D-CQ-UE Continuation Enumerator Questionnaire

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OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU

TM

Enumerator Continuation Questionnaire

FOR NPC
USE ONLY

ACO

State

Tract

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APPLY LABEL HERE

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Map Spot

County

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Enter ID Number from Barcode Label on the D-Q-UE for this household.

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questionnaire(s)

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Questionnaire

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CONTINUATION QUESTIONNAIRE FOR

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ENUMERATOR QUESTIONNAIRES

FORM

D-CQ-UE (02-05-2019) Draft 9

11870011

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1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

At a seasonal or
second residence

No

In a nursing home

Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K

Vietnamese

ze

Chinese

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C

iti

Opposite-sex husband/wife/spouse

Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C

Some other race – Print race or origin. C

o

Is this person male or female? Mark K
J ONE box.
I
Female

N

Male

What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Age on April 1, 2020

Year of birth

ra

years

Print numbers in boxes.
Month
Day

ft:

5.

American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C

For another reason

For a job or business

4.

ip

In a jail or prison

For college

ns
h

With a parent or other relative

For a military assignment

3.

Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C

Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K

C

2.

6.

D

➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.

2

11870029

§,x!F¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

At a seasonal or
second residence

No

Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

ze

In a nursing home

Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C

C

Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C

Some other race – Print race or origin. C

o

Is this person male or female? Mark K
J ONE box.
I
Female

N

Male

What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day

ft:

5.

American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C

For another reason

For a job or business

4.

ip

In a jail or prison

For college

ns
h

With a parent or other relative

For a military assignment

3.

Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C

Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K

iti

2.

Age on April 1, 2020

Year of birth

ra

years

➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.

D

6.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.

3

11870037

§,x!N¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

At a seasonal or
second residence

No

In a nursing home

Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K

Vietnamese

ze

Chinese

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C

iti

Opposite-sex husband/wife/spouse

Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C

Some other race – Print race or origin. C

o

Is this person male or female? Mark K
J ONE box.
I
Female

N

Male

What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Age on April 1, 2020

Year of birth

ra

years

Print numbers in boxes.
Month
Day

ft:

5.

American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C

For another reason

For a job or business

4.

ip

In a jail or prison

For college

ns
h

With a parent or other relative

For a military assignment

3.

Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C

Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K

C

2.

6.

D

➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.

4

11870045

§,x!U¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

At a seasonal or
second residence

No

Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

ze

In a nursing home

Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C

C

Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C

Some other race – Print race or origin. C

o

Is this person male or female? Mark K
J ONE box.
I
Female

N

Male

What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day

ft:

5.

American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C

For another reason

For a job or business

4.

ip

In a jail or prison

For college

ns
h

With a parent or other relative

For a military assignment

3.

Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C

Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K

iti

2.

Age on April 1, 2020

Year of birth

ra

years

➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.

D

6.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.

5

11870052

§,x!]¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

At a seasonal or
second residence

No

In a nursing home

Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K

Vietnamese

ze

Chinese

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C

iti

Opposite-sex husband/wife/spouse

Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C

Some other race – Print race or origin. C

o

Is this person male or female? Mark K
J ONE box.
I
Female

N

Male

What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Age on April 1, 2020

Year of birth

ra

years

Print numbers in boxes.
Month
Day

ft:

5.

American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C

For another reason

For a job or business

4.

ip

In a jail or prison

For college

ns
h

With a parent or other relative

For a military assignment

3.

Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C

Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K

C

2.

6.

D

➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.

6

11870060

§,x!o¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

At a seasonal or
second residence

No

Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

ze

In a nursing home

Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C

C

Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C

Some other race – Print race or origin. C

o

Is this person male or female? Mark K
J ONE box.
I
Female

N

Male

What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day

ft:

5.

American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C

For another reason

For a job or business

4.

ip

In a jail or prison

For college

ns
h

With a parent or other relative

For a military assignment

3.

Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C

Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K

iti

2.

Age on April 1, 2020

Year of birth

ra

years

➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.

D

6.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If needed, continue with the next person on another
Continuation Questionnaire (D-CQ-UE) and update the
number of continuation questionnaires on page 1 of
both D-Q-UE and D-CQ-UE questionnaires.

7

11870078

§,x!w¤

iti

ze

ns
h

ip

OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx

D

ra

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11870086