Attachment O(b) - CEQ Worksheet Overview

Our next interview is on ________________________ at________

Consumer Expenditure Quarterly Interview Survey

PREPARING FOR YOUR NEXT INTERVIEW
A Census field representative will visit you again in three months to ask you
about your household’s expenses. You may find the information below and
the worksheet provided on the back helpful in preparing for your next
interview. The worksheet shows you some of the types of spending that I’ll
be asking about, and if you note these expenses on the worksheet, the
interview may be faster while also making it easier for you to give accurate
amounts.
To learn more about the survey and how valuable your response is, visit
http://www.bls.gov/respondents/cex/.
Thank you for your participation!
 Talk to everyone in your household – family members and anyone else living in your
home that you share expenses with. Be ready to answer questions for them or ask
them to sit in on part of the interview.
 Collect records to help you remember details about your expenses. Ask others in the
household if they have any records, too. Store the records where you can access them
during the interview and print or download any online records before the interview.
Records will only be used for reference during the interview; we will not keep them.
Types of Records:
 Bills

 Checkbooks

 Receipts

 Paystubs

 Statements

 Online Records

Questions?
Field Representative Name:
Phone:

Expense Worksheet

Housing Expenses and Utilities

Month 1

Month 2

Month 3

_______________

_______________

_______________

Mortgage
Rent
Other Housing Expenses
(e.g. Homeowner’s Association Fees, Condominium Fees)

Specify:
Specify:
Telephone, Internet, and Cable/Satellite TV Expenses
Specify:
Specify:
Electricity
Gas or Oil
Water and Sewerage
Garbage and Recycling Collection
Other Utilities
(e.g. Water Softening Service, Septic Tank Cleaning)

Specify:
Specify:

Insurance

x

Frequency of Payment
(Specify: monthly, annually, etc.)

Amount

Long Term Care Insurance
Life Insurance
Homeowner’s Insurance
Renter’s Insurance
Vehicle Insurance
Health Insurance
Dental Insurance
Vision Insurance
Other Insurance
(e.g. pet, PMI, credit card)

Specify:
Specify:

PRIVACY ACT STATEMENT The U.S. Census Bureau Is conducting the Consumer Expenditure Quarterly Interview Survey for the Bureau of Labor Statistics of the U.S.
Department of Labor under Title 29, United States Code. The survey’s purpose is to obtain information on what people are purchasing in order to update the Consumer
Price Index. All survey information will be used for statistical purposes only. Any information you provide for this survey is confidential, by law, under Title 13, Unite d
States Code. Participation in this survey is voluntary and there are no penalties for refusing to answer any question(s). However, your cooperation is extremely
important to help ensure the completeness and accuracy of these data.