Attachment C - 2017 New York City Housing and Vacancy Survey Flashcard, Form H-100A

3-14-2016 2pm
H-100A

(XX-XX-XXXX)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

V

VI

FLASHCARD
NEW YORK CITY HOUSING AND
VACANCY SURVEY – 2017

What is the main reason for not seeking work?

How much school have you completed?

01.

Believes no work available in line of work or area

01.

No school completed

02.

Could not find any work

02.

Up to 6th grade

03.

Lacks necessary schooling, training, skills,
or experience

03.

7th or 8th grade

04.
04.

Employers think too young or too old

9th, 10th, 11th, or 12th
grade, but no H.S. diploma

05.

Other personal handicap in finding a job

05.

H.S. diploma

06.

Can’t arrange child care

06.

Some college, but no degree

07.

Family responsibilities

07.

Associate degree

A.

Husband/wife

08.

In school or other training

08.

College graduate

B.

Son/daughter (own, adopted, step)

09.

Ill health, physical disability

09.

Some graduate/professional training

C.

Brother/sister (stepbrother/sister)

D.

Father/mother

10.

Retired

10.

Graduate/professional degree

E.

Father-in-law/mother-in-law

11.

Other

F.

Grandchild

G.
Don’t know

Grandparent

12.

H.

Other relative (cousin, nephew, etc.)

H-100A (XX-XX-XXXX)

I
RELATIONSHIPS
Pick the category that best describes each
household member’s relationship to the person
(adult) listed on line 1.

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I.

Roomer/boarder/foster child

J.

Unmarried partner

K.

Housemate/roommate

L.

Other non-relative

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3-14-2016 2pm

II

IV

III

Indicate the race(s) of each household member.
Select one or more categories.
1. White

Where was the most recent place...(reference
person) lived for six months or more before moving
into this apartment (house)?
IN NEW YORK CITY, SAME BUILDING

2. Black or African American

01.
02.

3. American Indian or Alaska Native

Always lived in this unit
Another unit in same building

IN NEW YORK CITY, OTHER BUILDING

ASIAN

03.
04.
05.
06.
07.

4. Chinese
5. Filipino
6. Korean
7. Vietnamese

Bronx
Brooklyn
Manhattan
Queens
Staten Island

NATIVE HAWAIIAN OR
OTHER PACIFIC ISLANDER
10. Native Hawaiian
11. Other Pacific Islander

16.

Armenia, Azerbaijan, Belarus, Estonia, Georgia,
Kazakhstan, Kyrgyzstan, Latvia, Lithuania,
Moldova, Russia, Tajikistan, Turkmenistan,
Ukraine, or Uzbekistan

17. Other European countries
18. China, Hong Kong, Taiwan
19. Korea
20. India
21. Pakistan, Bangladesh
22. Philippines
23. Southeast Asia (Cambodia, Laos, Malaysia,
Myanmar (Burma), Singapore, Thailand,
Vietnam)
24. Other Asia
25. Africa
26. All other countries (Specify)

H-100A (XX-XX-XXXX)

H-100A (XX-XX-XXXX)

3-14-2016 2pm

Bronx

04.

Brooklyn

05.
06.

Manhattan
Queens

07.

Staten Island

08.

NY, NJ, Connecticut

09.
10.

Other State
Puerto Rico

11.

Dominican Republic

13.
14.

08. NY, NJ, Connecticut
09. Other State
10. Puerto Rico
11. Dominican Republic
12. Caribbean (other than Puerto Rico or Dominican
Republic)
13. Mexico
14. Central America, South America
15. Canada

9. Other Asian

03.

12. Caribbean (other than Puerto Rico or
Dominican Republic)

OUTSIDE OF NEW YORK CITY

8. Asian Indian, Pakistani, Bangladeshi

Place of birth. Where was...born?

Mexico
Central America, South America

15. Canada
16. Armenia, Azerbaijan, Belarus, Estonia, Georgia,
Kazakhstan, Kyrgyzstan, Latvia, Lithuania,
Moldova, Russia, Tajikistan, Turkmenistan,
Ukraine, or Uzbekistan
17.

Other European countries

18.
19.
20.

China, Hong Kong, Taiwan
Korea

21.

Pakistan, Bangladesh

22.

Philippines

23.

Southeast Asia (Cambodia, Laos, Malaysia,
Myanmar (Burma), Singapore, Thailand,
Vietnam)

24.
25.
26.

Other Asia
Africa
All other countries (Specify)

India

H-100A (XX-XX-XXXX)