2016 Census Test - Self and Enumerator Response

Screen Name	CONFIRM
Help Text link	CONFIRM
Help Text	We need to make sure that you are completing this survey for the correct address. The address in this question should match the one to which we mailed your survey invitation letter. If this address is not the same, please answer “no” to this question.

Screen Name

NONID LOGIN

Help Text link

NONIDLOGIN

Help Text

We ask you to check the “I’m not a robot box” and enter the text that appears, if applicable, to ensure you are a human visitor and to prevent automated spam entries. If you cannot read the text, click the circle with an arrow to see a new word.

Your email address is a unique identifier, assigned to you, that lets you enter the survey. A valid email address uses the form: [email protected].

TQA Login Screens

Screen Name	TQA CONFIRM
Help Text link	CONFIRM
Help Text	We need to make sure that you are completing this survey for the correct address. The address in this question should match the one to which we mailed your survey invitation letter. If this address is not the same, please answer “no” to this question.

Screen Name

TQA NONID LOGIN

Help Text link

NONIDLOGIN

Help Text

Your email address is a unique identifier, assigned to you, that lets you enter the survey. A valid email address uses the form: [email protected].

Verify Address

Screen Name	VERIFY ADDRESS
Help Text link	VERIFY ADDRESS
Help Text	We need to count people where they live and sleep most of the time. Answer “Yes” if you <FILL1> living or staying at the address in this question on <REFDATE>. Otherwise, answer “No.”
Help Text Fills	FILLS: If current date is before REFDATE, then <FILL1>=will be If current date is on or after REFDATE, then <FILL1>=were

Screen Name	ANYONE
Help Text link	ANYONE
Help Text	We need to count people where they live and sleep most of the time. Answer “Yes” if anyone <FILL1> living or staying at <ADDRESS> on <REFDATE>. Otherwise, answer “No.”
Help Text Fills	FILLS: If current date is before REFDATE then <FILL1> = will be If current date is on or after REFDATE then <FILL1> = was

Screen Name

VACANCY

Help Text link

VACANCY

Help Text

We ask questions about whether a home is owned or rented to understand local housing markets. These statistics are used to analyze whether communities are affordable for residents, where new development could thrive, how to combat vacant and abandoned properties, and a number of other issues.

Select “For rent,” if the unit is for rent only or for either rent OR for sale.

Select “Rented, not occupied,” if the unit is paid or agreed upon, BUT the renter has not yet moved in.

Select “For sale only,” if the unit is for sale only; that is, the owner/landlord will not consider renting the unit. Include units in cooperatives if the individual units are offered “For sale only” OR if the unit is in condominium projects AND the individual units are offered “For sale only.”

Select “Sold, not occupied,” if the unit is recently sold, BUT the new owner has not yet moved in.

Select “For seasonal, recreational, or occasional use,” if the unit is used OR intended for use in certain seasons or for weekend or other occasional use throughout the year, including:

Units used for summer or winter sports or recreation, such as beach cottages and hunting cabins
Quarters for such workers as herders and loggers

If unit is an interval ownership unit, sometimes called shared ownership or time-sharing condominiums.

Select “For migrant workers” if intended for occupancy by migrant workers employed in farm work during crop season.

Select “Other ,” if the unit is

Held for the settlement of an estate
Held off market for personal reasons, such as:
The owner has not yet decided whether or not the unit will be torn down
The owner is remodeling or repairing the unit AND will not make it available for rent or sale until the work is completed
Held for the occupancy of a caretaker or janitor
Temporarily used for storage of excess house furniture
Has renters who moved during the month although rent has been paid to the end of the month.

NonID Address

Screen Name	RESIDENCE
Help Text link	RESIDENCE
Help Text	Please type in the street address of the place where you <FILL1> on <REFDATE>. If you have more than one address associated with your residence, please provide the street address if available. For example, if you normally use a P.O. Box or Rural Route address for mailing purposes, please enter a physical street address, such as what you would give to a shipping company to have a package delivered to your home. In addition, some P.O. Boxes look like street addresses, but are actually the addresses for private mailboxes at a business or the Post Office. We only want the street address of where you lived or stayed on <REFDATE>. For Street Addresses, such as 5007 N Maple Ave, you can enter your address into the address fields. Address Number is the numeric or alphanumeric identifier from your street address, for example 5007 or 5007-A. Street Name is the name of your street, for example N Maple Ave. Apt/Unit refers to any unit information that is part of your address, such as an apartment number, unit number, or lot. You will need to enter both the unit type and number. For example, enter “Apt A” or “Lot 3” or “Unit 2-H” or “Room 12”. If you share the same address with other living quarters, such as a basement or garage apartment, or even a separate structure on the same lot (e.g., a trailer behind the main house), please provide this in the Apt/Unit. If you normally use a Rural Route address for mailing purposes, you will need to select the Rural Route address by clicking the button to the left of the Rural Route label then enter your address into the fields. In a subsequent screen you will be able to enter a physical street address, such as what you would give to a shipping company to have a package delivered to your home. Use the drop-down menu to select the Rural Route Descriptor, such as RR – Rural Route HC – Contract Delivery Service Route (formerly Highway Contract Route) SR – Star Route PSC – Postal Service Center RTE – Route Provide the number of the Rural Route Provide the number of the Box Provide a city, state, and ZIP Code If you normally use a P.O. Box address for mailing purposes, you will need to select the P.O. Box address type (by clicking the button to the left of the P.O. Box label) and enter your address into the P.O. Box address fields. In a subsequent screen you will be able to enter a physical street address, such as what you would give to a shipping company to have a package delivered to your home. Provide the number of the Box Provide a city, state, and ZIP Code
	FILLS: If the current date is before REFDATE then FILL1 = will be living If the current data is on or after REFDATE then FILL1 = were living

Screen Name

ADDRESS STANDARDIZATION

Help Text link

ADDRESS STANDARDIZATION

Help Text

Click “Yes” if the address shown correctly reflects the street address information you provided.

Otherwise, click “No.” On the next screen, you will be able to make changes to your address.

Screen Name

RESIDENCE_PHYS

Help Text link

RESIDENCE_PHYS

Help Text

If you normally use a Rural Route or P.O. Box address for mailing purposes, please enter a physical street address, such as what you would give to a shipping company to have a package delivered to your home.

Screen Name	WEBMAP INTERFACE
Help Text link	WEBMAP
Help Text	<FILL1> How to Use the Map: The map will automatically zoom to an appropriate scale. To enlarge or shrink the map, click the “+” or “-“sign at the top left corner of the map. To move or pan around the map, click the left mouse button and drag the mouse to a desired location. To highlight an area, click once with the left mouse button. To highlight a different block, simply click on the new block. To turn satellite imagery on or off, click on the Imagery button. To undo all selections, zooming, and panning, click on the Start Over button.
Help Text Fills	<FILL1> (If Address Type=1 (street) and RT_MATCH_STATUS=2,3,5): If the highlighted area on the map correctly reflects the location of the address you provided, then continue to the next page. If the highlighted area on the map does not correctly reflect the location of the address you provided, then please determine and select the area on the map that correctly reflects the location of the address you provided. Once the correct location is determined, then continue to the next page. If you are unable to determine the area on the map which correctly reflects the location of the address you provided, then click the “Cannot Locate Area” checkbox. (If Address Type=1 (street) and RT_MATCH_STATUS=0,4) or Address Type =2, 3: Use the map to determine and select the area that correctly reflects the location of the address you provided. If unable to determine the area on the map which correctly reflects the location of the address you provided, mark the “Cannot Locate Area” checkbox and then continue to the next page.

Roster

Help Text link

RESPONDENT

Help Text

In the spaces provided, type in your name (first, middle, and last) and phone number.

Enter your legal name. If you use Junior or Senior, enter your last name and the suffix in the Last Name field.

In the past, the Census Bureau has mailed most households in the United States a paper census form and visited people who did not respond. In an effort to reduce the cost of the census, we are considering alternative ways of contacting people, such as email. The information you provide here will assist us in that research.

If you do not have an email address, continue to the next page.

Screen Name	POPCOUNT
Help Text link	POPCOUNT
Help Text	If INTERNET_ROSTER=1, display: Enter the number of people that live or stay at this address most of the time as of <REFDATE>. If your situation is not covered by the guidelines, look here for additional help: http://www.census.gov/population/www/cen2010/resid_rules/resid_rules.html. If INTERNET_ROSTER=2, display: Count the people who live at this address using our guidelines. We need to count people where they usually live and sleep For people with more than one place to live, we need to count them at the place where they sleep most of the time Do NOT INCLUDE these people: College students who live away from <ADDRESS> most of the year Armed forces personnel who live away People who, on <REFDATE>, <FILL> in a nursing home, mental hospital, jail, prison, detention center, etc. DO include these people: Babies and children living at <ADDRESS>, including foster children Roommates Boarders People staying at <ADDRESS> on <REFDATE> who have no permanent place to live
Help Text Fills	FILLS: If current date is before REFDATE, then FILL = will be If the current date is on or after REFDATE, then FILL = were

Screen Name	OTHERS, PEOPLE
Help Text link	PEOPLE
Help Text	Count the people who live at this address using our guidelines. We need to count people where they usually live and sleep For people with more than one place to live, we need to count them at the place where they sleep most of the time Do NOT INCLUDE these people: College students who live away from <ADDRESS> most of the year Armed forces personnel who live away People who, on <REFDATE>, <FILL1> in a nursing home, mental hospital, jail, prison, detention center, etc. DO include these people: Babies and children living at <ADDRESS>, including foster children Roommates Boarders People staying at <ADDRESS> on <REFDATE> who have no permanent place to live If your situation is not covered by the guidelines above, look here for additional help: http://www.census.gov/population/www/cen2010/resid_rules/resid_rules.html. In the spaces provided, type in the name (first, middle, and last) of every person who <FILL1> living or staying at the address in this question on <REFDATE>. Enter the person’s legal name. If the person uses Junior or Senior, enter the last name and the suffix in the Last Name field. If you have more people to report than the number of spaces provided, click on the link directly below the last space to add more names.
Help Text Fills	FILLS: If the current date is before REFDATE, then <FILL1> = will be If the current date is on or after REFDATE, then <FILL1> = were

Undercount Screens

Screen Name

ADD_PPL

Help Text link

ADD_PPL

Help Text

The purpose of this question is to collect the name(s) of people living or staying at this address who you have NOT already listed in the previous screen.

Answer “Yes” if someone should be added. You will be asked to provide the name of the person(s) who should be added. You will be able to add more than one person.

Babies include newborn babies, babies still at the hospital, and young children.

Other relatives include adult children, cousins, in-laws, etc.

People not related to you include roommates, boarders, live-in babysitters, etc.

After adding all of the people, continue to the next page.

Screen Name	ADD_NOPERM
Help Text link	ADD_NOPERM
Help Text	The purpose of this question is to collect the name(s) of people living at this address who you have NOT already listed in the previous screens. Answer “Yes” to this question if someone NOT already listed is staying at this address and <FILL2> no other permanent place to stay on <REFDATE>. You will be asked to provide the name of the person who should be added. You will be able to add more than one person. After adding all the people, continue to the next page.
Help Text Fills	FILLS: If the current date is before REFDATE then <FILL2>=has If the current date is on or after REFDATE then <FILL2>=had

Screen Name

UC2

Help Text link

UC2

Help Text

The purpose of this question is to collect the name(s) of people living or staying at this address who you have NOT already listed in the previous screen.

Answer “Yes” if someone should be added. You will be asked to provide the name of the person(s) who should be added. You will be able to add more than one person.

Babies include newborn babies, babies still at the hospital, and young children.

Other relatives include adult children, cousins, in-laws, etc.

People not related to you include roommates, boarders, live-in babysitters, etc.

After adding all of the people, continue to the next page.

Tenure

Screen Name

HOME

Help Text link

HOME

Help Text

Owned by you or someone in this household with a mortgage or loan

Select this response option to describe any house, apartment, or mobile home that has any type of loan secured by real estate. These liens may be called mortgages, deeds of trust, trust deeds, or contracts to purchase. Owner-occupied units with reverse mortgages and home equity loans are considered to be “owned with a mortgage or loan” as are owner-occupied mobile homes with installment loans.

Owned by you or someone in this household free and clear (without a mortgage or loan)

Select this response option to describe owner-occupied properties without any loans secured by real estate.

Rented

Select this response option to describe units where money rent is paid or contracted.

'Continuing care,' sometimes called life care, is a contract between an individual and housing services provider. The contract requires that shelter, usually a house or apartment, and services such as meals or transportation to shopping or recreation, be provided. For these kinds of living arrangements, mark the 'Rented' box.

Occupied without payment of rent

Select this response option if the house or apartment is not owned or being bought by a member of the household and if money rent is not paid or contracted. (For example, a house or apartment that is provided free to a janitor, caretaker, or superintendent in exchange for services.)

Screen Name

OWNER

Help Text link

OWNER

Help Text

If HOME = (1,2), display:

Please select the person who owns the residence at the address in this question.

If more than one person owns this residence you may select multiple people.
If none of the people on the list own this residence, please select the “None of the above” response option.

If HOME=3, display:

Please select the person who pays the rent for the residence at the address in this question.

If more than one person pays the rent for this place, you may select multiple people.
If none of the people on the list pay rent for this residence, please select the “None of the above” response option.

Demographics

Screen Name	RELATIONSHIP
Help Text link	RELATIONSHIP
Help Text	Other relative Related by birth, marriage, or adoption, but NOT one of the options listed- for example, a niece or nephew. If a foster child is related to the householder, include in the appropriate relative category, such as grandchild, or include in the “Other relative” category.
Help Text Fills	Other relative Related by birth, marriage, or adoption, but NOT one of the options listed- for example, a niece or nephew. If a foster child is related to the householder, include in the appropriate relative category, such as grandchild, or include in the “Other relative” category. If INTERNET_RELATION=1, display: Roomer or boarder Occupies room(s) AND makes cash or non-cash payment(s) If INTERNET_RELATION=2 or 3, display: (blank) If INTERNET_RELATION=1 or 2, display: Housemate or roommate 15 years old or over, who is not related to the householder, and shares living quarters primarily in order to share expenses. If INTERNET_RELATION=3, display: (blank) Unmarried partner Is in in intimate relationship with the householder, such as a boyfriend or girlfriend. Other nonrelative Not related AND not one of the options listed.

Screen Name	SEX
Help Text link	SEX
Help Text	Select the box that indicates the person’s biological sex.

Screen Name

DOB

Help Text link

DOB

Help Text

This question consists of two parts: the first part asks for the date of birth, and the second part asks for the age of the person.

If you know the date of birth, enter it. The person’s age will be automatically calculated.
If you do not know the exact date of birth, enter as much as you know.
If you do not know the date of birth at all, leave it blank and fill in the person’s age. If you don’t know the age, please estimate.

Date of Birth

Select the month, day, and year of birth. If you do not know part of the date of birth (month, day, or year) please leave that part blank and enter or confirm the age in the age box.

Age

Enter the person’s age as of <REFDATE>. Do not round the age up if the person was close to having a birthday on <REFDATE>. If you do not know the exact age, an estimate will do. For babies who were not yet one year old on <REFDATE>, enter “0.”

Screen Name

RACE, WHITE, HISPANIC, BLACK, ASIAN, AIAN, MENA, NHOPI, SOR

Help Text link

RACE

Help Text

RACE, ETHNICITY, OR ORIGIN

In the 2016 Census Test, an individual’s response is based upon self-identification. People may choose one or more response categories to represent their identity or identities. The categories included in the questionnaire generally reflect social definitions recognized in this country, and do not attempt to define groups biologically, anthropologically, or genetically.

The major categories, detailed checkboxes, and examples are listed in order of population size, from largest to smallest. Detailed groups are employed as examples to represent the different geographic regions in each of the major categories.

The following descriptions define each of the categories:

White

The category “White” includes all individuals who identify with one or more nationalities or ethnic groups originating in Europe. Examples of these groups include, but are not limited to, German, Irish, English, Italian, Polish, and French. The category also includes groups such as Scottish, Norwegian, Dutch, Slavic, Cajun, Roma, etc. Individuals should report the person’s White group or groups in the space provided.

Hispanic, Latino, or Spanish

The category “Hispanic, Latino, or Spanish” includes all individuals who identify with one or more nationalities or ethnic groups originating in Mexico, Puerto Rico, Cuba, Central and South American, and other Spanish cultures. Examples of these groups include, but are not limited to, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, and Colombian. The category also includes groups such as Guatemalan, Honduran, Spaniard, Ecuadorian, Peruvian, Venezuelan, etc. Individuals should report the person’s Hispanic, Latino, or Spanish group or groups in the space provided.

Black or African American

The category “Black or African American” includes all individuals who identify with one or more nationalities or ethnic groups originating in any of the black racial groups of Africa. Examples of these groups include, but are not limited to, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali. The category also includes groups such as Ghanaian, South African, Barbadian, Kenyan, Liberian, Bahamian, etc. Individuals should report the person’s Black or African American group or groups in the space provided.

Asian

The category “Asian” includes all individuals who identify with one or more nationalities or ethnic groups originating in the Far East, Southeast Asia, or the Indian subcontinent. Examples of these groups include, but are not limited to, Chinese, Filipino, Asian Indian, Vietnamese, Korean, and Japanese. The category also includes groups such as Pakistani, Cambodian, Hmong, Thai, Bengali, Mien, etc. Individuals should report the person’s Asian group or groups in the space provided.

American Indian or Alaska Native

The category “American Indian or Alaska Native” includes all individuals who identify with any of the original peoples of North and South America (including Central America) and who maintain tribal affiliation or community attachment. It includes people who identify as “American Indian” or “Alaska Native” and includes groups such as Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. Individuals should report the person’s American Indian or Alaska Native tribe or tribes in the space provided.

Middle Eastern or North African

The category “Middle Eastern or North African” includes all individuals who identify with one or more nationalities or ethnic groups originating in the Middle East or North Africa. Examples of these groups include, but are not limited to, Lebanese, Iranian, Egyptian, Syrian, Moroccan, and Algerian. The category also includes groups such as Israeli, Iraqi, Tunisian, Chaldean, Assyrian, Kurdish, etc. Individuals should report the person’s Middle Eastern or North African group or groups in the space provided.

Native Hawaiian or Other Pacific Islander

The category “Native Hawaiian or Other Pacific Islander” includes all individuals who identify with one or more nationalities or ethnic groups originating in Hawaii, Guam, Samoa, or other Pacific Islands. Examples of these groups include, but are not limited to, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese. The category also includes groups such as Palauan, Tahitian, Chuukese, Pohnpeian, Saipanese, Yapese, etc. Individuals should report the person’s Native Hawaiian or Other Pacific Islander group or groups in the space provided.

Some other race, ethnicity, or origin

‘Some other race, ethnicity, or origin’ includes all other responses not included in the categories above.

Screen Name

OC

Help Text link

Help Text

Answer “Yes” if this person sometimes lives or stays at a different address than <ADDRESS> for any reason.

Stays with a parent, grandparent, or other person could occur for children under the age of 18 who stay at multiple addresses to be with another parent, grandparent, or another guardian. It could also occur for an adult who stays with a parent or grandparent to help take care of them, for example.

Stays at a different address while attending college includes dorm rooms, sorority and fraternity houses, off campus apartments, etc.

People who stay at a different address for a job or military purposes include military members staying away in barracks, on ships, or in on-base or off-base housing. Other examples include someone who stays in another place during the week to be closer to a job but comes home on the weekends.

Stays at a nursing home or group home. include skilled nursing facilities and residential treatment centers, as well as a mental health institution or psychiatric unit (hospital) for long-term non-acute care.

Select “Yes, in a jail or prison” if this person has been in a correctional facility recently. Include federal, state and local jails and prisons for adults or juveniles.

People who stay at a second home includes people who leave their northern homes and spend the winter living at a different address farther south.

If this person stays at a different address for any reason not covered in the other options, enter the reason why he or she stays at the other place.

Screen Name

FULLSTAY_REL, FULLSTAY_COLLEGE, FULLSTAY_MIL, FULLSTAY_NURSE, FULLSTAY_JAIL, FULLSTAY_SEASON, FULLSTAY_OTHER

Help Text link

FULLSTAY

Help Text

Please select the address of the place where <NAME#> sometimes lives or stays. If the place is not already listed, type in the street address of the place where <NAME#> sometimes lives or stays around <REFDATE>?

If <NAME#> has more than one address associated with this residence, please provide the street address if available. For example, if you normally use a P.O. Box or Rural Route address for mailing purposes, please enter a physical street address such as what you would give to a shipping company to have a package delivered to your home.

For Street Addresses, such as 5007 N Maple Ave, you can enter your address into the address fields.

Address Number is the numeric identifier from your street address, for example 5007.

Street Name is the name of your street, for example N Maple Ave.

Apt/Unit refers to any unit information that is part of your address, such as an apartment number, unit number, or lot. You will need to enter both the unit type and number. For example, enter “Apt A” or “Lot 3” or “Unit 2-H” or “Room 12”.

If you share the same address with other living quarters, such as a basement or garage apartment, or even a separate structure on the same lot (e.g., a trailer behind the main house), please provide this in the Apt/Unit.

For Rural Route addresses, you will need to select the Rural Route address by clicking the button to the left of the Rural Route label then enter your address into the fields.

Use the drop-down menu to select the Rural Route Descriptor, such as
- RR – Rural Route
- HC – Contract Delivery Service Route (formerly Highway Contract Route)
- SR – Star Route
- PSC – Postal Service Center
- RTE – Route
Provide the number of the Rural Route
Provide the number of the Box
Provide a city, state, and ZIP code

If you use a P.O. Box address instead of a street address, you will need to select the P.O. Box address type (by clicking the button to the left of the P.O. Box label) and enter your address into the P.O. Box address fields.

Provide the number of the Box
Provide a city, state, and ZIP code

Screen Name

MOST

Help Text link

MOST

Help Text

Choose the option that best describes where this person is living and sleeping MOST OF THE TIME around <REFDATE>.

Here are some examples of what we mean by MOST OF THE TIME:

If, around the time of <REFDATE>, a person lives at one residence for part of each week and at another residence for the other part of each week, then that person is on a “weekly cycle,” and you should select the residence where that person stays most of the time during each week (e.g., commuter workers).

The same concept would apply to someone who is on a “monthly cycle” (e.g., children in shared custody) or a “yearly cycle” (e.g., people with a seasonal residence). You should select the residence where that person stays most of the time during each cycle (e.g., most of each month, or most of each year).

If the person stays equal amounts of time at each place during each cycle, then you should select “Equal time at all places.”

Screen Name	WHERE
Help Text link	WHERE
Help Text	Choose the option that best describes where <NAME#> <FILL1> on <REFDATE>.
Help Text Fills	FILLS: If the current date is before Census Day, <FILL1> = will be staying If the current date is on or after Census Day, <FILL1> = was staying

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Gianna S Dusch
File Modified	0000-00-00
File Created	2021-01-24