Attachment D - Survey Questionnaire

Attachment D: 2018 COFA Questionnaire
OMB No. 0607-XXXX: Approval expires mm/dd/year
Form COFA-I (2018)

2018 Survey of Compact of Free Association (COFA) Migrants

INTRODUCTION
S1.

Hello, my name is (Your name) and I'm an official working with the U.S. Census Bureau on the 2018 Survey of
Compact of Free Association (COFA) Migrants. (Show ID card.)

S2.
For the average household, this interview should take about 20 minutes. This letter from the Director of the U.S.
Census Bureau and Frequently Asked Questions (hand respondent the letter and FAQs) explain the purpose of the
survey and that your answers are kept confidential. Do you live in this (house/apartment/mobile home)?
Yes _____
No _____
What is your name?
_______________________________________________________________________
S3.
In case we need to contact you about this survey, what is your telephone number and the best time to call?
(__ __ __) __ __ __ - __ __ __ __
Day ____ Evening ____
Either ____
S4.

How many people are living or staying in this (house/apartment/mobile home) at this address?
INCLUDE everyone living or staying here for more than 2 months. INCLUDE anyone 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.
Number of people ___ ___

We estimate that completing the 2018 Survey of Compact of Free Association (COFA) Migrants will take 20 minutes on
average. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to U.S. Department of Commerce, U.S. Census Bureau, 4600 Silver Hill Road, 8H590,
Washington, DC 20233. You may email comments to [email protected]; use "COFA Paperwork Project 0607XXXX" as the subject. This collection has been approved by the Office of Management and Budget (OMB). The eight-digit
OMB approval number that appears at the upper left of the form confirms this approval. If this number were not displayed
we could not conduct this survey.

Relationship to Person 1

Sex

0=Person 1 1=Husband or wife
3=Biological son or daughter
4=Adopted son or daughter
5=Stepson or stepdaughter
6=Brother or sister 7=Father or
mother 8=Grandchild 9=Parentin-law 10=Son-in-law or
daughter-in-law 11=Other
relative 12=Roomer or boarder
13=Housemate or roommate
14=Unmarried partner
15=Foster child 16=Other
0=Male
nonrelative
1=Female
Person 1 -- Last Name
First Name

MI

Person 2 -- Last Name
First Name

MI

Person 3 -- Last Name
First Name

MI

Person 4 -- Last Name
First Name
Person 5 -- Last Name

MI

Age

(in years) 0 if
less than 1 year
old month

Date of birth

day

year

Place of birth

When came to this
Area to stay
Marital status

name of island, village, U.S. state,
commonwealth, territory, or foreign
country

Year If person
entered Area more
than once, what is the
latest year?

1=now married
2=widowed
3=divorced
4=separated 5=never
married

First Name

MI

Person 6 -- Last Name
First Name

MI

Person 7 -- Last Name
First Name

MI

Person 8 -- Last Name
First Name

MI

Person 9 -- Last Name
First Name

MI

Person 10 -- Last Name
First Name

MI

Person 11 -- Last Name
First Name

MI

Person 12 -- Last Name
First Name

MI