THIS LISTING CONTAINS CONFIDENTIAL INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C., OMB NO. APPROVAL EXPIRES | |||||||||||||||
D-352.1GQ (GQE) | U.S. Department of Commerce | ||||||||||||||
Economic and Statistics Administration | |||||||||||||||
U.S. Census Bureau | |||||||||||||||
GROUP QUARTERS ENUMERATION RECORD | |||||||||||||||
GROUP QUARTERS ENUMERATION | |||||||||||||||
2018 CENSUS Test | |||||||||||||||
RCC: | |||||||||||||||
ACO: | |||||||||||||||
GQ ID: | |||||||||||||||
||| BARCODE Number ||| | |||||||||||||||
GQ Name: | ##### ### #### ## | ||||||||||||||
Facility Name: | Items 1-28 and notes should be prepopulated | ||||||||||||||
1. State: | 2. County: | 3. BCU No: | 4. Map Spot No: | 5. GQ Type Code: | |||||||||||
6a. Street Number: | 6b. Street Name: | 6c. Apt/Unit: | |||||||||||||
7. Rural Route or P.O. Box Number: | |||||||||||||||
8. City: | 9. Zip Code: | ||||||||||||||
10. Building Name: | 11. Building Number: | ||||||||||||||
12. Location Description: | |||||||||||||||
13. GQ Contact Name: | 14. GQ Contact Title: | ||||||||||||||
15. GQ Contact Telephone Number: | 16. Business Email: | ||||||||||||||
17. Secondary Contact Name: | 18. Secondary Contact Title: | ||||||||||||||
19. Secondary Contact Telephone Number: | 20. Max Pop: | ||||||||||||||
21. Will this facility be operating on April 1, 2018? q Yes q No SEE NOTES SECTION | |||||||||||||||
22. Expected Pop: | 23. Are clients males only, females only, or both? | q Males q Females q Both | |||||||||||||
24. How will this facility be enumerated? *Only show the enumeration type selected in Advanced Contact* | |||||||||||||||
Enumeration Types consist of: | |||||||||||||||
In-Person Interview Drop off/Pick up Questionnaire Paper Response Data Transfer | |||||||||||||||
Facility Self Enumeration (CORRECTIONAL FACILITIES & HOSPITALS ONLY) Electronic Response Data Transfer (eResponse) | |||||||||||||||
25. Are there any people at this location that do not speak or understand English? q Yes q No | |||||||||||||||
If yes - What language do they speak? | |||||||||||||||
26. Enumeration appointment (Date & Time): | |||||||||||||||
27. Any specific instructions Census staff need to know in order to count the people at this location? | |||||||||||||||
qYes q No SEE NOTES SECTION | |||||||||||||||
28. Do you have a roster available for our use during enumeration? q Yes q No | |||||||||||||||
29. Can you or a staff member assist with the enumeration? | q Yes q No | ||||||||||||||
30. Staff member name and telephone number: | |||||||||||||||
Name ______________________________________________ Telephone ________________________________ | |||||||||||||||
NOTES SECTION | |||||||||||||||
31. (Lead) Enumerator Name & ID: | 32. Date Assigned (mm/dd/yy): | ||||||||||||||
33. Date Enumeration Completed/Pick-up Date (mm/dd/yy): | 34. # of ICQs (Census Day pop): | ||||||||||||||
35. I certify that I have completed enumeration (Enumerator Signature): | |||||||||||||||
36. For Supervisory Use Only: | |||||||||||||||
q N q R q D-1 q D-2 Survivor ID# ___________ q V q O | |||||||||||||||
Office Use Only: q Rework | |||||||||||||||
#### | THIS IS THE CONTROL NUMBER FOR THIS GROUP QUARTERS. | #### | |||||||||||||
YOUR MATERIALS FOR ENUMERATION INCLUDE LABELS | |||||||||||||||
PRINTED WITH THIS NUMBER. | |||||||||||||||
THIS LISTING CONTAINS CONFIDENTIAL INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C., OMB NO. 0607-0919-C APPROVAL EXPIRES MM/DD/YYYY | ||||||||||||||||
D-352.1MFV (SBE) | U.S. Department of Commerce | |||||||||||||||
(MM/DD/YYYY) | Economic and Statistics Administration | |||||||||||||||
U.S. Census Bureau | ||||||||||||||||
REGULARLY SCHEDULED MOBILE FOOD VAN ENUMERATION RECORD | ||||||||||||||||
GROUP QUARTERS ENUMERATION | ||||||||||||||||
2018 CENSUS Test | ||||||||||||||||
RCC: | ||||||||||||||||
ACO: | ||||||||||||||||
GQ ID: | ||||||||||||||||
||| BARCODE Number ||| | ||||||||||||||||
GQ Name: | ##### ### #### ## | |||||||||||||||
Facility Name: | ||||||||||||||||
1. State: | 2. County: | 3. BCU No: | 4. Map Spot No: | 5. GQ Type Code: | ||||||||||||
6a. Street Number: | 6b. Street Name: | 6c. Apt/Unit: | ||||||||||||||
7. Rural Route or P.O. Box Number: | Items 1-26 and notes should be prepopulated | |||||||||||||||
8. City: | 9. Zip Code: | |||||||||||||||
10. Location Description: | ||||||||||||||||
11. GQ Contact Name: | 12. GQ Contact Title: | |||||||||||||||
13. GQ Contact Telephone Number: | 14. Secondary Contact Name: | |||||||||||||||
15. Secondary Contact Title: | 16. Secondary Contact Telephone Number: | |||||||||||||||
17. Business Email: | 18. Max Pop: | |||||||||||||||
19. What are the major intersections of this stop? | ||||||||||||||||
20. Arrival and departure time of this stop? | Arrival Time Departure Time | 21. Expected Pop: | ||||||||||||||
____:____ a.m. ____:____ a.m. | ||||||||||||||||
____:____ p.m. ____:____ p.m. | ||||||||||||||||
22. Do clients stay near van? q Yes q No | ||||||||||||||||
23. Method of receiving food (i.e. line up, congregate, other): SEE NOTES SECTION | ||||||||||||||||
24. Enumeration appointment date and time: | q Wednesday, March 28 | ____:____ a.m. | ____:____ p.m. | |||||||||||||
q Thursday, March 29 | ____:____ a.m. | ____:____ p.m. | ||||||||||||||
q Friday, March 30 | ____:____ a.m. | ____:____ p.m. | ||||||||||||||
25. Are there any people at this location that do not speak or understand English? q Yes q No | ||||||||||||||||
If yes - What language do they speak? | ||||||||||||||||
26. Any specific instructions Census staff need to know in order to count the people at this location? | ||||||||||||||||
qYes q No SEE NOTES SECTION | ||||||||||||||||
NOTES SECTION | ||||||||||||||||
25. (Lead) Enumerator Name & ID: | 26. Date Assigned (mm/dd/yy): | |||||||||||||||
27. I certify that I have completed enumeration (Enumerator Signature) | ||||||||||||||||
28. Date Enumeration Conducted (mm/dd/yy): | 29. # of ICQs (Census Day pop): | |||||||||||||||
30. For Supervisory Use Only: | ||||||||||||||||
q N q R q D-1 q D-2 Survivor ID# ___________ q V q O | ||||||||||||||||
#### | THIS IS THE CONTROL NUMBER FOR THIS GROUP QUARTERS. | #### | ||||||||||||||
YOUR MATERIALS FOR ENUMERATION INCLUDE LABELS | ||||||||||||||||
PRINTED WITH THIS NUMBER. | ||||||||||||||||
THIS LISTING CONTAINS CONFIDENTIAL INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C., OMB NO. 0607-0919-C APPROVAL EXPIRES MM/DD/YYYY | |||||||||||||||||
D-352.1SH (SBE) | U.S. Department of Commerce | ||||||||||||||||
(MM/DD/YYYY) | Economic and Statistics Administration | ||||||||||||||||
U.S. Census Bureau | |||||||||||||||||
SHELTER ENUMERATION RECORD | |||||||||||||||||
GROUP QUARTERS ENUMERATION | |||||||||||||||||
2018 CENSUS Test | |||||||||||||||||
RCC: | |||||||||||||||||
ACO: | |||||||||||||||||
GQ ID: | |||||||||||||||||
||| BARCODE Number ||| | |||||||||||||||||
GQ Name: | ##### ### #### ## | ||||||||||||||||
Facility Name: | |||||||||||||||||
1. State: | 2. County: | 3. BCU No: | 4. Map Spot No: | 5. GQ Type Code: | Items 1-29 and notes should be prepopulated | ||||||||||||
6a. Street Number: | 6b. Street Name: | 6c. Apt/Unit: | |||||||||||||||
7. Rural Route or P.O. Box Number: | |||||||||||||||||
8. City: | 9. Zip Code: | ||||||||||||||||
10. Building Name: | 11. Building Number: | ||||||||||||||||
12. Location Description: | |||||||||||||||||
13. GQ Contact Name: | 14. GQ Contact Title: | ||||||||||||||||
15. GQ Contact Telephone Number: | 16. Business Email: | ||||||||||||||||
17. Secondary Contact Name: | 18. Secondary Contact Title: | ||||||||||||||||
19. Secondary Contact Telephone Number: | 20. Max Pop: | ||||||||||||||||
21. How early do clients arrive? | 22. What is the earliest clients may enter? | 23. Expected Pop: | |||||||||||||||
___:___ a.m. | ___:___ p.m. | ___:___ a.m. | ___:___ p.m. | ||||||||||||||
24. Are clients males only, females only, or both? | 25. What are the general procedures clients follow when they enter | ||||||||||||||||
q Males Only q Females Only q Both | the shelter? GO TO NOTES SECTION | ||||||||||||||||
26. Are there any people at this location that do not speak or understand English? q Yes q No | |||||||||||||||||
If yes - What language do they speak? | |||||||||||||||||
27. Any specific instructions Census staff need to know in order to count the people at this location? | |||||||||||||||||
qYes q No SEE NOTES SECTION | |||||||||||||||||
28. Enumeration appointment date and time: | q Wednesday, March 28 | ____:____ a.m. | ____:____ p.m. | ||||||||||||||
q Thursday, March 29 | ____:____ a.m. | ____:____ p.m. | |||||||||||||||
q Friday, March 30 | ____:____ a.m. | ____:____ p.m. | |||||||||||||||
29. Do you have a roster of clients that will be available for our use during enumeration? q Yes q No | |||||||||||||||||
30. Can a staff member assist with the enumeration? q Yes q No | |||||||||||||||||
31. Staff member name and telephone number: | |||||||||||||||||
Name _______________________________________________ | Telephone ______________________________ | ||||||||||||||||
NOTES SECTION | |||||||||||||||||
32. (Lead) Enumerator Name & ID: | 33. Date Assigned (mm/dd/yy): | ||||||||||||||||
34. Date enumeration conducted (mm/dd/yy): | 35. # of ICQs (Census Day pop): | ||||||||||||||||
36. For Supervisory Use Only: | |||||||||||||||||
q N q R q D-1 q D-2 Survivor ID# ___________ q V q O | |||||||||||||||||
#### | THIS IS THE CONTROL NUMBER FOR THIS GROUP QUARTERS. | #### | |||||||||||||||
YOUR MATERIALS FOR ENUMERATION INCLUDE LABELS | |||||||||||||||||
PRINTED WITH THIS NUMBER. | |||||||||||||||||
THIS LISTING CONTAINS CONFIDENTIAL INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C., OMB NO. 0607-0919-C APPROVAL EXPIRES MM/DD/YYYY | |||||||||||||||||
D-352.1SK (SBE) | U.S. Department of Commerce | ||||||||||||||||
(MM/DD/YYYY) | Economic and Statistics Administration | ||||||||||||||||
U.S. Census Bureau | |||||||||||||||||
SOUP KITCHEN ENUMERATION RECORD | |||||||||||||||||
GROUP QUARTERS ENUMERATION | |||||||||||||||||
2018 CENSUS Test | |||||||||||||||||
RCC: | |||||||||||||||||
ACO: | |||||||||||||||||
GQ ID: | |||||||||||||||||
||| BARCODE Number ||| | |||||||||||||||||
GQ Name: | ##### ### #### ## | ||||||||||||||||
Facility Name: | |||||||||||||||||
1. State: | 2. County: | 3. BCU No: | 4. Map Spot No: | 5. GQ Type Code: | Items 1-27 and notes should be prepopulated | ||||||||||||
6a. Street Number: | 6b. Street Name: | 6c. Apt/Unit: | |||||||||||||||
7. Rural Route or P.O. Box Number: | |||||||||||||||||
8. City: | 9. Zip Code: | ||||||||||||||||
10. Building Name: | 11. Building Number: | ||||||||||||||||
12. Location Description: | |||||||||||||||||
13. GQ Contact Name: | 14. GQ Contact Title: | ||||||||||||||||
15. GQ Contact Telephone Number: | 16. Business Email: | ||||||||||||||||
17. Secondary Contact Name: | 18. Secondary Contact Title: | ||||||||||||||||
19. Secondary Contact Telephone Number: | 20. Max Pop: | ||||||||||||||||
20. Which meal serves the largest number of people? | q Breakfast q Lunch q Dinner | ||||||||||||||||
21. At what time is this meal served? | 22. Expected pop at this meal? | 23. At what time do clients assemble for this meal? | |||||||||||||||
____:____ a.m. ____:____ p.m. | ____:____ a.m. ____:____ p.m. | ||||||||||||||||
24. Method of receiving food (i.e. line up, congregate, other): SEE NOTES SECTION | |||||||||||||||||
25. Are there any people at this location that do not speak or understand English? q Yes q No | |||||||||||||||||
If yes - What language do they speak? | |||||||||||||||||
26. Enumeration appointment date and time: | q Wednesday, March 28 | ____:____ a.m. | ____:____ p.m. | ||||||||||||||
q Thursday, March 29 | ____:____ a.m. | ____:____ p.m. | |||||||||||||||
q Friday, March 30 | ____:____ a.m. | ____:____ p.m. | |||||||||||||||
27. Any specific instructions Census staff need to know in order to count the people at this location? | |||||||||||||||||
qYes q No SEE NOTES SECTION | |||||||||||||||||
28. Can a staff member assist with the enumeration? q Yes q No | |||||||||||||||||
29. Staff member name and telephone number: | |||||||||||||||||
Name ______________________________________________ | Telephone ______________________________ | ||||||||||||||||
NOTES SECTION | |||||||||||||||||
30. (Lead) Enumerator Name & ID: | 31. Date Assigned (mm/dd/yy): | ||||||||||||||||
32. Date enumeration conducted (mm/dd/yy): | 33. # of ICQs (Census Day pop): | ||||||||||||||||
34. For Supervisory Use Only: | |||||||||||||||||
q N q R q D-1 q D-2 Survivor ID# ___________ q V q O | |||||||||||||||||
#### | THIS IS THE CONTROL NUMBER FOR THIS GROUP QUARTERS. | #### | |||||||||||||||
YOUR MATERIALS FOR ENUMERATION INCLUDE LABELS | |||||||||||||||||
PRINTED WITH THIS NUMBER. | |||||||||||||||||
THIS LISTING CONTAINS CONFIDENTIAL INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C., OMB NO. 0607-0919-C APPROVAL EXPIRES MM/DD/YYYY | |||||||||||||||||
D-352.1TNSOL (SBE) | U.S. Department of Commerce | ||||||||||||||||
(MM/DD/YYYY) | Economic and Statistics Administration | ||||||||||||||||
U.S. Census Bureau | |||||||||||||||||
TARGETED NONSHELTERED OUTDOOR LOCATION ENUMERATION RECORD | |||||||||||||||||
GROUP QUARTERS ENUMERATION | |||||||||||||||||
2018 CENSUS Test | |||||||||||||||||
RCC: | |||||||||||||||||
ACO: | |||||||||||||||||
GQ ID: | |||||||||||||||||
||| BARCODE Number ||| | |||||||||||||||||
GQ Name: | ##### ### #### ## | ||||||||||||||||
Facility Name: | |||||||||||||||||
1. State: | 2. County: | 3. BCU No: | 4. Map Spot No: | 5. GQ Type Code: | |||||||||||||
6a. Street Number: | 6b. Street Name: | Items 1-21 and notes should be prepopulated | |||||||||||||||
7. Rural Route or P.O. Box Number: | |||||||||||||||||
8. City: | 9. Zip Code: | ||||||||||||||||
10. Location Description: | |||||||||||||||||
11. GQ Contact Name: | 12. GQ Contact Title: | ||||||||||||||||
13. GQ Contact Telephone Number: | 14. Secondary Contact Name: | ||||||||||||||||
15. Secondary Contact Title: | 16. Secondary Contact Telephone Number: | ||||||||||||||||
17. Hours location is occupied between 12:00 a.m. to 7:00 a.m.: | From | To | |||||||||||||||
_____:_____ a.m. | _____:_____ a.m. | ||||||||||||||||
18. Expected Pop: | 19. Security issues: q Yes SEE NOTES SECTION q No | ||||||||||||||||
20. Are there any people at this location that do not speak or understand English? q Yes q No | |||||||||||||||||
If yes - What language do they speak? | |||||||||||||||||
21. Any specific instructions Census staff need to know in order to count the people at this location? | |||||||||||||||||
qYes q No SEE NOTES SECTION | |||||||||||||||||
NOTES SECTION | |||||||||||||||||
22. (Lead) Enumerator Name & ID: | 23. Date Assigned (mm/dd/yy): | ||||||||||||||||
24. Date enumeration conducted (mm/dd/yy): | 25. # of ICQs (Census Day pop): | ||||||||||||||||
26. For Supervisory Use Only: | |||||||||||||||||
q N q R q D-1 q D-2 Survivor ID# ___________ q V q O | |||||||||||||||||
#### | THIS IS THE CONTROL NUMBER FOR THIS GROUP QUARTERS. | #### | |||||||||||||||
YOUR MATERIALS FOR ENUMERATION INCLUDE LABELS | |||||||||||||||||
PRINTED WITH THIS NUMBER. | |||||||||||||||||
File Type | application/vnd.ms-excel |
Author | worth307 |
Last Modified By | Seantoia D Swanston (CENSUS/NY FED) |
File Modified | 2017-05-16 |
File Created | 2006-09-18 |