| THIS LISTING CONTAINS CONFIDENTIAL INFORMATION THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13 U.S.C |
OMB NO. XXXX-XXXX-X: APPROVAL EXPIRES XX/XX/XXXX |
| FORM DH-1059(SE) |
|
|
|
|
|
|
U.S.DEPTARTMENT OF COMMERCE |
| (XX-XX-XXXX) |
|
|
|
|
|
|
Economics and Statistics Administration |
|
SELF-ENUMERATING GROUP QUARTERS |
U.S CENSUS BUREAU |
|
FACILITY CONTACT CHECKLIST |
|
|
|
OPERATION: SELF-ENUMERATION |
|
|
|
2018 CENSUS TEST |
|
|
| A. CENSUS CONTACT NAME |
|
B. CENSUS CONTACT TELEPHONE |
|
| C. ACO NAME |
|
D. ACO TELEPHONE |
|
| PRE-ENUMERATION TASKS |
| TASK 1 |
CHECK YOUR MATERIALS: |
|
|
|
|
|
Form DH-116, Group Quarters Listing Sheets |
|
|
|
|
|
Form DH-20, Individual Census Questionnaires (ICQ) |
|
|
|
|
|
Form DH-20(S) , Individual Census Questionnaires (ICQ) - Spanish |
|
|
|
Form DH-31, Confidentially Notices |
|
|
|
|
|
|
|
|
|
|
|
|
Form DH-352.1, Group Quarters Enumeration Record |
|
|
|
|
|
|
|
|
|
|
|
|
Form DH-40, Individual Census Questionnaire Envelopes |
|
|
|
|
|
Form DH-40(S), Individual Census Questionnaire Envelopes - Spanish |
|
|
|
|
Form DH-40(GQ) - Group Quarters Envelope(s) |
|
|
|
|
|
Rubber bands |
|
|
|
|
|
Pencils |
|
|
|
|
|
|
|
|
|
|
|
| TASK 2 |
LIST RESIDENTS ON FORM DH-116, GROUP QUARTERS LISTING SHEET(S): |
|
|
|
Get a list of residents who were assigned to the Group Quarters as of Census Day, April 1, 2018. |
|
Update the list, if necessary, by adding any missing residents or deleting anyone who should not |
|
be included. |
|
|
|
|
|
ADDITIONAL INSTRUCTIONS FOR: |
|
|
|
|
|
PRISONS: |
List people staying in your Group Quarters as of 12:01 a.m., Census Day. The list must include: |
|
|
|
|
*All inmates present at the correctional facility, including any in transit to other institutions that are aassigned to your faciilty. |
|
|
|
|
|
|
*Inmates who are temporarily elsewhere but still under the daily charge of your facility. For example, someone in court or in the hosiptal or on work release. |
|
|
|
|
|
|
*Inmates on sanctioned of authorized leave but still under the charge of your facility. |
|
|
|
|
|
|
|
|
|
|
| HOSPITALS: |
You may have more than one type of Group Quarters. Create a list for each Group Quarters. Look at the GQ Type Code, Item 5 on the Enumeration Record so see who to include on the list. List people staying in the Group Quarters as of 12:01 a.m., Census Day in the following groups: |
|
|
|
|
|
|
301 - Patients in your skilled nursing unit |
|
|
|
|
401 - Patients in your mential health or psychiatric unit who are there for long term care |
|
|
|
|
402 - All the patients in your acility who have no disposition or exit plan |
|
|
|
|
403 - Patients in your in-patient hospice unit |
|
|
|
|
|
|
|
|
|
|
|
|
| TASK 3 |
PREPARE INDIVIDUAL CENSUS QUESTIONNIARE PACKETS |
|
|
|
|
|
|
On the Individual Census Questionnaire envelopes, complete the For, Return to, Return by Date and For Official Use only sections. |
|
On the Individual Censsu Questionniares, complete PN in the For Official Use Only section. |
|
|
Put the Individual Census Questionnaire into the Individual Census Questionniare envelope. |
|
| U S C E N S U S B U R E A U |
|
|
|
|
|
|
|
| ENUMERATION TASKS |
| TASK 1 |
CONDUCT ENUMERATION (DISTRIBUTE INDIVIDUAL CENSUS QUESTIONNIARES OR CONDUCT INTERVIEW |
|
Give or provide each resident or client an Individual Census Questionnaire packet or conduct an interview. |
| Make sure each residnet or client understands that he/she should complete the Individual Census Questionniare and then seal it in the Individual Census Questionniare envelope provided. |
|
|
|
|
|
|
|
|
|
|
|
|
| TASK 2 |
COLLECT INDIVIDUAL CENSUS QUESTIONNAIRES |
|
Sort the returned Individual Census Questionniares envelopes in Person Number order |
|
|
Check each Individual Census Questioniares against the Group Quarters Listing Sheet. Mark an X in Column (d) for each returned form. |
|
|
|
|
| TASK 3 |
REVIEW INDIVIDUAL CENSUS QUESTIONNAIRES |
|
Check that each Individual Census Questionnaire is completed and legible. The miniumum data for a complete Individual Census Questionniare is if Questions 1, 4, and 5 are answered: name, sex, and age or date of birth. |
|
Make sure there is a Group Quarters ID number in the For Official Use Only section of the Individual Census Questionniare. |
|
On the back of each Individual Census Questionnaire, complete Item B Answered by. Mark the Respondent box if the respondent completed or was interviewed personally. Mark Group Quarters Administrator if the ICQ was completed using adminstrative records. |
|
|
Mark results of review as Complete or Incomplete in Column (e) of the Group Quarters Listing Sheet. |
|
|
|
|
|
|
| POST- ENUMERATION TASKS |
| TASK 1 |
GET DATA FOR INCOMPLETE OR MISSING ICQS |
|
|
|
Make arrangements with the administrative source to follow up on incomplete and missing Individual Census Questionnaires. Use adminstrative lists if available. |
|
Complete an Individual Census Questionniare for all residents who are no longer at the Group Quarteters but were residents on Census Day, April 1. |
|
For any Individual Census Questionnaires you had previously makred Incomplete that are now Complete, update the Group Quarters Listing Sheet to show the questionniare is now complete. |
|
|
Document in the Notes Section of the Enumeration Record if you are submitting incomplete Individual Census Questionnaires and how many there are. |
|
|
|
|
|
|
|
|
|
|
|
| TASK 2 |
TURN IN FORMS FOR COMPLETED GROUP QUARTERS ASSIGNMENT |
|
Complete the Group Quarters Listing Sheet. |
|
|
|
|
|
|
|
|
|
|
|
On the Group Quarters Listiing Sheet, be sure to complete the Sheet ___of ____Sheets . |
|
|
Be sure that every line on the Group Quarters Listing Sheet shows a checked in and complete/incomplete Individual Census Questionnaire. |
|
|
|
Complete the Enumeration Record. |
|
|
|
|
|
Count all the Individual Census Questionnaires, complete and incomplete. Write that number in Item 31 on the Enumeration Record. |
|
|
Write in the date you completed the enumeration in Item 30 on the Enumeration Record. |
|
Clip the Individual Census Questionnaires together. Keep each Group Quarters forms with its Enumeration Record and Group Quarters Listing Sheet. |
|
Complete the Group Quarters Envelope. |
|
|
Write your name in the Enumerator space. |
|
|
Fill in the name of the Group Quarters as shown on the Enumeration Record as well as the date you completed the enumeration, the total number of questionnaires for the Group Quarters and the total number of questionniares in the Group Quarters Envelope. |
|
Put only one Group Quarter in a Group Quarters Envelope. If you need multiple Group Quarters Envelopes for your Group Quarters, your total number of questionnaires and total number in the Group Quarter envelope will be different. You will also fill in the Envelope ___ of ____ total envelopes so the Census contact will know how many Group Quarters Envelopes they should have for your Group Quarters. |
|
Place all the forms for the Group Quarters in the Group Quarters Envelope:- Enumeration Record, Individual Census Questionnaires and Group Quarters Listing Sheets |
|
Give the Group Quarters Envelope(s) to the Census Bureau contact. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| U S C E N S U S B U R E A U |
|
|
|
|
|
|
|