning

6 What is Person

What is Person 1’s race? Mark (X) one or more boxes.
White

Education

White

State and local planners analyze
social
Data about sex are used to allocate
Black,
African Am., or Negro
and economic characteristics of males
funds to institutions of higher learning
American Indian or Alaska Native — Print name of enrolled or principal tribe.
and females to predict future needs for
that increase participation, particularly
housing, education, childcare, health care,
of minority women, in scientific and
transportation, and employment.
engineering programs under the Higher
Education
Act.
Asian Indian
Japanese
Native Hawaiian
Chinese

Employment

Filipino

Korean

Social Vietnamese
Services

Asian Indian
Chinese

Samoan

Filipino

Some other race – Print race.

American Ind

Guamanian or Chamorro

Data about sex are used to evaluate
Other Asian – Print race,
Other Pacific Islander –
employment practices under for
theexample,
Civil Hmong, At the state and countyPrint
levels,
about
race, data
for example,
Laotian, Thai, Pakistani,sex are used to allocate
Fijian,
Tongan,
and
Rights Act.
funds
for food,
Cambodian, and so on.
so on.
health care services, and classes in meal
The Equal Employment Opportunity
planning to low-income women with
Commission, using data about sex,
children.
establishes and evaluates guidelines
dealing with equal employment
opportunity.

Black, African

Other Asian
for example,
Laotian, Thai
Cambodian,

Some other r

Housing
Data about sex are used to evaluate

§.4{6¤
housing policies and practices under the
Civil Rights Act.

ACS-1(2009)KFI, Page 2, Base (Black)

ACS-1(2009)KFI, Page 2, G

www.census.gov

Biological son or daugh

What is Person 1’s name?

Adopted son or daught

Last Name (Please print)

First Name

Stepson or stepdaught

American Community Survey

Brother or sister
Father or mother

How is this person
related to Person 1?
2 Question
Population:
on Age
X

Grandchild

Person 1

Parent-in-law

3 What is Person 2’s sex?

What is Person 1’s sex? Mark (X) ONE box.

Question as it Female
appears in the questionnaire.
Male

Male

4 What is Person 2’s age a

What is Person 1’s age and what is Person 1’s date of birth?
Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.
Age (in years)

Month

Day

Please report babies as ag
Pr

Year of birth

Age (in years)

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

Source: ACS-1(2009)KFI
Question 6

➜ NOTE: Please answer

about race. For this survey, Hispanic origins are not races.

Question 6 about race.

5 Is Person 2 of Hispanic,

Is Person 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

No, not of Hispanic, La

Yes, Mexican, Mexican Am., Chicano

Yes, Mexican, Mexican

MEETING FEDERAL NEEDS

Age is central for any number
of federal
programs that target funds or services to children, Yes, Puerto Rican
Yes, Puerto
Rican
working-age adults, women of childbearing age, or the older population. The U.S. Department
Yes, Cuban
Yes, Cuban
of Education uses census age data in its formula for allotment to states. Under the Voting
another Hispanic,
another Hispanic,
Latino,age
or Spanish
origin – Print
origin, for example,
Rights Act, these data onYes,
population
of voting
are required
for legislative
redistricting. Yes,
Argentinean, Colombia
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
The U.S. Department of Veterans
and so on.
and so on. Affairs uses age to develop its mandated state projections on
the need for hospitals, nursing homes, cemeteries, domiciliary services, and other benefits for
veterans.
6

6 What is Person 2’s race

What is Person 1’s race? Mark (X) one or more boxes.
White

White

Black, African Am., or Negro

Black, African Am., or N

COMMUNITY
American
Indian or Alaska NativeBENEFITS
— Print name of enrolled or principal tribe.
Education
Asian Indian
Counties and school districts
are allotted
funds based on age data.
ChineseThese funds
provide resources and
services to
Filipino
improve the education of economically
Other Asian – Print race,
disadvantaged children
and children
with
for example,
Hmong,
Laotian, Thai, Pakistani,
disabilities.

health services, and retirement homes by
using age data.Native Hawaiian
Japanese

Asian Indian

Korean

Chinese

Cambodian, and so on.

Guamanian or Chamorro

Vietnamese
Employment Samoan

Locations where new schools are needed,
as well as the required grade levels
(elementary, middle, or high school) are
identified using data Some
aboutother
age.race – Print race.
Government

American Indian or Ala

§.4{6¤

Filipino

Islander
–
Data about ageOther
are Pacific
used to
target
Print race, for example,
for job trainingFijian,
programs.
Tongan, and
so on.

veterans

Equal employment opportunities are
enforced using data about age.

Other Asian – Print race
for example, Hmong,
Laotian, Thai, Pakistani
Cambodian, and so on.

Some other race – Prin

Social Services
Age data are used to forecast the number
of people eligible for Social Security and
Medicare benefits.

Data presenting the voting-age population
are used by states to meet legislative
Under the Older Americans Act, age data
redistricting requirements.
part of the formula used
to allocate
ACS-1(2009)KFI, Page 2, Baseare
(Black)
ACS-1(2009)KFI,
Page 2, Green Pa
funds for services to seniors with low
Planners at all levels of government
incomes.
forecast the need for highways, hospitals,

www.census.gov

3
4

What is
Mark
(X) ONE
box. 1’s date of birth?
What
is Person
Person 1’s
1’s sex?
age and
what
is Person
Please
report babies as age
0 when the child is less than 1 year old.
Male
Female
Print numbers in boxes.
What
Person 1’s age
and what
date of birth?
Age
(inis
years)
Month
Day is Person
Year of1’s
birth
Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

American Community Survey

What is
Ma
3 What
is Person
Person 2’s
2’s sex?
age and
4

Population:AgeQuestion
on Hispanic
(in years)
Month Day Origin
Year of birth

Age (in years)

➜ NOTE: Please answer BOTH Question 5 about Hispanic origin and

Please answer BOTH Question 5 about Hispanic origin and
➜ NOTE: Question
as
itLatino,
appears
in the
questionnaire.
No, not6ofabout
Hispanic,
or Spanish
origin
Question
race.
For this
survey,
Hispanic origins are not races.

Month

➜ NOTE: Please answer BO

Question 6 about race. For this survey, Hispanic origins are not races.

Is Person 1 of Hispanic, Latino, or Spanish origin?

Please
report babies as age
Male
Fema0
Print
What
Person 2’s age
and
Age
(inis
years)
Month
Please report babies as age 0
Print

Question 6 about race. For

Is Person 2 of Hispanic, La

➜ NOTE: Please answer BO

No, not6ofabout
Hispanic,
Latino
Question
race.
For

Yes, Mexican,
Mexican Am
2 of Hispanic,
La
5 Is Person

Yes, Mexican,
Mexican Am.,
Chicano
Is Person
1 of Hispanic,
Latino,
or Spanish origin?
Yes,
Puerto
Rican
No, not
of Hispanic,
Latino, or Spanish origin

Yes,
Puerto
Rican
No, not
of Hispanic,
Latino

Yes, Mexican,
Cuban
Mexican Am., Chicano

Yes, Mexican,
Cuban
Mexican Am

Yes, another
Hispanic, Latino, or Spanish origin – Print origin, for example,
Puerto Rican
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
Yes,
Cuban
and so on.

Yes, another
Hispanic, Lati
Puerto Rican
Argentinean, Colombian, D
Yes,
Cuban
and so on.

Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
and so on.

Yes, another Hispanic, Lati
Argentinean, Colombian, D
and so on.

What is Person 1’s race? Mark (X) one or more boxes.

6 What is Person 2’s race? M

White

Black,
African1’s
Am.,
or Negro
is Person
race?
Mark (X) one or more boxes.
6 What
Source:
ACS-1(2009)KFI

African2’s
Am.,
or Neg
is Person
race?
M
6 WhatBlack,

American
Indian or Alaska Native — Print name of enrolled or principal tribe.
White

American
Indian or Alaska
White

Black, African Am., or Negro

Black, African Am., or Neg

American Indian or Alaska Native — Print name of enrolled or principal tribe.

American Indian or Alaska

MEETING FEDERAL NEEDS

Indian
Asian Indian
Native Hawaiian
Hispanic origin is usedAsian
in numerous
programsJapanese
and is vital in making
policy decisions. These
data are needed to determine
provisions of antidiscrimination
in employment
Chinese compliance withKorean
Chinese
Guamanian or Chamorro
and minority recruitment
legislation.
Under
the
Voting
Rights
Act,
data
about
Hispanic
origin
Filipino
Vietnamese
Filipino
Samoan
Asian Indian
Japanese
Asian Indian
Native Hawaiian
are essential to ensure enforcement of bilingual election rules. Hispanic origin classifications
Other
Asian
–
Print
race,
Other
Pacific
Islander
–
Other Asian – Print race,
Chinese
Korean
Guamanian or Chamorro
used by the Census Bureau
and Hmong,
other federal agencies
meet the
requirements
of standardsChinese
for example,
Print
race, for example,
for example, Hmong,
Filipino
Vietnamese
Filipino Thai, Pakistani,
Samoan
Thai, Pakistani,
Fijian,
Tongan,
issued by the Office ofLaotian,
Management
and Budget
in 1997 (Revisions
to the and
Standards for theLaotian,
Cambodian, and so on.
so on.
Cambodian, and so on.
Classification of Federal
Data
on– Print
Racerace,
and Ethnicity). These standards
set
forth–guidance for
Other
Asian
Other Pacific
Islander
Other Asian – Print race,
for example,
Hmong,
Print
race,
for example,
for example, Hmong,
statistical collection and
reporting
on
race
and
ethnicity
used
by
all
federal
agencies.
Laotian, Thai, Pakistani,
Fijian, Tongan, and
Laotian, Thai, Pakistani,
Cambodian, and so on.
Some other race – Print race.

so on.

Cambodian, and so on.
Some other race – Print rac

Some other race – Print race.

Some other race – Print rac

COMMUNITY BENEFITS
§.4{6¤

Social Services

Employment

§.4{6¤
ACS-1(2009)KFI,
ACS-1(2009)KFI,
Under the Public
Health
ServicePage
Act, 2, Base (Black)
Data about Hispanic origin
are used to Page 2, Green Pant
2

Hispanic origin is one of the factors used
monitor and enforce equal employment
in identifying segments of the population
opportunities under the Civil Rights Act.
ACS-1(2009)KFI, Page 2, Base (Black)
ACS-1(2009)KFI, Page 2, Green Pant
who may not be getting needed medical
services.
Government
The Voting Rights Act ensures equality in
voting. Compliance of local jurisdictions is
monitored using counts of the voting-age
population by national origin.

www.census.gov

6
5

is Person
2’s race?Latino,
Mark (X)
6
Is Person
2 of Hispanic,
o
5 What

What
is Person
1’s race?Latino,
Mark (X)
or more
boxes.
Is Person
1 of Hispanic,
orone
Spanish
origin?
White
No, not of Hispanic, Latino, or Spanish origin

White
No, not of Hispanic, Latino, or Spa

Black,
African Am.,
or Negro
Yes, Mexican,
Mexican
Am., Chicano

Black,
African Am.,
or Negro
Yes, Mexican,
Mexican
Am., Chica

American
Indian
Yes, Puerto
Ricanor Alaska Native — Print name of enrolled or principal tribe.

American
Indian
Yes, Puerto
Ricanor Alaska Native

American Community
Survey
Yes, Cuban

Yes, Cuban

Population: Question on Race

Yes, another Hispanic, Latino, or S
Argentinean, Colombian, Dominica
Jap
Asian
and soIndian
on.
Ko
Chinese

Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard,
Asian
Japanese
Native Hawaiian
and soIndian
on.
Chinese
Korean
Guamanian or Chamorro

Question
as it appearsVietnamese
in the questionnaire.
Filipino
Samoan
6

Filipino

Asian –1’s
Print
race, Mark (X) one or more boxes.
Other Pacific Islander –
WhatOther
is Person
race?
for example, Hmong,
White
Laotian, Thai, Pakistani,
Cambodian, and so on.
Black, African Am., or Negro

Print race, for example,
Fijian, Tongan, and
so on.

Vie

Asian –2’s
Print
race, Mark (X)
is Person
race?
6 WhatOther
for example, Hmong,
White
Laotian, Thai, Pakistani,
Cambodian, and so on.
Black, African Am., or Negro

American Indian or Alaska Native — Print name of enrolled or principal tribe.

American Indian or Alaska Native

Some other race – Print race.

Asian Indian

Japanese

Native Hawaiian

Asian Indian

Jap

Chinese

Korean

Guamanian or Chamorro

Chinese

Samoan

Filipino

Vie

Other Pacific Islander –
Print race, for example,
Fijian, Tongan,
and
ACS-1(2009)KFI,
so on.

Other Asian – Print race,
for example, Hmong,
Laotian,2,
Thai,
Pakistani,
Page
Green
Pantone
Cambodian, and so on.

§.4{6¤Vietnamese

Filipino

Other Asian – Print race,
for example, Hmong,
Laotian, Thai, Pakistani,
ACS-1(2009)KFI,
Page 2,
Cambodian, and so on.

Base (Black)

Some other race – Print race.

§.4{6¤

Source: ACS-1(2009)KFI

MEETING FEDERAL NEEDS

Race is key to implementing
any number
laws and is a critical
factor in the basic
ACS-1(2009)KFI,
Page of
2, federal
Base (Black)
ACS-1(2009)KFI,
Page 2, Green Pantone 3
research behind numerous policies. Race data are required by federal programs promoting
equal employment opportunity and are needed to assess racial disparities in health and access
to care, among other uses. Racial classifications used by the Census Bureau and other federal
agencies meet the requirements of standards issued by the Office of Management and Budget
in 1997 (Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity).
These standards set forth guidance for statistical collection and reporting on race and ethnicity
used by all federal agencies.

COMMUNITY BENEFITS
Education

Social Services

Under Title 20, race is used as part of
the formula to fund programs that foster
equal opportunity through postsecondary
education for African Americans. This
is achieved by funding programs at
historically Black colleges and universities
in professional and academic areas where
African Americans are underrepresented in
society.

For the Public Health Service Act, race is
a key factor in identifying segments of
the population who may not be receiving
needed medical services.

Employment
Race, under the Civil Rights Act, is used to
assess fairness of employment practices.

Government
States require data about the racial
makeup of the voting-age population
to meet legislative redistricting requirements.
Data about race are needed to monitor
compliance with the Voting Rights Act by
local jurisdictions.

www.census.gov

American Community
PersonSurvey
1

Population: Question on Place of Birth
➜ Please copy the name of Person 1 from page 2,
Question on Citizenship

11 What is the highest degree or level of sch

this person has COMPLETED? Mark (X) ON
If currently enrolled, mark the previous grade
highest degree received.

then continue answering questions below.

NO SCHOOLING COMPLETED

Last Name
Question on Year of Entry

No schooling completed

NURSERY OR PRESCHOOL THROUGH GRAD

First Name

Nursery school

Questions as they appear in the questionnaire.
7

Kindergarten
Grade 1 through 11 – Specify
grade 1 – 11

Where was this person born?
In the United States – Print name of state.

12th grade – NO DIPLOMA

Outside the United States – Print name of
foreign country, or Puerto Rico, Guam, etc.

HIGH SCHOOL GRADUATE

Regular high school diploma
GED or alternative credential

COLLEGE OR SOME COLLEGE

Is this person a citizen of the United States?

Some college credit, but less than 1 yea
college credit

Yes, born in the United States ➔ SKIP to 10a
Yes, born in Puerto Rico, Guam, the
U.S. Virgin Islands, or Northern Marianas

1 or more years of college credit, no deg

Associate’s degree (for example: AA, AS

Yes, born abroad of U.S. citizen parent
or parents

Bachelor’s degree (for example: BA, BS

Yes, U.S. citizen by naturalization – Print year
of naturalization

AFTER BACHELOR’S DEGREE

Master’s degree (for example: MA, MS,
MEd, MSW, MBA)
Professional degree beyond a bachelor’
(for example: MD, DDS, DVM, LLB, JD)

No, not a U.S. citizen

Doctorate degree (for example: PhD, Ed

When did this person come to live in the
United States? Print numbers in boxes.
Year

F
At any time
10 a.
Source:
ACS-1(2009)KFI

IN THE LAST 3 MONTHS, has this
person attended school or college? Include
only nursery or preschool, kindergarten,
elementary school, home school, and schooling
which leads to a high school diploma or a college
degree.

MEETING
FEDERAL NEEDS
No, has not attended in the last 3

Answer question 12 if this person has a
bachelor’s degree or higher. Otherwise,
SKIP to question 13.

12 This question focuses on this person’s

BACHELOR’S DEGREE. Please print below
specific major(s) of any BACHELOR’S DEG
These questions provide essential data
setting
evaluating
immigration
and
thispolicies
person has
received. (For example: che
Yes,for
public
school,and
public
college
elementary
laws. Knowing the characteristics of immigrants helps legislators and othersengineering,
understand
how teacher education,
Yes, private school, private college,
organizational psychology)
different immigrant groups are assimilated.
Federal agencies require these data to develop
home school
programs for refugees and other
foreign-born
individuals.
Vitalattending?
information on lifetime
b. What
grade or level
was this person
Markfrom
(X) ONE
box.
migration among states also comes
the
place of birth question.
months ➔ SKIP to question 11

Nursery school, preschool
Kindergarten
Grade 1 through 12 – Specify
grade 1 – 12

College undergraduate years (freshman to
senior)
Graduate or professional school beyond a
bachelor’s degree (for example: MA or PhD
program, or medical or law school)

§.4{y¤

American Community Survey
Population: Question on Place of Birth
Question on Citizenship
Question on Year of Entry

COMMUNITY BENEFITS
Education

Government

Data are used to allocate funds to public
and private nonprofit organizations to
provide employment resources aimed at
making the foreign-born economically
self-sufficient.

The U.S. Department of Homeland Security
uses citizenship data to project staffing
and other resource needs to complete the
naturalization process for noncitizens.

Social Services
These data are used, in conjunction with
the Public Health Service Act, to assist
states and local agencies with developing
health care and other services tailored to
the language and cultural diversity of the
foreign-born.

Under the Voting Rights Act, these data
are required to evaluate voting practices
of governmental subdivisions (e.g., states,
counties, and school districts).
Employment
Data about place of birth and citizenship
are used to evaluate the effectiveness of
equal employment opportunity policies
and programs under the Civil Rights Act.

www.census.gov

Year Yes, born abroad of U.S. citizen parent
or parents

Associate’s degree (for example: AA, AS)

Not
all to
thenatSKIP
Bachelor’s
degree
(for
example:
BA,
BS)
13 What is this p
What
is the highest
degree
or level
Answer
question
12 if this
person
has aof school
F 11
Yes, U.S. citizen by naturalization – Print year
Mark (X) ONE box.
this
person
hasor
COMPLETED?
AFTER
BACHELOR’S
DEGREE
15 a. Did this person l
bachelor’s
degree
higher. Otherwise,
of naturalization
1 year ago?
Ifto
currently
enrolled,
mark the previous grade or
any time
IN THE
LAST of
3 MONTHS,
has this
question
13.
10 a.➜At Please
copy
the name
Person 1 from
page 2, SKIPMaster’s
degree
(for example: MA, MS, MEng,
highest degree
received.
No, differen
Include
person
attended
school
or
college?
MEd, MSW, MBA)
then continue answering questions below.
Puerto
PersonRico
is un
only nursery or preschool, kindergarten,
NO SCHOOLING
COMPLETED
11 Professional
13 What
What
is the degree
highest
degreea or
level of degree
school
question
is this16p
Last Name
beyond
bachelor’s
elementary
school, home school, and schooling
Mark
thisexample:
person has
did
this p
No, leads
not a to
U.S.
citizen
(For
example:
(for
MD,COMPLETED?
DDS,
DVM, LLB,
JD) (X) ONE box. b. Where
which
a high
school diploma
a college
Population:
Question
onorEducational
Attainment
No schooling
completed
Yes,
this ho
If currently
enrolled, mark
the previous grade or
Cambodian, Ca
degree.
Address
(Numbe
copy the name of Person 1 from page
2,
➜ Please
Doctorate
degree
(for
PhD, EdD)
highest
degree
received.
focuses
on example:
this person’s
French
Canadia
NURSERY
OR PRESCHOOL
THROUGH
GRADE 12
No, outside
Whenthen
did this
person
come to Enrollment
live
in the below. 12 This question
9 Question
on
School
continue
answering
questions
No,
has
not
attended
in
the
last
3
Nigerian,
Mexi
BACHELOR’S
DEGREE.
Please
print
below
the
Puerto
Rico
MI
First
Name
United
States?
Print
numbers
in
boxes.
NO
SCHOOLING
COMPLETED
Nurseryof
school
months
Last
Name ➔ SKIP to question 11
specific major(s)
any BACHELOR’S DEGREES
or U.S. Virg
Year
example:
then
SKIP to
this personNo
has
received.completed
(For example: chemical
schooling
Yes, public school, public college
14 (For
Kindergarten
a. Does thisCa
p
Cambodian,
engineering, elementary teacher education,
English
at
as they appear
in the
questionnaire.
Answer
question
12
if this
has a GRADE 12
French
Canadia
NURSERY
OR
PRESCHOOL
THROUGH
F organizational
Yes, private school,Questions
private college,
Grade
1 through
11person
– Specify
psychology)
Nigerian,
Mexi
Name
of city,
to
7 First
Where
was
this person born?
degree
or higher. Otherwise,
home
school
1 – 11
MI bachelor’sgrade
Name
Nursery school
Yes
a.
At
any
time
IN
THE
LAST
3
MONTHS,
has
this
SKIP
to
question
13.
11
13 What
What is the highest degree or level of school
10 b. What grade
orUnited
level was
this
person
attending?
is
this
In the
States
– Print
name
of state.
No, differenp
person
Kindergarten
this person
has COMPLETED? Mark (X) ONE box. 14 a. Puerto
Does No
this
Mark
(X)attended
ONE box. school or college? Include
➔p
Rico
only nursery or preschool, kindergarten,
If currently
enrolled,
mark
the or
previous
grade
or
English
atp
11
13
What
is
the
highest
degree
level
of
school
What
is
this
Grade
1
through
11
–
Specify
Please
copy
thehome
name
of Person
1 from page 2,
Nursery
school,
preschool
elementary
school,
school,
and schooling
➜
highest degree received.
b. What
is thi
didU.S.
this
p
Name
of
co
7which
Where
was
person
this
person
grade
1has
– 11–COMPLETED?
leads
to athis
high
school born?
diploma
or a college
12th grade
NO DIPLOMAMark (X) ONE box. b. Where
then
continue
answering
questions
below.
Yes
Puerto Rico
Kindergarten
If
currently
enrolled,
mark the previous grade or
degree. Outside the United States – Print name of
NO
SCHOOLING
COMPLETED
Address
(Numbe
Last Name
In copy
the United
Statesof– Print
name
of state.
the name
Person
1 from
page
2,
➜ Please
HIGH SCHOOL
GRADUATE
focuses
on this person’s
highest
degree
received.
foreign
country,
Puerto
Rico,
etc.12 This question
No ➔
(For example:
Grade
through
12 or
– in
Specify
then
continue
answering
questions
below.
No,
has1 not
attended
the
last
3 Guam,
BACHELOR’S
print below the
No DEGREE.
schoolingPlease
completed
Cambodian,
Ca
Regular
high
school
diploma
grade 1 –➔12
NO
SCHOOLING
COMPLETED
months
SKIP
to
question
11
specific major(s) of any BACHELOR’S DEGREES
Last Name
example
French
Canadia
NURSERY
OR
PRESCHOOL
THROUGH
GRADE 12
b. For
What
is thi
this
person
has
received.
(For
example:
chemical
12th
grade
–
NO
DIPLOMA
(For
example:
GED
or
alternative
credential
Yes,
public school, public college
Nigerian,
Mexi
No schooling completed
Name
of U.S.
First
Name
elementary
teacher education,
Cambodian,
Ca
c. How
wellst
d
Nursery
school
Outside the United States – Print name of MI engineering,
HIGH
SCHOOL
GRADUATE
Puerto
Rico
COLLEGE
OR
SOME
COLLEGE
French
Canadia
NURSERY
OR
PRESCHOOL
THROUGH
GRADE
12
Yes,
private
school,
private
college,
organizational
psychology)
country,
or Puerto
Guam,
etc.
8 Is thisforeign
person
a citizen
of theRico,
United
States?
Name
of city,
top
Nigerian,
Mexi
14
Kindergarten
home
school
a. Does
this
Very
w
College
undergraduate years (freshman to
MI
First
Name
Regular
high
school
Some college
credit, diploma
but less than 1 year of
Nursery
school
Yes, or
born
in the
States ➔
SKIP to 10a
English
at
For
example
b. Whatsenior)
grade
level
wasUnited
this person
attending?
college
credit
Grade
1
through
11
–
Specify
Well
GED
credential
(X)
ONE
box.
14 a.
Kindergarten
7Mark
Where
was
this
born?
gradeor1 alternative
– 11
this p
Graduate
or
professional
school
beyond
Yes,
born
inperson
Puerto Rico,
Guam,
the a
c. Does
How well
1 or more years of college credit, no degree
Yesatwd
Not
bachelor’s
degree
(for
example:
MA
or
PhD
English
U.S.
Virgin
Islands,
or
Northern
Marianas
COLLEGE
OR
SOME
COLLEGE
Nursery
school,
preschool
Grade
1
through
11
–
Specify
In
the
United
States
–
Print
name
of
state.
8 Is this
person
a
citizen
of
the
United
States?
program,
or
medical
or law school)
Name of U.S.
co
Associate’s
(for example: AA, AS)
7 Where
was
this
person
No ➔
Very
grade
– 11degree
Not
atw
Yes,
born
abroad
of born?
U.S. citizen parent
Some 1college
credit, but less than 1 year of
Puerto Rico
Kindergarten
Yes
Yes,
born in the United States ➔ SKIP to 10a
or
parents
college credit
Bachelor’s
degree (for example: BA, BS)
In the United States – Print name of state.
b. WhatWell
is thi
8
Grade
through
12 by
– Specify
No
➔
Yes,1U.S.
born
in Puerto
Rico, Guam, the
12th
gradeyears
– NOof
DIPLOMA
citizen
naturalization
– Print year
a. Did this
pe
1 or
more
college credit, no degree
AFTER
BACHELOR’S
DEGREE
15
grade
1
–
12
Not
w
U.S.
Virgin
Islands,
or
Northern
Marianas
of
naturalization
Outside
the United States – Print name of
1
year
ago?
HIGH SCHOOL GRADUATE
b.
What
is
thi
Associate’s
degree
(for
example:
AA,
AS)
foreign
country,
or
Puerto
Rico,
Guam,
etc.
Master’s
degree
(for
example:
MA,
MS,
MEng,
Not at
Yes, born abroad of U.S. citizen parent
12th grade – NO DIPLOMA
Name of U.S.
st
MEd,
MSW,
MBA)
Regular
high
school
diploma
or
parents
Person
Outside
the United
– Print(Black)
name of
degree
(for
example:
ACS-1(2009)KFI,
PageStates
8, Base
ACS-1(2009)KFI,
PageBA,
8,BS)
Green Pantone
354
(2
Puerto
HIGH Bachelor’s
SCHOOL
GRADUATE
ForRico
example
questi
foreign
country,
or
Puerto
Rico,
Guam,
etc.
Professional
degreecredential
beyond a bachelor’s degree
GED
or alternative
Yes, U.S.
citizen by naturalization
– Print
year
a.
Did
this
pe
AFTER
BACHELOR’S
DEGREE
15
College
undergraduate
years
(freshman
to
No,
not
a
U.S.
citizen
(for example:
MD, DDS,
DVM, LLB, JD)
c. How
well
d
Regular
high school
diploma
of naturalization
Yes,
th
1
year
ago?
senior)
For
example
COLLEGE OR SOME COLLEGE
8 Is this person a citizen of the United States?
Master’s
degree
(for
example:
MA,
MS,
MEng,
Doctorate
degree
(for
example:
PhD,
EdD)
GED
or
alternative
credential
No, ou
did this
person come
to live
in the
Graduate
or professional
school
beyond
a
9 When
Very
w
MEd, MSW,
c. How well
d
Some
collegeMBA)
credit, but less than 1 year of
Person
Puerto
Yes,
born
inPrint
the(for
United
States
➔ SKIP
to 10a
bachelor’s
degree
example:
MA
or PhD
United
States?
numbers
in boxes.
COLLEGE
OR
SOME
COLLEGE
college
credit
questi
8 Is this
person
a citizen
the
United States?
or U.S
Well
Professional degree beyond a bachelor’s degree
program,
or medical
orof
law
school)
Year No,
Very
w
Yes,not
born
in Puerto
a U.S.
citizenRico, Guam, the
then
S
(for
example:
MD,
DDS,
DVM,
LLB,no
JD)
Some
college
credit,
but
less
than
1
year
of
Yes,wth
1
or
more
years
of
college
credit,
degree
Yes,
born
in
the
United
States
➔
SKIP
to
10a
Not
U.S. Virgin Islands, or Northern Marianas
college
credit
Source: ACS-1(2009)KFI
Well
Doctorate
degree
example:
PhD,
question
12 (for
if(for
this
person
hasEdD)
a
8 9 WhenYes,
No, ou
Associate’s
degree
example:
AA,
AS)
F Answer
did born
this person
come
live parent
in
in
Puerto
Rico,
Guam,
thethe
Not
at
abroad
of
U.S. to
citizen
1 or more
years or
of college
no degree
Puerto
bachelor’s
degree
higher.credit,
Otherwise,
United
States?
numbers
in boxes.
Not
w
U.S.
Virgin Print
Islands,
or Northern
Marianas
or
parents
Bachelor’s
degree
(for
example:
BA,
BS)
or
U.S
a. At any time IN THE LAST 3 MONTHS, has this
SKIPAssociate’s
to question
13. (for example: AA, AS)
10 Year
degree
No,
di
thenpe
Not
atS
Yes, U.S.
born
abroad
ofnaturalization
U.S.orcitizen
parent
citizen
by
– Print
year
Include
person
attended
school
college?
AFTER BACHELOR’S DEGREE
15 a. Did this
Puerto
or
parents or preschool,
of nursery
naturalization
only
1
year
ago?
Bachelor’s
degree
(for
example:
BA,
BS)
ACS-1(2009)KFI,
Page 8, kindergarten,
Base (Black)
ACS-1(2009)KFI,
Page
8,
Green
Pantone
354
(2
question
if this
person
F Answer
Master’s
degree12(for
example:
MA,has
MS,a MEng,
elementary
home
school, and– schooling
Yes, U.S.school,
citizen by
naturalization
Print year
Did this
pet
b. Where
did
bachelor’s
degree
or
higher. Otherwise,
AFTER
BACHELOR’S
DEGREE
15 a.
MEd,
MSW,
MBA)
which
leads
to
a
high
school
diploma
or
a
college
Person
of naturalization
1
year
ago?
degree.
a.
At
any
time
IN
THE
LAST
3
MONTHS,
has
this
SKIP
to
question
13.
10
questi
Address
(N
Master’s
degree
(for
example:
MA, MS, MEng,
Professional
degree
beyond
a bachelor’s
degree
No,
di
focuses
on
this person’s
person
attended
school or college? Include 12 This question
No,No,
not
a U.S.
citizen
MEd,
MSW,
MBA)
(for
example:
MD,
DDS,
DVM,
LLB,
JD)
Puerto
has
not
attended
in
the
last
3
BACHELOR’S
DEGREE.
Please
print
below
the
Person
Yes,
th
only nursery or preschool, kindergarten,
months
➔ SKIP
to question
questi
specific
major(s)
of any
BACHELOR’S
DEGREES
elementary
school,
home
school, 11
and schooling
Professional
degree
beyond
a bachelor’s
degree
Doctorate
degree
(for
example:
PhD,
EdD)
b. WhereNo,
didout
didleads
this
person
come
todiploma
live in or
the
9 When
this person
has received.
example:
chemical
which
a high
school
No,
not
a to
U.S.
citizen
(for example:
MD, DDS,(For
DVM,
LLB, JD)
Yes,
public
school,
public
college a college
Yes,
th
Puerto
United
States?
Print
numbers
in boxes.
degree.
engineering, elementary teacher education,
Address
(N
or U.S
question
focuses
on example:
this person’s
Doctoratepsychology)
degree (for
PhD, EdD)
12 This
Yes,
private
school,
private
college,
organizational
No,
ou
When did
this
person
come
to
live
in
the
9 Year
S
No,
has
not attended in the last 3
BACHELOR’S DEGREE. Please print below the
Namethen
of ci
home
school
Puerto
United States?
Print
numbers
in boxes.
months ➔
SKIP
to question
11
specific
major(s)
of
any
BACHELOR’S
DEGREES
or
U.S
Answer question 12 if this person has a
b. What grade or level was this person attending?F this
Year
person has received. (For example: chemical
then S
Yes,ONE
public
school, public college
Mark (X)
box.
bachelor’s degree
or higher.
Otherwise,
engineering,
elementary
teacher education,
MEETING
FEDERAL
NEEDS
time
IN
THE
LAST
3 MONTHS,
SKIP to question
13.
Answer
question
12 if this person has a
10 a. At any
Yes,
private
school,
private
college, has this F organizational
psychology)
Nursery
school,
preschool
U
NameNo,
of di
ci
person
attended
home
school school or college? Include
bachelor’s degree or higher. Otherwise,
Puerto
only
nursery
or
preschool,
kindergarten,
Puerto
Ric
Kindergarten
Educational
attainment
andLAST
school
enrollment
data are SKIP
needed
for use13.
in assessing the
What
or
was
this
person
attending?
a. elementary
At
anygrade
timeschool,
INlevel
THE
3
MONTHS,
has
this
to
question
10 b.
home school, and schooling
No,
b. Where
diddit
Mark
ONE
person
attended
school
college?
socioeconomic
condition
ofschool
school-age
children.
Grade
1tobox.
through
12
–or
Specify
which(X)
leads
a high
diploma
orInclude
a college Government agencies also require these data
Puerto
only
nursery
or
preschool,
kindergarten,
grade 1 – 12and program planning and implementation. These data are needed
for fundingdegree.
allocations
Address (N
Nursery
school,
preschool
elementary
school,
home
school, and schooling 12 This question focuses on this person’s
Name of
b. Where
didUt
which
leads
tonot
a high
school
diploma
or of
a college
No,
has
attended
in
the
last
3
BACHELOR’S
DEGREE.
Please
print
below
the
to determine the
extent
of
illiteracy
rates
citizens
in
language
minorities
in
order
to
meet
Name
of
U
Puerto
Ric
Kindergarten
degree.
months ➔ SKIP to question 11
specific
major(s)
of any
AddressRic
(N
statutory requirements
under the Voting Rights Act.
Puerto
question
focuses
onBACHELOR’S
this person’sDEGREES
12 This
Grade
1
through
12
–
Specify
this
person
has
received.
(For
example:
chemical
No,
has undergraduate
notschool,
attended
inyears
the
last
3
BACHELOR’S DEGREE. Please print below the
Yes,
public
college
College
(freshman
to
gradepublic
1 –➔12
engineering,
elementary
education,
months
SKIP to question 11
specific major(s)
of anyteacher
BACHELOR’S
DEGREES
senior)
Yes, private school, private college,
organizational
psychology)
this
person
has
received.
(For
example:
chemical
Name
of U
ci
Yes,
public
school,
public
college
home school
Graduate
or professional school beyond a
Name of
engineering, elementary teacher education,
bachelor’s
degree
(for
example:
MA
or
PhD
Puerto
Ric
b. WhatYes,
grade
or level
was this person
attending?
private
organizational psychology)
program,
or school,
medicalprivate
or law college,
school)
Name of ci
Mark (X)
ONE
box.
home
school
College
undergraduate
years (freshman to
b. Whatsenior)
grade or
level was
this person attending?
Nursery
school,
preschool
Name of U
8 Mark (X)
ONE box.
Graduate
or professional school beyond a
Puerto Ric
Kindergarten
bachelor’s
degree (for example: MA or PhD
Nursery school,
preschool
program,
or medical
or law school)
Name of U
Grade 1 through 12 – Specify
Puerto Ric
Kindergarten
grade 1 – 12
Page 8, Base (Black)
ACS-1(2009)KFI, Page 8, Green Pantone 35
8 ACS-1(2009)KFI,
Grade 1 through 12 – Specify
Name of U
grade 1 – 12
Puerto Ric
College undergraduate years (freshman to
Name of U

Person 1

Person Community
1
American
Survey

Person 1
Person 1

§.4{y¤

§.4{y¤
§.4{y¤

ACS-1(2009)KFI, Page 8, Base (Black)

ACS-1(2009)KFI, Page 8, Green Pantone 35

American Community Survey
Population: Question on Educational Attainment
Question on School Enrollment

COMMUNITY BENEFITS
Education

Government

Based on data about educational
attainment, school districts are allocated
funds to provide classes in basic skills
to adults who have not completed high
school.

The U.S. Department of Justice uses school
enrollment data in the enforcement work
against discrimination in education.

The U.S. Department of Education uses
school enrollment data to develop adult
education and literacy programs based
on the number of individuals with limited
English proficiency.

Employment
Employers use information about the
educational attainment levels of the labor
force to locate new jobs and stimulate
economic growth.

www.census.gov

of naturalization

Professional
degree
a bachelor’s
degree
Master’s
degree
(for beyond
example:
MA, MS, MEng,
(for example:
MD, DDS, DVM, LLB, JD)
MEd,
MSW, MBA)

No, not a U.S. citizen

hen did this person come to live in the
No,States?
not a U.S.
citizen
nited
Print
numbers in boxes.
ar
hen did this person come to live in the
nited States? Print numbers in boxes.
Population:
ar

Doctorate
degree
(forbeyond
example:
PhD, EdD)degree
Professional
degree
a bachelor’s
(for example: MD, DDS, DVM, LLB, JD)

Doctorate degree
(for example: PhD, EdD)
American Community
Survey
questionof
12 ifDegree
this person has a
Question
on Field
F Answer

At any time IN THE LAST 3 MONTHS, has this
person attended school or college? Include

bachelor’s degree or higher. Otherwise,
SKIP
to question
Answer
question 13.
12 if this person has a

bachelor’s degree or higher. Otherwise,
only nursery or preschool, kindergarten,
it appears
At any timeschool,
IN THE
LAST
3 MONTHS,
has this Question
SKIP toas
question
13. in the questionnaire.
elementary
home
school,
and schooling
which leads
to a high
school
a college
person
attended
school
ordiploma
college?orInclude
degree.
only
nursery or preschool, kindergarten,
elementary school, home school, and schooling 12 This question focuses on this person’s
hastonot
attended
indiploma
the last 3or a college
BACHELOR’S DEGREE. Please print below the
whichNo,
leads
a high
school
months ➔ SKIP to question 11
specific major(s) of any BACHELOR’S DEGREES
degree.
question
focuses
on this
12 This
this person
has
received.
(For person’s
example: chemical

Yes,
public
public
college
No, has
notschool,
attended
in the
last 3
months
➔
SKIP
to
question
11
Yes, private school, private college,
homepublic
school
Yes,
school, public college
What grade or level was this person attending?
Yes,ONE
private
Mark (X)
box.school, private college,
home school
school,
preschool
WhatNursery
grade or
level was
this person attending?
Mark (X) ONE box.
Kindergarten
Nursery school, preschool
Grade 1 through 12 – Specify
grade 1 – 12
Kindergarten

BACHELOR’S
DEGREE.teacher
Pleaseeducation,
print below the
engineering, elementary
specific
major(s)
of any BACHELOR’S DEGREES
organizational
psychology)
this person has received. (For example: chemical
engineering, elementary teacher education,
organizational psychology)

Yes, thisishouse
SKIP old
to question
Person
under ➔
1 year
➔ SKIP to16
question
16
No, outside the United States and
Puerto
Rico
– Print
nametoofquestion
foreign 16
co
Yes,
this
house
➔ SKIP
or U.S. Virgin Islands, Guam, etc., belo
thenoutside
SKIP tothe
question
No,
United16
States and
Puerto Rico – Print name of foreign co
or U.S. Virgin Islands, Guam, etc., belo
then SKIP to question 16

No, different house in the United State
Puerto Rico

No,
houselive
in the
United
State
b. Where
diddifferent
this person
1 year
ago?
Puerto Rico
Address (Number and street name)
b. Where did this person live 1 year ago?
Address (Number and street name)
Name of city, town, or post office
Name of city, town, or post office
Name of U.S. county or municipio in
Puerto Rico
Name of U.S. county or municipio in
Puerto Rico

Source: ACS-1(2009)KFI

Grade 1 through 12 – Specify
grade 1 – 12

1 yearquestion
ago? 16

MEETING FEDERAL NEEDS

Name of U.S. state or
Puerto Rico

College undergraduate years (freshman to
U.S. state or
Field of Degree (FOD) data are needed for use in assessing the qualifications Name
of theofU.S.
senior)
Puerto Rico
college-educated
workforce.
Government
agencies
will
use
these
data
to
examine
the
supply of
Graduate
or professional
school
beyond to
a
College
undergraduate
years
(freshman
bachelor’s
degree
(for
example:
MA
or
PhD
highly-skilled
workers
in
a
variety
of
fields,
the
need
to
encourage
greater
participation
in
senior)
program, or medical or law school)
certain
fields,
and
the
representation
of
different
demographic
groups
in
various
fields
of
study.
Graduate or professional school beyond a
bachelor’s degree (for example: MA or PhD
program, or medical or law school)

§.4{y¤
§.4{y¤

ACS-1(2009)KFI, Page 8, Base (Black)

ZIP Code
ZIP Code

COMMUNITY
BENEFITS
ACS-1(2009)KFI,
Page 8, Green Pantone 354 (20, 40, 50 and 100%

Education
Government
ACS-1(2009)KFI, Page 8, Base (Black)
ACS-1(2009)KFI, Page 8, Green Pantone 354 (20, 40, 50 and 100%
College administrators, educators,
The National Science Foundation (NSF)
students, parents and professional
uses these data to draw a sample for
societies use these data to assess how
a large workforce survey, the National
graduates in various fields are faring in
Survey of College Graduates, which
the job market as well as informing them
gathers important information about the
about the kinds of training graduates
education, employment and characteristics
should be receiving to be prepared for
of scientists and engineers. NSF and
the jobs that are likely to be available.
other agencies use the data to analyze the
It provides timely information for
types of jobs that graduates in a particular
prospective students and their parents
field hold, their earnings and how these
about employment possibilities for those
outcomes vary within and across fields by
majoring in a particular field in college.
race/ethnicity, gender, and citizenship.
Employment
Employers use information about the
field of degree of college graduates to
assess the supply of potential employees,
nationally and in specific areas.

www.census.gov

American Community Survey
Population: Question on Ancestry
13199088

Question as it appears in the questionnaire.

13 What is this person’s ancestry or ethnic origin?
What is the highest degree or level of school
his person has COMPLETED? Mark (X) ONE box.

currently enrolled, mark the previous grade or
ighest degree received.

O SCHOOLING COMPLETED

No schooling completed

URSERY OR PRESCHOOL THROUGH GRADE 12

Nursery school

(For example: Italian, Jamaican, African Am.,
Cambodian, Cape Verdean, Norwegian, Dominican,
French Canadian, Haitian, Korean, Lebanese, Polish,
Nigerian, Mexican, Taiwanese, Ukrainian, and so on.)

14 a.ACS-1(2009)KFI
Does this person speak a language other than
Source:

Kindergarten
Grade 1 through 11 – Specify
grade 1 – 11

English at home?
Yes

MEETING
No ➔ SKIPFEDERAL
to question 15a NEEDS

Ancestry identifies the ethnic b.
origins
thelanguage?
population. Federal agencies regard this information
What isofthis
as essential for fulfilling many important needs. Ancestry is required to enforce provisions
IGH SCHOOL GRADUATE
under the Civil Rights Act, which prohibits discrimination based upon race, sex, religion, and
Regular high school
diploma
national
origin. More generally, For
these
data are needed to measure the social and economic
example: Korean, Italian, Spanish, Vietnamese
characteristics
of ethnic groups and to tailor services to accommodate cultural differences.
GED or alternative
credential
12th grade – NO DIPLOMA

OLLEGE OR SOME COLLEGE

c. How well does this person speak English?

Some college credit, but less than 1 year of
college credit

Very well

1 or more years of college credit, no degree

Not well

Associate’s degree (for example: AA, AS)

Not at all

Bachelor’s degree (for example: BA, BS)

FTER BACHELOR’S DEGREE

Well

Did this person live inBENEFITS
this house or apartment
15 a.COMMUNITY

1 year ago?
Master’s degree (for example: MA, MS, MEng,
MEd, MSW, MBA)
Person is under 1 year old ➔ SKIP to
Employment
question 16
Professional degreeSocial
beyond aServices
bachelor’s degree
(for example: MD, DDS,
DVM,
LLB,
JD)
Yes,
this
house
➔
SKIP to
question
16
Data about ancestry assist states and local
Data
about
ancestry
are used to evaluate
Doctorate degree (for
example:
PhD,
EdD)
agencies to develop health care and
the effectiveness
of equal employment
No, other
outside the United
States and
Puerto and
Rico – Printopportunity
name of foreign
country,and programs for
services tailored to meet the language
policies
or U.S. Virgin Islands, Guam, etc., below;
cultural diversity of the elderly in then
these
different
ethnic groups under the Civil
SKIP to question
16

Rights Act.
Answer question 12 if groups.
this person has a
bachelor’s degree or higher.
Otherwise,
Under the Public Health Service Act,
SKIP to question 13. ancestry is one of the factors used in
No, different house in the United States or
Puerto Rico
identifying segments of the population
who may not be receiving b.
needed
Where medical
did this person live 1 year ago?
services.
Address (Number and street name)

his question focuses on this person’s
BACHELOR’S DEGREE. Please print below the
pecific major(s) of any BACHELOR’S DEGREES
his person has received. (For example: chemical
ngineering, elementary teacher education,
rganizational psychology)

Name of city, town, or post office

Name of U.S. county or municipio in
Puerto Rico

Name of U.S. state or
Puerto Rico

ZIP Code

www.census.gov

13199088

13 What is this person’s ancestry or ethnic origin?
hat is the highest degree or level of school
is person has COMPLETED? Mark (X) ONE box.

American Community Survey

currently enrolled, mark the previous grade or
ghest degree received.

Population:
O SCHOOLING COMPLETED

Question on Language Spoken at Home

No schooling completed

URSERY OR PRESCHOOL THROUGH GRADE 12

Nursery school

(For example: Italian, Jamaican, African Am.,
Cambodian, Cape Verdean, Norwegian, Dominican,
French Canadian, Haitian, Korean, Lebanese, Polish,
Question
it appears
in the
questionnaire.
Nigerian,as
Mexican,
Taiwanese,
Ukrainian,
and so on.)

14 a. Does this person speak a language other than

Kindergarten
Grade 1 through 11 – Specify
grade 1 – 11

English at home?
Yes

No ➔ SKIP to question 15a
12th grade – NO DIPLOMA

b. What is this language?

GH SCHOOL GRADUATE

Regular high school diploma
GED or alternative credential

OLLEGE OR SOME COLLEGE

For example: Korean, Italian, Spanish, Vietnamese

c. How well does this person speak English?

Some college credit, but less than 1 year of
college credit

Very well

1 or more years of college credit, no degree

Not well

Associate’s degree (for example: AA, AS)

Not at all

Well

Bachelor’s degree (for example: BA, BS)

TER BACHELOR’S DEGREE

Source:
Did this person live in this house or apartment
15 a.ACS-1(2009)KFI

1 year ago?
Master’s degree (for example: MA, MS, MEng,
MEETING
FEDERAL
MEd, MSW, MBA)
Person is under
1 year old ➔NEEDS
SKIP to
question
16
Professional degree
beyond a bachelor’s
degree
Government
agencies
use information on language spoken at home for their programs that
(for example: MD, DDS, DVM, LLB, JD)
house ➔ SKIP
to question
serve the needs of the foreign-bornYes,
andthis
specifically
those
who 16
have difficulty with English.
Doctorate degree (for example: PhD, EdD)
No, outside
the United
States
and
Under the Voting Rights Act, language
is needed
to meet
statutory
requirements for making
Puerto Rico – Print name of foreign country,
voting materials available in minority
languages.
Specifically,
the
Census
Bureau is directed,
or U.S. Virgin Islands, Guam, etc., below;
then
SKIP to
question
16
using data about language spoken at
home
and
the ability
to speak English, to identify minority

groups
that speak
nswer question 12
if this person
has a a language other than English and to assess their English-speaking ability.
The
U.S. Otherwise,
Department of Education uses these data to prepare a report to Congress on the social
achelor’s degree or
higher.
KIP to question 13.
and economic status of children served
by different
school
districts.
No, different
house inlocal
the United
States
or
Puerto Rico
b. Where did this person live 1 year ago?

Address (Number and street name)
is question focuses on this person’s
COMMUNITY
BENEFITS
ACHELOR’S DEGREE. Please print below the
ecific major(s) of any BACHELOR’S DEGREES
Social Services
is person has received.Education
(For example: chemical
gineering, elementary teacher
education,
Data on language are used to allocate
State and local agencies concerned with
ganizational psychology)
of city,
town, oraging
post office
grants to school districts forName
children
with
develop health care and other

limited English language proficiency.

services tailored to the language and
cultural diversity of the elderly under the
State and local educational agencies
Older Americans Act.
receive grants for programsName
to improve
of U.S. county or municipio in
Puerto
Rico
educational skills, complete secondary
schooling, and provide job training and
Government
placement for adults based on data about
Under the Voting Rights Act, these data
language.
Name of U.S. state or
are needed
to assess the fairness of voting
Puerto Rico
ZIP Code
practices in governmental subdivisions.

www.census.gov

ACS-1(2009)KFI, Page 8, Green Pantone 354 (20, 40, 50 and 100%)

1 or more years of college credit, no degree
12th grade – NO DIPLOMA
Associate’s degree (for example: AA, AS)

Not
well language?
b. What
is this
Not at all

GH SCHOOL GRADUATE

Bachelor’s degree (for example: BA, BS)
Regular high school diploma

person
live inItalian,
this house
or apartment
15 a. Did
Forthis
example:
Korean,
Spanish,
Vietnamese
1 year ago?
GED or alternative credential
Master’s degree (for example: MA, MS, MEng,
c. How well does this person speak English?
OLLEGE
OR SOME
COLLEGE
MEd, MSW,
MBA)
Population: Question onPerson
Residence
1 old
Year
Ago
is under 1 year
➔ SKIP
to
question
16
Very
well
Professional
degree
beyond
a
bachelor’s
degree
Some college credit, but less than 1 year of
(for
example:
college
creditMD, DDS, DVM, LLB, JD)
Yes,
Wellthis house ➔ SKIP to question 16
Doctorate
(forcollege
example:
PhD,
1 or moredegree
years of
credit,
noEdD)
degree
No,
Notoutside
well the United States and
Rico – Printin
name ofquestionnaire.
foreign country,
Associate’s degree (for example: AA, AS)
QuestionPuerto
as
it
Not
at appears
all
or U.S.
Virgin
Islands,the
Guam, etc., below;
then SKIP to question 16
Bachelor’s degree (for example: BA, BS)

American Community Survey

TER BACHELOR’S DEGREE

nswer
question 12DEGREE
if this person has a
FTER BACHELOR’S
15 a. Did this person live in this house or apartment
1 year ago?
achelor’s degree or higher. Otherwise,
Master’s degree (for example: MA, MS, MEng,
KIP MEd,
to question
13.
MSW, MBA)
No,
different
house
in the
States
Person
is under
1 year
oldUnited
➔ SKIP
to or
Puerto
Rico16
question
Professional degree beyond a bachelor’s degree
(for example: MD, DDS, DVM, LLB, JD)
this house
SKIP1 to
question
b. WhereYes,
did this
person➔live
year
ago? 16
Doctorate degree (for example: PhD, EdD)
No,(Number
outside the
United
and
Address
and
streetStates
name)
s question focuses on this person’s
Puerto Rico – Print name of foreign country,
ACHELOR’S DEGREE. Please print below the
or U.S. Virgin Islands, Guam, etc., below;
ecific major(s) of any BACHELOR’S DEGREES
then SKIP to question 16
s person has received. (For example: chemical
Answer
question
12 teacher
if this person
has a
gineering,
elementary
education,
bachelor’s
or higher. Otherwise,
ganizationaldegree
psychology)
Name of city, town, or post office
SKIP to question 13.
No, different house in the United States or
Puerto Rico

his question focuses on this person’s
ACHELOR’S DEGREE. Please print below the
pecific major(s) of any BACHELOR’S DEGREES
his person has received. (For example: chemical
ngineering, elementary teacher education,
rganizational psychology)

b. Where did this person live 1 year ago?
Name of U.S. county or municipio in
Address
(Number and street name)
Puerto
Rico

Name of U.S. state or
Puerto
Code
Name Rico
of city, town, or postZIP
office

Name of U.S. county or municipio in
Puerto Rico

Name of U.S. state or
Puerto Rico

ZIP Code

ACS-1(2009)KFI, Page 8, Green Pantone 354 (20, 40, 50 and 100%)

Source: ACS-1(2009)KFI

MEETING FEDERAL NEEDS

ACS-1(2009)KFI, Page 8, Green Pantone 354 (20, 40, 50 and 100%)
Residence 1 year ago is used to assess the residential stability and the effects of migration in
both urban and rural areas. This item provides information on the mobility of our population.
Knowing the number and characteristics of movers is essential for federal programs dealing
with employment, housing, education, and the elderly. The U.S. Department of Veterans Affairs
develops its mandated projections of the need for hospitals and other veteran benefits for
each state with migration data about veterans. The Census Bureau develops state age and sex
estimates and small-area population projections based on data about residence 1 year ago.

American Community Survey
Population: Question on Residence 1 Year Ago

COMMUNITY BENEFITS
Social Services

Government

State and local agencies concerned with
aging develop health care and other
services for the elderly using information
on where people lived 1 year ago. These
data indicate changes in the location of
seniors that may affect the need for future
services in specific areas.

Planners and policy makers use data about
the number of persons moving into, or out
of, an area to estimate state and county
population growth.

Local governments use data about
migration to forecast the demand for new
public facilities such as schools, hospitals,
libraries, and fire and police stations.

Research, based on data about migration,
shows changes in the socioeconomic
profiles of areas. These data are used by
many government agencies for program
planning, especially for rural parts of the
country.

www.census.gov

American Community Survey

1319909

Population: Question on Health Insurance Coverage

Person 1 (continued)

Answer question 19 if this person is
15 years old or over. Otherwise, SKIP to
the questions for Person 2 on page 12.

Person 1 (continued)

c. How long has this grandparent been
responsible for the(se) grandchild(re

If the grandparent is financially responsi

Is this person CURRENTLY covered by any of the
more than one grandchild, answer the q
following types of health insurance or health Question as it appears in the questionnaire. H Answer
for the
grandchild
whom
the grandpa
question
19 iffor
this
person
is
beenold
responsible
the longestSKIP
period
coverage plans? Mark "Yes" or "No" for EACH type
15 years
or over.for
Otherwise,
too
of coverage in items a – h.
Because
of aCURRENTLY
physical, mental,
or emotional
the questions for Person 2 on page 12.
person
covered
by any of the
1619Is this
Less than 6 months
Yes No
condition,
does
person
have difficulty
following
types
ofthis
health
insurance
or health
a. Insurance through a current or
doing errands
alone"Yes"
suchor
as"No"
visiting
a doctor’s
coverage
plans? Mark
for EACH
type
6 to 11 months
former employer or union (of this
office or in
shopping?
of coverage
items a – h.
person or another family member)
19 Because of1 aorphysical,
2 years mental, or emotion
Yes No
condition, does this person have difficult
b. Insurance purchased directly from
Yes through a current or
a. Insurance
3 or 4alone
yearssuch as visiting a doc
doing errands
an insurance company (by this
former employer or union (of this
office or shopping?
Noor another family member)
person or another family member)
person
5 or more years
c. Medicare, for people 65 and older,
b. What
Insurance
purchased
directly
from
Yes
is
this
person’s
marital
status?
20
or people with certain disabilities
an insurance company (by this
26 Has this person ever served on active d
NoArmed Forces, military Reserves, o
person or another family member)
U.S.
Now married
d. Medicaid, Medical Assistance, or
Guard? Active duty does not include trainin
c. Medicare, for people 65 and older,
any kind of government-assistance
is thisorperson’s
status?
20 What
Reserves
National marital
Guard, but
DOES inclu
Widowed
or people
with certain disabilities
plan for those with low incomes
activation, for example, for the Persian Gulf
or a disability
Divorced
Now married
d. Medicaid,
Medical Assistance, or
Yes, now on active duty
any
kind
of government-assistance
Separated
e. TRICARE or other military health care
Widowed
plan for those with low incomes
Yes, on active duty during
or a disability
Never married ➔ SKIP to I
Divorced
f. VA (including those who have ever
the last 12 months, but not now
used or enrolled for VA health care)
Separated
e.
TRICARE
or
other
military
health
care
Yes, on active duty in the past, but no
21 In the PAST 12 MONTHS did this person get –
g. Indian Health Service
during the last 12 months
Yes
No
Never
married ➔ SKIP to I
f. VA (including those who have ever
No, training for Reserves or National
used
or enrolled for VA health care)
h. Any other type of health insurance
a.
Married?
only ➔
to question
28aperson g
12SKIP
MONTHS
did this
21 In the PAST
or health coverage plan – Specify
g. Indian Health Service
Yes
No
No, never served in the military ➔ SK
b. Widowed?
question 29a
h. Any other type of health insurance
a. Married?
c.
or Divorced?
health coverage plan – Specify
27 When did this person serve on active du
b. U.S.
Widowed?
Armed Forces? Mark (X) a box for EA
22 How many times has this person been married?
in which this person served, even if just for
a. Is this person deaf or does he/she have
serious difficulty hearing?
c. period.
Divorced?
Once
September
2001
or later
times has
this
person been ma
22 How many
Two
timesdeaf or does he/she have
Yes
Is this
person
17 a.
Source:
ACS-1(2009)KFI
August
1990
to
August
2001 (includin
serious
difficulty
Three
or morehearing?
times
No
Once
Persian Gulf War)
b. Is this person blind or does he/she have
Two
times
Yesyear did this person last get married?
September
1980 to July 1990
23 In what
serious difficulty seeing even when wearing
Three
more
Mayor1975
to times
August 1980
glasses?
Year No

b. Is this person blind or does he/she have
(August
April
19
year didera
this
person1964
lasttoget
marr
23 In whatVietnam
serious difficulty seeing even when wearing
March
1961
to
July
1964
glasses?
Year
No
MEETING
FEDERAL NEEDS
February 1955 to February 1961
Yesquestion
Answer
24 if thisSurvey
person (ACS)
is
I
This
question
was
added
to
the
American
Community
to
enable
the
U.S.
Answer question 18a – c if this person is
Korean War (July 1950 to January 19
female
– 50 years old. Otherwise,
Noand 15
Department
Health
Services
and other federal agencies to more accurately
5 years old or over.
Otherwise,ofSKIP
to and Human
SKIP to question 25a.
January 1947 to June 1950
distribute
resources
the questions for
Person 2 on
page 12. and better understand state and local health insurance needs.
Answer question 24 if this person is
I
World War II (December 1941 to Dece
G Answer question 18a – c if this person is
female and 15 – 50 years old. Otherwise,
Has
this
person
given
birth
to
any
children
in
24
5
years
old
or
over.
Otherwise,
SKIP
to
November
1941 or earlier
Planning and implementing many federal health programs requires accurateSKIP
statetoand
local25a.
question
a. Because of a physical, mental, or emotional
past 12 months?
thethe
questions
for Person 2 on page 12.
information
on health
condition, does
this person have
seriousinsurance status. Obtaining data on the uninsured rate among Americans
28 a. Does this person have a VA service-c
difficulty concentrating,
is of greatremembering,
importance or
to policy makers
Yes at federal, state, and local levels.
personrating?
given birth to any childre
disability
24 Has this
making decisions?
18 a. Because
the past 12 months?
No of a physical, mental, or emotional
condition, does this person have serious
Yes (such as 0%, 10%, 20%, ... , 10
Yes
difficulty
concentrating,
remembering,
or
Does this
person have any
of his/her own
25 a.
Yes
No ➔ SKIP to question 29a
making
decisions?
grandchildren
under the age of 18 living in
No
No
this house or apartment?
b. Does this person have serious difficulty
Yes
What
is person
this person’s
service-connec
Does
this
have any
of his/her ow
25 a. b.
Yes
walking or climbing stairs?
disability rating?
grandchildren
under the age of 18 livin
No
this house or apartment?
No ➔ SKIP to question 26
Yes
0 percent
b. Does this person have serious difficulty
b.
Is this or
grandparent
currently responsible for
Yes10 or 20 percent
walking
climbing stairs?
No
most of the basic needs of any grandchild(ren)
No ➔ SKIP to question 26
c. Does this person have difficulty dressing or
under
Yes the age of 18 who live(s) in this house or
30 or 40 percent
bathing?
apartment?
b. Is this grandparent
currently responsib
No
50 or 60 percent
most of the basic needs of any grandch
Yes
Yes
70 age
percent
or who
higher
c. Does this person have difficulty dressing or
under the
of 18
live(s) in this h
bathing?
apartment?
No
No ➔ SKIP to question 26
Yes

Yes

American Community Survey
Population: Question on Health Insurance Coverage

COMMUNITY BENEFITS
Social Services
One of the nation’s important sources of
insurance data, the Current Population
Survey, has annual sample sizes that are
too small for many states. Adding a health
insurance question to the ACS offers an
improved data source to smaller states and
communities.
State and localities will use the statistically
reliable county-level data on the uninsured
to more efficiently target outreach and
enrollment efforts to those who are eligible

for Medicaid and the State Children’s
Health Insurance Program, but are not
enrolled, thereby facilitating increased
insurance coverage.
Public Health
Measuring health insurance status helps
agencies target public health grant
resources to locations where need is great.

www.census.gov

plan for those
withmilitary
low incomes
e. TRICARE
or other
health care
or a disability
f. VA (including those who have ever
or enrolled
VA health
care)
e. used
TRICARE
or otherfor
military
health
care

Widowed
Separated
Divorced
Never
married ➔ SKIP to I
Separated
21 In the PAST 12 MONTHS did this person get –
Never married ➔Yes
SKIP toNo I

Yes, now on a

activation, for exam

Yes, on active
the
12on
mo
Yes,last
now
Yes,
Yes, on
on active
active
g.
Health Service
during
f. Indian
VA (including
those who have ever
the lastthe
12 las
mo
used or enrolled for VA
health 1830–1930,
care)
asked
since
1970
No,
training
f
h. Any other type of health insurance
Married?
In the
PAST 12 MONTHS did this person get –
Yes,
on
active
21 a.
only
➔ the
SKIPlast
health
coverage
plan – Specify
g. or
Indian
Health
Service
during
Yes
No
Population: Question on Disability b. Widowed?
No,
ser
No, never
training
h. Any other type of health insurance
a. Married?
question
29aft
only
➔
SKIP
c. How long h
or health coverage plan – Specify
Answer question 19 if this person is
H
c. Divorced?
responsible
did
this per
27 WhenNo,
never
ser
b. Widowed?
15 years old or over. Otherwise, SKIP to
If the grandp
U.S. Armed
Force
question
29a
How
many
times
has
this
person
been
married?
the
questions
for
Person
2
on
page
12.
22
Is
this
person
CURRENTLY
covered
by
any
of
the
16
more
than
o
in
which
this
person
a.
Is
this
person
deaf
or
does
he/she
have
17
Questions
as they
appear c.
in Divorced?
the questionnaire.
following
types hearing?
of health
insurance
or health
for the
When did
thisgran
per
27 period.
serious
difficulty
been respon
Once
coverage plans? Mark "Yes" or "No" for EACH type
U.S. Armed
Force
22 How many times has this person been married?
coverage
indeaf
itemsora does
– h. he/she have
September
20
in which
this perso
person
17 a. Isofthis
Because
of
a
physical,
mental,
or
emotional
19
Two
times
Yes
Less
th
period.
serious difficulty hearing?
Yes No
condition,
does this person have difficulty
August
1990
t
Once
a. Insurance
through a current or
Three
or
more
times
No
doing errands alone such as visiting a doctor’s
6Gulf
to 11
Persian
W
former employer or union (of this
September
20
Two times
office
or shopping?
Yes
b. Is this
person
blind orfamily
does member)
he/she have
person
or another
September
or 19
2
23 In what year did this person last get married?
August11990
serious
difficulty
seeing
even
when
wearing
Three
or more times
No
b. Insurance
purchased directly from
Yes
Persian
Gulf
W
May
1975
to
glasses?
Year
3
or
4A
an person
insurance
company
(byhe/she
this have
b. Is this
blind
or
does
September
No did this person last get married?
person or another family member)
23 In what year
Vietnam
5 era
or 19
m(
serious
Yesdifficulty seeing even when wearing
c. Medicare, for people 65 and older,
May
1975
toto
A
glasses?
YearWhat is this person’s marital status?
March
1961
20
orNo
people with certain disabilities
this perso
26 Has
Vietnam
era
February
1955
Yes
U.S.
Armed
F(
Now married
d. Medicaid, Medical Assistance, or
Answer question
24 if this person is
I
Guard?
Active
March 1961
to
kind of government-assistance
question
18a – c if this person is
Korean
War
(
No
G Answerany
female and
15 – 50 years old. Otherwise,
Reserves
or Na
Widowed
low incomes
5 yearsplan
oldfor
or those
over.with
Otherwise,
SKIP to
February
195
activation,
for
e
SKIP
to
question
25a.
January
1947
or a disability
Answer question
Divorced 24 if this person is
I
the
questions
for
Person
2
on
page
12.
question 18a – c if this person is
Korean
War
G Answer
female and 15 – 50 years old. Otherwise,
World
War
II(
Yes,
now
Separated
e. TRICARE
or other
military health
5 years
old or over.
Otherwise,
SKIPcare
to
SKIP
to
question
25a.
January
1947
24 Has this person given birth to any children in
November
Yes, on19a
theBecause
questions
Person
2 onhave
page
12.
Never
married ➔ SKIP to I
18 a.
of afor
physical,
mental,
or
emotional
the past 12
months?
f.
VA (including
those who
ever
theWar
lastII1
World
condition,
thisfor
person
havecare)
serious
used ordoes
enrolled
VA health
a.
Does
this
perso
28
theperson
PAST given
12 MONTHS
personinget –
Yes, on19
a
Has In
this
birth todid
anythis
children
24 21
difficulty concentrating, remembering, or
November
Yes
disability
ratin
g. Indian
Servicemental, or emotional
during
th
18 a. making
Because
ofHealth
a physical,
the past 12 months? Yes
decisions?
No
No
condition, does this person have serious
No,(such
traini
this
perso
28 a. DoesYes
h. Any other
type of healthremembering,
insurance
a.Yes
Married?
difficulty
concentrating,
or
Yes
onlyratin
➔S
disability
or
health
coverage
plan
–
Specify
a.
Does
this
person
have
any
of
his/her
own
25
making decisions?
No
➔
SKIP
grandchildren
under
the
age
of
18
living
in
No, neve
b.No
Widowed?
No
Yes
(such
this house or apartment?
question
Yes
a.
Does
this
person
have
any
of
his/her
own
25
b. Does this person have serious difficulty
c. Divorced?
b. What
isdid
this
pe
No
➔ SKIP
When
this
27
grandchildren
under the age of 18 living in
Yes
walking
No or climbing stairs?
disability
ratin
U.S.
Armed
Fo
this
house
or
apartment?
many
times
has this26
person been married?
22 HowNo
➔ SKIP
to question
in which this pe
a. IsYes
thisperson
personhave
deaf serious
or does difficulty
he/she have
17
b. Does
this
b.
What
is
this
pe
0
percent
period.
serious
difficultystairs?
hearing?
Yes
walking
or climbing
Once
disability ratin
b. Is this grandparent
currently responsible for
No
10Septemb
or 20 pe
➔ SKIP
to needs
question
most No
of
the
basic
of26
any grandchild(ren)
Two
times
Yes Yes
0
percent
c. Does this person have difficulty dressing or
under the age of 18 who live(s) in this house or
30August
or 40 pe
1
b. apartment?
Is this Three
grandparent
responsible for
or morecurrently
times
bathing?
No No
10Persian
or 60
20 pe
pe
G
50
or
most of the basic needs of any grandchild(ren)
b. IsYes
this person
person have
blinddifficulty
or does he/she
have
c. Does
this
dressing
or
under
the
age
of
18
who
live(s)
in
this
house
or
Yes year did this person last get married?
30Septemb
or 40 pe
23 In what
70
percent
serious difficulty seeing even when wearing
bathing?
apartment?
1975
glasses?
No
50May
or 60
pe
YearNo ➔ SKIP to question 26
Yes
Yes
70Vietnam
percent
Yes
Source: ACS-1(2009)KFI
No
No ➔ SKIP to question 26
March 19
No
February
Answer question 24 if this person is
I
18a – c if this person is
Korean W
G Answer questionPage
female and 15 – 50 years old. Otherwise,
ACS-1(2009)KFI,
9, BaseSKIP
(Black)
ACS-1(2009)KFI,
Page 9, Green Pantone 354 (10
5 years old or over. Otherwise,
to
SKIP
to
question
25a.
January 1
MEETING FEDERAL NEEDS
the questions for Person 2 on page 12.
World W
ACS-1(2009)KFI,
Page
9, Base
ACS-1(2009)KFI,
Green Pantone 354 (10
Information
on disability
is used
by a(Black)
number of federal
to distribute Page
funds9,
and
this person given birth to any children in
24 Hasagencies
Novembe
develop
people mental,
with disabilities.
about the size, distribution,
18 a.programs
Because offor
a physical,
or emotionalFor example,
the past data
12 months?
condition,
does
this
person
have
serious
and needs of the disabled population are essential for developing disability employment
28 a. Does this p
difficulty concentrating, remembering, or
Yes
disability r
policy. Formaking
the Americans
decisions? with Disabilities Act, data about functional limitations are important
No available for all segments of the
to ensure that comparable public transportation services are
Yes (s
Yes
population. Federal
grants are awarded, under the
Older
Americans
Act,
based
the number
a. Does
this person
have
any ofon
his/her
own
25
No ➔
of elderly people
No with physical and mental disabilities. grandchildren under the age of 18 living in
this house or apartment?
b. Does this person have serious difficulty
b. What is thi
Yes
walking or climbing stairs?
disability r
No
➔
SKIP
to
question
26
Yes
0 perc
b. Is this grandparent currently responsible for
No
10 or 2
most of the basic needs of any grandchild(ren)
c. Does this person have difficulty dressing or
under the age of 18 who live(s) in this house or
30 or 4
bathing?
apartment?
50 or 6
Yes
Yes
70 per

DISABILITY
American
Community Survey
Person 1 (continued)

§.4{£¤
§.4{£¤

§.4{£¤

No ➔ SKIP to question 26

American Community Survey
Population: Question on Disability

COMMUNITY BENEFITS
Transportation

Social Services

Disability data are used to allocate funds
for mass transit systems to provide
handicapped facilities.

Under the Older Americans Act, these data
assist state and local agencies concerned
with aging to develop health care and
other services tailored to the disabilities of
the elderly.

Under the Americans with Disabilities Act,
local transit authorities use these data on
the number of individuals with functional
limitations in order to ensure public
transportation services are comparable to
those for individuals without disabilities.

Disability data are used by state and
county agencies to plan for eligible
recipients under the Medicare and
Medicaid programs.

Employment
Data about people with disabilities are
used to allocate funds to states and local
areas for employment and job training
programs for veterans.

www.census.gov

erson 1 (continued)

Answer question 19 if this person is
15 years old or over. Otherwise, SKIP to
the questions for Person 2 on page 12.

this person CURRENTLY covered by any of the
llowing types of health insurance or health
verage plans? Mark "Yes" or "No" for EACH type
coverage in items a – h.
19 Because of a physical, mental, or emotional
Yes No
condition, does this person have difficulty
Population:
Question
on
Marital
Status
Insurance through a current
or
doing
errands
alone such
as visiting a doctor’s
former employer or union (of this
office or shopping?
person or another family member)

American Community Survey

Insurance purchased directly from
an insurance company (by this
person or another family member)

QuestionNoas it appears in the questionnaire.

Medicare, for people 65 and older,
or people with certain disabilities

20 What is this person’s marital status?

Yes

c. How long has this grandparent been
responsible for the(se) grandchild(ren)?

If the grandparent is financially responsible f
more than one grandchild, answer the questi
for the grandchild for whom the grandparent
been responsible for the longest period of tim

Less than 6 months
6 to 11 months
1 or 2 years
3 or 4 years
5 or more years

26 Has this person ever served on active duty

U.S. Armed Forces, military Reserves, or N
Guard? Active duty does not include training fo

Medicaid, Medical Assistance, or
any kind of government-assistance
plan for those with low incomes
or a disability

Now married

TRICARE or other military health care

Separated

Yes, now on active duty

VA (including those who have ever
used or enrolled for VA health care)

Never married ➔ SKIP to I

Yes, on active duty during
the last 12 months, but not now

Indian Health Service

Widowed

Reserves or National Guard, but DOES include
activation, for example, for the Persian Gulf Wa

Divorced

Source:
ACS-1(2009)KFI
the PAST 12 MONTHS did this person get –
21 In

Yes

Any other type of health insurance
or health coverage plan – Specify

Yes, on active duty in the past, but not
during the last 12 months

a. Married?

No, training for Reserves or National Gua
only ➔ SKIP to question 28a

b. Widowed?

No, never served in the military ➔ SKIP to
question 29a

c.
Divorced?
MEETING

FEDERAL NEEDS

27 When did this person serve on active duty i
U.S. Armed Forces? Mark (X) a box for EACH
How
many
times
has
this
person
been
married?
22
and implementing
many government programs calls for accurate in
information
on served, even if just for part
which this person
Is this person deafPlanning
or does he/she
have
period. widowed
serious difficulty marital
hearing?status, such as the number of married women in the labor force, elderly
Once
individuals, or young single people who soon may establish homes of their own.
For the
September
2001 or later
Two times
Yes
U.S. Department of Housing and Urban Development, data about marital statusAugust
help define
1990 to August 2001 (including
Three or more Housing
times
No
Persian
Gulf War)
qualifying census tracts for the Low-Income
Tax Credits and the Mortgage
Revenue
Is this person blind
or does
he/she have
Bonds
Programs.
September
1980 to July 1990
23 In what year did this person last get married?

serious difficulty seeing even when wearing
glasses?

May 1975 to August 1980

Year

Vietnam era (August 1964 to April 1975)

Yes

March 1961 to July 1964

nswer question 18a – c if this person is
years old or over. Otherwise, SKIP to
e questions for Person 2 on page 12.

Social Services

Answer question 24 if this person is
female and 15 – 50 years old. Otherwise,
SKIP
to question 25a.
COMMUNITY
BENEFITS

Housing
to any children in
24 Has this person given birth

February 1955 to February 1961
Korean War (July 1950 to January 1955)
January 1947 to June 1950

World War II (December 1941 to Decembe

November 1941 or earlier
Because of a physical, mental, or emotional
the past 12 months?
Data have
about
marital status are used for
Local governments use data about marital
condition, does this person
serious
Does this person have a VA service-conn
28 a.for
difficulty concentrating,
remembering,
or
budget
and resource
planningYes
to identify
status in assessing needs
housing
and
disability
rating?
making decisions?
the number of children needing
other community development services.
No special
Yes (such as 0%, 10%, 20%, ... , 100%)
services (e.g., children in single-parent
Yes
25 a. Does this person have any of his/her own
households).
No ➔ SKIP to question 29a
grandchildren under the age of 18 living in
No
Employment
this
house
or
apartment?
use census data about
Does this person haveCommunities
serious difficulty
What
is this person’s service-connected
Community organizationsb.use
data
marital status to pinpoint areas with
Yes large
walking or climbing stairs?
disability
rating?
about
marital
status
to
identify
needs
for
numbers of single-parent families
Noand
➔ SKIP to question 26
Yes
job
training
and
housing
for
displaced
0
percent
identify needs for childcare, medical care,
this grandparent currently
responsible for
homemakers.
No
and other social services.b. Is
10 or 20 percent
most of the basic needs of any grandchild(ren)
Does this person have difficulty dressing or
under the age of 18 who live(s) in this house or
30 or 40 percent
bathing?
apartment?
www.census.gov
50 or 60 percent
Yes
Yes
70 percent or higher
No

No ➔ SKIP to question 26

§.4{£¤

S-1(2009)KFI, Page 9, Base (Black)

ACS-1(2009)KFI, Page 9, Green Pantone 354 (10, 20, 40 and 50%)

former employer or union (of this
person or another family member)
b. Insurance purchased directly from
an insurance company (by this
person or another family member)

office or shopping?

1 or 2 years

Yes

3 or 4 years

5 or more years

c. Medicare, for people 65 and older,
or people with certain disabilities

marital status?
20 What is this person’s
American Community
Survey

d. Medicaid, Medical Assistance, or
Population:
any kind of government-assistance
plan for those with low incomes
or a disability

26 Has this person ever served on active duty in the

U.S. Armed Forces, military Reserves, or Nationa
Guard? Active duty does not include training for the

Now married

Questions on Marital History

e. TRICARE or other military health care
f. VA (including those who have ever
used or enrolled for VA health care)

Widowed

Reserves or National Guard, but DOES include
activation, for example, for the Persian Gulf War.

Divorced
Separated

Yes, now on active duty

Never married ➔ SKIP to I

Yes, on active duty during
the last 12 months, but not now

Questions as they appear in the questionnaire.

g. Indian Health Service

21 In the PAST 12 MONTHS did this person get –
Yes

h. Any other type of health insurance
or health coverage plan – Specify

a. Married?

No, training for Reserves or National Guard
only ➔ SKIP to question 28a

b. Widowed?

No, never served in the military ➔ SKIP to
question 29a

c. Divorced?

17 a. Is this person deaf or does he/she have

22 How many times has this person been married?

serious difficulty hearing?

Yes, on active duty in the past, but not
during the last 12 months

Once

Yes

Two times

Three or more times

27 When did this person serve on active duty in the

U.S. Armed Forces? Mark (X) a box for EACH period
in which this person served, even if just for part of the
period.
September 2001 or later
August 1990 to August 2001 (including
Persian Gulf War)

b. Is this person blind or does he/she have
23 In what year did this person last get married?
serious difficulty seeing even when wearing
glasses?
Year

September 1980 to July 1990
May 1975 to August 1980
Vietnam era (August 1964 to April 1975)

Yes

March 1961 to July 1964

Answer question 18a – c if this person is
5 years old or over. Otherwise, SKIP to
the questions for Person 2 on page 12.

18 a. Because of a physical, mental, or emotional
condition, does this person have serious
difficulty concentrating, remembering, or
making decisions?

February 1955 to February 1961

Source:
ACS-1(2009)KFI
Answer
question 24 if this person is

Korean War (July 1950 to January 1955)

female and 15 – 50 years old. Otherwise,
SKIP to question 25a.

January 1947 to June 1950

World War II (December 1941 to December 1946

24 Has this person given birth to any children in

November 1941 or earlier

the past 12 months?

Yes
MEETING
FEDERAL NEEDS

28 a. Does this person have a VA service-connected
disability rating?

Yes (suchof
as federal
0%, 10%, 20%, ... , 100%)
Marital history data enables 25
multiple
agencies to more accurately measure the effects
a. Does this person have any of his/her own
➔ SKIP to question 29a
focus onunder
the the
well-being
of families.
AddingNomeasures
grandchildren
age of 18 living
in
No and state policies and programs that
this house
or apartment?
of
marital
transitions
to
the
American
Community
Survey
will
provide
estimates
of
marriage
b. Does this person have serious difficulty
b. What is this person’s service-connected
divorce
rates and duration, as well
information
is
Yesas flows into and out of marriage. This
walking orand
climbing
stairs?
disability rating?
critical for more refined analyses of eligibility
for
program
services
and
benefits,
and
of
changes
No ➔ SKIP to question 26
Yes
0 percent
resulting from federal policies and
programs.
b. Is this grandparent currently responsible for
Yes

c. Does this person
have and
difficulty
dressing
or
Marriage
divorce
data
bathing?

most of the basic needs of any grandchild(ren)
18 who live(s)
in this
house
or
be under
usedthe
at age
theofnational,
state,
and
sub-state
apartment?

10 or 20 percent

or plan
40 percent
will
level30to
for
50 or 60behavior.
percent
and assess state and community activities designed to influence marital and divorce
Yes Equally important are tax and entitlement
Yes forecasting functions in a variety of federal
programs
70 percent
or higher
No including Medicare and Medicaid.
No ➔ SKIP to question 26

§.4{£¤
ACS-1(2009)KFI, Page 9, Base (Black)

ACS-1(2009)KFI, Page 9, Green Pantone 354 (10, 20, 40 and 50%)

American Community Survey
Population: Questions on Marital History

COMMUNITY BENEFITS
Social Services

Government

Data will be used for formulation and
assessment of Temporary Assistance for
Needy Families (TANF) policies and programs
at both the federal and state level.
Data will be used to plan for and assess the
success of grantees funded under the new
Healthy Marriage grant program.

Marital history will permit analyses
and projections of tax policies that can
create or mitigate “marriage penalties”
—increased taxes for a married couple
compared with what the same couple
would pay if filing as unmarried
individuals.

Rates of marriage and divorce data are
used to track and forecast changes in
areas with large numbers of single-parent
families, and thus identify needs for
childcare, child support, and other social
services.

Local governments use data about marital
history in assessing needs for
housing and other community
development services under the
Community Development Block Grant
Evaluation.

www.census.gov

Three or more times

Is this person blind or does he/she have
23 In what year did this person last get married?
serious difficulty seeing even when wearing
glasses?
Year
Yes
No

American Community Survey

nswer question 18a – c if this person is
years old or over. Otherwise, SKIP to
e questions for Person 2 on page 12.

Because of a physical, mental, or emotional
condition, does this person have serious
difficulty concentrating, remembering, or
making decisions?
Yes

Answer question 24 if this person is
female and 15 – 50 years old. Otherwise,
SKIP to question 25a.

Vietnam era (August 1964 to April 1975)
February 1955 to February 1961
Korean War (July 1950 to January 1955)
January 1947 to June 1950

24 Has this person given birth to any children in

November 1941 or earlier

the past 12 months?

World War II (December 1941 to Decembe

28 a. Does this person have a VA service-conn

Yes

disability rating?

No
Source: ACS-1(2009)KFI

Does this person have serious difficulty
walking or climbing stairs?

May 1975 to August 1980

Question as it appears in the questionnaire.

25 a. Does this person have any of his/her own

September 1980 to July 1990

March 1961 to July 1964

Population: Question on Fertility

August 1990 to August 2001 (including
Persian Gulf War)

grandchildren under the age of 18 living in
this house or apartment?

Yes (such as 0%, 10%, 20%, ... , 100%)
No ➔ SKIP to question 29a
b. What is this person’s service-connected
disability rating?

Yes
No ➔ SKIP to question 26

Yes

0 percent
b. Is this grandparent currently responsible for
MEETING
FEDERAL
10 or 20 percent
most of the basic
needs of anyNEEDS
grandchild(ren)
Does this person have difficulty dressing or
under the age of 18 who live(s) in this house or
30 or 40 percent
The number of children born inapartment?
the past 12 months is a measure of fertility that is used to
bathing?
or 60 percent
project the future size of the population, a basic planning tool for agencies of the50government.
Yes
Yes
70 percent or higher
The U.S. Department of Health and Human Services uses these data to carry out various
No

No ➔ SKIP
to question the
26 need for family planning services
programs required by statute, including
determining
within the Indian Health Service, investigating matters on child welfare in the Children’s Bureau,
and conducting research for voluntary family planning programs.

§.4{£¤

S-1(2009)KFI, Page 9, Base (Black)

ACS-1(2009)KFI, Page 9, Green Pantone 354 (10, 20, 40 and 50%)

COMMUNITY BENEFITS
Social Services
Data about fertility are used to predict
the number of children who will need
adoptive homes under the Child Welfare
Act.

Information about children born in the
past 12 months is used in research on
the family size of female adolescents and
their actual birth rates in later life.

The Indian Health Service uses data about
the number of babies born to determine
the need for family planning services for
its service-eligible population.

The National Center for Health Statistics
computes vital statistics for subnational
areas using data about children born in
the past 12 months.

www.census.gov

March 1961 toMarch
July 1964
1961 to July 1964

24 question
if this person
24 if is
this person is
I Answer question
I Answer
nswer
ion 18aquestion
– c if this
18a
person
– c if is
this person is female and 15
female
– 50 and
years
15old.
– 50Otherwise,
years old. Otherwise,
years
over. old
Otherwise,
or over. SKIP
Otherwise,
to
SKIP to SKIP to question
SKIP to
25a.
question 25a.
efor
questions
Person 2for
onPerson
page 12.
2 on page 12.

American Community Survey

February 1955February
to February
19551961
to February 1961
Korean War (July
Korean
1950
War
to (July
January
1950
1955)
to January 1955)
January 1947January
to June 1947
1950 to June 1950

World War II (December
World War II1941
(December
to December
1941 to
1946)
Decemb

Population:
Question
on
Grandparents
aschildren
Caregivers
this24
person
Has given
this person
birth to
given
any birth
children
to any
in
in November 1941
24 Has
November
or earlier1941 or earlier

aBecause
physical,
ofmental,
a physical,
or emotional
mental, or emotional
the past 12 months?
the past 12 months?
does
condition,
this person
does have
this person
serioushave serious
this a.
person
Does have
this person
a VA service-connected
have a VA service-con
28 a. Does28
oncentrating,
difficulty concentrating,
remembering,
remembering,
or
or Yes
Yes
disability rating?
disability rating?
cisions?
making decisions?
Question as it appears in the questionnaire.
No
No
Yes (such as 0%,
Yes 10%,
(such20%,
as 0%,
... ,10%,
100%)
20%, ... , 100%)
Yes
this a.
person
Does have
this person
any of his/her
have any
own
of his/her own
25 a. Does25
No
➔
SKIP
to
No
question
➔
SKIP
29a
to
question
29a
grandchildren
grandchildren
under the age
under
of 18the
living
age in
of 18 living in
No
this house orthis
apartment?
house or apartment?
erson
Does have
this person
serioushave
difficulty
serious difficulty
b. What is this
b. What
person’s
is this
service-connected
person’s service-connected
Yes
Yes
climbing
walking stairs?
or climbing stairs?
disability rating?
disability rating?
No ➔ SKIP toNo
question
➔ SKIP26to question 26
Yes
0 percent
0 percent
b. Is this grandparent
b. Is this grandparent
currently responsible
currently responsible
for
for
No
10 or 20 percent
most of the basic
most of
needs
the basic
of anyneeds
grandchild(ren)
of any grandchild(ren) 10 or 20 percent
erson
Does have
this person
difficulty
have
dressing
difficulty
or dressing under
or
under
agelive(s)
of 18in
who
the age
of 18the
who
thislive(s)
houseinorthis house or30 or 40 percent
30 or 40 percent
bathing?
apartment? apartment?
50 or 60 percent
50 or 60 percent
Yes
Yes
Yes
70 percent or 70
higher
percent or higher
No
No ➔ SKIP toNo
question
➔ SKIP26to question 26 13199096

4{£¤
§.4{£¤
nswer
question 19 if this person is

years old or over. Otherwise, SKIP to
e questions for Person 2 on page 12.

CS-1(2009)KFI,
)KFI, Page 9, Base
Page
(Black)
9, Base (Black)

ecause of a physical, mental, or emotional
ondition, does this person have difficulty
oing errands alone such as visiting a doctor’s
fice or shopping?

If the grandparent is financially responsible for
more than one grandchild, answer the question
for the grandchild
for
whom9,
theGreen
grandparent
has
ACS-1(2009)KFI,
ACS-1(2009)KFI,
Page
Page Pantone
9, Green
354
Pantone
(10, 20,
35440
(10,
and
20,
50%)
40 and
been responsible for the longest period of time.

Less than 6 months
6 to 11 months
1 or 2 years

Yes

3 or 4 years

5 or more years

hat is this person’s marital status?

c. How long has this grandparent been
responsible for the(se) grandchild(ren)?

this person ever served on active duty in the
Source:
ACS-1(2009)KFI
26 Has

U.S. Armed Forces, military Reserves, or National
Guard? Active duty does not include training for the

Now married
Widowed

Reserves or National Guard, but DOES include
activation, for example, for the Persian Gulf War.

MEETING FEDERAL NEEDS

Divorced

Yes, now on active duty

Separated

This question was added to the American
Community
Yes, on active
duty during Survey in 1999 to comply with legislation
Never married ➔ SKIP to I
the last 12
months,
but not now census program obtain information
passed in the 104th Congress requiring
that
the decennial
the PAST 12 MONTHS
didgrandparents
this person getwho
–
Yes, onresponsibility
active duty in the for
past,the
but care
not of their grandchildren. The
about
have primary
during Services
the last 12 months
Yes
No
U.S. Department
of Health and Human
uses these data to distinguish households in
training for Reserves
or National
Guard
which a grandparent has primary No,
responsibility
for a child
or children
and also uses these data
Married?
only ➔ SKIP to question 28a
for the High Performance Bonus Awards Program under the Temporary Assistance to Needy
No, never served in the military ➔ SKIP to
Widowed?
Families Program.
question 29a
Divorced?

27 When did this person serve on active duty in the

ow many times has this person been married?
Once
Two times

Business

U.S. Armed Forces? Mark (X) a box for EACH period
in which this person served, even if just for part of the
period.

COMMUNITY BENEFITS
September 2001 or later

Government

August 1990 to August 2001 (including
Persian Gulf
War)
Daycare centers and other businesses
use
State and local governments, faith-based
these
to develop new products
and1980 to July
and
other nonprofit organizations, and
September
1990
what year did this person
lastdata
get married?

Three or more times

services for their communities.May 1975 to August 1980
businesses use these data to plan, budget,
and pay benefits.
Vietnam era (August 1964 to April 1975)

nswer question 24 if this person is
male and 15 – 50 years old. Otherwise,
KIP to question 25a.

as this person given birth to any children in
e past 12 months?

March 1961 to July 1964
February 1955 to February 1961
Korean War (July 1950 to January 1955)
January 1947 to June 1950
World War II (December 1941 to December 1946)
November 1941 or earlier

www.census.gov

50%)

nce, or Now married
son
is
sistance
e,
SKIPWidowed
to
omes
page 12.
Divorced

Separated
health care

U.S. Armed Forces, military
U.S.
Reserves,
Armed Forces,
or National
military Reserves, or National
Now
married
c. How long
has
this grandparent
been Active duty does notGuard?
Guard?
include Active
training
duty
for does
the not include training for the
responsible
for the(se) grandchild(ren)?
Reserves or National Guard, Reserves
but DOESor
include
National Guard, but DOES include
Widowed
If the grandparent is financially responsible
activation, for example, for the
activation,
Persian Gulf
for example,
War.
for the Persian Gulf War.
Divorced
more than
one grandchild, answer the question
for the grandchild for whom the grandparent
hason active duty
now
Yes, now on active duty
Separatedfor the longest periodYes,
been responsible
of time.

AmericanSTATUS
Community
VETERAN
AND Survey
PERIOD OF MILITARY SERVICE

on active duty during Yes, on active duty during
Never married ➔ SKIP to I Never married ➔ SKIP to I Yes,
or
aveemotional
ever
asked
1840,
1890,
theVeteran
last 12 months,
but not
now
the
last
12
months,
but1910,
not nowsince 1930
Less than 6 Questions
months
Population:
on
Status
and
Period
e difficulty
alth
care)
In the
PAST 12 MONTHS
In the
this
person
12get
MONTHS
–
did this Yes,
person
get – duty in the past,
on active
Yes,
but
onnot
active duty in the past, but not
21 did
iting
a doctor’s
6 toPAST
11 months
during the last 12 months during the last 12 months
of
Service
Yes Military
No
Yes
No
1 or 2 years
No, training for Reserves or National
No, training
Guard
for Reserves or National Guard
surance
a. Married?
a. Married?
only ➔ SKIP to question 28a only ➔ SKIP to question 28a
3 or 4 years
Specify
questionnaire.
No,they
neverappear
served inin
thethe
military
No, ➔
never
SKIPserved
to
in the military ➔ SKIP to
b. Widowed?
b. Widowed?
5 or more years Questions as
question 29a
question 29a
atus?
c. Divorced?
c. Divorced?
person ever served 27
on active
in the
Whenduty
did this
person 27
serve
When
on active
did this
duty
person
in theserve on active duty in the
26 Has this
U.S.
Armed
Forces,
military
Reserves,
or
National
Mark (X)
a box
for EACH
period
Mark (X) a box for EACH period
U.S.
Armed
Forces?
U.S.
Armed
Forces?
How
many
times has 22
this person
How many
beentimes
married?
has this person
been
married?served, even
which
this
in which
if just
this
forperson
part ofserved,
the
even if just for part of the
es
he/she
have
Guard? Active duty does not includeintraining
for person
the
period.
period.
Reserves or National Guard, but DOES
include
g?
Once
Once
activation, for example, for the Persian Gulf War.
September 2001 or later
September 2001 or later
Two times
Two times
Yes, now on active duty
August
1990
to
August
2001
August
(including
1990 to August 2001 (including
Three or more times
Three or more times
Persian Gulf War)
Persian Gulf War)
Yes, on active duty during
lastget
12
months,
butperson
not now
es
havedid this person
September
1980 to July 1990September 1980 to July 1990
In he/she
what year
last
year
married?
did this
last get
married?
23 Inthewhat
when
seven
person
getwearing
–
Yes, on active duty in the past, but not
May
1975
to
August 1980 May 1975 to August 1980
Year
Year
during the last 12 months
Vietnam
April 1975)
era (August 1964 to April 1975)
No, training for Reserves or National
Guard era (August 1964 toVietnam
only ➔ SKIP to question 28a
March 1961 to July 1964
March 1961 to July 1964

No, never served in the military ➔ SKIP to
February 1955 to February 1961
February 1955 to February 1961
question
29a
Answer question 24 ifIthisAnswer
personquestion
is
24 if this person is
this
person
Korean
Korean1955)
War (July 1950 to January 1955)
female
and is
15 –Source:
50
female
old.
and
15 – 50
years
Otherwise,
When
didOtherwise,
this
person
serve
on old.
active
duty
in War
the (July 1950 to January
27years
ACS-1(2009)KFI
wise,
SKIP
to
U.S.
Armed
Forces?
Mark
(X) a box for EACH
period
SKIP
to
question
25a.
SKIP
to
question
25a.
January
1947
to
June
1950
January
1947 to June 1950
non
been
married?
in which this person served, even if just for part of the
page
12.
period.
World War II (December 1941World
to December
War II (December
1946)
1941 to December 1946)
Has this person given24
birthHas
to any
this children
person given
in birth to anyNovember
children in
1941 or earlier November 1941 or earlier
September
or later
ental,
or emotional
the past
12 months?
the
past 12 2001
months?
son have serious
August 1990 to August 2001
a. Does this person have
Does
service-connected
this person have a VA service-connected
28 (including
28 aa.VA
, remembering,
or
Persian
Yes
YesGulf War)
disability rating?
disability rating?
September
1980 to July 1990
t get married?
No
No
Yes (such
as 0%, 10%, 20%,
...
Yes
, 100%)
(such as 0%, 10%, 20%, ... , 100%)
MEETING
FEDERAL
NEEDS
to August
a. Does this person have
a.May
Does
of1975
his/her
this
person
own 1980
have any
of his/her own
25 any
No
➔ SKIP
grandchildren under theVietnam
age
grandchildren
of 18
living
under
in 1964the
age of
18
living
in to question 29a No ➔ SKIP to question 29a
era
(August
to April
1975)
Veteran status,
including
period
of military
service, is used primarily by the U.S. Department
this house or apartment?
this house
or apartment?
erious difficulty of Veterans
March
1961 toto
July
1964
Affairs
measure
the
needs
of veterans
and
to evaluate
the impact
of veterans’
b. What
is this
person’s service-connected
b. What
is this person’s
service-connected
Yes
Yes with education, disability
rs?
rating?
disability
rating?
programs
dealing
employment,
and
health
care.
These
data
are
needed to
February 1955 to February 1961
on is
No ➔ SKIPconduct
to question
26 No
➔ SKIP toprogram
question 26planning, and budgeting for federal veterans’ programs and
policy
analysis,
Korean War (July 1950 to January 1955)
0 percent
0 percent
Otherwise,
for reports
Congress
on currently
state projections
b. Is this grandparent
currently
b.
Isto
this
responsible
grandparent
for
responsibleof
forveterans’ facilities and services.
January
1947
to June
1950
10
or
20
percent
10 or 20 percent
most of the basic needs ofmost
any grandchild(ren)
of the basic needs of any grandchild(ren)
fficulty
dressing
under
the ageor
of 18 whoWorld
live(s)
under
inthe
this
house
of 18orwho
in30
this
house
or
War
II age
(December
1941live(s)
to December
1946)
or 40 percent
30 or 40 percent
apartment?
apartment?
ny children
in
November 1941 or earlier
50 or 60 percent
50 or 60 percent
Yes
Yes
70 percent or higher
70 percent or higher
28 a. Does this person have a VA service-connected
COMMUNITY
BENEFITS
No ➔ SKIP to question
26 No
➔ SKIP to question 26
disability
rating?

For the Public Health Service Act, veteran
status is used as one factor
9 to determine
At stateNo
and
county
levels,29a
veteran status
➔ SKIP
to question
the
segments
of
the
population
who may
is used for budgeting and program
not
be
receiving
needed
medical
services.
planning
services and nursing
b. What is for
thismedical
person’s service-connected
9, Base (Black)
ACS-1(2009)KFI,
Page
ACS-1(2009)KFI,
9,
Green
Pantone
Page
354
9,
(10,
Green
20,
Pantone
40
and
50%)
354
(10,
20,
40
and
50%)
disability
rating?
home care for veterans.

£¤

his/her own
of 18 living in

responsible for
ny grandchild(ren)
s) in this house or

Social Yes
Services
(such as 0%, 10%, 20%, ... , 100%)

0 percent
The U.S.
Department of Veterans Affairs
needs data
veteran status in
10 or about
20 percent
planning
the
locations
and sizes of
30 or 40 percent
veterans’ cemeteries.

Employment
Data about veteran status are used to
allocate funds to states and local areas for
employment and job training programs for
veterans.

50 or 60 percent

70 percent or higher

www.census.gov

9
Page 9, Green Pantone 354 (10, 20, 40 and 50%)

n what year did this person last get married?
Once
ear
Two times

period.
September 1980 to July 1990

May 1975 to2001
August
1980
September
or later
Vietnam
era
(August
1964
to (including
April 1975)
August 1990 to August
2001
Three or more times
Persian Gulf War)
March 1961 to July 1964
September 1980 to July 1990
n what year did this person last get married?
February 1955 to February 1961
nswer
question
24
if
this
person
is
May
to August 1980
ear
Population:
Question
on
VA1975
Service-Connected
Disability
Korean
War (July 1950 to January 1955)
emale and 15 – 50 years old. Otherwise,
Vietnam era (August 1964 to April 1975)
KIP to question 25a.
January 1947 to June 1950
March 1961 to July 1964
World War II (December 1941 to December 1946)
February
1955 to February
Question
as it appears
in the1961
questionnaire.
as
this
person
given
birth
to
any
children
in
November
1941 or earlier
nswer question 24 if this person is
he past 12 months?
Korean
War
(July
1950
to
January
1955)
emale and 15 – 50 years old. Otherwise,
this
person
have
a
VA
service-connected
28 a. Does
KIP Yes
to question 25a.
January 1947 to June 1950
disability rating?
World War II (December 1941 to December 1946)
No
Yes (such as 0%, 10%, 20%, ... , 100%)
as this person given birth to any children in
November 1941 or earlier
. Does
person have any of his/her own
he
pastthis
12 months?
No ➔ SKIP to question 29a
grandchildren under the age of 18 living in
28 a. Does this person have a VA service-connected
this
house
or
apartment?
Yes
rating?
b. disability
What is this
person’s service-connected
NoYes
disability rating?
Yes (such as 0%, 10%, 20%, ... , 100%)
SKIP tohave
question
. Does No
this➔person
any 26
of his/her own
0 percent
No
➔ SKIP to question 29a
grandchildren under the age of 18 living in
. Is
this
grandparent
currently
responsible for
this house or apartment?
10
or
20 percent
most of the basic needs of any grandchild(ren)
b.
What
is
this
underYes
the age of 18 who live(s) in this house or
30 or 40person’s
percent service-connected
disability rating?
apartment?
50 or 60 percent
No ➔ SKIP to question 26
0 percent
Yes
70 percent or higher
. Is this grandparent currently responsible for
10 or 20 percent
➔ SKIP
to needs
question
most No
of the
basic
of26
any grandchild(ren)
under the age of 18 who live(s) in this house or
30 or 40 percent
Source: ACS-1(2009)KFI
apartment?
50 or 60 percent
9
Yes
70 percent
or higher
MEETING
FEDERAL
NEEDS

American Community Survey

Rating

No ➔ SKIP to question 26

Veterans Affairs (VA) service-connected disability rating was added to the American Community
ACS-1(2009)KFI, Page 9, Green Pantone 354 (10, 20, 40 and 50%)
Survey (ACS) to enable the U.S. Department of Veterans Affairs to measure a veteran’s serviceconnected disability compensation entitlement status. This information9will improve the VA’s
ability to accurately anticipate the need for VA care and its associated cost.
ACS-1(2009)KFI,
Page
9, Green
354 (10,
20, 40 and
VA is required
to provide
anPantone
annual report
to Congress
that50%)
determines whether VA health care
appropriations for the coming fiscal year are sufficient to cover expenditures associated with
the expected demand for VA health care services. Adding the proposed service-connected
disability status measure to the ACS will enable VA to make county-level estimates of veterans
classified by income, service-connected status, and several other characteristics that are needed
to classify enrollment priorities.

This information will fundamentally improve VA’s capability to describe the total veteran
population in terms of age, priority, and market area and to more accurately estimate the
demand for VA care.

COMMUNITY BENEFITS
Health
VA medical centers and their associated
outpatient clinics would use these data to
measure key determinants of the demand
for VA care.

Data on service-connected disability
ratings would allow VA medical centers
(and their regional networks) to engage
in meaningful local area planning that
accounts for expectations of the future
demand for VA care.

www.census.gov

usually rode to work in the car, truck, or van
LAST WEEK?
Person(s)

on do ANY work
as one hour?

37 LAST WEEK, could this person have started a
job if offered one, or returned to work if
recalled?
Yes, could have gone to work

American Community SurveyNo, because of own temporary illness

n 35a

erson work LAST

33
Population:
Questions
on Labor
What time did this
person usually leave
home
to go to work LAST WEEK?

at more than one
e worked most

Hour

No, because of all other reasons (in school, etc.)

Force Status

38 When did this person last work, even for a few

Minute

days?

a.m.

Within the past 12 months
p.m.
Person 1 (continued)
Questions as they appear in the questionnaire.

reet name)

continued)

34 How
many
minutes
did 32
it
usually
takefor
this
29
a.JLAST
WEEK,
did this
person
pay
Answer
question
if youwork
marked
"Car,

nown, give a
uch as the building
or
is intersection.
person work for pay
s)? office
ost

person
to get
from home to work LAST WEEK?
at atruck,
job
(or
or business)?
van" in question 31. Otherwise,
Minutes
SKIP to question 33.
Yes ➔ SKIP to question 30
No – Did not work (or retired)

question 30

ork (or retired)

de
the limits
of that
s person
do ANY
workK
little as one hour?

39
32

b.32
LAST
WEEK,
this person
do ANY
How
manydid
people,
including
this work
person,
forusually
pay, even
fortoaswork
littlein
asthe
onecar,
hour?
rode
truck, or van
Answer
questions
LAST
WEEK? 35 – 38 if this person
Yes
did NOT
work last week. Otherwise,
Person(s)
SKIP to No
question
➔ SKIP39a.
to question 35a

33
30 At what location did this person work LAST
35 a.
LASTIfWEEK,
was this
person
on layoff
from
this person
worked
at more
than one
WEEK?
33
What
time
did he
this
usually
leave home
a job?
location,
print
where
orperson
she worked
most

wn
limits35a
uestion

to go to work LAST WEEK?
last week.

his person work LAST

orked at more than one
or she worked most

Yes ➔ SKIP
to question 35c
Hour
Minute
a. Address
(Number
and street name)
No
a.m.

eign country
nd street name)

p.m.
b. LAST WEEK, was this person TEMPORARILY 34
absent
from
a job or
business?
If the exact
address
is not
known, give a
description of the location such as the building
name
or the
street
or intersection.
34
How
many
minutes
did
it usually
Yes,
onnearest
vacation,
temporary
illness,take this 40
person
to get
from
home
to work LAST WEEK?
maternity
leave,
other
family/personal
b. Namereasons,
of city,bad
town,
or
post
office
weather, etc. ➔ SKIP to
Minutes
question 38

not known, give a
ation such as the building
treet or intersection.

, or post office

No ➔ SKIP to question 36

y get to work LAST

c. Is the work location inside the limits of that K
c. Has
person been informed that he or she
city this
or town?
will be recalled to work within the next
AnswerOR
questions
35 a– date
38 if to
this
person
6 months
been given
return
to
n inside the limits of that K
Yes
did NOT work last week. Otherwise,
work?
Motorcycle
No, outside
the city/town
SKIP
to question
39a. limits
Yes ➔ SKIP to question 37
Bicycle
35
d. Name of county
Walked
city/town
limits
No

used more than one
ng the trip, mark (X)
ost of the distance.

Worked at
35 a. LAST WEEK, was this person on layoff from
home ➔ SKIP Source: ACS-1(2009)KFI
a job?
to question 39a
e. Name of U.S. state or foreign country
Yes ➔ SKIP to question 35c
Other method
No

or foreign country

13199104
36 During the LAST 4 WE
Answer
32➔if SKIP
you to
marked
1 toquestion
5 years ago
L "Car,
ACTIVELY looking for
truck, or van" in question 31. Otherwise,
Over
5 years ago
or never worked ➔ SKIP to
SKIP
to
question
33.
36 question
During
the
LAST
4
WEEKS,
has
this
person
been
47
Yes
ACTIVELY looking for work?
No ➔ SKIP to ques
a. During the
YesPAST 12 MONTHS (52 weeks), did
this
person
workincluding
50 or more
weeks?
Count
How
many
people,
this
No
➔ as
SKIP
to question
38person,
paid time
work.
usually
rodeoff
to work
in the car, truck, or van
37 LAST WEEK, could thi
LAST WEEK?
job if offered one, or r
Yes ➔ SKIP to question 40
recalled?
Person(s)
37 LAST
No WEEK, could this person have started a
job if offered one, or returned to work if
Yes, could have go
recalled?
b. How many weeks DID this person work, even
No, because of ow
for a fewYes,
hours,
including
paid
vacation, paid
could
have gone
to work
No, because of all
sick leave, and military service?
What time No,
did because
this person
usually
leave illness
home
of own
temporary
to go to50
work
WEEK?
to
52LAST
weeks
No,
because
of all other reasons (in school, etc.)
38 When did this person
Hour 48 to
Minute
49 weeks
days?
a.m.
40 to 47 weeks
38 When
did this person p.m.
last work, even for a few
Within the past 12
days?
27 to 39 weeks
1 to 5 years ago ➔
14 to
26 weeks
Within
the past 12 months
Over 5 years ago o
How many
did
it ➔
usually
13 weeks
or less
question 47
1minutes
to 5 years
ago
SKIP totake
L this
person to get from home to work LAST WEEK?
Over 5 years ago or never worked ➔ SKIP to
Minutes
39 a. During the PAST 12
During thequestion
PAST 1247MONTHS, in the WEEKS
this person work 50
WORKED, how many hours did this person
paid time off as wo
usually
each
39 a. work
During
theWEEK?
PAST 12 MONTHS (52 weeks), did
this
person
work
50
or
more
weeks?
Count
Usual hours worked each WEEK
Yes ➔ SKIP to q
paid time off as work.
No
Answer questions 35 – 38 if this person
➔ week.
SKIP toOtherwise,
question 40
did NOT workYes
last
b. How many weeks D
SKIP to question
No 39a.
for a few hours, inc
sick leave, and mili
b. How many weeks DID this person work, even
for a few hours, including paid vacation, paid
50 to 52 weeks
a. LAST sick
WEEK,
wasand
thismilitary
person service?
on layoff from
leave,
a job?
48 to 49 weeks
50 to 52 weeks
40 to 47 weeks
Yes ➔ SKIP to question 35c
48 to 49 weeks
27 to 39 weeks
No
40 to 47 weeks
14 to 26 weeks
27 was
to 39this
weeks
b. LAST WEEK,
person TEMPORARILY
13 weeks or les
absent from
business?
14atojob
26 or
weeks

MEETING FEDERAL NEEDS

ZIPb.Code
Labor f.
force
status
is keywas
tothis
understanding
work and unemployment
and the
LAST WEEK,
person TEMPORARILY
13vacation,
weeks orpatterns
less
Yes, on
temporary
illness,
40 During the PAST 12 M
from aBased
job or business?
leave, other levels,
family/personal
availability ofabsent
workers.
on labor market areas andmaternity
unemployment
the U.S.
WORKED, how many h
reasons, bad weather, etc. ➔ SKIP to
Department of Labor
identifies
serviceillness,
delivery areas andquestion
determines
amounts to be allocatedusually work each WE
Yes, on
vacation, temporary
38
40 During the PAST 12 MONTHS, in the WEEKS
maternity The
leave,impact
other family/personal
to each for job training.
of immigration on WORKED,
the
economy
andhours
job
markets is
Usual hours worked eac
how
many
No ➔ SKIP
to question
36 did this person
reasons, bad weather, etc. ➔ SKIP to
usually work
each WEEK?
determined
byusually
labor get
force
data,LAST
and this information
is included
in required reports
38
31 How didpartially
this question
person
to work
WEEK? IfACS-1(2009)KFI,
this
usually
used
more 10,
one
Theperson
Office
of
Management
and Budget,
under
the
Paperwork
Reduction
Act,
Usual
hours
worked
eachand
WEEK
0, Base (Black) to Congress.
Page
Green
Pantone
354
(10,
20, informed
40
50%)
c. Has
this
person
been
that he or she
No
➔ SKIP
to question
36 than
method of transportation
during
the trip,
mark (X)
will befor
recalled
to work
within the nextareas. The
about
workers
as part of the criteria
defining
metropolitan
sually get to work uses
LAST data
the box
of theemployed
one used for most
of the distance.
6 months
OR beenwith
givenother
a date to
return
ually used more than
one
Bureau
of Economic
Analysis
thisthat
information,
conjunction
data,
totodevelop
c. Has this person
beenuses
informed
he or she in
work?
n during the trip, mark (X)
Car,
truck,
or
van
Motorcycle
will
be
recalled
to
work
within
the
next
its state per capita income estimates used in the allocation formulas and eligibility criteria of
for most of the distance.
months
OR been given aBicycle
date to return to
Yes ➔ SKIP to question 37
Bus6or
trolley bus
many federal
programs
such as Medicaid.
work?

%¤

y car

Motorcycle
Bicycle
Walked

Worked at
home ➔ SKIP
to question 39a
Other method

Streetcar or trolley car
Walked
Yes ➔ SKIP to question 37
Subway or elevated
Worked at
home ➔ SKIP
Railroad No
to question 39a
Ferryboat
Other method
Taxicab

American Community Survey
Population: Questions on Labor Force Status

COMMUNITY BENEFITS
Employment
For local areas with substantial
unemployment, labor force data are
used to allocate funds and identify
programs that create new jobs.
Data are used to target state and
local areas with a labor force surplus

for programs that promote business
opportunities.
Within the U.S. Department of Labor,
data about the labor force are needed to
evaluate job complaints reported on the
basis of disability.

www.census.gov

J
29 a. LAST WEEK, did this person work for pay
at a job (or business)?

Answer question 32 if you marked "Car,
truck,
van"ofincounty
question 31. Otherwise,
d. or
Name
SKIP to question 33.

Yes ➔ SKIP to question 30
Namepeople,
of U.S.including
state or foreign
country
American
Community Survey
32 Howe.many
this person,
No – Did not work (or retired)

usually rode to work in the car, truck, or van

Population: Questions on Place of Work
and Journey to Work
LAST WEEK?
b. LAST WEEK, did this person do ANY work
for pay, even for as little as one hour?

Person(s)
f. ZIP Code

ACTIVELY
35
a. LASTlooking
WEEK, fo
w

a job?
Yes
Yes ➔
No ➔ SKIP
to SKI
que
No

37 LAST WEEK, could th
b. offered
LAST WEEK,
w
job if
one, or
absent from a
recalled?

Yes, on va
Yes, could
have g
maternity
reasons,
b
No, because of ow
question 3
No, because of al
No ➔ SKIP

Yes
No ➔ SKIP to question
35a as they appear in the questionnaire.
Questions

30 At what location did this person work LAST
WEEK? If this person worked at more than one
location, print where he or she worked most
last week.

33 What time did this person usually leave home
31
How
did this
person
usually get to work LAST
to go
to work
LAST
WEEK?
WEEK? If this person usually used more than one38 When
c. did
Hasthis
thisperson
person
HourmethodMinute
of transportation during the trip, mark (X)
the box of the one used for
most of the distance.
a.m.

a. Address (Number and street name)

Car, truck, or van

p.m.

Bus or trolley bus
If the exact address is not known, give a
description of the location such as the building
name or the nearest street or intersection.

Motorcycle
Bicycle

b. Name of city, town, or post office

29 a. LAST WEEK, did this person work for pay
at a job (or business)?

Yes ➔ SKIP to question 30
c. Is the work location inside the limits of that
city or town?
No – Did not work (or retired)

Over 5 No
years ago
question 47
person toSubway
get from
home
to
work
LAST
WEEK?
or elevated
Worked at
home ➔ SKIP 36
Minutes Railroad
39 a. During
Duringthe
thePAST
LAST1
J Answer question 32 if you markedto "Car,
question 39a
ACTIVELY
lookin5
this
person work
truck,Ferryboat
or van" in question 31. Otherwise,
paid time off as wo
Other method
SKIP to question 33.
Yes
Taxicab
Yes ➔ SKIP to
No ➔ SKIP to
No
Answer questions 35 – 38 if this person
32
people,
including
this person,
did How
NOT many
work last
week.
Otherwise,
rode to
work in the car, truck, or van
b. How
many
weeks
37
LAST
WEEK,
coul
SKIPusually
to question
39a.
10LAST WEEK?
for
few
hours,one
in
joba if
offered
sick
leave, and mil
recalled?
Person(s)

§.4|%¤

Yes WEEK, did this person do ANY work
b. LAST
for
even
for
as littlelimits
as one hour?
No,pay,
outside
the
city/town

35 a.
LAST WEEK, was this
person
onBase
layoff(Black)
from
ACS-1(2009)KFI,
Page
10,
a job?

Yes ➔ SKIP to question 35c

30
At what
location
this person
work LAST
e. Name
of U.S.
statedid
or foreign
country
WEEK? If this person worked at more than one

location, print where he or she worked most
last week.

a. Address (Number and street name)
f. ZIP Code

If the exact address is not known, give a
description of the location such as the building
name
the nearest
street
orto
intersection.
Source:
ACS-1(2009)KFI
31 How
did
thisorperson
usually
get
work LAST
WEEK?
If
this
person
usually
used
more
than one
b. Name of city, town, or post office
method of transportation during the trip, mark (X)
the box of the one used for most of the distance.

Car, truck, or van

1 to 5 years
Yes ➔ago
SKI➔

Streetcar
or did
trolley
car
34 How many
minutes
it usually
takeWalked
this

Person 1 (continued)

d. Name of Yes
county
No ➔ SKIP to question 35a

days? will be recalled
6 months OR b
work?the past 1
Within

Motorcycle

33 What time did this person usually leave home
Noto work LAST WEEK?
to go

50Yes,
to 52
weeks
could
ha

ACS-1(

48No,
to because
49 weeks

40No,
to because
47 weeks

27 to 39 weeks

14did
to 26
weeks
38 When
this
per
Hour
Minute
days?
b. LAST WEEK, was this persona.m.
TEMPORARILY
13 weeks or le
absent from a job or business?
Within the pa
p.m.
Yes, on vacation, temporary illness,
40
During
the
12a
1 toPAST
5 years
maternity leave, other family/personal
WORKED, how many
reasons, bad weather, etc. ➔ SKIP to
Over each
5 years
usually work
W
38
34 Howquestion
many minutes
did it usually take this
question 47
person to get from home to work LAST WEEK?
Usual hours worked ea
No ➔ SKIP to question 36
Minutes
39 a. During the PAS
this person wo
c. Has this person been informed that he or she
paid time off a
will be recalled to work within the next
6 months OR been given a date to return to
Yes ➔ SKI
work?

No
questions
35 – 3837
if this person
c.Bus
Is the
work bus
location inside Bicycle
the limits of that K Answer
Yes ➔
SKIP to question
or trolley
did
NOT
work
last
week.
Otherwise,
city or town?
b. How many wee
Streetcar or trolley car
Walked
SKIPNo
to question 39a.
for a few hours
Yes
Subway or elevated
Worked at
sick leave, and
➔ SKIPand the characteristics of commuter travel come
Basic knowledge
about
patterns
No,
outsidecommuting
the city/town home
limits
Railroad
to
question
39a
50 to 52 w
from responses to these questions. The commuting
are essential for planning highway
35data
a. LAST WEEK, was this person on layoff from
d.Ferryboat
Name of county
Othertransportation
method
improvements and developing public
services,
a job? as well as for designing programs
48 to 49 w
Taxicab
to ease traffic
problems during peak periods, conserve energy, reduce pollution, and estimate
40 to 47 w
Yes ➔ SKIP to question 35c
and project the demand for alternative-fueled vehicles. These data are required to develop
27 to 39 w
No
Name
of U.S. work-related
state or foreign vehicle
country trips and increasing
standards e.
for
reducing
passenger occupancy during
14 to 26 w
peak periods of travel. The Bureau of Economic Analysis (BEA) plans to use county-level data in
b. LAST WEEK, was this person TEMPORARILY
10
13 weeks o
computing gross commuting flows to develop place-of-residence
estimates from placeabsent fromearnings
a job or business?

MEETING FEDERAL NEEDS

§.4|%¤

of-work estimates
by industry. In addition, BEA also plans to use these data for state personal
f. ZIP Code
on vacation, temporary illness,
40 During the PAST
income estimates for determining federal fund allocations. Yes,
maternity leave, other family/personal
ACS-1(2009)KFI, Page 10, Base (Black)

31 How did this person usually get to work LAST
WEEK? If this person usually used more than one
method of transportation during the trip, mark (X)
the box of the one used for most of the distance.
Car, truck, or van

Motorcycle

Bus or trolley bus

Bicycle

ACS-1(2009)KFI,
Page 10, Green Pantone
354 (10,
2
WORKED,
how m
reasons, bad weather, etc. ➔ SKIP to
question 38

usually work eac

No ➔ SKIP to question 36

Usual hours worke

c. Has this person been informed that he or she
will be recalled to work within the next
6 months OR been given a date to return to
work?
Yes ➔ SKIP to question 37

American Community Survey
Population: Questions on Place of Work and Journey to Work

COMMUNITY BENEFITS
Transportation

Emergency Preparedness

These data form the database used by
state departments of transportation
and the more than 350 metropolitan
planning organizations responsible for
comprehensive transportation planning
activities.

Police and fire departments use data about
where people work to plan emergency
services in areas of high concentrations of
employment.

Metropolitan planning organizations use
these data to manage traffic congestion
and develop strategies to mitigate
congestion, such as carpooling programs
and flexible work schedules.
Public transit agencies use these data to
plan for transit investments, identify areas
needing better transit service, determine
the most efficient routes, and plan for
services for disabled persons.

Employment
Data are used to identify patterns of
discrimination in hiring among minorities
and other population groups within labor
markets.
Banking
Financial institutions use data about
commuting patterns and occupation to
define market areas for describing lending
practices and the effects of bank mergers.

www.census.gov

Yes, could have gone to work
No, because of own temporary illness

33 What time did this person usually leave home

AST

ne
X)
e.

KIP
n 39a

hod

American Community
38 When did this Survey
person last work, even for a few

to go to work LAST WEEK?
Hour

Minute

days?

a.m.
Population:
Questions on Work Status Last Year

p.m.

Within the past 12 months

1 to 5 years ago ➔ SKIP to L
Over 5 years ago or never worked ➔ SKIP to
34 How many minutes did it usually take this Questions as
they47appear in the questionnaire.
question
person to get from home to work LAST WEEK?

that

No, because of all other reasons (in school, etc.)

Minutes

39 a. During the PAST 12 MONTHS (52 weeks), did
this person work 50 or more weeks? Count
paid time off as work.
Yes ➔ SKIP to question 40

Answer questions 35 – 38 if this person
did NOT work last week. Otherwise,
SKIP to question 39a.

No
b. How many weeks DID this person work, even
for a few hours, including paid vacation, paid
sick leave, and military service?

35 a. LAST WEEK, was this person on layoff from

50 to 52 weeks

Yes ➔ SKIP to question 35c

40 to 47 weeks

27 to 39 weeks

a job?

48 to 49 weeks

14 to 26 weeks
b. LAST WEEK, was this person TEMPORARILY
absent from a job or business?
Yes, on vacation, temporary illness,
maternity leave, other family/personal
reasons, bad weather, etc. ➔ SKIP to
question 38
No ➔ SKIP to question 36

13 weeks or less

40 During the PAST 12 MONTHS, in the WEEKS
WORKED, how many hours did this person
usually work each WEEK?
Usual hours worked each WEEK

c. Has this person been informed that he or she
will be recalled to work within the next
6 months OR been given a date to return to
work?
Source: ACS-1(2009)KFI
Yes ➔ SKIP to question 37
No

MEETING FEDERAL NEEDS

To comply with provisions of the Civil Rights Act, the U.S. Department of Justice uses these data
to determine the availability of individuals for work. Government agencies, in considering the
programmatic and policy aspects of providing federal assistance to areas, have emphasized
the requirements for reliable data to determine the employment resources available. Data
about the number of weeks and hours worked last year are essential because these data allow
the characterization of workers by full-time/part-time and full-year/part-year status. Data
about working last year are also necessary for collecting accurate income data by defining the
universe of persons who should have earnings as part of their total income.

ACS-1(2009)KFI, Page 10, Green Pantone 354 (10, 20, 40 and 50%)

COMMUNITY BENEFITS
Employment
Under the Older Americans Act, these data
are used to plan employment programs for
the elderly.

Companies use data on work status last
year to make decisions on where to place
new plants or offices.

Researchers use these data to analyze
differences between men and women or
among various race or ethnic groups for
individuals with similar weeks or hours
worked.

Data on work status last year are used for
legal cases on discrimination under the
Civil Rights Act.

www.census.gov

Person 1 (continued)
L

an employee of a PRIVATE FOR-PROFIT

of work or
was
this person
doing?
45 What kindcompany
business,
or of an
individual, for

(For example:
registered
personnel manager,
wages,
salary,nurse,
or commissions?
supervisor of order department, secretary,
accountant)an employee of a PRIVATE NOT-FOR-PROFIT,

Person 1 (continued)

Answer questions 41 – 46 if this person
worked in the past 5 years. Otherwise,
SKIP to question 47.
41 – 46 if this
person
L Answer questions
Population:
Question
on
Class
worked in the past 5 years. Otherwise,
SKIP
to CURRENT
question
47.
41 – 46
OR MOST RECENT JOB
Questions
on Industry
ACTIVITY. Describe clearly this person’s chief

of work was
this person
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45 What kindtax-exempt,
or charitable
organization?

(For example: registered nurse, personnel manager,
American Community Survey
supervisor aoflocal
order
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GOVERNMENT
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job activity or business last week. If this person
had more than one job, describe the one at
41 – 46
CURRENT
OR MOST
RECENT
which
this
person worked
the most
hours.JOB
If this
person
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job or business
last
week, give
ACTIVITY.
Describe
clearly this
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his/her last
or business.
job activity or
last job
week.
If this person
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Was this
person
person
had
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last week,
Questions
asgive
they
Mark (X) ONE
information
forbox.
his/her last job or business.

Questions on Occupation

accountant)

of Worker(city, county, etc.)?

a state GOVERNMENT employee?

46 What were this person’s most important

GOVERNMENT
(For example: employee?
patient care,
activities aorFederal
duties?
directing hiring policies, supervising order clerks,
SELF-EMPLOYED
in
own
NOT
INCORPORATED
typing and filing, reconciling financial records)

professional
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this person’s
most important
46 What werebusiness,

activities or duties? (For example: patient care,
SELF-EMPLOYED
in own INCORPORATED
directing hiring
policies, supervising
order clerks,
professional
practice,
or farm?
typing andbusiness,
filing, reconciling
financial
records)

working WITHOUT PAY in family business
appear in the questionnaire.

an employee
41 Was this
person – of a PRIVATE FOR-PROFIT
company
or business, or of an individual, for
Mark (X)
ONE box.
wages, salary, or commissions?

or THE
farm?
47 INCOME IN
PAST 12 MONTHS

42
didbox
thisforperson
work?
MarkFor
(X) whom
the "Yes"
each type
of income this
person received, and give your best estimate of the

If now
active
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inMONTHS
47 INCOME
INon
THE
PAST
12
TOTAL
AMOUNT
during
the
PAST 12 MONTHS.

Mark (X) the "Yes" box
d. Social
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orand
Railr
person
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g
TOTAL AMOUNT durin
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today’s
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person received, and give your best estimate of the
Name of company,
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box to the
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43 What kind of business or industry was this?
Do NOT include Social Se
For income
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If
netDescribe
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box to mail
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house,amount
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mark the "No" box for the other person.
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For income received jointly, report the appropriate
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h. Any other sources
of in
TOTAL
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share for each person – or, if that’s not possible,
12
a.
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report
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or tips
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all for
jobs.
amount before
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mark
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theReport
other person.
c. Interest, dividends
deductions for taxes, bonds, dues, or other items.
or alimony.
Do
NOT inclu
royalty
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or
h.
Any
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of
Is this mainly – Mark (X) ONE box.
such and
as money
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in
44
trusts.
Report
a. Wages, salary, commissions, bonuses,
regularly
such as
Vetere
home.
to
an
account.
or tips
from
all
jobs.
Report
amount
before
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.00
Yes
➔ $
manufacturing?
deductions for taxes, bonds, ,dues, or other items.
or alimony. Do NOT inclu
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such as
money
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Yes
➔
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TOTAL AMOUNT for past
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12
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$
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If now of
oncompany,
active duty
in
Name
business,
or other employer
,
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TOT
the Armed Forces, mark (X) this box ➔
Noother (agriculture, construction, service,
12
Yes ➔ $
b. Self-employment
income
from for
own
nonfarm
TOTAL
AMOUNT
past
government,
etc.)?
and print the branch of the Armed Forces.
12 months including
businesses or farm businesses,
No
Name of company, business, or other employer
proprietorships and partnerships. Report
TOTAL to
A
48 What was this person’s
NET income after business expenses.
PAST 12 MONTHS? Add 12
en
b.
Self-employment
income
from
own
nonfarm
What
kind
of
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this
person
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Social Security
or IR
45
to 47h;
any losses.
43 What kind of business or industry was this?
businesses
or farm
businesses,
including
(For
example:
registered
nurse,
personnel
manager,
enter the amount and mark (
Describe the activity at the location where employed.
proprietorships
anddepartment,
partnerships.
Report
supervisor
secretary,
What
wasamount.
this person’s to
.00
48 the
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dollar
(For example: hospital, newspaper publishing, mail
,
accountant)
NET
income
after
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expenses.
PAST 12 MONTHS?
$ en
Yes ➔ Add
orderAnswer
house, auto
engine 41
manufacturing,
bank)
questions
–
46
if
this
person
No
L kind of business or industry was this?
to 47h; subtract any losses. I
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43 What
TOTAL
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Otherwise,
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, TOTA
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the dollar amount.
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publishing, mail
to question
47.
,
order house, auto engine manufacturing, bank)
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TOTAL A
Loss
c. ACS-1(2009)KFI,
Interest, dividends,
rental
income,
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AMOUNT
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None OR $ACS-1(20
12 months
royalty income, or income
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What
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this person’s
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46and
41mainly
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MOST
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44 Is this
trusts.
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ACTIVITY. Describe clearly this person’s chief
TOTAL A
todirecting
an account.
hiring policies,
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job
activity or business last week. If this person
c. Interest,
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Yes ➔
typing income,
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had more than one job, describe the one at
royalty
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wholesale
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44 Is this
and trusts.
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No
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person had no job or business last week, give
TOTA
,
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retail
trade?for his/her last job or business.
information
manufacturing?
No
Loss
TOTAL AMOUNT for past
other
(agriculture,
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trade? construction, service,
12 months
.00
Yes ➔ $
41 Was
this person
–
government,
etc.)?
f. Any public assistan
,
Mark
ONE box.
retail(X)
trade?
47 INCOME
from the state or lo
No IN THE PAST 12 MONTHS
Loss
TOTAL AMOUNT for past
Continue with the questio
➜
otheran
(agriculture,
construction,
service,
months
employee of a PRIVATE FOR-PROFIT
Mark (X) the "Yes" box12for
each type of income this next page. If only 1 person
government,
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$
person received, and give your best estimate of the SKIP to pageYes
28➔
for mailin
salary, or commissions?
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MONTHS. labor
These questionswages,
describe
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the12American
No
Continue
with
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questio
➜
(NOTE: The "past 12 months" is the period from
TOTA
an employee
of a PRIVATEpolicy
NOT-FOR-PROFIT,
next page. If only 1 person
force. Data are used
to formulate
and programs
for date
employment,
career
today’s
one year ago up
throughdevelopment
today.)
tax-exempt, or charitable organization?
SKIP to page 28 for mailin
and training, and to measure compliance with antidiscrimination policies. Mandated reports
Mark (X) the "No" box to show types of income
local GOVERNMENT employee
g. Retirement, surviv
for Congress on a(city,
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laboretc.)?
force rely on the analysis ofNOT
these
characteristics. The Bureau of
received.
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NOT include Soci
Economic
Analysis uses Page
this information,
in conjunction with
other data, toPage
develop
its state
per Do 354
ACS-1(2009)KFI,
11, Base (Black)
ACS-1(2009)KFI,
11, Green
Pantone
(10, 20,
a state GOVERNMENT employee?
If net income was a loss, mark the "Loss" box to
capita income estimates used in the allocation formulas
or for
eligibility
criteria in many federal
the right
of the
dollar amount.
Yes ➔ $
a Federal GOVERNMENT employee?
programs such as Medicaid and plans to use the county-level information to develop its county
ACS-1(2009)KFI,
Page
11,
Base
(Black)
ACS-1(2009)KFI,
Page
11,
Green
Pantone
354
For
income
received
jointly,
report
the
appropriate
No (10, 20,
SELF-EMPLOYED in own NOT INCORPORATED
and state per capita
income
estimates.
TOTA
share for each person – or, if that’s not possible,
business,
professional
practice, or farm?
report the whole amount for only one person and
mark the "No" box for the other person.
SELF-EMPLOYED in own INCORPORATED
business, professional practice, or farm?
h. Any other sources
a. Wages, salary, commissions, bonuses,
regularly such as V
working WITHOUT PAY in family business
or tips from all jobs. Report amount before
unemployment com
or farm?
deductions for taxes, bonds, dues, or other items.
or alimony. Do NOT
such as money from
42 For whom did this person work?
home.
$
.00
Yes ➔
If now on active duty in
,
an employee of a PRIVATE FOR-PROFIT
NOT-FOR-PROFIT,
company or or
business,
or of
an individual, for
tax-exempt,
charitable
organization?
wages, salary, or commissions?
a local GOVERNMENT employee
an
employee
of a PRIVATE NOT-FOR-PROFIT,
(city,
county, etc.)?
tax-exempt, or charitable organization?
a state GOVERNMENT employee?
a local GOVERNMENT employee
a(city,
Federal
GOVERNMENT
employee?
county,
etc.)?
in own
NOT INCORPORATED
aSELF-EMPLOYED
state GOVERNMENT
employee?
business, professional practice, or farm?
a Federal GOVERNMENT employee?
SELF-EMPLOYED in own INCORPORATED
SELF-EMPLOYED
in own
NOT INCORPORATED
business,
professional
practice,
or farm?
business, professional practice, or farm?
working WITHOUT PAY in family business
SELF-EMPLOYED
in own INCORPORATED
or
farm?
business, professional practice, or farm?
42 For whom
didWITHOUT
this person
working
PAYwork?
in family business
or
farm?
If now on active duty in
the Armed Forces, mark (X) this box ➔
Source:
42 For
whom
did
this person
work?Forces.
andACS-1(2009)KFI
print the
branch
of the Armed

Person 1 (continued)

§.4|-¤

MEETING FEDERAL NEEDS

§.4|-¤
§.4|-¤

American Community Survey
Population: Question on Class of Worker
Questions on Industry
Questions on Occupation

COMMUNITY BENEFITS
Employment
Information about industry, occupation,
and class of worker is important for
creating jobs as companies use these data
to decide where to locate new plants,
stores, or offices.
Agencies use these data to plan jobtraining programs for seniors.

Federal agencies use these data
in litigation where employment
discrimination is alleged.
Social Services
Data are used to estimate the demand
for staff in health care occupations and
their geographic distribution based on
these data.

www.census.gov

(For example: registered nurse, personnel manager,
supervisor of order department, secretary,
accountant)

41 – 46 if this person
5 years. Otherwise,
7.

Yes ➔

.00

13199112
13199112
TOTAL AMOUNT for past
12 months
d.
Social
Security
or
Railroad
Retirement.
45
What kind
kind of
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work was
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this person
person doing?
doing?
d.
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Security
or
Railroad
Retirement.
45 What
(For example:
example: registered
registered nurse,
nurse, personnel
personnel manager,
manager,
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e.
Supplemental
Security
Income
(SSI).
supervisor
of
order
department,
secretary,
What wereofthis
person’s
mostsecretary,
important
46 supervisor
OR MOST RECENT JOB
order
department,
accountant)
$
(For example:on
patient
care,
activities or duties?
.00
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➔
clearly
this
person’s
chief Population:
accountant)
$
.00
Questions
Income
Yes
41
–
46
if
this
person
,,
41
– 46week.
if this
person
directing hiring policies, supervising order clerks,
ss last
If this
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5 years.
years.
Otherwise,
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Otherwise,
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,
TOTAL
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orked
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TOTAL
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7.
7.
No
12 months
business last week, give
monthsfor past13199112
TOTAL 12
AMOUNT
er last job or business.
12 months
Questions as they appeare. in
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questionnaire.
What were
were this
this person’s
person’s most
most important
important
46 What
OR
e. Supplemental
Supplemental Security
Security Income
Income (SSI).
(SSI).
46
OR MOST
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RECENT JOB
JOB
(For example:
example: patient
patient care,
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activities or
or duties?
duties? (For
f.
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clearly this
this person’s
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What
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45
directing
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ss
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47 directing
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IN THE
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the state$or local welfare office.
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ss last week. If this person
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at
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If this
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the "Yes" box for each type of income this
orked
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13199112
business
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siness,
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for
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TOTAL
person received, and give your best estimate of the
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for
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er
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(NOTE: The "past 12 months" is the period from
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estion
47. NOT-FOR-PROFIT,
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12 months
today’s
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one
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45 What kind of work was this person doing?
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47 (For
INCOME
IN THE
THE
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12
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the state
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local welfare
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47
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Mark (X) the
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types
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NMENT employee
supervisor
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What
were this
person’s
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46
RRENT
OR MOST
RECENT JOB
NOT
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accountant)
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c.)?
$Social Security.
Mark
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for
type
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the
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ERNMENT
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ED
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ssional
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What
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12
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46
OR
MOST
RECENT
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the whole amount for only one person and
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erson
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mark the "No" box for the other person.
ED
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Do NOT
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ss
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box.
ssional practice,
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➔
47
INCOME
IN
THE
PAST
12
MONTHS
from
the
state
or
local
welfare
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NMENT
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If
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to
h.
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NMENT
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,
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orked
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ERNMENT
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ployee
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ERNMENT
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Report
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AMOUNT
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er last
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ED
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ED
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ssional
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person
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ployee of a PRIVATE NOT-FOR-PROFIT,report
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and
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ED
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47 INCOME
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ssional
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ssional
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the Armed
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ounty,
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Report
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siness,
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,
48 What was this person’s
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47apast
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,Railroad
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ess
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the
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supervisor
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NMENT
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ERNMENT
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Report
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Otherwise,
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What was
was
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total
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thepayments
48
deductions
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estion
TOTAL
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What
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ssional47.
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12
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ininheritance
questions 47a
47athe sale of a
PAST 12
12 MONTHS?
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anin
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questions
report
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subtract
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ess
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ED
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Yes
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enter the amount and mark (X) the "Loss" box next to
to
royalty income,
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ctive
in where
at
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, important
ssional
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e.amount.
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➔
the
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What
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most
h.
Any
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46
$
al,
newspaper
publishing,
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RRENT
OR
MOST
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k
(X)
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the
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and trusts. Report
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example:
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regularly
such
as
Veterans’
(VA)
payments,
Describe
clearly
this
person’s
chief
gine
manufacturing,
bank)
to
an
account.
TOTAL AMOUNT for Loss
past
No
e branch
of family
the Armed
Forces.
OUT
PAY in
business
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No
directing
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Report
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child
? business last week. If this person
TOTAL
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past
Loss
12for
months
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typing
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mpany, business, or other employer
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months
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,, AMOUNT
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e?
erson worked the most hours. If this
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12 months
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person
no
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,
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from own nonfarm home.
TOTAL
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for
TOTAL AMOUNT
AMOUNT for
for past
past past
TOTAL
for his/her last job or business.
c. Interest,
Interest,
dividends,
net
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$
No
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businesses
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y in
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TOTAL
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, from
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income
estates
proprietorships
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partnerships.
Report
ure,
construction,
48 What was this person’s total income during the
royalty
or
from
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mark
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ONE
box.
and trusts.
trusts.
even
amounts
credited
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.00
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ONE
box.
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income
after
business
expenses.
Add entries
in
questions
47a
PAST
12
MONTHS?
erson
–
and
Report
even
small
amounts
credited
TOTAL AMOUNT for past
of the Armed Forces.
f. Any public assistance
or welfare
payments
,
to an
an account.
account.
to 47h; subtract any losses.
If net income was a loss,
E box.
to
12
months
of
business or industry was this?
47
INCOME
IN
THE
PAST
12
MONTHS
from
the
state
or
local
welfare
office.
No
?
the
amount
and
mark
(X)
"Loss"
box next to
? activity atorthe
business,
other
employer
e
location
where employed.
with
the
questions
for Person
2 on the
TOTAL
AMOUNT
forthe
past
➜ Continueenter
Source:
.00
Yes ➔ $
the dollar amount.12 months
e:
hospital,
publishing,
mail ACS-1(2009)KFI
ployee
of a newspaper
PRIVATE FOR-PROFIT
e?
next page. If only 1 person
is listed on page 2,
Mark➔(X)$
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e?
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manufacturing,
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➔
any or business, or of an individual, for
$ instructions.
.00
,, your best estimate of the
SKIP to page 28Yes
for ➔
mailing
No
personor
received,
and give
businesses
farm businesses,
including
Loss
,
TOTAL
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past
, salary, or commissions?
No
TOTAL AMOUNT
during
the
PAST
12for
MONTHS.
No
None
OR $ total income during the .00
Loss 48 What was this
proprietorships
and
partnerships.
Report
No
person’s
TOTAL
AMOUNT
for
past
Loss
12
months
, AMOUNT
, for past
TOTAL
AMOUNT
for past
(NOTE:after
The
"past 12
12 months"
ure,
construction,
service,
TOTAL
business
expenses.is the period from PAST 12 MONTHS? Add entries
ployee
of a PRIVATE
NOT-FOR-PROFIT, NET income
ure,
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in questions
47a
12 months
months
c.)?
today’s date one year
ago up through today.)
12
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11 Loss
c.)? ororindustry
empt,
charitable
organization?
to 47h; subtract any losses. IfTOTAL
net income
was afor
loss,
AMOUNT
past
ess
was
this?
c.
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net
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enter the amount and mark (X) the "Loss"
box next to
12 months
at the location where employed.
Mark
"No" box
show types
income
.00of
Yes
➔(X)$the
dollar amount.
GOVERNMENT
employeemail
royalty
income,
orto
income
from
estates
Continue
with the
for
2
➜
al,
newspaper publishing,
Continue
the questions
questions
for Person
Person
2 on
on the
the
➜ the
g.with
Retirement,
survivor,
or on
disability
pensions.
,
NOT
received.
nly
– manufacturing,
Mark
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ounty,
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and
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small amounts creditednext
If
1
person
is
gine
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next page.
page.Do
If only
only
1include
person
is listed
listed
on page
page 2,
2,
NOT
Social
Security.
No
Loss
to an account.
SKIP
to
page
28
for
mailing
instructions.
Page 11, Base (Black)
ACS-1(2009)KFI,
Page
11,
Green
Pantone
354
(10,
20,
40
and
50%)
TOTAL
AMOUNT
for the
past"Loss" box to SKIPNone
to page
$ for mailing instructions. .00
GOVERNMENT employee?
If net income
was12
a loss,
mark
OR 28
acturing?
months
,
,
the right of the dollar amount.
.00
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ral GOVERNMENT
employee?
Loss
sale
trade?
.00
Yes ➔ $
TOTAL
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for ,past
11
,
11
For
income
received
jointly,
report
the
appropriate
c.
Interest,
dividends,
net
rental
income,
No
EMPLOYED
in own NOT INCORPORATED
rade?
12 months
TOTAL
AMOUNT
past to
share
forNo
each
person
–from
or,AMOUNT
if estates
that’s
not
royalty
income,
or income
Loss
Income
measure
of TOTAL
general
economic
Income
data
are for
used
ess, professional practice,
or farm? is a vital
for possible,
past circumstances.
12 months
kagriculture,
(X) ONE box.
construction, service,
report Report
the whole
for
only
one
person
and
and trusts.
evenamount
small amounts
credited
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determine poverty
to for
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nment, etc.)?in own INCORPORATED
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the other person.
EMPLOYED
to an account.
11,
(Black)
ACS-1(2009)KFI, Page
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(10,
40 and
50%)
? Page
Page
11, Base
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(Black)
Page
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Pantoneh.354
354
(10, 20,
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50%)
ess,
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or farm?
assistance.
TheseACS-1(2009)KFI,
data are included
in 11,
federal
allocation
formulas
for40many
government
Any other
sources
of
income
received
Continue
with
the
questions
for
Person
2 on the
➜
a.
Wages,
salary,
commissions,
bonuses,
regularly
such
as
Veterans’
(VA)
payments,
e? WITHOUT PAY in family
$
.00
Yes
➔
ng
business
programs.
next
page.
If
only
1
person
is
listed
on page
2,
or tips from all jobs.
unemployment compensation, child
support
, Report amount before
m?
SKIP
to page 28
mailing
items.
or alimony.
Dofor
NOT
includeinstructions.
lump sum payments
No deductions for taxes, bonds, dues, or other
Loss
TOTAL AMOUNT for past
such as money from an inheritance or the sale of a
ure,
service,
did construction,
this person work?
12 months
home.
c.)?
.00
Yes ➔ $
11
ctive duty in
,
Forces, mark (X) this box ➔
No
Continue with the
questions
for
Person
2
on
the
➜
$
.00
Yes ➔
TOTAL AMOUNT for past
e branch of the Armed Forces.
, page 2,
next page. If only 1 person is listed on
12 months
SKIP to page 28No
mailing instructions.
mpany,
business,
or
other
employer
09)KFI, Page 11, Base (Black)
ACS-1(2009)KFI, Page 11, Green Pantonefor
354
(10,
20,AMOUNT
40 andfor50%)
TOTAL
past
12 months
b. Self-employment income from own nonfarm
businesses or farm businesses, including
11
proprietorships and partnerships. Report
48 What was this person’s total income during the
NET income after business expenses.
PAST 12 MONTHS? Add entries in questions 47a

(continued)

American Community Survey

on 1 (continued)

(continued)

on 1 (continued)

|-¤

.4|-¤

|-¤

MEETING FEDERAL NEEDS

American Community Survey
Population: Questions on Income

COMMUNITY BENEFITS
Social Services

Housing

Under the Older Americans Act, funds for
food, health care, and legal services are
distributed to local agencies based on data
about elderly people with low incomes.

Under the Low-Income Home Energy
Assistance Program, income data are used
to allocate funds to areas for home energy
aid.

Data about income at the state and county
levels are used to allocate funds for food,
health care, and classes in meal planning
to low-income women with children.

Under the Community Development
Block Grant Program, funding for
housing assistance and other community
development is based on income and other
decennial census data.

Employment
Income data are used to identify local areas
eligible for grants to stimulate economic
recovery, run job-training programs, and
define areas such as empowerment or
enterprise zones.

Education
Data about poor children are used to
allocate funds to counties and school
districts. These funds provide resources
and services to improve the education of
economically disadvantaged children.

www.census.gov

File Type	application/pdf
File Title	American Community Survey--Administrative Questions for use in the ACS
Subject	Population
Author	Bureau of the Census
File Modified	2010-09-01
File Created	2010-01-26