The American Community Survey

Attachment R

Sheet ____ of ____ Sheets

FORM ACS-290(GQ) (7-14-2011)

U.S. DEPARTMENT OF COMMERCE (1) GQ Name
Economics and Statistics Administration

U.S. Census Bureau

(2) Sample Date

GROUP QUARTERS LISTING SHEET

(3) FR Code/Initial

(4) Interview Date
Month/Day/Year

(5) GQ Control Number

AMERICAN COMMUNITY SURVEY (ACS)
(6) Total Number of Current Residents (Current Pop)

Line
No.
(7)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
(10) Footnotes

Sample Resident Name and
Location Description
(8)

Telephone Number/Remarks
(9)