2016 Census Test - Focus Group Selection Contacts

2016 Census Test

Focus Group Contact information worksheet

2016 Census Test - Focus Group Selection Contacts

OMB: 0607-0989

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Focus Group Worksheet

2015 Census Test



This information will not be used to contact you. Your response is voluntary and will only be used for research purposes.



  1. What is your name?



_____________________ _____________________

First Last





  1. What is your address?



Street number and name: ____________________________________________



Apartment or unit number: ___________________________________________



City: ____________________________________________



State: _____________________



ZIP Code: _________________





  1. How many people are living or staying at this address?



________





  1. Please provide a phone number where you can be reached.

( ________ ) - ________ - ___________



  1. Please provide an email address where you can be reached.



_______________________________________ @ __________________ . _________

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJessica L Holzberg
File Modified0000-00-00
File Created2021-01-24

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