The American Community Survey

ACS Attachments J-T

April 1, 2019

Collection Materials

J

American Community Survey Failed Edit Follow-up Questions

K

American Community Survey Vacant Unit Questions

L

American Community Survey Housing Unit Reinterview Questions

M

American Community Survey CAPI Tools
•
ACS-16(L) (1-2020) Introductory Letter in Multiple Languages
•
ACS-26(L) (1-2020) ACS Thank You Letters in Multiple Languages
•
ACS-50(HU) (1-2020), Informational Brochure in Multiple Languages
•
ACS-51(HU) (1-2020), Q&A Brochure in Multiple Languages
•
ACS-613R(L)(January 2018) Refusal Letters in Multiple Languages
•
ACS-Measuring America Flyer (1-2020)

N

American Community Survey Group Quarters Facilities Data Collection Package
•
ACS-18(L)(C)(GQ)(RO name)(2020)(12-2018) ACS GQ Student Housing
Introductory Letter
•
ACS-18(L)(H)(RO name)(2020)(12-2018) ACS GQ Health Care Introductory Letter
•
ACS-18(L)(GQ)(RO name)(2020)(12-2018), ACS GQ Facility Manager Introductory
Letter
•
ACS-18(L)(GQ)(PR)(2020)(12-2018) PRCS GQ Introductory Letter (English)
•
ACS-18(L)(GQ)(PR)(S)(2020)(12-2018) PRCS GQ Introductory Letter (Spanish)
•
ACS-51(GQ)(F)(December 2018) ACS GQ Facility FAQ
•
ACS-26(L)(GQ)(F)(2020)(12-2018), ACS Facility Thank You Letter (English/Spanish)
•
ACS-26(L)(GQ)(PR)(F)(2020)(12-2018), PRCS Facility Thank You Letter
(English/Spanish)

O

American Community Survey Group Quarters Facility Questionnaire and Listing Sheets
•
GQFQ Facilities Questionnaire
•
ACS-290(GQ)(7-16-2014) ACS GQ Listing Sheet
•
ACS-290(GQ)(PR)(SP)(8-15-2017) PRCS GQ Listing Sheet
•
ACS-290B(GQ)(8-1-2011) ACS GQ Control List
•
ACS-290B(GQ)(PR)(SP)(8-14-2017) PRCS GQ Control List (Spanish)

P

American Community Survey Group Quarters Resident Data Collection Package
•
ACS-17(L)(GQ)(2020)(12-2018), ACS Resident Introductory Letter (English)
•
ACS-17(L)(GQ)(S)(2020)(12-2018), ACS Resident Introductory Letter (Spanish)

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ACS-21(GQ) (12-2018), ACS GQ Confidentiality Notice (English/Spanish)
ACS-1(GQ)(2019) (2-14-2018), ACS GQ Questionnaire (English/Spanish)
ACS-30(GQ)(2020)(8-2018), ACS GQ Instruction Guide (English/Spanish)
ACS-26(L)(GQ)(R)(2020)(12-2018), ACS GQ Resident Thank You Letter
(English/Spanish)
ACS-50(GQ)(September 2018) ACS Brochure
ACS-51(GQ)RA(December 2018) ACS GQ Remote Alaska FAQ
6385-46(GQ) (8-2017) ACS Business Reply Mail Envelope

Q

Puerto Rico Community Survey – Group Quarters Resident Questionnaire Package:
•
ACS-17(L)(GQ)(PR)(2020)(12-2018), PRCS Resident Introductory Letter
(English/Spanish)
•
ACS-21(GQ)(PR)(12-2018), PRCS GQ Confidentiality Notice (English/Spanish)
•
ACS-1(GQ)(PR)(2019) (2-14-2018), PRCS GQ Questionnaire (English/Spanish)
•
ACS-30(GQ)(PR)(2020)(8-2018) PRCS GQ Instruction Guide (English/Spanish)
•
ACS-26(L)(GQ)(PR)(R)(2020)(12-2018), PRCS Resident Thank You Letter
(English/Spanish)
•
ACS-51(GQ)PR (December 2018) PRCS GQ Puerto Rico FAQ
•
6385-46(GQ)(PR)(8-17-2017) PRCS GQ Business Reply Mail Envelope

R

American Community Survey Group Quarters Reinterview Questions

S

Comments on the Federal Register Notice received by the Census Bureau

T

Modified Materials to distinguish between ACS and the 2020 Census

AMERICAN COMMUNITY SURVEY
Questions in Computer-assisted Telephone Interviewing (CATI) Failed Edit Follow Up (FEFU)
That Differ from Those in the Paper Questionnaire
Paper Questionnaire Item Number: Roster7
FEFU Screen Name: DIAL1.DRIVING
Before I go any further, for safety purposes, are you driving?

♢ Even if the respondent is using a hands-free device while driving, you must end the call.

❍1. Yes
❍2. No

FEFU Screen Name: USTATVER
On (RDATE), was there anyone living or staying at this address for more than two months?

***NOTE: RDATE stands for the Response Date, or the estimated date the respondent completed the
questionnaire.
FEFU Screen Name: CJIC2
On (RDATE) was this housing unit....?
❍ 1. Temporarily Occupied
❍ 2. Vacant

❍ 3. a Group Quarters

❍ 4. for Commercial Use Only
FEFU Screen Name: CJIC3
On (RDATE) was this housing unit....?

1

❍1. For rent
❍2. Rented, not occupied
❍3. For sale only
❍4. Sold, not occupied
❍5. For seasonal, recreational or occasional use
❍6. For migrant workers
❍7. Other vacant
FEFU Screen Name: VACOTH
Why is this unit Vacant?
❍1. Foreclosure

❍ 2. Personal/family reasons
❍ 3. Legal proceedings

❍ 4. Preparing to rent/sell

❍ 5. Held for storage of household furniture

❍ 6. Needs repairs

❍ 7. Currently being repaired/renovated
❍ 8. Specific use housing
❍ 9. Extended absence

❍ 10. Abandoned/possibly to be demolished/possibly condemned
❍ 11. Other

2

FEFU Screen Name: CJIC4
How many months has this unit been vacant?
❍1. Less than 1 month
❍2. 1 up to 2 months
❍3. 2 up to 4 months
❍4. 4 up to 6 months
❍5. 6 up to 12 months
❍6. 12 up to 24 months
❍7. 24 or more months

FEFU Screen Name: CoverageP
[I’d like to make sure that we’ve included everyone. I see that the household size ( / ) but we have data for
persons.]
I have listed: () How many people were here for more than two months on
()?
01 Sally

P

Smith

02 John

D

Smith

03 Brandon C

Smith

04
05
06
07
.
.
.
20

3

FEFU Screen Name: LN_PG2, FN_PG2, MI_PG2
(Last/First) Name (MI)
(INCLUDE everyone living or staying here for more than two months.
INCLUDE anyone else staying here who does not have another place to stay even if they are
here for two months or less.
DO NOT INCLUDE anyone who is living somewhere else for more than two months, such as a
college student living away.)

Paper Questionnaire Item Number: Demographic 2
FEFU Screen Name: REL

How is related to ? is 's
❍ 0. Householder
❍ 1.Opposite-sex husband/wife/spouse
❍ 2. Opposite-sex unmarried partner
❍ 3. Same-sex husband/wife/spouse
❍ 4. Same-sex unmarried partner
❍ 5. Biological son or daughter
❍ 6. Adopted son or daughter
❍ 7. Stepson or stepdaughter
❍ 8. Brother or sister
❍ 9. Father or mother
❍ 10. Grandchild
❍ 11. Parent-in-law
❍ 12. Son-in-law or daughter-in-law
❍ 13. Other relative
❍ 14. Roommate or housemate
❍ 15. Foster child
❍ 16. Other nonrelative

4

Paper Questionnaire Item Number: Demographic 3
FEFU Screen Name: SEX

(Are you /Is ) male or female?

❍ 1. Male

❍ 2. Female
Paper Questionnaire Item Number: Demographic 4
FEFU Screen Name: P2DOB

What is (’s/your) date of birth?
♢ Enter the month/day/4-digit year

FEFU Screen Name: AGEP
So that makes (/you) as of ?
Is that correct?
❍ 1. Yes
❍ 2. No

FEFU Screen Name: AGEVER
When I calculate {’s/your} age from the birth date provided, that makes
{/you} as of , but age given on the questionnaire was
. Which is correct as of ?
❍1.
❍2.

5

❍3. Neither

FEFU Screen Name: AGEASK
How old {was/were you} as of ?

Paper Questionnaire Item Number: Demographic 5
FEFU Screen Name: HISW
What is that origin?
(For example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so
on.)

Paper Questionnaire Item Number: Demographic 6
FEFU Screen Name: RAC
What is (’s/your) race? You may choose one or more races. For this survey, Hispanic
origin is not a race.
♦ Enter all that apply, separate with commas.
❍ 11. White

❍ 16. Filipino

❍ 13. American Indian or
Alaska Native

❍ 18. Korean

❍ 12. Black, African Am.

❍ 14. Asian Indian

❍ 15. Chinese

❍ 17. Japanese
❍ 19. Vietnamese

❍ 20. Other Asian (For
example, Hmong, Laotian,
Thai, Pakistani, Cambodian,
and so on.)

❍ 21. Native Hawaiian

❍ 22. Guamanian or
Chamorro
❍ 23. Samoan

❍ 24. Other Pacific Islander
(For example, Fijian, Tongan,
and so on.)
❍ 25. Some other race

FEFU Screen Name: RCW1
What is (his/her/your/’s) enrolled or principal tribe? You may list one or more tribes.

FEFU Screen Name: RCW2

6

If RAC is <20>:
What is that other Asian group?
(For example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.)
If RAC is <24>:
What is that other Pacific Islander group?
(For example, Fijian, Tongan, and so on.)
If RAC is <20> and <24>
What is that other Asian group and other Pacific Islander group?
(For example, Hmong, Laotian, Thai, Pakistani, Cambodian, Fijan, Tongan, and so on.)

FEFU Screen Name: RCW3

What is {his/her/’s/your} other race group?

Paper Questionnaire Item Number: Housing 2
FEFU Screen Name: YBL
About when was this first built?
(If you do not know exact year, give your best estimate.)
❍ 1. 2000 or later
❍ 2. 1990-1999
❍ 3. 1980-1989
❍ 4. 1970-1979
❍ 5. 1960-1969
❍ 6. 1950-1959

❍ 7. 1940-1949

7

❍ 8. 1939 or earlier
FEFU Screen Name: YBLW
(What year was this built?)

Paper Questionnaire Item Number: Housing 3
FEFU Screen Name: MVM
When did (you/) move into this ?
♢ Select month

FEFU Screen Name: MVY
When did (you/) move into this ?
♢ Enter the year the household moved into this (mobile home/ house/ apartment/ unit).

Paper Questionnaire Item Number: Housing 7a
FEFU Screen Name: RWATPR (Puerto Rico Only)
Does this have running water?

Paper Questionnaire Item Number: Housing 7b
FEFU Screen Name: HOTWAT (Puerto Rico Only)
Does this have a water heater?

Paper Questionnaire Item Number: Housing 8
FEFU Screen Name: TEL
Can you or any member of this household both make and receive phone calls when at this
house, apartment or mobile home? Include calls using cell phones, land lines, or other
phone devices.

8

❍1. Yes
❍2. No

Paper Questionnaire Item Number: Housing 9a
FEFU Screen Name: LAPTOP
At this do you or any member of this household
own or use a desktop, laptop, netbook, or notebook computer? EXCLUDE GPS devices,
digital music players, and devices with only limited computing capabilities, for example:
household appliances.

Paper Questionnaire Item Number: Housing 9b
FEFU Screen Name: SMARTPHONE
At this do you or any member of this household
own or use a smartphone?

Paper Questionnaire Item Number: Housing 9c
FEFU Screen Name: TABLET
At this , do you or any member of this household
own or use a tablet or other portable wireless computer?
Paper Questionnaire Item Number: Housing 9d
FEFU Screen Name: COMPOTH
At this do you or any member of this household
own or use some other type of computer?
EXCLUDE GPS devices, digital music players, and devices with only limited computing
capabilities, for example: household appliances.

FEFU Screen Name: COMPOTHW
What is this other type of computer?

9

Paper Questionnaire Item Number: Housing 10
FEFU Screen Name: WEB
At this do you or any member of this household
access the Internet?

FEFU Screen Name: SUBSCRIBE
At this , do you or any member of this household
pay a cell phone company or Internet service provider to access the Internet?

Paper Questionnaire Item Number: Housing 11a
FEFU Screen Name: BROADBND
Do you or any member of this household access the internet using a cellular data plan for a
smartphone or other mobile device?
Paper Questionnaire Item Number: Housing 11b
FEFU Screen Name: HISPEED
Do you or any member of this household access the Internet using broadband or high
speed Internet service such as cable, fiber optic, or DSL service installed in this
?

Paper Questionnaire Item Number: Housing 11c
FEFU Screen Name: SATELLITE
Do you or any member of this household access the Internet using a satellite Internet
service installed in this ?
Paper Questionnaire Item Number: Housing 11d
FEFU Screen Name: DIALUP

10

Do you or any member of this household access the Internet using dial-up Internet
serviced installed in this ?

Paper Questionnaire Item Number: Housing 11e
FEFU Screen Name: OTHSVCE
Do you or any member of this household access the Internet using some other service?
FEFU Screen Name: OTHSVCEW
What is this other type of Internet service?

Paper Questionnaire Item Number: Housing 14a
FEFU Screen Name: ELE
LAST MONTH, what was the cost of electricity for this ?

FEFU Screen Name: ELEX
Was the electricity -- Included in rent or condominium fee, or No charge for electricity or
electricity not used?
❍ 1. Included in rent or condominium fee
❍ 2. No charge or electricity not used
Paper Questionnaire Item Number: Housing 14b
FEFU Screen Name: GAS
LAST MONTH, what was the cost of gas for this ?

FEFU Screen Name: GASX

11

Was the gas -- Included in rent or condominium fee, Included in electricity payment, or No
charge or gas not used?
❍ 1. Included in rent or condominium fee
❍ 2. Included in electricity payment
❍ 3. No charge or gas not used

Paper Questionnaire Item Number: Housing 14c
FEFU Screen Name: WAT
IN THE PAST 12 MONTHS, what was the cost of water and sewer for this ?

FEFU Screen Name: WATX
Was the water and sewer -- Included in rent or condominium fee, or
No charge for water or sewer?
❍ 1. Included in rent or condominium fee
❍ 2. No charge

Paper Questionnaire Item Number: Housing 14d
FEFU Screen Name: FUL
IN THE PAST 12 MONTHS, what was the cost of oil, coal, kerosene, wood, etc., for this
?

FEFU Screen Name: FULX
Were the Other Fuel costs -- Included in the rent or condominium fee, or No charge or
these fuels are not used?
❍ 1. Included in rent or condominium fee
❍ 2. No charge, or these fuels not used

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Paper Questionnaire Item Number: Housing 16
FEFU Screen Name: CONX
Is this part of a condominium?

FEFU Screen Name: CON
What is the monthly condominium fee?

Paper Questionnaire Item Number: Housing 18a
FEFU Screen Name: RenterRN
What is the monthly rent?
♢ Estimate monthly rent in dollars.

Paper Questionnaire Item Number: Person 7
FEFU Screen Name: PBX1
Where (was /were you) born?
❍ 1. In the United States

❍ 2. Outside the United States
FEFU Screen Name: PBW2 (if PBX1 = 1)
In what state was that?

FEFU Screen Name: PBW3 (if PBX1 = 2)
In what country (were you/was )born?

13

Paper Questionnaire Item Number: Person 8
FEFU Screen Name: CIT
(Is /Are you) a CITIZEN of the United States?
(How was the citizenship obtained?)
❍ 1. Yes, born in the United States

❍ 2. Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands or Northern Marianas

❍ 3. Yes, born abroad of U.S. citizen parent or parents

❍ 4. Yes, a U.S. citizen by naturalization
❍ 5. No, not a U.S. citizen

FEFU Screen Name: CITW
In what year did (/you) become a naturalized citizen of the United States?
Paper Questionnaire Item Number: Person 9
FEFU Screen Name: YOE
When did {/you} come to live in {the United States / Puerto Rico}? If
{/you} came to live in {the United States / Puerto Rico} more than once, give the
latest year.

Paper Questionnaire Item Number: Person 10b
FEFU Screen Name: SCHG
What grade or level (was / were you) attending?
❍ 1. Nursery school, preschool
❍ 2. Kindergarten

❍ 3. Grade 1 through 12

❍ 4. College undergraduate years (freshman to senior)

❍ 5. Graduate or professional school beyond a bachelor’s degree (for example: MA
or PhD program, or medical or law school)

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FEFU Screen Name: SCHGW
(What grade (was / were you) attending?)

Paper Questionnaire Item Number: Person 11
FEFU Screen Name: SCHL
What is the highest degree or level of school ( has/you have) COMPLETED?
❍ 1. No schooling completed
❍ 2. Nursery school

❍ 3. Kindergarten

❍ 4. Grade 1 through 11

❍ 5. 12th grade - NO DIPLOMA

❍ 6. Regular high school diploma

❍ 7. GED or alternative credential

❍ 8. Some college credit, but less than 1 year of college credit
❍ 9. 1 or more years of college credit, no degree

❍10. Associate’s degree (for example: AA, AS)
❍11. Bachelor’s degree (for example: BA, BS)

❍12. Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

❍13. Professional degree beyond a bachelor’s degree (for example: MD, DDS,
DVM, LLB, JD)

❍14. Doctorate degree (for example: PhD, EdD)
FEFU Screen Name: SCHLW (if SCHG = 3)
(What is the highest grade ( has/you have) COMPLETED?)

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Paper Questionnaire Item Number: Person 15
FEFU Screen Name: MIG
Did (/you) live in this 1 year ago?
❍ 1. Person is under 1 year old
❍ 2. Yes, this house

❍ 3. No, outside the United States and Puerto Rico

❍ 4. No, different house in the United States or Puerto Rico
FEFU Screen Name: MGW1 (if MIG = 3)
What was the foreign country?

FEFU Screen Name: MGW2 (if MIG = 4)
Where did (/you) live 1 year ago? What was the street address?

FEFU Screen Name: MGW3 (if MIG = 4)
What was the city, town, or post office?

FEFU Screen Name: MGW4 (if MIG = 4)
What was the U.S. county or municipio in Puerto Rico?

FEFU Screen Name: MGW5 (if MIG = 4)
What was the U.S. state, or was that in Puerto Rico?

FEFU Screen Name: MGW6 (if MIG = 4)
What was the ZIP code?

16

Paper Questionnaire Item Number: Person 16
FEFU Screen Name: HINS1
(Are you/Is ) currently covered by health insurance through a current or former
employer or union of (yours/ or another family member)?

FEFU Screen Name: HINS2
(Are you/Is ) currently covered by health insurance purchased directly from an
insurance company by (you/you or another family member/ or another family
member)?

FEFU Screen Name: HINS3
(Are you/Is ) currently covered by Medicare, for people age 65 or older or people
with certain disabilities?

FEFU Screen Name: HINS4
(Are you/Is ) currently covered by Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low incomes or a disability?

FEFU Screen Name: HINS5
(Are you/Is ) currently covered by TRICARE or other military health care?

FEFU Screen Name: HINS6
(Are you/Is ) currently covered through the VA or have you enrolled for VA health
care?

FEFU Screen Name: HINS7
(Are you/Is ) currently covered through the Indian Health Service?
FEFU Screen Name: HINS8
(Are you/Is ) currently covered by any other health insurance or health coverage
plan?

17

FEFU Screen Name: HINSW
What is the name of the health care plan?
Paper Questionnaire Item Number: Person 17a
FEFU Screen Name: HIPREM
Is there a premium for this plan? A premium is a fixed amount of money paid on a regular
basis for health coverage. It does not include copays, deductibles, or other expenses such
as prescription costs.

Paper Questionnaire Item Number: Person 17b
FEFU Screen Name: HISUB
[Do you/Does ] or another family member receive a tax credit or subsidy based on
family income to help pay the premium?

Paper Questionnaire Item Number: Person 21
FEFU Screen Name: MAR
(Is /Are you) married, widowed, divorced, separated, or never married?
❍ 1. Now married
❍ 2. Widowed
❍ 3. Divorced

❍ 4. Separated

❍ 5. Never married
Paper Questionnaire Item Number: Person 22
FEFU Screen Name: MARHM
In the past 12 months, did (/you) get married?

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FEFU Screen Name: MARHW
In the past 12 months, did (/you) become a ()?

FEFU Screen Name: MARHD
In the past 12 months, did (/you) get divorced?

Paper Questionnaire Item Number: Person 23
FEFU Screen Name: MARHT
How many times (has /have you) been married? Is that -❍ 1. Once

❍ 2. Two times

❍ 3. Three or more times

Paper Questionnaire Item Number: Person 27
FEFU Screen Name: VET
(Has /Have you) ever served on ACTIVE DUTY in the U.S. Armed Forces, Reserves, or
National Guard?

FEFU Screen Name: TRAINING
{Was /Were you} on active duty ONLY FOR TRAINING in the Reserves or National
Guard?

FEFU Screen Name: ACTIVE
{Is /Are you} currently on active duty?

FEFU Screen Name: RESERVES
{Has / Have you} ever been in the Reserves or National Guard?

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Paper Questionnaire Item Number: Person 30a
FEFU Screen Name: WRK
During the week of (), did (/you) do any work for pay at a job or
business?
(Include any work even if (/you) worked only 1 hour, or helped without pay in a
family business or farm for 15 hours or more, or (was/were) on active duty in the Armed
Forces.)

Paper Questionnaire Item Number: Person 30b
FEFU Screen Name: WRKJ
During the week of (), did (/you) do ANY work for pay, even for as little
as one hour?

Paper Questionnaire Item Number: Person 31a
FEFU Screen Name: PWW1
During the week of (), at what location did (/you) work?
(What is the street number and street name of the location?)

Paper Questionnaire Item Number: Person 31b
FEFU Screen Name: PWW2
What is the city, town, or post office where {/you} worked during the week of
{} ?

Paper Questionnaire Item Number: Person 31d
FEFU Screen Name: PWW4
What is the name of the county where (/you) worked during the week of
()?

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Paper Questionnaire Item Number: Person 31e
FEFU Screen Name: PWW5
What is the state or foreign country where (/you) worked during the week of
()?

Paper Questionnaire Item Number: Person 31f
FEFU Screen Name: PWW6
What is the ZIP Code where (/you) worked during the week of ()?

Paper Questionnaire Item Number: Person 32
FEFU Screen Name: JWTR
LAST WEEK, how did /you) USUALLY get to work?
(If he/she//you) usually used more than one method of transportation during the
trip, report the one used for most of the distance.)
❍ 1. Car, truck, or van
❍ 2. Bus

❍ 3. Subway or elevated

❍ 4. Long-distance train or commuter rail
❍ 5. Light rail, streetcar, or trolley

❍ 6. Ferryboat
❍ 7. Taxicab

❍ 8. Motorcycle

❍ 9. Bicycle

❍ 10. Walked

❍ 11. Worked from home
❍ 12. Other Method

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Paper Questionnaire Item Number: Person 33
FEFU Screen Name: JWRI
During the week of (), how many people, including (/you) usually rode
to work together?

Paper Questionnaire Item Number: Person 34
FEFU Screen Name: JWLH
During the week of (),, what time did ’s/your> trip to work usually
begin -- (what hour)?

FEFU Screen Name: JWLM
(How many minutes past that hour?)

FEFU Screen Name: JWAM
(-- was that AM or PM?)
❍ 1. AM
❍ 2. PM

Paper Questionnaire Item Number: Person 35
FEFU Screen Name: JWMN
During the week of (), how many minutes did it usually take (/you) to
get from home to work?

Paper Questionnaire Item Number: Person 36a
FEFU Screen Name: NWLA
During the week of (), (was /were you) on layoff from a job?

22

Paper Questionnaire Item Number: Person 36b
FEFU Screen Name: NWAB
During the week of (), (was /were you) TEMPORARILY absent from a
job or business?
❍ 1. Yes, on vacation, temporary illness, maternity leave, other family/personal reasons,
bad weather, etc.
❍ 2. No

Paper Questionnaire Item Number: Person 36c
FEFU Screen Name: NWRE
As of the week of (), had (/you) been informed that (/you)
would be recalled to work within the next six months OR been given a date to return to
work?

Paper Questionnaire Item Number: Person 37
FEFU Screen Name: NWLK
As of the week of (), during the LAST 4 WEEKS, had (/you) been
ACTIVELY looking for work?

Paper Questionnaire Item Number: Person 38
FEFU Screen Name: NWAV
During the week of (), could (/you) have started a job if offered one, or
returned to work if recalled?
❍ 1. YES, could have gone to work

❍ 2. NO, because of temporary illness

❍ 3. NO, because of all other reasons (in school, etc.)
Paper Questionnaire Item Number: Person 40a
FEFU Screen Name: WKWX
During the PAST 12 MONTHS or 52 weeks, did {/ you} work EVERY week? Count paid
vacation, paid sick leave, and military service as work.

23

❍ 1. Yes
❍ 2. No

Paper Questionnaire Item Number: Person 40b
FEFU Screen Name: WKW
During the PAST 12 MONTHS or 52 weeks, how many WEEKS did {/ you} work?
Include paid time off and include weeks when {/ you} only worked for a few hours.

Paper Questionnaire Item Number: Person 41
FEFU Screen Name: WKH
How many hours did {/ you} usually work each week?

Paper Questionnaire Item Number: Person 42
FEFU Screen Name: COW
The next series of questions is about the type of employment {/ you} had
If {/ you} had more than one job, describe the one at which the most hours were
worked.
I am going to read 5 categories. Please choose the one that best describes {’s/ your}
employment - a private organization or company, government, active duty U.S. Armed Forces or
Commissioned Corps, self-employed, or worked without pay in a for-profit family business or
farm.

❍ 1. Private company or organization

❍ 2. Government
❍ 3. Active duty U.S. Armed Forces or Commissioned Corps
❍ 4. Self-employed
❍ 5.Working without pay in a for-profit family business or farm

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FEFU Screen Name: COWB
Did {/ you} work for a for-profit company or non-profit organization?

❍ 1. For- profit company
❍ 2. Non-profit organization

FEFU Screen Name: COWC
Did {/ you} work for a local, state, or federal government?

❍ 1. Local
❍ 2. State
❍3. Federal
FEFU Screen Name: COWD
Was {’s/ your} self-employed business, professional practice, or farm incorporated or
not incorporated?

❍ 1. Incorporated

❍ 2. Not incorporated

FEFU Screen Name: COWE
Did {/ you} work without pay in this for-profit family business or farm for 15 hours or
more per week?

❍ 1. Yes
❍ 2. No

FEFU Screen Name: INW2
What was the name of the company, business or other employer?

FEFU Screen Name: INMIL
Which branch of the Armed Forces or Commissioned Corps {did / do you} work for?

❍ 1. U.S. Army
❍ 2. U.S. Navy

25

C3. U.S. Air Force
❍4. U.S. Marine Corps
❍5. U.S. Coast Guard
❍6. U.S. Public Health Service
❍7. National Oceanic and Atmospheric Administration (NOAA)
FEFU Screen Name: INW3
What kind of business or industry was this? Include the main activity, product, or service provided
at the location where employed. For example: elementary school, residential construction, or
another kind of business.

FEFU Screen Name: INX4
Is this business mainly -- manufacturing, wholesale trade, retail trade or some other
kind of business?

❍ 1.Manufacturing
❍ 2. Wholesale trade
C 3. Retail trade
❍ 4. Other (agriculture, construction, service, government, etc.)
Paper Questionnaire Item Number: Person 37
FEFU Screen Name: OCW1

What was {’s/ your} main occupation? For example: 4th grade teacher, entry-level
plumber, or another occupation

Paper Questionnaire Item Number: Person 37
FEFU Screen Name: OCW2
Describe ’s/your most important activities or duties. For example: instruct and
evaluate students and create lesson plans, assemble and install pipe sections and review
building plans for work details, or other duties.

26

Paper Questionnaire Item Number: Person 43
FEFU Screen Name: P8_INTRO
Next I’ll ask about income during the last 12 months—that is, from {} to {.
❒1. Continue
Paper Questionnaire Item Number: Person 43a
*If respondent has provided a monetary response in 43a of the paper form, (s)he is asked WAGX.
FEFU Screen Name: WAGX
Did {/you} receive any wages, salary, commissions, bonuses or tips?

*If respondent has not provided a monetary response in 43a of the paper form, (s)he is asked the
following four questions, in lieu of WAGX.
FEFU Screen Name: EARNX
Did receive any wages or salary?

FEFU Screen Name: EARN
How much did {/you} receive in wages and salary from all jobs before taxes and
deductions?

FEFU Screen Name: TIPSX
Did {/you} receive any [if EARNX=yes, fill with "additional"] tips, bonuses or
commissions?
FEFU Screen Name: TIPS
How much did {/you} receive in tips, bonuses, or commissions from all jobs before
taxes and deductions?

27

Paper Questionnaire Item Number: Person 43b
FEFU Screen Name: SEMX
Did (/you) receive any self-employment income from own nonfarm businesses or
farm businesses, including proprietorships and partnerships?

FEFU Screen Name: SEM
What was the amount of the self-employment income that (/you) received?

FEFU Screen Name: SEML
Was that self-employment income a loss?

Paper Questionnaire Item Number: Person 43c
*If respondent has provided a monetary response in 43a of the paper form, (s)he is asked INTRESTX.
FEFU Screen Name: INTRESTX
Did (/you) receive any interest, dividends, net rental income, royalty income or
income from estates and trusts?

*If respondent has not provided a monetary response in 43a of the paper form, (s)he is asked the
following six questions, in lieu of INTRESTX.
FEFU Screen Name: INTRX
Did receive any interest or dividends? Report even small amounts credited to
an account.

FEFU Screen Name: INTR
What was the amount?

FEFU Screen Name: RENTX
Did receive any net rental income?
Net rental income is the total amount after expenses.

28

FEFU Screen Name: RENT
How much did {/you} receive in tips, bonuses, or commissions from all jobs before
taxes and deductions?

FEFU Screen Name: ROYALX
Did receive any royalty income or income from estates and trusts?

FEFU Screen Name: ROYAL
Was that interest, dividends, net rental income, royalty income or income from estates
and trusts income a loss?

Paper Questionnaire Item Number: Person 43d
FEFU Screen Name: SS
Did (/you) receive any Social Security or Railroad Retirement income?

FEFU Screen Name: SSX
What was the amount of the Social Security or Railroad Retirement income that
(/you) received?

Paper Questionnaire Item Number: Person 43e
FEFU Screen Name: SSIX
Did (/you) receive any Supplemental Security Income (SSI)?
FEFU Screen Name: SSI
What was the amount of the Supplemental Security Income (SSI) that (/you)
received?

29

Paper Questionnaire Item Number: Person 43f
FEFU Screen Name: PAX
Did (/you) receive any public assistance or public welfare income?

FEFU Screen Name: PA
What was the amount of the public assistance or public welfare income that
(/you) received?

Paper Questionnaire Item Number: Person 43g
FEFU Screen Name: SURVDISX
Did (/you) receive any survivor or disability income?

FEFU Screen Name: SURVDIS
What was the amount of the survivor or disability income that (/you) received?

FEFU Screen Name: PENSIONX
Did (/you) receive a pension or any retirement income from a previous employer
or union, or any regular withdrawals or distributions from retirement accounts such as
401(k), 403(b), IRA, Roth IRA, or other accounts designed specifically for retirement?

FEFU Screen Name: PENSION
What was the amount of pension or any retirement income from a previous employer or
union, or any regular withdrawals or distributions from retirement accounts such as
401(k), 403(b), IRA, Roth IRA, or other accounts designed specifically for retirement that
(/you) received?

Paper Questionnaire Item Number: Person 43h
FEFU Screen Name: OIX
Did {/you} receive any other income on a REGULAR basis, such as - - Veterans’
(VA) payments, unemployment compensation, child support or alimony? (Include all

30

reoccurring income. Do not include one-time lump sum payments such as refunds,
inheritances, withdrawals from savings or IRAs, etc.)
FEFU Screen Name: OI
What at was the amount of the other income that (/you) received?

Paper Questionnaire Item Number: Person 44
FEFU Screen Name: TI
What was the total income for (/you)?

FEFU Screen Name: TIN
I have recorded that {/you} received no income. Is that correct?

FEFU Screen Name: TIL
Was that income a loss?

31

VACUNIT_CP
Vacant Unit Status

Is this unit…?
1.
2.
3.
4.
5.
6.
7.

For rent
Rented, not occupied
For sale only
Sold, not occupied
For seasonal, recreational or occasional use
For migrant workers
Other vacant

VACOTH_CP
Other Vacant Unit Status

Ask if necessary.
Why is this unit vacant?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Foreclosure
Personal/Family Reasons
Legal Proceedings
Preparing to Rent/Sell
Held for Storage of Household Furniture
Needs Repairs
Currently Being Repaired/Renovated
Specific Use Housing
Extended Absence
Abandoned/Possibly to be Demolished/Possibly Condemned
Other

VACMO_CP
Length of time the unit has been vacant

How many months has this unit been vacant?
1.
2.
3.
4.
5.
6.
7.

Less than 1 month
1 up to 2 months
2 up to 4 months
4 up to 6 months
6 up to 12 months
12 up to 24 months
24 or more months

ACS Housing Unit Centralized Reinterview Questions

2

Block:

FAQs

Variable Name:

RIREASON

Info Pane:
Reinterview Help Menu
♦

Press F8 to proceed to the reinterview.

 1. Why are you calling me again?
 2. Are you calling everyone or am I just lucky?
 3. Don't you have anything better to do with my tax dollars?
I'm too busy to answer your questions again.
 4. Are you "checking up" on me? I told you the truth the first time you called.
 5. Do I have to answer your questions?
 6. Return to reinterview.

Skip Instructions:

<1>
<2>
<3>
<4>
<5>
<6>

[go to RIREF1]
[go to RIREF2]
[go to RIREF3]
[go to RIREF4]
[go to RIREF5]
[return to reinterview]

Block:

FAQs

Variable Name:

RIREF1

Info Pane:
Why are you calling me again?
Like any business, we're interested in maintaining the quality of our product, so each month we
reinterview a few households who are in the survey to ensure we are efficiently and accurately
collecting data.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

Block:

FAQs

Variable Name:

RIREF2

3

Are you calling everyone or am I just lucky?
We are able to get a reliable measure of data quality by reinterviewing only a small percentage of
the total households interviewed in the survey.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

Block:

FAQs

Variable Name:

RIREF3

Info Pane:
Don't you have anything better to do with my tax dollars?
I'm too busy to answer your questions again.
[Fill: RIREF3_DESCR]
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

Block:

FAQs

Variable Name:

RIREF4

Info Pane:
Are you “checking up” on me?
I told you the truth the first time you called.
The purpose of reinterview is not to check up on respondents. In order to ensure that we are efficiently
and accurately collecting data, we reinterview a few households who are in the survey.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

4

Block:

FAQs

Variable Name:

RIREF5

Info Pane:
Do I have to answer your questions?
Your participation in this survey is voluntary. However, the information you provide will help us
to ensure the efficiency and accuracy of our data collection procedures. Like any business, we’re
interested in maintaining the quality of our product.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

Block:

FAQs

Variable Name:

H_PURPOSE

Info Pane:
Choose from the following topics of frequently asked questions:

♦

Press F8 to proceed to the reinterview.

 1. What is this survey all about?
 2. How will this information be used?
 3. How was I selected?
 4. Do I have to participate?
 5. Send me another questionnaire in the mail
 6. Is this survey authorized by law ~ is this survey legitimate?
 7. What confidential protection do I have?
 8. Why can’t you get the information from other sources?
 9. I think this is a waste of taxes.
 10. I thought you only counted people.
 11. Confirm call/survey -- toll-free number
 12. Where do I send survey comments?
 13. What is the American Community Survey (ACS) WEB Site Address
 14. How do I benefit by completing the [Fill: SURVEY_NAME]?
 15. Why am I not eligibleto respond via the internet?
 16. I lost my PIN
 17. Return to reinterview.

5

Skip Instructions:

<1>

[goto H_PURPOSE1]

<2>

[goto H_PURPOSE2]

<3>

[goto H_PURPOSE3]

<4>

[goto H_PURPOSE4]

<5>

[goto H_PURPOSE5]

<6>

[goto H_PURPOSE6]

<7>

[goto H_PURPOSE7]

<8>

[goto H_PURPOSE8]

<9>

[goto H_PURPOSE9]

<10>

[goto H_PURPOSE10]

<11>

[goto H_PURPOSE11]

<12>

[goto H_PURPOSE12]

<13>

[goto H_PURPOSE13]

<14>

[goto H_PURPOSE14]

<15>

[goto H_PURPOSE15]

<16>

[goto H_PURPOSE16]

<17>

[return to reinterview]

Block:

FAQs

Variable Name:

HPURPOSE1

Info Pane:
What is this survey all about?
The [Fill: SURVEY_NAME] collects information on topics such as housing, education, income and
jobs. This information was typically collected during the census every ten years. However, the [Fill:
SURVEY_NAME] is an ongoing, monthly survey which can provide more accurate and up-to-date
information continuously, not just every ten years.
This means that people who use the data - - businesses for example, or local, state or Federal
governments will have more timely information with which to make informed decisions.
You can also visit our WEB site to learn more about the [Fill: SURVEY_NAME]. The address is:
www.census.gov/acs/
 1. Continue
 2. Back to Reinterview Help Menu

6

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to HPURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE2

Info Pane:
How will this information be used?
The data from all interviews is summarized so that no one person can be identified. The summary
statistics are available on the ACS Web Site. [Fill 1: Federal, state, and local/ Federal, Puerto Rico, and
municipio] governments use the data as an information base for planning, administering and evaluating
government programs.
Businesses use the data to make informed decisions. For example, a business may look at the
education level of the residents of a community to see if that community would have the appropriate
workforce for that business.
The housing quality of an area can be assessed from the housing data collected in the [Fill 2:
ACS/PRCS]. Using the income data, the poverty level of an area can be determined.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE3

Info Pane:

7

How was I selected?
Your address was randomly selected from a list of residential addresses in your
[Fill: county/ municipio].

Why don't you select someone else?
Your address was randomly selected from a list of addresses, so we can't substitute anyone else's
address for yours. One of the advantages of a random sample is that we can use it to measure the
whole population without having to actually interview every household. But in order for it to work,
you can't pick and choose -- the sample has to be truly random. Your participation is very important if
we're going to be able to produce accurate statistics from this survey.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE4

Info Pane:
Do I have to participate?
This is a mandatory survey as provided by Title 13 of the United States Code. Because it's a sample
survey, your participation is very important if we're going to be able to produce accurate statistics from
it.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE5

Info Pane:

8

Send me another questionnaire in the mail
Unfortunately, the time for conducting this survey by mail has passed. We need to collect
your information now in order to keep to our schedule. As you answer the survey questions I
will be entering the data directly into a computer, so we can process it very quickly and meet
our deadlines.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE6

Info Pane:

9

IS THIS SURVEY AUTHORIZED BY LAW?
This survey is authorized by Title 13, Section 141, 193, and 221, of the United States Code. The U.S.
Census Bureau is required by law to keep your information confidential. The Census Bureau is not
permitted to publicly release your responses in a way that could identify this household. Per the
Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data.
IS THIS SURVEY LEGITIMATE?
The Office of Management and Budget (OMB) oversees all Federal Government surveys. This office
gives clearance to conduct a survey by providing an approval number. The approval number must be
printed on every questionnaire. In addition, if requested, we must provide the approval number when
we call regardless if we reach a business or private address.
If someone calls claiming to be a Census Bureau employee and you are concerned whether
or not the survey is legitimate, ask the caller for the OMB approval number. If the caller
can’t provide the number, that very well could mean the purpose of the call is not legitimate.
The OMB approval number for the [Fill 1: ACS/PRCS] is: 0607-0810.
If the respondent has a copy of the [Fill 2: ACS-1/ACS-1 PR(SP)] questionnaire, read the statement
below.
For the [Fill 3: American/Puerto Rico] Community Survey, you can find the approval number on page
1 of the questionnaire in the bottom right corner.
1. Proceed with interview
2. Return to FAQ list
PRS
¿ES ESTA ENCUESTA AUTORIZADA POR LEY?
Esta encuesta está autorizada por las secciones 141, 193, y 221 del título 13 del Código de los Estados
Unidos. La Oficina del Censo de los EE. UU. está obligada por ley a mantener confidencial su
información. A la Oficina del Censo no se le permite divulgar sus respuestas de manera que este hogar
pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de seguridad cibernética
mediante los controles aplicados a los sistemas que trasmiten su información.
¿ES LEGÍTIMA ESTA ENCUESTA?
La Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés) supervisa todas las
encuestas del gobierno federal. Esta oficina aprueba que se lleve a cabo una encuesta al proveer el
número de aprobación. El número de aprobación debe estar impreso en cada cuestionario. Además, si
se pide, debemos proveer el número de aprobación cuando llamemos sin tener en cuenta si hablamos
con un negocio o dirección privada.
Si alguien llame y finge ser un empleado del Negociado del Censo, y usted está preocupado si la
encuesta es o no es legítima, pregunta a la persona que llama por el número de aprobación de OMB.

10

Si la persona que llama no puede proveer el número, esto puede significar que el propósito de la
llamada no es legítimo.
El número de aprobación para la Encuesta sobre la Comunidad de Puerto Rico es 0607-0810.
Si el respondedor tiene una copia del cuestionario ACS-1 PR(SP), lea la información a continuación.
Para la Encuesta sobre la Comunidad de Puerto Rico, puede encontrar el número de aprobación en la
página 1 del cuestionario en la parte inferior derecha.
1. Proceda con la entrevista
2. Regrese a la lista de Preguntas Frecuentes
ESP
¿ES ESTA ENCUESTA AUTORIZADA POR LEY?
Esta encuesta está autorizada por las secciones 141, 193, y 221 del título 13 del Código de los Estados
Unidos. La Oficina del Censo de los EE. UU. está obligada por ley a mantener confidencial su
información. A la Oficina del Censo no se le permite divulgar sus respuestas de manera que este hogar
pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de seguridad cibernética
mediante los controles aplicados a los sistemas que trasmiten su información.
¿ES LEGÍTIMA A ESTA ENCUESTA?
La Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés) supervisa todas las
encuestas del gobierno federal. Esta oficina aprueba que se lleve a cabo una encuesta al proveer el
número de aprobación. El número de aprobación debe estar impreso en cada cuestionario. Además, si
se pide, debemos proveer el número de aprobación cuando llamemos sin tener en cuenta si hablamos
con un negocio o dirección privada.
Si alguien llama y finge ser un empleado de la Oficina del Censo, y usted está preocupado si la
encuesta es o no es legítima, pregunte a la persona que llama por el número de aprobación de OMB.
Si la persona que llama no puede proveer el número, esto puede significar que el propósito de la
llamada no es legítimo.
El número de aprobación para la Encuesta sobre la Comunidad Estadounidense es 0607 0810.
Si el respondedor tiene una copia del cuestionario ACS-1, lea la información a continuación.
Para la Encuesta sobre la Comunidad Estadounidense, puede encontrar el número de aprobación en la
página 1 del cuestionario en la parte inferior derecha.
1. Proceda con la entrevista
2. Regrese a la lista de Preguntas Frecuentes
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE7

Info Pane:
WHAT CONFIDENTIAL PROTECTION DO I HAVE?
The U.S. Census Bureau is required by law to protect your information. The Census Bureau is not
permitted to publicly release your responses in a way that could identify your household. By law, the
Census Bureau can only use your responses to produce statistics. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the
systems that transmit your data. Like all Census Bureau interviewers, I have taken an oath of
confidentiality.
PRS
¿QUÉ PROTECCIÓN DE LA CONFIDENCIALIDAD TENGO?
La Oficina del Censo de los EE. UU. está obligada por ley a proteger su información. A la Oficina del
Censo no se le permite divulgar sus respuestas de manera que este hogar pudiera ser identificado. Por
ley, la Oficina del Censo solamente puede usar sus respuestas para producir estadísticas. En
conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos
están protegidos contra los riesgos de seguridad cibernética mediante los controles aplicados a los
sistemas que trasmiten su información. Al igual que todos los entrevistadores de la Oficina del Censo,
he tomado un juramento para mantener la confidencialidad.
ESP
¿QUÉ PROTECCIÓN DE LA CONFIDENCIALIDAD TENGO?

La Oficina del Censo de los EE. UU. está obligada por ley a proteger su información. A la Oficina del
Censo no se le permite divulgar sus respuestas de manera que este hogar pudiera ser identificado. Por
ley, la Oficina del Censo solamente puede usar sus respuestas para producir estadísticas. En
conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos
están protegidos contra los riesgos de seguridad cibernética mediante los controles aplicados a los
sistemas que trasmiten su información. Al igual que todos los entrevistadores de la Oficina del Censo,
he tomado un juramento para mantener la confidencialidad.
 1. Continue
 2. Back to Reinterview Help Menu

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<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE8

Info Pane:

12

Why can’t you get the information from other sources?
When it is possible to obtain data from other sources, the Census Bureau does use Administrative
Records. However, we have done extensive review of the Administrative Records available and have
found that they do not match our data needs. This is a function of the lack of availability of high
quality, National-level Administrative Records, as well as differences in the data definitions and
formats used by Administrative Records= sources and this survey.
 1. Continue
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FAQs

Variable Name:

HPURPOSE9

Info Pane:
I think this is a waste of taxes!!
There are many reasons why it's definitely NOT a waste of tax dollars. Government agencies,
businesses, and the general public rely on up-to-date statistics, like the information we are collecting in
the [Fill: SURVEY_NAME], to make informed decisions.
The [Fill: SURVEY_NAME] will provide more timely information for decision makers to plan
programs for everyone in your community.
For example -It will offer more accurate, timely and detailed demographic, housing and economic information
whenever a community needs facts about a town or local area.
It will also help businesses evaluate a community’s potential for the business to locate or expand in the
community.
 1. Continue
 2. Back to Reinterview Help Menu

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<1> [return to reinterview]
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13

Block:

FAQs

Variable Name:

HPURPOSE10

Info Pane:
I thought you only counted people.
Actually, the Census Bureau collects lots of information on a wide range of topics -- such as
housing quality, unemployment, crime, health, and education. The census which is
conducted every ten years is what most people know about, but we do hundreds of
thousands of other kinds of interviews every year with governments, businesses, and people.
 1. Continue
 2. Back to Reinterview Help Menu

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<1> [return to reinterview]
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Block:

FAQs

Variable Name:

HPURPOSE11

Info Pane:
Confirm call/survey -- toll-free number
If you would like to verify that I am from the Census Bureau, you may call our toll-free
number: [Fill: 1-800-(fill as appropriate for your TC or RO)/1-800-361-6891].
My name is . . . , and this is the [Fill: SURVEY_NAME]. Your "Case ID" is: [Fill: CASEID].
(To verify that the toll-free number is a legitimate Census Bureau number, you may call Directory
Assistance on: 1-800-555-1212.)
 1. Continue
 2. Back to Reinterview Help Menu

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FAQs

14

Variable Name:

HPURPOSE12

Info Pane:
Where do I send survey comments?
The address you can write to for expressing your opinion about this survey is:
Paperwork Project: 0607-0810
U.S. Census Bureau
4600 Silver Hill Rd, AMSD - 3K138
Washington, DC 20233
Because we do so many different surveys, be sure to mention the name of this one -- the [Fill:
SURVEY_NAME] Or you may e-mail comments to [email protected]. Use "Paperwork Project
0607-0810" as the subject.
If you would like to talk to someone about my performance as an interviewer, you may call our tollfree number: [Fill: 1-800-(fill as appropriate for your TC or RO)/1-800-361-6891]. My name is . . . ,
and this is the [Fill: SURVEY_NAME]. Your "Case ID" is: [Fill: CASEID].
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
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Block:

FAQs

Variable Name:

HPURPOSE13

Info Pane:

15

What is the AMERICAN COMMUNITY SURVEY (ACS) WEB SITE ADDRESS
[Fill 1: NOTE TO INTERVIEWER: In the United States this survey is called the American
Community Survey. There is no separate web site for the Puerto Rico Community Survey, however
you can refer respondents to this web site where they can learn about the American Community Survey
and Puerto Rico Community Survey or more about the Census Bureau.]
To learn more about the American Community Survey and the Census Bureau, you can visit
our home page at:
“http://www.census.gov”
To go directly to information about the American Community Survey:
Click on “Subjects Index A-Z”
Click on “A”
Click on “American Community Survey (ACS) Home page”
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE14

Info Pane:

16

HOW DO I BENEFIT BY COMPLETING THE ACS?
Communities, states, and federal agencies say they do not have the up-to-date information they need to
better understand community issues, respond to needs, and allocate programs and resources. A
community leader said, "Guessing is always fun, but seldom effective." The [Fill 1: American/Puerto
Rico] Community Survey will provide communities with up-to-date housing and population data every
year.
By responding to the [Fill 1: American/Puerto Rico] Community Survey, you are helping your
community establish community goals, identify community problems and solutions, locate facilities
and programs, and measure the performance of programs.
The [Fill 1: American/Puerto Rico] Community Survey data are used by:
Local governments:
- - for budgeting, evaluating programs, and planning for community development projects.
Community Programs:
- - such as for the elderly, scout programs, libraries, churches, banks, hospitals, and other
community organizations, to provide services to the community and to locate buildings,
services, and programs.
Transportation planners (using summarized journey-to-work information):
- - to plan for peak volumes of traffic to reduce traffic congestion, plan for parking, and to
develop strategies such as car pooling programs and flexible work schedules.
- - to decide where to build new roads or add capacity to existing roads.
- - to develop transit systems such as light rail or subways by projecting rider ship.
- - by businesses, for determining the location of new buildings and services, such as banks
selecting sites for ATM machines.
Utility companies
- - to understand their customer bases so they can project future needs. Every time you
turn on your water faucet or a light switch in your home, summarized census data are
behind the services you receive.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE15

Info Pane:

17

Why am I not eligible to respond via the internet?
As part of our process your address was identified as needing to be contacted by a Census
representative.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE16

Info Pane:
I lost my PIN.
I’m sorry to hear that you lost your PIN, but unfortunately I cannot provide or reset it for you. Without
having the original PIN, you would not be able to continue a survey you have already started. Instead
you can complete the interview with me.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE17

Info Pane:
How many days do I have to complete this on the Internet?
We would like you to complete the survey as soon as possible. If we have not received your response in
a few days, we will follow up with you again.
 1. Continue
 2. Back to Reinterview Help Menu

18

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

KEY_REF

Info Pane:
F1
F2
F3
F4
F5
F6
F7
F8
F9
F10
F11
F12

Function Key Settings
Item Specific Help

Jump Menu

Item notes/remarks
Return from skip
Exit-skip to END
Calculator
Copy

Skip Instructions:

Shift-F1
Shift-F2
Shift-F3
Shift-F4
Shift-F5
Shift-F6
Shift-F7
Shift-F8
Shift-F9
Shift-F10
Shift-F11
Shift-F12
Ctrl-D
Ctrl-K
Ctrl-R
Ctrl_F3
Ctrl-F7
Ctrl-H
Ctrl-M
Ctrl-S
Ctrl-F

Block:

FAQs

Variable Name:

H_ABBREV1

Info Pane:

View Remarks/Items Notes

Display function keys
Standard abbreviation list
Original CAPI notes
Don’t know (D)
Function key description
Refusal (R)
Reinterview notes
Show Info
Show Don’t Know & Refusals
Save
Search

[return to reinterview]
Ctrl-F

Skip Instructions:

Household roster
Original Interview FAQs
Reinterview FAQs

Search

[return to reinterview]

19

Standard Abbreviation List
[Display the standard abbreviation list]
NOTE: This screen can be accessed at any time during the reinterview by pressing "Shift F11."

Skip Instructions:

[return to reinterview]

Block:

CATI_Front

Variable Name:

REACTOCAPI_RI_CT

Info Pane:
This should not have been assigned to CATI because this case [fill: BADCASE].
This case needs to be recycled to field.
 1. Continue

Skip Instructions:

<1>

[go to CATI_Back.SHOW_CTRL]

Block:

CATI_Front

Variable Name:

HELLO_TC_CT

Info Pane:
Hello, This is ... from the U.S. Census Bureau.
May I please speak to [Fill: RESPNAME]?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. This is correct person, or correct person called to the phone.
 2. Person not available now. Call back later.
 3. Person cannot be reached. Speak with another household member.
 4. Person unknown at this number.
 5. Person no longer lives there.
 6. Person deceased.
 7. Person can be reached at another number.
 8. Other outcome OR problem interviewing household

Skip Instructions:

<1> [go to CATI_Front.INTRO_TC_CT].
<2,7> [go to CATI_Back.SHOW_CTRL].

20

<3, 5>
<4>
<6>
<8>

[go to CATI_Front.HHMEM_CT].
[go to CATI_Front.VERTELE_CT].
[go to CAPI_Back.THANK_REF].
[go to CATI_Front.HELLO_PRB_RI_CT].

Block:

CATI_Front

Variable Name:

HELLO_TCX_CT

Info Pane:
Hello. This is ... from the U.S. Census Bureau.
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your
household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?

Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:

Block:
Variable Name:

<1>
<2>
<3>

[go to CATI_Front.ADDVER_CT].
[go to CATI_Front.HELLO_PRB_RI_CT].
[go to CATI_Back.SHOW_CTRL].

CATI_Front
HELLO_TN_CT

Info Pane:
Hello, This is ... from the U.S. Census Bureau.
May I please speak to [Fill: NAME]?
Status: [Fill: ]

Cutoff Date: [Fill: ]

21

 1. This is correct person, or correct person called to the phone.
 2. Person not available now.
 3. Person unknown at this number.
 4. Person no longer lives there.
 5. Person deceased.
 6. Person can be reached at another number.
 7. Other outcome OR problem interviewing household

Skip Instructions:

<1>
<2>
<3>
<4>
<5>
<6>
<7>

[go to CATI_Front.INTRO_TN_CT].
[go to CATI_Front.PROX_N_CT].
[go to CATI_Front.VERTELE_CT].
[go to CATI_Front.PROX_N_CT].
[go to CAPI_Back.THANK_REF].
[go to CATI_Back.SHOW_CTRL].
[go to CATI_Front.HELLO_PRB_RI_CT].

Block:

CATI_Front

Variable Name:

HELLO_TNX_CT

Info Pane:
Hello. I'm ... from the U.S. Census Bureau.
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your location
to verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:

<1>
<2>
<3>

[go to CATI_Front.INTROB_RI_CT].
[go to CATI_Front.HELLO_PRB_RI_CT].
[go to CATI_Back.SHOW_CTRL].

22

Block:

CATI_Front

Variable Name:

INTRO_TC_CT

Info Pane:
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
Is your address: [Fill:

ADDRESS1]?

 1. Yes
 2. No
 3. Refused to verify Address

Skip Instructions:

< 1, 2, 3 >

[go to CATI_Front.INTROB_RI_CT].

Block:

CATI_Front

Variable Name:

INTRO_TN_CT

Info Pane:
Thank you for recently helping us verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
♦
Enter 1 to continue.
 1. Continue

Skip Instructions:

<1>

[go to CATI_Front.INTROB_RI_CT].

Block:

CATI_Front

Variable Name:

INTROB_RI_CT

Info Pane:
This call may be recorded for quality assurance purposes. Do I have permission to record this call?
♦

If the respondent does not wish to be recorded:
Click on the NICE stop recording button.

23

Read: I appreciate your concern. I am turning off the recording.
 1. Yes; continue with the interview.
 2. Inconvenient time; schedule an appointment to callback.
 3. No; recording is turned off. Continue interview.

Skip Instructions: <1, 3> If ORIOUT_RSLT = ‘INT’, then [go to CAPI_Middle.RIRESP].
Else if ORIOUT_RSLT = B1, B2, C1, or C2, then
[go to CAPI_Middle.CONTACT_N].
<2> [go to CATI_Back.SHOW_CTRL].
Block:

CATI_Front

Variable Name:

VERTELE_CT
OR (HELLO_TN_CT = 3)

Info Pane:
Excuse me. I need to verify your telephone number again.
Have I reached area code [Fill: (AREA) PREFIX-SUFFIX, ext. EXTN] /
[CPPHON, ext. CPEXT]?
 1. Yes
 2. No. Exit instrument and redial.
 3. Refused to verify

Skip Instructions:

<1>
<2>
<3>

If (HELLO_TC_CT = 4 ) [go to CAPI_Front.ADDVER_CT].
Else if (HELLO_TN = 3) [go to CAPI_Front.ADDVER_N_CT ].
[go to CATI_Back.SHOW_CTRL].
[go to CAPI_Back.THANK_REF]

Block:

CATI_Front

Variable Name:

ADDVER_CT

Info Pane:
I need to verify that the address there is:
[Fill:

ADDRESS1]

 1. Same Address.
 2. Not same Address.
 3. Refused to verify.

24

Skip Instructions:

<1>
<2>
<3>

If (HELLO_TC_CT = 4) then [go to CATI_Front.HHMEM_CT].
Else [go to CATI_Front.INTROB_RI_CT].
[go to CAPI_Back.THANK_SORRY].
[go to CAPI_Back.THANK_REF].

Block:

CATI_Front

Variable Name:

HHMEM_CT

Info Pane:
Perhaps you can help me.
Are you a household member [Fill: “who is” MIN_AGE “years or older” / blank]?
 1. Yes
 2. No

Skip Instructions:

<1>
<2>

If (HELLO_TC_CT = 4) then [go to CATI_Front.PROX_UC_CT].
Else [go to CATI_Front.PROX_C_CT].
[go to CATI_Front.HHMEM2_CT].

Block:

CATI_Front

Variable Name:

HHMEM2_CT

Info Pane:
Is there a household member present I may speak to [Fill: “who is” MIN_AGE “years or older” /
blank]?
 1. Yes
 2. No

Skip Instructions:

<1>
<2>

If HELLO_TC_CT = 4 then [go to CATI_Front.PROX_UC_CT].
Else [go to CATI_Front.PROX_C_CT].
[go to CAPI_Back.THANK_NOHH].

Block:

CATI_Front

Variable Name:

PROX_C_CT

Info Pane:

25

Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your
household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:

<1> [go to CATI_Front.ADDVER_CT].
<2, R> If (HELLO_TC_CT = 3) then [go to CATI_Back.SHOW_CTRL].
If (HELLO_TC_CT = 5) then
[go to CATI_Front.HELLO_PRB_RI_CT].
<3>

[go to CATI_Back.SHOW_CTRL].

Block:

CATI_Front

Variable Name:

PROX_N_CT

Info Pane:
Perhaps you can help me.
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted this location to
verify the status of :
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No

Skip Instructions:

<1>
<2>

[go to CATI_Front.INTROB_RI_CT].
If (HELLO_TN_CT = 2) then [go to CATI_Back.SHOW_CTRL].
If (HELLO_TN_CT = 4) then
[go to CATI_Front.HELLO_PRB_RI_CT].

Block:

CATI_Front

26

Variable Name:

PROX_UC_CT

Info Pane:
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your
household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:

<1>
<2>
<3>

[go to CATI_front.LIVEHERE_CT].
[go to CATI_front.HELLO_PRB_RI_CT].
[go to CATI_Back.SHOW_CTRL].

Block:

CATI_Front

Variable Name:

LIVEHERE_CT

Info Pane:
Were you living here on [Fill: INTDATE]?
 1. Yes
 2. No
 3. Inconvenient time. Try again later. Make an appointment.

Skip Instructions:

<1>
<2, D>
<3>

[go to CAPI_Middle.RIRESP].
[go to CAPI_Middle.SOMEONE_ELSE].
[go to CATI_Back.SHOW_CTRL]
[go to CAPI_Back.THANK_REF].

Block:

CATI_Front

Variable Name:

ADDVER_N_CT

Info Pane:
Perhaps you can help me.
I’m trying to find out information about:

27

[Fill: ADDRESS1].
Can you or someone else help me?
 1. Yes
 2. Inconvenient time, call back later. Make an appointment.
 3. No, but I have the phone number of someone who can.
 4. No.

Skip Instructions:

<1> If HELLO_TN_CT = 3, then [go to CATI_Front.PROX_UN_CT].
<2,3> [go to CATI_Back.SHOW_CTRL].
<4> [go to CAPI_Back.THANK_YOU].

Block:

CATI_Front

Variable Name:

PROX_UN_CT

Info Pane:
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted this location to
verify the status of:
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
 1. Continue

Skip Instructions:

<1>

[go to CATI_Front.INTROB_RI_CT].

Block:

CATI_Front

Variable Name:

HELLO_PRB_RI_CT

Info Pane:
Thank you for your cooperation. You’ve been very helpful.

♦ Problem reinterviewing household – Household not available or another problem
♦ If necessary, M make several attempts before selecting choice 8 or 9. Then contact your
supervisor.
 1. Hard r Refusal.
 2. Respondent can’t remember.
 3. Entire HH institutionalized or temporarily ineligible.

28

 4.
 5.
 6.
 7.
 8.
 9.

Entire HH under age [Fill: MIN_AGE].
Temporarily occupied by persons with Usual Residence Elsewhere (URE).
Entire household deceased.
Entire household moved.
No knowledgeable proxy available.
Other problems with reinterview

Skip Instructions:

<1-7> [go to CAPI_Back.FALSIF].
<8, 9> [go to CATI_Back.SHOW_CTRL].

Block:

CAPI_Front

Variable Name:

FIN

Info Pane:
THIS CASE IS NOT COMPLETED
♦

Enter 1 to continue

 1. Continue

Skip Instructions:

<1>

If MODE = 1 then [go to CATI_Back.APPT_CT]
Else [go to CAPI_Back.APPT]

Block:

CAPI_Front

Variable Name:

START_1A

Info Pane:
CONTACT PERSON INFORMATION
Name:
Title:
Phone:
Address:

[Fill: CPNAME]
[Fill: CPTITL]
[Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT])
[Fill: CPADD1
CPADD2
CPPO, CPST, CPZP5-CPZP4

[Fill: “NO CONTACT PERSON INFORMATION IS AVAILABLE” / blank]
 1. Continue

29

Skip Instructions:

<1>

[go to CAPI_Front.METHOD].

Block:

CAPI_Front

Variable Name:

START_1A

Info Pane:
CONTACT PERSON INFORMATION
Name:
Title:
Phone:
Address:

[Fill: CPNAME]
[Fill: CPTITL]
[Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT])
[Fill: CPADD1
CPADD2
CPPO, CPST, CPZP5-CPZP4

[Fill: “NO CONTACT PERSON INFORMATION IS AVAILABLE” / blank]
 1. Continue

Skip Instructions:

<1>

[go to CAPI_Front.METHOD].

Block:

CAPI_Front

Info Pane:
The interviewer determined the original outcome by observation. No contact person information was
collected.
♦

Enter 1 to continue.

 1. Continue
Form Pane:
Type B/C noninterview by observation [fill]

Skip Instructions:

<1>

[go to CAPI_Front.METHOD].

Block:

CAPI_Front

Info Pane:
♦ Choose one of the following options to continue:

30

 1. Telephone Reinterview
 2. Personal Visit Reinterview
 3. Quit - Attempt later
 4. Reinterview Noninterview
 5. RO/HQ Discretion – Type A (Contact Supervisor)

Skip Instructions:

<1>

<2>

<3>
<4>
<5>

If (ORIOUT = (B1, C1, B2, C2 or VINT) and BYOBS = 1)
then [go to CAPI_Front.VERBYOBS].
If (ORIOUT_RSLT = A) then [go to CAPI_Front.VERTPEA]
Else [go to CAPI_Front.DIAL].
If (USE_CKSUP = Yes) then [go to CAPI_Front.CKSUP].
If ORIO_RSLT = A) then [go to CAPI_Front.VERTYPEA]
If (ORIOUT_RSLT = INT and RESPNAME empty)
then [go to CAPI_Front.HELLO_PCX].
If (ORI_RSLT = INT and RESPNAME empty) then [go to
CAPI_Front.HELLO_PC]
If (BYOBS = 1) then [go to CAPI_Front.VERBYOBS].
If (ORIOUT_RSLT = INT) then [go to CAPI_Front.HELLO_PC].
If (CPNAME = empty) then [go to CAPI_Front.HELLO_PNX].
Else [go to CAPI_Front.HELLO_PN]
[go to CAPI_Back.WRAP_UP].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.RO_DISC]

Block:

CAPI_Front

Variable Name:

DIAL

Info Pane:
Respondent Name:
Respondent Address:
/
Contact Name:
Contact Address:

♦

[Fill: RESPNAME]
[Fill: ADDRESS1]
[Fill: CPNAME]
[Fill: CPADD1
CPADD2
CPPO, CPST, CPZP5-CPZP4]

Dial this number:
([Fill: AREA]) [Fill: PREFIX]-[Fill: SUFFIX], ext. [Fill: EXTN] ([Fill: PHTYP’s description]) /
[Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT’s description])

 1. Someone answers
 2. Enter new telephone number
 3. Reinterview noninterview
 4. Quit - Attempt later

31

Skip Instructions:

<1>

<2>
<3>

If (ORIOUT_RSLT = INT and RESPNAME empty)
then [go to CAPI_Front.HELLO_TCX].
If (ORIOUT_RSLT = INT)
then [go to CAPI_Front.HELLO_TC].
If (CPNAME empty) then [go to CAPI_Front.HELLO_TNX].
Else [go to CAPI_Front.HELLO_TN].
[go to CAPI_Front._INTRO_].
[go to CAPI_Back.STATUS_RI].

Block:

CAPI_Front

Variable Name:

_INTRO_

Info Pane:
♦

Enter 1 to update the telephone number.

Enter a text of at most 1 characters

Skip Instructions: <1> If (ORIOUT_RSLT = INT) then [go to
CAPI_Front.NEWNUMBER_A].
Else [go to CAPI_Front.NEWNUMBER_CP].

Block:

CAPI_Front

Variable Name:

NEWNUMBER_A

Info Pane:
♦

Record new number.

In Area Code: [Fill: AREA]
♦ Edit area code or press Enter for same.
New Number: [Fill: PREFIX]-[Fill: SUFFIX]
EXT: [Fill: EXTN]
Enter a text of at most 3 characters

Skip Instructions:

<100 - 999>

[go to CAPI_Front.NEWNUMBER_P].

Block:

CAPI_Front

Variable Name:

NEWNUMBER_P

32

Info Pane:
♦

Record new number.

In Area Code: [Fill: NEWNUMBER_A]
New Number: [Fill: PREFIX]-[Fill: SUFFIX]
EXT: [Fill: EXTN]

♦

Edit prefix or press Enter for same.

Enter a text of at most 3 characters

Skip Instructions:

<100 - 999>

[go to CAPI_Front.NEWNUMBER_S].

Block:

CAPI_Front

Variable Name:

NEWNUMBER_S

Info Pane:
♦

Record new number.

In Area Code: [Fill: NEWNUMBER_A]
New Number: [Fill: NEWNUMBER_P]-[Fill: SUFFIX] ♦ Edit suffix or press Enter for same.
EXT: [Fill: EXTN]
Enter a text of at most 4 characters

Skip Instructions:

<0000 - 9999>

Block:

CAPI_Front

Variable Name:

NEWNUMBER_E

Info Pane:

[go to CAPI_Front.NEWNUMBER_E].

33

♦

Record new number.

In Area Code:
New Number:
EXT:

[Fill: NEWNUMBER_A]
[Fill: NEWNUMBER_P]-[Fill: NEWNUMBER_S]
[Fill: EXTN] ♦ Edit extension or press Enter for same.

Enter a text of at most 5 characters

Skip Instructions:

<00000 - 99999, blank>

Block:

CAPI_Front

Variable Name:

NEWNUMBER_CP

[go to CAPI_Front._END_]

Info Pane:
♦

Record new number.

New Number: [Fill: CPPHON]
EXT: [Fill: CPEXT]

♦

Edit phone number or press Enter for same.

Enter the 10-digit phone number, using no hyphens (-).

Skip Instructions:

<1001000000 - 9999999999> [go to CAPI_Front.NEWNUMBER_CE].

Block:

CAPI_Front

Variable Name:

NEWNUMBER_CE

Info Pane:
♦

Record new number.

New Number: [Fill: NEWNUMBER_CP]
EXT: [Fill: CPEXT] ♦ Edit extension or press Enter for same.
Enter a text of at most 5 characters

Skip Instructions:

<00000 - 99999, blank>

Block:

CAPI_Front

[go to CAPI_Front._END_].

34

Variable Name:

_END_

Info Pane:
♦

Enter 1 to go back to Dial screen.

♦

You may have to press Enter twice to update the phone number entries.

 1. Redial.
Skip Instructions:

<1>

[go to CAPI_Front.DIAL].

Block:

CAPI_Front

Variable Name:

CKSUP

Info Pane:
♦

Contact your supervisor for authorization before conducting a personal visit.

 1. Personal visit reinterview authorized
 2. Quit - Attempt later

Skip Instructions:

<1>

<2>

If ORIOUT_RSLT = A) then [go to CAPI_Front.VERTYPEA]
If (ORIOUT_RSLT = INT and RESPNAME empty)
then [go to CAPI_Front.HELLO_PCX].
If (ORIOUT_RSLT = INT) then [go to CAPI_Front.HELLO_PC].
If (BYOBS = 1) then [go to CAPI_Front.VERBYOBS].
If (CPNAME = empty) then [go to CAPI_Front.HELLO_PNX].
Else [go to CAPI_Front.HELLO_PN].
[go to CAPI_Back.WRAP_UP].

Block:

CAPI_Front

Variable Name:

HELLO_TC

Info Pane:

35

Hello, I'm ... from the U.S. Census Bureau.
May I speak to [Fill: RESPNAME]?
 1. This is correct person, or correct person called to the phone.
 2. Person not available now. Call back later.
 3. Person cannot be reached. Speak with another household member.
 4. Person unknown at this number.
 5. Person no longer lives there.
 6. Person deceased.
 7. Person can be reached at another number.
 8. Reinterview Noninterview.

Skip Instructions:
<1>
<2>
<3>
<4>
<5>
<6>
<7>
<8>

[go to CAPI_Front.INTRO_TC].
[go to CAPI_Back.APPT2].
If (RPROXY_A = 1) then [go to CAPI_Front.HHMEM].
Else [go to CAPI_Back.THANK_YOU]
[go to CAPI_Front.VERTELE].
If (RPROXY_A = 1)then [go to CAPI_Front.HHMEM].
Else [go to CAPI_Back.THANK_YOU]
[go to CAPI_Back.THANK_REF].
[go to CAPI_Front._INTRO_].
[go to CAPI_Back.STATUS_RI]

Block:

CAPI_Front

Variable Name:

HELLO_TCX

Info Pane:
Hello. This is ... from the U.S. Census Bureau.
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.

36

Skip Instructions:
<1>
<2>
<3>

[go to CAPI_Front.ADDVER].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

VERTELE

Info Pane:
Have I reached area code [Fill: (AREA) PREFIX-SUFFIX, ext. EXTN] /
[CPPHON, ext. CPEXT]?
 1. Yes
 2. No
 3. Refused to verify

Skip Instructions:

<1>
<2>
<3>

If (HELLO_TC = 4 ) [go to CAPI_Front.ADDVER].
Else if (HELLO_TN = 3) [go to CAPI_Front.ADDVER_N].
[go to CAPI_Front.WRNUM].
[go to CAPI_Front.REFNUM].

Block:

CAPI_Front

Variable Name:

INTRO_TC

Info Pane:
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our interviewers
are following correct procedures.
Is your address: [Fill:

ADDRESS1]?

 1. Yes
 2. No
 3. Refused to verify Address

Skip Instructions:

<1, 2, 3>

Block:

CAPI_Front

[go to CAPI_Middle.RIRESP].

37

Variable Name:

WRNUM

Info Pane:
I'm sorry. I must have dialed incorrectly. I'll try again.
♦

Enter 1 to go back to Dial screen.

♦

You may have to press Enter twice to go back to Dial screen.

 1. Redial.

Skip Instructions:

<1>

[go to CAPI_Front.DIAL].

Block:

CAPI_Front

Variable Name:

REFNUM

Info Pane:
I'm sorry. I'll dial again to be sure I've dialed correctly.
 1. After several attempts, wrap up case.
 2. Redial

Skip Instructions:

<1>
<2>

[go to CAPI_Back.THANK_REF].
[go to CAPI_Front.DIAL].

Block:

CAPI_Front

Variable Name:

HELLO_TN

Info Pane:
Hello, I’m... from the U.S. Census Bureau.
May I speak to [Fill: CPNAME]?
 1. This is correct person, or correct person called to the phone.
 2. Person not available now.
 3. Person unknown at this number.
 4. Person no longer lives there.
 5. Person deceased.
 6. Person can be reached at another number.
 7. Reinterview Noninterview

38

Skip Instructions:

<1>
<2, 4>
<3>
<5>
<6>
<7>

[go to CAPI_Front.INTRO_TN].
[go to CAPI_Front.PROX_N].
[go to CAPI_Front.VERTELE].
[go to CAPI_Back.THANK_REF].
[go to CAPI_Front._INTRO_].
[go to CAPI_Back.STATUS_RI].

Block:

CAPI_Front

Variable Name:

REFNUM

Info Pane:
I'm sorry. I'll dial again to be sure I've dialed correctly.
 1. After several attempts, wrap up case.
 2. Redial

Skip Instructions:

<1>
<2>

[go to CAPI_Back.THANK_REF].
[go to CAPI_Front.DIAL].

Block:

CAPI_Front

Variable Name:

HELLO_TN

Info Pane:
Hello, I’m... from the U.S. Census Bureau.
May I speak to [Fill: CPNAME]?
 1. This is correct person, or correct person called to the phone.
 2. Person not available now.
 3. Person unknown at this number.
 4. Person no longer lives there.
 5. Person deceased.
 6. Person can be reached at another number.
 7. Reinterview Noninterview

Skip Instructions:

<1>
<2, 4>
<3>
<5>
<6>
<7>

[go to CAPI_Front.INTRO_TN].
[go to CAPI_Front.PROX_N].
[go to CAPI_Front.VERTELE].
[go to CAPI_Back.THANK_REF].
[go to CAPI_Front._INTRO_].
[go to CAPI_Back.STATUS_RI].

39

Block:

CAPI_Front

Variable Name:

VERTYPEA

Info Pane:
This case was a Type A in the original interview.
♦

Please use any available resource to check that the original outcome was:

[Fill: ORIOUT’s description] [Fill: “-” TYPEA_SP / blank] on [Fill: INTDATE].
 1. Original outcome was correct.
 2. Original outcome was incorrect.
 3. Reinterview Noninterview.
 4. Quit - Attempt later.

Skip Instructions:

<1>
<2>

<3>
<4>

[go to CAPI_Back.READYWRAP]
If (DISCREPANCY [1] = 1 or DISCREPANCY [5] = 5 or
DISCREPANCY [10] = 10) then [go to CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF]
[go to CAPI_Back.NONINT]
[go to CAPI_Back.WRAP_UP]

Block:

CAPI_Front

Variable Name:

INTRO_TN

Info Pane:

Block:

CAPI_Front

Variable Name:

HELLO_TNX

Info Pane:
Hello. I'm ... from the U.S. Census Bureau.
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your location
to verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?

40

 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:

<1>
<2>
<3>

[go to CAPI_Middle.CONTACT_N].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.APPT].

Thank you for recently helping us verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our interviewers
are following correct procedures.
♦ Enter 1 to continue.
 1. Continue

Skip Instructions:

<1>

[go to CAPI_Middle.CONTACT_N].

Block:

CAPI_Front

Variable Name:

HELLO_PC

Info Pane:
Hello. I’m ... from the U.S. Census Bureau.
Here is my identification card.
♦

Show ID card.

May I speak to [FILL: RESPNAME]?
 1. Correct person available.
 2. Person not available now.
 3. Person unknown at this address.
 4. Person no longer lives there.
 5. Person deceased.
 6. No one lives at this address.
 7. Reinterview Noninterview.

41

Skip Instructions:

<1>
<2>

[go to CAPI_Front.INTRO_PC].
If (RPROXY_A = 1) then [go to CAPI_Front.HHMEM].
Else If (RPROXY_A = 0) then [go to CAPI_Front.APPT2].
<3> [go to CAPI_Front.ADDVER].
<4> If (RPROXY_A = 1) then [go to CAPI_Front.HHMEM].
Else [go to CAPI_Back.THANK_YOU]
<5> [go to CAPI_Back.THANK_REF].
<6, 7> [go to CAPI_Back.STATUS_RI].

Block:

CAPI_Front

Variable Name:

HELLO_PCX

Info Pane:
Hello, I'm ... from the U.S. Census Bureau. Here is my identification card.
♦

Show ID card.

Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
 4. No one lives at this address.
Skip Instructions:

<1>
[go to CAPI_Front.ADDVER].
<2, 4> [go to CAPI_Back.STATUS_RI].
<3>
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

INTRO_PC

Info Pane:
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
Is your address: [Fill:

ADDRESS1]?

42

 1. Yes
 2. No
 3. Refused to verify address

Skip Instructions:

<1, 2, 3>

[go to CAPI_Middle.RIRESP].

Block:

CAPI_Front

Variable Name:

HELLO_PCX

Info Pane:
Hello, I'm ... from the U.S. Census Bureau. Here is my identification card.
♦

Show ID card.

Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
 4. No one lives at this address.
Skip Instructions:

<1>
[go to CAPI_Front.ADDVER].
<2, 4> [go to CAPI_Back.STATUS_RI].
<3>
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

INTRO_PC

Info Pane:
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
Is your address: [Fill:

ADDRESS1]?

43

 1. Yes
 2. No
 3. Refused to verify address

Skip Instructions:

<1, 2, 3>

Block:

CAPI_Front

Variable Name:

HELLO_PN

[go to CAPI_Middle.RIRESP].

Info Pane:
Hello. I’m... from the U.S. Census Bureau.
Here is my identification card.
♦

Show ID card.

May I speak to [Fill: CPNAME]?
 1. Correct person available.
 2. Person not available now.
 3. Person unknown at this address.

Skip Instructions:

<1>
<2, 4>
<3>
<5>
<6>

Block:

CAPI_Front

Variable Name:

HELLO_PNX

 4. Person no longer lives there.
 5. Person deceased.
 6. Reinterview Noninterview.

[go to CAPI_Front.INTRO_PN].
[go to CAPI_Front.PROX_N].
[go to CAPI_Front.ADDVER_N].
[go to CAPI_Back.THANK_REF].
[go to CAPI_Back.STATUS_RI].

Info Pane:
Hello, I’m... from the U.S. Census Bureau. Here is my identification card.
♦

Show ID card.

Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted this location to
verify the status of:
[Fill: ADDRESS1]
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.

44

Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:

<1>
<2>
<3>

[go to CAPI_Middle.CONTACT_N].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

ADDVER

Info Pane:
I need to verify that the address [Fill: “here” / “there”] is:
[Fill: ADDRESS1]
 1. Same Address.
 2. Not same Address.
 3. Refused to verify.

Skip Instructions:
<1>

<2>
<3>

If HELLO_TC = 4 or HELLO_PC = 3
then go to CAPI_Front.HHMEM]
Else [go to RIRESP]
[go to CAPI_Back.THANK_SORRY]
[go to CAPI_Back.THANK_REF]

Block:

CAPI_Front

Variable Name:

INTRO_PN

Info Pane:
Thank you for recently helping us verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
♦

Enter 1 to continue.

 1. Continue

45

Skip Instructions:

[go to CAPI_Middle.CONTACT_N].

Block:

CAPI_Front

Variable Name:

VERBYOBS

Field Description:

Type B/C noninterview by observation

Block:

CAPI_Front

Variable Name:

HHMEM

Info Pane:
Perhaps you can help me.
Are you a household member [Fill: “who is” MIN_AGE “years or older” / blank]?
 1. Yes
 2. No

Skip Instructions:

<1>

If (HELLO_TC = 4 or HELLO_PC = 3) then
[go to CAPI_Front.PROX_UC].
Else [go to CAPI_Front.PROX_C].
<2, R> [go to CAPI_Front.HHMEM2].

Block:

CAPI_Front

Variable Name:

HHMEM2

Info Pane:
Is there a household member present I may speak to [Fill: “who is” MIN_AGE “years or older” /
blank]?
 1. Yes
 2. No

Skip Instructions:
<1>

If (HELLO_TC = 4 or HELLO_PC = 3) then
[go to CAPI_Front.PROX_UC].
Else [go to CAPI_Front.PROX_C].
<2, R> [go to CAPI_Back.THANK_NOHH].

46

Block:

CAPI_Front

Variable Name:

PROX_C

Info Pane:
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:
<1>
<2, R>
<3>

[go to CAPI_Front.ADDVER].
If (HELLO_PC = 2) then [go to CAPI_Back.APPT2].
Else [go to CAPI_Back.THANK_YOU].
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

PROX_N

Info Pane:
Perhaps you can help me.
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted this location to
verify the status of :
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No

Skip Instructions:
<1> [go to CAPI_Middle.CONTACT_N].
<2> If (HELLO_PN = 2 or HELLO_TN = 2) then [go to
CAPI_Back.APPT2].

47

If (HELLO_PN = 4 or HELLO_TN = 4)
then [go to CAPI_Back.THANK_YOU].

Block:

CAPI_Front

Variable Name:

PROX_UC

Info Pane:
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Skip Instructions:
<1>
<2>
<3>

[go to CAPI_Front.LIVEHERE].
[go to CAPI_Back.RI_OUTCM].
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

LIVEHERE

Info Pane:
Were you living here on [Fill: INTDATE]?
 1. Yes
 2. No
 3. Inconvenient time. Try again later (make an appointment).

Skip Instructions:

Block:

<1>
<2, D>
<3>

[go to CAPI_Middle.RIRESP].
[go to CAPI_Middle.SOMEONE_ELSE ]
[go to CAPI_Back.APPT]
[go to CAPI_Back.THANK_REF]

CAPI_Front

48

Variable Name:

ADDVER_N

Info Pane:
Perhaps you can help me.
I’m trying to find out information about:
[Fill:

ADDRESS1]

Can you or someone else help me?
 1. Yes
 2. Inconvenient time, call back later.
 3. No, but I have the phone number of someone who can.
 4. No.

Skip Instructions:

<1>
<2>
<3>
<4>

[go to CAPI_Front.PROX_UN].
[go to CAPI_Back.APPT].
[go to CAPI_Front._INTRO_].
[go to CAPI_Back.THANK_YOU]

Block:

CAPI_Front

Variable Name:

PROX_UN

Info Pane:
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted someone [Fill:
NUM_HERE] to verify the status of:
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
 1. Continue

Skip Instructions:

<1>

Block:

CAPI_Middle

Variable Name:

RIRESP

Info Pane:

[go to CAPI_Middle.CONTACT_N].

49

Line No.

Name

Relationship

Age

Sex

HH_INFO1

HH_INFO2

HH_INFO3

[Fill:
LNO]

[Fill:
FNAME
LNAME]

[Fill: REL]

[Fill: AGE]

[Fill: SEX]

[Fill:
HH_FILL1]

[Fill:
HH_FILL2]

[Fill:
HH_FILL3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦ Ask if necessary
♦ With whom am I speaking?
♦ Enter line of person you are speaking to ot (0) if person is not on roster.

Skip Instructions: <0 - maximum line number>

Block:

CAPI_Middle

Variable Name:

RIRESPB_RI_CT

If (MODE = 1 and NEWRESP = 1 and
INTROB_RI_CT ne 3) OR
(LIVEHERE_CT = 1 and
INTROB_RI_CT ne 3)
then [go to CAPI_Middle.RIRESPB_RI_CT]
Else [go to CAPI_Middle.CONTACT_C].

Info Pane:
This call may be recorded for quality assurance. Do I have permission to record this
call?
♦

If the respondent does not wish to be recorded:
- Click on the NICE stop recording button.
- Read: I appreciate your concern. I am turning off the recording.

 1. Continue
 2. Inconvenient time; schedule an appointment to callback.
 3. No; recording is turned off. Continue interview
Skip Instructions:

<1,3> If (CONTACT_N=1 or CONTACT_C=1) then [go to
middle.PROX_PRESENT].
<2> [go to Show_Ctrl].

Block:

CAPI_Middle

50

Variable Name:

CONTACT_C

Info Pane:
Did an interviewer contact you on or about [Fill: INTDATE] ] and ask questions about [Fill:
CONTACT_C_INFO1]?
 1. Yes
 2. No

Skip Instructions:

<1>

If MODE=1 and (INTROB_RI_CT = empty OR
NEWRESP = 1) then [go to
CAPI_Middle.RIRESPB_RI_CT]
Else if (PROX_C = 1) OR (PROX_UC =1) OR
(HELLO_TCX =1) OR (HELLO_PCX = 1) OR
(PROX_C_CT = 1) OR (PROX_UC_CT =1)
then [go to CAPI_Middle.PROX_PRESENT].
Else [go to CAPI_Middle.ORMODE].

<2, D>

If (PROX_UC_CT = 1 and LIVEHERE_CT = 1) then
[go to to CAPI_Middle.RIRESPB_RI_CT]
Else [go to CAPI_Middle.SOMEONE_ELSE].

Block:

CAPI_Middle

Variable Name:

ORMODE

Info Pane:
Did the interviewer conduct the interview in person or over the telephone?
 1. Personal visit only
 2. Telephone call only
 3. Both - Interviewer visited and called

Skip Instructions:

<1, 3, D>

[go to CAPI_Middle.POLITE].

<2>

If (CONTACT_C = 1 and PV_ONLY = Yes)
then [go to CAPI_Middle.PHONE_REQUEST]
Else [go to CAPI_Middle.POLITE].

Block:

CAPI_Middle

Variable Name:

PHONE_REQUEST

51

Info Pane:
 1. Yes
 2. No - Telephone interview requested by interviewer

Skip Instructions:

<1, 2, D, R >

Block:

CAPI_Middle

Variable Name:

POLITE

[go to POLITE]

Info Pane:

Was the interviewer polite and professional?
 1. Yes
 2. No

Skip Instructions:

<1, D, R >

<2>

Block:

CAPI_Middle

If (CONTACT_C = 1)
then [go to CAPI_Middle.LENGTH_H].
If (ORMODE = 1 or 3) then [go to CAPI_Middle.LAPTOP]
If (ORIOUT_RSLT = B2 or C2)
then [go to CAPI_Middle.STAT_PROBE].
If (ORIOUT_RSLT = B1 or C1)
then [go to CAPI_Middle.STATUS].
Else If VACANT_INT = Yes
then [go to CAPI_Middle.VACANT]
[go to CAPI_Middle.PO_NOTES].

52

Variable Name:

PO_NOTES

Info Pane:
♦

Enter comments from the reinterview respondent here.

Skip Instructions:

If (CONTACT_C = 1) then [go to CAPI_Middle.LENGTH_H].
Else if (ORMODE = 1 or 3) then [go to CAPI_Middle.LAPTOP].
Else if (ORIOUT_RSLT = B2 or C2) then
[go to CAPI_Middle.STAT_PROBE].
IF (ORIOUT_RSLT = B1 or C1) then [go to CAPI_Middle.STATUS].
Else If VACANT_INT = Yes then [go to CAPI_Middle.VACANT]

Block:

CAPI_Middle

Variable Name:

LENGTH_H

Info Pane:
About how long did the interview last?
____ hours
♦

____ min.

If no hours, enter 0.

Block:

CAPI_Middle

Variable Name:

POLITE

Info Pane:

Was the interviewer polite and professional?
 1. Yes
 2. No

Skip Instructions:

<1, D, R >

If (CONTACT_C = 1)
then [go to CAPI_Middle.LENGTH_H].
If (ORMODE = 1 or 3) then [go to CAPI_Middle.LAPTOP]
If (ORIOUT_RSLT = B2 or C2)
then [go to CAPI_Middle.STAT_PROBE].
If (ORIOUT_RSLT = B1 or C1)
then [go to CAPI_Middle.STATUS].

53

<2>

Block:

CAPI_Middle

Variable Name:

PO_NOTES

Else If VACANT_INT = Yes
then [go to CAPI_Middle.VACANT]
[go to CAPI_Middle.PO_NOTES].

Info Pane:
♦

Enter comments from the reinterview respondent here.

Skip Instructions:

If (CONTACT_C = 1) then [go to CAPI_Middle.LENGTH_H].
Else if (ORMODE = 1 or 3) then [go to CAPI_Middle.LAPTOP].
Else if (ORIOUT_RSLT = B2 or C2) then
[go to CAPI_Middle.STAT_PROBE].
IF (ORIOUT_RSLT = B1 or C1) then [go to CAPI_Middle.STATUS].
Else If VACANT_INT = Yes then [go to CAPI_Middle.VACANT]

Block:

CAPI_Middle

Variable Name:

LENGTH_H

Info Pane:
About how long did the interview last?
____ hours
♦

____ min.

If no hours, enter 0.

Skip Instructions:

<0 - 9>

[go to CAPI_Middle.LENGTH_M].
If (ORMODE = 1 or 3) then [go to CAPI_Middle.LAPTOP]

.
Else [go to CAPI_Middle.ROSTER_1].

Block:

CAPI_Middle

Variable Name:

LENGTH_M

Info Pane:

54

About how long did the interview last?
[Fill: LENGTH_H] hours ________________ minutes

Skip Instructions:

<0 - 90>

Block:

CAPI_Middle

Variable Name:

LAPTOP

If (ORMODE = 1 or 3) then [go to CAPI_Middle.LAPTOP].
Else [go to CAPI_Middle.ROSTER_1].

Info Pane:
Did the interviewer use a laptop computer?
 1. Yes
 2. No

Skip Instructions:
<1, 2, D, R > If (CONTACT_C = 1) then [go to API_Middle.ROSTER_1].
If (ORIOUT_RSLT = B2 or C2) then
[go to CAPI_Middle.STAT_PROBE].
If (ORIOUT_RSLT = B1 or C1) then
[go to CAPI_Middle.STATUS].
Else If VACANT_INT = Yes then [go to
CAPI_Middle.VACANT]

Block:

CAPI_Middle

Variable Name:

ROSTER_1

55

Info Pane:
Line No.

Name

Relationship

Age

Sex

HH_INFO1

HH_INFO2

HH_INFO3

[Fill:
LNO]

[Fill:
FNAME
LNAME]

[Fill: REL]

[Fill: AGE]

[Fill: SEX]

[Fill:
HH_FILL1]

[Fill:
HH_FILL2]

[Fill:
HH_FILL3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

Our records indicate that ♦Read above name(s) in blue ♦ [Fill: HH_SIZE] living or staying at
[Fill: ADDRESS1]
on [Fill: INTDATE].
Is this correct?
 1. Yes
 2. No

Skip Instructions:
If ORIOUT <> 501
<1, D, R>
<2>

[go to CAPI_Middle.ROSTER_1A].
[go to CAPI_Middle.ROSTER_2].

If ORIOUT = 501
<1, D, R>
<2>

[go to CAPI_Middle.ROSTER_3]
[go to CAPI_Middle.ROSTER_2]

Block:

CAPI_Middle

Variable Name:

ROSTER_2

Info Pane:
Line No.

Name

Relationship

Age

Sex

HH_INFO1

HH_INFO2

HH_INFO3

[Fill:
LNO]

[Fill:
FNAME
LNAME]

[Fill: REL]

[Fill: AGE]

[Fill: SEX]

[Fill:
HH_FILL1]

[Fill:
HH_FILL2]

[Fill:
HH_FILL3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦ Enter the line number of the household member(s) (above name(s) in blue) who wasn’t/weren’t
living or staying at the household on [Fill: INTDATE].
List of line numbers from household roster.

56

Skip Instructions:
<1 - maximum line number> [go to CAPI_Middle.ROSTER_1A].
<1 - maximum line number> and ORIOUT = '501' [go to CAPI_Middle.ROSTER_3].

Block:

CAPI_Middle

Variable Name:

ROSTER_1A

Info Pane:
Line No.

Name

Relationship

Age

Sex

HH_INFO1

HH_INFO2

HH_INFO3

[Fill:
LNO]

[Fill:
FNAME
LNAME]

[Fill: REL]

[Fill: AGE]

[Fill: SEX]

[Fill:
HH_FILL1]

[Fill:
HH_FILL2]

[Fill:
HH_FILL3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

I would also like to verify that we recorded each persons age correctly.
♦Read above name(s) and age(s) in blue ♦
 1. Yes
 2. No

Skip Instructions:

<1, D, R>
<2>

Block:

CAPI_Middle

Variable Name:

ROSTER_1B

[go to CAPI_Middle.ROSTER_3].
[go to CAPI_Middle.ROSTER_1B].

Info Pane:
Line No.

Name

Relationship

Age

Sex

HH_INFO1

HH_INFO2

HH_INFO3

[Fill:
LNO]

[Fill:
FNAME
LNAME]

[Fill: REL]

[Fill: AGE]

[Fill: SEX]

[Fill:
HH_FILL1]

[Fill:
HH_FILL2]

[Fill:
HH_FILL3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦ Enter correct age for each person on the roster with an incorrect age ♦
Enter Corrected Age
 1. Yes
 2. No

Skip Instructions:

<0-999> if another person on roster with DCODE = 0
[go to CAPI_Middle.ROSTER_1B]
Else [go to CAPI_Middle.ROSTER_3].

57

Block:

CAPI_Middle

Variable Name:

ROSTER_3

Info Pane:
Line No.

Name

Relationship

Age

Sex

HH_INFO1

HH_INFO2

HH_INFO3

[Fill:
LNO]

[Fill:
FNAME
LNAME]

[Fill: REL]

[Fill: AGE]

[Fill: SEX]

[Fill:
HH_FILL1]

[Fill:
HH_FILL2]

[Fill:
HH_FILL3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

Have I missed any household member who [Fill: ROSTER_INFO1]
 1. Yes
 2. No

Skip Instructions: <1> [go to CAPI_Middle.ROSTER_4].
<2, D, R> [go to CAPI_Middle.SURVEY_SPECIFIC].

Block:

CAPI_Middle

Variable Name:

ROSTER_4

Info Pane:
Line No.

Name

Relationship

Age

Sex

HH_INFO1

HH_INFO2

HH_INFO3

[Fill:
LNO]

[Fill:
FNAME
LNAME]

[Fill: REL]

[Fill: AGE]

[Fill: SEX]

[Fill:
HH_FILL1]

[Fill:
HH_FILL2]

[Fill:
HH_FILL3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦ Enter the name of each Missing household member who [Fill: ROSTER_INFO1]
♦

Press Enter after each name and again after last name to continue.

Skip Instructions:

[go to CAPI_Middle.SURVEY_SPECIFIC]

Block:

CAPI_Middle

58

Variable Name:

SURVEY_1

Info Pane:
Did the interviewer ask questions about the total number of rooms and bedrooms in this unit?
 1. Yes
 1. No

Skip Instructions:

<1, 2, D, R>

Block:

CAPI_Middle

Variable Name:

SURVEY_2

[go to CAPI_Middle.SURVEY_2]

Info Pane:
Now think about each person who lives in this unit who is at least 15 years old. Did the interviewer ask
questions about income for each of the people?
 1. Yes
 1. No

Skip Instructions:

Block:

<1, 2, D, R> [go to CAPI_Back.THANK_YOU]

CAPI_Middle

59

Variable Name:

PROX_PRESENT

Info Pane:
Were you present during the original interview?
 1. Yes
 2. No

Skip Instructions:

<1> [go to CAPI_Middle.ORMODE].
<2, D, R> If (CONTACT_C = 1) then [go to APPT2]
If (ORIOUT_RSLT = B2 or C2) then [go to
CAPI_Middle.STAT_PROBE].
If (ORIOUT_RSLT = B1 or C1) then [go to
CAPI_Middle.STATUS]
Else If VACANT_INT = YES then [go to CAPI_Middle.VACANT]

Block:

CAPI_Middle

Variable Name:

SOMEONE_ELSE

Info Pane:
Could the interviewer have spoken to another person [Fill: AT_ABOUT]
[Fill:

ADDRESS1]

 1. Yes
 2. No
Skip Instructions:
<1>
<2, D, R >

[go to CAPI_Middle.SPEAKTO].
If (CONTACT_C = (2 or D) and RIRESP ≠ 0)
then [go to THANK_YOU]
If [LIVEHERE = (2 or D) and SPEAKTO = empty] OR
[LIVEHERE_CT= (2 or D) and SPEAKTO = empty] OR
[LIVEHERE =(2 or D) and SPEAKTO = 1 and CONTACT_N = (2 or D)
OR [LIVEHERE_CT = (2 or D) and SPEAKTO = 1 and
CONTACT_N = (2 or D)] then [go to CAPI_Back.THANK_YOU].
If (RIRESP = 0) then [go to THANK_YOU]
If (ORIOUT_RSLT = B2 or C2) then
[go to CAPI_Middle.STAT_PROBE].
If (ORIOUT_RSLT = B1 or C1) then [go to CAPI_Middle.STATUS].
Else if VACANT_INT = YES [go to CAPI_Middle.VACANT]

Block:

CAPI_Middle

Variable Name:

SPEAKTO

60

Info Pane:
May I speak to that person?
 1. Yes
 2. No

Skip Instructions:

<1>

<2, R,D>

If [(CONTACT_C = 2 or D) then [go to
CAPI_Middle.RIRESP].
Else [go to CAPI_Middle.CONTACT_N].
If (MODE=0 and LIVEHERE=(2 or D) and
SOMEONE_ELSE=1) then [go to CAPI_Back.APPT].
If (MODE=1 and LIVEHERE_CT=(2 or D) and
SOMEONE_ELSE=1) then [go to APPT_CT].
If (RIRESP = 0) then [go to THANK_NOHH]
If (CONTACT_C = (2 or D) and RIRESP ≠ 0)
then [go to THANK_REF]
If (ORIOUT_RSLT = B2 or C2) then
[go to CAPI_Middle.STAT_PROBE].
If (ORIOUT_RSLT = B1 or C1) then [go to
CAPI_Middle.STATUS].
If VACANT_INT = YES then [go
to CAPI_Middle.VACANT]

Block:

CAPI_Middle

Variable Name:

CONTACT_N
OR (INTRO_TN_CT = 1 and INTROB_RI_CT = (1 or 3))
OR (PROX_N_CT = 1 and INTROB_RI_CT = (1 or 3))
OR (HELLO_TN_CT = 3 and PROX_UN_CT = 1 and INTROB_RI_CT = (1 or
3))

Info Pane:
Did an interviewer visit or call regarding:
[Fill: ADDRESS1]?
 1. Yes
 2. No

61

Skip Instructions:

<1>

If MODE=1 and (INTROB_RI_CT=empty or NEWRESP = 1) then
[go to CAPI_Middle.RIRESPB_RI_CT]
Else if (PROX_N = 1) OR (PROX_UN = 1) OR
(HELLO_TNX = 1) OR (HELLO_PNX = 1) OR (PROX_N_CT = 1)
OR (PROX_UN_CT = 1) OR (PROX_UC=1)
then [go to CAPI_Middle.PROX_PRESENT].
Else [go to CAPI_Middle.ORMODE].
<2, D> If (ORIOUT_RSLT = B2 or C2) then
[go to CAPI_Middle.STAT_PROBE].
Else if (ORIOUT_RSLT = (B1 or C1)) then
[go to CAPI_Middle.STATUS].
Else [go to CAPI_Middle.SOMEONE_ELSE].

Block:

CAPI_Middle

Variable Name:

VACANT

Info Pane:
Was
[Fill:

ADDRESS1]

vacant on [Fill: INTDATE]?
 1. Yes
 2. No

Skip Instructions:

<1>
<2>

Block:

CAPI_Middle

Variable Name:

STAT_VER

[go to CAPI_Middle.SURVEY_SPECIFIC]
[go to STAT_PROB2]
[go to STAT_VER]

Info Pane:
Is there someone present I could speak with who could tell me the status of
[Fill:

ADDRESS1]

on or about [Fill: INTDATE]?
 1. Yes
 2. No

Skip Instructions:

<1>
<2, D, R>

[go to CAPI_Middle.SPEAKTO2]
[go to CAPI_Back.THANK_YOU]

62

Block:

CAPI_Middle

Variable Name:

SPEAKTO2

Info Pane:
May I speak to that person?
 1. Yes
 2. No

Skip Instructions:

<1>
<2, D, R>

Block:

CAPI_Middle

Variable Name:

VACANT2

[go to CAPI_Middle.VACANT2]
[go to CAPI_Back.THANK_YOU]

Info Pane:
Hello, I’m ... from the U.S. Census Bureau.
Our records show that one of our interviewers [Fill : , FR_NAME,], recently contacted this location to
verify the status of:
[Fill: ADDRESS1]
We’re doing a short quality control check to make sure that our interviewers are following
correct procedures.
Was
[Fill:

ADDRESS1]

vacant on [Fill: INTDATE]?
 1. Yes
 2. No

Skip Instructions:

<1>
<2>

Block:

CAPI_Middle

[go to CAPI_Back.THANK_YOU]
[go to CAPI_Middle.STAT_PROB2]
[go to CAPI_Middle.STAT_VER]

63

Variable Name:

STATUS

Info Pane:
Our records show that on [Fill: INTDATE],
[Fill:

ADDRESS1]

was [Fill: ORIOUT’s description].
Is this information correct?
 1. Yes
 2. No

Skip Instructions:

<1, D> [go to CAPI_Back.THANK_YOU].
<2, R> [go to CAPI_Middle.STAT_PROB2].

Block:

CAPI_Middle

Variable Name:

STAT_PROBE

Info Pane:
Original Outcome:

[Fill: ORIOUT] - [Fill: ORIOUT’s description] “-”
[Fill: TYPEB_SP / TYPEC_SP / blank]

Original Interview Date: [Fill: INTDATE]
What was the status of [Fill: ADDRESS1] on or about [Fill: INTDATE]?
♦

Enter reported status.

♦

Explain any discrepancy between reported status and original outcome.

Skip Instructions:

< text ≤ 240 characters >

Block:

CAPI_Middle

Variable Name:

STAT_PROB2

Info Pane:

[go to CAPI_Back.THANK_YOU].

64

Original Outcome:

[Fill: ORIOUT] - [Fill: ORIOUT’s description] “-”
[Fill: TYPEB_SP / TYPEC_SP / blank]

Original Interview Date: [Fill: INTDATE]
What was the status of
[Fill: ADDRESS1]
on or about [Fill: INDATE]?
♦

Enter reported status.

♦

Explain any discrepancy between reported status and original outcome.

Skip > [go to CAPI_Back.THANK_YOU].

Block:

CAPI_Back

Variable Name:

THANK_SORRY

Field Description:

Thank you for wrong address

Field Definition:
Universe:

[(MODE = 0) and (ADDVER = 2)]
OR [(MODE = 1) and (ADDVER_CT = 2)]

Info Pane:
I'm sorry. I have the wrong address or telephone number. Thank you for your help.
♦ Attempt to contact the correct household now or at a later time.
 1. Continue

Skip Instructions:

<1>

Block:

CAPI_Back

Variable Name:

THANK_YOU

Info Pane:

[go to CAPI_Back.RI_OUTCM].

65

Thank you for your cooperation. You've been very helpful.
♦

Enter 1 to continue.

 1. Continue

Skip Instructions:

<1>

If (SOMEONE_ELSE = (2 or D) and LIVEHERE = (2 or D) and
SPEAKTO = empty) OR
(SOMEONE_ELSE = (2 or D) and LIVEHERE = (2 or D) and
SPEAKTO = 1 and CONTACT_N = (2 or D)) OR
(HELLO_PN = 4 and PROX_N = 2 ) OR
(HELLO_TN = 4 and PROX_N = 2) OR HELLO_TN_CT=4 and
PROX_N_CT=2
then [go to CAPI_Back.STATUS_RI].
Else [go to CAPI_Back.RI_OUTCM].

Block:

CAPI_Back

Variable Name:

THANK_REF

Info Pane:
I’m sorry to have bothered you.
 1. Continue

Skip Instructions:

<1>

Block:

CAPI_Back

Variable Name:

THANK_NOHH

Info Pane:

If (HELLO_PC = 5) OR (HELLO_PN = 5) OR
(HELLO_TC = 6) OR (HELLO_TN=5) OR
(HELLO_TC_CT = 6) OR (HELLO_TN_CT = 5)
then [go to CAPI_Back.NONINT].
Else if (LIVEHERE = R) or (VERTELE_CT = 3) or
(LIVEHERE_CT = R) or (SPEAKTO = 2 and CONTACT_C = (2 or
D) and RIRESP ≠ 0) then [go to CAPI_Back.STATUS_RI].
Else [go to CAPI_Back.RI_OUTCM].

66

Thank you for your help, but I need to speak to a household member. I'll try back later.
♦

Enter 1 to continue.

 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.STATUS_RI].

Block:

CAPI_Back

Variable Name:

APPT

Info Pane:
I'd like to schedule a date to complete the quality check. What Date and Time would be best to
call or visit?
Today is: [Fill: RIDATE].
♦

Enter Date and Time

♦

Enter (1) if you don’t intend to follow up on this case.

Skip Instructions:

<1>

Block:

CAPI_Back

Variable Name:

APPT2

[go to CAPI_Back.RI_OUTCM].
[go to CAPI_Back.CBTHANK].

Info Pane:
What Date and Time would be best to contact
[Fill: RESPNAME /CPNAME, CPTITL] in order to conduct the quality check?
Today is: [Fill: RIDATE]
♦

Enter Date and Time

♦

Enter (1) if you don't intend to follow up on this case.

Skip Instructions:

<1>

[go to CAPI_Back.RI_OUTCM].
[go to CAPI_Back.CBTHANK].

67

Block:

CAPI_Back

Variable Name:

APPT_CT

Info Pane:
♦

Once in WebCATI, set callback appointment. If necessary, ask respondent for best callback date
and time.

 1. Enter 1 to Continue

Skip Instructions:

[go to CATI_Back.SHOW_CTRL]

Block:

CAPI_Back

Variable Name:

CBTHANK

Info Pane:
Thank you for your help.
We will call or visit again at the time suggested.
 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back. WRAP_UP].

Block:

CAPI_Back

Variable Name:

STATUS_RI

Info Pane:
This case is not completed.
♦

If necessary, make M several attempts to contact respondent/contact person before selecting
reinterview noninterview.

 1. Quit - Complete later
 2. Reinterview Noninterview

Skip Instructions: <1>

If (MODE = 0) then [go to CAPI_Back. WRAP_UP].

68

Block:

CAPI_Back

Variable Name:

RI_OUTCM

Info Pane:
Original Outcome:
Original Interview Date:

[FILL: ORIOUT] - [FILL: ORIOUT’s description] “-”
[Fill: TYPEA_SP/TYPEB_SP/TYPEC_SP/blank]
[FILL: INTDATE].

♦ Was the original outcome correct?
 1. Yes
 2. No
 3. Reinterview Noninterview

Skip Instructions:

<1>

<2>

<3>

If DISCREPANCY[6] = 6, then
[go to CAPI_Back.RIOUT_NOTES].
Else if [(DISCREPANCY[1] = 1) or (DISCREPANCY[5] = 5) or
(DISCREPANCY[10] = 10)], then [go to CAPI_Back.FALSIF2].
Else [go to CAPI_Back.FALSIF].
If (ORIOUT_RSLT = VINT) then [go to CAPI_Back.MISC_VINT]
If (ORIOUT_RSLT = (B1 or B2) and VACANT_INT = No)
then [go to CAPI_Back.MISC_B]
If (ORIOUT_RSLT = (B1 or B2) and VACANT_INT = Yes)
then [go to CAPI_Back.MISC_BVINT]
If (ORIOUT_RSLT = (C1 or C2) and VACANT_INT = No)
then [go to CAPI_Back.MISC_C]
If (ORIOUT_RSLT = (C1 or C2) and VACANT_INT = Yes)
then [go to CAPI_Back.MISC_CVINT]
If DISCREPANCY [1] = 1 or DISCREPANCY [5] = 5 or
DISCREPANCY [10] = 10 then [go to CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF]
[go to CAPI_Back.NONINT].

Block:

CAPI_Back

Variable Name:

RIOUT_NOTES

Skip Instructions:

If [(DISCREPANCY[1] = 1) or (DISCREPANCY[5] = 5) or
(DISCREPANCY[10] = 10)], then [go to CAPI_Back.FALSIF2].
Else [go to CAPI_Back.FALSIF].

Block:

CAPI_Back

69

Variable Name:

NONINT

Info Pane:
♦

Which outcome describes this reinterview case?

 1. Type A Noninterview.
 2. Type B Noninterview.
 3. Type C Noninterview.
 4. Type D Noninterview - Household replaced by new household since the original interview.

Skip Instructions:

<1>
<2>
<3>
<4>

[go to CAPI_Back.TYPEA].
If [TYPEB_SPLIT = NO [go to CAPI_Back.TYPEB].
Else [ go to CAPI_Back.TYPEB_ALT]
[go to CAPI_Back.TYPEC].
If [(DISCREPANCY[1] = 1) or (DISCREPANCY[5] = 5) or
(DISCREPANCY[10] = 10)]} then, [go to CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF].

Block:

CAPI_Back

Variable Name:

TYPEA

Info Pane:
♦ Which Type A outcome describes this reinterview case?
 1. Unable to complete, bad telephone number.
 2. Unable to locate/Wrong Address.
 3. No one home.
 4. Temporarily absent.
 5. Refused.
 6. Language problem.
 7. Respondent can’t remember.
 8. Insufficient partial.
 9. Other Type A - Specify in the Reinterview Notes.

Skip Instructions:

<1-9>

If {(MODE=0 or 1) and [(DISCREPANCY[1] = 1) or
(DISCREPANCY[5] = 5) or (DISCREPANCY[10] = 10)]}
[go to CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF].

Block:

CAPI_Back

70

Variable Name:

TYPEB

Info Pane:
♦

Which Type B outcome describes this reinterview case?

 1. Vacant, regular or seasonal.
 2. Vacant, storage of household furniture.
 3. Converted to temporary business or storage.
 4. Unoccupied tent or trailer site.
 5. Unfit, to be demolished.
 6. HH institutionalized or temporarily ineligible.
 7. Entire HH under age [Fill: MIN_AGE].
 8. Temporarily occupied by persons with Usual Residence Elsewhere (URE).
 9. Other Type B - Specify in the Reinterview Notes.

Skip Instructions:

<1 -9>

Block:

CAPI_Back

Variable Name:

TYPEB_ALT

If DISCREPANCY [1] = 1 or DISCREPANCY [5] = 5 or
DISCREPANCY [10] = 10 then [go to
CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF].

Info Pane:
♦

Which Type B outcome describes this reinterview case?

 1. Vacant, regular.
 2. Vacant, seasonal.
 3. Vacant, storage of household furniture.
 4. Converted to temporary business or storage.
 5. Unoccupied tent or trailer site.
 6. Unfit, to be demolished.
 7. HH institutionalized or temporarily ineligible.
 8. Entire HH under age [Fill: MIN_AGE].
 9. Temporarily occupied by persons with Usual Residence Elsewhere (URE), regular.
 10. Temporarily occupied by persons with Usual Residence Elsewhere (URE), seasonal.
 11. Other Type B - Specify in the Reinterview Notes.

Skip Instructions:

<1-11>

If DISCREPANCY [1] = 1 or DISCREPANCY [5] = 5 or
DISCREPANCY [10] = 10 then [go to
CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF]

71

Block:

CAPI_Back

Variable Name:

TYPEC

Info Pane:
♦

Which Type C outcome describes this reinterview case?

 1. Demolished.
 2. House or trailer moved.
 3. Converted to permanent business or storage.
 4. Condemned.
 5. Deceased.
 6. Moved.
 7. Other Type C - Specify in the Reinterview Notes.
 8. Sample adjustment

Skip Instructions:

<1-8>

Block:

CAPI_Back

Variable Name:

MISC_B

If DISCREPANCY [1] = 1 or DISCREPANCY [5] = 5 or
DISCREPANCY [10] = 10 then [go to
CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF].

Info Pane:
♦

Which of the following options describes the misclassification of this original Type B case?

 1. Should have been an Interview or Type A.
 2. Should have been another Type B.
 3. Should have been a Type C.

Skip Instructions:

<1> [go to CAPI_Back.FALSIF2].
<2,3> If {DISCREPANCY[1] = 1) OR (DISCREPANCY[10] = 10}
then [go to CAPI_Back.FALSIF2].
Else [go to CAPI_Back.FALSIF].

Block:

CAPI_Back

Variable Name:

MISC_C

Info Pane:

72

♦

Which of the following options describes the misclassification of this original Type C case?

 1. Should have been an Interview or Type A (occupied at time of interview).
 2. Should have been a Type B.
 3. Should have been another Type C.

Skip Instructions:

<1> [go to CAPI_Back.FALSIF2].
<2,3> If [DISCREPANCY[1] = 1) OR (DISCREPANCY[10] = 10]
then [go to CAPI_Back.FALSIF2].
Else [go to CAPI_Back.FALSIF].

Block:

CAPI_Back

Variable Name:

MISC_VINT

Info Pane:
♦
case?

Which of the following options describes the misclassification of this original vacant interview

 1. Should have been an Interview or Type A.
 2. Should have been a Type B or C.

Skip Instructions:

<1, 2>

If DISCREPANCY [1] = 1 or DISCREPANCY [5] = 5 or
DISCREPANCY [10] = 10 then [go to
CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF]

Block:

CAPI_Back

Variable Name:

MISC_BVINT

Info Pane:
♦

Which of the following options describes the misclassification of this original Type B case?

 1. Should have been an Interview or Type A.
 2. Should have been a vacant interview.
 3. Should have been another Type B.
 4. Should have been a Type C.

Skip Instructions:

<1>

[go to CAPI_Back.FALSIF2]

73

<2,3,4>

If DISCREPANCY [1] = 1 or DISCREPANCY [10] = 10
then [go to CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF]

Block:

CAPI_Back

Variable Name:

MISC_CVINT

Info Pane:
♦

Which of the following options describes the misclassification of this original Type C case?

 1. Should have been an Interview or Type A.
 2. Should have been a vacant interview.
 3. Should have been a Type B.
 4. Should have been another Type C.

Skip Instructions:

<1>
<2,3,4>

Block:

CAPI_Back

Variable Name:

FALSIF

[go to CAPI_Back.FALSIF2]
If DISCREPANCY [1] = 1 or DISCREPANCY [10] = 10
then [go to CAPI_Back.FALSIF2]
Else [go to CAPI_Back.FALSIF]

Info Pane:
[Fill:

“Your reinterview indicates the following discrepancies:”
code and description of each code listed in DISCREPANCY array /
“Your reinterview did not indicate any discrepancies.”]

♦

Do you suspect falsification?

 1. Yes
 2. No
 3. Unable to determine

Skip Instructions:

<1>

If (HELLO_PRB_RI_CT = <1-7>) OR (RI_OUTCM = 2 or 3) OR
(RI_OUTCM = 1 and only one element in DISCREPANCY array
≥1)] then [go to CAPI_Back. READYWRAP].
Else if (RI_OUTCM = 1 and all elements in DISCREPANCY array
blank) then [go to CAPI_Back.NO_DISCREP].
Else if (RI_OUTCM = 1 and two or more elements in
DISCREPANCY array ≥1) then [go to CAPI_Back.SF_RIDISP].

74

<2>

<3>

If(HELLO_PRB_RI_CT = <1-7>) OR
(RI_OUTCM = 1 and all elements in DISCREPANCY array blank)
OR
(RI_OUTCM = 1 and one element in DISCREPANCY array AND
(DISCREPANCY [6] empty) and[(DISCREPANCY[1] empty) and
(DISCREPANCY[5] empty) and (DISCREPANCY[10] empty)] OR
(RI_OUTCM = 2 and ORIOUT_RSLT = (B1, C1, B2, or C2)) OR
(RI_OUTCM = 3) then [go to CAPI_Back READYWRAP].
Else [go to CAPI_Back.DISCREP_NOTES]
If (HELLO_PRB_RI_CT = <1-7>) OR
(RI_OUTCM = 2 and ORIOUT_RSLT = (B1, C1, B2, or C2)) OR
(RI_OUTCM = 3) OR (RI_OUTCM = 2 and ORIOUT_RSLT=INT
and DISCREPANCY[2] = 2 and all other elements in
DISCREPANCY array blank) OR
(RI_OUTCM = 2 and ORIOUT_RSLT=INT and only one element in
DISCREPANCY array ≥1) OR (RI_OUTCM = 1 and all elements in
DISCREPANCY array blank) OR
If (RI_OUTCM = 1 and only one element in DISCREPANCY array
≥1) OR (NONINT = (1, 2, 3, or 4) and RI_OUTCM blank) then
[go to CAPI_Back. READYWRAP].
Else [go to CAPI_Back.NSF_RIDISP].

Block:

CAPI_Back

Variable Name:

FALSIF2

Info Pane:
[Fill: “Your reinterview indicates the following discrepancies:”
code and description of each code listed in DISCREPANCY array]
♦

Falsification is suspected. Be sure to enter all proper notes explaining the situation.

 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.READYWRAP]

Block:

CAPI_Back

Variable Name:

DISCREP_NOTES

Info Pane:
[Fill: DISCREP_NTS]

Skip Instructions:

<1>

If (only one element in array DISCREPANCY ≥ 1)
then [go to CAPI_Back. READYWRAP].
Else [go to CAPI_Back.NSF_RIDISP].

75

Block:

CAPI_Back

Variable Name:

NSF_RIDISP

Info Pane:
Your reinterview detected multiple discrepancies.
♦ Enter the code of the detected discrepancy below which best describes this case.
 2.

You determined that the original status, [Fill: ORIOUT] “–“ [fill: ORIOUT’s description], was
incorrect.
 3. The status of this case was completed by observation in the original interview. You determined
that the original status, [Fill: ORIOUT] - [Fill: ORIOUT’s description from Attachment D] was
incorrect
 4. This case was a Type A in the original interview. You determined that the original status, [Fill:
ORIOUT] - [Fill: ORIOUT’s description from Attachment D], was incorrect.
 6. The reinterview respondent indicated that the original status, [Fill: ORIOUT] - [Fill:
ORIOUT’s description from Attachment D] was incorrect.
 7. The household roster was incorrect.
 8. Not all survey questions were asked in the interview.
 9. The interviewer conducted a telephone interview only instead of a personal visit interview, as
required.
 11. The interviewer entered a bad telephone number for this case.
 12. CU make-up incorrect.
 13. The reinterview respondent said that a diary was not dropped off, which disagrees with the interviewer.
 14. Respondent said CU either a) had expenses for blank diary, b) did not record or have
recalled expenses for completed diary, or c) did not have recalled expenses for Type B- 326
diary, which disagrees with the interviewer.
 15. The reinterview respondent indicated that the original Type B status for Week 1, [Fill
PICK_UP1] - [Fill PICK_UP1's description from Attachment D], was incorrect for a Week 2
interview
 16. The reinterview respondent said the contact person for an original Type B-Temporarily Absent
outcome was not responsible for the care of the residence.

Skip Instructions:

<2-4, 6-9, 11-16>

Block:

CAPI_Back

Variable Name:

RO_DISC

Info Pane:

[go to CAPI_Back.READYWRAP

76

♦ Caution: Obtain supervisor's permission before selecting an option below.
♦ Which of the following options describes this reinterview case?
 1. Hard to interview original case
 2. More than 50 miles from nearest reinterviewer and no phone number
 3. Observed during the original interview
 4. Personal visit needed, but not authorized
 5. Case management or ROSCO problems - Obtain HQ approval
 6. Sample adjustment - Obtain HQ approval
 7. Other RO discretion - Specify in the Reinterview Notes

Skip Instructions:

<1-7> [go to CAPI_Back. READYWRAP].

Block:

CAPI_Back

Variable Name:

NO_DISCREP

Info Pane:
♦

Explain why you suspect falsification in the Reinterview Notes now.

♦

Press Ctrl-F7 to access Reinterview Notes.

♦

Enter 1 when done with your explanation in the Reinterview Notes

 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.READYWRAP]

Block:

CAPI_Back

Variable Name:

SF_RIDISP

77

Info Pane:
Your reinterview detected multiple discrepancies.
♦

Enter the code of the discrepancy below which best describes the primary reason you suspect
falsification.

 2.

You determined that the original status, [Fill: ORIOUT] “–“ [fill: ORIOUT’s description], was
incorrect.
 3. The status of this case was completed by observation in the original interview. You determined
that the original status, [Fill: ORIOUT] - [Fill: ORIOUT’s description from Attachment D] was
incorrect
 4. This case was a Type A in the original interview. You determined that the original status, [Fill:
ORIOUT] - [Fill: ORIOUT’s description from Attachment D], was incorrect.
 6. The reinterview respondent indicated that the original status, [Fill: ORIOUT] - [Fill:
ORIOUT’s description from Attachment D] was incorrect.
 7. The household roster was incorrect.
 8. Not all survey questions were asked in the interview.
 9. The interviewer conducted a telephone interview only instead of a personal visit interview, as
required.
 11. The interviewer entered a bad telephone number for this case.
 12. CU make-up incorrect.
 13. The reinterview respondent said that a diary was not dropped off, which disagrees with the interviewer.
 14. Respondent said CU either a) had expenses for blank diary, b) did not record or have
recalled expenses for completed diary, or c) did not have recalled expenses for Type B- 326
diary, which disagrees with the interviewer.
 15. The reinterview respondent indicated that the original Type B status for Week 1, [Fill
PICK_UP1] - [Fill PICK_UP1's description from Attachment D], was incorrect for a Week 2
interview
 16. The reinterview respondent said the contact person for an original Type B-Temporarily Absent
outcome was not responsible for the care of the residence.

Skip Instructions:

<2-4, 6-9, 11-16>

Block:

CAPI_Back

Variable Name:

READYWRAP

[go to CAPI_Back.READYWRAP]

Info Pane:
This case is complete and ready to be transmitted. [fill: READY]
 1. Continue

Skip Instructions:

<1>

If (MODE = 0) then [go to CAPI_Back.WRAP_UP].
Else if (MODE = 1) then [go to CATI_Back.SHOW_CTRL].

78

Block:

CAPI_Back

Variable Name:

WRAP_UP

Info Pane:
OUTCOME: [fill: OUTCOME]
RI_DISP: [fill: RI_DISP]
 1. Continue

Skip Instructions:

<1>

[exit instrument].

Block:

CAPI_Back

Variable Name:

SHOW_CTRL

Info Pane:
Wc_case_status.Outcome = [fill: OUTCOME]
Wc_case_status.Outcome_subtype = [fill: OUTCOME_SUBTYPE]
Wc_case_status.Mark =
Wc_case_status.Marktwo =
Wc_case_status.Supplement =
 1. Continue

Skip Instructions:

<1>

[exit instrument].

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau ...
The U.S. Census Bureau is conducting the American Community Survey. A Census Bureau
representative will contact you to help you complete the survey. The survey will ask you
questions about your household’s characteristics, including such topics as education,
employment, and housing. I would appreciate your help, because the success of this survey
depends on you.
The American Community Survey produces critical up-to-date information that is used to meet
the needs of communities across the United States. For example, results from this survey
maybe used to decide where new schools, hospitals, and fire stations are needed. Survey
data areused by federal, tribal, state, and local governments to make decisions and to develop
programs that will provide health care, education, and transportation services that affect you
and your community. This survey information also helps communities plan for emergency
situations that might affect you and your neighbors.
The Census Bureau chose your address, not you personally, as part of a randomly selected
sample. You are required by U.S. law to respond to this survey (Title 13, United States
Code,Sections 141, 193, and 221). We estimate this survey will take about 40 minutes of your
time.
The Census Bureau is required by law to keep your information confidential. We are not
permitted to publicly release your responses in a way that could identify this household.
Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from
cybersecurity risks through screening of the systems that transmit your data. By law, the
Census Bureau can only use your responses to produce statistics.
If you have access to the internet and want to learn more about the American Community
Survey, please visit our website at census.gov/acs.
Thank you for your help.
Sincerely,

Steven D. Dillingham

ACS-16(L)(1-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau ...
The U.S. Census Bureau is conducting the Puerto Rico Community Survey. A Census Bureau
representative will contact you to help you complete the survey. The survey will ask you
questions about your household’s characteristics, including topics such as education,
employment, and housing. We would appreciate your help because the success of this survey
depends on you.
The Puerto Rico Community Survey paints a picture of life in Puerto Rico–education, housing,
jobs, and more. Every year, this survey provides up-to-date information to community leaders
as well as federal, Puerto Rico, and municipio governments. This information can be used to
identify the services and programs your community needs. For example, this survey can
provide information to plan services for the elderly, emergency services, and federal aid.
The Census Bureau chose your address, not you personally, as part of a randomly selected
sample. You are required by United States law to respond to this survey (Title 13, United
States Code, Sections 141, 193, and 221). We estimate this survey will take about 40 minutes
of yourtime.
The Census Bureau is required by law to keep your information confidential. We are not
permitted to publicly release your responses in a way that could identify this household. Per
the Federal Cybersecurity Enhancement Act of 2015, your data are protected from
cybersecurity risks through screening of the systems that transmit your data. By law, the
Census Bureau canonly use your responses to produce statistics.
If you have access to the Internet and want to learn more about the Puerto Rico Community
Survey, please visit our Web site at census.gov/acs.
Thank you for your help.
Sincerely,

Steven D. Dillingham

ACS-16(L)(PR)(1-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Un mensaje del Director de la Oficina del Censo de los Estados Unidos ...
La Oficina del Censo de los Estados Unidos está realizando la Encuesta sobre la Comunidad
de Puerto Rico. Un representante de la Oficina del Censo se comunicará con usted para
ayudarlo acompletar la encuesta. La encuesta le formulará preguntas sobre características de
su hogar, incluyendo temas, tales como la educación, el empleo y la vivienda. Le agradecería
su ayuda, ya que el éxito de esta encuesta depende de usted.
La Encuesta sobre la Comunidad de Puerto Rico ofrece un panorama de la vida en Puerto
Rico: la educación, la vivienda, los empleos y más. Todos los años, esta encuesta
proporciona información actualizada a los líderes de la comunidad, así como al gobierno
federal, al de Puerto Rico y a los de los municipios. Esta información puede usarse para
identificar los servicios y programas que su comunidad necesita. Por ejemplo, esta encuesta
puede proporcionar información para planificar servicios para las personas de la tercera edad,
servicios de emergencia y asistencia federal.
La Oficina del Censo no lo escogió a usted personalmente, sino su dirección particular como
parte de una muestra al azar. Todas las personas cuyos domicilios resultan seleccionados
están obligadas por ley a responder a esta encuesta (secciones 141, 193 y 221 del título 13
del Códigode los Estados Unidos). Calculamos que esta encuesta tomará aproximadamente
40 minutos desu tiempo.
La Oficina del Censo está obligada por ley a mantener confidencial su información. A nosotros
no se nos permite divulgar sus respuestas de manera que este hogar pudiera ser identificado.
En conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del
2015, sus datos están protegidos contra los riesgos de seguridad cibernética mediante los
controles aplicados a los sistemas que trasmiten su información. Por ley, la Oficina del Censo
puede usar sus respuestas solo para producir estadísticas.
Si tiene acceso a la Internet y desea obtener más información acerca de la Encuesta sobre la
Comunidad de Puerto Rico, visite nuestro sitio de Internet en census.gov/acs.
Gracias por su ayuda.
Atentamente,

Steven D. Dillingham

ACS-16(L)(PR)(1-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Un mensaje del Director de la Oficina del Censo de los Estados Unidos ...
La Oficina del Censo de los Estados Unidos está realizando la Encuesta sobre la Comunidad
Estadounidense. Un representante de la Oficina del Censo se comunicará con usted para
ayudarlo a completar la encuesta. La encuesta le formulará preguntas sobre características de
su hogar, incluyendo temas, tales como la educación, el empleo y la vivienda. Le agradecería
suayuda, ya que el éxito de esta encuesta depende de usted.
La Encuesta sobre la Comunidad Estadounidense obtiene información actual y crítica que se
utiliza para satisfacer las necesidades de comunidades en todo Estados Unidos. Por ejemplo,
puede que los resultados de esta encuesta se usen para decidir dónde se necesitan nuevas
escuelas, hospitales y estaciones de bomberos. El gobierno federal y los gobiernos estatales
y locales usan los datos de la encuesta para tomar decisiones y elaborar programas que
brindenatención médica, educación y servicios de transporte que los conciernen a usted y a
sucomunidad. La información de esta encuesta también ayuda a dichas comunidades a
formular planes de respuesta en situaciones de emergencia que pudieran afectarlo a usted y
a sus vecinos.
La Oficina del Censo no lo escogió a usted personalmente, sino su dirección particular como
parte de una muestra al azar. sobre temas que no aparecen en el Censo del 2020, tales
como transporte y acceso a internet. Todas las personas cuyos domicilios resultan
seleccionados están obligadas por ley a responder a esta encuesta (Título 13, Código de los
Estados Unidos, Secciones 141, 193 y 221). Calculamos que esta encuesta tomará
aproximadamente 40 minutos de su tiempo.
La Oficina del Censo está obligada por ley a mantener confidencial su información. A nosotros
no se nos permite divulgar sus respuestas de manera que este hogar pudiera ser identificado.
En conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del
2015, sus datos están protegidos contra los riesgos de seguridad cibernética mediante los
controles aplicados a los sistemas que trasmiten su información. Por ley, la Oficina del Censo
puede usar sus respuestas solo para producir estadísticas.
Si tiene acceso a la Internet y desea obtener más información acerca de la Encuesta sobre la
Comunidad Estadounidense, visite nuestro sitio de Internet en census.gov/acs.
Gracias por su ayuda.
Atentamente,

Steven D. Dillingham

ACS-16(L)(Spanish)(1-2020) (3-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(Arabic)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(French)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(Haitian Creole)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(Korean)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(Polish)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(Portuguese)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(Russian)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(S.Chinese)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(L)(Vietnamese)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau ...
On behalf of the U.S. Census Bureau,

for participating in the American Community Survey!
The Census Bureau is required by law to keep your information confidential. We are
not permitted to publicly release your responses in a way that could identify this
household. Per the Federal Cybersecurity Enhancement Act of 2015, your data are
protected from cybersecurity risks through screening of the systems that transmit you
rdata. The success of the survey depends upon cooperation from you and other
households selected for the survey.
Federal, tribal, state, and local governments will use summarized information from this
survey to make decisions and to develop programs that will provide health care,
education, and transportation services that affect you and your community. To learn
more about the American Community Survey and to review the survey results, visit our
website at census.gov/acs.
Your participation is greatly appreciated.
Sincerely,

Steven D. Dillingham

ACS-26(L)(1-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau ...

for participating in the Puerto Rico Community Survey!
The Census Bureau is required by law to keep your information confidential. We are
not permitted to publicly release your responses in a way that could identify this
household. Per the Cybersecurity Enhancement Act of 2015, your data are protected
from cybersecurity risks through screening of the systems that transmit your data. The
success of the survey depends upon cooperation from you and other house holds
selected for the survey.
Puerto Rico and local governments will use summarized information from this survey
to make decisions and to develop programs that will provide health care, education,
and transportation services that affect you and your community. To learn more about
the Puerto Rico Community Survey and to review the survey results, visit our Web site
at census.gov/acs.
Your participation is greatly appreciated.
Sincerely,

Steven D. Dillingham

ACS-26(L)(PR)(1-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Un mensaje del Director de la Oficina del Censo de los Estados Unidos ...

fpor su participación en la Encuesta de la Comunidad de Puerto Rico (PRCS)!
La Oficina del Censo está obligada por ley a mantener confidencial su información. A
nosotros no se nos permite divulgar sus respuestas de manera que este hogar
pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento de la
Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los riesgos
de seguridad cibernética mediante los controles aplicados a los sistemas que
trasmiten su información. El éxito de la encuesta depende de su cooperación y de la
de otros hogares seleccionados para participar en la misma.
El gobierno de Puerto Rico y los gobiernos locales usarán información resumida de
esta encuesta para tomar decisiones y elaborar programas que brindarán atención
médica, educación y servicios de transportación que les conciernen a usted y a su
comunidad. Para obtener más información sobre la PRCS, y para ver los resultados
de la misma, visite nuestro sitio de Internet en census.gov/acs.
Le agradecemos mucho su participación..
Atentamente,

Steven D. Dillingham

ACS-26(L)(PR)(1-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Un mensaje del Director de la Oficina del Censo de los Estados Unidos ...

por su participación en la Encuesta de la Comunidad Estadounidense!
La Oficina del Censo está obligada por ley a mantener confidencial su información. A
nosotros no se nos permite divulgar sus respuestas de manera que este hogar
pudiera seridentificado. En conformidad con la Ley para el Fortalecimiento de la
Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los riesgos
de seguridad cibernética mediante los controles aplicados a los sistemas que
trasmiten su información. El éxito de laencuesta depende de su cooperación y delade
otros hogares seleccionados para participaren la misma.
El gobierno federal y los gobiernos estatales y locales usarán información resumida de
esta encuesta para tomar decisiones y elaborar programas que brindarán atención
médica, educación y servicios de transporte que los conciernen a usted y a su
comunidad. Para obtener más información sobre la Encuesta sobre la Comunidad
Estadounidense, y paraver los resultados de la misma, visite nuestro sitio de
Interneten census.gov/acs.Le agradecemos mucho su participación.
Atentamente,

Steven D. Dillingham

ACS-26(L)(SP) (1-2020) (3-21-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(Arabic)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(French)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(Haitian Creole)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(Korean)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(Polish)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(Portuguese)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(Russian)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(S. Chinese)(1-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-26(L)(Vietnamese)(1-2020) (3-2019)
census.gov

The American
Community
Survey Brings
You Data Every
Year About . . .
Education, Children,
Families, Employment,
Income, Veterans,
Commuting Patterns,
and Housing.

How to Get More Information About
the American Community Survey
For more information about the American
Community Survey or to obtain survey
results, we encourage you to visit our Web
site at:
census.gov/acs
You may also contact us by mail at the
following address:

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
You can telephone the Census Bureau’s
Regional Office nearest you as listed below:
Census Bureau Regional Offices:
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50(HU)
Connect with us@uscensusbureau

The American
Community Survey

What Is the American
Community Survey?
The American Community Survey is a
survey conducted by the U.S. Census
Bureau. It provides information each
year about the social, economic, and
housing characteristics of the United
States. Previously, this information was
available only when the U.S. Census
Bureau conducted a population census
every 10 years. The American Community
Survey will ask you questions about your
household’s characteristics, including such
topics as education, employment, and
housing.
Only a small sample of addresses is
randomly selected to participate in
the American Community Survey and
they represent other addresses in the
community. A survey questionnaire is
delivered to a sample address to complete
and mail back. When households do not
mail back a questionnaire, the Census
Bureau attempts to contact the household
to complete the survey by phone or in
person.

Do I Have to Answer the
Questions on the American
Community Survey?
Yes, your response to this survey is
required by law (Title 13, United States
Code, Sections 141, 193, and 221).

How Will My Participation
Help Me and My Community?

Is the Information I Provide
Confidential?

Billions of government and business dollars
are distributed among states, communities,
and population groups based on the
social, economic, and housing information
available for that area.

Yes. The U.S. Census Bureau is required by
law to keep your information confidential.
We are not permitted to publicly release
your responses in a way that could
identify this household. Per the Federal
Cybersecurity Enhancement Act of 2015,
your data are protected from cybersecurity
risks through screening of the systems that
transmit your data.

The information you provide will help you
and other individuals, local governments,
nongovernmental organizations, and
businesses to:
•

Help distribute resources to
communities.

•

Improve your community by deciding
where in your town new highways,
schools, and hospitals can do the most
good.

•

Measure changes in the well-being of
children, families, and senior citizens to
help plan future programs.

•

Help communities plan for emergency
situations that might affect you or your
neighbors, such as floods, fires, and
other natural disasters.

By law, the Census Bureau can only use
your responses to produce statistics.
We may combine your survey data with
data that you may have provided to
other federal agencies. Any combined
information is given the same protections
as your survey information. Some
households that respond to the American
Community Survey may be asked to
participate in other Census Bureau surveys.

The American
Community
Survey Brings
You Data Every
Year About …
Education, Children,
Families, Employment,
Income, Veterans,
Commuting Patterns,
and Housing.

Will American Indians and Alaska
Natives be Recruited for Jobs?
The Census Bureau has always relied on the
help of American Indians and Alaska Natives to
make the census work, and will do the same to
make the American Community Survey work.

How Do I Get More Information
About the American Community
Survey in Alaska?
For more information about the American
Community Survey, we encourage you to visit
our Web site at:
census.gov/acs
Contact us by mail at:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500
Contact the Census Bureau’s
Los Angeles Regional Office at:
1-800-992-3530

Issued January 2020
ACS-50(HU)RA
Connect with us@uscensusbureau

The American
Community Survey

What is the American
Community Survey?
The American Survey is a survey conducted
by the U.S. Census Bureau. It provides
information each year about the social,
economic, and housing characteristics of the
United States. Previously, this information
was available only when the U.S. Census
Bureau conducted a population census every
10 years. The American Community Survey
will ask you questions about your household’s
characteristics, including such topics as
education, employment, and housing.
Only a small sample of addresses is randomly
selected to participate in the American
Community Survey and they represent other
addresses in the community. The Census
Bureau’s local field representative may visit
the household to complete the survey by
conducting a personal interview or may attempt
to contact the household by telephone to
complete the survey. If the address selected for
the survey is vacant or only occupied seasonally,
data on the characteristics of the unit will be
collected.

Do I Have to Answer the Questions
on the American Community
Survey?
Yes, your response to this survey is required by
law (Title 13, United States Code, Sections 141,
193, and 221).

How Will My Participation
Help Me and My Community?
Billions of dollars are allocated among
states, communities, Alaska Native villages,
and population groups based on the social,
economic, and housing information available for
that area.
The information you provide will help you
and other individuals, local governments,
nongovernmental organizations, and businesses
to:
• Help distribute resources to communities.
• Improve your community by deciding where
new roads, schools, hospitals, and improved
airstrips can do the most good for your town.
• Measure change in the well-being of children,
families, and senior citizens to help plan
future programs.
• Help communities plan for emergency
situations that might affect you or your
neighbors, such as floods, fires, and other
natural disasters.
• Help village leaders and Alaska Native
corporations plan for better education and
health services.

What About My Tribe or My Village?
The use of American Community Survey data
could result in improved utility services, new
housing, job training, better school facilities, or
a new or improved health clinic that benefits
you, your family, or your village. For example,
the Workforce Investment Act of 1998 requires
information about American Indian and Alaska
Native households to support training and
employment activities. Your participation in the
American Community Survey will provide this
critically important information.

Is the Information I Provide
Confidential?
Yes. The U.S. Census Bureau is required by law
to keep your information confidential. We are
not permitted to publicly release your responses
in a way that could identify this household.
Per the Federal Cybersecurity Enhancement
Act of 2015, your data are protected from
cybersecurity risks through screening of the
systems that transmit your data.
By law, the Census Bureau can only use your
responses to produce statistics. We may
combine your survey data with data that you
may have provided to other federal agencies.
Any combined information is given the same
protections as your survey information. Some
households that respond to the American
Community Survey may be asked to participate
in other Census Bureau surveys.

The Puerto Rico Community Survey

What Is the Puerto Rico
Community Survey?

How Will My Participation
Help Me and My Community?

Is the Information I Provide
Strictly Confidential?

The Puerto Rico Community Survey 
is a survey conducted by the U.S.
Census Bureau. It provides information each year about the social,
economic, and housing characteristics
of Puerto Rico. Previously, this information was available only when the
Census Bureau conducted a population census every 10 years. The Puerto
Rico Community Survey will ask you
questions about your household’s
characteristics, including such topics as education, employment, and
housing.

Billions of government and business
dollars are distributed among
municipios, communities, and
population groups based on the
social, economic, and housing
information available for that area.
The information you provide will 
help you and other individuals,
local governments, nongovernmental
organizations, and businesses to:

Yes. The U.S. Census Bureau is
required by law to keep your information confidential. We are not permitted to publicly release your responses
in a way that could identify this household. Per the Federal Cybersecurity
Enhancement Act of 2015, your data
are protected from cybersecurity risks
through screening of the systems that
transmit your data.

•

Help distribute resources to
communities.

•

Improve your community by
deciding where in your town
new highways, schools, and
hospitals can do the most good.

By law, the Census Bureau can only
use your responses to produce statistics. We may combine your survey
data with data that you may have
provided to other federal agencies.
Any combined information is given
the same protections as your survey information. Some households
that respond to the Puerto Rico
Community Survey may be asked to
participate in other Census Bureau
surveys.

Only a small sample of addresses
is randomly selected to participate
in the Puerto Rico Community Survey
and they represent other addresses
in the community. A survey questionnaire is delivered to a sample address
to complete and mail back. When
households do not mail back a
questionnaire, the Census Bureau
attempts to contact the household
to complete the survey by phone or
in person.

Do I Have to Answer the
Questions on the Puerto Rico
Community Survey?

•

•

Measure changes in the well-being
of children, families, and senior
citizens to help plan future
programs.
Help communities plan for
emergency situations that might
affect you or your neighbors, such
as floods, fires, and other natural
disasters.

How to Get More Information
About the Puerto Rico
Community Survey
For more information about the
Puerto Rico Community Survey or
to obtain survey results, we
encourage you to visit our Web
site at:
census.gov/acs
You may also contact us by mail at
the following address:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500
Or telephone the Census Bureau’s
New York Regional Office on:
1-800-991-2520

The Puerto Rico Community
Survey Brings You Data Every
Year About . . .
Education, Children, Families,
Employment, Income, Veterans,
Commuting Patterns, and Housing.

Yes, your response to this survey is
required by law (Title 13, United
States Code, Sections 141, 193, and
221).

Issued January 2020
ACS-50(HU)PR
Connect with us @uscensusbureau

La Encuesta sobre la Comunidad
de Puerto Rico

¿Qué es la Encuesta sobre la
Comunidad de Puerto Rico?
La Encuesta sobre la Comunidad de
Puerto Rico es una encuesta realizada
por el Negociado del Censo de los
Estados Unidos. Ésta proporciona
información anualmente sobre las características sociales, económicas y de
vivienda en Puerto Rico. En el pasado,
esta información estaba disponible
únicamente cada 10 años, cuando
el Negociado del Censo realizaba
un censo de población. La Encuesta
sobre la Comunidad de Puerto Rico le
formulará preguntas sobre características de su hogar, incluyendo temas,
tales como la educación, el empleo y
la vivienda.
Sólo una pequeña muestra de
domicilios se selecciona al azar para
participar en la Encuesta sobre la
Comunidad de Puerto Rico; esas
direcciones representan a otras direcciones en la comunidad. Se entrega
un cuestionario de la encuesta a una
dirección particular en la muestra
para llenarlo y enviarlo de vuelta por
correo. Si un hogar no devuelve la
encuesta, el Negociado del Censo
intenta comunicarse con el mismo
para completar la encuesta por teléfono o en persona.

¿Tengo que responder a las
preguntas de la Encuesta sobre la
Comunidad de P
 uerto Rico?
Así es. Si su domicilio resulta seleccionado, usted está obligado por ley a
responder a esta encuesta (secciones
141, 193 y 221 del título 13 del Código
de los Estados Unidos).

¿Qué beneficios obtendremos mi
comunidad y yo si participo?
Miles de millones de dólares del
gobierno y de empresas privadas se
distribuyen a los municipios, comunidades y grupos de población de
acuerdo con la información social,
económica y de vivienda disponible para el área correspondiente. La
información que usted proporcione
permitirá que usted y otras personas,
gobiernos locales, organizaciones no
gubernamentales y negocios:
•

Ayuden a distribuir recursos a las
comunidades.

•

Mejoren su comunidad al decidir
dónde sería de mayor beneficio
construir autopistas, escuelas y
hospitales nuevos.

•

Midan los cambios en el bienestar
de los niños, las familias y las
personas de edad avanzada, para
ayudar a planificar programas
futuros.

•

Ayuden a las comunidades a establecer planes para situaciones de
emergencia que puedan afectarlo
a usted o afectar a sus vecinos,
como inundaciones, incendios y
otros desastres naturales.

¿Se mantendrá confidencial la
información que proporcione?
Así es. La Oficina del Censo está
obligada por ley a mantener confidencial su información. A nosotros no se
nos permite divulgar sus respuestas
de manera que este hogar pudiera
ser identificado. En conformidad
con la Ley para el Fortalecimiento
de la Seguridad Cibernética Federal
del 2015, sus datos están protegidos contra los riesgos de seguridad
cibernética mediante los controles
aplicados a los sistemas que trasmiten
su información.
Por ley, la Oficina del Censo puede
usar sus respuestas solo para producir
estadísticas. Es posible que combinemos los datos de su encuesta con
datos que usted haya proporcionado
a otras agencias federales. Cualquier
información combinada recibe la
misma protección que la información
de su encuesta. Además, es posible
que se solicite que algunos hogares
que respondan a la Encuesta sobre la
Comunidad de Puerto Rico participen
en otras encues-tas de la Oficina del
Censo.

Cómo obtener más información
acerca de la Encuesta sobre la
Comunidad de Puerto Rico
Para obtener más información acerca
de la Encuesta sobre la Comunidad
de Puerto Rico, o para ver los resultados de la encuesta, visite nuestro sitio
en la Internet:
census.gov/acs
También puede comunicarse con
nosotros por correo en la siguiente
dirección: 
American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500
Puede llamar por teléfono a la Oficina
Regional del Censo en Nueva York al:
1-800-991-2520

Todos los años, la Encuesta sobre
la Comunidad de Puerto Rico le
brinda datos sobre . . .
educación, niños, familias, empleo,
ingreso, ingresos, veteranos militares, patrones de viaje al trabajo y
viviendas.

Publicado en enero de 2020
ACS-50(HU)PR
Conecta con nosotros @uscensusbureau

fold

fold

Todos los años, la
Encuesta sobre
la Comunidad
Estadounidense le
brinda datos sobre...

Encuesta sobre
la Comunidad
Estadounidense

Cómo obtener más información sobre
la Encuesta sobre la Comunidad
Estadounidense
Para obtener más información sobre
la Encuesta sobre la Comunidad
Estadounidense, o para ver los resultados de
la encuesta, visite nuestro sitio de Internet en:
census.gov/acs

educación, niños, familias,
empleos, ingresos, veteranos militares, patrones de
viaje al trabajo y viviendas.

También puede comunicarse con nosotros por
correo en la siguiente dirección:

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
Puede llamar por teléfono a la Oficina
Regional del Censo más cercana a usted,
según se indica a continuación:
Oficinas Regionales del Censo:
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(Spanish)
Connect with us @uscensusbureau

fold

2/25/2019 9:21:56 AM
fold

ACS-50 (HU)(Issued January 2020)_(SP).indd 1

¿Qué es la Encuesta sobre la
Comunidad Estadounidense?
La Encuesta sobre la Comunidad
Estadounidense es una encuesta
realizada por la Oficina del Censo de los
Estados Unidos. Proporciona información
anualmente sobre las características
sociales, económicas y de vivienda en los
Estados Unidos. En el pasado, esta
información estaba disponible únicamente
cada 10 años, cuando la Oficina del
Censo realizaba un censo de población.
La Encuesta sobre la Comunidad
Estadounidense le formulará preguntas
sobre características de su hogar,
incluyendo temas, tales como la educación,
el empleo y la vivienda.
Sólo una pequeña muestra de domicilios
se selecciona al azar para participar
en la Encuesta sobre la Comunidad
Estadounidense; esos domicilios
representan a otros domicilios en la
comunidad. Se entrega un cuestionario
de la encuesta a una dirección particular
de la muestra para llenarlo y enviarlo de
vuelta por correo. Si un hogar no devuelve
la encuesta, la Oficina del Censo intenta
comunicarse con el mismo para completar
la encuesta por teléfono o en persona.

¿Tengo que responder a las
preguntas de la Encuesta sobre la
Comunidad Estadounidense?
Así es. Si su domicilio resulta seleccionado,
usted está obligado por ley a responder
a esta encuesta (Título 13, Código de los
Estados Unidos, Secciones 141, 193 y 221).

ACS-50 (HU)(Issued January 2020)_(SP).indd 2

¿Qué beneficios obtendremos mi
comunidad y yo si participo?

¿Se mantendrá confidencial la
información que proporcione?

Miles de millones de dólares del gobierno
y de empresas privadas se distribuyen a
los estados, comunidades y grupos de
población de acuerdo con la información
social, económica y de vivienda disponible
para el área correspondiente.

Así es. La Oficina del Censo está obligada
por ley a mantener confidencial su información. A nosotros no se nos permite divulgar sus respuestas de manera que este
hogar pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento
de la Seguridad Cibernética Federal del
2015, sus datos están protegidos contra los
riesgos de seguridad cibernética mediante
los controles aplicados a los sistemas que
trasmiten su información.

La información que usted proporcione
permitirá que usted y otras personas,
gobiernos locales,organizaciones no
gubernamentales y negocios:
• Ayuden a distribuir recursos a las
comunidades.
•

Mejoren su comunidad al decidir dónde
sería de mayor beneficio construir
autopistas, escuelas y hospitales
nuevos.

•

Midan los cambios en el bienestar de
los niños, las familias y las personas
mayores, para ayudar a planificar
programas futuros.

•

Ayuden a las comunidades a establecer
planes para situaciones de emergencia
que puedan afectarlo a usted o afectar
a sus vecinos, como inundaciones,
incendios y otros desastres naturales.

Por ley, la Oficina del Censo puede usar
sus respuestas solo para producir estadísticas. Es posible que combinemos los datos
de su encuesta con datos que usted haya
proporcionado a otras agencias federales.
Cualquier información combinada recibe la
misma protección que la información de su
encuesta. Además, es posible que se solicite que algunos hogares que respondan a
la Encuesta sobre la Comunidad Estadounidense participen en otras encuestas de la
Oficina del Censo.

2/25/2019 9:22:08 AM

‫استبيان المجتمعات المحلية‬
‫في الواليات المتحدة األمريكية‬
‫يأتيكم‬
‫بالبيانات كل عام عن ‪...‬‬
‫التعليم واألطفال واألسر والتوظيف‬
‫والدخل والمحاربين القدامى ووسائل‬
‫المواصالت واإلسكان‪.‬‬

‫كيفية الحصول على مزيد من المعلومات‬
‫حول دراسة المجتمع األمريكي‬
‫للمزيد من المعلومات عن دراسة المجتمع األمريكي أو‬
‫للحصول على نتائج الدراسة‪ ،‬نوصيك بزيارة موقعنا على‬
‫اإلنترنت‪census.gov/acs :‬‬

‫استبيان المجتمعات المحلية في‬
‫الواليات المتحدة األمريكية‬

‫كما يمكن مراسلتنا بالبريد العادي على العنوان التالي‪:‬‬
‫‪ American Community Survey‬‬
‫‪ U.S. Census Bureau‬‬
‫‪ 4600 Silver Hill Rd.‬‬
‫‪ Washington, DC 20233-7500‬‬

‫ويمكن االتصال بأقرب فرع إقليمي لمكتب اإلحصاء كما هو‬
‫موضح أدناه‪:‬‬

‫المكاتب اإلقليمية التابعة لمكتب اإلحصاء‪:‬‬
‫‪1-800-424-6974‬‬
‫‪1-800-865-6384‬‬
‫‪1-800-852-6159‬‬
‫‪1-800-992-3530‬‬
‫‪1-800-991-2520‬‬
‫‪1-866-238-1374‬‬

‫ ‪Atlanta, GA‬‬
‫ ‪Chicago, IL‬‬
‫ ‪Denver, CO‬‬
‫ ‪Los Angeles, CA‬‬
‫ ‪New York, NY‬‬
‫ ‪Philadelphia, PA‬‬

‫‪Issued January 2020‬‬
‫)‪ACS-50 (HU)(Arabic‬‬
‫‪Connect with us @uscensusbureau‬‬

‫‪2/25/2019 9:16:20 AM‬‬

‫‪ACS-50 (HU_(Issued January 2020)_ARA.indd 1‬‬

‫ما هو استبيان المجتمعات المحلية في الواليات‬
‫المتحدة األمريكية؟‬
‫يمثل استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية استبياًنا يجريه مكتب اإلحصاء األمريكي‪ .‬ويقدم‬
‫المعلومات كل عام عن الخصائص االجتماعية واالقتصادية‬
‫والمتعلقة باإلسكان في الواليات المتحدة‪ .‬وفيما سبق‪ ،‬لم تكن‬
‫تتوفر هذه المعلومات إال عندما كان يجري مكتب اإلحصاء‬
‫األمريكي عملية التعداد السكاني كل ‪ 10‬سنوات‪ .‬وستطرح‬
‫دراسة المجتمع األمريكي عليك أسئلة حول خصائص أسرتك‪،‬‬
‫ومنها بعض المواضيع مثل التعليم والتوظيف واإلسكان‪.‬‬
‫يتم اختيار عينة صغيرة من العناوين عشوائيًا للمشاركة‬
‫في استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية‪ ،‬لكي تمثل العناوين األخرى في ذلك التجمع‪.‬‬
‫وتصل أسئلة الدراسة إلى أحد عناوين العينة إلكمالها‬
‫وإعادتها ثانية بالبريد العادي‪ .‬وفي حالة عدم إعادة األسرة‬
‫للدراسة بالبريد العادي‪ ،‬يحاول مكتب اإلحصاء االتصال‬
‫بتلك األسرة إلكمال الدراسة بالهاتف أو شخصيًا‪.‬‬

‫علي اإلجابة على أسئلة استبيان المجتمعات‬
‫هل يجب ّ‬
‫المحلية في الواليات المتحدة األمريكية‬
‫نعم‪ ،‬فاستجابتك على هذه الدراسة إلزامية بموجب‬
‫القانون (المادة ‪ 13‬من قانون الواليات المتحدة‪،‬‬
‫الفقرات ‪ 141‬و‪ 193‬و‪.)221‬‬

‫‪2/25/2019 9:16:22 AM‬‬

‫كيف تسهم مشاركتي في مساعدتي ومساعدة‬
‫مجتمعي؟‬
‫توزع الحكومة الفيدرالية والشركات التجارية مليارات‬
‫الدوالرات بين الواليات والمجتمعات والتجمعات السكانية‬
‫بناء على المعلومات االجتماعية واالقتصادية واإلسكانية‬
‫المتوفرة لتلك المناطق‪.‬‬
‫إن المعلومات التي تقدمها تساعدك وتساعد األفراد اآلخرين‬
‫والحكومات المحلية والمؤسسات األهلية وشركات األعمال‬
‫على‪:‬‬
‫▪ ‬

‫المساعدة في توزيع الموارد على المجتمعات‪.‬‬

‫▪ ‬

‫تحسين مجتمعك بتحديد أماكن المنشآت الجديدة من‬
‫طرق سريعة ومدارس ومستشفيات‪ ،‬لكي تجني‬
‫المدينة أقصى فائدة من خاللها‪.‬‬

‫▪ ‬

‫قياس التغيرات في مستوى رفاهية األطفال واألسر‬
‫وكبار السن‪ ،‬للمساعدة في التخطيط للبرامج‬
‫المستقبلية‪.‬‬

‫▪ ‬

‫مساعدة المجتمعات في التخطيط لحاالت الطوارئ‬
‫التي قد تؤثر عليك أو على جيرانك‪ ،‬كالفيضانات‬
‫والحرائق وغيرها من الكوارث الطبيعية‪.‬‬

‫هل المعلومات التي أقدمها سرية؟‬
‫نعم‪ .‬يلزم القانون مكتب اإلحصاء األمريكي بأن يحافظ على‬
‫معلوماتك السرية‪ .‬وغير مسموح لنا بنشر إجاباتك بشكل‬
‫عام بطريقة من شأنها أن تحدد هوية أسرتك‪ .‬وتتم حماية‬
‫البيانات ضد هجمات األمن اإللكتروني من خالل مراقبة‬
‫األنظمة التي تنقل بياناتك وذلك وفق قانون تعزيز األمن‬
‫اإللكتروني الفيدرالي لعام ‪.٢٠١٥‬‬
‫وحسب القانون‪ ،‬يمكن لمكتب اإلحصاء استخدام إجاباتك‬
‫إلنتاج اإلحصائيات فقط‪ .‬وقد نجمع بيانات الدراسة التي‬
‫قدمتها مع البيانات التي قد تكون قدمتها إلى الوكاالت‬
‫الفيدرالية األخرى‪ .‬وتحصل أي معلومات مجمّعة على نفس‬
‫أوجه حماية معلومات الدراسة الخاصة بك‪ .‬وقد يُطلب من‬
‫بعض األسر التي تستجيب إلى دراسة المجتمع األمريكي‬
‫المشاركة في دراسات أخرى تابعة لمكتب اإلحصاء‪.‬‬

‫‪ACS-50 (HU_(Issued January 2020)_ARA.indd 2‬‬

L’Enquête sur les
communautés
américaines vous
fournit chaque
année des
informations
en matière...
d’éducation, enfants,
familles, emploi, revenus
anciens combattants,
tendances actuelles des
trajets vers le lieu de
travail et logement.

Comment obtenir davantage
de renseignements concernant
l’Enquête sur les communautés
américaines ?
Pour en savoir plus au sujet de l’Enquête sur les
communautés américaines ou pour consulter les
résultats de l’enquête, nous vous conseillons de
visiter notre site Web :
census.gov/acs
Vous pouvez aussi nous contacter par courrier à
l’adresse suivante :

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
Vous pouvez téléphoner au bureau régional du U.S.
Census Bureau le plus proche de votre domicile
dont le numéro figure ci-dessous :

U.S. Census Bureau – Centres régionaux :
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(French)
Connect with us @uscensusbureau

L’Enquête sur les
communautés
américaines

L’Enquête sur les communautés
américaines, qu’est-ce que c’est ?
L’Enquête sur les communautés américaines est
menée par le U.S. Census Bureau. Elle fournit tous
les ans des informations en matière de société,
d’économie et de logement aux États-Unis. Ces
informations n’étaient autrefois disponibles
qu’une fois tous les 10 ans, lorsque le U.S. Census
Bureau organisait un recensement. L’Enquête
sur les communautés américaines comporte des
questions au sujet des caractéristiques de votre
foyer y compris en matière d’éducation, d’emploi
et de logement.
Seul un petit échantillon d’adresses est
sélectionné au hasard pour participer à cette
Enquête et pour représenter les autres adresses
de la communauté. Un questionnaire d’enquête
est remis à une adresse sélectionnée et doit être
rempli et renvoyé. Si le foyer ne renvoie pas le
questionnaire, le U.S. Census Bureau essaie de
le contacter par téléphone ou personnellement
pour s’assurer que le questionnaire est rempli.

Dois-je obligatoirement répondre
aux questions de l’Enquête sur les
communautés américaines ?
Oui, la loi exige que vous répondiez aux
questions de cette enquête (Livre 13 du Code des
États-Unis, Sections 141, 193 et 221).

Comment cette participation à
l’Enquête m’aidera-t-elle ainsi
que ma communauté ?
Des milliards de dollars issus des agences
gouvernementales et des entreprises sont
répartis entre différents états, communautés
et groupes de population en fonction des
informations disponibles en matière de société,
d’économie et de logement de la région en
question.
Les informations que vous fournissez vous
aideront, et aideront d’autres individus,
des agences gouvernementales régionales,
des agences non gouvernementales et des
entreprises à :
•

Répartir les ressources entre
différentes communautés.

•

Améliorer votre communauté en décidant
dans quelles zones de votre ville de
nouvelles autoroutes, de nouveaux
établissements scolaires et de nouveaux
hôpitaux se révéleront les plus utiles.

•

Mesurer l’évolution du bien-être des enfants,
des familles et des personnes âgées pour
planifier des programmes futurs.

•

Aider les communautés à se préparer à des
situations d’urgence susceptibles d’entrainer

des répercussions sur vos voisins ou vousmême, comme une inondation, un incendie
ou une autre catastrophe naturelle.

Les informations que je
vous communique sont-elles
confidentielles ?
Oui. Le U.S. Census Bureau a l’obligation
légale de préserver la confidentialité de vos
informations. Nous ne sommes pas autorisés à
divulguer publiquement toute information qui
permettrait d’identifier votre foyer. En vertu du
Federal Cybersecurity Enhancement Act de
2015 (loi fédérale américaine visant à améliorer
la cybersécurité), vos données sont protégées
contre les risques grâce au filtrage des systèmes
qui transmettent vos données.
La loi autorise le U.S. Census Bureau à utiliser
vos réponses uniquement dans un but
statistique. Il se peut que nous combinions
les informations que vous nous fournissez
dans cette enquête à celles que vous avez
fournies à d’autres agences fédérales. Toute
information combinée est protégée de la même
façon que vos réponses au questionnaire de
cette Enquête. Il est possible que certains
foyers qui répondent à cette Enquête sur les
communautés américaines prennent aussi part à
d’autres Enquête du U.S. Census Bureau.

Sondaj pou
Kominote
Ozetazini yo bay
enfòmasyon chak
ane sou…
edikasyon, timoun, fanmi,
travay, revni, ansyen
konbatan, kijan ak kilè
moun ale epi soti nan
travay, epi lojman.

Men kijan ou ka jwenn plis
enfòmasyon sou sondaj pou
Kominote Ozetazini yo

Sondaj pou
Kominote
Etaini yo

Si ou bezwen plis enfòmasyon sou sondaj
pou Kominote Ozetazini yo oswa si ou vle wè
rezilta sondaj la, n ap mande ou pou sitwèb
ale sou sit nou nan :
census.gov/acs
Oswa voye yon lèt ba :

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
Pou fini, ou ka rele biwo resansman rejyonal
kote ou rete a jan ou wè li make la a:

Biwo resansman rejyonal :
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(Haitian Creole)
Connect with us @uscensusbureau

ACS-50 (HU)(Issued January 2020)_HCR.indd 1

2/25/2019 9:09:45 AM

Kisa sondaj pou Kominote
Ozetazini yo an ye ?
Sondaj pou Kominote Ozetazini yo an se
yon sondaj biwo resansman ameriken an
ap fè. Se chak lane li founi enfòmasyon sou
kesyon zafè sosyal, ekonomik epi lojman
nan Etazini. Gen lontan, sèl lè nou te gen
enfòmasyon sa a se lè biwo resansman
ameriken an te fè yon resansman sou
popilasyon chak 10 zan. Sondaj pou
Kominote Ozetazini yo an se yon sondaj ki
poze w kesyon ou sipoze reponn sou moun
lakay ou; sètadi sou edikasyon, travay epi
sou kay la menm.
Se pa tout moun k ap patisipe men sè kèk
adrès kay ki chwazi o aza k ap patisipe
nan sondaj pou Kominote Ozetazini yo
an e se kay sa yo k ap reprezante lòt
adrès nan vwazinaj la. N ap livre kesyonè
sondaj la nan enpe kay yo k ap reprezante
tout lòt kay pou enpe kay sa yo reponn
kesyonè a epi voye li tounen. Si yon kay pa
remèt kesyonè a, biwo resansman an ap
rele moun kay sa a pou moun lan reponn
kesyon sondaj la nan telefòn oswa fasafas.

Èske m oblije reponn kesyon
ki nan sondaj pou Kominote
Ozetazini yo an ?
Wi, gen yon lwa ki di ou oblije reponn
sondaj la (Tit 13 – yon pati nan lwa
Ameriken, seksyon 141, 193 ak 221).

ACS-50 (HU)(Issued January 2020)_HCR.indd 2

Kijan patisipasyon m ap ede m
epi ede moun ki nan menm zòn
lan ?
Gen plizyè bilyon dola gouvènman
ak biznis ki distribye nan tout leta yo,
kominote yo ak nan gwoup popilasyon
moun daprè enfòmasyon nou genyen sou
zafè sosyal, ekonomik ak lojman yon zòn.
Enfòmasyon ou mete nan sondaj la ap ni
ede n ni ede lòt moun, gouvènman lokal,
òganizasyon ki pa gen anyen pou wè ak
gouvnèman an, epi biznis yo :
•

Ede distribye resous nan kominote yo.

•

Devlope kominote kote w rete a nan
desizyon kote l ap yon pi gwo benefis
pou mete nouvo wout, lekòl ak lopital.

•

Mezire chanjman nan byennèt timoun,
fanmi ak granmoun pou ede n tabli
pwogram pou lavni.

•

Ede kominote yo fè plan pou sitiasyon
ijan ki ka konsène ni oumnem ni
vwazen ou yo ; sètadi manje, dife ak lòt
katastwòf natirèl.

Èske enfòmasyon mwen bay nan
sondaj la ap rete sekrè ?
Wi. Lalwa egzije pou Biwo Resansman
Ameriken an kenbe enfòmasyon w sekrè.
Nou pa gen otorizasyon kominike repons
ou yo an piblik nan yon fason ki ta kapab
idantifye kay la. Dapre Lwa Federal 2015
pou Amelyorasyon Sekirite Entènèt, done
ou yo pwoteje kont risk ki gen nan sekirite
entènèt grasa kontwòl sou sistèm ki
transmèt done ou yo.
Dapre lalwa, Biwo Resansman an ka sèvi ak
repons ou yo pou kreye estatistik sèlman.
Konnen n ka mete ansanm enfòmasyon ou
founi nan sondaj la ak enfòmasyon ou founi
lòt ajans federal. Tout enfòmasyon nou
mete ansanm ap gen menm pwotekson ak
enfòmasyon ou bay nan sondaj la. Epi gen
kèk adrès kay ki patisipe nan sondaj pou
Kominote Ozetazini yo an ki ka resevwa
demann pou yo patisipe nan lòt sondaj
biwo resansman an.

2/25/2019 9:09:49 AM

미국 지역사회 조사는
매년 다음 사항에
대한자료를 수집하여
제공 합니다 …
교육, 아동, 가족, 고용,
소득, 재향군인, 출퇴근
실태 및 주택.

미국 지역사회 조사에 대한 자세한
정보를 얻는 방법
미국 지역사회 조사에 대해 더 자세한 내용
이나 조사 결과를 보시려면, 다음 웹사이트를
방문하시도록 권장합니다 census.gov/acs

미국 지역사회 조사

또한 다음 주소를 이용, 우편으로 저희에게
연락하실 수도 있습니다.

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
아래에 있는 인구조사국 지방 사무소 중
가까운 곳에 전화로 연락하셔도 됩니다.

인구조사국 지방 사무소
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(Korean)
Connect with us @uscensusbureau

ACS-50 (HU)(Issued January 2020)_KOR.indd 1

2/25/2019 9:20:09 AM

미국 지역사회 조사란 무엇입니까?
미국 지역사회 조사는 미국 인구조사국에서
실시하는 조사입니다. 본 조사는 매년 미국의
사회, 경제 및 주택 특성에 관한 정보를
제공하게 됩니다. 종전에는 미국 인구조사국이
10년마다 한번씩 인구조사를 실시한 때에만 이
정보가 제공되었습니다. 미국 지역사회 조사는
귀 가구의 특성, 즉, 교육, 고용 및 주택과
같은 문제에 대해 질문을 합니다.
단지 소수의 주소들만 미국 지역사회 조사에
참여할 표본으로 무작위 추출되며 이들은
지역사회 내의 다른 주소들을 대표 하게 됩니다.
조사 설문지가 표본주소로 전달되면, 해당
가구는 이를 작성하여 우편으로 다시 보내게
됩니다. 어느 가구 에서 설문지를 우편으로
제출하지 않는 경우, 인구조사국은 설문을
작성하기 위해 해당 가구에 전화를 하거나
방문을 통해 연락을 드립니다.

미국 지역사회 조사에 있는 질문에
대해 답해야 합니까?
그렇습니다. 귀하의 조사 참여는 미국 법(미
연방법 Title 13의 Section 141, 193, 221)
에 의거한 것으로, 조사에 응해 주시기를
부탁드립니다.

ACS-50 (HU)(Issued January 2020)_KOR.indd 2

나의 참여가 나와 나의 지역사회에
어떻게 도움이 됩니까?

내가 제공하는 정보는 비밀이
보장됩니까?

수십억 달러의 정부 및 기업 자금이 해당 지역에
관한 사회, 경제 및 주택 정보를 바탕으로 주,
지역사회 및 인구 집단 간에 분배됩니다.

그렇습니다.
미국
인구조사국은
법률에
의거하여 귀하의 정보를 비밀로 유지해야
합니다. 인구조사국은 귀 가구의 신원을 확인할
수 있는 방식으로 귀하의 응답을 공개적으로
발표해서는 안 됩니다. 2015년에 도입된 연방
사이버보안 강화법에 따라, 귀하의 자료는
자료를 전송하는 시스템을 걸러냄으로써 사이버
보안 위험으로부터 보호됩니다.

귀하가 제공하시는 정보는 귀하와 다른 개인,
지방 정부, 비정부 기구 및 사업체들 이 다음과
같은 일을 하는 데 도움이 될것입니다.
•

자원을

지역사회에

배분하는

데

도움.

• 
귀하가 거주하는 도시 내의 어느 지역
에 고속도로, 학교 및 병원을 신설하면
가장
유익할지를
결정함으로써
지역
사회를 개선.
•

미래의 계획 수립에 도움이 되도록 하기
위해
어린이,
가족
및
연장자들의
복지에 관련된 변화 측정.

•

지역사회가 홍수, 화재 및 기타 자연
재해와 같이 귀하나 귀하의 이웃에
영향을 미칠 수 있는 비상 사태에
대비한 계획을 세우도록 지원.

법률에 따라, 인구조사국은 귀하의 응답을 통계
작성용으로만 사용할 수 있습니다. 귀하가
이전에 다른 연방정부 기관 조사에 참여하신
적이 있으실 경우, 귀하의 응답은 이전에
제공하신 정보와 함께 사용될 수도 있습니다.
그러나 이 역시 동일한 법적인 보호를 받습니다.
조사에 응답하시는 일부 가구들은 인구조사국의
다른 조사에 참여하시도록 요청을 받을 수도
있습니다.

2/25/2019 9:20:10 AM

Środowiskowe
Badania Społeczne
w Stanach
Zjednoczonych
przynoszą co
roku dane na
następujące
tematy...
Oświata, dzieci, rodziny,
zatrudnienie, dochody,
weterani, dojazdy do
pracy i warunki mieszkaniowe.

W jaki sposób uzyskać
więcej informacji na temat
Środowiskowych Badań
Społecznych w Stanach
Zjednoczonych

Środowiskowe Badania
Społeczne w Stanach
Zjednoczonych

Aby dowiedzieć się więcej na temat
Środowiskowych Badań Społecznych w
Stanach Zjednoczonych lubuzyskać wyniki
badania, zapraszamy do naszej
witryny internetowej:
census.gov/acs
Można się do nas zwracać listownie pod
adresem:

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
Można zadzwonić do najbliższego
regionalnego biura spisu ludności pod jeden z
następujących numerów telefonów:

Biura regionalne Urzędu Spisu Ludności
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(Polish)
Connect with us @uscensusbureau

ACS-50 (HU)(Issued January 2020)_POL.indd 1

2/25/2019 10:35:50 AM

Co to są Środowiskowe Badania
Społeczne w Stanach
Zjednoczonych?
Środowiskowe Badania Społeczne w
Stanach Zjednoczonych to ankieta
przeprowadzana przez Amerykańskie
Biuro Spisu Ludności. Dostarcza ona
co roku informacji na temat warunków
społecznych, ekonomicznych i
mieszkaniowych w USA. Poprzednio
te dane były dostępne tylko po
przeprowadzeniu przez Amerykańskie
Biuro Spisu Ludności powszechnego spisu
ludności co 10 lat. Pytania w ankiecie
dotyczą cech charakterystycznych
mieszkańców, takich jak wykształcenie,
zatrudnienie i warunki mieszkaniowe.
Do udziału w Środowiskowych Badaniach
Społecznych w Stanach Zjednoczonych
wybierana jest losowo niewielka próbka
adresów, które reprezentują inne adresy
na danym terenie. Pod wybrane adresy
dostarczany jest kwestionariusz do
wypełnienia i odesłania. Jeżeli osoba
mieszkająca pod tym adresem nie
odeśle kwestionariusza, Biuro Spisu
Ludności spróbuje skontaktować się z
danym gospodarstwem domowym, aby
przeprowadzić badanie telefonicznie lub
osobiście.

Czy muszę odpowiadać na
pytania ankiety Środowiskowe
Badania Społeczne w Stanach
Zjednoczonych?
Tak, Zgodnie z prawem, musicie Państwo
udzielić odpowiedzi na pytania ankietowe.
Udział w ankiecie jest wymagany przez
prawo (Kodeks Stanów Zjednoczonych,
tytuł 13, art. 141, 193 i 221).

ACS-50 (HU)(Issued January 2020)_POL.indd 2

W jaki sposób mój udział
pomoże mnie i mojej
społeczności?
Miliardy dolarów z funduszy rządowych
i prywatnych są przyznawane stanom,
miejscowościom i grupom ludności
na podstawie informacji o ich
warunkach socjalnych, ekonomicznych i
mieszkaniowych.
Udzielone przez Państwa informacje
pomogą Wam i innym osobom, jak
też władzom lokalnym, organizacjom
pozarządowym, przedsiębiorstwom i
biznesom:
• rozdzielić środki finansowe dla ludności
•

poprawić warunki życia, decydując
gdzie w danej miejscowości nowe
drogi, szkoły i szpitale mogą się
najbardziej przydać

•

mierzyć zmiany jakości życia dzieci,
rodzin i ludzi starszych, aby lepiej
planować przyszłe programy

•

planować działania lokalne na wypadek
sytuacji takich jak np. powodzie, pożary
czy inne katastrofy naturalne, co
może mieć wpływ na życie Państwa i
Waszych sąsiadów.

Czy informacje jakich udzielę, są
poufne?
Tak. Biuro Spisu Ludności Stanów
Zjednoczonych jest zobligowane
przepisami prawa do zachowania
poufności Państwa danych. Nie
możemy publicznie udostępniać
Państwa odpowiedzi w żaden sposób,
który pozwoliłby na zidentyfikowanie
Państwa gospodarstwa domowego. Na
mocy ustawy federalnej z 2015 roku o
poprawie cyberbezpieczeństwa (Federal
Cybersecurity Enhancement Act) Państwa
dane są chronione przed zagrożeniami z
zakresu cyberbezpieczeństwa za pomocą
weryfikacji systemów przesyłających te
dane.
Na mocy prawa Biuro Spisu Ludności
może wykorzystywać Państwa odpowiedzi
wyłącznie do sporządzenia danych
statystycznych. Możemy połączyć dane
z ankiety z innymi danymi ewentualnie
udzielonymi przez Państwa innym
agencjom federalnym. Wszystkie inne
informacje uzyskane i połączone z tą
ankietą podlegają takiej samej ochronie jak
dane z tej ankiety. Niektóre gospodarstwa
domowe udzielające odpowiedzi na
Środowiskowe Badania Społeczne w
Stanach Zjednoczonych mogą być
poproszone o udział w innych badaniach
Biura Spisu Ludności.
2/25/2019 10:35:53 AM

Todos os anos,
a Pesquisa às
Comunidades nos
EUA apresenta
dados sobre ...
Educação, crianças,
famílias, emprego, renda,
veteranos, padrões de
deslocamento diário e
habitação.

Como obter mais informações
sobre a Pesquisa às Comunidades
nos EUA
Para obter mais informações sobre a Pesquisa
às Comunidades nos EUA ou para obter os
resultados da Pesquisa, visite o site :

Pesquisa às
Comunidades nos
EUA

census.gov/acs
Você também pode nos contatar por correio,
pelo seguinte endereço:

American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC 20233-7500

Pode também telefonar para os escritórios
regionais do Censo mais perto de você,
conforme listado a seguir

Escritórios regionais do Censo:
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
Nova York, NY
Filadélfia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(Portuguese)
Connect with us @uscensusbureau

ACS-50 (HU)(Issued January 2020)_POR.indd 1

2/25/2019 10:14:29 AM

O que é a Pesquisa às Comunidades nos EUA?
A Pesquisa às Comunidades nos EUA é
uma pesquisa realizada pelo U.S. Census
Bureau (Censo dos EUA). Todos os anos,
essa proporciona informações sobre as
características sociais, econômicas e
habitacionais dos Estados Unidos. No
passado, essas informações só estavam
disponíveis quando o Censo realizava um
censo da população a cada 10 anos. A
Pesquisa às Comunidades nos EUA fará
perguntas sobre as características do seu
domicílio, inclusive tópicos como educação,
emprego e habitação.

De que forma a minha
participação irá ajudar a mim
e à minha comunidade?

Apenas uma pequena amostra de residências
é aleatoriamente selecionada para participar
da Pesquisa às Comunidades nos EUA,
representando assim outras residências na
comunidade. Um questionário da pesquisa
é enviado para uma residência da amostra
para ser preenchido e devolvido. Quando os
domicílios não devolvem um questionário,
o Censo tenta contatar o mesmo para
preencher a pesquisa por telefone ou
pessoalmente.

Bilhões de dólares do governo e das
empresas são distribuídos pelos estados,
comunidades e grupos populacionais em
função das informações sociais, econômicas
e habitacionais disponíveis para cada área.

•

distribuir recursos nas comunidades;

Tenho que responder as
perguntas da Pesquisa às
Comunidades nos EUA?

•

melhorar a sua comunidade, determinando
onde novas estradas, escolas e hospitais
serão mais úteis na sua cidade;

•

avaliar mudanças no bem-estar das
crianças, famílias e cidadãos mais idosos
para ajudar a planejar futuros programas;

•

ajudar as comunidades a planejar ações
para situações de emergência que
possam afetar você e seus vizinhos, tais
como: enchentes, incêndios e outros
desastres naturais.

Sim, a lei dos Estados Unidos exige que você
responda a esta pesquisa (Título 13, Código
dos Estados Unidos, Seções 141, 193 e 221).

ACS-50 (HU)(Issued January 2020)_POR.indd 2

As informações fornecidas ajudarão você
e outros indivíduos, governos locais,
organizações não governamentais e empresas
a:

As informações são
confidenciais?
Sim. A lei exige que o Censo mantenha
suas informações confidenciais. Não temos
permissão para divulgar suas respostas
de modo a identificar o domicílio. De
acordo com a lei Federal Cybersecurity
Enchancement Act de 2015, seus dados
estão protegidos de riscos cibernéticos pelo
rastreio dos sistemas que os transmitem.
As suas respostas só poderão ser utilizadas
para fins estatísticos. Poderemos combinar
os dados da sua pesquisa com os dados que
você possa ter informado a outras agências
federais. Quaisquer informações combinadas
serão tratadas com a mesma proteção que as
informações coletadas pela pesquisa. Alguns
domicílios que responderem à Pesquisa
às Comunidades nos EUA poderão ser
solicitados a participar de outras pesquisas
do Censo.

2/25/2019 10:14:32 AM

Ежегодно
Анкетирование
населения США по
месту жительства
дает нам данные …

Как можно получить
дополнительную
информацию об Анкетировании
населения США по месту жительства?

Об образовании, детях,
семьях, занятости, доходе,
ветеранах, ежедневном
передвижении населения на
работу и с работы и жилье.

Чтобы получить дополнительную информацию
об Анкетировании населения США по месту
жительства или результаты самого
анкетирования, можно подключиться к
Интернету по адресу:
census.gov/acs

Анкетирование
населения США по
месту жительства

Вы можете также написать нам по следующему
адресу:

American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC 20233-7500

Можно также позвонить по телефону в
ближайший региональный офис Бюро переписи
населения США по указанному ниже номеру:

Региональные офисы Бюро
переписи населения:

Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(Russian)
Connect with us @uscensusbureau

ACS-50 (HU)(Issued January 2020)_RUS.indd 1

2/25/2019 10:43:12 AM

Что представляет собой
анкетирование населения США
по месту жительства?
Бюро переписи населения США проводит
анкетирование населения США по месту
жительства. Ежегодно по результатам
этого исследования получают сведения о
социальных, экономических и жилищных
условиях в Соединенных Штатах. Ранее эту
информацию можно было получить только
раз в десять лет во время переписи
населения. Анкетирование населения
США по месту жительства включает в
себя вопросы об образовании, занятости
и условиях жизни, касающиеся Вас и
проживающих с Вами лиц.
Для участия в Анкетировании населения
США по месту жительства выбрано
наугад лишь небольшое количество
адресов, которые представляют и другие
домохозяйства данного района. По данному
адресу будет послана анкета, которую
необходимо заполнить и отослать обратно.
Если представители данного домохозяйства
не вернут заполненную анкету,
представитель Бюро переписи населения
США постарается связаться с ними, чтобы
завершить анкетирование по телефону или
лично.

Должен ли я отвечать на
вопросы,
содержащиеся в
анкетировании
населения США по месту
жительства?
Да, закон требует, чтобы Bы ответили на эти
вопросы (Часть 13, Кодекс Соединенных
Штатов, разделы 141, 193 и 221).

ACS-50 (HU)(Issued January 2020)_RUS.indd 2

Как мое участие поможет мне и
моему району?
На основе информации о социальных,
экономических и жилищных условиях в
данной местности миллиарды долларов
правительственных и частных средств
распределяются между различными штатами,
районами и группами населения.
Предоставленные Вами сведения помогут
Вам и другим лицам, местным властям,
неправительственным организациям и
деловым предприятиям:
•

Распределить средства между районами
проживания жителей США.

•

Улучшить условия жизни Вашего района
путем принятия решений о том, где в
Вашем населенном пункте необходимо
построить новые шоссейные дороги,
школы и больницы с тем, чтобы они
принесли наибольшую пользу.

•

Определить, насколько изменилось
благосостояние детей, семей и пожилых
граждан с тем, чтобы спланировать
дальнейшие программы.

•

Помочь местным властям и жителям в
разработке планов действий на случай
чрезвычайных ситуаций, таких как
наводнения, пожары и другие стихийные
бедствия, которые могут затронуть Вас
или Ваших соседей.

Является ли предоставленная
мною
информация
конфиденциальной?
Да. Закон обязывает Бюро
переписи населения США сохранять
конфиденциальность предоставленной Вами
информации. Бюро переписи населения
не имеет права разглашать какую-либо
информацию, из которой можно получить
сведения о Вашей семье. В соответствии
с Федеральным законом об усилении
кибербезопасности от 2015 года, Ваши
данные защищены от рисков нарушения
кибербезопасности посредством введения
специальных мер защиты систем,
используемых для передачи данных.
Согласно закону, предоставленные
Вами сведения будут использованы
исключительно в статистических целях.
Данные, полученные в результате этого
исследования, могут быть скомбинированы
с данными, которые Вы, возможно,
предоставили в другие государственные
учреждения. Вся сводная информация
охраняется так же, как и информация,
полученная в результате данного
исследования. Кроме того, к некоторым
домохозяйствам, принявшим участие в
анкетировании населения США по месту
жительства, могут обратиться с просьбой об
участии в других исследованиях,
проводимых Бюро переписи населения.

2/25/2019 10:43:15 AM

美国社区问卷调查
每年向您提供有关以下
各项的数据...
教育、儿童、家庭、就业
收入、退伍军人、上下班
交通方式和住房

如何获得有关美国社区问卷调查
的进一步详情
欲获得有关美国社区问卷调查的进一步详情,我们鼓
励您访问以下网站：
census.gov/acs

美国社区问卷调查

您也可以通过致函至以下地址与我们联系

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
您还可致电至下列离您最近的人口普查局地区
办公室：

人口普查局区域办事处:
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(S. Chinese)
Connect with us @uscensusbureau

ACS-50 (HU)(Issued January 2020)_CHI.indd 1

2/25/2019 9:06:28 AM

什么是美国社区问卷调查
美国社区问卷调查是美国人口普查局所进行的一
项调查。这项调查每年提供有关美国社会、经济
和住房特点的信息。过去, 只有在美国人口普查
局进行十年一次的人口普查时才能获得此类信
息。美国社区问卷调查将提问您有关您住户特征
的问题, 包括例如教育、 就业和住房的问题。
参加美国社区问卷调查的住户是以随机抽样的方
式选出的。虽然数量很小, 但是, 这些住户代表
了所在地区的其他住户。被抽样选中的住户会收
到一份调查问卷, 该问卷需在填写后寄回。如果
某些住户没有寄回调查问卷, 人口普查局会尝试
以电话或上门方式与该住户联系, 以填写调查问
卷。

我必须回答美国社区问卷调查中的问
题吗？
是的, 根据法律规定, 您必须回答本调查中的问
题（《美国法典》第 13 篇第 141、 193 和 221
节）。

ACS-50 (HU)(Issued January 2020)_CHI.indd 2

我参加该项调查对我本人和我所在的
社区有什么帮助？
各州、 社区和人口群体所分配到的政府及商业资
金, 是根据所搜集到的该地区的社会、经济和住
房信息决定的。
您所提供的信息将有助于您和其他个人、
地方政府、 非政府机构和企业：
•

帮助向社区分配资源。

•

通过确定在您所在城镇的哪些地方修建新的
高速公路、新的学校和医院最合适, 来改善
您所在社区的状况。

•

衡量儿童、 家庭和老年人的生活变化,
帮助规划未来的计划。

•

帮助社区规划可能影响您或您所在社区的应
急预案, 例如水灾、 火灾和其他自然灾害。

我提供的信息是否会得到保密？
是的。根据法律规定，美国人口普查局将对您的
信息保密。人口普查局不得以可识别住户身份的
方式公开发布您的回复。根据《2015年联邦网络
安全增强法案》，我们将通过筛选传输数据的系
统保护您的数据，使其免于网络安全风险。
根据法律规定，人口普查局仅可将您的回复用于
编制统计数据。我们可能会把您在此项调查中所
提供的信息与您可能已向其他联邦机构提供的信
息进行合并。任何合并信息均将受到如您在此项
调查中所提供的信息一样的保护。我们可能会要
求某些参加此项调查的住户参加人口普查局的其
他调查。

2/25/2019 9:06:32 AM

Baûn Khaûo Saùt Coäng
Ñoàng Myõ Mang Ñeán
Cho Quyù Vò Caùc Soá
Lieäu Haøng Naêm
Ve. . .
Giaùo duïc, treû em, gia ñình,
vieäc laøm, lôïi töùc, cöïu chieán
binh, caùch thöùc ñi laïi, vaø
gia cö.

Caùch laáy thoâng tin veà cuoäc Kieåm Keâ
Daân Soá Hoa Kyø
Muoán bieát theâm thoâng tin veà baûn Khaûo Saùt Coäng
Ñoàng Myõ hay laáy keát quaû cuoäc khaûo saùt, quyù vò
neân vieáng thaêm maïng löôùi cuûa chuùng toâi taïi:
census.gov/acs

Baûn Khaûo Saùt Coäng
Ñoàng My

Quyù vò cuõng coù theå gôûi thô cho chuùng toâi taïi ñòa
chæ sau ñaây:

American Community Survey

U.S. Census Bureau

4600 Silver Hill Rd.

Washington, DC 20233-7500
Quyù vò coù theå goïi ñieän thoaïi cho Vaên Phoøng Khu
Vöïc cuûa Phoøng Kieåm Tra Daân Soá gaàn nhaát neâu
döôùi ñaây:
Vaên Phoøng Khu Vöïc cuûa Phoøng
Kieåm Tra Daân Soá:
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-800-852-6159
1-800-992-3530
1-800-991-2520
1-866-238-1374

Issued January 2020
ACS-50 (HU)(Vietnamese)
Connect with us @uscensusbureau

ACS-50 (HU)(Issued January 2020)_VIE.indd 1

2/25/2019 9:13:46 AM

Khaûo Saùt Coäng Ñoàng Myõ laø gì?
Khaûo Saùt Coäng Ñoàng Myõ laø cuoäc khaûo saùt
do Vaên Phoøng Kieåm Tra Daân Soá Hoa Kyø thöïc
hieän ñeå cung caáp thoâng tin haøng naêm veà caùc
ñaëc ñieåm xaõ hoäi, kinh teá, vaø gia cö cuûa Hoa
Kyø. Tröôùc ñaây, thoâng tin naøy chæ coù khi Vaên
Phoøng Kieåm Tra Daân Soá Hoa Kyø tieán haønh
vieäc kieåm tra daân soá möôøi naêm moät laàn. Baûn
Khaûo Saùt Coäng Ñoàng Myõ seõ hoûi veà ñaëc tính
cuûa gia hoä quyù vò goàm caùc ñeà taøi chaúng haïn
nhö hoïc vaán, vieäc laøm vaø gia cö.
Chæ coù moät soá nhoû ñòa chæ maãu ñöôïc choïn
ngaãu nhieân ñeå tham gia vaøo baûn Khaûo Saùt
Coäng Ñoàng Myõ vaø nhöõng ñòa chæ naøy tieâu bieåu
cho caùc ñòa chæ khaùc trong coäng ñoàng. Moät
baûn caâu hoûi khaûo saùt ñöôïc gôûi ñeán ñòa chæ
maãu ñeå ñieàn vaøo vaø gôûi traû laïi. Khi caùc gia
ñình khoâng gôûi traû laïi baûn caâu hoûi, Vaên Phoøng
Kieåm Tra Daân Soá seõ coá gaéng lieân laïc vôùi gia
ñình nhaèm hoaøn taát vieäc khaûo saùt qua ñieän
thoaïi hay ñeán gaëp taän maët quyù vò.

Coù caàn phaûi traû lôøi caâu hoûi treân
baûn Khaûo Saùt Coäng Ñoàng Myõ
khoâng?
Coù, traû lôøi caâu hoûi treân baûn khaûo saùt laø ñoøi hoûi
cuûa luaät phaùp (Töïa Ñeà 13, Quy Luaät Hoa Kyø,
Ñoaïn 141, 193, vaø 211).

ACS-50 (HU)(Issued January 2020)_VIE.indd 2

Vieäc tham gia cuûa toâi seõ giuùp toâi vaø
coäng ñoàng nhö theá naøo?

Thoâng tin cung caáp coù ñöôïc giöõ
kín khoâng?

Haøng tæ Myõ kim cuûa chaùnh phuû vaø doanh
nghieäp ñöôïc phaân phaùt cho tieåu bang, coäng
ñoàng, vaø nhoùm daân soá döïa theo thoâng tin veà
xaõ hoäi, kinh teá, vaø gia cö coù trong khu vöïc ñoù.

Có. Cục Thống Kê Dân Số Hoa Kỳ được pháp
luật yêu cầu bảo mật thông tin của quý vị.
Chúng tôi không được phép công bố công khai
các phản hồi của quý vị theo cách có thể nhận
diện gia đình quý vị. Theo Đạo luật Tăng cường
An ninh Mạng Liên bang năm 2015, dữ liệu của
quý vị được bảo vệ khỏi các rủi ro an ninh mạng
thông qua sàng lọc các hệ thống truyền đi dữ
liệu của quý vị.

Thoâng tin maø quyù vò cung caáp seõ giuùp quyù
vò vaø nhöõng ngöôøi khaùc, chaùnh quyeàn ñòa
phöông, caùc toå chöùc phi chaùnh phuû, vaø caùc
doanh nghieäp:
•

Phaân phoái taøi nguyeân cho coäng ñoàng.

•

Caûi tieán coäng ñoàng baèng caùch choïn nôi
naøo xaây döïng xa loä, tröôøng hoïc, vaø beänh
vieän môùi trong thaønh phoá laø toát nhaát.

•

Ñaùnh giaù caùc thay ñoåi veà söùc khoûe cuûa
treû em, gia ñình, vaø caùc laõo nieân nhaèm
giuùp hoaïch ñònh caùc chöông trình trong
töông lai.

•

Giuùp coäng ñoàng hoaïch ñònh cho caùc
tröôøng hôïp khaån caáp coù theå aûnh höông
tôùi quyù vò hay ngöôøi laùng gieàng, nhö luõ
luït, hoûa hoaïn, vaø caùc thieân tai khaùc.

Theo luật, Cục Thống kê Dân số chỉ được sử
dụng các phản hồi của quý vị để tạo ra các số
liệu thống kê. Chuùng toâi coù thể kết hợp dữ liệu
khảo sát của quý vị với dữ liệu maø tröôùc ñaây
quyù vò coù theå ñaõ cung caáp cho cô quan lieân
bang khaùc. Baát cöù thoâng tin phoái hôïp naøo
cuõng ñöôïc baûo veä gioáng nhö laø thoâng tin veà
khaûo saùt. Vaøi gia hoä tham gia vaøo cuoäc Khaûo
Saùt Coäng Ñoàng Myõ coù theå ñöôïc yeâu caàu tham
gia vaøo caùc cuoäc kieåm tra daân soá khaùc.

2/25/2019 9:13:49 AM

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Issued January 2020
ACS-51 (HU)(English)
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Questions and Answers

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AMERICAN COMMUNITY SURVEY

What is the American
Community Survey?

The American Community
Survey is a survey conducted
by the U.S. Census Bureau in
every county, American Indian
and Alaska Native Area, and
Hawaiian Home Land.

The American Community
Survey provides critical economic, social, demographic,
and housing information to this
country’s communities every
year. Communities tell us the
American Community Survey
helps them make informed decisions and is a key to their future.

census.gov/acs

I have not heard of the
American Community Survey.
How long have you been
conducting it?
The American Community
Survey began in 1996 in a sample
of counties across the country.
Today the survey is conducted
in all U.S. counties and in Puerto
Rico, where it is called the
Puerto Rico Community Survey.

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How are the answers that
I provide to the American
Community Survey used?

The questions on the American
Community Survey are required
to collect data needed to
manage or evaluate government
programs. These questions are
essentially the same questions
that have been asked as part of
the decennial census.
• Income information makes
it possible to compare the
economic levels of different
areas. Many federal and state
programs use such data to
distribute funds for community development.
• Your answers to the questions on journey to work are
used by the U.S. Department
of Transportation to plan
highway improvements,
develop public transportation
services, and design
programs to ease traffic
problems.
• Information about age is used
in federal programs to target

AMERICAN COMMUNITY SURVEY

funds or services to children,
working-age adults, or the
elderly.

• Responses to questions about
income and housing are
summarized and used by the
U.S. Department of Housing
and Urban Development to
assess the need for housing
assistance for elderly,
handicapped, and low-income
homeowners.
• Information about race,
Hispanic origin, and language
spoken at home is used to
determine bilingual election requirements under the
Voting Rights Act and the
monitoring of equal employment opportunities under the
Civil Rights Act. Race and
Hispanic origin (or ethnicity)
are considered distinct concepts and, therefore, require
separate questions.
• Information about military
service is used primarily
by the U.S. Department of
Veterans Affairs to measure

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AMERICAN COMMUNITY SURVEY

the needs of veterans and to
evaluate veterans’ programs
dealing with education,
employment, and health care.
How do I benefit by
answering the American
Community Survey?

Federal agencies, states, and
communities say that they
do not have the up-to-date
information they need to better
understand community issues,
respond to needs, and allocate
programs and resources. As
one community leader said,
“Guessing is always fun, but
seldom effective.”
By responding to the
American Community Survey
questionnaire, you are helping
your community establish
community goals, identify
community problems and
solutions, locate facilities and
programs, and measure the
performance of programs. The
American Community Survey
data are used by:

census.gov/acs

• Local governments for budgeting, evaluating programs,
and planning for community
development projects.
• Community programs, such
as those for the elderly, scout
programs, libraries, banks,
hospitals, and other community organizations, to provide
services to the community
and to locate buildings, services, and programs.
• Transportation planners, using
journey-to-work information,
to plan for peak volumes
of traffic in order to reduce
traffic congestion, plan for
parking, and develop strategies, such as carpooling
programs and flexible work
schedules. Decisions are
made to build new roads
or add capacity to existing
roads, and to develop transit
systems, such as light rail or
subways, by projecting future
needs.

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AMERICAN COMMUNITY SURVEY

Do I have to answer the
questions on the American
Community Survey?

Do I have to answer the
survey if I am staying at
this address temporarily?

Yes. Your response to this
survey is required by law (Title
13, United States Code, Sections
141, 193, and 221). The same law
protects the confidentiality of
the information that you
provide.

Yes. If you are staying at
the address for more than 2
months, you must complete
the entire survey. If you are
staying for 2 months or less,
you must still complete a
portion of the survey, according
to the instructions.A Census
Bureau representative can
assist you. This information
helps communities plan as the
population changes at different
times of the year.

Do I have to answer these
questions every year?
No. Only a small sample
of addresses is selected to
participate in the American
Community Survey. An address
may only be selected for the
sample once every 5 years.
These addresses are selected
at random and represent other
addresses in the community.
That is why it is so important
that every sampled household
respond.

Are my survey answers
confidential?
Yes. The U.S. Census Bureau is
required by law to keep your
information confidential. We
are not permitted to publicly
release your responses in a way
that could identify this household. Per the Cybersecurity
Enhancement Act of 2015, your
data re protected from cybersecurity risks through screening of

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AMERICAN COMMUNITY SURVEY

the systems that transmit your
data. By law, the Census
Bureau can only use your
responses to product statistics.

How can I see the results of the
survey?
This information is published on
the Census Bureau’s American
FactFinder® Web site at
factfinder.census.gov
The data are provided in several
formats for everyone from
beginners (who may just want
to look at the data) to
experienced researchers.
American FactFinder® provides
tables that:

census.gov/acs

I am elderly, disabled, or
otherwise unable to complete
the American Community
Survey questionnaire. What
do I do?
You may designate another
person to help you, or a Census
Bureau representative may call
you or may come to your house
and assist you in completing
the survey. Respondents may
call 1-800-354-7271 for
assistance.
To produce the most accurate
results, it is very important that
every household selected for
the survey participate.

• provide an overview of the
data quickly,
• compare data for different
places, and
• provide more extensive data
for more detailed research.

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AMERICAN COMMUNITY SURVEY

How can I get additional
information about the American
Community Survey?
There are several ways to obtain
information about the American
Community Survey:
For detailed information, we
encourage you to visit our Web
site at:
census.gov/acs
or call the Census Bureau’s
Regional Office nearest to you
as listed below:

Census Bureau Regional Offices
Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

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AMERICAN COMMUNITY SURVEY

For questions about the
American Community Survey
data or how to view survey
results, call our Customer
Services line at:

You may also contact us by
e-mail

301-763-INFO (4636)

via U.S. mail at:

1-888-346-9682

American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

ask.census.gov
or

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AMERICAN
COMMUNITY
SURVEY
U.S. CENSUS BUREAU

E-mail: ask.census.gov

Phone: 1-888-346-9682

Internet: census.gov/acs

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Issued January 2020
ACS-51 (HU)(Spanish)
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Preguntas y respuestas

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ENCUESTA SOBRE LA COMUNIDAD ESTADOUNIDENSE

¿Qué es la Encuesta sobre la
Comunidad Estadounidense?

La Encuesta sobre la Comunidad
Estadounidense es una encuesta
que la Oficina del Censo realiza
en cada condado, Área Indígena
Norteamericana y Nativa de Alaska así
como Territorio Autónomo Hawaiano.
La encuesta sobre la Comunidad
Estadounidense provee importante
información económica, social,
de población y de vivienda a las
comunidades de este país cada año.
Las comunidades nos indican que
la Encuesta sobre la Comunidad
Estadounidense les ayuda a obtener
la información necesaria para tomar
decisiones fundamentadas y es clave
para el futuro.

census.gov/acs

No había oído de la Encuesta sobre la
Comunidad Estadounidense. ¿Cuánto
tiempo llevan realizándola?
La Encuesta sobre la Comunidad
Estadounidense comenzó en 1996
con una muestra de condados a
través de todo el país. En la actualidad,
la encuesta se realiza en todos los
condados de Estados Unidos.

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ENCUESTA SOBRE LA COMUNIDAD ESTADOUNIDENSE

¿Cómo se usarán mis respuestas
proporcionadas a la Encuesta sobre
la Comunidad Estadounidense?

Se requiere que las preguntas de
la Encuesta sobre la Comunidad
Estadounidense obtengan los datos
necesarios para administrar o evaluar
programas del gobierno. Dichas
preguntas son esencialmente las
mismas que se han hecho como parte
del censo decenal.
• La información sobre ingresos
hace posible la comparación de
los niveles económicos de las
distintas regiones del país. Muchos
programas federales y estatales
usan esos datos para asignar
fondos de desarrollo comunitario.
• El Departamento de Transporte
de los Estados Unidos usa sus
respuestas a las preguntas
relacionadas con viajes al trabajo
para planificar mejoras a las
autopistas y carreteras, desarrollar
servicios de transporte público y
diseñar programas para aliviar los
problemas de tráfico.

• La información relacionada con
la edad se usa en programas
federales para dirigir la asignación
de fondos o servicios para niños,
adultos de edad laboral o ancianos.

• Las respuestas a las preguntas
sobre ingresos y vivienda son
resumidas y utilizadas por el
Departamento de la Vivienda
y Desarrollo Urbano de
Estados Unidos para evaluar
las necesidades de asistencia
relacionada con la vivienda para
ancianos, personas discapacitadas
y dueños de viviendas de bajos
recursos.
• La información relacionada con
la raza, el origen hispano y el
idioma hablado en casa se utiliza
para determinar los requisitos de
papeletas de elección bilingües en
conformidad con la Ley de Derecho
al Voto, así como la supervisión de
la igualdad de oportunidades de
empleo en conformidad con la Ley
de Derechos Civiles. La raza y el
origen (o el grupo étnico) hispano
se consideran conceptos distintos
y, por lo tanto, requieren preguntas
independientes.
• El Departamento de Asuntos de
Veteranos utiliza principalmente
la información relacionada con
el servicio militar para medir las
necesidades de los veteranos
y evaluar los programas para
veteranos relacionados con
educación, empleo y atención
médica.

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¿Cómo me beneficio al responder
a la Encuesta sobre la Comunidad
Estadounidense?

Las agencias federales, los estados y
las comunidades nos indican que no
tienen la información actualizada que
necesitan para comprender mejor los
asuntos relacionados con la comunidad, responder a sus necesidades y
asignar programas y recursos. Como
expresó un líder de la comunidad,
“Adivinar siempre es divertido, pero
casi nunca eficaz”.

Al responder al cuestionario de
la Encuesta sobre la Comunidad
Estadounidense, usted ayudará a su
comunidad a establecer sus metas,
identificar sus problemas y soluciones,
designar lugares para instalaciones y
programas, así como a medir el desempeño de dichos programas.
Los datos obtenidos por la Encuesta
sobre la Comunidad Estadounidense
son utilizados por:
• Gobiernos locales para crear
presupuestos, evaluar programas y
planificar proyectos de desarrollo
comunitario.
• Programas comunitarios, como los
destinados a ancianos, programas
de niños exploradores, bibliotecas,
bancos, hospitales y otras
organizaciones comunitarias para
brindar servicios a ésta y designar

census.gov/acs

lugares para la construcción de
edificios, la prestación de servicios
y programas.

• Planificadores de transporte
que utilizan la información sobre
viajes al trabajo para hacer planes
relacionados con volúmenes de
tráfico durante horas pico con el fin
de reducir la congestión de tránsito,
planificar espacios de
estacionamiento y desarrollar
estrategias, como programas de
viajes compartidos y horarios de
trabajo flexibles. Mediante el
cálculo
de necesidades futuras, se toman
decisiones de construir carreteras
nuevas o ampliar las ya existentes,
y de desarrollar sistemas de
tránsito en masa como trenes
ligeros y subterráneos.
¿Tengo que responder a las
preguntas de la Encuesta sobre la
Comunidad Estadounidense?
Así es. Si su domicilio resulta
seleccionado, usted está obligado
por ley a responder a esta encuesta
(Título 13, Código de los Estados
Unidos, Secciones 141, 193 y 221).
La misma ley protege el carácter
confidencial de la información que
usted proporcione.

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ENCUESTA SOBRE LA COMUNIDAD ESTADOUNIDENSE

¿Tengo que responder a estas preguntas todos los años?

¿Son confidenciales mis
respuestas a la encuesta?

No. Se selecciona únicamente una
pequeña muestra de direcciones para
participar en la Encuesta sobre la
Comunidad Estadounidense. Es posible que una dirección de domicilio
se seleccione para la muestra una vez
cada 5 años. Las direcciones de domicilio se seleccionan de manera al azar
y representan a otras dentro de la
comunidad. Por eso es tan importante
que responda cada hogar de la
muestra.

Así es. La Oficina del Censo está
obligada por ley a mantener
confidencial su información. A
nosotros no se nos permite divulgar
sus respuestas de manera que este
hogar pudiera ser identificado. En
conformidad con la Ley para el
Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus
datos están protegidos contra los
riesgos de seguridad cibernética
mediante los controles aplicados
a los sistemas que trasmiten su
información. Por ley, la Oficina del
Censo puede usar sus respuestas solo
para producir estadísticas.

¿Tengo que responder a la encuesta
si vivo en este
domicilio temporalmente?
Así es. Si vivirá en este domicilio por
más de 2 meses tiene que completar
la encuesta completa. Si vivirá allí
por 2 meses o menos, aún tendrá que
completar una porción de la encuesta
según las instrucciones. Un representante de la Oficina del Censo podrá
ayudarle. Esta información ayuda a las
comunidades a planificar, a medida
que la población cambia durante
distintas épocas del año.

¿Cómo puedo ver los resultados de la
encuesta?
La información se publica en el sitio
de Internet American FactFinder® (un
buscador de datos sobre los Estados
Unidos) de la Oficina del Censo en
factfinder.census.gov
Los datos se proveen en varios formatos, desde información para principiantes (es decir, personas que sólo
desean ver la información) hasta para
investigadores experimentados.

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American FactFinder® provee
tablas que:

• muestran una reseña general y
rápida de los datos,

• comparan los datos de distintos
lugares, y
• proveen información más a fondo
para realizar investigaciones más
detalladas.
¿Puede ver la policía o alguna agencia reglamentaria mis respuestas a la
encuesta?
No. La Oficina del Censo protege el
carácter privado de su información.
La policía no puede verla; y ningún
tribunal de ley tampoco. Nadie puede
ver ni usar sus respuestas específicas
para hacer cumplir ningún tipo de ley.

census.gov/acs

Si soy una persona anciana, discapacitada o, por algún motivo, no
puedo completar la Encuesta sobre
la Comunidad Estadounidense, ¿qué
hago?
Puede designar a una persona para
que le ayude, o es posible que un
representante de la Oficina del
Censo lo llame o vaya a su casa para
ayudarlo a completar la encuesta.
Los respondedores pueden llamar al
1-877-833-5625 para obtener ayuda.
Para lograr resultados más precisos,
es muy importante que cada hogar
seleccionado para la encuesta participe en ella.

Si algún empleado de la Oficina del
Censo violara estas disposiciones,
quedaría sujeto a rigurosas sanciones
penales impuestas por el Congreso –
hasta 5 años de encarcelamiento y/o
una multa de hasta $250,000 (Título
13 del Código de los Estados Unidos,
Sección 214, según enmendada por
el Título 18 del Código de Estados
Unidos, Secciones 3559 y 3571).

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ENCUESTA SOBRE LA COMUNIDAD ESTADOUNIDENSE

¿Cómo puedo obtener información
adicional sobre la Encuesta sobre la
Comunidad Estadounidense?

Hay varias maneras de obtener información sobre la Encuesta sobre la
Comunidad Estadounidense:

Para ver información detallada, le
invitamos a visitar nuestro sitio de
Internet en:
census.gov/acs
o llame a la Oficina Regional del Censo
más cercana según la lista siguiente:

Census Bureau Regional Offices
Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

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ENCUESTA SOBRE LA COMUNIDAD ESTADOUNIDENSE

census.gov/acs

Para preguntas sobre la
Encuesta sobre la Comunidad
Estadounidense o cómo ver los resultados de la misma, llame a nuestra línea de Servicio al Cliente al:

También puede comunicarse con nosotros por correo electrónico:

301-763-INFO (4636)

American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

1-888-346-9682

ask.census.gov
o bien por correo regular a:

7

ACS-51 (HU)(SP) Issued January 2020.indd 10

2/20/2019 11:35:09 AM

ACS-51 (HU)(SP) Issued January 2020.indd 11

2/20/2019 11:35:09 AM

AMERICAN
COMMUNITY
SURVEY
U.S. CENSUS BUREAU

E-mail: ask.census.gov

Phone: 1-888-346-9682

Internet: census.gov/acs

ACS-51 (HU)(SP) Issued January 2020.indd 12

2/20/2019 11:38:06 AM

Issued January 2020
ACS-51 (HU)(Arabic)
Connect with us @uscensusbureau

ACS-51HU_(Issued January 2020)_ARA.indd 1

2/19/2019 2:24:07 PM

‫أﺳﺌﻠﺔ وأﺟﻮﺑﺔ‬

‫ا‬
‫س‬
‫ت‬
‫ب‬
‫ي‬
‫ا‬
‫ن‬
‫ا‬
‫ل‬
‫ا‬
‫م‬
‫ل‬
‫م‬
‫ج‬
‫ت‬
‫ح‬
‫المت لية في ال معات‬
‫و‬
‫ح‬
‫د‬
‫ال‬
‫ي‬
‫ة‬
‫ا‬
‫ا‬
‫ت‬
‫أل‬
‫م‬
‫ر‬
‫ي‬
‫كية‬

‫‪2/19/2019 2:24:08 PM‬‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 2‬‬

ACS-51HU_(Issued January 2020)_ARA.indd 3

2/19/2019 2:24:08 PM

‫&‬

‫المتحدة األمريكية ‬
‫استبيان المجتمعات المحلية في الواليات ‬

‫ما هو استبيان المجتمعات المحلية في الواليات‬
‫المتحدة األمريكية؟‬

‫استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية هو استبيان يجريه مكتب اإلحصاء األمريكي‬
‫في كل مقاطعة ومناطق األمريكيين من أصل هندي‬
‫أحمر أو من سكان آالسكا األصليين وسكان هاواي‬
‫األصليين‪.‬‬
‫يقدم استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية معلومات هامة اقتصادية‪ ،‬اجتماعية‪ ،‬سكانية‬
‫وإسكانية إلى المجتمعات السكانية األمريكية كل عام‪.‬‬
‫فالمجتمعات تخبرنا أن استبيان المجتمعات المحلية‬
‫في الواليات المتحدة األمريكية يساعدهم في اتخاذ‬
‫القرارات المدروسة وهو دليل على المستقبل بالنسبة‬
‫لهم‪.‬‬

‫ ‬

‫ ‬

‫‪census.gov/acs‬‬

‫لم أسمع من قبل عن استبيان المجتمعات المحلية‬
‫في الواليات المتحدة األمريكية‪ .‬فمنذ متى وأنتم‬
‫تقومون بها؟‬
‫بدأ استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية عام ‪ 1996‬في عينة من المقاطعات في كل‬
‫أنحاء الدولة‪ .‬واليوم يتم االستبيان في كل المقاطعات‬
‫األمريكية وفي بورتوريكو‪ ،‬حيث يطلق عليه استبيان‬
‫المجتمعات المحلية في بورتوريكو‪.‬‬

‫ ‪1‬‬

‫‪2/19/2019 2:24:14 PM‬‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 4‬‬

‫&‬

‫ ‬
‫‪census.gov/acs‬‬

‫ ‬

‫كيف سيتم استخدام اإلجابات التي أقدمها إلى‬
‫استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية؟‬
‫األسئلة الواردة في استبيان المجتمعات المحلية في‬
‫الواليات المتحدة األمريكية أساسية لجمع البيانات‬
‫المطلوبة إلدارة البرامج الحكومية أو تقييمها‪ .‬وتلك‬
‫األسئلة هي بالطبع نفس األسئلة التي طرحت كجزء‬
‫من اإلحصاء الذي يجري كل عشر سنوات‪.‬‬

‫استبيان المجتمعات المحلية في الواليات المتحدة األمريكية‬

‫▪ إجابات األسئلة المتعلقة بالدخل واإلسكان يتم‬
‫تلخيصها واستخدامها في وزارة اإلسكان والتنمية‬
‫العمرانية األمريكية لتقييم الحاجة للمساعدة السكنية‬
‫بالنسبة لكبار السن والمعاقين ومالكي المساكن‬
‫ذوي الدخل المحدود‪.‬‬

‫▪ معلومات الدخل تتيح مقارنة المستويات االقتصادية‬
‫للمناطق المختلفة‪ .‬كما أن العديد من البرامج‬
‫الفيدرالية وبرامج الواليات تستخدم تلك البيانات‬
‫لتوزيع الموارد المالية لتنمية المجتمع‪.‬‬

‫▪ المعلومات المتعلقة بالعرق واألصول الالتينية‬
‫واللغة المتحدث بها في المنزل‪ُ ،‬تستخدم لتحديد‬
‫المتطلبات ثنائية اللغة في االنتخابات بموجب قانون‬
‫حقوق التصويت ومراقبة تكافؤ فرص التوظيف‬
‫بموجب قانون الحقوق المدنية‪ .‬العرق أو األصول‬
‫الهسبانية (أو الجذور العرقية) تعد مفاهيم متميزة‪،‬‬
‫ولذا فإنها تتطلب أسئلة منفصلة‪.‬‬

‫▪ إجاباتك على األسئلة المتعلقة بالتوجه إلى العمل‬
‫تستخدمها وزارة النقل األمريكية للتخطيط لتحسين‬
‫الطرق السريعة وتطوير خدمات النقل العام وتصميم‬
‫البرامج الكفيلة بالتخفيف من المشاكل المرورية‪.‬‬

‫▪ المعلومات المتعلقة بالخدمة العسكرية تستخدمها‬
‫اإلدارة األمريكية أساسًا لشؤون المحاربين القدامى‬
‫لقياس احتياجات المحاربين ولتقييم برامجهم المعنية‬
‫بالتعليم والتوظيف والرعاية الصحية‪.‬‬

‫▪ المعلومات المتعلقة بالعمر ُتستخدم في البرامج‬
‫الفيدرالية لتوجيه الموارد المالية أو الخدمات‬
‫إلى األطفال أو البالغين في سن العمل أو كبار‬
‫السن‪.‬‬

‫ ‪2‬‬

‫‪2/19/2019 2:24:16 PM‬‬

‫ ‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 5‬‬

‫&‬

‫المتحدة األمريكية ‬
‫استبيان المجتمعات المحلية في الواليات ‬

‫كيف سأستفيد من اإلجابة على استبيان‬
‫المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية؟‬

‫تقول الوكاالت الفيدرالية والواليات والمجتمعات أنه ال‬
‫يتوفر لديها أحدث المعلومات المطلوبة للتعرف بشكل‬
‫أفضل على قضايا المجتمع واالستجابة الحتياجاته‬
‫وتخصيص البرامج والموارد‪ .‬وكما قال أحد رواد‬
‫المجتمع‪« :‬التخمين دائمًا متعة‪ ،‬ولكن نادرً ا ما يكون‬
‫فعاالً»‪.‬‬
‫بالرد على أسئلة استبيان المجتمعات المحلية في‬
‫الواليات المتحدة األمريكية‪ ،‬فإنك تساعد مجتمعك‬
‫على تحقيق أهدافه االجتماعية وتحديد مشاكله وحلولها‬
‫والتعرف على المرافق والبرامج ومقياس أداء البرامج‪.‬‬

‫ ‬

‫ ‬

‫‪census.gov/acs‬‬

‫▪ البرامج المجتمعية‪ ،‬مثل المعنية بكبار السن والبرامج‬
‫الكشفية والمكتبات والمصارف والمستشفيات‬
‫وغيرها من المؤسسات المجتمعية‪ ،‬لتقديم الخدمات‬
‫للمجتمع وتحديد المنشآت والخدمات والبرامج‪.‬‬
‫▪ القائمين على تخطيط الطرق‪ ،‬وذلك باستخدام‬
‫معلومات التوجه إلى العمل‪ ،‬للتخطيط ألوقات‬
‫الذروة لتفادي االختناقات المرورية‪ ،‬والتخطيط‬
‫لساحات انتظار السيارات‪ ،‬ووضع االستراتيجيات‬
‫مثل برامج النقل الجماعي وجداول العمل‬
‫المرنة‪ .‬ويتم اتخاذ قرارات شق طرق جديدة أو‬
‫توسيع الطرق الحالية‪ ،‬وتطوير أنظمة النقل مثل‬
‫القطارات الخفيفة أو مترو األنفاق‪ ،‬وذلك باستقراء‬
‫االحتياجات المستقبلية‪.‬‬

‫بيانات استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية يستخدمها ك ٌل من‪:‬‬
‫▪ الحكومات المحلية للمساعدة في وضع الموازنات‬
‫وتقييم البرامج والتخطيط لمشاريع التنمية‬
‫المجتمعية‪.‬‬

‫ ‪3‬‬

‫‪2/19/2019 2:24:17 PM‬‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 6‬‬

‫&‬

‫ ‬
‫‪census.gov/acs‬‬

‫ ‬

‫علي اإلجابة على أسئلة استبيان‬
‫هل يجب ّ‬
‫المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية؟‬

‫نعم‪ .‬فاستجابتك لهذا االستبيان إلزامية بموجب القانون‬
‫(المادة ‪ 13‬من قانون الواليات المتحدة‪ ،‬الفقرات ‪141‬‬
‫و‪ 193‬و‪ .)221‬والقانون ذاته يحمي سرية المعلومات‬
‫التي تقدمها‪.‬‬

‫عام؟‬
‫هل يجب علي الرد على تلك األسئلة كل ِ‬
‫ال‪ .‬يتم اختيار عينة صغيرة من العناوين للمشاركة‬
‫في استبيان المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية‪ .‬وقد يتم اختيار عنوان ما للعينة مرة كل ‪5‬‬
‫سنوات‪ .‬ويتم اختيار تلك العناوين عشوائيًا لكي تمثل‬
‫العناوين األخرى في المجتمع‪ .‬ولذلك فإنه من األهمية‬
‫بمكان أن تجيب كل أسرة يقع عليها االختيار‪.‬‬

‫ ‪4‬‬

‫‪2/19/2019 2:24:17 PM‬‬

‫استبيان المجتمعات المحلية في الواليات المتحدة األمريكية‬

‫علي اإلجابة على االستبيان إذا كنت‬
‫هل يجب‬
‫ّ‬
‫مقي ًما في هذا العنوان بشكل مؤقت؟‬

‫نعم‪ .‬إذا كنت تقيم في هذا العنوان ألكثر من شهرين‪،‬‬
‫فيجب أن تكمل االستبيان كله‪ .‬أما إذا كنت تقيم‬
‫لمدة شهرين أو أقل‪ ،‬فيجب أيضًا أن تكمل جز ًء من‬
‫االستبيان‪ ،‬وف ًقا لإلرشادات‪ .‬ويمكن لممثل مكتب‬
‫اإلحصاء مساعدتك‪ .‬فهذه المعلومات تساعد المجتمعات‬
‫في التخطيط مع التغيرات السكانية في أوقات مختلفة‬
‫من العام‪.‬‬

‫هل أجوبتي على االستبيان سرية؟‬
‫نعم‪ .‬يلزم القانون مكتب اإلحصاء األمريكي بأن يحافظ‬
‫على معلوماتك السرية‪ .‬وغير مسموح لنا بنشر إجاباتك‬
‫بشكل عام بطريقة من شأنها أن تحدد هوية أسرتك‪.‬‬
‫وتتم حماية البيانات ضد هجمات األمن اإللكتروني‬
‫من خالل مراقبة األنظمة التي تنقل بياناتك وذلك وفق‬
‫قانون تعزيز األمن اإللكتروني الفيدرالي لعام ‪.٢٠١٥‬‬
‫وحسب القانون‪ ،‬يمكن لمكتب اإلحصاء استخدام‬
‫إجاباتك إلنتاج اإلحصائيات فقط‪.‬‬

‫ ‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 7‬‬

‫&‬

‫المتحدة األمريكية ‬
‫استبيان المجتمعات المحلية في الواليات ‬

‫كيف يمكنني أن أطلع على نتائج‬
‫االستبيان؟‬

‫ ‬

‫ ‬

‫‪census.gov/acs‬‬

‫ُتنشر هذه المعلومات على موقع‬
‫®‪ American FactFinder‬التابع لمكتب‬
‫اإلحصاء على اإلنترنت‬
‫‪factfinder.census.gov‬‬

‫ُتقدم البيانات بعدة تنسيقات لكل شخص‪ ،‬من المبتدئين‬
‫(الذين يريدون االطالع على البيانات وحسب) إلى‬
‫الباحثين المتخصصين‪.‬‬
‫يقدم ®‪ American FactFinder‬الجداول التي‪:‬‬
‫▪ تقدم نبذة عامة عن البيانات بسرعة‬
‫▪ تقارن بيانات األماكن المختلفة‬
‫▪ تقدم بيانات أكثر شمولية من أجل األبحاث األكثر‬
‫تفصيالً‪.‬‬

‫ ‪5‬‬

‫‪2/19/2019 2:24:19 PM‬‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 8‬‬

‫&‬

‫ ‬
‫‪census.gov/acs‬‬

‫ ‬

‫استبيان المجتمعات المحلية في الواليات المتحدة األمريكية‬

‫أنا عجوز أو معاق أو ال يمكنني إكمال أسئلة‬
‫استبيان المجتمعات المحلية في الواليات‬
‫المتحدة األمريكية‪ .‬فماذا أفعل؟‬

‫كيف أحصل على معلومات أكثر عن استبيان‬
‫المجتمعات المحلية في الواليات المتحدة‬
‫األمريكية؟‬

‫يمكنك اختيار شخص آخر لمساعدتك‪ ،‬أو من الممكن‬
‫أن يتصل بك ممثل مكتب اإلحصاء أو يأتي إلى منزلك‬
‫ويساعدك في إكمال االستبيان‪ .‬ويمكن للمعنيين االتصال‬
‫على ‪ ٧٢٧١_٣٥٤_٨٠٠_١‬لتلقي المساعدة‪.‬‬

‫توجد طرق عدة للحصول على معلومات عن دراسة‬
‫المجتمع األمريكي‪:‬‬

‫وللحصول على أدق النتائج‪ ،‬من األهمية بمكان أن‬
‫تشارك في االستبيان كل األسر المختارة‪.‬‬

‫للمعلومات المفصلة‪ ،‬نوصيك بزيارة موقعنا على‬
‫اإلنترنت‪:‬‬
‫‪census.gov/acs‬‬
‫أو االتصال بأقرب فرع إقليمي لمكتب اإلحصاء كما‬
‫هو أدناه‪:‬‬

‫المكاتب اإلقليمية التابعة لمكتب اإلحصاء‬

‫ ‪6‬‬

‫‪2/19/2019 2:24:23 PM‬‬

‫ ‪Los Angeles, CA‬‬
‫‪1-800-992-3530‬‬

‫‪Atlanta, GA‬‬
‫‪1-800-424-6974‬‬

‫ ‪New York, NY‬‬
‫‪1-800-991-2520‬‬

‫ ‪Chicago, IL‬‬
‫‪1-800-865-6384‬‬

‫ ‪Philadelphia, PA‬‬
‫‪1-866-238-1374‬‬

‫ ‪Denver, CO‬‬
‫‪1-800-852-6159‬‬

‫ ‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 9‬‬

‫&‬

‫المتحدة األمريكية ‬
‫استبيان المجتمعات المحلية في الواليات ‬

‫لطرح أسئلة حول بيانات استبيان المجتمعات‬
‫المحلية في الواليات المتحدة األمريكية أو لمعرفة‬
‫كيفية االطالع على نتائج االستبيان‪ ،‬يمكن االتصال‬
‫على خط خدمة العمالء‪:‬‬
‫)‪301-763-INFO (4636‬‬
‫‪1-888-346-9682‬‬

‫ ‬

‫ ‬

‫‪census.gov/acs‬‬

‫كما يمكن مراسلتنا بالبريد اإللكتروني‬

‫‪ask.census.gov‬‬

‫أو بالبريد العادي األمريكي على‪:‬‬
‫‪American Community Survey‬‬
‫‪U.S. Census Bureau‬‬
‫‪4600 Silver Hill Rd.‬‬
‫‪Washington, DC‬‬
‫‪20233-7500‬‬

‫ ‪7‬‬

‫‪2/19/2019 2:24:26 PM‬‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 10‬‬

ACS-51HU_(Issued January 2020)_ARA.indd 11

2/19/2019 2:24:26 PM

‫استبيان المجتمعات‬
‫المحلية في الواليات‬
‫المتحدة األمريكية‬
‫مكتب اإلحصاء األمريكي‬

‫بريد إلكتروني‪ask.census.gov :‬‬

‫هاتف‪1-888-346-9682 :‬‬

‫موقع اإلنترنت‪census.gov/acs :‬‬

‫‪2/19/2019 2:24:31 PM‬‬

‫‪ACS-51HU_(Issued January 2020)_ARA.indd 12‬‬

Qu

Issued January 2020
ACS-51 (HU)(French)
Connect with us @uscensusbureau

ACS-51(HU)(Issued January 2020)_FRE.indd 1

2/19/2019 2:23:39 PM

Questions et réponses

s
e
l
r
u
s
e és
t
ê
u aut
q
n
L’E mun nes
coméricai
am

ACS-51(HU)(Issued January 2020)_FRE.indd 2

2/19/2019 2:23:39 PM

ACS-51(HU)(Issued January 2020)_FRE.indd 3

2/19/2019 2:23:39 PM

&

L’ENQUÊTE SUR LES COMMUNAUTÉS AMÉRICAINES

L’Enquête sur les
communautés américaines,
qu’est-ce que c’est ?

L’Enquête sur les communautés
américaines est menée par le Bureau
de recensement des États-Unis dans
chaque comté, dans les territoires des
Indiens Américains et de l’Alaska et sur
le territoire d’Hawaï.

L’Enquête sur les communautés
américaines fournit tous les ans
aux différentes communautés
des Etats-Unis des informations
d’une importance cruciale en
matière d’économie, de société,
de démographie et de logement.
Ces dernières nous ont confié que
cette enquête les aide à prendre des
décisions basées sur des informations
récentes et qu’elle joue un rôle clé dans
leur avenir.

census.gov/acs

Je n’ai pas entendu parler
de l’Enquête sur les
communautés américaines.
Depuis combien de temps
cette enquête a-t-elle lieu ?
L’Enquête sur les communautés
américaines a été menée pour la
première fois en 1996, dans un
échantillonnage de comtés des
États-Unis. À l’heure actuelle, cette
enquête est menée dans tous les
comtés des États-Unis, ainsi qu’à Porto
Rico où elle porte le nom d’Enquête
sur la population des communautés
portoricaines.

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L’ENQUÊTE SUR LES COMMUNAUTÉS AMÉRICAINES

Comment mes réponses aux
questions posées dans le
cadre de l’Enquête sur les
communautés américaines
sont-elles utilisées ?

 es questions posées dans le cadre
L
de cette enquête ont pour but
de rassembler les informations
nécessaires à la gestion ou à
l’évaluation des programmes
gouvernementaux. Ces questions sont
essentiellement les mêmes que celles
qui ont été posées dans le cadre du
recensement décennal.
• Les informations au sujet du
revenu permettent de comparer le
niveau économique de différentes
régions. De nombreux programmes
fédéraux et des états se servent de
ces informations pour répartir les
fonds destinés au développement
des communautés.
• Vos réponses aux questions
concernant le trajet vers le lieu de
travail sont utilisées par le Ministère
des transports des États-Unis
pour planifier les améliorations du
réseau des autoroutes, développer
les transports publics et concevoir
des programmes afin de faciliter la
circulation routière.
• Les informations sur l’âge sont

utilisées dans le cadre des
programmes fédéraux pour cibler
les fonds ou les services destinés
aux enfants, aux adultes en âge de
travailler ou aux personnes âgées.

• Les réponses aux questions
concernant le revenu et le logement
sont présentées en bref et utilisées
par le Secrétariat au logement
et au développement urbain des
États-Unis afin d’évaluer les besoins
en matière d’aide au logement
pour les personnes âgées, les
handicapés et les propriétaires à
faible revenu.
• Les informations relatives à la
race, l’origine hispanique et la
langue parlée domicile sont
utilisées afin de déterminer les
exigences du bilinguisme pour les
élections dans le cadre du Voting
Rights Act (Loi sur le droit de
vote) et la surveillance de la nondiscrimination en matière d’emploi
dans le cadre du Civil Rights Act
(Loi sur les droits civiques). La
race et l’origine (ou ethnicité)
hispanique sont considérées
comme étant des concepts
différents et font donc l’objet de
questions distinctes.
• Les informations sur le
service militaire sont utilisées

2

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L’ENQUÊTE SUR LES COMMUNAUTÉS AMÉRICAINES

principalement par le Ministère des
anciens combattants des ÉtatsUnis pour estimer les besoins des
anciens combattants et évaluer
les programmes les concernant en
matière d’éducation, d’emploi et de
santé.

Quels bénéfices puis-je
tirer de ma participation
à l’Enquête sur les
communautés américaines ?
Les agences gouvernementales
fédérales, les états et les
communautés des États-Unis se
plaignent de ne pas disposer des
informations les plus récentes
leur étant nécessaires pour mieux
comprendre les problèmes liés aux
communautés, répondre aux besoins
et répartir les programmes et les
ressources. Comme l’a déclaré
un des responsables d’une
communauté : « C’est toujours
amusant de jouer aux devinettes, mais
ce n’est pas une manière vraiment
efficace de trouver une réponse. »
Vos réponses aux questions de
l’Enquête sur les communautés
américaines aideront votre
communauté à établir ses objectifs,
à identifier ses problèmes et à leur
trouver des solutions, à établir des

census.gov/acs

institutions et des programmes,
et à évaluer les performances des
programmes.
Les informations recueillies par
l’Enquête sur les communautés
américaines sont utilisées par :
• Les agences gouvernementales
régionales pour affecter les
ressources, évaluer les programmes
et planifier les projets de
développement des communautés.
• Les programmes de communauté,
comme ceux concernant les
personnes âgées, le scoutisme,
les bibliothèques, les banques,
les hôpitaux et autres agences
des communautés, pour offrir
des services à la communauté et
mettre en place des bâtiments, des
services et des programmes.
• Les planificateurs des transports,
utilisant les informations
concernant le trajet vers le lieu
de travail pour prévoir les heures
de pointe et prendre les mesures
nécessaires afin de réduire les
embouteillages, planifier les places
de stationnement et mettre au

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L’ENQUÊTE SUR LES COMMUNAUTÉS AMÉRICAINES

point des stratégies, comme des
programmes de covoiturage et
des horaires de travail flexibles.
Les décisions concernant la
construction de nouvelles voies
routières, l’accroissement de
la capacité des infrastructures
existantes, la mise en place
de systèmes de transports en
commun, comme des tramways ou
des métros, sont prises sur la base
de projections des besoins futurs.

Dois-je obligatoirement
répondre aux questions
de l’Enquête sur les
communautés
américaines ?
Oui. La loi exige que vous répondiez
aux questions de cette enquête (Livre
13, Code des États-Unis, Sections 141,
193 et 221). La même loi protège la
confidentialité des informations que
vous fournissez.

Dois-je obligatoirement
répondre à ces questions
chaque année ?

adresse ne peut être sélectionnée pour
cet échantillon qu’une fois tous les 5
ans. Ces adresses sont sélectionnées
au hasard et représentent d’autres
adresses de la communauté. C’est
pourquoi il est si important que
chaque foyer sélectionné réponde aux
questions de l’enquête.

Dois-je obligatoirement
répondre aux questions de
l’enquête si je n’habite que
temporairement à l’adresse
sélectionnée ?
Oui. Si vous habitez à l’adresse
sélectionnée pendant plus de 2 mois,
vous devez répondre à toutes les
questions de l’enquête. Si vous y habitez
pendant un maximum de 2 mois,
vous devez quand même répondre
à certaines questions de l’enquête,
comme indiqué dans les instructions. Un
représentant du Bureau de recensement
peut vous aider. Ces informations aident
les communautés, à différents moments
de l’année, à planifier leurs besoins
au fur et à mesure de l’évolution de la
population.

Non. Seul un petit échantillon
d’adresses est sélectionné auquel
sera envoyée l’Enquête sur les
communautés américaines. Une

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L’ENQUÊTE SUR LES COMMUNAUTÉS AMÉRICAINES

Mes réponses aux questions
de l’enquête sont-elles
confidentielles ?

Oui. Le Bureau de recensement des
États-Unis a l’obligation légale de
préserver la confidentialité de vos
informations. Nous ne sommes pas
autorisés à divulguer publiquement
toute information qui permettrait
d’identifier votre foyer. En vertu du
Federal Cybersecurity Enhancement Act
de 2015 (loi fédérale américaine visant à
améliorer la cybersécurité), vos données
sont protégées contre les risques liés
à la cybersécurité grâce au filtrage des
systèmes qui transmettent vos données.
La loi autorise le Bureau de recensement
des États-Unis à utiliser vos réponses.

Comment puis-je consulter les
résultats de l’enquête ?
Ces informations sont publiées sur
le site Web American FactFinder® du
Bureau de recensement des États-Unis :
factfinder.census.gov
Les données sont présentées sous
différents formats pour satisfaire les
novices (qui ne veulent que consulter
les informations) tout comme les
chercheurs chevronnés.

census.gov/acs

• donnent un aperçu rapide
des données,
• comparent les données de
différents emplacements et
• proposent des données plus
détaillées pour une recherche plus
poussée.

Je suis âgé(e), handicapé(e)
ou dans l’incapacité pour
une autre raison quelconque
de répondre aux questions
de l’Enquête sur les
communautés américaines.
Que dois-je faire ?
Vous pouvez désigner une autre
personne qui pourra vous aider, ou
bien un représentant du Bureau de
recensement des États-Unis pourra
vous téléphoner ou se rendre à votre
domicile pour vous aider à remplir
le questionnaire. Les répondants
peuvent demander de l’aide en
appelant le
1-800-354-7271.
Pour optimiser les résultats de
l’enquête, il est très important que
chaque foyer sélectionné participe à
l’enquête.

American FactFinder® présente des
tableaux qui :

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census.gov/acs

L’ENQUÊTE SUR LES COMMUNAUTÉS AMÉRICAINES

Comment puis-je obtenir de
plus amples informations
concernant l’Enquête sur les
communautés américaines ?

ou bien d’appeler le bureau régional
du Bureau de recensement le plus
proche de vous, indiqué dans la liste
ci-dessous :

Vous pouvez obtenir des
renseignements concernant l’Enquête
sur les communautés américaines de
plusieurs façons :
Pour obtenir des informations
détaillées, nous vous conseillons de
visiter notre site Web :
census.gov/acs

Bureaux régionaux du Bureau
de recensement des États-Unis
Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

6

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nal
s
ste

&

L’ENQUÊTE SUR LES COMMUNAUTÉS AMÉRICAINES

Si vous avez des questions
concernant les données de
L’enquête sur les communautés
américaines ou si vous désirez
savoir comment consulter les
résultats de l’enquête, veuillez
appeler notre service d’assistance à
la clientèle au :
301-763-INFO (4636)
1-888-346-9682

census.gov/acs

Vous pouvez également nous
contacter par e-mail
ask.census.gov

ou par courrier à l’adresse suivante :
American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

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L’ENQUÊTE SUR LES
COMMUNAUTÉS
AMÉRICAINES

BUREAU DE RECENSEMENT DES ÉTATS-UNIS

E-mail : ask.census.gov

Téléphone : 1-888-346-9682

Internet : census.gov/acs

ACS-51(HU)(Issued January 2020)_FRE.indd 12

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Ke

Issued January 2020
ACS-51 (HU) (Haitian Creole)
Connect with us @uscensusbureau

ACS-51(HU)(Issued January 2020)_HCR.indd 1

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Kesyon ak Repons

u
o
p
j
a
d
e
n
t
o
o
S
in yo
m
Ko zini
Eta

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SONDAJ POU KOMINOTE ETAZINI YO

Kisa sondaj pou kominote
ozetazini yo an ye ?

Sondaj pou kominote ozetazini yo
an se yon sondaj biwo resansman
ameriken an ap fè nan tout peyi a, epi
menm nan zòn kote endyen ameriken
epi natifnatal natal Alaska rete epi,
lèfini, sou teritwa Awayi.

Sondaj sou kominote ameriken an
ap, chak lane, bay enfòmasyon kritik
sou sitiyasyon ekonomik, sosyal,
demografik ak lojman nan tout
kominote peyi a. Tout kominote peyi a
di sondaj pou kominote Etazini yo an
ede yo pran bon dezisyon byen enfòme
e sondaj la fondamantal pou lavni
kominote a.

census.gov/acs

MWEN pa janm tande pale sou
sondaj pou kominote Etazini
yo. Èske ou ka di mwen depi
kilè y ap fè li ?
Sondaj pou kominote Etazini yo an
kòmanse nan lane 1996 nan kèk konte
peyi a. Jodi a sondaj la fèt nan tout
konte peyi Etazini epi nan Puerto Rico,
men la se sondaj pou kominote Puerto
Rico ke yo rele li.

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&

Kijan y ap itilize repons mwen
bay nan sondaj pou kominote
ozetazini yo an ?
Kesyon ki nan sondaj pou kominote
ozetazini yo an obligatwa pou n
ranmase enfòmasyon nesesè pou
n dirije oswa evalye pwogram
gouvènmantal. Kesyon ki nan sondaj
sa a se menm ak enpe nan kesyon ki
nan resansman chak 10 zan an.

• Enfòmasyon sou revni ede nou fè
konparezon nivo ekonomik ant
plizyè zòn. Gen anpil pwogram
federal ak pwogram leta ki sèvi
ak enfòmasyon sa a pou yo
distribye lajan k ap ede devlòpman
kominote a.
• Repons ou bay kesyon transpò
pou ale epi soti nan travay ap ede
depatman transpò ameriken an
tabli devlopman wout, devlopman
sèvis transpò piblik ak pwogram k
ap ede redui anbouteyaj.
• Enfòmasyon sou laj ap sèvi nan
pwogram federal pou pwoblèm
peman ak sèvis pou timoun, moun
ki nan laj pou yo travay epi pou
granmoun.

SONDAJ POU KOMINOTE ETAZINI YO

• Repons pou kesyon sou revni ak
lojman ap ofri yon enfòmasyon
jeneral pou depatman Kay ak
devlopman vil Ameriken yo an
evalye kisa granmoun, moun ki gen
andikap ak pwopriyetè kay ki pòv
bezwen lakay yo.
• Enfòmasyon sou ras, ansèt panyòl
ak lang manman ap sèvi pou nou
detèmine tout sa ki nesesè pou
nou gen yon eleksyon nan de lang
dapre lwa sou dwa moun nan
eleksyon epi pou nou kontwole
opòtinite egalego nan itilizasyon
travay dapre lwa sou dwa sivil. Ras
ak zansèt panyòl (oswa gwoup
etnik panyòl) pa menm kidonk
fòk n gen diferan kesyon pou yo
toulede.
• Enfòmasyon sou sèvis militè ap
sèvi pou depatman ki okipe zafè
ansyen konbatan ameriken mezire
sa ansyen konbatan yo bezwen
epi pou evalye pwogam ansyen
konbatan yo sou zafè edikasyon,
travay ak swen medikal.

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SONDAJ POU KOMINOTE ETAZINI YO

Ki avantaj k ap genyen pou
mwen si mwen patisipe nan
sondaj pou kominote Etazini
yo?

Touletwa ajans federal, ajans leta ak
kominote yo di yo pa gen tout dènye
enfòmasyon ki nesesè pou yo pi byen
konprann pwoblèm ki genyen nan
kominote yo, pou yo ofri sèvis nesesè
epi pou yo ofri pwogram ak resous.
M ap p ba ou egzanp sa yon chèf
kominote di : « Li toujou enteresan pou
nou jwe devinèt men sa pa toujou fè
bagay yo mache ».
Repons ou bay nan kesyon sondaj
pou kominote Etazini yo an pral ede
kominote kote ou rete a detèmine
objektif, idantifye pwoblèm epi jwenn
solisyon pou pwoblèm kominote
a, jwenn ekipman ak pwogram, epi
mezire rannman tout pwogram yo.
Moun k ap itilize enfòmasyon ki
dekouvri nan sondaj pou kominote
Etazini yo an se :

census.gov/acs

• Administrasyon lokal pou yo fè
bidjè, evalye pwogram epi fè plan
sou pwojè devlopman kominote a.
• Pwogram kominote (sètadi
pwogram pou granmoun, pwogram
eskout, bibliyotèk, bank, lopital
ak lòt òganizasyon nan kominote
a) pou yo ofri sèvis nan kominote
a epi pou jwenn bilding, sèvis ak
pwogram.
• Moun ki bay sèvis transpò, sèvi ak
enfòmasyon transpò moun itilize
pou yo ale epi soti nan travay pou
òganizasyon sikilasyon lè anpil
moun ki ale epi ki soti nan travay
epi pou devlopman estrateji, sètadi
pwogram woulib ak orè travay
ki chanje. Yo pran dezisyon pou
konstwi nouvo wout oswa pou elaji
wout ki la deja, epi pou devlope
sistèm transpò tankou tren lokal
ak tren banlye apati sa moun ap
bezwen pidevan.

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SONDAJ POU KOMINOTE ETAZINI YO

Èske m oblije reponn kesyon
ki nan sondaj pou kominote
ozetazini yo an ?

Èske mwen oblije reponn kesyon sondaj la menmsi m nan
kay la pou yon bout tan ?

Wi. Gen yon lwa ki di ou oblije reponn
sondaj la (Tit 13, kòd ameriken,
seksyon 141, 193 ak 221). Menm
lwa sa a di enfòmasyon ou bay ap l
rete sekrè.

Wi. Ou dwe reponn tout kesyon
sondaj la si ou rete nan adrès kay sa
a pandan omwen 2 mwa. Ou dwe
reponn yon pati nan sondaj la si w pa
p rete nan adrès kay la pou 2 mwa
kifè se pou w li enstriksyon yo pou
w konnen ki pati pou w reponn. Yon
reprezantan biwo resansman an ka
ede w. Enfòmasyon sa a ede kominote
yo, plizyè fwa nan ane a, fè plan ki
nesesè menmsi popilasyon an ap
chanje.

Èske se chak ane m ap gen
pou m reponn kesyon sa yo ?
Non. Se sèlman kèk adrès kay nou
chwazi pou yo patisipe nan sondaj
pou kominote Etazini yo an. Se chak 5
an yon adrès kay ka chwazi ankò pou
li patisipe nan sondaj la. Adrès sa yo
chwazi owaza epi yo reprezante tout
lòt adrès ki nan menm zòn lan. Se pou
sa li enpòtan pou tout adrès kay ki
chwazi patisipe nan sondaj la.

Èske repons mwen bay nan
sondaj la ap rete konfidansyèl?
Non. Sèlman nou chwazi yon ti
echantiyon adrès pou patisipe
nan Sondaj Kominote Etazini. Nou
ka chwazi yon adrès sèlman pou
echantiyon an yon fwa chak 5 ane.
Nou chwazi adrès yo owaza epi yo
reprezante lòt adrès ki nan kominote a.
se rezon sa a ki fè li enpòtan anpil pou
chak fanmi nou chwazi reponn kesyon
sondaj la.

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NI YO

&

SONDAJ POU KOMINOTE ETAZINI YO

census.gov/acs

Kijan m ka wè rezilta sondaj
la ?

Enfòmasyon sa a ap pibliye nan sit
entènèt biwo resansman American
Factfinder® a nan :
factfnder.census.gov

W ap jwenn rezilta yo sou plizyè
fòm pou tout moun ka konprann li,
sètadi moun k ap wè rezilta yo pou
premye fwa (moun ki sèlman vle wè
rezilta yo) jis nan moun ki gen gwo
eksperyans nan rechèch.
American FactFinder® ofri chema
k ap :
• ofri yon prezantasyon rapid epi
jeneral sou rezilta yo,
• fè konparezon ant rezilta plizyè
kote, epi
• ofri rezilta ki gen plis detay pou
moun ki fè rechèch pi detaye.

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SONDAJ POU KOMINOTE ETAZINI YO

Mwen se granmoun, moun ki
andikape oswa mwen gen lòt
pwoblèm ki anpeche m reponn
kesyonè sondaj pou kominote
ozetazini yo an. Kisa mwen ka
fè ?

Ki kote m ap jwenn plis
enfòmasyon sou sondaj pou
kominote ozetazini yo an ?

Ou ka chwazi yon lòt moun pou moun
sa ede w, oubyen yon reprezantan
biwo resansman an ka swa rele ou
oswa vini lakay ou pou l ede w reponn
kesyon sondaj la. Moun ki chwazi pou
patisipe nan sondaj la ka rele 1-800354-7271 pou jwenn moun ede yo.

Pou jwenn plis enfòmasyon detaye,
nou mande ou pou ale sou sitwèb nou
an nan :
census.gov/acs
oubyen rele biwo resansman rejyonal
kote ou rete a jan w wè li make la a:

Gen plizyè fason pou w jwenn
enfòmasyon sou sondaj pou kominote
ozetazini yo an :

Pou nou bay rezilta ki korèk, li enpòtan
anpil pou tout adrès kay ki chwazi
patisipe nan sondaj la.

Biwo resansman rejyonal
Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

6

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NI YO

&

SONDAJ POU KOMINOTE ETAZINI YO

Tanpri rele nimewo sèvis kliyantèl
nou an si ou gen kesyon sou rezilta
sondaj pou kominote Etazini yo
an oubyen si ou ta renmen konnen
kijan ou ka wè rezilta sondaj la :
301-763-INFO (4636)
1-888-346-9682

census.gov/acs

Si ou vle ou ka voye yon lèt ba:
ask.census.gov

oubyen nan lapòs ba:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

7

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SONDAJ POU
KOMINOTE
OZETAZINI YO
BIWO RESANSMAN NAN ETAZIN

Imel : ask.census.gov

Telefòn : 1-888-346-9682

Entènèt : census.gov/acs

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질

Issued January 2020
ACS-51 (HU)(Korean)
Connect with us @uscensusbureau

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질문과 답

미국 사회
지역
조사

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미국 지역사회 조사

&

미국 지역사회 조사란 무엇입니까?
인구조사국은 모든 카운티,아메리칸
인디언 및 알래스카 원주민 지역,
하와이 원주민 본토에서 미국
지역사회 조사를 실시합니다.
미국 지역사회 조사는 매년 중요한
경제, 사회, 인구통계 및 주택
정보를 이 나라의 지역사회에
제공합니다. 미국 지역사회 조사는
합리적인 결정을 내리는 데 도움이
되며 지역사회의 미래에 중요
하다고 여러 지역사회에서 말합니다.

census.gov/acs

나는 미국 지역사회 조사에 대해
들어본 적이 없습니다. 이 조사를
얼마나 오랫동안 실시해 왔습니까?
미국 지역사회 조사는 1996년에 전
국적으로 몇몇 카운티에서 시범적으
로 시작되었습니다. 오늘날 이 조사
는 미국 전 카운티와 푸에르토리코
에서 실시되며, 푸에르토리코의 경
우 ‘푸에르토리코 지역사회 조사’
라고 합니다.

1

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census.gov/acs

&

내가 미국 지역사회 조사에 제공
하는 답은 어떻게 사용됩니까?

미국 지역사회 조사의 질문들은
정부프로그램을 관리하거나 평가
하는 데 필요한 자료를 수집하는 데
필요합니다. 이 질문들은 기본적
으로 10년에 한번씩 실시되는 인구
조사(센서스)의 일부 질문들과 동일
합니다.

미국 지역사회 조사

• 소득

및 주택에 관한 질문에
대한 응답은 요약되어 미국 주택
도시 개발부에서 노인, 장애인
및 저소득 주택 소유자들을 위한
주택 지원의 필요성을 평가하는
데 사용됩니다.

• 인종, 중남미 출신, 가정에서

정보는 각 지역의 경제
수준을 비교할 수 있게 합니다.
이 자료는 많은 연방 및 주
프로그램에서 지역사회 개발기금
을 분배하는 데 사용됩니다.

사용하는 언어 등에 대한 정보는
민권법에 보장된 고용평등을
감독하고, 투표권법에 따른 이중
언어 요건을 결정하기 위해 사용
됩니다. 인종과 중남미 출신
(또는 민족)은 별개의 개념으로
간주되므로 별도의 질문이 필요
합니다.

• 통근에 관한 질문에 대한 응답은

• 군복무에 관한 정보는 미국 재향

미 교통부에서 고속도로 개선을
계획하고, 대중 교통 서비스를
개발하며, 교통 문제 완화에
필요한 프로그램을 만드는 데
사용됩니다.

군인 원호부에서 재향 군인들이
필요한 것이 무엇인지를 파악
하고, 이들을 위한 교육, 취업 및
건강 관리 프로그램을 평가하는
데 주로 사용됩니다.

• 소득

• 연령에

관한 정보는 어린이,
경제활동 인구 또는 노인에게
제공하는 기금이나 서비스를
목적으로 하는 연방 프로그램에
사용됩니다.

2

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회 조사

미국 지역사회 조사

&

미국 지역사회 조사에 응답함으로써
어떻게 혜택을 받습니까?

연방 정부 기관, 주 및 지역사회들
은 지역사회의 문제를 더 잘 이해
하고 필요에 대응하며 프로그램과
자원을 배분하는 데 필요한 최신
정보가 없다고 말합니다. 한 지역
사회 지도자가 말한 것처럼, “추측
은 항상 재미있지만 좀처럼 효과적
이지는 않습니다.”

미국 지역사회 조사 설문지에 응답
하 는 것은 , 여 러 분 의 지 역 사 회 가
지역사회 목표를 수립하고, 지역
사 회 문제 와 해 결 책 을 파 악 하 며 ,
시설과 프로그램의 장소를 찾고,
프로그램의 성과를 측정하도록
돕는 것입니다.
미국 지역사회 조사 자료는 다음
기관에 의해 사용됩니다.

census.gov/acs

• 지역사회

프로그램, 예를 들면,
노인, 보이/걸 스카우트 프로그램,
도서관, 은행, 병원 및 기타
지역사회 단체들이 지역사회에
서비스를 제공하고 건물, 서비스
및 프로그램 실시 장소를 찾기
위해.

• 교통

계획 수립자들이 통근
정보를 사용하여, 출퇴근 시간의
정체를 줄이기 위한 최대허용
교통량을 계획하고, 주차 계획을
세우며, 승용차 함께 타기
(카풀)나 탄력근무제와 같은
전략을 개발하기 위해. 미래의
도로교통량을 미리 예상해
봄으로써 도로를 신설하거나
기존 도로의 수용량을 늘리고
전철 또는 지하철과 같은 교통
시설을 개발하기 위한 결정을
내립니다.

• 지방 정부가 예산 책정, 프로그램

평가 및 지역사회 개발 사업계획
수립을 위해.

3

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&

census.gov/acs

미국 지역사회 조사

미국 지역사회 조사에 있는 질문에
대해 답을 해야 합니까?

이 주소에 임시로 거주하는 경우
에도 조사에 응해야 합니까?

그렇습니다. 귀하의 조사 참여는
미국법에 따라 의무적인 것입니다
(미 연방법 Title 13, Section 141, 193,
221).

그렇습니다. 2개월 넘게 해당 주
소에 거주해 왔다면, 전체 설문지
를 작성해야 합니다. 거주 기간이
2개월 혹은 그보다 짧은 경우에도,
지시 사항에 따라 설문지의 일부를
작성해야 합니다. 인구조사국 직원
이 작성을 도와드릴 수 있습니다.
인구가 연중 변화하므로 이 정보는
지역사회가 계획을 세우는 데 도움
이 됩니다.

나의 설문조사
보장됩니까?

응답은

비밀이

그렇습니다. 미국 인구조사국은 법률
에의거하여 귀하의 정보를 비밀로
유지해야 합니다. 인구조사국은 귀
가구의 신원을 확인할 수 있는 방식
으로 귀하의 응답을 공개적으로
발표해서는 안 됩니다. 2015년에
도입된 연방 사이버보안 강화법에
따라,
귀하의
자료는
자료를
전송하는
시스템을
걸러냄으
로써 사이버 보안 위험으로부터
보호됩니다. 법률에 따라, 인구조
사국은
귀하의
응답을
통계
작성용으로만 사용할 수 있습니다.

이러한 질문에 매년 답해야 합니까?
아닙니다. 단지 소수의 주소들만
미국 지역사회 조사에 참여하도록
선정됩니다. 어느 주소든 5년마다
표본으로 선정될 수 있습니다.
이 주소들은 무작위로 선정되며
지역사회 내의 다른 주소들을
대표합니다. 그렇기 때문에 선정된
모든 표본 가구들이 응답하는 것이
매우 중요합니다.

4

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회 조사

미국 지역사회 조사

&

census.gov/acs

설문조사의 결과를 어떻게 볼 수
있습니까?

이 정보는 인구조사국의 미국에 관한
정보찾기 (American FactFinder®)
웹사이트인 factfinder.census.gov 에서
발표됩니다.
자료는 초보자(그저 자료가 궁금
한 일반인)로부터 경험이 많은
연구원들에
이르기까지
모든
사람들을 위해 몇 가지 형식으로
제공됩니다.
미국에 관한 정보찾기 (American
FactFinder®) 는 다음 표들을 제공
합니다.
• 간략한 자료 개요 제공
• 지역별 자료 비교 및
• 보다 자세한 연구를 위한 대규모

자료 제공

5

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&

census.gov/acs

나는 노인 또는 장애인이거나 다른
사정으로 인해 미국 지역사회 조사
설문지를 작성할 수 없습니다. 어떻게
해야 합니까?

다른 사람에게 부탁하여 도움을
받거나 인구조사국 직원이 전화로
또는 귀하의 자택을 방문하여
설문지를 작성하도록 도와드릴 수
있습니다. 응답자들은 1-800-7726728 번으로 전화하여 도움을 요청할
수 있습니다. 가장 정확한 결과를
얻기 위해 조사 대상으로 선정된
모든 가구가 참여 하는 것이 매우
중요합니다.

미국 지역사회 조사

미국 지역사회 조사에 대한 추가
정보를 얻는 방법이 있습니까?
미국 지역사회 조사에 대한 정보를
얻는 방법이 몇 가지 있습니다.

자세한 내용을 보시려면 인구조사국
웹사이트인
census.gov/acs
를
방문하시거나
아래에
나열된
인구조사국 지방 사무소 중 가까운
곳에 전화로 연락하셔도됩니다.

인구조사국의 지방 사무소
Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

6

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회 조사

미국 지역사회 조사

&

미국 지역사회 조사 자료나 조사
결과를 보는 법에 대해 질문이
있으시면, 다음 이용자 서비스
번호로 문의하십시오.
301-763-INFO (4636)
1-888-346-9682

census.gov/acs

아래 웹사이트를 통해 이메일을
보내시거나
ask.census.gov

또는 다음 주소로 편지로
문의하셔도 됩니다.
American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

7

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미국
지역사회
조사
미국 인구조사국

이메일: ask.census.gov

전화: 1-888-346-9682

인터넷: census.gov/acs

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Issued January 2020
ACS-51 (HU)(Polish)
Connect with us @uscensusbureau

Pytania i odpowiedzi

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&

ŚRODOWISKOWE BADANIA SPOŁECZNE W STANACH ZJEDNOCZONYCH census.gov/acs

Co to są Środowiskowe
Badania Społeczne w Stanach
Zjednoczonych?

Środowiskowe Badania Społeczne
w Stanach Zjednoczonych jest to
ankieta przeprowadzana przez
Biuro Spisu Ludności Stanów
Zjednoczonych (USCB) we
wszystkich powiatach, terytoriach
Indian, na Alasce oraz na Hawajach.

Dostarcza ona co roku ważnych
informacji na temat warunków
społecznych, ekonomicznych i
mieszkaniowych w poszczególnych
miejscowościach. Dowiadujemy
się od ludności, że Środowiskowe
Badania Społeczne w Stanach
Zjednoczonych pomagają w
podejmowaniu świadomych decyzji i
stanowi klucz do przyszłości.

Nie słyszałem o Środowiskowych
Badaniach Społecznych w Stanach
Zjednoczonych. Od jak dawna ta
ankieta jest przeprowadzana?
Środowiskowe Badania Społeczne
w Stanach Zjednoczonych
przeprowadzono po raz pierwszy
w roku 1996 na próbce powiatów
w całym kraju. Obecnie ankieta
prowadzona jest we wszystkich
powiatach USA oraz na Portoryko,
gdzie nazywa się Badaniem
Społecznym w Portoryko.

1

&

census.gov/acs ŚRODOWISKOWE BADANIA SPOŁECZNE W STANACH ZJEDNOCZONYCH

W jaki sposób wykorzystywane
są odpowiedzi, których udzielę
w Środowiskowych Badaniach
Społecznych w Stanach
Zjednoczonych?

Pytania w Środowiskowych
Badaniach Społecznych w Stanach
Zjednoczonych mają na celu zebranie
danych potrzebnych do zarządzania
programami rządowymi i do ich
oceny. Są to zasadniczo te same
pytania, które zadawane są w ramach
powszechnego spisu ludności co 10
lat.

• Informacje o dochodach

umożliwiają porównywanie
poziomów ekonomicznych
na różnych obszarach. Wiele
programów federalnych i
stanowych również wykorzystuje
te dane do dystrybucji funduszy
przeznaczonych na rozwój
miejscowości.

• Odpowiedzi na pytania

dotyczące dojazdów do pracy
są wykorzystywane przez
Departament Transportu
Stanów Zjednoczonych do
planowania ulepszeń sieci dróg,
opracowywania usług transportu
publicznego i opracowywania

2

programów usprawniania ruchu
drogowego.

• Informacje na temat wieku służą

do dystrybucji funduszy i usług w
ramach programów federalnych
dla dzieci i dla osób starszych.

• Odpowiedzi na pytania

dotyczące dochodów i warunków
mieszkaniowych są gromadzone
i wykorzystywane przez
Departament Mieszkalnictwa
i Rozwoju, aby ocenić
potrzeby zapewnienia pomocy
mieszkaniowej dla osób
starszych, niepełnosprawnych i
właścicieli domów, którzy mają
niskie dochody.

• Informacje na temat rasy,

pochodzenia latynoskiego
i języka, którego używa się
w domu służą do określenia
wymogów w zakresie
dwujęzycznych dokumentów
wyborczych na podstawie ustawy
o prawie do głosowania oraz do
kontrolowania równouprawnienia
pracowników na podstawie
ustawy o prawach obywatelskich.
Rasa i pochodzenie latynoskie
są traktowane jako różne pojęcia
i dlatego wymagają odrębnych
pytań.

&

ŚRODOWISKOWE BADANIA SPOŁECZNE W STANACH ZJEDNOCZONYCH census.gov/acs

• Informacje o służbie wojskowej

są wykorzystywane głownie
przez Amerykański Departament
ds. Kombatantów w celu
określenia potrzeb kombatantów
i oceny przeznaczonych dla
nich programów oświatowych,
zatrudnienia i opieki zdrowotnej.

udogodnień i programów oraz
mierzeniu skuteczności programów.
Dane uzyskane w Środowiskowych
Badaniach Społecznych w Stanach
Zjednoczonych są wykorzystywane
przez:

• władze lokalne: w celu

układania budżetów, oceny
programów i planowania rozwoju
społecznego.

Jaką będę miał korzyść z
udzielenia odpowiedzi na pytania
w Środowiskowych Badaniach
Społecznych w Stanach
Zjednoczonych?

• Programy społeczne

Agencje federalne, stanowe i lokalne
stwierdzają, że nie mają aktualnych
informacji potrzebnych do lepszego
zrozumienia potrzeb ludności,
reagowania na te potrzeby i
rozdziału środków na poszczególne
programy. Jak stwierdził pewien
działacz społeczny: „Zgadywanie
jest zawsze ciekawe, ale rzadko
bywa skuteczne”.

• Instytucje planujące sieć

Odpowiadając na kwestionariusz
Środowiskowych Badań
Społecznych w Stanach
Zjednoczonych pomagają Państwo
swojej społeczności w ustalaniu
celów, określaniu problemów i
ich rozwiązań, rozmieszczaniu

przeznaczone dla osób starszych,
harcerzy, bibliotek, banków,
szpitali i innych organizacji
społecznych, aby świadczyć
usługi i lokalizować budynki,
usługi i programy.
transportu na podstawie
danych o dojazdach do pracy
opracowują ulepszenie rozwiązań
w czasie nasilonego ruchu
drogowego, planują parkingi
i opracowują programy takie,
jak podwożenie do pracy,
czy ruchome godziny pracy.
Podejmowane są decyzje o
budowie nowych lub zwiększeniu
przepustowości istniejących
dróg oraz o rozwoju systemów

3

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census.gov/acs ŚRODOWISKOWE BADANIA SPOŁECZNE W STANACH ZJEDNOCZONYCH

komunikacji zbiorowej, takich jak
tramwaje czy koleje podziemne,
z uwzględnieniem przyszłych
potrzeb.
Czy muszę odpowiadać na
pytania Środowiskowych
Badań Społecznych w Stanach
Zjednoczonych?
Tak. Udzielenie odpowiedzi na
pytania ankietowe jest wymagane
przez prawo (Kodeks Stanów
Zjednoczonych, tytuł 1, art. 141,
193 i 221). Ta sama ustawa chroni
poufność udzielanych informacji.
Czy muszę odpowiadać na te
pytania
co roku?
Nie. Do udziału w Środowiskowych
Badaniach Społecznych w Stanach
Zjednoczonych wybierana jest
tylko mała próbka adresów. Dany
adres może zostać wybrany nie
częściej niż raz na 5 lat. Adresy są
wybierane losowo i reprezentują
inne adresy w danej miejscowości.
Dlatego jest tak ważne, aby każde
domostwo wybrane drogą losową
udzieliło odpowiedzi.

4

Czy muszę wziąć udział w badaniu,
jeżeli przebywam pod danym
adresem tymczasowo?
Tak. Jeżeli przebywają Państwo
pod danym adresem dłużej niż 2
miesiące, musicie wypełnić całą
ankietę. Osoby mieszkające w
danym lokalu do 2 miesięcy, muszą
wypełnić część ankiety zgodnie z
instrukcjami. Przedstawiciel Biura
Spisu Ludności może udzielić
pomocy. Te informacje pomagają
miejscowościom w planowaniu z
uwzględnieniem zmian zaludnienia
w różnych porach roku.
Czy moje odpowiedzi na ankietę
są poufne?
Tak. Biuro Spisu Ludności Stanów
Zjednoczonych jest zobligowane
przepisami prawa do zachowania
poufności Państwa danych. Nie
możemy publicznie udostępniać
Państwa odpowiedzi w żaden
sposób, który pozwoliłby na
zidentyfikowanie Państwa
gospodarstwa domowego. Na mocy
ustawy federalnej z 2015 roku o
poprawie cyberbezpieczeństwa
(Federal Cybersecurity Enhancement
Act) Państwa dane są chronione
przed zagrożeniami z zakresu

&

ŚRODOWISKOWE BADANIA SPOŁECZNE W STANACH ZJEDNOCZONYCH census.gov/acs

cyberbezpieczeństwa za pomocą
weryfikacji systemów przesyłających
te dane. Na mocy prawa Biuro Spisu
Ludności może wykorzystywać
Państwa odpowiedzi wyłącznie do
sporządzenia danych statystycznych.
Jak mogę się zapoznać z
wynikami badania?
Te informacje są publikowane w
witrynie internetowej Biura Spisu
Ludności, na stronie American
FactFinder®:
factfinder.census.gov.

Dane są przedstawiane w kilku
formatach przeznaczonych dla
różnych osób, począwszy od tych,
którzy chcą tylko poznać wyniki, do
doświadczonych badaczy.
American FactFinder® przedstawia
tabele, które:

Co powinienem zrobić jako
osoba w podeszłym wieku,
niepełnosprawna lub jeżeli z
innego powodu nie jestem w
stanie wypełnić kwestionariusza
Środowiskowych Badań
Społecznych w Stanach
Zjednoczonych?
Można wskazać inną osobę, która
pomoże wypełnić ankietę lub też
przedstawiciel Biura Spisu Ludności
może zadzwonić albo przyjść
do domu i udzielić pomocy w
wypełnieniu ankiety. Aby uzyskać
pomoc, należy zadzwonić pod
numer 1-800-354-7271.
Aby uzyskać jak najbardziej
rzetelne wyniki, bardzo ważne jest,
aby każde gospodarstwo domowe
wybrane do udziału w badaniu, w
niej uczestniczyło.

• pozwalają szybko przejrzeć
dane zbiorcze

• porównać dane z różnych
miejscowości

• wykorzystać rozszerzone dane
do bardziej szczegółowych
badań.

5

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census.gov/acs ŚRODOWISKOWE BADANIA SPOŁECZNE W STANACH ZJEDNOCZONYCH

Skąd mogę uzyskać
dodatkowe informacje na
temat Środowiskowych Badań
Społecznych w Stanach
Zjednoczonych?

lub zatelefonowania do najbliższego
regionalnego Biura Spisu Ludności
Ludności wskazanego poniżej:

Jest szereg sposobów uzyskania
informacji na temat Środowiskowych
Badań Społecznych w Stanach
Zjednoczonych:
Aby uzyskać szczegółowe
informacje, można odwiedzić naszą
stronę internetową pod adresem:
census.gov/acs

Biura regionalne Urzędu Spisu Ludności

6

Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

&

ŚRODOWISKOWE BADANIA SPOŁECZNE W STANACH ZJEDNOCZONYCH census.gov/acs

Pytania na temat danych
ze Środowiskowych Badań
Społecznych w Stanach
Zjednoczonych lub tego, jak
można zapoznać się z wynikami
badania, prosimy kierować do
działu obsługi klientów
301-763-INFO (4636)
1-888-346-9682

Można także skontaktować się z
nami za pomocą poczty elektronicznej
ask.census.gov

lub pisząc na adres:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

7

Środowiskowe Badania
Społeczne w Stanach
Zjednoczonych
U.S. CENSUS BUREAU

E-mail: ask.census.gov

Telefon: 1-888-346-9682

Internet: census.gov/acs

Pe

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Perguntas e Respostas

s
à
a
is
s
u
e
q
d
s
a
e
d
i
P
un
m
Co EUA
nos

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PESQUISA ÀS COMUNIDADES NOS EUA

O que é a Pesquisa às Comunidades
nos EUA?

A Pesquisa às Comunidades nos EUA
é uma pesquisa realizado pelo Censo
dos EUA em todos os municípios,
áreas indígenas americanas e nativas
do Alasca e Havaí.
A Pesquisa às Comunidades nos EUA
proporciona a todas as comunidades
deste país dados econômicos,
sociais, demográficos e habitacionais
importantes. As comunidades
nos informam que a Pesquisa às
Comunidades nos EUA ajuda a
tomar decisões conscientes, sendo
fundamental para o futuro.

census.gov/acs

Nunca ouvi falar da Pesquisa às
Comunidades nos EUA. Há quanto
tempo a realizam?
A Pesquisa às Comunidades nos EUA
começou em 1996, com uma amostra
dos municípios de todo o país. Hoje em
dia, a pesquisa é realizada em todos os
municípios dos Estados Unidos e em
Porto Rico, onde se chama Pesquisa à
Comunidade porto-riquenha.

1

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&

De que forma são usadas as
respostas à Pesquisa às Comunidades
nos EUA?
As perguntas da Pesquisa às
Comunidades nos EUA são
necessárias para colher dados, para
administrar ou avaliar programas
do governo. Estas perguntas são
essencialmente as mesmas que têm
sido feitas nos censos a cada dez
anos.

• Os dados sobre a renda permitem
comparar os níveis econômico de
diferentes áreas. Muitos programas
federais e estaduais utilizam esses
dados para distribuir fundos para o
desenvolvimento da comunidade.
• As suas respostas às perguntas
sobre deslocamento para
o trabalho são usadas pelo
Departamento dos Transportes
dos Estados Unidos para planejar
melhorias nas auto-estradas,
desenvolver serviços de transporte
público e conceber programas para
sanar os problemas do trânsito.
• Os dados sobre a idade são usados
em programas federais para
direcionar fundos ou serviços para
crianças, adultos ativos ou idosos.

PESQUISA ÀS COMUNIDADES NOS EUA

• As respostas às perguntas sobre
renda e habitação são resumidas
e usadas pelo Departamento de
Habitação e Planejamento Urbano
dos Estados Unidos para avaliar
a necessidade de assistência
domiciliar aos idosos, pessoas com
deficiência e proprietários com
baixa renda.
• Informações sobre raça, origem
hispânica e língua falada em
casa são usadas para determinar
a necessidade de disponibilizar
material bilíngue para as eleições,
ao abrigo da lei relativa aos direitos
de voto (Voting Rights Act), bem
como para controlar a igualdade
de oportunidades de emprego,
de acordo com a lei relativa aos
direitos civis (Civil Rights Act). Raça
e origem hispânica (ou etnicidade)
são considerados conceitos
distintos, que requerem perguntas
diferentes.
• As informações sobre o serviço
militar são basicamente usadas
pelo Departamento de Veteranos
de Guerra dos Estados Unidos
para avaliar as necessidades dos
veteranos e os programas para
veteranos relativos à educação,
emprego e saúde.

2

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S EUA

&

PESQUISA ÀS COMUNIDADES NOS EUA

De que forma me beneficio
ao responder à Pesquisa às
Comunidades nos EUA?

As agências federais, os estados e as
comunidades dizem que não dispõem
de informações atualizadas das quais
precisam para melhor compreender
os problemas das comunidades,
responder às necessidades e criar
programas e designar recursos. Como
disse, uma vez, um líder comunitário:
“Adivinhar é sempre divertido, mas
raras vezes é eficaz.”

Ao responder à Pesquisa às
Comunidades nos EUA, você estará
ajudando a sua comunidade a
estabelecer objetivos comunitários,
a identificar problemas e soluções
comunitárias, a determinar instalações
e programas e a avaliar o desempenho
dos programas.
Os dados da Pesquisa às
Comunidades nos EUA são usados
por:
• Governos locais para estabelecer
orçamentos, avaliar programas
e planejar projetos de
desenvolvimento comunitário.

census.gov/acs

• Programas comunitários, como
programas para idosos, programas
de escoteiros, bibliotecas, bancos,
hospitais e outras organizações
comunitárias, a fim de prestar
serviços à comunidade e a localizar
edifícios, serviços e programas.

• Planejadores de transportes,
que utilizam os dados dos
deslocamentos diários das
pessoas que estão saindo do
trabalho ou indo para o trabalho
para planejar as horas de
trânsito intenso a fim de reduzir
congestionamentos, planejar o
estacionamento e desenvolver
estratégias, como programas de
carona solidária e horários de
trabalho flexíveis. São tomadas
decisões no sentido de construir
novas estradas ou de aumentar a
capacidade das estradas existentes
e de desenvolver sistemas de
transporte, como veículos leves
sobre trilhos e metrô, prevendo
futuras necessidades.

3

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census.gov/acs

Tenho que responder às
perguntas da Pesquisa às
Comunidades nos EUA?

&

Sim. A lei dos Estados Unidos exige
que responda a esta pesquisa (Título
1, Código dos Estados Unidos, Seções
141, 193 e 221).
As minhas respostas à pesquisa são
confidenciais?

Sim. A lei exige que o Censo dos
EUA mantenha suas informações
confidenciais. Não temos
permissãopara divulgar suas
respostas de modo a identificar o
domicílio. Deacordo com a lei Federal
Cybersecurity Enhancement Act de
2015, seus dados estão protegidos de
riscos cibernéticos através do rastreio
dos sistemas que os transmitem.
Por lei, o Censo só pode usar suas
respostas para produzir estatísticas.

PESQUISA ÀS COMUNIDADES NOS EUA

Tenho que responder à pesquisa se
estiver morando nesta residência
temporariamente?
Sim. Se estiver morando na residência
atual por mais de 2 meses, você terá
que responder à pesquisa por inteiro.
Se estiver residindo durante 2 meses
ou menos, tem de responder a uma
parte da pesquisa, de acordo com
as instruções. Um representante
do Censo pode ajudá-lo. Estas
informações ajudam as comunidades
no seu planejamento, já que ocorrem
alterações na população em
diferentes períodos do ano.
Tenho que responder a estas
perguntas todos os anos?
Não. Apenas uma pequena amostra
de residências é selecionada
para participar da Pesquisa às
Comunidades nos EUA. Uma
residência só pode ser selecionada
para a amostra uma vez a cada
5 anos. Estas residências são
selecionadas aleatoriamente e
representam outras residências na
comunidade. É por isso que é tão
importante que todos os domicílios
selecionados respondam.

4

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S EUA

&

PESQUISA ÀS COMUNIDADES NOS EUA

census.gov/acs

Como posso ver os resultados
da pesquisa?

Estas informações são publicadas no
site American FactFinder® do Census
Bureau em:
factfinder.census.gov

Os dados são apresentados em vários
formatos para todas as pessoas,
desde principiantes (que apenas
possam querer ver os dados) a
investigadores experientes.
O American FactFinder®
disponibiliza tabelas que:
• proporcionam uma visão geral
dos dados;
• comparam dados de diferentes
locais; e
• proporcionam dados mais
extensos para uma investigação
mais detalhada.

5

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&

census.gov/acs

PESQUISA ÀS COMUNIDADES NOS EUA

Sou idoso, def iciente ou incapaz de
preencher o questionário da Pesquisa
às Comunidades nos EUA. Que devo
fazer?

Você pode designar outra pessoa para
ajudar ou um representante do Censo
pode telefonar ou visitar em sua casa
para ajudar a preencher a pesquisa.
Os participantes podem telefonar para
o número 1-800-354-7271 para pedir
ajuda.
A fim de produzir os resultados mais
exatos, é muito importante que cada
domicílio selecionado para a pesquisa
participe.

Como posso obter mais informações
sobre a Pesquisa às Comunidades
nos EUA?
Há várias formas de obter
informações sobre a Pesquisa às
Comunidades nos EUA:
Para obter informações detalhadas,
visite o nosso site:
census.gov/acs
ou telefone para os escritórios
regionais do do Censo mais próximo,
conforme listado a seguir:

Escritórios regionais do Census Bureau

Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

Nova York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Filadélfia, PA
1-866-238-1374

6

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S EUA

&

PESQUISA ÀS COMUNIDADES NOS EUA

Para fazer perguntas sobre os
dados da Pesquisa às Comunidades
nos EUA ou ver os resultados do
inquérito, utilize a linha telefônica
da pesquisa ao cliente pelo número:
301-763-INFO (4636)
1-888-346-9682

census.gov/acs

Também é possível entrar em contato
por e-mail, pelo endereço:
ask.census.gov
ou por correio:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

7

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PESQUISA ÀS
COMUNIDADES
NOS EUA
U.S. CENSUS BUREAU

E-mail: ask.census.gov

Telefone: 1-888-346-9682

Internet: census.gov/acs

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Во

Issued January 2020
ACS-51 (HU)(Russian)
Connect with us @uscensusbureau

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Вопросы и ответы

е
и
н
а
в
о
р
и
т ия ту
е
к
Ан селено мес
на А п ства
СШтель
жи

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&

АНКЕТИРОВАНИЕ НАСЕЛЕНИЯ США ПО МЕСТУ ЖИТЕЛЬСТВА

Что такое Анкетирование населения
США по месту жительства?

Бюро переписи населения проводит
анкетирование населения США по месту
жительства в каждом округе страны, а
также в местах проживания американских
индейцев, коренных жителей Аляски и
Гавайских островов.
Анкетирование населения США по месту
жительства ежегодно предоставляет
важную информацию о населении
нашей страны в экономической,
социальной и демографической сфере и
в области жилья. Местные организации
и общественность сообщают нам, что
анкетирование населения США по
месту жительства помогает принимать
правильные решения на местном уровне
и является важным условием для
будущего развития регионов.

census.gov/acs

Я не слышал о проведении
Анкетирования населения США по
месту жительства. Как долго оно уже
проводится?
Анкетирование населения США по месту
жительства началось в 1996 году в ряде
округов, расположенных в разных районах
страны. Сегодня такое анкетирование
проводится во всех округах Соединенных
Штатов.

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census.gov/acs

&

АНКЕТИРОВАНИЕ НАСЕЛЕНИЯ США ПО МЕСТУ ЖИТЕЛЬСТВА

Как используются ответы на вопросы,
которые я предоставил
в ходе анкетирования населения
США по месту жительства?

Вопросы, включенные в анкетирование
населения США по месту жительства,
нужны для сбора данных, необходимых
для проведения правительственных
программ или их оценки. Эти вопросы
представляют собой практически те же
самые вопросы, которые задаются в ходе
переписи населения.
• Информация о доходе дает
возможность сравнить экономические
уровни различных районов.
Многие федеральные программы и
программы штатов используют эти
данные для распределения средств,
предназначенных для экономического
развития на местах.
• Ваши ответы на вопросы,
посвященные дороге на работу,
используются Министерством
транспорта для планирования
улучшения скоростных шоссейных
дорог, развития услуг общественного
транспорта и создания программ,
направленных на решение
транспортных проблем.
• Информация о возрасте используется
в федеральных программах для
распределения финансовых средств
или услуг, предназначенных для
детей, взрослого работоспособного
населения или для лиц пожилого
возраста.

• Ответы на вопросы о доходах и
жилье суммируются и используются
Министерством жилищного
строительства и городского развития
США для оценки потребностей
в области помощи с жильем,
предоставляемой престарелым,
инвалидам и домовладельцам с
низкими доходами.
• Информация о расе,
латиноамериканском происхождении
и языке, на котором общаются
дома, используется для выработки
правил, требующих употребления
двух языков при проведении выборов
согласно Закону о праве на участие
в голосовании и для наблюдения
за обеспечением равноправия
при приеме на работу согласно
Закону о гражданских правах.
Раса и латиноамериканское (или
этническое) происхождение считаются
различными понятиями и поэтому
требуют отдельных вопросов.
• Информация о военной службе
используется в основном
Министерством США по делам
ветеранов для определения
потребностей этой категории
населения страны, а также для оценки
программ, связанных с образованием,
трудоустройством и медицинским
обслуживанием ветеранов.

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ЬСТВА

&

АНКЕТИРОВАНИЕ НАСЕЛЕНИЯ США ПО МЕСТУ ЖИТЕЛЬСТВА

Что дают мне ответы на вопросы,
содержащиеся в Aнкетировании
населения США по месту жительства?
Федеральные ведомства, штаты и
местные органы власти говорят, что
не имеют актуальной информации,
необходимой им для лучшего понимания
местных проблем, удовлетворения
существующих на местах потребностей,
осуществления программ и выделения
ресурсов. Как сказал один из местных
руководителей, «угадывание
всегда интересно, но редко бывает
эффективно».
Отвечая на вопросы, содержащиеся в
анкете, Вы содействуете постановке
нужных задач на местах, выявлению
местных проблем и их решению,
помогаете в определении учреждений
и программ, а также в деле оценки
эффективности этих программ.
Данные, полученные в ходе
анкетирования населения США по месту
жительства, используются:
• Местными органами управления
для составления бюджетов, оценки
программ, а также планирования
проектов по развитию на местах.

census.gov/acs

• Местными программами, такими,
как программы для пожилых
американцев и молодежи, а также
библиотеками, банками, больницами
и другими местными организациями
для предоставления услуг
местному населению и нахождения
необходимых зданий, услуг и
программ.
• Теми, кто занимается
транспортным планированием.
Используя информацию о дороге
на работу, они составляют планы
пиковых транспортных нагрузок для
уменьшения автомобильных пробок,
планы парковок автотранспорта
и разрабатывают стратегию,
включающую программы совместных
поездок на работу и гибкие рабочие
графики. Принимаются решения
о строительстве новых дорог или
расширении уже существующих,
а также о создании транспортных
систем, таких как рельсовые
транспортные средства или
метро, методом прогнозирования
интенсивности будущих транспортных
потоков.

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census.gov/acs

&

АНКЕТИРОВАНИЕ НАСЕЛЕНИЯ США ПО МЕСТУ ЖИТЕЛЬСТВА

Обязан ли я отвечать на вопросы,
содержащиеся в анкете, заполняемой
по месту жительства?

Должен ли я отвечать на вопросы,
если я проживаю по данному адресу
временно?

Да. Согласно закону Bы обязаны
ответить на вопросы, содержащиеся
в этой анкете (часть 13 Кодекса
законов США, разделы 141, 193 и 221).
Тот же самый закон обеспечивает
конфиденциальность предоставляемой
Вами информации.

Да. Если Вы находитесь по данному
адресу более 2 месяцев, Вы должны
ответить на все вопросы. Если Вы
находитесь по этому адресу 2 месяца
или меньше, то в соответствии с
инструкциями Вы должны ответить на
часть вопросов. При необходимости
представитель Бюро переписи населения
поможет Вам в этом. Такая информация
помогает подготавливать планы по мере
того, как население меняется в разное
время года.

Должен ли я отвечать на эти вопросы
каждый год?
Нет. Только небольшое количество
адресов отбирается для участия в
анкетировании населения США по месту
жительства. Один и тот же адрес может
быть отобран для участия в опросе
не чаще одного раза в пять лет. Эти
домохозяйства выбираются по принципу
случайного отбора и представляют
другие домохозяйства данного района.
Вот почему очень важно, чтобы все
отобранные домохозяйства ответили
на вопросы, содержащиеся в анкете,
заполняемой по месту жительства.

Являются ли конфиденциальными
те ответы, которые я предоставляю в
ходе анкетирования?
Да. Закон обязывает Бюро переписи
населения США сохранять
конфиденциальность предоставленной
Вами информации. Бюро переписи
населения не имеет права разглашать
какую-либо информацию, из которой
можно получить сведения о Вашей
семье. В соответствии с Федеральным
законом об усилении кибербезопасности
от 2015 года, Ваши данные защищены
от рисков нарушения кибербезопасности
посредством введения специальных
мер защиты систем, используемых для
передачи данных. Согласно закону,
предоставленные Вами сведения
будут использованы исключительно в
статистических целях.

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ЬСТВА

&

АНКЕТИРОВАНИЕ НАСЕЛЕНИЯ США ПО МЕСТУ ЖИТЕЛЬСТВА

census.gov/acs

Как я могу ознакомиться с
результатами анкетирования?

Эта информация опубликована на сайте
American FactFinder® Бюро переписи
населения США, который находится по
следующему адресу:
factfinder.census.gov
Эти данные представлены в нескольких
форматах для каждого, кто желает с
ними ознакомиться – от начинающих
(тех, кто просто хочет взглянуть
на них) до опытных специалистов,
занимающихся исследованиями.
С помощью таблиц на сайте
«Американский источник фактов»
(American FactFinder) можно :
• осуществить быстрый обзор данных,
• с
 равнить информацию, полученную
из разных районов, и
• п
 олучить более подробную
нформацию для проведения более
детального анализа.

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census.gov/acs

&

АНКЕТИРОВАНИЕ НАСЕЛЕНИЯ США ПО МЕСТУ ЖИТЕЛЬСТВА

Я отношусь к категории престарелых
жителей страны, инвалид или не
в состоянии заполнить анкету по
каким-либо другим причинам. Что мне
делать?

Вы можете попросить другого человека
помочь Вам, или представитель Бюро
переписи населения может позвонить
Вам или приехать к Вам домой, чтобы
помочь Вам заполнить анкету. Для
получения помощи позвоните по
телефону 1-866-225-2297. Для получения
наиболее точных результатов важно,
чтобы в анкетировании населения
США по месту жительства приняли
участие все отобранные для этой цели
домохозяйства.

Как я могу получить дополнительную
информацию об анкетировании
населения США по месту жительства?
Существует несколько способов
для получения информации об
анкетировании населения США по месту
жительства:
Для получения подробной информации
мы рекомендуем посетить наш сайт
census.gov/acs
или позвонить в один из приводимых
ниже региональных офисов
Бюро переписи населения США,
расположенный ближе всего к месту
Вашего проживания:

Региональные офисы Бюро переписи населения США

Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

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ЬСТВА

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АНКЕТИРОВАНИЕ НАСЕЛЕНИЯ США ПО МЕСТУ ЖИТЕЛЬСТВА

Если у Bас есть вопросы о данных
анкетирования населения США по
месту жительства или о том, как
посмотреть результаты анкетирования,
позвоните в нашу службу,
занимающуюся работой с населением,
по телефону:

301-763-INFO (4636)
1-888-346-9682

census.gov/acs

Вы также можете связаться с
нами по электронной почте:

ask.census.gov
или написать нам по адресу:

American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

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АНКЕТИРОВАНИЕ
НАСЕЛЕНИЯ США ПО
МЕСТУ ЖИТЕЛЬСТВА
БЮРО ПЕРЕПИСИ НАСЕЛЕНИЯ США

Эл. почта: ask.census.gov

Телефон: 1-888-346-9682

Интернет: census.gov/acs

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常

Issued January 2020
ACS-51 (HU)(Simplified Chinese)
Connect with us @uscensusbureau

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常见问题及解答

查
调
卷

问
区
社

美国

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ACS-51(HU)(Issued January 2020)_CHI.indd 3

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美国社区问卷调查

&

什么是美国社区问卷调查？

美国社区问卷调查是美国人口普查局在
每一个县、美洲印第安人和阿拉斯加本
地人地区以及夏威夷本土人地区所进行
的一项调查。
美国社区问卷调查每年向美国的社区提
供至关重要的经济、社会、人口特征和
住房信息。社区的人士告诉我们，美
国社区问卷调查帮助他们作出明智的
决定，对他们的未来起到极为重要的
作用。

census.gov/acs

我从未听说过美国社区问卷调查。
你们从事此项调查已有多长时间？
美国社区问卷调查从 1996 年开始，
在全国选出的一些试点县进行。如今，
该项调查在美国所有的县和波多黎各开
展，后者称为波多黎各美国社区问卷
调查。

1

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census.gov/acs

&

我在美国社区问卷调查中作出的
回答将被如何使用？

美国社区问卷调查中的问题用于搜集管
理或评估政府计划所需的数据。这些问
题基本上与每十年一次的人口普查中提
出的问题相同。
• 收入信息可用于比较不同地区的经
济水平。很多联邦和州计划使用此
类数据分配用于社区发展的资金。
• 美国交通部将根据您对上下班交通
问题的回答，来规划高速公路的改
进，开发公共交通服务和设计缓解
交通问题的计划。

美国社区问卷调查

• 有关种族、西班牙裔及在家使用的
语言的信息被用于确定《选举权法
案》所规定的双语选举要求，也将
被用于监管《民权法案》所规定的
平等就业机会。种族和西班牙裔（
或族裔）是两个不同的概念，因此
需要用不同的问题。
• 美国退伍军人事务部根据服兵役
的信息衡量退伍军人的需求，并且
评估有关退伍军人教育、就业和健
康护理问题的计划。

• 联邦计划根据有关年龄的信息，
来分配用于儿童、工作适龄成年人
或老年人的资金或服务。
• 对收入和住房问题的回答将由美国
住房与城市发展部进行汇总，并用
来评估有关老年人、残障人士和低
收入房主的住房协助需求。

2

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卷调查

美国社区问卷调查

&

我如何从回答美国社区问卷调查中
受益？

联邦机构、州政府和社区认为，
他们没有所需的最新信息，以更好地理
解社区问题、对社区需求作出回应以及
分配计划和资源。正如一位社区领导人
所说：“猜测总是一件有趣的事，但很
少会有成效。”
通过回答美国社区问卷调查问卷，您可
以帮助您所在的社区建立社区目标，发
现社区问题和解决方案，确定设施和计
划的位置以及衡量计划的绩效。

census.gov/acs

• 社区计划，例如老年人计划、童子
军计划、图书馆、银行、医院和其
他社区组织，用于向社区提供服务
和确定建筑物、服务和计划的位
置。

• 交通规划者利用“上下班交通”信
息，来规划高峰期交通，以便减少
交通堵塞状况，规划停车并制定策
略，例如合伙搭车项目和灵活工作
时间。通过预测未来的需求，作出
有关决定，以建造新道路或扩大现
有道路容量以及开发运输系统，例
如轻轨或地铁。

以下机构和人员使用美国社区问卷调
查数据：
• 地方政府用于预算，评估计划和规
划社区发展项目。

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census.gov/acs

&

美国社区问卷调查

我必须回答美国社区问卷调查中的
问题吗？

如果我在这个地址暂住，我需要回
答调查问卷吗？

是的, 根据法律规定, 您必须回答本调
查中的问题（《美国法典》第 13 篇第
141、 193 和 221 节）。

是的，如果您在这个地址居住超过两个
月，您必须填写整份调查问卷。如果您
的居住时间为两个月或更短，您仍然必
须按照说明填写部分调查问卷。人口
普查局的普查员可协助您。该信息可
帮助社区随着一年内不同时间的人口
变化作出
规划。

我在调查问卷中的回答是保密
的吗？
是的，根据法律规定，美国人口普查
局对您的信息保密。人口普查局不得
以可识别住户身份的方式公开发布您
的回复。根据《2015年联邦网络安全
增强法案》，我们将通过筛选传输数
据的系统保护您的数据，使其免于网
络安全风险。根据法律的规定，人口
普查局仅限将您的回复用于编制统计
数据。

我必须每年回答这些问题吗？
不是，只有少数地址被抽样选中参加美
国社区问卷调查。一个地址仅限每五年
一次被抽选。这些地址是以随机抽样方
式选出的，以代表所在社区的其他地
址。这就是为什么每一个选中的住户均
须回答调查问卷的原因。

4

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卷调查

美国社区问卷调查

我如何查阅调查结果？

&

census.gov/acs

信息将发布在人口普查局的美国信息
检索站 (American FactFinder®)
网站上，网址：
factfinder.census.gov
数据以几种不同的格式提供，供从普
通读者（可能只是希望查阅数据的
人）到有经验的研究人员的各类人员
使用。
美国信息检索站(American
FactFinder®) 提供各种数据表，
其可:
• 快速提供数据的概览，
• 比较不同地点的数据，并且
• 为
 更深入的研究提供更详细的
数据。

5

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&

census.gov/acs

我是老年人、残障人士或因其他
原因无法填写美国社区问卷调查问
卷。我应当怎么办？

您可以指定另一个人帮助您，或者人口
普查局的普查员可以通过电话或到您家
中协助您填写调查问卷。受访者可拨打
1-800-354-7271请求协助。为了产生
最准确的结果，每个被选中的住户均参
加调查十分重要。

美国社区问卷调查

我如何获得有关美国社区问卷
调查的其他信息？
获得有关美国社区问卷调查信息的方
法有数种：欲获得更详细信息，我们
鼓励您访问我们的网站：
census.gov/acs
或者致电至以下离您
最近的人口普查局地区办公室:

人口普查局地区办公室
佐治亚州亚特兰大市

加利福尼亚州洛杉矶市

1-800-424-6974

1-800-992-3530

伊利诺斯州芝加哥市

纽约州纽约市

科罗拉多州丹佛市

宾夕法尼亚州费城

1-800-865-6384
1-800-852-6159

1-800-991-2520
1-866-238-1374

6

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卷调查

美国社区问卷调查

&

如对美国社区问卷调查数据有任
何疑问或希望了解如何查阅调查
结果，请拨打我们的客户服务专
线号码
301-763-INFO (4636)
1-888-346-9682

census.gov/acs

您还可通过电子邮件与
我们联系:
ask.census.gov

或者通过函件与我们联系，
邮寄地址:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

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美国社区问卷调查
美国人口普查局

电子邮件: ask.census.gov

电话: 1-888-346-9682

互联网: census.gov/acs

ACS-51(HU)(Issued January 2020)_CHI.indd 12

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Ho

Issued January 2020
ACS-51 (HU)(Vietnamese)
Connect with us @uscensusbureau

ACS-51(HU)(Issued January 2020)_VIE.indd 1

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Hoûi & Ñaùp

ûo g
a
h
K Coän
õ
t
ù
y
a
S
M
g
Ñoàn

ACS-51(HU)(Issued January 2020)_VIE.indd 2

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ACS-51(HU)(Issued January 2020)_VIE.indd 3

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KHAÛO SAÙT COÄNG ÑOÀNG MYÕ

&

Khaûo Saùt Coäng Ñoàng Myõ laø gì?
Khaûo Saùt Coäng Ñoàng Myõ laø cuoäc
khaûo saùt do Vaên Phoøng Kieåm Tra
Daân Soá Hoa Kyø thöïc hieän taïi moãi
quaän, vuøng ñaát ngöôøi Myõ Da Ñoû,
baûn xöù Alaska vaø quaàn ñaûo Haï Uy
Di thuoäc quoác gia.

Khaûo Saùt Coäng Ñoàng Hoa Kyø cung
caáp caùc thoâng tin quan troïng veà kinh
teá, xaõ hoäi, nhaân khaåu, vaø gia cö cho
nhöõng coäng ñoàng quoác gia naøy moãi
naêm. Caùc coäng ñoàng cho chuùng
toâi bieát raèng cuoäc Khaûo Saùt Coäng
Ñoàng Myõ giuùp hoï laáy nhieàu quyeát
ñònh saùng suoát vaø raát quan troïng cho
töông lai cuûa hoï.

census.gov/acs

Toâi chöa nghe gì veà cuoäc Khaûo
Saùt Coäng Ñoàng Myõ. Quyù vò ñaõ
tieán haønh ñöôïc bao laâu roài?
Khaûo Saùt Coäng Ñoàng Myõ baét ñaàu
vaøo naêm 1996 taïi moät soá quaän tieâu
bieåu ôû khaép quoác gia. Ngaøy nay
khaûo saùt ñöôïc tieán haønh taïi khaép
caùc quaän ôû Hoa Kyø.

1

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census.gov/acs

&

Caùc caâu traû lôøi treân baûn Khaûo
Saùt Coäng Ñoàng Myõ seõ ñöôïc söû
duïng nhö theá naøo?

Caùc caâu hoûi treân baûn Khaûo Saùt
Coäng Ñoàng Myõ ñöôïc ñeå thaâu thaäp
döõ kieän caàn thieát ñeå quaûn lyù hay
ñaùnh giaù caùc chöông trình cuûa chaùnh
phuû. Nhöõng caâu hoûi naøy töông töï
nhö nhöõng caâu hoûi coù trong phaàn
kieåm keâ daân soá möôøi naêm moät laàn.
• Thoâng tin veà lôïi töùc ñöôïc ñeå so
saùnh möùc kinh teá cuûa nhöõng khu
vöïc khaùc nhau. Nhieàu chöông
trình lieân bang vaø tieåu bang duøng
nhöõng döõ lieäu nhö theá ñeå phaân
phoái ngaân quyõ khai trieån coäng
ñoàng.
• Caâu traû lôøi cuûa quyù vò cho caùc
caâu hoûi caùch thöùc ñi laøm ñöôïc
Boä Giao Thoâng Hoa Kyø söû duïng
ñeå hoaïch ñònh caûi tieán xa loä, khai
trieån dòch vuï vaän chuyeån coâng
coäng, vaø thieát keá caùc chöông
trình ñeå giaûi quyeát vaán ñeà giao
thoâng.
• Thoâng tin veà tuoåi taùc ñöôïc duøng
ôû caùc chöông trình lieân bang ñeå
phaân chia ngaân quyõ hay dòch vuï
cho treû em, ngöôøi lôùn ôû ñoä tuoåi ñi
laøm, hoaëc laõo nieân.

KHAÛO SAÙT COÄNG ÑOÀNG MYÕ

• Caùc caâu traû lôøi cho nhöõng caâu
hoûi veà lôïi töùc vaø gia cö ñöôïc toùm
löôïc vaø ñöôïc Boä Gia Cö vaø Phaùt
Trieån Coäng Ñoàng Hoa Kyø duøng
ñeå ñaùnh giaù nhu caàu trôï caáp nhaø
cöûa cho laõo nieân, ngöôøi taøn taät
vaø chuû nhaø coù lôïi töùc thaáp.
• Thoâng tin veà chuûng toäc, nguoàn
goác Taây Ban Nha, vaø ngoân ngöõ
söû duïng taïi gia ñöôïc ñeå xaùc ñònh
yeâu caàu baàu cöû song ngöõ theo
Ñaïo Luaät Quyeàn Baàu Cöû vaø giaùm
saùt cô hoäi laøm vieäc bình ñaúng
theo Luaät Daân Quyeàn. Chuûng
toäc vaø nguoàn goác Taây Ban Nha
nguyeân thuûy (hay chuûng toäc)
ñöôïc xem nhö laø khaùi nieäm khaùc
bieät vaø do ñoù ñoøi hoûi caùc caâu
hoûi rieâng bieät.
• Thoâng tin veà quaân ñoäi chuû yeáu
do Boä Söï Vuï Cöïu Quaân Nhaân
söû duïng ñeå ñaùnh giaù nhu caàu
cuûa cöïu quaân nhaân vaø caùc
chöông trình cuûa nhöõng ngöôøi
naøy veà giaùo duïc, vieäc laøm vaø
chaêm soùc söùc khoûe.

2

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G MYÕ

KHAÛO SAÙT COÄNG ÑOÀNG MYÕ

&

Toâi seõ höôûng lôïi ích naøo khi
traû lôøi baûn Khaûo Saùt Coäng
Ñoàng Myõ?

Caùc cô quan lieân bang, tieåu bang
vaø coäng ñoàng cho bieát laø hoï khoâng
coù thoâng tin môùi nhaát ñeå hieåu roõ hôn
caùc vaán ñeà coäng ñoàng, ñaùp öùng caùc
nhu caàu, vaø phaân ñònh chöông trình
vaø taøi nguyeân. Theo lôøi cuûa moät vò
laõnh ñaïo coäng ñoàng noùi thì “Öôùc tính
thì khaù hay nhöng ít coù hieäu quaû.”
Qua caùch traû lôøi baûn Khaûo Saùt Coäng
Ñoàng Myõ, quyù vò giuùp cho coäng
ñoàng mình thieát laäp muïc tieâu coäng
ñoàng, nhaän bieát caùc vaán ñeà vaø caùc
giaûi phaùp cuûa coäng ñoàng, tìm caùc cô
sôû vaø chöông trình, vaø ñaùnh giaù
möùc hieäu quaû cuûa chöông trình.
Caùc chöông trình vaø thöïc theå sau
ñaây duøng döõ kieän cuûa baûn Khaûo
Coäng Ñoàng Myõ:

census.gov/acs

• Caùc chöông trình coäng ñoàng,
nhö nhöõng chöông trình cho laõo
nieân, chöông trình höôùng ñaïo,
thö vieän, ngaân haøng, beänh vieän,
vaø caùc toå chöùc coäng ñoàng khaùc,
nhaèm cung caáp dòch vuï cho coäng
ñoàng vaø ñeå tìm caùc toøa nhaø, dòch
vuï, vaø chöông trình.
• Chuyeân vieân hoaïch ñònh vaän
chuyeån, duøng thoâng tin veà caùch
thöùc ñi laøm, ñeå hoaïch ñònh löôïng
löu thoâng cao ñieåm nhaèm giaûm
taéc ngheõn löu thoâng, hoaïch ñònh
choã ñaäu xe, vaø khai trieån chieán
löôïc, nhö chöông trình ñi chung
xe vaø thôøi bieåu laøm vieäc uyeån
chuyeån. Hoï seõ laáy quyeát ñònh
ñeå xaây ñöôøng môùi hay môû roäng
ñöôøng hieän taïi, vaø ñeå khai trieån
heä thoáng vaän chuyeån, nhö xe
ñieän nheï hay xe ñieän ngaàm, baèng
caùch döï ñoaùn nhu caàu töông lai.

• Chaùnh phuû ñòa phöông ñeå caáp
ngaân saùch, ñaùnh giaù chöông
trình, vaø hoaïch ñònh cho caùc döï
aùn phaùt trieån coäng ñoàng.

3

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census.gov/acs

&

KHAÛO SAÙT COÄNG ÑOÀNG MYÕ

Toâi coù phaûi traû lôøi các câu hỏi
trên baûn Khaûo Saùt Coäng Ñoàng
Myõ khoâng?

Toâi coù phaûi traû lôøi cho baûn
khaûo saùt neáu chæ ôû taïm thôøi taïi
ñòa chæ naøy?

Coù. Traû lôøi caâu hoûi treân baûn khaûo
saùt ñöôïc luaät phaùp ñoøi hoûi (Töïa Ñeà
13, Quy Luaät Hoa Kyø, Ñoaïn 141,
193, vaø 221).

Coù. Neáu ôû taïi ñòa chæ naøy trong
hôn 2 thaùng, quyù vò phaûi ñieàn vaøo
toaøn boä baûn khaûo saùt. Neáu ôû trong
2 thaùng hay ngaén hôn, quyù vò vaãn
phaûi hoaøn taát moät phaàn baûn khaûo
saùt, theo chæ daãn. Ñaïi dieän Phoøng
Kieåm Tra Daân Soá coù theå giuùp quyù
vò. Thoâng tin naøy giuùp cho coäng
ñoàng hoaïch ñònh khi daân soá thay ñoåi
ôû thôøi ñieåm khaùc nhau trong naêm.

Câu trả lời trong bản khảo sát
của tôi có được giữ kín không?
Có. Cục Thống Kê Dân Số Hoa Kỳ
được pháp luật yêu cầu bảo mật thông
tin của quý vị. Chúng tôi không được
phép công bố công khai các phản hồi
của quý vị theo cách có thể nhận diện
gia đình quý vị. Theo Đạo luật Tăng
cường An ninh Mạng Liên bang năm
2015, dữ liệu của quý vị được bảo vệ
khỏi các rủi ro an ninh mạng thông qua
sàng lọc các hệ thống truyền đi dữ liệu
của quý vị. Theo luật, Cục Thống kê chỉ
được sử dụng các phản hồi của quý vị
để tạo ra các số liệu thống kê.

Tôi có phải trả lời các câu hỏi
này mỗi năm không?
Không. Chỉ một số địa chỉ mẫu được
chọn tham gia vào cuộc Khảo Sát
Cộng Đồng Mỹ. Một địa chỉ chỉ có
thể được chọn làm mẫu mỗi 5 năm
một lần. Những địa chỉ này được
chọn ngẫu nhiên và tiêu biểu cho
những địa chỉ khác trong cộng đồng.
Đó là lý do vì sao việc các hộ được
chọn làm mẫu phải trả lời lại quan
trọng như vậy.

4

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KHAÛO SAÙT COÄNG ÑOÀNG MYÕ

&

census.gov/acs

Laøm theá naøo ñeå xem ñöôïc keát
quaû khaûo saùt?
Thoâng tin naøy ñöôïc coâng boá treân
maïng löôùi American FactFinder®
cuûa Phoøng Kieåm Tra Daân Soá taïi:
factfinder.census.gov

Döõ kieän ñöôïc cung caáp döôùi moät
soá daïng thöùc khaùc nhau ñeå cho moïi
ngöôøi töø ngöôøi môùi baét ñaàu (coù theå
chæ muoán xem döõ lieäu) cho ñeán nhaø
nghieân cöùu nhieàu kinh nghieäm.
American FactFinder® cung caáp
caùc baûng maø:
• cung caáp caùi nhìn toång quaùt veà caùc
döõ kieän moät caùch nhanh choùng.
• so saùnh döõ kieän cho nhöõng nôi
khaùc nhau vaø,
• cung caáp döõ kieän bao quaùt ñeå
nghieân cöùu chi tieát hôn.

5

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&

KHAÛO SAÙT COÄNG ÑOÀNG MYÕ

census.gov/acs

Toâi laø ngöôøi laõo nieân, taøn taät,
hay noùi caùch khaùc laø khoâng
theå hoaøn taát baûng caâu hoûi
Khaûo Saùt Coäng Ñoàng Myõ. Vaäy
thì phaûi laøm sao?

Toâi coù theå laáy theâm thoâng tin
veà cuoäc Khaûo Saùt Coäng Ñoàng
Myõ baèng caùch naøo?

Quyù vò coù theå chæ ñònh ngöôøi khaùc
giuùp mình, hay ñaïi dieän Vaên Phoøng
Kieåm Tra Daân Soá coù theå goïi cho quyù
vò hoaëc ñeán nhaø ñeå giuùp quyù
vò ñieàn baûn khaûo saùt. Ngöôøi traû lôøi
coù theå goïi soá 1-877-221-9436 ñeå
ñöôïc giuùp ñôõ. Ñeå coù keát quaû chính
xaùc nhaát, ñieàu quan troïng laø moãi
gia ñình naøo ñöôïc choïn neân tham
gia vaøo cuoäc khaûo saùt.

Muoán bieát thoâng tin chi tieát, chuùng
toâi khuyeán khích quyù vò vieáng
thaêm maïng löôùi cuûa chuùng toâi taïi:

Coù moät soá caùch ñeå laáy thoâng tin
veà Khaûo Saùt Coäng Ñoàng Myõ:

census.gov/acs

hoaëc goïi cho Vaên Phoøng Khu Vöïc
cuûa Vaên Phoøng Kieåm Tra Daân Soá
gaàn nhaø quyù vò nhaát ñöôïc lieät
keâ döôùi ñaây:

Vaên Phoøng Khu Vöïc cuûa
Vaên Phoøng Kieåm Tra Daân Soá
Atlanta, GA
1-800-424-6974

Los Angeles, CA
1-800-992-3530

Chicago, IL
1-800-865-6384

New York, NY
1-800-991-2520

Denver, CO
1-800-852-6159

Philadelphia, PA
1-866-238-1374

6

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G MYÕ

KHAÛO SAÙT COÄNG ÑOÀNG MYÕ

&

Neáu coù thaéc maéc veà döõ kieän
Khaûo Saùt Coäng Ñoàng Myõ hay
muoán bieát caùch xem keát quaû cuûa
cuoäc khaûo saùt, xin goïi cho ñöôøng
daây Dòch Vuï Khaùch Haøng theo
soá:
301-763-INFO (4636)
1-888-346-9682

census.gov/acs

Quyù vò cuõng coù theå lieân laïc vôùi
chuùng toâi baèng ñieän thö:
ask.census.gov

hoaëc gôûi thô cho chuùng toâi taïi
ñòa chæ sau ñaây:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Rd.
Washington, DC
20233-7500

7

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KHAÛO SAÙT
COÄNG ÑOÀNG MYõ
PHOØNG KIEÅM TRA DAÂN SOÁ HOA KYØ

Ñieän thö: ask.census.gov

Ñieän thoaïi: 1-888-346-9682

Internet: census.gov/acs

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ACS-613R(L)(ENGLISH)
Revised June 2017

APPROVED REFUSAL LETTER
<>

<>

<>
<>
Dear <>:
Recently, a U.S. Census Bureau representative, <>, visited your household on
behalf of the American Community Survey. The Census Bureau is conducting this survey
under the authority of Title 13, Sections 141, 193, and 221, of the United States Code. I
understand that you have some concerns about participating in this survey, but your
household's participation is important to the success of this survey.
The American Community Survey contains questions about your household characteristics
including such topics as education, employment, and housing. The primary goal of this survey
is to provide information each year about the social, economic, and housing characteristics of
the United States. Your participation helps provide the information needed by your community,
county, state, and nation, to plan and fund programs at all levels. The American Community
Survey will provide communities annually updated, detailed information previously available
only when the Census Bureau conducted a census every 10 years.
The U.S. Census Bureau is required by law to keep your information. We are not permitted to
publicly release your responses in a way that could identify this household. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data. By law, the Census Bureau can only
use your responses to produce statistics.
A member of our staff will contact you again in a few days, or you can contact
<> at <>, to arrange an interview at your convenience. Your
participation and cooperation are important to the success of the survey. If you have any
questions, contact <>, Program Supervisor, at <>. For
more information about the American Community Survey, visit our website at
http://www.census.gov/acs.
Sincerely,

Program Supervisor
Enclosures

ACS-613R(L)(KOREAN)
Revised May 2017

APPROVED REFUSAL LETTER
<>

<>

<>
<>
<>님께:
최근에 미국 통계청(U.S. Census Bureau) 직원인 <>이(가) 미국
지역사회 설문조사와 관련하여 귀하의 가정을 방문했습니다. 통계청은 미국 연방
법령 제 13 장 141, 193 및 221 조항에 의거하여 본 설문조사를 실시하고 있습니다.
귀하께서 본 설문조사 참여와 관련하여 우려하시는 점을 이해하지만 여러분 가정의
참여는 본 설문조사의 성공에 있어서 중요합니다.
미국 지역사회 설문조사는 교육, 고용 및 주택과 같은 주제를 포함하여 가정의 특성과
관련된 질문을 포함하고 있습니다. 본 설문조사의 주 목적은 매년 미국 사회, 경제 및
주거 특성에 관한 정보를 제공하는 것입니다. 귀하의 참여는 지역사회, 카운티, 주 및
국가에서 모든 각계 분야의 프로그램을 계획하고 자금을 조달하는데 있어서 필요한
정보를 제공하는데 도움이 됩니다. 미국 지역사회 설문조사는 예전에는 10 년 마다
인구조사를 수행했을 경우에만 이용가능한 상세 정보를 매년 갱신해서 지역사회에
제공합니다.
미국 통계청은 법률에 따라 귀하의 정보를 기밀로 유지합니다. 저희가 참여 가정을
식별할 수 있는 방법으로 귀하의 답변을 공개적으로 발표하는 것은 허용되지 않습니다.
2015 년 연방 사이버보안 개선 법안에 따라서 데이터를 전송하는 시스템의 검사를
통하여 귀하의 데이터를 사이버 보안 위험으로부터 보호합니다. 법률에 의거하여
통계청에서는 귀하의 응답을 통계 목적으로만 사용할 수 있습니다.
편하신 시간에 인터뷰를 예약하실 수 있도록 저희 직원이 수 일 내로 다시
연락드리거나 <>번으로 <>에게 연락하실 수 있습니다.
귀하의 참여와 협조는 성공적인 설문조사를 위해 중요합니다. 문의사항이 있으신
경우에는 프로그램 감독관인 <>에게 <>번으로
연락하여 주십시오. 미국 지역사회 설문조사에 관한 보다 자세한 정보는 웹사이트
http://www.census.gov/acs 에서 확인하십시오.
감사합니다.

프로그램 감독관
첨부

ACS-613R(L)(RUSSIAN)
Revised May 2017

APPROVED REFUSAL LETTER
<>

<>

<>
<>
Уважаемый(-ая) <>:
Недавно представитель Бюро переписи США <> посетил ваше
домохозяйство от имени программы Анкетирования населения США по месту
жительства. Бюро переписи проводит это анкетирование в соответствии с пунктом 13,
разделов 141, 193 и 221 Кодекса Соединенных Штатов. Я понимаю, что у вас есть
определенное беспокойство по поводу участия в этом анкетировании, но участие вашего
домохозяйства очень важно для успешного проведения этого анкетирования.
В Анкетировании населения США по месту жительства содержатся вопросы о
характеристиках домохозяйств, включая такие темы, как образование, занятость и жилье.
Основная цель этого анкетирования — ежегодно предоставлять информацию о
социальных, экономических и жилищных характеристиках населения Соединенных
Штатов. Ваше участие в этом анкетировании помогает получить информацию,
необходимую вашему сообществу, округу, штату и государству в целом для
планирования и финансирования программ на всех уровнях. Анкетирование населения
США по месту жительства будет предоставлять сообществам ежегодно обновляемую
подробную информацию, ранее доступную только каждые 10 лет, когда Бюро переписи
проводило перепись населения.
В соответствии с законом Бюро переписи США обязано сохранять конфиденциальность
вашей информации. Нам не разрешается публиковать ваши ответы таким образом, чтобы
можно было идентифицировать конкретное домохозяйство. В соответствии с
Федеральным законом об усилении кибербезопасности от 2015 года ваши данные
защищены от рисков нарушения кибербезопасности посредством скрининга систем,
которые передают ваши данные. По закону Бюро переписи может использовать ваши
ответы только для получения статистических данных.
Через несколько дней наш сотрудник снова свяжется с вами, или вы сможете связаться
с <>, позвонив по номеру <>, чтобы договориться о
проведении интервью в удобное для вас время. Ваше участие и сотрудничество очень
важны для успешного проведения анкетирования. Если у вас есть какие-либо вопросы,
звоните
>,
руководителю
программы,
по
номеру
<>. Для получения дополнительной информации об Анкетировании
населения США по месту жительства посетите наш веб-сайт по адресу
http://www.census.gov/acs.
С уважением,
руководитель программы
Вложения

ACS-613R(L)(SIMPLIFIED CHINESE)
Revised May 2017

APPROVED REFUSAL LETTER
<>

<>

<>
<>
尊敬的 <>：
最近，美国人口普查局代表 <> 为美国社区调查事宜访问了您的家庭。人口普
查局在美国法典第 13 章第 141、193 和 221 节的授权下进行这项调查。我理解您对
参加本调查有一些顾虑，但是，您家庭的参与对本调查取得成功很重要。
美国社区调查包含关于家庭特征的问题，包括教育、就业和住房等主题。本调查的主要
目标是每年提供有关美国的社会、经济和住房特征的信息。您的参与有助于提供您所在
社区、县、州和国家所需的信息，并在所有层面制定计划及提供资金支持。美国社区调
查将每年向社区提供最新、详细的信息，以前只有在人口普查局每隔 10 年进行人口普
查时才会提供这些信息。
法律要求美国人口普查局将您的信息保密。我们不允许以可能识别此家庭的方式公开发布
您的回复。根据 2015 年联邦网络安全增强法案，我们通过筛查传输您的数据的系统，消
除您的数据的网络安全风险。根据法律，人口普查局只能使用您的回复生成统计数据。
我们的员工将在几天内再次联系您，或者您可拨打电话 <> 联系
<>，以安排在您方便的时间进行面谈。您的参与和合作对调查取得成功很重
要。如果您有任何问题，请拨打电话 <> 联系项目主管
<>。有关美国社区调查的详细信息，请访问我们的网站
http://www.census.gov/acs。
此致，

项目主管
附件

ACS-613R(L)(SPANISH)
Revised May 2017

APPROVED REFUSAL LETTER
<>

<>

<>
<>
Estimado(a) <>:
Recientemente, un representante de la Oficina del Censo de los EE. UU., <>,
visitó su hogar en nombre de la Encuesta sobre la Comunidad Estadounidense. La Oficina del
Censo realiza esta encuesta en conformidad con la autoridad del Título 13, Secciones 141, 193
y 221 del Código de los Estados Unidos. Comprendo sus preocupaciones sobre la participación
en esta encuesta, pero la participación de su hogar es importante para el éxito de esta encuesta.
La Encuesta sobre la Comunidad Estadounidense contiene preguntas sobre las características de
su hogar, incluidos temas como la educación, el empleo y la vivienda. El objetivo principal de
esta encuesta es proporcionar información anual sobre las características sociales, económicas y
de vivienda de los Estados Unidos. Su participación ayuda a proporcionar la información que
necesitan su comunidad, condado, estado y país para planificar y financiar programas en todos
los niveles. La Encuesta sobre la Comunidad Estadounidense les proporcionará a las
comunidades información anual actualizada y detallada que previamente solo estaba disponible
cuando la Oficina del Censo llevaba a cabo un censo cada 10 años.
La Oficina del Censo de los EE. UU. está obligada por ley a mantener confidencial su
información. No se nos permite divulgar sus respuestas de manera que su hogar pudiera ser
identificado. En conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética
Federal del 2015, sus datos están protegidos contra los riesgos de seguridad cibernética mediante
los controles aplicados a los sistemas que los transmiten. Por ley, la Oficina del Censo puede
usar sus respuestas solamente para producir estadísticas.
Uno de nuestros empleados se comunicará de nuevo con usted en los próximos días, o usted
puede comunicarse con <> al <> para concertar una entrevista a su
conveniencia. Su participación y cooperación son importantes para el éxito de la encuesta. Si
tiene preguntas, comuníquese con <>, el supervisor del programa, al
<>. Para obtener más información sobre la Encuesta sobre la Comunidad
Estadounidense, visite nuestro sitio web en http://www.census.gov/acs.
Atentamente,

Supervisor del programa
Documentos adjuntos

ACS-613R(L)(VIETNAMESE)
Revised May 2017

APPROVED REFUSAL LETTER
<>

<>

<>
<>
Kính gửi <>:
Gần đây, một đại diện của Cục Thống Kê Dân Số Hoa Kỳ, <>, đã đến hộ
gia đình của quý vị thay mặt Khảo Sát Cộng Đồng tại Mỹ. Cục Thống Kê Dân Số tiến
hành cuộc khảo sát này theo thẩm quyền của Mục 13, Phần 141, 193 và 221 của Đạo
Luật Hoa Kỳ. Tôi hiểu rằng quý vị có một số lo ngại về việc tham gia vào cuộc khảo
sát này, nhưng việc tham gia của hộ gia đình của quý vị rất quan trọng nhằm giúp
cuộc khảo sát này thành công.
Cuộc Khảo Sát Cộng Đồng tại Mỹ gồm các câu hỏi về đặc điểm hộ gia đình của quý vị
bao gồm các chủ đề như giáo dục, việc làm và nhà ở. Mục tiêu chính của cuộc khảo
sát này là nhằm cung cấp thông tin mỗi năm về các đặc điểm xã hội, kinh tế và nhà ở
tại Hoa Kỳ. Sự tham gia của quý vị sẽ giúp cung cấp thông tin cần thiết cho cộng đồng,
quận, tiểu bang và quốc gia để lập kế hoạch và tài trợ các chương trình thuộc mọi cấp
độ. Khảo Sát Cộng Đồng tại Mỹ sẽ cung cấp cho cộng đồng thông tin cập nhật, chi tiết
hàng năm mà trước đó chỉ có khi Cục Thống Kê Dân Số tiến hành điều tra dân số 10
năm một lần.
Luật pháp yêu cầu Cục Thống Kê Dân Số Hoa Kỳ giữ bảo mật thông tin của quý vị.
Chúng tôi không được phép công bố công khai phần trả lời của quý vị theo cách thức
có thể xác định hộ gia đình này. Theo Đạo Luật Củng Cố An Ninh Mạng Liên Bang
2015, dữ liệu của quý vị được bảo vệ khỏi các rủi ro an ninh mạng thông qua sàng lọc
các hệ thống truyền tải dữ liệu của quý vị. Theo luật, Cục Thống Kê Dân Số chỉ có thể
sử dụng phần trả lời của quý vị để lập số liệu thống kê.
Một nhân viên của chúng tôi sẽ liên hệ lại với quý vị trong vài ngày tới, hoặc quý vị có
thể liên hệ với <> theo số <>, để sắp xếp phỏng vấn tiện lợi
nhất cho quý vị. Sự tham gia và hợp tác của quý vị rất quan trọng để khảo sát này
thành công. Nếu quý vị có bất kỳ thắc mắc nào, xin hãy liên hệ với
<>, Giám Sát Viên Chương Trình, theo số <>.
Để biết thêm thông tin về Khảo Sát Cộng Đồng tại Mỹ, xin hãy truy cập trang web của
chúng tôi tại địa chỉ http://www.census.gov/acs.
Trân trọng,
Giám Sát Viên Chương Trình
Tài liệu đính kèm

MEASURING AMERICA
Issued January 2020

Your Answers,
Your Future

The American Community Survey (ACS) provides vital information on a
yearly basis about our nation and its people. Through the ACS, we know
more about jobs and occupations, educational attainment, veterans,
whether people own or rent their home, and other topics. Public officials,
planners, and entrepreneurs use this information to assess the past and plan
the future. When you respond to the ACS, you are doing your part to help
your community plan hospitals and schools, support school lunch programs,
improve emergency services, build bridges, and inform businesses looking
to add jobs and expand to new markets, and more. The ACS consists of
72 questions pertaining to the topics shown below.

What we ask about...

How your responses help...

Employment
The ACS asks whether respondents
are employed, unemployed, and out
of the labor force. It also asks about
weeks and hours worked and about
industry and occupation.

This information helps government at all
levels better understand unemployment
and the availability of workers, plan
unemployment programs and services,
and develop programs to boost
employment. Communities learn which
occupations and industries are growing
in their areas and businesses can find
locations with the workforce they need.

PHARMACY

Boutique
Help
Wanted

Education
The ACS asks about school
enrollment, gathering information on
America’s students from nursery
school to graduate school and on
whether they are in a private or
public school. It also asks about
educational attainment—did the
respondent earn a high school
diploma or the equivalent, a
bachelor's degree, or higher?

These statistics help communities to
measure how well educational resources
are serving their populations, measure
changes in education over time, evaluate
the educational attainment of the
workforce, and identify the educational
and training needs of adults. This
information also helps communities to
bridge gaps between the educational
attainment of potential workers and the
educational requirements of potential
employers.

Veterans
The ACS asks about a person’s
military service, where veterans are
moving throughout the country,
their ages, and their VA
service-connected disability rating
status to understand veterans’ needs
at the community level. Though the
Department of Veterans Affairs (VA)
maintains veterans’ records, the ACS
provides additional statistics about all
veterans, regardless of whether they
utilize VA services.

These statistics about veterans help
communities plan for future health care
and nursing homes, plan and fund job
training, and improve the home loan
guarantee program. They also benefit
businesses looking to hire or serve
veterans.

Hospital

Income and Housing Costs

Bills

The ACS asks several questions about
the money you receive from various
sources and your regular living
expenses such as rents, mortgages,
taxes, and utilities.

The statistics that result from these
questions help gauge the need for economic
and housing assistance. How many people
live in poverty, what are their characteristics—
the ACS is the only source of these data at
the community level. Income and poverty
estimates factor into funding requests that
address need. When combined with income,
selected monthly owner costs provide an
excellent measure of affordability and
excessive shelter costs.

Grocery Store

Commuting
The ACS asks about your daily
commute—where you go, how you
get there, what time you leave for
work, and how long it takes—
to understand where people are
traveling during a normal day.

Precise information about your
commuting patterns is crucial to
planning improvements to roads and
highways, developing transportation
and services, and creating emergency
response strategies.

Disability and Health Insurance
The ACS asks about a person’s
difficulty with specific daily living
tasks: Do you have difficulty seeing or
hearing? Do you have difficulty
walking or climbing stairs or in
dressing or bathing?

Communities use these statistics to
plan services such as transportation,
employment programs, and public service
accessibility for people with disabilities.
Businesses that serve this population may
also seek areas that have a high demand
for their services.

The ACS also asks whether people
have health insurance, including type
of health insurance for those who
have health coverage plans.

From these statistics, we learn which groups
are at risk of experiencing limited health care
access, poor health, and poor health outcomes.

Housing Characteristics
The ACS asks questions about
plumbing, kitchen facilities, and
other housing features to help
identify areas with substandard
housing.

Through your ACS responses, we learn
about communities eligible for housing
assistance, rehabilitation loans, and other
programs that help people afford decent,
safe, and sanitary housing.

Questions about the size and age of
housing also flag local problems like
overcrowding, health hazards, and
congestion.

Your responses help communities plan
solutions. In places where disaster
strikes, these data are vital in planning
recovery.

Owners and Renters
For Sale
For Rent

The ACS asks about whether you
own or rent your home, and the
amount of monthly rent or how
much the home and property are
worth.

These statistics are used to analyze
whether housing is affordable, protect
owners and renters, and allocate and fund
assistance programs. Governments use
these statistics to understand changes
in local housing markets, monitor
affordability, qualify for assistance, and
reduce the tax revenue losses from vacant
or abandoned properties. Businesses use
these data to design and market homes,
and home goods.

People and Relationships
The ACS asks respondents about their
age, sex, race, Hispanic origin, and
their relationship to others in the
household.

This information, along with other
statistics, is used to monitor well-being,
discrimination, and economic hardship.
Federal agencies use this information to
administer programs providing funds and
services for groups such as single
parents, low-income families, older
people living alone, etc. Businesses use
these estimates to evaluate local market
demand for products and services.

Source: U.S. Census Bureau, American Community Survey Questions and Why We Ask .

#MeasuringAmerica
Connect with us @uscensusbureau

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Facility Manager
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your facility is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
scout programs, libraries, and hospitals.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as correctional
facilities, juvenile facilities, military barracks, and college residence halls. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
ACS-18(LZ)(GQ)(ATLANTA)(2020)(2-14-2019)

census.gov

● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about various
topics such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may need
your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Atlanta Regional Office toll-free
number at 1–800–424–6974, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(GQ)(ATLANTA)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Facility Manager
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your facility is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
scout programs, libraries, and hospitals.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as correctional
facilities, juvenile facilities, military barracks, and college residence halls. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
ACS-18(LZ)(GQ)(CHICAGO)(2020)(2-14-2019)

census.gov

● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about various
topics such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may need
your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Chicago Regional Office toll-free
number at 1–800–865–6384 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(GQ)(CHICAGO)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Facility Manager
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your facility is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
scout programs, libraries, and hospitals.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as correctional
facilities, juvenile facilities, military barracks, and college residence halls. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
ACS-18(LZ)(GQ)(DENVER)(2020)(2-14-2019)

census.gov

● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about various
topics such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may need
your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Denver Regional Office toll-free
number at 1–888–209–7659, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(GQ)(DENVER)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Facility Manager
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your facility is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
scout programs, libraries, and hospitals.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as correctional
facilities, juvenile facilities, military barracks, and college residence halls. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
ACS-18(LZ)(GQ)(LOS ANGELES)(2020)(2-14-2019)

census.gov

● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about various
topics such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may need
your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Los Angeles Regional Office
toll-free number at 1–800–992–3530 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(GQ)(LOS ANGELES)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Facility Manager
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your facility is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
scout programs, libraries, and hospitals.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as correctional
facilities, juvenile facilities, military barracks, and college residence halls. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
ACS-18(LZ)(GQ)(NEW YORK)(2020)(2-14-2019)

census.gov

● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about various
topics such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may need
your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s New York Regional Office
toll-free number at 1–800–991–2520 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(GQ)(NEW YORK)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Facility Manager
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your facility is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
scout programs, libraries, and hospitals.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as correctional
facilities, juvenile facilities, military barracks, and college residence halls. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
ACS-18(LZ)(GQ)(PHILADELPHIA)(2020)(2-14-2019)

census.gov

● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about various
topics such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may need
your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Philadelphia Regional Office
toll-free number at 1–866–238–1374, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(GQ)(PHILADELPHIA)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Director of Student Housing
Your student housing facility has been randomly selected to participate in a very important
national survey conducted by the U.S. Census Bureau called the American Community
Survey (ACS). The ACS is separate from the 2020 Census. Some facilities, including yours,
will be contacted by representatives from the ACS and from the 2020 Census this year.
Participating in both is required by U.S. law (Title 13, United States Code, Sections 141, 193,
221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of students who live or stay in student housing is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by businesses and private nonprofit organizations.
● The ACS estimates are used by federal agencies to determine the distribution of
Title I funding and college tuition grant and loan programs.
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for libraries and
new schools.
● Other organizations use this information to provide services to the community and
to plan or establish new facilities, buildings, and programs.
● Researchers and planners at your own institution almost certainly use ACS estimates
themselves.
Throughout the year, representatives for the ACS contact different facilities, such as college
residence halls, dormitories, and fraternity/sorority housing recognized by the college or
university. During the next month, one of our ACS field representatives will contact you or
someone in your office to discuss the survey and to schedule an appointment to visit
your facility.

ACS-18(LZ)(C)(GQ)(ATLANTA)(2020)(2-14-2019)

census.gov

The field representative will:
● answer any questions you may have about the ACS or about interviewing residents
of your facility.
● collect and verify basic information about your student housing facility such as the
facility name and address.
● ask for a list of students who are currently living or staying at the sampled
student housing facility to establish a basis for their sample. According to the
Family Education Rights and Privacy Act (FERPA) the Census Bureau is
permitted to collect this information.
● select a random sample of students to take part in the ACS.
● interview the selected students. If a student is unable to participate in an interview,
the field representative will work with you to determine if there are other ways to
get the needed information.
Selected students will be asked to respond to the ACS and provide information about various
topics, such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of students. The field
representative will need access to the students chosen. For those students who do not
complete the survey, colleges and universities can lawfully disclose directory information from
student records to the Census Bureau without prior consent of the student, parents, or
guardians as stated in the FERPA. Directory information includes a student’s name, date of
birth, school address, and dates of attendance.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s website at census.gov/acs.
If you have further questions, please call the Census Bureau’s Atlanta Regional Office toll-free
number at 1–800–424–6974, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(C)(GQ)(ATLANTA)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Director of Student Housing
Your student housing facility has been randomly selected to participate in a very important
national survey conducted by the U.S. Census Bureau called the American Community
Survey (ACS). The ACS is separate from the 2020 Census. Some facilities, including yours,
will be contacted by representatives from the ACS and from the 2020 Census this year.
Participating in both is required by U.S. law (Title 13, United States Code, Sections 141, 193,
221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of students who live or stay in student housing is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by businesses and private nonprofit organizations.
● The ACS estimates are used by federal agencies to determine the distribution of
Title I funding and college tuition grant and loan programs.
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for libraries and
new schools.
● Other organizations use this information to provide services to the community and
to plan or establish new facilities, buildings, and programs.
● Researchers and planners at your own institution almost certainly use ACS estimates
themselves.
Throughout the year, representatives for the ACS contact different facilities, such as college
residence halls, dormitories, and fraternity/sorority housing recognized by the college or
university. During the next month, one of our ACS field representatives will contact you or
someone in your office to discuss the survey and to schedule an appointment to visit
your facility.
ACS-18(LZ)(C)(GQ)(CHICAGO)(2020)(2-14-2019)

census.gov

The field representative will:
● answer any questions you may have about the ACS or about interviewing residents
of your facility.
● collect and verify basic information about your student housing facility such as the
facility name and address.
● ask for a list of students who are currently living or staying at the sampled
student housing facility to establish a basis for their sample. According to the
Family Education Rights and Privacy Act (FERPA) the Census Bureau is
permitted to collect this information.
● select a random sample of students to take part in the ACS.
● interview the selected students. If a student is unable to participate in an interview,
the field representative will work with you to determine if there are other ways to
get the needed information.
Selected students will be asked to respond to the ACS and provide information about various
topics, such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of students. The field
representative will need access to the students chosen. For those students who do not
complete the survey, colleges and universities can lawfully disclose directory information from
student records to the Census Bureau without prior consent of the student, parents, or
guardians as stated in the FERPA. Directory information includes a student’s name, date of
birth, school address, and dates of attendance.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s website at census.gov/acs.
If you have further questions, please call the Census Bureau’s Chicago Regional Office toll-free
number at 1–800–865–6384 (ext.1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(C)(GQ)(CHICAGO)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Director of Student Housing
Your student housing facility has been randomly selected to participate in a very important
national survey conducted by the U.S. Census Bureau called the American Community
Survey (ACS). The ACS is separate from the 2020 Census. Some facilities, including yours,
will be contacted by representatives from the ACS and from the 2020 Census this year.
Participating in both is required by U.S. law (Title 13, United States Code, Sections 141, 193,
221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of students who live or stay in student housing is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by businesses and private nonprofit organizations.
● The ACS estimates are used by federal agencies to determine the distribution of
Title I funding and college tuition grant and loan programs.
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for libraries and
new schools.
● Other organizations use this information to provide services to the community and
to plan or establish new facilities, buildings, and programs.
● Researchers and planners at your own institution almost certainly use ACS estimates
themselves.
Throughout the year, representatives for the ACS contact different facilities, such as college
residence halls, dormitories, and fraternity/sorority housing recognized by the college or
university. During the next month, one of our ACS field representatives will contact you or
someone in your office to discuss the survey and to schedule an appointment to visit
your facility.
ACS-18(LZ)(C)(GQ)(DENVER)(2020)(2-14-2019)

census.gov

The field representative will:
● answer any questions you may have about the ACS or about interviewing residents
of your facility.
● collect and verify basic information about your student housing facility such as the
facility name and address.
● ask for a list of students who are currently living or staying at the sampled
student housing facility to establish a basis for their sample. According to the
Family Education Rights and Privacy Act (FERPA) the Census Bureau is
permitted to collect this information.
● select a random sample of students to take part in the ACS.
● interview the selected students. If a student is unable to participate in an interview,
the field representative will work with you to determine if there are other ways to
get the needed information.
Selected students will be asked to respond to the ACS and provide information about various
topics, such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of students. The field
representative will need access to the students chosen. For those students who do not
complete the survey, colleges and universities can lawfully disclose directory information from
student records to the Census Bureau without prior consent of the student, parents, or
guardians as stated in the FERPA. Directory information includes a student’s name, date of
birth, school address, and dates of attendance.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s website at census.gov/acs.
If you have further questions, please call the Census Bureau’s Denver Regional Office toll-free
number at 1–888–209–7659, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(C)(GQ)(DENVER)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Director of Student Housing
Your student housing facility has been randomly selected to participate in a very important
national survey conducted by the U.S. Census Bureau called the American Community
Survey (ACS). The ACS is separate from the 2020 Census. Some facilities, including yours,
will be contacted by representatives from the ACS and from the 2020 Census this year.
Participating in both is required by U.S. law (Title 13, United States Code, Sections 141, 193,
221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of students who live or stay in student housing is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by businesses and private nonprofit organizations.
● The ACS estimates are used by federal agencies to determine the distribution of
Title I funding and college tuition grant and loan programs.
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for libraries and
new schools.
● Other organizations use this information to provide services to the community and
to plan or establish new facilities, buildings, and programs.
● Researchers and planners at your own institution almost certainly use ACS estimates
themselves.
Throughout the year, representatives for the ACS contact different facilities, such as college
residence halls, dormitories, and fraternity/sorority housing recognized by the college or
university. During the next month, one of our ACS field representatives will contact you or
someone in your office to discuss the survey and to schedule an appointment to visit
your facility.

ACS-18(LZ)(C)(GQ)(LOS ANGELES)(2020)(2-14-2019)

census.gov

The field representative will:
● answer any questions you may have about the ACS or about interviewing residents
of your facility.
● collect and verify basic information about your student housing facility such as the
facility name and address.
● ask for a list of students who are currently living or staying at the sampled
student housing facility to establish a basis for their sample. According to the
Family Education Rights and Privacy Act (FERPA) the Census Bureau is
permitted to collect this information.
● select a random sample of students to take part in the ACS.
● interview the selected students. If a student is unable to participate in an interview,
the field representative will work with you to determine if there are other ways to
get the needed information.
Selected students will be asked to respond to the ACS and provide information about various
topics, such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of students. The field
representative will need access to the students chosen. For those students who do not
complete the survey, colleges and universities can lawfully disclose directory information from
student records to the Census Bureau without prior consent of the student, parents, or
guardians as stated in the FERPA. Directory information includes a student’s name, date of
birth, school address, and dates of attendance.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s website at census.gov/acs.
If you have further questions, please call the Census Bureau’s Los Angeles Regional Office
toll-free number at 1–800–992–3530 (ext.1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(C)(GQ)(LOS ANGELES)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Director of Student Housing
Your student housing facility has been randomly selected to participate in a very important
national survey conducted by the U.S. Census Bureau called the American Community
Survey (ACS). The ACS is separate from the 2020 Census. Some facilities, including yours,
will be contacted by representatives from the ACS and from the 2020 Census this year.
Participating in both is required by U.S. law (Title 13, United States Code, Sections 141, 193,
221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of students who live or stay in student housing is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by businesses and private nonprofit organizations.
● The ACS estimates are used by federal agencies to determine the distribution of
Title I funding and college tuition grant and loan programs.
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for libraries and
new schools.
● Other organizations use this information to provide services to the community and
to plan or establish new facilities, buildings, and programs.
● Researchers and planners at your own institution almost certainly use ACS estimates
themselves.
Throughout the year, representatives for the ACS contact different facilities, such as college
residence halls, dormitories, and fraternity/sorority housing recognized by the college or
university. During the next month, one of our ACS field representatives will contact you or
someone in your office to discuss the survey and to schedule an appointment to visit
your facility.

ACS-18(LZ)(C)(GQ)(NEW YORK)(2020)(2-14-2019)

census.gov

The field representative will:
● answer any questions you may have about the ACS or about interviewing residents
of your facility.
● collect and verify basic information about your student housing facility such as the
facility name and address.
● ask for a list of students who are currently living or staying at the sampled
student housing facility to establish a basis for their sample. According to the
Family Education Rights and Privacy Act (FERPA) the Census Bureau is
permitted to collect this information.
● select a random sample of students to take part in the ACS.
● interview the selected students. If a student is unable to participate in an interview,
the field representative will work with you to determine if there are other ways to
get the needed information.
Selected students will be asked to respond to the ACS and provide information about various
topics, such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of students. The field
representative will need access to the students chosen. For those students who do not
complete the survey, colleges and universities can lawfully disclose directory information from
student records to the Census Bureau without prior consent of the student, parents, or
guardians as stated in the FERPA. Directory information includes a student’s name, date of
birth, school address, and dates of attendance.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s website at census.gov/acs.
If you have further questions, please call the Census Bureau’s New York Regional Office
toll-free number at 1–800–991–2520 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(C)(GQ)(NEW YORK)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Director of Student Housing
Your student housing facility has been randomly selected to participate in a very important
national survey conducted by the U.S. Census Bureau called the American Community
Survey (ACS). The ACS is separate from the 2020 Census. Some facilities, including yours,
will be contacted by representatives from the ACS and from the 2020 Census this year.
Participating in both is required by U.S. law (Title 13, United States Code, Sections 141, 193,
221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of students who live or stay in student housing is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by businesses and private nonprofit organizations.
● The ACS estimates are used by federal agencies to determine the distribution of
Title I funding and college tuition grant and loan programs.
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for libraries and
new schools.
● Other organizations use this information to provide services to the community and
to plan or establish new facilities, buildings, and programs.
● Researchers and planners at your own institution almost certainly use ACS estimates
themselves.
Throughout the year, representatives for the ACS contact different facilities, such as college
residence halls, dormitories, and fraternity/sorority housing recognized by the college or
university. During the next month, one of our ACS field representatives will contact you or
someone in your office to discuss the survey and to schedule an appointment to visit
your facility.

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The field representative will:
● answer any questions you may have about the ACS or about interviewing residents
of your facility.
● collect and verify basic information about your student housing facility such as the
facility name and address.
● ask for a list of students who are currently living or staying at the sampled
student housing facility to establish a basis for their sample. According to the
Family Education Rights and Privacy Act (FERPA) the Census Bureau is
permitted to collect this information.
● select a random sample of students to take part in the ACS.
● interview the selected students. If a student is unable to participate in an interview,
the field representative will work with you to determine if there are other ways to
get the needed information.
Selected students will be asked to respond to the ACS and provide information about various
topics, such as education and employment. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data (Title 13, United
States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of students. The field
representative will need access to the students chosen. For those students who do not
complete the survey, colleges and universities can lawfully disclose directory information from
student records to the Census Bureau without prior consent of the student, parents, or
guardians as stated in the FERPA. Directory information includes a student’s name, date of
birth, school address, and dates of attendance.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s website at census.gov/acs.
If you have further questions, please call the Census Bureau’s Philadelphia Regional Office
toll-free number at 1–866–238–1374, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(C)(GQ)(PHILADELPHIA)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Facility Manager
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the Puerto Rico Community Survey (PRCS).
The PRCS is separate from the 2020 Census. Some facilities, including yours, will be
contacted by representatives from the PRCS and the 2020 Census this year. Participating in
both is required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The PRCS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your facility is included in the PRCS.
Information from the PRCS is used by federal, Puerto Rico and municipio governments, as
well as by nonprofit organizations and communities, for example:
● Puerto Rico and municipio governments use this information for budgeting, evaluating
programs, and planning for community development projects, such as services
for the elderly, emergency preparation, and federal aid.
● Organizations and businesses can use this information to provide services to the
community, and to plan or establish new facilities, buildings, and programs.
Throughout the year, representatives for the PRCS contact different facilities such as
correctional facilities, juvenile facilities, military barracks, and college residence halls.
During the next month, one of our PRCS field representatives will contact you or someone
in your office to discuss the survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the PRCS or about interviewing residents
of your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
● ask for a list of residents who are currently living or staying at your facility to establish
a basis for their sample.

ACS-18(LZ)(GQ)(PR)(2020)(2-2019)

census.gov

● select a random sample of residents to take part in the PRCS.
● interview the selected residents. If a resident is unable to participate in an interview,
the field representative will work with you to determine if there are other ways to get
the needed information.
Selected residents will be asked to respond to the PRCS and provide information about various
topics such as education and employment. The Census Bureau is required by law to keep
your information confidential. We are not permitted to publicly release your responses in
a way that could identify you. Per the Federal Cybersecurity Enhancement Act of 2015,
your data are protected from cybersecurity risks through screening of the systems that
transmit your data (Title 13, UnitedStates Code, Section 9).
Your cooperation is essential to the success of the PRCS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen.
The enclosed brochure provides answers to frequently asked questions about the PRCS. If you
want to learn more about the PRCS, please visit the Census Bureau’s Web site
atcensus.gov/acs.
If you have any further questions, please call the Census Bureau’s New York Regional Office
toll-free number at 1–800–991–2520 (ext. 1), and ask for the PRCS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosures

ACS-18(LZ)(GQ)(PR)(2020)(2-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Para: Administrador de la instalación
Su instalación ha sido seleccionada al azar para participar en una encuesta nacional muy
importante conocida como la Encuesta sobre la Comunidad de Puerto Rico (PRCS, por
sus siglas en inglés), la cual es llevada a cabo por el la Oficina del Censo de los EE. UU. La
PRCS es una encuesta independiente del Censo del 2020. Este año, algunas instalaciones
serán contactadas por representantes tanto de la PRCS como del Censo del 2020. Participar
en ambos es requerida por la ley de los EE. UU. (Título 13 del Código de los EE. UU.,
Secciones 141, 193, 221 y 223).
El gobierno federal, el de Puerto Rico y los de los municipios, as como las organizaciones
sinfines de lucro y las comunidades usan la informaci n de la PRCS; por ejemplo:
● El gobierno de Puerto Rico y los de los municipios usan esta información para

preparar presupuestos, evaluar programas y planificar proyectos de desarrollo en la
comunidad, tales como servicios para personas de la tercera edad, preparación para
emergencias y asistencia federal.
● Las organizaciones y las empresas pueden usar esta información para proporcionar
servicios a la comunidad y para planificar o establecer nuevas instalaciones, edificios y
programas.
Durante el año, los representantes de la PRCS se comunican con diferentes instalaciónes,
tales como instituciones de corrección, instituciones para jóvenes, barracas militares y
residencias de estudiantes universitarios. Dentro del próximo mes, uno de nuestros
representantes de la PRCS se comunicará con usted o con alguien en su oficina para hablar
sobre la encuesta y hacer una cita para visitar su instalación.

ACS-18(LZ)(GQ)(PR)(S)(2020)(2-2019)
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El representante de la Oficina del Censo:
● le contestará cualquier pregunta que usted tenga sobre la PRCS o sobre los
procedimientos para las entrevistas con los residentes de su instalación.
● recopilará y verificará información básica sobre su instalación, tal como el nombre y
la dirección.
● solicitará una lista de las personas que actualmente residen o se quedan en la
instalación, con el fin de crear una base para la muestra.
● seleccionará al azar una muestra de residentes para que participen en la PRCS.
● entrevistará a los residentes seleccionados. Si algún residente no puede participar en la
entrevista, el representante de la Oficina del Censo trabajará con usted para determinar
si hay otra manera de obtener la información necesaria.
Se les pedirá a los residentes seleccionados que respondan a la PRCS y que provean
información sobre varios temas, tales como la educación y el empleo. La Oficina del Censo
de los EE. UU. está obligada por ley a mantener confidencial su información. A la Oficina
del Censo no se le permite divulgar sus respuestas de manera que usted pudiera ser
identificado. En conformidad con la Ley parael Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de seguridad
cibernética mediante los controles aplicados a los sistemas que trasmiten su información
(sección 9del título 13 del Código de los EE. UU.).
Su cooperación es esencial para el éxito de la PRCS y el representante podrá llegar a
necesitar su asistencia para recopilar información de la encuesta de la muestra de residentes.
El representante del Censo necesitará tener acceso a los residentes seleccionados.
El folleto que se incluye provee respuestas a las preguntas más frecuentes sobre la PRCS. Si
usted desea aprender más sobre la PRCS, visite la página de la Oficina del Censo en
census.gov/acs.
Si tiene alguna otra pregunta, por favor, llame sin cargos a la Oficina Regional del Censo en
Nueva York al número de teléfono 1–800–991–2520 (ext. 1) y pida hablar con el supervisor de
la PRCS.
Se le agradece su cooperación por adelantado y esperamos poder contar con usted.
Atentamente,

Steven D. Dillingham
Director
Anejo

ACS-18(LZ)(GQ)(PR)(S)(2020)(2-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.
ACS-18(LZ)(H)(GQ)(ATLANTA)(2020)(2-14-2019)

census.gov

● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. The
Census Bureau is required by law to keep your information confidential. We
are not permitted to publicly release your responses in a way that could
identify you. Per the Federal Cybersecurity Enhancement Act of 2015, your
data are protected from cybersecurity risks through screening of the systems
that transmit your data (Title 13, United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Atlanta Regional Office toll-free
number at 1–800–424–6974, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(H)(GQ)(ATLANTA)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.

ACS-18(LZ)(H)(GQ)(CHICAGO)(2020)(2-14-2019)

census.gov

● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. The
Census Bureau is required by law to keep your information confidential. We
are not permitted to publicly release your responses in a way that could
identify you. Per the Federal Cybersecurity Enhancement Act of 2015, your
data are protected from cybersecurity risks through screening of the systems
that transmit your data (Title 13, United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Chicago Regional Office
toll-free number at 1–800–865–6384 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(H)(GQ)(CHICAGO)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.

ACS-18(LZ)(H)(GQ)(DENVER)(2020)(2-14-2019)

census.gov

● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. The
Census Bureau is required by law to keep your information confidential. We
are not permitted to publicly release your responses in a way that could
identify you. Per the Federal Cybersecurity Enhancement Act of 2015, your
data are protected from cybersecurity risks through screening of the systems
that transmit your data (Title 13, United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Denver Regional Office
toll-free number at 1–888–209–7659, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(H)(GQ)(DENVER)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.

ACS-18(LZ)(H)(GQ)(LOS ANGELES)(2020)(2-14-2019)

census.gov

● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. The
Census Bureau is required by law to keep your information confidential. We
are not permitted to publicly release your responses in a way that could
identify you. Per the Federal Cybersecurity Enhancement Act of 2015, your
data are protected from cybersecurity risks through screening of the systems
that transmit your data (Title 13, United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Los Angeles Regional Office
toll-free number at 1–800–992–3530 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(H)(GQ)(LOS ANGELES)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.

ACS-18(LZ)(H)(GQ)(NEW YORK)(2020)(2-14-2019)

census.gov

● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. The
Census Bureau is required by law to keep your information confidential. We
are not permitted to publicly release your responses in a way that could
identify you. Per the Federal Cybersecurity Enhancement Act of 2015, your
data are protected from cybersecurity risks through screening of the systems
that transmit your data (Title 13, United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s New York Regional Office
toll-free number at 1–800–991–2520 (ext. 1), and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(H)(GQ)(NEW YORK)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

To: Health Care Facility Administrator
Your facility has been randomly selected to participate in a very important national survey
conducted by the U.S. Census Bureau called the American Community Survey (ACS).
The ACS is separate from the 2020 Census. Some facilities, including yours, will be contacted
by representatives from the ACS and from the 2020 Census this year. Participating in both is
required by U.S. law (Title 13, United States Code, Sections 141, 193, 221, and 223).
The ACS is an on-going survey that tells us what the population looks like and how it lives. A
sample of residents who live or stay in your hospitals, nursing facilities/skilled nursing facilities,
and inpatient hospice facilities is included in the ACS.
Estimates from the ACS are used by federal, tribal, state, and local governments, as well as
by private nonprofit organizations and communities, for example:
● Local governments use these estimates for budgeting, evaluating programs, and
planning for community development projects, such as those for the older population,
hospitals, and senior centers.
● Other organizations use this information to provide services to the community and to
plan or establish new facilities, buildings, and programs.
● Administrators at your own facility may use ACS estimates themselves.
Throughout the year, representatives for the ACS contact different facilities, such as hospitals,
nursing facilities/skilled nursing facilities, and inpatient hospice facilities. During the next month,
one of our ACS field representatives will contact you or someone in your office to discuss the
survey and to schedule an appointment to visit your facility.
The field representative will:
● answer any questions you may have about the ACS or about interviewing residents of
your facility.
● collect and verify basic information about your facility, such as the facility name and
address.

ACS-18(LZ)(H)(GQ)(PHILADELPHIA)(2020)(2-14-2019)

census.gov

● ask for a list of residents who are currently living or staying at your facility to establish a
basis for their sample.
● select a random sample of residents to take part in the ACS.
● interview the selected residents. If a resident is unable to participate in an interview, the
field representative will work with you to determine if there are other ways to get the
needed information.
Selected residents will be asked to respond to the ACS and provide information about
various topics, such as education, military service, insurance coverage and disability. The
Census Bureau is required by law to keep your information confidential. We
are not permitted to publicly release your responses in a way that could
identify you. Per the Federal Cybersecurity Enhancement Act of 2015, your
data are protected from cybersecurity risks through screening of the systems
that transmit your data (Title 13, United States Code, Section 9).
Your cooperation is essential to the success of the ACS, and the field representative may
need your assistance in collecting survey information from the sample of residents. The field
representative will need access to the residents chosen. For those residents who cannot
complete the survey, according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA), to the extent required by Title 13 or other law, an organization or facility covered
by HIPAA is permitted under the Privacy Rule to disclose protected health information to the
Census Bureau for survey purposes.
The enclosed brochure provides answers to frequently asked questions about the ACS. If you
want to learn more about the ACS, please visit the Census Bureau’s Web site at
census.gov/acs.
If you have further questions, please call the Census Bureau’s Philadelphia Regional Office
toll-free number at 1–866–238–1374, and ask for the ACS supervisor.
Thank you in advance for your cooperation, and we look forward to working with you.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-18(LZ)(H)(GQ)(PHILADELPHIA)(2020)(2-14-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Dear Facility Administrator:

On behalf of the U.S. Census Bureau, I thank you for participating in the American
Community Survey. The success of the survey depends upon cooperation from you
and the residents selected for the survey. The Census Bureau is required by law to
keep your information confidential. We are not permitted to publicly release your
responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks through
screening of the systems that transmit your data.
Federal, tribal, state, and local governments will use summarized information from this
survey to make decisions that affect you and your community, and to develop
programs that will provide many goods and services, including health care, education,
and transportation. To learn more about the American Community Survey and to
review the survey results, visit our Web site at census.gov/acs.
Your participation is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(F)(2020) (2-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Estimado administrador(a) de la instalación:

En nombre de la Oficina del Censo de los EE. UU., le agradezco su participación en
la Encuesta sobre la Comunidad Estadounidense. El éxito de esta encuesta depende
de la cooperación que recibimos de usted y de los residentes seleccionados para esta
encuesta. La Oficina del Censo de los EE. UU. está obligada por ley a mantener
confidencial su información. No se nos permite divulgar sus respuestas de manera
que usted pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento
de la Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los
riesgos de seguridad cibernética mediante los controles aplicados a los sistemas que
trasmiten su información.
El gobierno federal y los gobiernos tribales, estatales, y locales usarán información
resumida de esta encuesta para tomar decisiones que les conciernen a usted y su
comunidad, y para elaborar programas que proporcionarán muchos bienes y servicios,
incluso atención médica, educación y transporte. Para obtener más información
acerca de la Encuesta sobre la Comunidad Estadounidense y para revisar los
resultados de la encuesta, visite nuestro sitio en Internet en census.gov/acs.
Le agradecemos mucho su participación.
Atentamente,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(F)(2020) (2-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Dear Facility Administrator:

On behalf of the U.S. Census Bureau, I thank you for participating in the Puerto Rico
Community Survey (PRCS). The success of the survey depends upon cooperation
from you and the residents selected for the survey. The U.S. Census Bureau is
required by law to keep your information confidential. The Census Bureau is not
permitted to publicly release your responses in a way that could identify you. Per the
Federal Cybersecurity Enhancement Act of 2015, your data are protected from
cybersecurity risks through screening of the systems that transmit your data.
Puerto Rico and local governments will use summarized information from this survey
to make decisions that affect you and your community, and to develop programs that
will provide many goods and services, including health care, education, and
transportation. To learn more about the PRCS and to review the survey results, visit
our Web site at census.gov/acs.
Your participation is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(PR)(F)(2020) (2-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Estimado administrador(a) de la instalación:

En nombre de la Oficina del Censo de los EE. UU., le agradezco su participación en
la Encuesta sobre la Comunidad de Puerto Rico. El éxito de esta encuesta depende
de la cooperación que recibimos de usted y de los residentes se leccionados para
esta encuesta. La Oficina del Censo de los EE. UU. está obligada por ley a mantener
confidencial su información. A la Oficina del Censo no se le permite divulgar sus
respuestas de manera que usted pudiera ser identificado. En conformidad con la Ley
para el Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos están
protegidos contra los riesgos de seguridad cibernética mediante los controles
aplicados a los sistemas que trasmiten su información.
El gobierno de Puerto Rico y los gobiernos locales usarán información resumida de
esta encuesta para tomar decisiones que les conciernen a usted y su comunidad, y
para elaborar programas que proporcionarán muchos bienes y servicios, incluso
atención médica, educación y transportación. Para obtener más información acerca de
la Encuesta sobre la Comunidad de Puerto Rico y para revisar los resultados de la
encuesta, visite nuestro sitio en la Internet en census.gov/acs.
Le agradecemos mucho su participación.
Atentemente,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(PR)(F)(2020) (2-2019)
census.gov

Frequently Asked Questions
for Facility Administrators

American Community Survey
Group Quarters

Your Community’s Key to the Future

AMERICAN COMMUNITY SURVEY www.census.gov/acs

What is the American Community
Survey?
The American Community Survey
is a survey conducted by the U.S.
Census Bureau in every county,
American Indian and Alaska Native
Area, and Hawaiian Home Land.
It replaced the long form in the
decennial census and greatly
simplified operations so that the
focus of the decennial census is
solely on counting the population.
The American Community Survey
provides current demographic,
social, economic, and housing
characteristics every year. In
the past, this information was
only available every 10 years
when the decennial census was
conducted. Estimates from the
American Community Survey
help communities make informed
decisions and is a key to their
future.

The American Community Survey
does not count the population,
but it does provide information
that reflects what the population
looks like and how it lives.
That information is vital for
states and local communities
in determining how to plan for
schools, roads, senior citizen
centers, and other goods and
services.
The U.S. Office of Management
and Budget (OMB) approved this
survey and gave it OMB approval
No. 0607-0810. Displaying this
number shows that the Census
Bureau is authorized to conduct
this survey. Please use this
number in any correspondence
concerning this survey.
Respondents are not required
to respond to any information
collection unless it displays a valid
approval number from the OMB.

1

www.census.gov/acs

We have not heard of the
American Community Survey.
How long have you been
conducting it?
The American Community Survey
began in 1996 in a sample of
counties across the country. The
American Community Survey
began sampling group quarters
in 2006. Today, the survey is
conducted in all U.S. counties, as
well as in Puerto Rico where it is
called the Puerto Rico Community
Survey.
How does this group quarters
and its residents benefit
by answering the American
Community Survey?
The American Community
Survey provides up-to-date
information for your community.
By responding to the American
Community Survey you are
helping your community to
establish goals, identify problems
and solutions, and measure the
performance of programs.

AMERICAN COMMUNITY SURVEY

Communities need data about
the well-being of children,
families, and the elderly to
provide services to them. These
estimates are also used to decide
where to locate new highways,
schools, libraries, hospitals,
and community centers, and to
determine the goods and services
its residents need.
What type of group quarter
facilities are included in the
American Community Survey?
Examples of group quarter
facilities include:
• College/university student
housing.
• Residential treatment centers
for adults.
• Nursing facilities/
skilled-nursing facilities.
• Group homes intended for
adults.
• Military quarters.
• Correctional facilities for adults.
• Workers’ group living quarters
and Job Corps centers.

2

AMERICAN COMMUNITY SURVEY www.census.gov/acs

Why did the Census Bureau
select this group quarters
facility?

What level of assistance is
expected from my staff during
the survey period?

Group quarters facilities are
randomly selected each year from
a sample list of all group quarters
in your area. The larger the
group quarters, the greater the
probability that it will be selected
to participate in the survey one or
more times each year.

Your staff will be asked to:

Your participation is very
important for us to be able to
produce accurate information
from this survey.
We have already participated
in this survey. How many times
during the year will the Census
Bureau sample my facility?
The number of times we visit
your facility depends on the size
of your facility. Large facilities
may be sampled multiple times
throughout the year.

• Provide a list of residents
currently staying at your
facility.
• Give the Census Bureau
representative access to the
sample residents to conduct
interviews.
• Inform the Census Bureau
representative of any special
requirements that may assist
them in conducting interviews
at your facility.
How are residents at my facility
selected to be in the sample?
After you provide a list of all
residents currently staying at
your facility, field representatives
randomly select residents to take
part in the American Community
Survey. One of the advantages
of a random sample is that we
can use it to measure the whole

3

www.census.gov/acs

population without having to
actually interview every resident
at every facility. But in order for
it to work properly, we cannot
substitute sample residents—the
sample has to be truly random.
Do the sampled group quarters
and sampled residents have to
answer the questions on the
American Community Survey?
Yes. You are required by law to
answer the American Community
Survey. Two provisions of
Title 13, United States Code,
require your participation. Section
221 of Title 13 makes it mandatory
for individuals to participate in
the American Community Survey,
and Section 223 of Title 13 makes
it mandatory for building owners
and others to provide access to
individuals in order to conduct
the American Community Survey
group quarters interviews.
The same law protects the
confidentiality of the information

4

AMERICAN COMMUNITY SURVEY

you provide. For more information
about Title 13, you may visit the
Census Bureau’s Web site at

and select the topic: “American
Community Survey: Must I
respond?”
How will information be
collected from sampled residents
in this facility?
The American Community Survey
collects residents’ information
through face-to-face or telephone
interviews. This can either be
with the sampled resident or a
proxy respondent. The sampled
resident may also fill out the
questionnaire on his/her own. The
Census Bureau representative will
leave the questionnaire with the
resident and return to pick up the
completed questionnaire at an
agreed upon time.

AMERICAN COMMUNITY SURVEY www.census.gov/acs

Why do you select residents who
may be physically or mentally
unable to answer the American
Community Survey?
Residents are randomly selected
to take part in the American
Community Survey. Sampled
residents may designate another
person, such as a relative,
guardian, or facility administrator
to help with the survey. The
facility administrator may talk with
the Census Bureau representative
to resolve any issues. To produce
the most accurate results, it is
very important that every resident
selected for the survey is included.
How long will it take to complete
the survey?
We estimate that the facility
survey will take about 15 minutes
to complete and each resident
survey will take about 25 minutes
to complete. Send comments
regarding this burden estimate or
any other aspect of this collection
of information, including
suggestions for reducing this

burden, to: Paperwork Reduction
Project, U.S. Census Bureau,
4600 Silver Hill Road,
ADDC-4H277, Washington, DC
20233. You may e-mail
comments to
[email protected];
use “Paperwork Project”
as the subject.
Can the sampled resident
interviews be done via e-mail or
online?
No. At this time, the survey
cannot be completed via e-mail
or online.
Why do you ask detailed
questions that may seem
unnecessary for residents living
in this facility?
The American Community Survey
asks very detailed questions
because we are required to
collect specific information that is
used for a variety of federal and
state programs. The questionnaire
is used for residents of many
types of facilities. Therefore,
not every question will apply to
everyone who receives it.

5

www.census.gov/acs

Will the Census Bureau keep
the group quarter facility
and resident information
confidential?
Yes. The U.S. Census Bureau is
required by law to keep your
information confidential. The
Census Bureau is not permitted
to publicly release your responses
in a way that could identify you.
Per the Federal Cybersecurity
Enhancement Act of 2015,
your data are protected from
cybersecurity risks through
screening of the systems that
transmit your data.
How will the Census Bureau
use the information the group
quarters and sampled residents
provide?
By law, the Census Bureau can
only use your responses to
produce statistics. The Census
Bureau is not permitted to
publicly release your responses in
a way that could identify you. Per
the Federal Cybersecurity
Enhancement Act of 2015, your
data are protected from
6

AMERICAN COMMUNITY SURVEY

cybersecurity risks through
screening of the systems that
transmit your data. The Census
Bureau will also use this
information to improve the
American Community Survey,
ultimately resulting in even better
data for your community and the
nation.
Who can see the answers this
group quarters or its residents
provide to the survey?
Your facility and resident
responses will only be seen by
Census Bureau personnel with
a work-related need to know.
The Census Bureau protects the
confidentiality of the information.
The police cannot see it and no
court of law can see it. No one can
see or use your specific answers to
enforce any type of law or amend
any kind of benefit.
If any Census Bureau employee
were to share information about
your facility or its residents, he or
she would be subject to severe
criminal sanctions imposed
by Congress—up to 5 years

AMERICAN COMMUNITY SURVEY www.census.gov/acs

imprisonment and/or up to a
$250,000 fine (Title 13, United
States Code, Section 214, as
amended by Title 18, United
States Code, Sections 3559 and
3571).
When will results of the survey
be available?
The previous years’ results of the
American Community Survey
are released every fall. Survey
estimates are released each year
for areas of 65,000 or more
people. For smaller areas, results
are available in the form of 3-year
and 5-year estimates.
How can the group quarters and
the residents see the results of
the survey?
This information is published on
the Census Bureau’s American
FactFinder Web site at
.

Where can the facility and its
residents get assistance or find
more information about the
American Community Survey?
You can contact the Census
Bureau’s regional office nearest
you as listed below:

Census Bureau Regional Offices
Atlanta, GA
1-800-354-7271
Chicago, IL
1-800-865-6384 (ext. 1)
Denver, CO
1-888-209-7659
Los Angeles, CA
1-800-992-3530 (ext. 1)
New York, NY
1-800-991-2520 (ext. 1)
Philadelphia, PA
1-866-238-1374

7

www.census.gov/acs

For more information about the
American Community Survey, or
to obtain survey results from past
years, we encourage you to visit
our Web site at:
www.census.gov/acs
You may also contact us by calling
301-763-INFO (4636), or by visiting
, or by mail
at the following address:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500

8

AMERICAN COMMUNITY SURVEY

AMERICAN
COMMUNITY
SURVEY
U.S. CENSUS BUREAU

http://ask.census.gov

Phone: 1-888-346-9682

Internet: www.census.gov/acs

Issued March 2019
ACS-51(GQ)(F)

Connect with us @uscensusbureau

Sheet ____ of ____ Sheets

FORM ACS-290(GQ) (7-16-2014)

U.S. DEPARTMENT OF COMMERCE (1) GQ Name
Economics and Statistics Administration

U.S. Census Bureau

(2) Sample Date

GROUP QUARTERS LISTING SHEET

(3) Username

(4) Interview Date
Month/Day/Year

(5) GQ Control Number

AMERICAN COMMUNITY SURVEY (ACS)
(6) Total Number of Current Residents (Current Pop)

Line
No.
(7)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
(10) Footnotes

Sample Resident Name and
Location Description
(8)

Telephone Number/Remarks
(9)

FORMA

ACS-290(GQ)(PR)(SP)

Hoja ______ de _______ Hojas

(8-15-2017)

DEPARTAMENTO DE COMERCIO DE LOS EE.UU. (1) Nombre del GQ
Administración de Economía y Estadísticas

OFICINA DEL CENSO DE LOS EE.UU.

(2) Fecha de la
Muestra

HOJA DE LISTADO DEL ALOJAMIENTO DE GRUPO
ENCUESTA SOBRE LA COMUNIDAD
DE PUERTO RICO (PRCS)

(3) Nombre de
usuario

(4) Fecha de la Entrevista
Mes/Día/Año

(5) Número de Control del GQ

(6) Número Total de Residentes Actuales (Población Actual)

Núm.
de
Línea

Nombre del Residente en la Muestra
y Descripción de la Localización

Número de Teléfono/Comentarios

(7)

(8)

(9)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
(10) Notas al Calce

FORM ACS-290B(GQ) (8-1-2011)

U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

1. GQ Name

U.S. CENSUS BUREAU

2. GQ Control Number

SURVEY PACKAGE CONTROL LIST FOR
SPECIAL SWORN STATUS (SSS)
INDIVIDUALS
AMERICAN COMMUNITY SURVEY
GROUP QUARTERS

3. SSS Name
4. SSS Phone Number

NOTE – Please return this form to the Field Representative who picks up the survey package.
Sample Resident Name
(a)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Date questionnaire –
Distributed Collected
Month

Remarks

(c)

(b)

Day

Month

Day

(d)

FORMA ACS-290B(GQ)(PR)(SP) (8-14-2017)

DEPARTAMENTO DE COMERCIO DE LOS EE.UU.
Administración de Economía y Estadísticas
OFICINA DEL CENSO DE LOS EE.UU.

1. Nombre del GQ

2. Número de control del GQ

LISTA DE CONTROL DEL PAQUETE DE
MATERIALES DE LA ENCUESTA PARA LOS
EMPLEADOS ESPECIALES JURAMENTADOS
ENCUESTA SOBRE LA COMUNIDAD DE
PUERTO RICO

3. Nombre del empleado especial juramentado

4. Número de teléfono del empleado especial juramentado

ALOJAMIENTO DE GRUPO

NOTA – Por favor, devuelva esta forma al Representante de Campo cuando él/ella
regrese a recoger los paquetes de materiales de la encuesta.
Fecha del cuestionario –
Nombre del Residente en la Muestra
(a)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Distribuido

Recogido

(b)

(c)

Mes

Día

Mes

Día

Comentarios
(d)

GQFQ Specification for 2019 Production
Instrument:

Screen names are listed in parenthesis with the title of each question.
All questions are must fill with only listed values being valid, unless noted.
Do not put D or R response options on the screen.
Initialize OUTCOME to 800.
Make the following variables global and update them anytime the relevant
data change: GQNAME, all address fields, all CP variables, and GQTYPE.
Initialize GQNAME from SCIF and CP vars from CP1 and CP2 vars on
SCIF.Initialize GQADDLINE1 and GQADDLINE2 from parsed address fields
on SCIF. Initialize DESC var from SCIF.
Note: GQADDLINE1 consists of: HNO, HNOSUF, STRPRXD, STRPRXT,
STRNAME, STRSFXT, STRFXD, and STRNAMX. GQADDLINE2 consists
of PO, ST, ZIP5, and ZIP4. Initialize GQPHONE =
AREA||PREFIX||SUFFIX (|| means concatenate). Initialize GQEXT =
EXTN.
The text accompanying the answer box in the form pane is the title of the
question unless noted.
Every time the instrument is closed, write out a case history record
containing CTRLNUM, case ID, FR code current OUTCOME, current
GQTYPE, and date/time stamp, USERID(8 character alphanumeric),.

BoP only – Set BoP flag in the setup script based on GQTYPE = 101 or 102 and
RT8501 exists.

Block
Variable Name
Field Description
Universe
Screen

BInitial
INITSCREEN
1. Initial Screen
All
[Census Logo] U.S. Census Bureau

Fill in DATE/Fill in TIME

[fill: AMERICAN/PUERTO RICO] COMMUNITY SURVEY (ACS)
GROUP QUARTERS FACILITY QUESTIONNAIRE
V[fill: Version Number] [fill: Version date]

Place Contact
Person 2
information to
the right of
Contact Person 1
information
Input Options

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

PHYSICAL DESC/LOCATION:
BUILDING NAME:
BUILDING ID:

Fill in PHYSDES
Fill in BLDGNAME
Fill in BLDGID

GENERAL/MAIN PHONE #:

Fill in GQPHONE, GQEXT

CONTACT PERSON 1:
CONTACT PHONE:

Fill in CP1NAME, Fill in CP1TITL
Fill in CP1PHON, CP1EXT

CONTACT PERSON 2:
CONTACT PHONE:

Fill in CP2NAME, Fill in CP2TITL
Fill in CP2PHON, CP2EXT

1.
2.
3.
4.
5.

Non-Working Telephone Number
Telephone calls to GQ to set up appointment for personal interview at GQ
Personal interview at GQ without an appointment
Personal interview at GQ with a set appointment
Quit-do not attempt now

Valid Values: 1,2,3,4,5,do not accept DK or R
Fill Instructions
Skip Instructions

If PRFLAG=1, display “Puerto Rico”, else display “American”
1. If INITSCREEN = 1 and PEAS_FL = 1 or PEAS_FL = 0, exit instrument
and go to Notes. Set OUTCOME = 803.
2. If INITSCREEN = 2 and PEAS_FL = 1, go to IDOFPLACE.
3. If INITSCREEN = 2 and if PEAS_FL = 0, display hard error message that
says: “All GQ contact information has already been collected. Conduct a
personal visit.” Suppress is not online. Close and GoTo go back to

4.
5.
6.
7.
8.

INITSCREEN.
If INITSCREEN = 3 and if PEAS_FL = 1, go to IDOFPLACE.
If INITSCREEN = 3 and If PEAS_FL = 0, go to PEOPLEATGQ.
If INITSCREEN = 4 and If PEAS_FL = 1, go to INTRO.
If INITSCREEN = 4 and if PEAS_FL = 0, go to PEOPLEATGQ.
If INITSCREEN = 5, go to NOTES. Only display if INITSCREEN ne 1,2,3
or 4.

Skip Instructions
for BoP

1. If INITSCREEN = 2 and BoP_FL = 1 and PEAS_FL = 1, go to
IDOFPLACE.
2. If INITSCREEN = 2 and BoP_FL = 1, and PEAS_FL = 0, display hard
error message that says: “There has already been an appointment made for
this GQ. After you have conducted the interviews, select Option 4 to finish
the case.” Suppress exits the instrument. Close and goto return to
INITSCREEN.
3. If INITSCREEN = 4 and BoP_FL = 1, and [PEAS_FL = 1 or PEAS_FL =
0], display soft error box that reads: “In selecting this option, you are
verifying that: *You should have only selected this option if you have
received notification from the S/FR that the survey packages have been
delivered to the GQ. *Remember to assign completed PAPIs with
appropriate outcome codes, in Case Management, upon receiving the
questionnaires from the GQ facility. Set outcome code to 801.
4. If INITSCREEN = 4, and BoP_Flag = 1, and PEAS_FL = 1 and
APPOINTMENT1=empty, display soft error message that reads: “You
must contact the facility to set up an appointment before you can enter this
option.” Suppress is online. Close and goto exit the instrument and go to
NOTES. Set OUTCOME = 802.

Special
Instructions

1. If INITSCREEN = 1, display a soft error that reads: “You must conduct
research to find a valid number. If you cannot do this, then you must
conduct a personal visit. [Leave a blank linebetween this sentence and the
next one.] Click Suppress to exit or Goto to return.”

BoP Special
Instruction

1. The INITSCREEN should only allow for options1,2, 4 and 5.
2. If INITSCREEN=1, and BoP_Flag = 1, display a soft error that reads
“Contact your RO immediately and inform them of the situation. Do not
conduct a personal visit without making an appointment first.”

Block
Variable Name
Field Description
Universe

Screen

BInitial
IDOFPLACE
2.1 Identification of Place
[INITSCREEN=2 and if PEAS_FL=1] or [INITSCREEN=3 and if PEAS_FL=1].
Universe for BoP should include: [INITSCREEN=2 and PEAS_FL=1 and
BoP_Flag=1]
SPECIAL PLACE NAME:
Fill in SPECPLACE
GROUP QUARTERS NAME: Fill in GQNAME
GENERAL/MAIN PHONE #:

Fill in GQPHONE, GQEXT

CONTACT PERSON 1:
CONTACT PERSON TITLE 1:
CONTACT PHONE 1:
CONTACT PERSON 2:
CONTACT PERSON TITLE 2:
CONTACT PHONE 2:
ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

Hello. My name is _______. I’m with the U.S. Census Bureau. We are
currently conducting an important survey in your community and I’d like to
verify that this is [fill: GQNAME]?
♦ [Use fill in SPNAME if appropriate]
Input Options

1. Yes
2. No
Valid Values: 1,2, Do not accept DK or R

Fill Instructions

1. IF PRFLAG=1, display “Puerto Rico”, else display “American.”

Skip Instructions

1. If INITSCREEN = 2 or 3 and IDOFPLACE = 1 and SPNAME =
GQNAME, go to GQ_HAS_SP.
2. If INITSCREEN = 2 or 3 and if SPNAME ne GQNAME go to
UPDATESPNAME.
3. If INISTCREEN=2 and IDOFPLACE=2, go to VERIFY_PHONUM.
4. If INITSCREEN = 3 and IDOFPLACE = 2, go to EVER_GQ_NAME.

Skip Instructions
for BoP

1. If INITSCREEN = 2 and IDOFPLACE = 1 and BoP_Flag = 1, go to
SRCHKNWLRESP.

2. If INITSCREEN = 2 and IDOFPLACE = 2 and BoP_Flag = 1, go to
VERIFY_PHONUM.
Special
Instructions
BoP Special
Instruction

Block
Variable Name
Field Description
Universe

BInitial
VERIFY_PHONUM
2.1.2 Verify GQ Phone #
If INITSCREEN=2 and IDOFPLACE=2 or [IDOFPLACE=2 and BoP_Flag=1]

Screen

SPECIAL PLACE NAME:
Fill in SPECPLACE
GROUP QUARTERS NAME: Fill in GQNAME
GENERAL/MAIN PHONE #:

Fill in GQPHONE, GQEXT

CONTACT PERSON 1:
CONTACT PERSON TITLE 1:
CONTACT PHONE 1:
CONTACT PERSON 2:
CONTACT PERSON TITLE 2:
CONTACT PHONE 2:
ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

Have I reached [fill: GQPHONE]
Input Options

1. Yes
2. No
Valid Values: 1,2

Fill Instructions
Skip Instructions

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If Yes, go to EVER_GQ_NAME
2. If No, go to WRONG_NUM
1. If VERIFY_PHONUM=2 and BoP_Flag=1, go to WRONG_NUM.

1. If VERIFY_PHONUM=1 and IDOFPLACE=2 and BoP_Flag=1, display
soft edit to say “I’m sorry, I must’ve reached you by mistake. Thank you
for your time.”
♦ Hang up and contact your RO immediately to inform them of the situation.
Suppress exits the instrument. Close and goto returns to VERIFY_PHONUM.
Set OUTCOME code=803.

Block
Variable Name
Field Description

BInitial
WRONG_NUM
Dialed Wrong Number

Universe

VERIFY_PHONUM=2 or [VERIFY_PHONUM=2 and BoP_Flag=1]

Screen
I’m sorry, I must have dialed the wrong number. Thank you for your time.
♦Hang up.
Input Options
Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Enter 1 to continue.
1. Exit the instrument, go to notes and set OUTCOME=803.

Block
Variable Name
Field Description

BInitial
EVER_GQ_NAME
Has place ever been…

Universe

VERIFY_NUM=1 or INITSCREEN=3 and IDOFPLACE=2

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

GENERAL/MAIN PHONE #:

Fill in GQPHONE, GQEXT

CONTACT PERSON 1:
CONTACT TITLE:
CONTACT PHONE:

Fill in CP1NAME
Fill in CP1TITL
Fill in CP1PHON, CP1EXT

CONTACT PERSON 2:
CONTACT TITLE:
CONTACT PHONE:

Fill in CP2NAME
Fill in CP2TITL
Fill in CP2PHON, CP2EXT

Has this place ever operated under the name of [fill: GQNAME]?
Input Options
Fill Instructions
Skip Instructions

Skip Instructions
for BoP
Special
Instructions

BoP Special
Instruction

1. Yes
2. No
1. If Yes, go to UPDATEGQNAME
2. If No, see special instructions

1. If INITSCREEN=2 and if EVER_GQ_NAME=2, display soft error box that
reads: “Would you happen to know how I could reach [fill: GQNAME] or
where [fill: GQNAME] is or might be located?” Suppress exits the
instrument and goes to NOTES. Close and Goto go back to
EVER_GQ_NAME.
2. If INITSCREEN=2 and If EVER_GQ_NAME=2, set OUTCOME =802.
3. If INITSCREEN=3 and If EVER_GQ_NAME=1, go to
UPDATEGQNAME.

Block
Variable Name
Field Description
Universe

BInitial
UPDATEGQNAME
2.2 Update GQ Name
EVER_GQ_NAME=1

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

What is the name of this place?
Update GQ name (GQNAME - 100 characters)
Fields available to enter contact information (and variable name and length). Use
these titles for the form pane:
Instrument: Prefill all of these fields with the current value.
Valid Values: Alphanumeric (field length 100), Do not accept DK or R.
Input Options
Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Updated GQ name – 100 Characters maximum
1. If GQNAME=SPNAME, Go to GQ_HAS_SP.
2. If GQNAME does not equal SPNAME, Go to UPDATESPNAME.

Block
Variable Name
Field Description

BInitial
UPDATESPNAME
2.3 Update SP Name

Universe

[UPDATEGQNAME has a value and SPNAME ne GQNAME] or
[IDOFPLACE=1 and SPNAME ne GQNAME]

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

Is [fill: GQNAME] owned by or affiliated with [fill:SPECPLACE]?
Fields available to enter contact information (and variable name and length). Use
these titles for the form pane:

Input Options

1. Yes
2. No
Valid Values: 1,2, Do not accept DK or R.

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If 1, go to VERIFYADDR.
2. If 2, go to GQ_HAS_SP.

Instrument: Prefill all of these fields with the current value.

Block
Variable Name
Field Description

BInitial
GQ_HAS_SP
2.4 Is GQ associated with SP

Universe

([UPDATESPNAME = 2] or [UPDATEGQNAME =1 AND
GQNAME=SPNAME] or [IDOFPLACE = 1 and GQNAME = SPNAME]) and
[BOP_FLAG ne 1.]

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

Is [fill: GQNAME] owned by or affiliated with another organization or
company?

Input Options

1. Yes
2. No
Valid Values: 1,2,DK,R

Fill Instructions
Skip Instructions

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If 1, go to NEW_SP_NAME
2. If 2, DK, R go to VERIFYADDR

1. If UPDATESPNAME=2, replace the SP name fill for GQ_HAS_SP with the
GQNAME.

Block
Variable Name
Field Description

BInitial
NEW_SP_NAME
2.5 New Special Place name

Universe

[GQ_HAS_SP=1]

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

What is the name of that company or organization that [fill: GQ name] is
associated with?

Input Options

Field available to enter the SP name. Field length is 100 Characters maximum.
Valid Value: Alphanumeric characters – field length is 100 characters maximum.
Accept DK, R.

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. Go to VERIFYADDR.

Block
Variable Name
Field Description
Universe

BInitial
VERIFYADDR
2.6 Address on file correct?
[UPDATESPNAME=1] or [GQ_HAS_SP=2, DK or R] or [NEW_SPNAME ne
blank] and [BoP_Flag ne 1]

Screen

Special Place Name: [fill: SPNAME]
Group Quarters Name: [fill: GQNAME]

I have your address listed as [fill: GQADDLINE1
GQADDLINE2].
Is this correct?
Input Options

1. Yes
2. No
Valid Values: 1,2, Do not accept DK or R.

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If Yes, go to SRCHKNWLRESP.
2. If No, go to NHNO

1. If PRFLAG=1, only display PRADDR1, PRADDR2 and PHYSDES in
form pane.

Block
Variable Name

BInitial
NEWHNO, NEWHNOSUF, NEWSTRPRXD,NEWSTRPRXT,
NEWSTRNAME,NEWSTRSFXT, NEWSTRSFXD, NEWSTRNAMX,
NEWUNITDES, NEWRRDESC, NEWRRID, NEWBOXDESC, NEWBOXID,
NEWPO, NEWST, NEWZIP5, NEWZIP4, NEWPRADDR1, NEWPRADDR2,
NEWPHYSDES

Field Description

House number (HNO - 10 characters)
House number suffix (HNOSUF - 3 characters)
Street name prefix dir. (STRPRXD - 2 characters)
Street name prefix type (STRPRXT - 4 characters)
Street name (STRNAME - 28 characters)
Street name suffix type (STRSFXT - 4 characters)
Street name suffix dir. (STRSFXD - 2 characters)
Street name extension (STRNAMX - 3 characters)
Unit designation (UNITDES - 20 characters)
Rural route description (RRDESC - 4 characters)
Rural route ID (RRID - 4 characters)
Box or PO box (BOXDESC - 6 characters)
Box ID (BOXID - 10 characters)
City name (PO - 28 characters)
State (ST - 2 characters)
Zip5 (ZIP5 - 5 characters)
Zip4 (ZIP4 - 4 characters)
PR address line 1 (PRADDR1 - 60 characters)
PR address line 2 (PRADDR2 - 60 characters)
Physical description (PHYSDES - 99 characters
All variables are not must fill.
Instrument: Prefill all of these fields with the current value. Put physical
description in its own form pane.

Universe

[VERIFYADDR= 2]

Screen

OLD ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

What is the correct address for [Fill: GQNAME]?
 Update the [fill: full field name.] Press if the field is not applicable.

Input Options
Fill Instructions
Skip Instructions

Instrument: “Full field name” is “house number”, “house number suffix”, etc.
Alphanumeric fields – character length for each field is listed above in the field
description row.
1. Go to ADDRCHNG
Valid Values: Do not accept DK or R.

Skip Instructions
for BoP
Special
Instructions

BoP Special
Instruction

1. If NEWHNO ne blank and STRNAME is blank, display a soft error that
reads: “You have entered that the location address contains a street name.
A street name must be entered.” In the bottom-half of the box, questions.
2. RRID is a must fill if RRDESC has a value.
3. BOXID is a must fill if BOXDESC has a value.
4. City name and State are must fills.
5. Display address information from the SCIF in the corresponding address
fields in the form pane.
6. If PRFLAG=1, only display PRADDR1, PRADDR2, and PHYSDES in
form pane.

Block
Variable Name
Field Description

BInitial
ADDRCHNG
2.7B FR Instruction to document why it is an address change.

Universe

[INITSCREEN=2 and VERIFYADDR=2] or [INITSCREEN=3 and
VERIFYADDR=2]
See below under fill instructions. This screen is a FR instruction screen.

Screen
Input Options

1. Yes
2. No
Valid Values: 1,2, Do not accept DK or R
Fill Instructions
Question fill if INITSCREEN=2:
Does the address change represent a physical location that is different from
the sample GQ Address?
FR Instruction Fill if INITSCREEN=3
♦Does the address change represent a physical location that is different from the
sample GQ Address? If so, select Option 1 for Yes. If not, select Option 2 for No.
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

If ADDRCHNG=1 or 2, go to SRCHKNWLRESP.

Block
Variable Name
Field Description
Universe

BInitial
SRCHKNWLRESP
2.8 Search for Knowledgeable Resp
[VERIFY_ADDR=1] or [EVER_BEEN_ADDY=1 or 2] or [IDOFPLACE=1 and
BoP_Flag=1] or [ADDRCHNG=1 or 2]

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

GENERAL/MAIN PHONE #:

Fill in GQPHONE, GQEXT

CONTACT PERSON 1:
CONTACT TITLE:
CONTACT PHONE:
CONTACT EMAILADDRESS:

Fill in CP1NAME
Fill in CP1TITL
Fill in CP1PHON, CP1EXT
FILL in EMAILADDRESS

CONTACT PERSON 2:
CONTACT TITLE:
CONTACT PHONE:

Fill in CP2NAME
Fill in CP2TITL
Fill in CP2PHON, CP2EXT

I’d like to speak with someone who can give me the authority to conduct this
survey which means getting access to interview selected people staying at [fill:
GQNAME]. Would that person be you or should I speak to someone else?

Input Options

1. Yes, this is the correct person.
2. No, need to speak to someone else.
Valid Values: 1,2, DK, R
**Input Options for BoP:
1. Yes, they are available.
2. No, you’ll need to call back.
Valid Values for BoP only: 1,2 only

Fill Instructions

Skip Instructions

If BoP_Flag=1 Use the following fill:
“May I speak with [fill: CP1NAME]?
1. If 1 or 2, Go to NEWCP1NAME.
2. If DK or R, go to INTRO.

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If SRCHKNWLRESP=1 and BoP_Flag=1, Goto INTRO.
2. IF SRCHKNWLRESP=2 and BoP_Flag=1, Goto TCALLBACK.

Block
Variable Name
Field Description

BInitial
NEWCP1NAME, NEWCP1TITL, NEWCP1PHON, NEWCP1EXT,
EMAILADDRESS
Finding the Contact Person and capturing contact person information. The
following describes each field:
Instrument: Field is name, title, phone number, phone number extension, or email
address whichever is appropriate.
Fields available to enter contact information (and variable name and length). Use
these titles for the form pane:
·
Update Contact #1 Name (CP1NAME - 42 characters)
·
Update Contact #1 Title (CP1TITL - 20 characters)
·
Update Contact #1 Phone (CP1PHON - 10 characters)
·
Update Contact #1 Extension (CP1EXT - 5 characters)
· Update Contact #1 email address (EMAILADDRESS – 80 characters)
CP1TITL, CP1PHON, CP1EXT, and EMAILADDRESS are not must fill. If
CP1PHON is not filled, do not fill CP1EXT.

Universe

Instrument: Prefill all of these fields with the current value.
[SRCHKNWLRESP=1,2] and [BoP_Flag ne 1]

Screen

[fill #1 May I have your name, title, phone number, and email address?]
[fill #2 May I have the name of the person who can help me?]
 Enter Contact #1’s information. Press if a field is not applicable.
CONTACT PERSON 1:
CONTACT TITLE:
CONTACT PHONE:
EMAIL ADDRESS:

Input Options

Fill in CP1NAME
Fill in CP1TITL
Fill in CP1PHON, CP1EXT
FILL in EMAILADDRESS

See Field description above for length of alpha numeric input options. S/FR will
input any corrections or updates for contact person information.
Valid Values:
For CP1NAME - Don’t accept DK; allow alphanumeric and R
For CP1TITLE - alphanumeric DK, R
For CP1PHON - numeric, R
For CP1Ext - alphanumeric, blank, DK, R
For EMAILADDRESS – alphanumeric, DK, R, @, _

Fill Instructions

1. If SRCHKNWLRESP = 1, then display fill #1
2. If SRCHKNWLRESP = 2 or R, then display fill #2

Skip Instructions

Skip Instructions
for BoP
Special
Instructions

BoP Special
Instruction

1. If SRCHKNWLRESP=1, go to INTRO
2. If SRCHKNWLRESP=2, go to SPEAKNOW

1. CP1PHON – Display hard edit that reads: “You must enter all 10 digits of
the contact person’s phone number” if entry is less than 10 digits. Suppress
is offline. Close and Goto return to NEWCP1PHON.
2. CP1PHON – Display hard edit pop up box if 0 or 1 are the first digits of the
area code or prefix. For the area code the box should read: “The area code
cannot begin with a ‘0’ or a ‘1’.” Suppress is offline. Close and Goto
return to NEWCP1PHON. For the prefix, the box should read, “The phone
number cannot begin with a ‘0’ or ‘1’.” Suppress is offline. Close and
Goto return to NEWCP1PHON.

Block
Variable Name
Field Description
Universe

BInitial
SPEAKNOW
2.10 Speak to respondent
[SRCHKNWLRESP=2] and [BoP_Flag ne 1]

Screen

May I talk to [fill: CP1NAME] now?

Input Options

1. Yes
2. No
Valid Values: 1,2,R, Do not accept DK

Fill Instructions
Skip Instructions

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1.
2.
3.
4.
5.

If SPEAKNOW = 1 and INITSCREEN = 2, go to INTRO.
If SPEAKNOW = 1 and INITSCREEN = 3, go to INTRO.
If SPEAKNOW = 2 and INITSCREEN = 2, go to TCALLBACK.
Is SPEAKNOW = 2 and INITSCREEN = 3, go to TCALLBACK.
If SPEAKNOW = R and INITSCREEN = 2 or 3, go to TCALLBACK.

Block
Variable Name
Field Description
Universe

BInitial
INTRO
3.0 Introduction
[SRCHKNWLRESP = 1, DK or R] or [SPEAKNOW= 1 and INITSCREEN = 2 or 3]
or [INITSCREEN = 4 and PEAS_FL= 1] or [SRCHKNWLRESP = 1 and BoP
flag = 1]

Screen

CONTACT PERSON 1:
CONTACT TITLE 1:
CONTACT PHONE 1:

Fill in CP1NAME
Fill in CP1TITL
Fill in CP1PHON, CP1EXT

APPOINTMENT DATE/TIME:
APPOINTMENT1

Fill in Response TCALLBACK or

Question
Fill #1
{Hello. My name is _____________. I’m with the U. S. Census Bureau. We are
currently conducting an important survey in your community, the American /
Puerto Rico Community Survey. Did you receive the letter and brochure we
mailed to you recently?
 If no, ask if they would like you to FAX them a copy.
 Press Shift + F2 and use FAQ #1 to provide further info on the survey. Use other
FAQs to answer additional questions.
To conduct this survey, I need to schedule a day and time to meet with you. On
the day of our meeting, I will collect additional information from you about [fill:
GQNAME]. Then, I will ask you for a current list of all the people that are
living/staying there. On the day of this visit, I will also need access to the people
that are selected for the survey so I can conduct the interviews while I'm there.
Do you have any questions?}
Fill #2
We are currently conducting an important survey in your community, the
American / Puerto Rico Community Survey. Did you receive the letter and
brochure we mailed to you recently?
 If no, ask if they would like you to FAX them a copy.
 Press Shift + F2 and use FAQ #1 to provide further info on the survey. Use other
FAQs to answer additional questions.
To conduct this survey, I need to schedule a day and time to meet with you. On

the day of our meeting, I will collect additional information from you about [fill:
GQNAME]. Then, I will ask you for a current list of all the people that are
living/staying there. On the day of this visit, I will also need access to the people
that are selected for the survey so I can conduct the interviews while I'm there.
Do you have any questions?}
Fill #3 (If INTSCREEN = #4)
{Hello. My name is _____________. I’m with the U. S. Census Bureau. We are
currently conducting an important survey in your community, the American /
Puerto Rico Community Survey. Did you receive the letter and brochure we
mailed to you recently?
 If no, give them a copy of the letter and brochure.
 Show GQ contact the questionnaire.
 Press Shift + F2 and use FAQ #1 to provide further info on the survey. Use other
FAQs to answer additional questions.
I want to describe what I would like to do during the rest of my visit here today.
First, I will collect additional information from you about [fill: GQNAME].
Second, I will ask you for a list of all people staying here as of today. Then, I will
need access to the people I select for the survey. I will do all of these tasks today.
I would like to continue with the interview. Do you have any questions?}
Fill #4
Did you receive the letter and brochure we mailed to you recently?
 If no, give them a copy of the letter and brochure.
 Show GQ contact the questionnaire.
 Press Shift + F2 and use FAQ #1 to provide further info on the survey. Use other
FAQs to answer additional questions.
I want to describe what I would like to do during the rest of my visit here today.
First, I will collect additional information from you about [fill: GQNAME].
Second, I will ask you for a list of all people staying here as of today. Then, I will
need access to the people I select for the survey. I will do all of these tasks today.
Do you have any questions?}
Fill #5
{Hello. My name is _____________. I’m with the U. S. Census Bureau.
Thanks for agreeing to meet with me today.

I have a few more questions about [fill:GQNAME].}

Special BoP Fill #6
We are currently conducting an important survey in your community, the
American / Puerto Rico Community Survey.
To conduct this survey, we need to schedule a day and time to meet with you.
We need to schedule an appointment with your facility to swear you in and
provide you with all of the materials necessary for data collection at your
facility. Do you have any questions?
 Press Shift + F2 and use FAQ #1 to provide further info on the survey. Use
other FAQs to answer additional questions.
Input Options

1. Enter ‘1’ to Continue.
Valid Values:
1, DK, R

Fill Instructions

1. Display Fill #1 if INITSCREEN = 2 and PEAS_FL = 1 and SRCHKNWLRESP =
2 and SPEAKNOW =1
2. Display fill #2 if INITSCREEN = 2 and PEAS_FL = 1 and SRCHKNWLRESP =
1
3. Display fill #3 if INITSCREEN = 3 and PEAS_FL = 1 and SRCHKNWLRESP =
2 and SPEAKNOW = 1
4. Display fill #4 if INITSCREEN = 3 and PEAS_FL=1 and SRCHKNWLRESP = 1
5. Display fill #5 if INITSCREEN = 4, PEAS_FL= 1
6. Display fill #2 if INITSCREEN = 2 and PEAS_FL = 1 and SRCHKNWLRESP =
DK or R]
7. Display fill #4 if INITSCREEN = 3 and PEAS_FL = 1 and SRCHKNWLRESP =
DK or R
Special BoP Fill Instruction:
1. Display Fill #6 if INITSCREEN=2 and PEAS_FL=1 and SRCHKNWLRESP=1
and BoP_Flag = 1.

Skip Instructions

1. If INTRO = 1 and INITSCREEN = 2 and PEAS_FL = 1, go to
APPOINTMENT
2. If INTRO = 1 and INITSCREEN =3 and PEAS_FL = 1, go to CONDINTNOW
3. If INITSCREEN = 4 and PEAS_FL = 1, go to MAILADDYSAME
4. If DK or R, go to INTSTAT

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If INTRO = 1 and INITSCREEN = 2 and PEAS_FL = 1 and BoP flag = 1,
go to APPOINTMENT.

Block
Variable Name
Field Description
Universe

BInitial
CONDINTNOW
3.1 Conduct Interview Now?
INTRO=1 and INITSCREEN=3 and PEAS_FL=1

Screen

Question
 Are you going to conduct the interview now?
 Try to convince the contact person to continue and finish the interviews today.

Input Options

1. Yes
2. No
Valid Values: 1,2, Do not accept DK, R.

Fill Instructions
Skip Instructions

1.
2.
3.

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

[If CONDINTNOW = 1] and [HNO or STRNAME = blank] go to
MAILHNO
[If CONDINTNOW = 1] and [HNO and STRNAME ne blank] go to
MAILADDYSAME
If CONDINTNOW = 2, go to APPOINTMENT

Block
Variable Name
Field Description
Universe

Screen

Bcontact2
MAILADYSAME
3.2 Update mailing address
1. [INTRO=1] and [INITSCREEN=4 and PEAS_FL=1] and [PRFLAG=0]
2. [CONDINTNOW=1] and [PRFLAG=0]
3.
SPECIAL PLACE NAME:
Fill in SPECPLACE
GROUP QUARTERS NAME:
Fill in GQNAME
ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

PHYSICAL DESCRIPTION: Fill in PHYSDES
Is (read address above) also the mailing address for fill in GQNAME?
Instrument: Update GQADDRESS1 and GQADDRESS2 based on the responses to
Question 2.9.
Input Options

1. Yes
2. No
Valid Values: 1,2 Do not accept DK or R

Fill Instructions

1. In the form pane, display all components of the address including PRADDR1,
PRADDR2 and physical description.
2. Set MAILHNO = HNO. Do the same thing (set the “MAIL” version of the
variable equal to the “non-MAIL” version) for all of the fields in
MAILADDYSAME except physical description.
3. Display what ever address info is on the SCIF in the corresponding address
fields in the form pane

Skip Instructions

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If MAILADYSAME = 1, go to NEWBLDGNAME
2. If MAILADDYSAME = 2, go to MAILHNO

Block
Variable Name
Field Description
Universe

Bcontact2
MAILHNO to MAILZIP4
3.3 Mail House Number
[MAILADDYSAME=2] or [PRFLAG=1]

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

What is the mailing address for fill in GQNAME?
 Mail full field name. Press if the field is not applicable.
Instrument: “Full field name” is “house number”, “house number suffix”, etc.

Input Options

Fields available to enter address information (and variable name and length):
Same as in Question 2.10, except that building name and physical description are
not included.
Valid Values: Do not accept DK or R

Fill Instructions

1. If MAILHNO ne blank and MAILSTRNAME is blank, display a soft error that
reads “You have entered that the location address contains a street name. A street
name must be entered.” In the bottom-half of the box, questions.
2. MAILRRID is a must fill if RRDESC has a value
3. MAILBOX ID is a must fill if MAILBOXDESC has a value.
4. City name and state are must fills.
5. Display what ever address info is on the SCIF in the corresponding address fields
in the form pane
6. If mail address is updated in CM, then it should be passed and displayed in
GQFQ. The mailing address should never be overwritten with phys add inside the
instrument. I will put out that mail add might = phys add but any time mail add is
updated whether CM or instrument it should never be over written with phys add.
7. If PRFLAG=1, only display PRADDR1, PRADDR2 and PHYSDES in form
pane

Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. Go to NEWBLDGNAME

Block
Variable Name
Field Description

Bcontact2
NEWBLDGNAME
GQ building name

Universe

Documentation Note: Any GQ TYPE should have the ability to update the GQ
NAME (MAD)

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

Is there a unique name or building identification for this building?
 The GQ building name is the actual name on the GQ structure or on a sign
easily seen in front of the GQ structure. Examples are: Building 202 or Building
A-1.
Input Options

1. Yes
2. No
Valid Values: 1, 2, DK, R

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If 1, go to UPDATEBLDGNAME
2. If 2, DK, or R go to UPDATECONTACT2INFO

Block
Variable Name
Field Description

Bcontact2
UPDATEBLDGNAME
Update GQ building Name

Universe

NEWBLDGNAME=1

Screen

NEWBLDGNAME = 1
Question
SPECIAL PLACE NAME:
GROUP QUARTERS NAME:
ADDRESS:

BUILDING NAME:

Fill in SPECPLACE
Fill in GQNAME
Fill in GQADDLINE1
Fill in GQADDLINE2

Fill in BLDGNAME

 Enter the building name.

Fields available to enter address information (and variable name and length):
·
Update GQ building name (BLDGNAME - 60 characters)

Input Options
Fill Instructions

Valid Values: alphanumeric, DK, R (go to NEWBLDGID)
Fields available to enter address information (and variable name and length):
·
Update GQ building name (BLDGNAME - 60 characters)

Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Go to NEWBLDGID

Block
Variable Name
Field Description

Bcontact2
NEWBLDGID
Update GQ building ID

Universe

NEWBLDGNAME=1

Screen

NEWBLDGNAME = 1
Question
SPECIAL PLACE NAME:
GROUP QUARTERS NAME:
ADDRESS:

BUILDING NAME:
BUILDING ID:

Fill in SPECPLACE
Fill in GQNAME
Fill in GQADDLINE1
Fill in GQADDLINE2

Fill in BLDGNAME
Fill in BLDGID

 Enter the building ID.

Fields available to enter address information (and variable name and length):
·

Input Options
Fill Instructions

Valid Values: alphanumeric, DK, R (go to UPDATECONT2INFO)
Fields available to enter address information (and variable name and length):
·

Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Update GQ building ID (BLDGID - 12 characters)

Update GQ building ID (BLDGID - 12 characters)

Go to UPDATECONTACT2INFO

Block
Variable Name
Field Description

Bcontact2
UPDATECONT2INFO
Update Contact #2 Info

Universe

[NEWBLDGNAME=2, DK or R] or [BLDGNAME ne empty]

Screen

CONTACT PERSON 2:
CONTACT TITLE2:
CONTACT PHONE2:

Fill in CP2NAME
Fill in CP2TITL
Fill in CP2PHON, CP2EXT

Is there another person who might be able to help us if needed?
 Update the Second GQ contact name.

Input Options

1. Yes
2. No
Valid Values: 1,2

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If 1, go to NEWCP2NAME
2. If 2, go to NEWGENPHON

Block
Variable Name
Field Description

Bcontact2
NEWCP2NAME, NEWCP2TITL, NEWCP2PHON, NEWCP2EXT
Contact #2 Name, Contact #2 Title, Contact #2 Phone, Contact #2 Extension

Universe

UPDATECONT2INFO=1

Screen

CONTACT PERSON 2:

Fill in CP2NAME

CONTACT TITLE2:

Fill in CP2TITL

CONTACT PHONE2:

·

Fill in CP2PHON, CP1EXT

For CP2NAME display “Enter Contact #2 Name (CP1NAME - 42
characters)”

·

For CP2TITLT display “Enter Contact #2 Title (CP1TITL - 20
characters)”

·

For CP2PHON display “Enter Contact #2 Phone (CP1PHON - 10
characters)”

·

For CP2EXT display “Enter Contact #2 Extension (CP1EXT - 5
characters)”

Instrument: Field is name, title, phone number, or phone number extension,
whichever is appropriate.
Fields available to enter contact information (and variable name and length).
Use these tiles for the form pane:
All variables are not must fill. If CP2PHON is not filled, do not fill CP2EXT.

Instrument: Prefill all of these fields with the current value.

Input Options

See Screen Section
Valid Values:
For CP2NAME - Don’t accept DK; allow alphanumeric and R
For CP2TITLE - alphanumeric DK, R
For CP2PHON - numeric, R
For CP2Ext - alphanumeric, blank, DK, R

Fill Instructions

See Screen Section

Skip Instructions
Skip Instructions
for BoP
Special
Instructions

Go to NEWGENPHON

1. CP2PHON - Display hard edit that reads “You must enter all 10 digits of the
contact person’s phone number” if entry is less than 10 digits.
2. CP2PHON - Display hard edit pop up box if 0 or 1 are the first digits of the area
code or prefix. For the area code the box should read “The area code cannot begin
with a ‘0' or ‘1'.” Suppress is off line. Close and Goto return to NEWCP2PHON.
For the prefix, the box should read, “The phone number cannot begin with a ‘0' or
‘1'.” Suppress is off line. Close and Goto return to NEWCP2PHON.

BoP Special
Instruction

Block
Variable Name
Field Description

Bcontact2
NEWGENPHON and NEWGENEXT
3.7 General Phone Number, General Phone Extension

Universe

[CP2EXT ne blank or entered through] or [UPDATECONT2INFO=2]

Screen

What is the general or main phone number for fill in GQNAME?
GENERAL/MAIN PHONE #:

Fill in GQPHONE, GQEXT

 Update the main or general phone number of the group quarters/special place.
Field available to enter general contact information (and variable name and length).
Use these tiles for the form pane:
·
General phone number (GQPHONE - 10 characters)
·
General phone extension (GQEXT - 5 characters)
R is allowed for GQPHONE. If GQPHONE is not filled or R, do not fill GQEXT.
Instrument: Prefill all of these fields with the current value.
Input Options

See screen section
Valid Values: numeric only, R, Blank

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions

1. If entry, blank or R, go to STAY_NOW

1. GQPHON - Display hard edit that reads “You must enter all 10 digits of the
contact person’s phone number” if entry is less than 10 digits.
2. GQPHON- Display hard edit pop up box if 0 or 1 are the first digits of the area
code or prefix.

BoP Special
Instruction

Block
Variable Name
Field Description

Bcontact2
STAY_NOW
3.8 Stay Now

Universe

CP2EXT ne blank or entered through

Screen

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECNAME
Fill in GQNAME

Are people currently living or staying at fill in GQNAME ?

Input Options

1. Yes
2. No
Valid Values: 1,2, R. Do not accept blank.

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If STAY_NOW = 1,2 or R, go to GQMAIN1.

1. If 2, then set OUTCOME = 843.

Block
Variable Name
Field Description

BInitial
APPOINTMENT1
4.0 Appointment Date

Universe

[If INITSCREEN = 2 and PEAS_FL = 1 and INTRO = 1 or CONDINTNOW =2]
[If INITSCREEN = 2 and PEAS_FL = 1 and BoP Flag = 1 and INTRO = 1]

Screen

I want to schedule a date and time in the next few days to complete our
interview and the interviews with the people I select for the survey. What date
and time would be the best to visit?

Special BoP Question text
We would like to schedule this visit to happen as soon as possible. What date and
time would be the best for someone to visit you?
 Ask for directions if necessary. Press Ctrl + F7 keys simultaneously and record
details in Notes.

Input Options

Appointment Date/Time: _________________________

Fill Instructions

[Fillin the blank. Allow 20 characters]

Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If INITSCREEN = 2 and PEAS_FL = 1, go to SECPROCS
2. If INITSCREEN = 3 and PEAS_FL = 1, go to SECPROCS

1. Set OUTCOME = 806
1. If INITSCREEN = 2, and PEAS_FL = 1 and BoP flag = 1 go to SECPROCS.

Block
Variable Name
Field Description

BInitial
SECPROCS
4.1 Security Procedures?

Universe

APPOINTMENT ne blank

Screen

I will have a picture ID with me on the day of my visit. Are there any specific
procedures I need to know of prior to my visit for entering this place or
interviewing the residents.
 If yes, press Ctrl + F7 keys simultaneously and record details in Notes.

Input Options

1. Yes
2. No
Valid Values: 1,2

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. Go to THANKYOU

1. Pass out to CM
2. Set SECPROCS = SECURREQ

Block
Variable Name

?
EXITING CASE

Field Description

4.2 When exiting the case, the system will do the following: [Set
SampleGQType=GQTYPE] and [Set SECURREQ = SECPROCS]

Universe
Screen
Input Options
Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Block
Variable Name

?
SUBROUTINES

Field Description

4.3 EXIT [FR gets here by hitting F10 to exit the instrument]

Universe

Selection of F10 in the instrument or [INTRO = DK or R] or [CREATE ALLBEDS
= 2, r] or [BoP_Flag=1]

Screen
Input Options
Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Block
Variable Name
Field Description

BF10_Exit BExit
INTSTAT
4.4 Interview Status

Universe
Screen

F10, Intro=DK,R or (Create_ALL_Beds=2,R) or (BOP_Flag = 1)
 Is the respondent able to complete the interview?
♦If this is a Federal Prison or a Federal Detention Center select option 3 for Other
Noninterview. (This option does not apply to privately operated correctional
facilities that house mostly federal prisoners.)
♦If you are at a privately operated correctional facility that contains federal, state,
or local prisoners, do not exit the interview. Continue with the GQFQ interview,
sampling and interviewing the persons selected for sample. Select the F8 to return
to the interview. Instructions are directly below on how these GQs will be
classified.
♦If you are at a privately operated correctional facility that contains mostly federal
prisoners, you will continue with the interview. This GQ will be coded out as a
102, Federal Prison.
♦If you are at a privately operated correctional facility that contains mostly state
prisoners, you will continue with the interview. This GQ will be coded out as a
103, State Prison.
♦If you are at a privately operated correctional facility that contains mostly local
prisoners, you will continue with the interview. This GQ will be coded out as a
104, Local Jail. (Local jails include tribal as well.)

Input Options

Fill Instructions

Skip Instructions

Skip Instructions
for BoP
Special
Instructions

1. Inconvenient Time. Try again later.
2. Refusal.
3. Other noninterview
For BoP: Special BoP Fill [do not include the above instructions in the BoP
instrument.]
Use this instead:
 Is the respondent able to complete the interview?
1. If 1, go to PCALLBACK
2. If 2, go to REFREASON
3. If 3, go to REASONINT

1. If 1, OUTCOME = 802

BoP Special
Instruction

Block
Variable Name

BF10_Exit BExit
PCALLBACK

Field Description

4.5 Best callback day/time

Universe

INSTAT=1

Screen

What day and time would be best to contact you again?

Input Options

Date/Time:
[Fill in the blank. Allow 25 characters]

Fill Instructions

Allow 25 alpha/numeric characters]

Skip Instructions

1. Go to THANKYOU

Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. Store in CALLBACK variable and pass out to CM
2. Variable length = 25 characters

Block
Variable Name

BF10_Exit BExit
REFREASON

Field Description

4.7 Refusal Reason

Universe

INSTAT=2

Screen

Question
 Mark all that apply.

Input Options

Answer Categories
1.
Respondent busy.
2.
Interview too long
3.
Survey is a waste of taxpayers money
4.
Respondent questions legitimacy of survey
5.
Confidentiality reasons
6.
Respondent says that he/she cannot comply because of legal restrictions
7.
Other – Specify in Notes

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

1. If 1-5 OR 7, go to THANKYOU
2. If 6, go to REASON811

1. If 6, set OUTCOME=808, STOREOUT = 811, GeocodeReqd = 1
2. If 1-5 OR 7, set OUTCOME = 808, STOREOUT = 818, GeocodeReqd = 1

Block
Variable Name

BF10_Exit BExit
REASON811

Field Description

4.8 Reason for 811 Outcome

Universe

REFREASON=6

Screen

Question
 What is the legal restriction cited by the respondent? Get the name of the law, if
possible, and whether it is a federal or state law.

Input Options

Fill in the blank – 60 characters.

Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Go to THANKYOU.

Block
Variable Name

BExit
TCALLBACK

Field Description

4.9 Best time to callback

Universe

1. SPEAKNOW = 2, or R AND INITSCREEN = 2, 3 or [SRCHKNWLRESP = 2
and BoP_flag = 1]

Screen

When is a good time for me to call back?
Callback date/time: ____________________

Input Options

Callback date/time: [Fillin the blank. Allow 25 characters]
Valid Values: Do not allow DK or R

Fill Instructions

Allow for 25 characters to be entered

Skip Instructions
Skip Instructions
for BoP
Special
Instructions

1. Go to THANKYOU

BoP Special
Instruction

1. Set OUTCOME=805
2. Store this in CALLBACK variable
3. Pass out to CM

Block
Variable Name

BF10_Exit BExit
REASONINT

Field Description

4.10 Reason for Noninterview

Universe

INSTAT=3

Screen

Question
 Indicate the reason for the noninterview.
Answer Categories
1.
Unable to locate
2.
Other Type A - Specify in Notes.
3.
GQ no longer exists
4.
GQ is actually a housing unit (in addition to standard housing units, this
includes assisted / independent living units, RV parks, campgrounds,
marinas, or racetracks)
5.
GQ is a domestic violence shelter or sensitive place
6.
Other Type C - Specify in Notes.
7.
Natural disaster - Type B
8.
Type C - no residents during survey period
9.
Federal Prison
10.
Federal Detention Center

Input Options

Answer Categories
1.
Unable to locate
2.
Other Type A - Specify in Notes.
3.
GQ no longer exists
4.
GQ is actually a housing unit (in addition to standard housing units, this
includes assisted / independent living units, RV parks, campgrounds,
marinas, or racetracks)
5.
GQ is a domestic violence shelter or sensitive place
6.
Other Type C - Specify in Notes.
7.
Natural disaster - Type B
8.
Type C - no residents during survey period
9.
Federal Prison
10.
Federal Detention Center
Valid Values: Must fill. DK, R not acceptable.

Fill Instructions
Skip Instructions

1.
2.
3.
4.

If REASONINT = 1,3, 4, 5, 7, 8, 9, 10 go to NOTES
If REASONINT = 2, go to REASON819
If REASONINT = 6, go to REASON844.
If REASONINT = 9, display soft error that says the following:

♦This facility is out of scope at this time. You have reached a Federal Prison
outside of the data collection period for Federal Prisons. You will be exited out
of the interview and your case will be closed. Please read the script below to
the contact person.
“I’m sorry, we have contacted you at a time outside of the data collection
period for Federal Prisons. This ends the interview. Those Federal
correctional facilities, selected for sample for the ACS, will be visited
beginning in September, in which your facility may be one of those. You
will be notified prior to our return. Thank you for your time.”
Suppress exits the instrument. Close and Go to returns to REASONINT.
Set GQTYPE CODE = 102
5. If REASONINT = 10, display soft error that says the following:
♦This facility is out of scope at this time. You have reached a Federal
Detention Center outside of the data collection period for Federal Detention
Centers. You will be exited out of the interview and your case will be closed.
Please read the script below to the contact person.
“I’m sorry, we have contacted you at a time outside of the data collection
period for Federal Detention Centers. This ends the interview. Those
Federal correctional facilities, selected for sample for the ACS, will be
visited beginning in September, in which your facility may be one of those.
You will be notified prior to our return. Thank you for your time.”
*****Suppress exits the instrument. Close and Go to exit the instrument.
SET GQTYPE = 101
Skip Instructions
for BoP
Special
Instructions

1.
2.
3.
4.
5.
6.
7.
8.
9.

If REASONINT = 1, set OUTCOME = 814
If REASONINT = 2, set OUTCOME = 808, STOREOUT = 819,
GeocodeReqd = 1
If REASONINT = 3, set OUTCOME = 840
If REASONINT = 4, set GQTYPE / GQTYPE1 = 999, set OUTCOME =
841
If REASONINT = 5, set GQTYPE / GQTYPE1 = 703, set OUTCOME =
842
If GQTYPECODE1 =999, clear out GQTypeDesc1.
If GQTYPECODE2 = 999, clear out GQTypeDesc2.
If GQTYPECODE3 = 999, clear out GQTypeDesc3
If REASONINT = 6, set OUTCOME = 844

10.
11.

If REASONINT = 7 set OUTCOME = 833
If REASONINT = 8 set OUTCOME = 843
12. If REASONINT = 9 set GQTYPE/GQTYPE1 = 102, OUTCOME = 844
IF REASONINT = 10, set GQTYPE/GQTYPE1 = 101, set OUTCOME = 844
BoP Special
Instruction

Block
Variable Name

BF10_Exit BExit
REASON819

Field Description

4.6 Reason for 819 Outcome

Universe

REASONINT=2

Screen

Question
 Specify the reason for this Other Type A outcome.

Input Options
Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Fill in the blank – allow for 60 characters.
Go to THANKYOU.

Block
Variable Name

BF10_Exit BExit
REASON844

Field Description

4.11 Reason for 844 Outcome

Universe

REASONINT=6

Screen

Question
 Specify the reason for this Other Type C outcome.

Input Options
Fill Instructions
Skip Instructions
Skip Instructions
for BoP
Special
Instructions
BoP Special
Instruction

Fill in the blank – allow for 60 characters.
Go to Notes.

Block
Variable Name

BF10_Exit BExit
THANKYOU

Field Description

4.12 Thank you

Universe

[PCALLBACK ne blank] or [TCALLBACK ne blank] or
[SECPROCS = 1 or 2] or [INSTAT = 2] or [REASONINT = 2]
Thank you for helping the Census Bureau with the [fill in
American/Puerto Rico] Community Survey

Screen

Input Options

♦Enter 1 to continue
Do not accept DK, R or empty

Fill Instructions

1. If PRFLAG=1, display “Puerto Rico”, else display “American”

Skip Instructions

Go to Notes

Special
Instructions

1. If PCALLBACK ne blank, set outcome code = 805
2. If TCALLBACK ne blank, set outcome code = 805
3. If APPOINTMENT ne blank, set outcome code = 806
4. If STOREOUT = <801, 811, 818 or 819>, go to GCDREMIND

Block
Variable Name

BGQtype1
GQMAIN1

Field Description

5.0 First GQ Category

Universe

STAY_NOW ne blank

Screen

Special Place Name:
fill in SPECNAME
Group Quarters Name: fill in GQNAME
This is a list of places where people live, could live, or stay and/or
receive services. Using this list, please select ONLY ONE
category that BEST describes [fill in GQNAME]
♦Give the contact person time to read all the categories on the
flashcard and provide you with a selection. If they choose more than
one category, ask for the one that has the most residents and note that
we’ll ask about the other categories later.

Input Options

Answer Categories
1. Educational Facility
2. Correctional Facility
3. Group Home
4. Health Care or Treatment Facility
5. Military
6. Other Group Living Facilities
7. None of the Above”
Valid Values
1 through 7
Do not accept DK, R

Fill Instructions
Skip Instructions

1. If 1, go to EDU_DD
2. If 2, go to CORRECTIONAL_DD
3. If 3, go to GROUPHOME_DD
4. If 4, go to HEALTH_DD
5. If 5, go to MILITARY_DD
6. If 6, go to OGLF_DD
7. If 7, go to OUTOFSCOPE

Block
Variable Name

BGQtype1
EDU_DD

Field Description

6.0 Education drill-down

Universe

GQMAIN = 1

Screen

♦Select category based on GQ contact’s response.

Input Options

1. College/University, Student Housing
2. Residential School for People with Disabilities

Fill Instructions
Skip Instructions

Special
Instructions

1. If EDU_DD = 1, go to COLLEGE
2. If EDU_DD = 2, go to MAXCAP1
1. If EDU_DD = 2, then set GQTYPECODE1 = 405.

Block
Variable Name

BGQtype1
College

Field Description

6.1 College/University Student Housing

Universe

EDU_DD = 1 and GQMAIN1 = 1

Screen

“Is [fill: GQNAME] used primarily to provide housing for
college students?”
1. Yes
2. No

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. If College=1, go to MAXCAP1
2. If College = 2, go to OUTOFSCOPE_TY
1. If 1, GQTYPECODE1 = 501
2. If 2, GQTYPECODE1 = 999
3. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear out GQTypeDesc3.

Block
Variable Name

BGQtype1
CORRECTIONAL_DD

Field Description

7.0 Correctional drill-down

Universe

GQMAIN1 = 2

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Correctional Residential Facility
2. Juvenile Correctional Facility

Fill Instructions
Skip Instructions

Special
Instructions

1. If CORRECTIONAL_DD = 1, go to CF_DESC.
2. If CORRECTIONAL_DD = 2, go to MAXCAP1.
If CORRECTIONAL_DD = 2, then set GQTYPECODE1 = 203

Block
Variable Name

BGQtype1
CF_DESC

Field Description

7.1 Correctional Facility Type

Universe

CORRECTIONAL_DD = 1 and GQMAIN1 = 2

Screen

Which of the following categories describes [fill in GQNAME]?
♦ If more than one flashcard category applies, mark the one with the
most prisoners.
♦ If this is a Federal Prison or a Federal Detention Center, select
either Option 5 or Option 6 respectively to exit out of the interview.
♦ If you are at a privately operated facility that contains federal, state
or local prisoners, do not exit the interview. Continue with the
GQFQ interview, sampling and interviewing the persons selected for
sample. Instructions are directly below on how to code privately
operated facilities out.
♦ If you are at a privately operated correctional facility that contains
mostly state prisoners, you will select Option 1 and continue with the
interview. This case will have the GQ Type code of 103, State
Prison.
♦ If you are at a privately operated correctional facility that contains
mostly local/county prisoners, you will select Option 2 and continue
with the interview. This case will have the GQ Type code of 104,
Local Jail. (Local jails include tribal as well)
♦ If you are at a privately operated correctional facility that contains
mostly federal prisoners, you will select Option 4 and continue with
the interview. This case will have the GQ Type code of 102.

Input Options

Fill Instructions

1. State Prison/Privately Operated Facility housing mainly state
prisoners
2. Local or County Jail/Privately Operated Facility housing mainly
local or county prisoners.
3. Adult Residential Correctional Facility
4. Privately Operated Facility housing mainly federal prisoners.
5. Federal Prison
6. Federal Detention Center

Skip Instructions

1. If CF_DESC = 1 through 4 go to MAXCAP1
2. If CF_DESC = 5, display soft error that says:
This facility is out of scope at this time. You have reached a
Federal Prison outside of the data collection period for Federal
Prisons. You will be exited out of the interview and your case
will be closed. Please read the script below to the contact person.
“I’m sorry, we have contacted you at a time outside of the data
collection period for Federal Prisons. This ends the interview.
Those Federal correctional facilities, selected for sample for the
ACS, will be visited beginning in September, in which your
facility may be one of those. You will be notified prior to our
return. Thank you for your time,”
Suppress exits the instrument. Close and GO returns to CF_DESC.
Set GQTYPE = 102
3. If CF_DESC = 6 display soft error that says:
This facility is out of scope at this time. You have reached a
Federal Detention Center outside of the data collection period
for Federal Detention Centers. You will be exited out of the
interview and your case will be closed. Please read the script
below to the contact person.
“I’m sorry, we have contacted you at a time outside of the data
collection period for Federal Detention Centers. This ends the
interview. Those Federal correctional facilities, selected for
sample for the ACS, will be visited beginning in September, in
which your facility may be one of those. You will be notified
prior to our return. Thank you for your time,”
Suppress exits the instrument. Close and GO returns to CF_DESC.
Set GQTYPE = 101

Special
Instructions

1. If CF_DESC = 1, then GQTYPECODE1 = 103.
2. If CF_DESC = 2, then GQTYPECODE1 = 104.
3. If CF_DESC = 3, then GQTYPECODE1 = 105.
4. If CF_DESC = 4, then GQTYPECODE1 = 102
5. If CF_DESC=5, then GQTYPECODE1=102, Set OUTCOME
code to 844.
6. If CF_DESC=6, then GQTYPECODE1=101, Set OUTCOME
code to 844.

Block
Variable Name

BGQtype1
GROUPHOME_DD

Field Description

8.0 Group Home drill-down

Universe

GQMAIN1 = 3

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Group Home
2. Juvenile Group Home

Fill Instructions
Skip Instructions

Special
Instructions

1. If GROUPHOME_DD = 1 go to MAXCAP1.
2. If GROUPHOME_DD = 2, go to MAXCAP1.
1. If GROUPHOME_DD = 1, then GQTYPE1 = 801.
2. If GROUPHOME_DD = 2, then GQTYPE1 = 201.

Block
Variable Name

BGQtype1
HEALTH_DD

Field Description

9.0 Health Facility drill-down

Universe

GQMAIN1 = 4

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Residential Treatment Center (non-correctional)
2. Assisted Living, Independent Living or Continuing Care Facility
3. Nursing or Skilled Nursing Facility
4. In-Patient Hospice Facility
5. Hospital
6. Juvenile Residential Treatment Center (non-correctional)

Fill Instructions
Skip Instructions

Special
Instructions

1. If 1,3, 4 or 6 go to MAXCAP1.
2. If 2, go to ALF
3. If 5, go to HOSP_DESC
1. If HEALTH_DD = 1, then set GQTYPECODE1 = 802.
2. If HEALTH_DD = 3, then set GQTYPECODE1=301.
3. If HEALTH_DD = 4, then set GQTYPECODE1 = 403.
4. If HEALTH_DD = 6, then set GQTYPECODE1 = 202.

Block
Variable Name

BGQtype1
ALF

Field Description

9.1 Assisted/Ind. Living

Universe

HEALTH_DD = 2 and GQMAIN1 = 4

Screen

Does [GQNAME] have a skilled nursing unit or a nursing unit?

Input Options

1. Yes
2. No

Fill Instructions
Skip Instructions

Special
Instructions

1. If ALF = 1, go to MAXCAP1
2. If ALF = 2, got to OUTOFSCOPE_TY
1. If ALF = 1, then GQTYPECODE1 = 301
2. If ALF = 2, then GQTYPECODE1 = 999,
set outcome code to 841
3. If GQTYPECODE1 = 999, clear GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear GQTypeDesc3.

Block
Variable Name

BGQtype1
HOSP_DESC

Field Description

9.3 Facility Provides Treatment

Universe

HEALTH_DD = 5 and GQMAIN1 = 4

Screen

Does [GQNAME] provide treatment or care that includes:
♦If more than one Information Card category applies, enter the one
with the most patients.

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. Mental / Psychiatric Hospital or Unit
2. Skilled Nursing Unit
3. Patients Who Have No Usual Home Elsewhere.
4. None Of The Above Apply To This Hospital

1. If HOSP_DESC = 3, go to UHE_COUNT
2. If HOSP_DESC = 1 or 2, go to MAXCAP1.
3. If HOSP_DESC = 4, go to OUTOFSCOPE_TY.
1. If HOSP_DESC = 1, GQTYPECODE1 = 401
2. If HOSP_DESC = 2, GQTYPECODE1 = 301
3. If HOSP_DESC = 3, GQTYPECODE1 = 402
4. If HOSP_DESC = 4, GQTYPECODE1 = 999.
Set OUTCOME CODE = 843.
5. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
6. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
7. If GQTYPECODE3 = 999, clear out GQTypeDesc3

Block
Variable Name

BGQtype1
UHE_COUNT

Field Description

9.4.1 UHE Capacity

Universe

[If HOSP_DESC = 3 and GQMAIN1 = 4] or [HOTEL_UHE = 1 and
GQMAIN1 = 6]

Screen

Fill #1 [What is the maximum number of people who have no
usual home elsewhere who live or stay here?]
Fill #2 [What is the maximum number of people experiencing
homelessness who can live or stay in this building?]

Input Options

Fill in the blank. Numeric answers accepted. D, R are acceptable.

Fill Instructions

1. If HOSP_DESC = 3, then display fill #1.
2. If HOTEL_UHE = 1, then display fill #2.

Skip Instructions

Go to SECGQ.

Special
Instructions

Block
Variable Name

BGQtype1
MILITARY_DD

Field Description

10.0 Military Facility drill-down

Universe

GQMAIN1 = 5

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Barracks or Academy Residence Hall
2. Disciplinary Barracks or Jail
3. Ship
4. Military Treatment Facility with Assigned Patients

Fill Instructions
Skip Instructions
Special
Instructions

MILITARY_DD – 1 through 4, go to MAXCAP1.
1. MILITARY_DD = 1, then set GQTYPECODE1 = 601.
2. MILITARY_DD = 2, then set GQTYPECODE1 = 106.
3. MILITARY_DD = 3, then set GQTYPECODE1 = 602
4. MILITARY_DD=4, then set GQTYPECODE1=404

Block
Variable Name

BGQtype1
OGLF_DD

Field Description

Other Facility Drill-down

Universe

GQMAIN1 = 6

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Commune, Recreational Vehicle Park, Campground,
Marina, Racetrack.
2. Religious Facility
3. Hotel, Motel, Inn, Resort, Lodge, or Bed and Breakfast.
4. Job Corps or Vocational Training Facility
5. Shelter
6. Worker’s Group Living Facility

Fill Instructions
Skip Instructions

Special
Instructions

1. If OGLF_DD = 1, go to OUTOFSCOPE_TY.
2. If OGLF_DD = 2,4,6, go to MAXCAP1.
3. If OGLF_DD = 3, go to HOTEL_UHE.
4. If OGLF_DD=5, go to DVS_DD.
1. If OGLF_DD = 1, then set GQTYPECODE1 = 999.
2. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
3. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
4. If GQTYPECODE3 = 999, clear out GQTypeDesc3.
5. If OGLF_DD = 2, then set GQTYPECODE1 = 902.
6. If OGLF_DD = 4 or 6, then set GQTYPECODE1 = 901.

Block
Variable Name

BGQtype1
DVS_DD

Field Description

Domestic Violence Shelter Screener Question

Universe
Screen

OGLF_DD=5
Interviewer instruction in blue –
♦ Domestic Violence Shelters are always out of scope for the
American Community Survey.
Scripted question:

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

Is this facility a Domestic Violence Shelter?
1. Yes
2. No

1. If DVS_DD = 1, go to OUTOFSCOPE_TY.
2. If DVS_DD= 2 go to MAXCAP1.
1. If DVS_DD=1, then set GQTYPECODE1=703.
2. If DVS_DD = 2, then set GQTYPECODE1 = 701.
-3. If DVS_DD=1, then set OUTCOME=842.

Block
Variable Name

BGQtype1
HOTEL_UHE

Field Description

11.1 Shelter for homeless?

Universe

OGLF_DD = 3 and GQMAIN1 = 6

Screen

Does [fill GQNAME] or part of [fill GQNAME] provide shelter
for people experiencing homelessness?

Input Options

1. Yes
2. No

Fill Instructions
Skip Instructions

Special
Instructions

1. If HOTEL_UHE = 1, go to UHE_COUNT.
2. If HOTEL_UHE = 2, go to OUTOFSCOPE_TY.
1. If HOTEL_UHE = 1, set GQTYPECODE1 = 701.
2. If HOTEL_UHE = 2, set GQTYPECODE1 = 999,
set OUTCOME = 843.
3. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear out GQTypeDesc3.

Block
Variable Name

BGQtype1
OUTOFSCOPE_DD

Field Description

Out of Scope Drill-down

Universe

GQMAIN1 = 7

Screen

Is [fill GQNAME] a..?

Input Options

1. Soup Kitchen
2. Regularly Scheduled Mobile Food Van
3. Targeted Non-Sheltered Outdoor Location
4. Natural Disaster Shelter
5. Maritime/Merchant Vessel
6. None of these

Fill Instructions
Skip Instructions

Special
Instructions

1. If OUTOFSCOPE = 1 through 5, go to OUTOFSCOPE_TY.
2. If OUTOFSCOPE = 6, go to HU.
1. If OUTOFSCOPE = 1, GQTYPECODE1 = 702.
2. If OUTOFSCOPE = 2, GQTYPECODE1 = 704.
3. If OUTOFSCOPE = 3, GQTYPECODE1 = 706.
4. If OUTOFSCOPE = 4, GQTYPECODE1 = 903.
5. If OUTOFSCOPE = 5, GQTYPECODE1 = 900.
6. If GQTYPECODE1=702, GQTypeDesc1= Soup Kitchen
7. If GQTYPECODE1=704, GQTypeDesc1= Regularly Scheduled
Mobile Food Van
8. If GQTYPECODE1=706, GQTypeDesc1= Targeted NonSheltered Outdoor Location
9. If GQTYPECODE1=903, GQTypeDesc1= Natural Disaster
Shelter
10. If GQTYPECODE1=900, GQTypeDesc1= Maritime/Merchant
Vessel
11. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
12. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
13. If GQTYPECODE3 = 999, clear out GQTypeDesc3.
14. Create a variable called GQCENSUS.
15. If OUTOFSCOPE = 1, GQCENSUS = 702.
16. If OUTOFSCOPE = 2, GQCENSUS = 704.
17. If OUTOFSCOPE = 3, GQCENSUS = 706.
18. If OUTOFSCOPE = 4, GQCENSUS = 903
19. If OUTOFSCOPE = 5, GQCENSUS = 900.
20. If OUTOFSCOPE = 1 though 6, OUTCOME = 844.

Block
Variable Name

BGQtype1
HU

Field Description

11.3 Housing Unit

Universe

If OUTOFSCOPE – 6 and GQMAIN1 = 7

Screen

♦ Is this a housing unit?

Input Options

1. Yes
2. No
Valid Values
1, 2, do not accept DK or R

Fill Instructions
Skip Instructions
Special
Instructions

1. If HU = 1 or 2, go to OUTOFSCOPE_TY.
1. If HU = 1, then set GQTYPE1 = 999, set OUTCOME = 841.
2. If HU = 2, then set GQTYPE1=999, set OUTCOME = 844.
3. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear out GQTypeDesc3.

Block
Variable Name

BGQtype1
OUTOFSCOPE_TY

Field Description

GQ is out of scope

Universe

COLLEGE = 2 or ALF = 2 or OGLF = 1 or HOTEL_UHE = 2 or
HOSP_DESC = 4 or OUTOFSCOPE_DD = 1-5 or HU ne blank or
DVS_DD=1

Screen

This place is not in scope for this part of the American / Puerto
Rico Community Survey.
In the future, you may be contacted again for an interview.

Input Options

Enter 1 to continue

Fill Instructions

If PRFLAG=1, display “Puerto Rico”, else display “American”

Skip Instructions

Go to Notes.

Special
Instructions

Block
Variable Name

BGQtype1
MAXCAP1

Field Description

11.3.0 Maximum Capacity

Universe

GQTYPECODE1 ne 402 or HOTEL_UHE = 1 or DVS_DD=2 or
GQMAIN1 ne 7

Screen

What is the maximum number of people who can live or stay at
[fill GQNAME]? Include only those people who are part of the
[fill GQTYPECODE1DESC] section of [fill GQNAME]. Please
[fill BGQtype1_STAFFINTS] include any staff living or staying
at [fill GQNAME].

Input Options

Numeric from 1 – 15,000
R and DK are acceptable

Fill Instructions

if GQTYPECODE1 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 403,404, or 405 [fill BGQtype1_STAFFINTS] = “ DO
NOT include”
if GQTYPECODE1 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BGQtype1_STAFFINTS]= “include”
GO to SECGQ

Skip Instructions
Special
Instructions

1. Display a soft error if FR enters a number 10,000 up to and
including 15,000. “this is an unusually large amount; are you
sure?” Suppress, Close and Goto return to MAXCAP1.
2.Display a standard Blaise error message that reads “Input invalid.
Value not in range 1 to 15,000.”
3. Display a soft error if (MAXCAP1 is not empty, not equal to Don’t
Know or Refused) and (GQTYPECODE1 not equal to GQTYPE) and
(GQTYPE is not empty).
“Please confirm that this GQ has changed from a GQTYPE
[GQTYPE]([GQTypeDesc]) to a [GQTYPECODE1]
([GQTypeDesc1]).
If this is correct, select ‘Suppress’ and move forward with the
interview. If this is not correct, select ‘Close’ or ‘Goto’ and
return to the GQMAIN1 screen and correct the GQ type
classification.
If you need additional information regarding the GQ types,
please consult the GQ Definitions Tab.”

Block
Variable Name

BGQtype2
SECGQ

Field Description

11.3 Second Group Type

Universe

If GQTYPECODE1 <998 and ne (101 or 102 or 702 or 703 or 704 or
706 or 900 or 903) or (CF_DES=4 and GQTypecode1 =102)

Screen

This is the same list of places where people live, could live or stay
and/or receive services. Is [fill GQNAME] also one of the
categories on the card?
♦Give the contact person some time to read all the categories and
provide you with a selection.

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. Yes
2. No

1. If SECGQ = 1, go to SECGQ_NAME.
2. If SECGQ = 2 and STAY_NOW = 1, go to PEOPLEATGQ.
3. If SECGQ = 2 and STAY_NOW = 2, go to RI_BCT.

Block
Variable Name

BGQtype2
SECGQNAME

Field Description

Updated GQ Name

Universe

SECGQ = 1

Screen

What is the name of this place?
♦Enter the name that accurately describes only that part of the GQ
that the contact identified on the Information Card.
PRIMARY GQ NAME:
PRIMARY GQ TYPE:

[fill GQNAME]
[fill GQTYPE1CODE]

SECOND GQ NAME:
SECOND GQ TYPE:

[fill GQNAME#2]
[fill GQTYPE2CODE]

Input Options

Fill in the blank. Allow 100 characters.

Fill Instructions
Skip Instructions

Go to GQMAIN2

Special
Instructions

1. Interviewer instructions “SECOND GQ NAME: [fillGQNAME#2
for second GQ]
SECOND GQ TYPE; [fill GQTYPE2CODE] can only be filled after
this information is collected. Thus, these will not be displayed when
info is collected. However, after this info is collected and upon
backing up to this, display this info.

Block
Variable Name

BGQtype2
GQMAIN2

Field Description

11.5 Second GQ Category

Universe

SECGQ_NAME ne blank

Screen

Special Place Name: fill SPECNAME
Group Quarters name: fill GQNAME
Please tell me which is the category that best describes [fill
GQNAME#2]?
♦This type code must be different from the first type code.
♦The second GQ name must accurately describe only the GQ that
reflects the second type code.

Input Options

1. Educational Facility
2. Correctional Facility
3. Group Home
4. Health Care Treatment Facility
5. Military
6. Other Group Living Facilities
Valid Values
1 through 6, do not accept DK, R

Fill Instructions
Skip Instructions

Special
Instructions

1. If GQMAIN2 = 1, go to EDU_DD
2. If 2, go to CORRECTIONAL_DD
3. If 3, go to GROUPHOME_DD
4. If 4, go to HEALTH_DD
5. If 5, go to MILITARY_DD
6. If 6, go to OGLF_DD

Block
Variable Name

BGQtype2
EDU_DD

Field Description

6.0 Education drill-down

Universe

GQMAIN2 = 1

Screen

♦ Select category based on GQ contact’s response.

Input Options

1. College/University Student Housing
2. Residential School for People with Disabilities

Fill Instructions
Skip Instructions

Special
Instructions

1. If EDU_DD = 1, go to COLLEGE
2. If EDU_DD = 2, go to MAXCAP2
1. If EDU_DD = 2, then set GQTYPECODE2 = 405

Block
Variable Name

BGQtype2
College

Field Description

6.1 College/University Student Housing

Universe

EDU_DD = 1 and GQMAIN2 = 1

Screen

“Is [fill: GQNAME] used primarily to provide housing for
college students?”
1. Yes
2. No

Input Options

Fill Instructions
Skip Instructions

1. If College = 1, go to MAXCAP2
2. If College = 2, go to PEOPLEATGQ.

Special
Instructions

1. If College = 1, GQTYPECODE2 = 501
2. If College = 2, GQTYPECODE2 = 999
3. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear out GQTypeDesc3.

Block
Variable Name

BGQtype2
CORRECTIONAL_DD

Field Description

7.0 Correctional drill-down

Universe

GQMAIN2 = 2

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Correctional Residential Facility
2. Juvenile Correctional Facility

Fill Instructions
Skip Instructions

Special
Instructions

1. If CORRECTIONAL_DD = 1, go to CF_DESC.
2. If CORRECTIONAL_DD = 2, go to MAXCAP2.
If CORRECTIONAL_DD = 2, then set GQTYPECODE2 = 203

Block
Variable Name

BGQtype2
CF_DESC

Field Description

7.1 Correctional Facility Type

Universe

CORRECTIONAL_DD = 1 and GQMAIN2 = 2

Screen

Which of the following categories describes [fill in GQNAME#2]?
♦If more than one flashcard category applies, mark the one with the
most prisoners.

Input Options

Fill Instructions
Skip Instructions

1. State Prison
2. Local or County Jail
3. Adult Residential Correctional Facility
4. Privately Operated Correctional Facility (federal)
5. Federal Prison
6. Federal Detention Center
1. If CF_DESC = 1 through 4 go to MAXCAP2 This Goes to
PEOPLEATGQ and should be going to MAXCAP2
2. If CF_DESC = 5, display soft error that says:
“ You have attempted to collect GQ information for Federal
Prison outside of the data collection period for Federal
Prisons. Please read the script below to the respondent and
continue with the interview.
Federal facilities are out of scope at this time of data
collection. Is this GQ another of the categories on this card?
Suppress is off line. Close and GO returns to SECGQ.
3. If CF_DESC = 6 display soft error that says:
You have attempted to collect GQ information for Federal
Prison outside of the data collection period for Federal
Prisons. Please read the script below to the respondent and
continue with the interview.
Federal facilities are out of scope at this time of data
collection. Is this GQ another of the categories on this card?

Special
Instructions

Suppress is off line. Close and GO returns to SECGQ.
1. If CF_DESC = 1, then GQTYPECODE2 = 103.
2. If CF_DESC = 2, then GQTYPECODE2 = 104.
3. If CF_DESC = 3, then GQTYPECODE2 = 105.

4. If CF_DESC = 4, then GQTYPECODE1 = 102
5. If CF_DESC=5, then GQTYPECODE1=102, Set OUTCOME
code to 844.
6. If CF_DESC=6, then GQTYPECODE1=101, Set OUTCOME
code to 844.

Block
Variable Name

BGQtype2
GROUPHOME_DD

Field Description

8.0 Group Home drill-down

Universe

GQMAIN2 = 3

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Group Home
2. Juvenile Group Home

Fill Instructions
Skip Instructions

Special
Instructions

1. If GROUPHOME_DD = 1 go to MAXCAP2.
2. If GROUPHOME_DD = 2, go to MAXCAP2.
1. If GROUPHOME_DD = 1, then GQTYPECODE2 = 801.
2. If GROUPHOME_DD = 2, then GQTYPECODE2 = 201.

Block
Variable Name

BGQtype2
HEALTH_DD

Field Description

9.0 Health Facility drill-down

Universe

GQMAIN2 = 4

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Residential Treatment Center (non-correctional)
2. Assisted Living, Independent Living or Continuing Care Facility
3. Nursing or Skilled Nursing Facility
4. In-Patient Hospice Facility
5. Hospital
6. Juvenile Residential Treatment Center (non-correctional)

Fill Instructions
Skip Instructions

Special
Instructions

1. If 1, 3, 4 or 6 go to MAXCAP2.
2. If 2, go to ALF
3. If 5, go to HOSP_DESC
1. If HEALTH_DD = 1, then set GQTYPECODE2 = 802.
2. If HEALTH_DD = 3, then set GQTYPECODE2 = 301.
3. If HEALTH_DD = 4, then set GQTYPECODE2 = 403.
4. If HEALTH_DD = 6, then set GQTYPECODE2 = 202.

Block
Variable Name

BGQtype2
ALF

Field Description

9.1 Assisted/Ind. Living

Universe

HEALTH_DD = 2 and GQMAIN2 = 4

Screen

Does [GQNAME#2] have a skilled nursing unit or a nursing
unit?

Input Options

1. Yes
2. No

Fill Instructions
Skip Instructions

Special
Instructions

1. If ALF = 1, go to MAXCAP2
2. If ALF = 2, got to PEOPLEATGQ
1. If ALF = 1, then GQTYPECODE2 = 301
2. If ALF = 2, then GQTYPECODE2 = 999,
set outcome code to 841
3. If GQTYPECODE1 = 999, clear GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear GQTypeDesc3.

Block
Variable Name

BGQtype2
HOSP_DESC

Field Description

9.3 Facility Provides Treatment

Universe

HEALTH_DD = 5 and GQMAIN2 = 4

Screen

Does [GQNAME#2] provide treatment or care that includes:
♦If more than one Information Card category applies, enter the one
with the most patients.

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. Mental /Psychiatric Hospital or Unit.
2. Skilled Nursing Unit
3. Patients Who Have No Usual Home Elsewhere.
4. None Of The Above Apply To This Hospital

1. If HOSP_DESC = 3, go to UHE_COUNT
2. If HOSP_DESC = 1 or 2, go to MAXCAP2.
3. If HOSP_DESC = 4, go to PEOPLEATGQ.
1. If HOSP_DESC = 1, GQTYPECODE2 = 401
2. If HOSP_DESC = 2, GQTYPECODE2 = 301
3. If HOSP_DESC = 3, GQTYPECODE2 = 402
4. If HOSP_DESC = 4, GQTYPECODE2 = 999.
5. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
6. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
7. If GQTYPECODE3 = 999, clear out GQTypeDesc3

Block
Variable Name

BGQtype2
UHE_COUNT

Field Description

9.4.1 UHE Capacity

Universe

[If HOSP_DESC = 3 and GQMAIN2 = 4] or [HOTEL_UHE = 1 and
GQMAIN2 = 6]

Screen

Fill #1 [What is the maximum number of people who have no
usual home elsewhere who live or stay here?]
Fill #2 [What is the maximum number of people experiencing
homelessness who can live or stay in this building?]

Input Options

Fill in the blank. Numeric answers accepted. D, R are acceptable.

Fill Instructions

1. If HOSP_DESC = 3, then display fill #1.
2. If HOTEL_UHE = 1, then display fill #2.

Skip Instructions

Go to TERGQ.

Special
Instructions

Block
Variable Name

BGQtype2
MILITARY_DD

Field Description

10.0 Military Facility drill-down

Universe

GQMAIN2 = 5

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Barracks or Academy Residence Hall
2. Disciplinary Barrack or Jail
3. Ship
4. Military Treatment Facility with Assigned Patients

Fill Instructions
Skip Instructions
Special
Instructions

MILITARY_DD – 1 through 4, go to MAXCAP2.
1. MILITARY_DD = 1, then set GQTYPECODE2 = 601.
2. MILITARY_DD = 2, then set GQTYPECODE2 = 106.
3. MILITARY_DD = 3, then set GQTYPECODE2 = 602
4. MILITARY_DD = 4, then set GQTYPECODE2 = 404

Block
Variable Name

BGQtype2
OGLF_DD

Field Description

Other Facility Drill-down

Universe

GQMAIN2 = 6

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Commune, Recreational Vehicle Park, Campground,
Marina, Racetrack.
2. Religious Facility
3. Hotel, Motel, Inn, Resort, Lodge, or Bed and Breakfast.
4. Job Corps or Vocational Training Facility
5. Shelter
6. Worker’s Group Living Facility

Fill Instructions
Skip Instructions

Special
Instructions

1. If OGLF_DD = 1, go to PEOPLEATGQ.
2. If OGLF_DD = 2,4,6 go to MAXCAP2.
3. If OGLF_DD = 3, go to HOTEL_UHE.
4. If OGLF_DD=5, go to DVS_DD
1. If OGLF_DD = 1, then set GQTYPECODE2 = 999.
2. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
3. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
4. If GQTYPECODE3 = 999, clear out GQTypeDesc3.
5. If OGLF_DD = 2, then set GQTYPECODE2 = 902.
6. If OGLF_DD = 4 or 6, then set GQTYPECODE2 = 901.

Block
Variable Name

BGQtype2
DVS_DD

Field Description

Domestic Violence Shelter Screener Question

Universe

OGLF_DD=5

Screen

♦ Domestic Violence Shelters are always out of scope for the
American Community Survey.
Is this facility a Domestic Violence Shelter?

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. Yes
2. No

1. If DVS_DD = 1, go to OUTOFSCOPE_TY.
2. If DVS_DD= 2 go to MAXCAP2.
1. If DVS_DD = 2, then set GQTYPECODE2 = 701.

Block
Variable Name

BGQtype2
HOTEL_UHE

Field Description

11.1 Shelter for homeless?

Universe

OGLF_DD = 3 and GQMAIN2 = 6

Screen

Does [fill GQNAME#2] or part of [fill GQNAME#2] provide
shelter for people experiencing homelessness?

Input Options

1. Yes
2. No

Fill Instructions
Skip Instructions

Special
Instructions

1. If HOTEL_UHE = 1, go to UHE_COUNT.
2. If HOTEL_UHE = 2, go to PEOPLEATGQ.
1. If HOTEL_UHE = 1, set GQTYPECODE2 = 701.
2. If HOTEL_UHE = 2, set GQTYPECODE2 = 999,
3. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear out GQTypeDesc3.

Block
Variable Name

BGQtype2
MAXCAP2

Field Description

11.3.0 Maximum Capacity

Universe

GQTYPECODE1 ne 402 or HOTEL_UHE = 1 or DVS_DD=2

Screen

“What is the maximum number of people who can live or stay at
[fill GQNAME#2]? Include only those people who are part of the
[fill GQTYPECODE2DESC] section of [fill GQNAME#2]. Please
[fill BGQtype2_STAFFINTS] include any staff living or staying
at [fill GQNAME#2].”

Input Options

Numeric from 1 – 15,000
R and DK are acceptable

Fill Instructions

if GQTYPECODE2 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 403,404, or 405 [fill BGQtype2_STAFFINTS] = “DO NOT
include”
if GQTYPECODE2 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BGQtype2_STAFFINTS]= “include”
GO to TERGQ

Skip Instructions
Special
Instructions

1. Display a soft error if FR enters a number 10,000 up to and
including 15,000. “This is an unusually large amount; are you
sure?” Suppress, Close and Goto return to MAXCAP2.
2. Display a standard Blaise error message that reads “Input invalid.
Value not in range 1 to 15,000.”
3. If GQTYPECODE1 = GQTYPECODE2, then display a hard error
message that says “The secondary GQ type code [fill
GQTYPECODE2] must be different from the primary GQ type code
[fill GQTYPECODE1]. Please correct.

Block
Variable Name

BGQtype3
TerGQ

Field Description

11.3 Third Group Type

Universe

MAXCAP2 has entry

Screen

This is the same list of places where people live, could live or stay
and/or receive services. Is [fill GQNAME] also one of the
categories on the card?
♦Give the contact person some time to read all the categories and
provide you with a selection.

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. Yes
2. No

1. If TerGQ = 1, go to TERGQNAME.
2. If TerGQ = 2 and STAY_NOW = 1, go to PEOPLEATGQ.
3. If TerGQ = 2 and STAY_NOW = 2, go to RI_BCT.

Block
Variable Name

BGQtype3
TERGQNAME

Field Description

11.4 Updated GQ Name

Universe

TERGQ = 1

Screen

What is the name of this place?
♦Enter the name that accurately describes only the part of the GQ
that the contact identified on the Information Card.
PRIMARY GQ NAME:
PRIMARY GQ TYPE:

[fill GQNAME]
[fill GQTYPE1CODE]

SECOND GQ NAME:
SECOND GQ TYPE:

[fill GQNAME#2]
[fill GQTYPE2CODE]

THIRD GQ NAME:
THIRD GQTYPE:

[fill: GQNAME#3 for third GQ]
[fill: GQTYPE3CODE]

Input Options

Fill in the blank. Allow 100 characters.

Fill Instructions
Skip Instructions

Go to GQMAIN3

Special
Instructions

Block
Variable Name

BGQtype3
GQMAIN3

Field Description

11.5 Third GQ Category

Universe

TerGQNAME ne blank

Screen

Special Place Name: fill SPECNAME
Group Quarters name: fill GQNAME
Please tell me which is the category that best describes [fill
GQNAME#3]?
♦This type code must be different from the first type code.
♦The third GQ name must accurately describe only the GQ that
reflects the third type code.

Input Options

1. Educational Facility
2. Correctional Facility
3. Group Home
4. Health Care Treatment Facility
5. Military
6. Other Group Living Facilities
Valid Values
1 through 6, do not accept DK, R

Fill Instructions
Skip Instructions

Special
Instructions

1. If GQMAIN3 = 1, go to EDU_DD
2. If GQMAIN3 = 2, go to CORRECTIONAL_DD
3. If GQMAIN3 = 3, go to GROUPHOME_DD
4. If GQMAIN3 = 4, go to HEALTH_DD
5. If GQMAIN3 = 5, go to MILITARY_DD
6. If GQMAIN3 = 6, go to OGLF_DD

Block
Variable Name

BGQtype3
EDU_DD

Field Description

6.0 Education drill-down

Universe

GQMAIN3 = 1

Screen

♦Select category based on GQ contact’s response.

Input Options

1. College/University Student Housing
2. Residential School for People with Disabilities

Fill Instructions
Skip Instructions

Special
Instructions

1. If EDU_DD = 1, go to COLLEGE
2. If EDU_DD = 2, go to MAXCAP3
1. If EDU_DD = 2, then set GQTYPECODE3 = 405

Block
Variable Name

BGQtype3
College

Field Description
Universe

6.1 College/University Student Housing
EDU_DD = 1 and GQMAIN3 = 1

Screen

“Is [fill: GQNAME] used primarily to provide housing for
college students?”
1. Yes
2. No

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. If College=1, go to MAXCAP3
2. If College = 2, go to PEOPLEATGQ
1. If 1, GQTYPECODE3 = 501
2. If 2, GQTYPECODE3 = 999
3. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear out GQTypeDesc3.

Block
Variable Name

BGQtype3
CORRECTIONAL_DD

Field Description

7.0 Correctional drill-down

Universe

GQMAIN3 = 2

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Correctional Residential Facility
2. Juvenile Correctional Facility

Fill Instructions
Skip Instructions

Special
Instructions

1. If CORRECTIONAL_DD = 1, go to CF_DESC.
2. If CORRECTIONAL_DD = 2, go to MAXCAP3.
If CORRECTIONAL_DD = 2, then set GQTYPECODE3 = 203

Block
Variable Name

BGQtype3
CF_DESC

Field Description

7.1 Correctional Facility Type

Universe

CORRECTIONAL_DD = 1 and GQMAIN3 = 2

Screen

“Which of the following categories describes [fill in
GQNAME#3]?
♦If more than one flashcard category applies, mark the one with the
most prisoners.”

Input Options

Fill Instructions
Skip Instructions

1. State Prison
2. Local or County Jail
3. Adult Residential Correctional Facility
4. Privately Operated Correctional Facility (federal)
5. Federal Prison
6. Federal Detention Center
1. If CF_DESC = 1 through 4 go to MAXCAP3 Going to
PEOPLEATGQ and it should be going to MAXCAP3
2. If CF_DESC = 5, display soft error that says:
“ You have attempted to collect GQ information for Federal
Prison outside of the data collection period for Federal
Prisons. Please read the script below to the respondent and
continue with the interview.
“Federal facilities are out of scope at this time of data
collection. Is this GQ another one of the categories on this card?”
Suppress is off line. Close and GO returns to TERGQNAME.
3. If CF_DESC = 6, display soft error that says:
You have attempted to collect GQ information for Federal
Prison outside of the data collection period for Federal
Prisons. Please read the script below to the respondent and
continue with the interview.
“Federal facilities are out of scope at this time of data
collection. Is this GQ another one of the categories on this card?”

Special
Instructions

Suppress is off line. Close and GO returns to TERGQNAME.
1. If CF_DESC = 1, then GQTYPECODE3 = 103.
2. If CF_DESC = 2, then GQTYPECODE3 = 104.

3. If CF_DESC = 3, then GQTYPECODE3 = 105.
4. If CF_DESC = 4, then GQTYPECODE3= 102
5. If CF_DESC=5, then GQTYPECODE1=102
6. If CF_DESC=6, then GQTYPECODE1=101

Block
Variable Name

BGQtype3
GROUPHOME_DD

Field Description

8.0 Group Home drill-down

Universe

GQMAIN3 = 3

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Group
2. Juvenile Group

Fill Instructions
Skip Instructions

Special
Instructions

1. If GROUPHOME_DD = 1 go to MAXCAP3.
2. If GROUPHOME_DD = 2, go to MAXCAP3.
1. If GROUPHOME_DD = 1, then GQTYPECODE3 = 801.
2. If GROUPHOME_DD = 2, then GQTYPECODE3 = 201.

Block
Variable Name

BGQtype3
HEALTH_DD

Field Description

9.0 Health Facility drill-down

Universe

GQMAIN3 = 4

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Adult Residential Treatment Center (non-correctional)
2. Assisted Living, Independent Living or Continuing Care Facility
3. Nursing or Skilled Nursing Facility
4. In-Patient Hospice Facility
5. Hospital
6. Juvenile Residential Treatment Center (non-correctional)

Fill Instructions
Skip Instructions

Special
Instructions

1. If 1, 3, 4 or 6 go to MAXCAP3.
2. If 2, go to ALF
3. If 5, go to HOSP_DESC
1. If HEALTH_DD = 1, then set GQTYPECODE3 = 802.
2. If HEALTH_DD=3, then set GQTYPECODE3 = 301.
3. If HEALTH_DD = 4, then set GQTYPECODE3 = 403.
4. If HEALTH_DD = 6, then set GQTYPECODE3 = 202.

Block
Variable Name

BGQtype3
ALF

Field Description

9.1 Assisted/Ind. Living

Universe

HEALTH_DD = 2 and GQMAIN3 = 4

Screen

Does [GQNAME#3] have a skilled nursing unit or a nursing
unit?

Input Options

1. Yes
2. No

Fill Instructions
Skip Instructions

Special
Instructions

1. If ALF = 1, go to MAXCAP3
2. If ALF = 2, got to PEOPLEATGQ
1. If ALF = 1, then GQTYPECODE3 = 301
2. If ALF = 2, then GQTYPECODE3 = 999,
set outcome code to 841
3. If GQTYPECODE1 = 999, clear GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear GQTypeDesc3.

Block
Variable Name

BGQtype3
HOSP_DESC

Field Description

9.3 Facility Provides Treatment

Universe

HEALTH_DD = 5 and GQMAIN3 = 4

Screen

Does [GQNAME#3] provide treatment or care that includes:
♦If more than one Information Card category applies, enter the one
with the most patients.”

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. Mental/Psychiatric Hospital or Unit
2. Skilled Nursing Unit.
3. Patients Who Have No Usual Home Elsewhere.
4. None Of The Above Apply To This Hospital

1. If HOSP_DESC = 3, go to UHE_COUNT
2. If HOSP_DESC = 1 or 2, go to MAXCAP3.
3. If HOSP_DESC = 4, go to PEOPLEATGQ.
1. If HOSP_DESC = 1, GQTYPECODE3 = 401
2. If HOSP_DESC = 2, GQTYPECODE3 = 301
3. If HOSP_DESC = 3, GQTYPECODE3 = 402
4. If HOSP_DESC = 4, GQTYPECODE3 = 999.
5. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
6. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
7. If GQTYPECODE3 = 999, clear out GQTypeDesc3

Block
Variable Name

BGQtype3
UHE_COUNT

Field Description

9.4.1 UHE Capacity

Universe

[If HOSP_DESC = 3 and GQMAIN3 = 4] or [HOTEL_UHE = 1 and
GQMAIN3 = 6]

Screen

Fill #1 [What is the maximum number of people who have no
usual home elsewhere who live or stay here?]
Fill #2 [What is the maximum number of people experiencing
homelessness who can live or stay in this building?]

Input Options

Fill in the blank. Numeric answers accepted. D, R are acceptable.

Fill Instructions

1. If HOSP_DESC = 1, then display fill #1.
2. If OGLF_DD = 3, then display fill #2.

Skip Instructions

1. If STAY_NOW = 1, go to PEOPLEATGQ
2. If STAY_NOW = 2, go to RI_BTC

Special
Instructions

Block
Variable Name

BGQtype3
MILITARY_DD

Field Description

10.0 Military Facility drill-down

Universe

GQMAIN3 = 5

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Barracks or Academy Residence Hall
2. Disciplinary Barracks or Jail
3. Ship
4. Military Treatment Facility with Assigned Patients

Fill Instructions
Skip Instructions
Special
Instructions

MILITARY_DD – 1 through 4, go to MAXCAP3.
1. MILITARY_DD = 1, then set GQTYPECODE3 = 601.
2. MILITARY_DD = 2, then set GQTYPECODE3 = 106.
3. MILITARY_DD = 3, then set GQTYPECODE3 = 602
4. MILITARY_DD = 4, then set GQTYPECODE3 = 404.

Block
Variable Name

BGQtype3
OGLF_DD

Field Description

Other Facility Drill-down

Universe

GQMAIN3 = 6

Screen

♦Select category based on GQ contact’s response.

Input Options

1. Commune, Recreational Vehicle Park, Campground,
Marina, Racetrack.
2. Religious Facility
3. Hotel, Motel, Inn, Resort, Lodge, or Bed and Breakfast.
4. Job Corps or Vocational Training Facility
5. Shelter
6. Worker’s Group Living Facility

Fill Instructions
Skip Instructions

Special
Instructions

1. If OGLF_DD = 1, go to PEOPLEATGQ.
2. If OGLF_DD = 2,4,6, go to MAXCAP3.
3. If OGLF_DD = 3, go to HOTEL_UHE.
4. If OGLF_DD=5, go to DVS_DD.
1. If OGLF_DD = 1, then set GQTYPECODE3 = 999.
2. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
3. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
4. If GQTYPECODE3 = 999, clear out GQTypeDesc3.
5. If OGLF_DD = 2, then set GQTYPECODE3 = 902.
6. If OGLF_DD = 4 or 6, then set GQTYPECODE3 = 901.

Block
Variable Name

BGQtype3
DVS_DD

Field Description

Domestic Violence Shelter Screener Question

Universe

OGLF_DD=5

Screen

♦ Domestic Violence Shelters are always out of scope for the
American Community Survey.
Is this facility a Domestic Violence Shelter?

Input Options

Fill Instructions
Skip Instructions

Special
Instructions

1. Yes
2. No

1. If DVS_DD = 1, go to OUTOFSCOPE_TY.
2. If DVS_DD= 2 go to MAXCAP3.
1. If DVS_DD = 2, then set GQTYPECODE3 = 701.

Block
Variable Name

BGQtype3
HOTEL_UHE

Field Description

11.1 Shelter for homeless

Universe

OGLF_DD = 3 and GQMAIN3 = 6

Screen

Does [fill GQNAME#3] or part of [fill GQNAME#3] provide
shelter for people experiencing homelessness?

Input Options

1. Yes
2. No

Fill Instructions
Skip Instructions

Special
Instructions

1. If HOTEL_UHE = 1, go to UHE_COUNT.
2. If HOTEL_UHE = 2, go to PEOPLEATGQ.
1. If HOTEL_UHE = 1, set GQTYPECODE3 = 701.
2. If HOTEL_UHE = 2, set GQTYPECODE3 = 999,
3. If GQTYPECODE1 = 999, clear out GQTypeDesc1.
4. If GQTYPECODE2 = 999, clear out GQTypeDesc2.
5. If GQTYPECODE3 = 999, clear out GQTypeDesc3.

Block
Variable Name

BGQtype3
MAXCAP3

Field Description

11.3.0 Maximum Capacity

Universe

GQTYPECODE1 ne 402 or HOTEL_UHE = 1 or DVS_DD=2

Screen

What is the maximum number of people who can live or stay at
[fill GQNAME#3]? Include only those people who are part of the
[fill GQTYPECODE3DESC] section of [fill GQNAME#3]. Please
[fill BGQtype3_STAFFINTS] include any staff living or staying
at [fill GQNAME#3].

Input Options

Numeric from 1 – 15,000
R and DK are acceptable

Fill Instructions

if GQTYPECODE3 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 403,404, or 405 [fill BGQtype3_STAFFINTS] = “DO NOT
include”
if GQTYPECODE3 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BGQtype3_STAFFINTS]= “include”
GO to PEOPLEATGQ

Skip Instructions
Special
Instructions

Field Description

13 Identifying The GQ Type For Sampling

Skip Instructions

GO to PEOPLEATGQ

Special
Instructions

You will need to use variable called C2K_TYPE to program this.
C2K_TYPE can be found on RT8500 of the SCIF. This section will
determine behind the scenes which area of the GQ the FR should
sample if the GQ has more than 1 type code.
Then create a variable SampleGQName.
This all happens behind the scenes.
1. If SECGQ = 2, then set SampleGQName = GQNAME. In English
this means that if the contact says there is only one GQ type at this
GQ we sample that one. Even if the GQ type is now different than
type code collected in Census 2000 (C2K_TYPE), we continue on to
sampling and use GQNAME.
Go to PEOPLEATGQ.
If SECGQ =1 or TERGQ = 1 and GQTYPE1, GQTYPE2 or
GQTYPE3 ne C2KTYPE, then look at the maximum capacity
variables and set the one with the greatest maximum capacity to
SampleGQName.
2. If SECGQ = 1 and GQTYPE2 = C2K_TYPE, then set
SampleGQName = GQNAME2. In English this means that if the
second GQ type identified matches what we collected in Census
2000, then we use GQTYPE2 and GQNAME2. Go to
PEOPLEATGQ.

3. If TERGQ = 1 and GQTYPE3 = C2K_TYPE, then set
SampleGQName = GQNAME3.
Else if 11.6 = 1 and GQTYPE3 ne C2KTYPE, then set
SampleGQName = GQNAME2 if GQTYPE2 = C2K_TYPE. Go to
PEOPLEATGQ.
4.Else if TERGQ = 1 and GQTYPE3 ne C2KTYPE, then set
SampleGQName = GQNAME1 if GQTYPE1 = C2K_TYPE. Go to
PEOPLEATGQ.
NOTE: C2K_TYPE variable will be populated from the GQ type
code found in record type 2580. This is in place of changing
C2K_TYPE in the spec.

Block
Variable Name

BListingsheet
PEOPLEATGQ

Field Description

14.1 People living at GQ

Universe

[PEAS_FL = 1 and STAY_NOW = 1] or [PEAS_FL = 0 and
INITSCREEN = 3 or 4]

Screen

“We need to take a sample of the [fill BListingsheet_RES] of [fill:
GQNAME] to determine who I should interview. To take the
sample, I will now need a list of all occupied beds as of TODAY.
The list needs to include sufficient information so that I can
locate that person. For example: the resident’s name, floor
number, room number and bed designation. Can you provide me
with this type of list?
♦[fill BListingsheet_STAFF] any staff members living or staying at
the GQ.
♦Do not include Held Beds.”

Input Options

1. Yes
2. No
Valid Values
1,2,R

Fill Instructions

Skip Instructions

Special
Instructions

if GQTYPECODE1 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 402,403,404, or 405 [fill BListingsheet_RES] = “residents”
if GQTYPECODE1 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BListingsheet_RES]= “residents and staff”

if GQTYPECODE1 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 402, 403,404, or 405 [fill BListingsheet_STAFF] = “DO
NOT include”
if GQTYPECODE1 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BListingsheet_STAFF]= “Be sure to include”
1. If PEOPLEATGQ = 1, go to CURRENTPOP
2. If PEOPLEATGQ = 2,R go to ALLBEDS

Block
Variable Name

BListingsheet
ALLBEDS

Field Description

14.2 List of all beds availability

Universe

PEOPLEATGQ = 2 or R

Screen

Is there an up-to-date list of all beds at [fill: GQNAME]
♦[fill BListingsheet_STAFF] any staff members living or staying at
the GQ.

Input Options

1. Yes
2. No
Valid Values
1, 2, R

Fill Instructions

Skip Instructions

Special
Instructions

if GQTYPECODE1 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 402, 403,404, or 405 [fill BListingsheet_STAFF] = “DO
NOT include”
if GQTYPECODE1 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BListingsheet_STAFF]= “Be sure to include”
1. If ALLBEDS = 1, go to CURRENTPOP
2. If ALLBEDS = 2,R go to CREATE_OCCBEDS

Block
Variable Name

BListingsheet
CREATE_OCCBEDS

Field Description

14.2 List of occupied beds

Universe

ALLBEDS = 2 or R

Screen

Can you help me create a list of occupied beds?
♦[fill BListingsheet_STAFF] any staff members living of staying at
the GQ.
♦Do not include Held Beds.”

Input Options

1. Yes
2. No
Valid Values
1,2,R

Fill Instructions

Skip Instructions

Special
Instructions

if GQTYPECODE1 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 402, 403,404, or 405 [fill BListingsheet_STAFF] = “DO
NOT include”
if GQTYPECODE1 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BListingsheet_STAFF]= “Be sure to include”
1. If CREATE_OCCBEDS = 1, go to CURRENTPOP
2. If CREATE_OCCBEDS = 2, R go to CREATE_ALLBEDS.

Block
Variable Name

BListingsheet
CREATE_ALLBEDS

Field Description

14.2.2 List of all beds

Universe

CREATE_OCCBEDS = 2 or R

Screen

Can you help me create a list of all beds?
♦ [fill BListingsheet_STAFF] any staff members living of staying at
the GQ.

Input Options

1. Yes
2. No
Valid Values
1,2,R

Fill Instructions

Skip Instructions

Special
Instructions

if GQTYPECODE1 = 101, 102, 103, 104, 105, 106, 201, 202, 203,
301, 401, 402, 403,404, or 405 [fill BListingsheet_STAFF] = “DO
NOT include”
if GQTYPECODE1 = 501, 601, 602, 701, 702, 703, 801, 802, 900,
901, 902 [fill BListingsheet_STAFF]= “Be sure to include”
1. If CREATE_ALLBEDS = 1, go to CURRENTPOP
2. If CREATE_ALLBEDS = 2, R go to INSTAT
1. If CREATE_ALLBEDS = 2, then show a hard edit error message
that says “You can not continue because you don’t have a list to
perform the sampling. End the interview and contact your RO for
further instructions.” The hard edit should prohibit the FR from going
any further in the instrument. The FR should be able to go back to
question.

Block
Variable Name

BListingsheet
CURRENTPOP

Field Description

14.3 Current GQ Population

Universe

[PEOPLEATGQ = 1] or [ALLBEDS = 1] or [CREATE_OCCBEDS
= 1] or [CREATE_ALLBEDS = 1]

Screen

“What is the total number of [fill 1: occupied beds] or [fill 2: all
beds] at this place?
♦ Be sure you have the resister/list that you just received from or
created with the GQ contact person.”

Input Options

Numeric 1 – 15,000

Fill Instructions

1. If PEOPLEATGQ = 1 or CREATE_OCCBEDS = 1, then fill with
“occupied beds”.
2. If ALLBEDS = 1 or CREATE_ALLBEDS = 1, then fill with “all
beds”

Skip Instructions

Go to CONFIRMATION

Special
Instructions

1. If interviewer back up over this question, the current pop, the
sampling interval, and the starting case number are to be wiped out
and the current pop must be re-entered by interviewer. Allow the
current pop to be overwritten.
2. Display a soft error if the FR enters a number greater than 10,000
and equal to or less than 15,000 that reads, “This is an unusually large
amount; are you sure?”
3. Display a hard error that reads “Input invalid. Value not in range 1
to 15,000.” if entry is greater than 15,000.
4. If CURRENTPOP > MAXPOP or if CURRENTPOP >
UHE_COUNT have a pop-up window with an error message. The
message should say “You have entered a value for Current Pop that
exceeds the amount of Maximum Capacity specified at the GQ.
Please correct.”
This should be a Hard Error. Allow the FR to go back to MAXCAP
and CURRENTPOP.

Block
Variable Name

BListingsheet
CONFIRMATION

Field Description

14.5 Confirm total number enter

Universe

CURRENTPOP ne blank

Screen

♦You have entered that the total number of [fill1: occupied beds] or
[fill2: all beds] is [fill3: CURRENTPOP]. Verify, using your list,
that this number is accurate and then re-enter the correct number.

Input Options

Numeric 1 – 15,000

Fill Instructions

1. If PEOPLEATGQ = 1 or CREATE_OCCBEDS = 1. then fill 1
with “occupied beds”.
2. If ALLBEDS = 1 or CREATE_ALLBEDS = 1, then fill 2 with “all
beds”.
3. Fill 3 and Fill 4 is the value from CURRENTPOP
4. Fill 5 is the value from CONFIRMATION.

Skip Instructions

Go to RI_BCT

Special
Instructions

1. Display a hard error message if CURRENTPOP ne
CONFIRMATION. The text in the box should read. The number you
entered in CURRENTPOP [fill4: CURRENTPOP] does not match
the number you entered in CONFIRMATION [fill5:
CONFIRMATION]. Verify which one is correct. Make sure that the
CURRENTPOP entry equals the CONFIRMATION entry.

Block
Variable Name

BListingsheet
RI_BCT

Field Description

14.6 Best day/time to contact

Universe

CURRENTPOP ne blank or STAY_NOW = 2 or R.

Screen

Thank you for your help with the [fill American / Puerto Rico]
Community Survey.
In order to evaluate the quality of my work, my supervisor may
contact you to verify that I am doing my job correctly. What is
the best time to contact you?

Input Options
Fill Instructions
Skip Instructions

Special
Instructions

alphanumeric (allow 20 characters)

1. If STAY_NOW = 1, go to GQCONTACTFINISH
2. If STAY_NOW = 2, go to NOTES
3. If STAY_NOW = R, go to NOTES

Block
Variable Name

BListingsheet
GQCONTACTFINISH

Field Description

14.7 Finished with GQ contact

Universe

RI_BCT ne blank
STAY_NOW ne2 or R

Screen

♦You are now finished getting the information you need from the
GQ contact.
♦Let the GQ contact know that it will take a few minutes to take the
sample.
♦Let the GQ contact know that you will need to meet with them once
you are finished sampling so they can help you find the people in
sample to interview.
♦Ask the GQ contact if there is a room that you can sit in to finish
the sampling.

Input Options

Enter 1 to continue

Fill Instructions
Skip Instructions

Go to TAKESAMPLE

Special
Instructions

Block
Variable Name

BListingsheet
TAKESAMPLE

Field Description

14.8 About to Take Sample

Universe

GQCONTACTFINISH = 1

Screen

♦You need to have you register in front of you. You are about to
draw the sample for [fill: GQNAME].
♦Reminders:
• Be sure to ONLY include those people who are currently
staying at the GQ.
• For those GQs where you have determined there is a mix of
housing units and GQs, ONLKY include those people
currently staying in the sample GQ.
• Do not include Held Beds.

Input Options
Fill Instructions
Skip Instructions

Special
Instructions

Enter 1 to continue

Go to SAMPROSTER, PHONENUM, and EXTENSION for each
person.

Block
Variable Name

BListingsheet
SAMPROSTER, PHONENUM , and EXTENSION

Field Description

14.9 Sample Roster for each person

Universe

TAKESAMPLE = 1

Screen

Enter Name of person, bed, or room
♦Using you register and referring to the sample line below, enter
the room #, bed #, floor # and / or sample person’s name for each of
the GQ residents that were selected in the sample.
Sample line number (This column is prefilled and cannot be changed
by the interviewer)
Phone Number
Enter the telephone number for the sample person, room, or bed if
you were able to get a telephone number.
Phone Number extension
Enter the telephone number extension for the sampled person, room,
or bed if one exists. If phone number is blank, DK or R only accept
blank.
ACS Control Number (This column is prefilled and can not be
changed by the interviewer.
D, R or no answer are acceptable for Phone number and Phone
Number extension. If Phone number is blank, D or R, only accept no
answer for Phone number extension.

Input Options
Fill Instructions
Skip Instructions
Special
Instructions

Go to COLLINDV
1. Phone number – Display hard edit that reads “You must enter all
10 digits of the contact person’s phone number” if entry is less than
10 digits. Suppress is off line. Close and Goto return to
NEWCP1PHON.
2. Phone number – Display hard edit pop up box if 0 or 1 are the first
digits of the area code or prefix.
For the area code, the box should reads “the area code cannot begin
with a ‘0’ or a ‘1’.” Suppress is off line. Close and Goto return to
PHONENUM.

Block
Variable Name

BListingsheet
COLLINDV

Field Description

14.10 Collection of individual data

Universe

SAMPROSTER ne BLANK, person’s, rooms, beds has entry for last
row

Screen

♦You are now ready to conduct interviews with sample residents
using your CAPI instrument. You may need to distribute an ACS1(GQ) questionnaire for sample residents who are unable to complete
a CAPI interview, therefore, in order to save time at the GQ, please
have a PAPI-level survey package containing the ACS-1(GQ)
questionnaire available for each resident.

Input Options

Enter 1 to continue

Fill Instructions
Skip Instructions

Special
Instructions

1. If INITSCREEN = 3 or 4; PEAS_FL = 1 and GeocodeCmplt = 1,
set STOREOUT = 801, set GeocodeReqd = 1 goto FINISH.
2. If INITSCREEN = 3 or 4; PEAS_FL = 1 and GeocodeCmplt = 0,
set OUTCOME =807, set STOREOUT = 801, set GeocodeReqd = 1
goto GCDRemind.
3. If INITSCREEN = 3 or 4; PEAS_FL = 0, set STOREOUT = 801,
goto FINISH.
4. If Ctrl+G is pressed, go to GCDCORRECT.

Block
Variable Name

Data Model Level & F10 Exit
GCDREMIND

Field Description

Geocode Reminder

Universe

COLLINDV=1 and GeocodeCmplt=0 and PEAS_FL=1 and
BoP_Flag ne ‘yes’.
♦ Geocoding is required for this case and has not yet been completed.
Please geocode during this personal visit to the sample unit.

Screen

♦Select the Geocoding Tab or Press Ctrl+G to proceed to the
geocoding screen now
♦If you exit the instrument before Geocoding, this case will not be
complete and you will not be able to transmit.

Input Options

Enter 1

Fill Instructions
Skip Instructions

Special
Instructions

If GCDREMIND=1 and GeocodeCmplt=1, Goto FINISH.

1.If GCDREMIND = 1 and GeocodeCmplt = 0, display soft error
message that says: “You must go to the Geocoding Tab and geocode
this case. You can not transmit until you have completed the
Geocoding tab. Select Suppress to return to Case Management.
Select Close or Goto to return to the GCDREMIND screen”
Suppress go to Case Management Close and GoTo go back to
GCDREMIND.
2. If Ctrl+G is pressed, go to GCDCORRECT.

Results

Block
Variable Name
Field Description
Universe
Screen
Input Options
Fill Instructions
Skip Instructions
Special
Instructions

Data Model Level & F10 Exit
FINISH
Ready to Transmit
GeocodeCmplt=and GCDCHECK=1 and STOREOUT = <801,
811,818, or 819>
♦This case is ready to be transmitted. Enter 1 to continue.
Valid Values 1
If FINISH = 1 and STOREOUT ne blank, set OUTCOME =
STOREOUT and Goto NOTES.
For cases that meet the universe requirements, this should be the last
screen displayed before exiting to the Notes Module.

GEOCODING MODULE TAB
Variable Name

START_GCD

Field Description

Start Geocode

Universe
Screen

OUTCOME = 807 or 808 when entering a case.
♦ You have completed an interview for this case, but geocoding is
still incomplete. Would you like to proceed to the geocoding screen
now?

Input Options

SPECIAL PLACE NAME:
GROUP QUARTERS NAME:

Fill in SPECPLACE
Fill in GQNAME

ADDRESS:

Fill in GQADDLINE1
Fill in GQADDLINE2

PHYSICAL DESC/LOCATION:

Fill in PHYSDES

1. Yes
2. No – transmit case without geocoding
3. Quit – do not attempt now.

Fill Instructions
Skip Instructions

If START_GCD = 1 goto GCDCORRECT.
If START_GCD = 2 goto SNDNOGCD.
If START_GCD = 3 goto Notes

Special
Instructions

If BoP_FL ne ‘yes’ and PEAS_FL = 1 and SRCHKNLRESP = 1 or 2,
or INTRO =1, DK or R make Geo tab active and set
FstFRReqd=.

Results

Variable Name

GCDCORRECT

Field Description

Are Geocodes Correct

Universe

Available by clicking on tab labeled “Geo”, pressing Ctrl+G or
START_GCD = 1

Screen
Original geocodes provided for this case:
STCOU: [Fill1: PSU]
Tract: [Fill2: Tract]
Block: [Fill3: Block]
Are you ready to geocode?

Input Options

1. Return to the interview without geocoding.
2. Geocode the sample unit.
3. [Fill 4: Geocodes verified to be correct ]
4. Unable to Geocode

Valid Values: 1- 4
Fill Instructions

1. If PSU, Tract, and Block are ALL NOT blank on the
.in file and lima_flag=’No’, then use the appropriate
values from the CASEID.in file:
[Fill 1: PSU (display all 5 characters including leading zeroes)] ,
[Fill2: Tract (display all 6 characters, including leading zeroes)],
[Fill3: Block (display the first 4 characters, including leading zeroes)]
[Fill4: Geocodes verified to be correct]
2. If at least one of PSU, Tract, and Block are blank on the
.in file and lima_flag=’No’, then use the appropriate
values (or blank where not provided) from the CASEID.in file:
[Fill 1: PSU (display all 5 characters, including leading zeroes)] ,
[Fill2: Tract (display all 6 characters, including leading zeroes)],
[Fill3: Block (display all 4 characters, including leading zeroes)]

[Fill4: ]
3. If lima_flag=’Yes’, then use the appropriate
values (or blank where not provided) from the CASEID.in file:
[Fill 1: PSU (display all 5 characters, including leading zeroes)] ,
[Fill2: Tract (display all 6 characters, including leading zeroes)],
[Fill3: Block (display all 4 characters, including leading zeroes)]
[Fill4: ]
Skip Instructions

If GCDCORRECT=1, go to Main Path
If GCDCORRECT=2 and lima_flag=’No’, go to NEWSTCOU
If GCDCORRECT=2 and lima_flag=’Yes’, launch LiMA
If GCDCORRECT= 3, see special instructions.
If GCDCORRECT=4, go to SNDNOGCD
1. If GCDCORRECT=<3> set GeocodeCmplt = 1.

Special
Instructions

Special Instr.
GeocodeCmplt is a one-character variable stored at the root level
with values 1(complete) and 0 (incomplete). GeocodeCmplt
should be read in from the .in file, and should be set to 0
when the case is first created. If GeocodeCmplt is ever set = 1 in
the instrument, then it must stay=1 (should never be changed
back to 0) and be passed out via the .out file and
eventually passed up to ROSCO. ROSCO must then pass back a
value of GeocodeCmplt =1 to the case, including when the case is
reassigned and be passed into the instrument via the .in
file.
2. IF (GCDCORRECT= 3 and OUTCOME=807 or 808 and
STOREOUT is non-blank), then set OUTCOME=STOREOUT.
3. Show Answer Cat #3 when PSU, Tract, and Block are ALL NOT
blank on the .in file. “Hide” Answer Cat #3 when at least
one of PSU, Tract, and Block are blank on the .in file.

4. Hard Error: (display when GCDCORRECT=3 and at least one of
PSU, Tract, and Block are blank on the .in file.)
(Interviewer Instruction)

♦ Invalid Response
5. IF on the .in file ALL of the following are true:
GeocodeCmplt=1, PSU=NEWSTCOU (both non-blank), TRACT
=NEWTRACT (both non-blank), and BLOCK=NEWBLOCK (Both
non-blank), [meaning this FR or another FR verified the geocodes to
be correct on a prior attempt], THEN set GCDCORRECT=3 when
starting the case.
6. IF on the .in file GeocodeCmplt=1, AND ANY of the
following are also true on the .in file: PSU<>NEWSTCOU
(both non-blank), TRACT <>NEWTRACT (both non-blank), and
BLOCK<>NEWBLOCK (Both non-blank), [meaning this FR or
another FR verified the geocodes to be incorrect on a prior attempt
and captured the corrected code(s)] THEN set GCDCORRECT=2,
GCDCHECK=1, and pre-fill NEWSTCOU, NEWTRACT, and
NEWBLOCK with the corresponding values from the .in
file when starting the case.
7. If GCDCORRECT=3 and FstFRCmplt=, then set
FstFRCmplt= the USERID of the FR working the case. If
FstFRCmplt is not blank, then make no change to the value of
FstFRCmplt. The FstFRCmplt variable must be passed out via the
.out file and eventually passed up to ROSCO. ROSCO must
then pass back the value of FstFRCmplt to the case when the case is
reassigned, and be passed into the instrument via the .in file.
FstFRCmplt should not be blanked out once it has been filled with an
USERID.
8. If GCDCORRECT = 3, FstFRCmplt = , and
FstFRReqd = , set FstFRReqd = FstFRCmplt. If FstFRReqd
= , then make no change to the value of FstFRReqd.
9. If GCDCORRECT = 3 and ANY of the following are true:
PSUNEWSTCOU, TRACTNEWTRACT, or
BLOCKNEWBLOCK, then set NEWSTCOU = PSU,
NEWTRACT = TRACT, and NEWBLOCK = BLOCK (even if
TRACT or BLOCK = ).
(NEW Variable = fldGEOCmplt added 5/9/2013 to correct
geocoding ROSCO reports and case management flag display)
if ((outcome is not 807,808 and ((GEOCODECMPLT = 0 and
GeocodeReqd = 1) or
(GEOCODECMPLT = 0 and

GeocodeReqd = 0) or
(GEOCODECMPLT = 1 and
GeocodeReqd = 1)) or
(outcome is 807,808 and (START_GCD = YES)))
and (GCDCORRECT <> empty) and ((GCDCORRECT =
incorrect{2} AND (NEWSTCOU, NEWTRACT, NEWBLOCK
not EMPTY) )
or
((GCDCORRECT = correct{3}) and (PSU <> Empty) and(Origtract
<> Empty) and (Origblock<> Empty))
THEN
fldGeoCmplt = 1
else
fldGeoCmplt = 0

Variable Name
Field Description
Universe
Screen

Input Options
Fill Instructions

NEWSTCOU
STCOU Code
GCDCORRECT=2
•

Enter the correct five-digit STCOU code.

•

[Fill 4: Press if the original
STCOU code is correct/]

Original geocodes provided for this case:
STCOU: [Fill1: PSU]
Tract: [Fill2: Tract]
Block: [Fill3: Block]
Valid Values 01001-72999, 88002, 88008
1. Use the appropriate values from the CASEID.in file:
[Fill 1: PSU (display all 5 characters,
Including leading zeroes)] ,

Skip Instructions
Special
Instructions

[Fill2: Tract (display all 6 characters,
including leading zeroes)],
[Fill3: Block (display the first 4 characters, including leading zeroes)]
Goto NEWTRACT
1. IF on the .in file GeocodeCmplt=1, AND
PSUNEWSTCOU, pre-fill the answer space with the
NEWSTCOU value from the .in file, ELSE, pre-fill
the answer space with the original STCOU code from the
.in file.
Output any changed value using the NEWSTCOU
variable.
2.

Hard Error: (display when less than 5 characters
entered.)
Interviewer Instruction (use blue font, precede
with a hyphen)
ENG: Invalid Response—You must
enter all five digits of the STCOU code.

3.

Hard Error: (display when 5 characters are
entered, but the characters are outside of the
valid values range)
Interviewer Instruction (use blue font, precede
with a hyphen)

ENG: Invalid Response—You must enter a
value between 01001 and 72999.

Variable Name
Field Description
Universe
Screen

NEWTRACT
Tract Code
GCDCORRECT=2
•

Enter the correct six-digit tract code with no
decimal point.

•

[Fill 4: Press if the original tract
code is correct/].

Original geocodes provided for this case:
STCOU: [Fill1: PSU]
Tract: [Fill2: Tract]
Block: [Fill3: Block]

Input Options
Fill Instructions

Valid Values: 000100-999999
1. Use the appropriate values from the CASEID.in file:
[Fill 1: PSU (display all 5 characters,
including leading zeroes)] ,
[Fill2: Tract (display all 6 characters, including leading
zeroes)],
[Fill3: Block (display the first 4
characters, including leading zeroes)]

Skip Instructions
Special
Instructions

Goto NEWBLOCK
1. IF on the .in file GeocodeCmplt=1, AND
TRACTNEWTRACT, pre-fill the answer space with the
NEWTRACT value from the .in file, ELSE, pre-fill the
answer space with the original TRACT code from the .in
file.
2. Output any changed value using the NEWTRACT variable.
3. Hard Error: (display when less than 6 characters entered.)
Interviewer Instruction (use blue font, precede with a hyphen)
ENG: Invalid Response—You must enter all six digits of the
tract code.
4. Hard Error: (display when 6 characters are entered, but the
characters are outside of the valid values range)

Interviewer Instruction (use blue font, precede with a diamond)
Invalid Response—You must enter a value between 000100 and
999999.

Variable Name
Field Description
Universe
Screen

NEWBLOCK
Block Code
GCDCORRECT=2
•

Enter the correct four-digit block code.

•

[Fill 4: Press if the original block
code is correct/]

Original geocodes provided for this case:
STCOU: [Fill1: PSU]
Tract: [Fill2: Tract]
Block: [Fill3: Block]

Input Options
Fill Instructions

Valid Values 1000-9999
1. Use the appropriate values from the CASEID.in file:
[Fill 1: PSU (display all 5 characters, including leading zeroes)] ,
[Fill2: Tract (display all 6 characters, including leading zeroes)],
[Fill3: Block (display the first 4
characters, including leading zeroes)]
2. If Block is blank [Fill 4:]

Skip Instructions
Special
Instructions

Else [Fill 4: Press if the original block code
is correct.]
Goto GCDCHECK
1. IF on the .in file GeocodeCmplt=1, AND
BLOCKNEWBLOCK, pre-fill the answer space with the
NEWBLOCK value from the .in file, ELSE, pre-fill the
answer space with the original BLOCK code from the
.in file.
2. Output any changed value using the NEWBLOCK variable.
3. Hard Error: (display when less than 4 characters entered.)
Interviewer Instruction (use blue font, precede with a hyphen)
ENG: Invalid Response—You must enter all four digits of the
block code.

4. Hard Error: [Display when (STCOU from
Caseid>.in=NEWSTCOU) and (Tract from
.in=NEWTRACT) and (Block from
.in=NEWBLOCK) and GCDCORRECT=2]
Interviewer Instruction (use blue font, precede with a hyphen)
ENG: You have recorded that the original geocodes are not correct or
complete, but you have not entered any updated geocodes—which is
correct?
Questions involved: GCDCORRECT,
NEWSTCOU, NEWTRACT, NEWBLOCK
5. Hard Error: (display when 4 characters are entered, but the
characters are outside of the valid values range)
Interviewer Instruction (use blue font, precede with a diamond)
ENG: Invalid Response—You must enter a value between 1000 and
9999.

Variable Name
Field Description
Universe
Screen

GCDCHECK
Confirm New Codes
GCDCORRECT=2
•

Confirm that the codes below are correct.
Back up to the appropriate screen to make
corrections, or enter 1 to continue with the
interview.

Original geocodes provided for this case:
STCOU: [Fill1: PSU]
Tract: [Fill2: Tract]
Block: [Fill3: Block]
Updated Geocodes:
STCOU: [Fill4: NEWSTCOU]
Tract: [Fill5: NEWTract]
Block: [Fill6: NEWBlock]

Input Options
Fill Instructions

Valid Values: 1
1. Use the appropriate values from the CASEID.in file:
[Fill 1: PSU (display all 5 characters, including leading zeroes)] ,
[Fill2: Tract (display all 6 characters, including leading zeroes)],
[Fill3: Block (display the first 4 characters, including leading
zeroes)]
2. Use the appropriate values entered or confirmed on the prior
screens:
[Fill4: NEWSTCOU (display all 5 characters, including leading
zeroes)]
[Fill5: NEWTract (display all 6 characters, including leading
zeroes)]
[Fill6: NEWBlock (display all 4 characters, including leading
zeroes)]

Skip Instructions
Special
Instructions

goto Main Path
1. If GCDCHECK=1, set GeocodeCmplt=1.
2. If GCDCHECK=1 and FstFRCmplt=, then set
FstFRCmplt= the USERID of the FR working the case. If
FstFRCmplt is not blank, then make no change to the value of
FstFRCmplt. The FstFRCmplt variable must be passed out via the

.out file and eventually passed up to ROSCO. ROSCO must
then pass back the value of FstFRCmplt to the case when the case is
reassigned, and be passed into the instrument via the .in file.
FstFRCmplt should not be blanked out once it has been filled with an
USERID.
3. If GCDCHECK = 1, FstFRCmplt = , and FstFRReqd =
, set FstFRReqd = FstFRCmplt. If FstFRReqd = , then make no change to the value of FstFRReqd.

Variable Name

SNDNOGCD

Field Description

Why not verified

Universe

GCDCORRECT = 4 or START_GCD = 2

Screen

♦Why did you not geocode the sample unit?
1. Did not geocode during personal visit-return visits were
not made or authorized.
2. [Fill1: ALMI dataset needed to geocode this sample unit
was not loaded./Device not connected to the network.
Geographic (block) data needed to geocode this sample unit
was not loaded.]
3. [Fill2: ALMI/LiMA] software malfunction
4. [Fill 3: Streets on the ground are missing in theALMI
]
5. [Fill4: Can't locate the block boundary on the
ground./]
6. GQ inaccessible due to weather or road conditions, or
access refused situations

• Since a personal visit was made to this sample unit and this case is
not a Type A - 814, Type B, or Type C noninterview, geocoding is
required. Your RO will be notified that you are transmitting this
case without geocoding.
• Please select a reason why the geocoding was not done

Input Options
Fill Instructions

1. If lima_flag=’No’, then:
[Fill 1: ALMI dataset needed to geocode this sample unit was not
loaded.]
[Fill2: ALMI]
[Fill3: Streets on the ground are missing in the ALMI]
[Fill4: Can't locate the block boundary on the ground]

2. If lima_flag=’Yes’, then:
[Fill 1: Device not connected to the network. Geographic (block) data
needed to geocode this sample unit was not loaded.]
[Fill2: LiMA]
[Fill3: ]
[Fill4:]

Skip Instructions

Set GeocodeCmplt = 1 and goto Mainpath.

Special
Instructions

1. For SNDNOGCD=<1-6 > and Outcome in (807,808), set Outcome
= STOREOUT.
2. If SNDNOGCD=<1-6 > and FstSNDNOGCD= then set
FstSNDNOGCD = SNDNOGCD. FstSNDNOGCD is a one-character
variable stored at the root level with values 1-6. FstSNDNOGCD
should be read in from the .in file, and should be set to
when the case is first created. If FstSNDNOGCD is ever set
= <1-6> in the instrument, then it must retain that value (should never
be changed to another value or changed to blank) and be passed out
via the .out file and eventually passed up to ROSCO.
ROSCO must then pass back the value of FstSNDNOGCD to the
case when the case is reassigned and be passed into the instrument via
the .in file.

8-17-2017

6-1/16 x 11.5" with 3 x 5" open window

U.S. Census Bureau
Washington, DC 20233
Office of the Director

Survey Form Enclosed

YOUR RESPONSE IS
REQUIRED BY LAW

DC

6385-46(GQ) (12-2018)

13260013

DC

The American Community Survey

PLACE LABEL
HERE

This questionnaire is available in either English or Spanish.
Este cuestionario está disponible en español o en inglés.
To complete the English questionnaire, begin on
page 2. To complete the Spanish questionnaire, flip
this over and complete the green side.

Para completar el cuestionario en inglés, comience
en la página 2. Para completar el cuestionario en
español, vírelo y complete el lado verde.

Please complete this form as soon as possible.
Place it in the envelope provided and HOLD it for a
census representative to return to pick it up.

Por favor, complete este cuestionario tan
pronto sea posible. Colóquelo en el sobre que se
provee y GUÁRDELO hasta que un representante del
censo lo venga a recoger.

If you need help or have questions about
completing this form, call the number that our
census representative has given you.

Si necesita ayuda o tiene preguntas sobre cómo
completar este cuestionario, llame al número de
teléfono que le ha dado nuestro representante del
censo.

For more information about the American
Community Survey, visit our web site at:
http://www.census.gov/acs

CENSUS USE ONLY

Para obtener más información sobre la Encuesta
sobre la Comunidad Estadounidense, vaya a nuestra
página en la Internet: http://www.census.gov/acs

How was this form completed?
English

ACS-1(GQ)(2020)

FORM
(03-26-2019) Draft 4

Spanish
OMB No. 0607-0810

§.;!.¤
ACS-1GQ, Page 1, Base (Black)

ACS-1GQ, Page 1, Blue Pantone 313 (15%)

ACS-1GQ, Page 1, green Pantone 354 (20%)

13260021

1

What is your name? Please print your name.
Include your telephone number, and today’s
date. We will only contact you if needed for
official Census Bureau business.
Last Name

First Name

MI

5 What is your race? Mark (X) one or more
boxes AND print origins.
White – Print, for example, German, Irish,
English, Italian, Lebanese, Egyptian, etc. C

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

7 Are you a citizen of the United States?
Yes, born in the United States ➔ SKIP to
question 9a
Yes, born in Puerto Rico, Guam, the
U.S. Virgin Islands, or Northern Marianas
Yes, born abroad of U.S. citizen parent or
parents
Yes, U.S. citizen by naturalization – Print
year of naturalization

Area Code + Number
—
Today’s Date
Month
Day

2

Female

What is your age and what is your date of
birth? For babies less than 1 year old, do not
write the age in months. Write 0 as the age.
Print numbers in boxes.
Age (in years) Month Day
Year of birth

Chinese

Japanese

Filipino

Native Hawaiian

Asian Indian

Samoan

Vietnamese

Chamorro

Korean

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

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

A

8 When did you come to live in the

United States? If you came to live in the
United States more than once, print latest year.
Year

What is your sex? Mark (X) ONE box.
Male

3

Year

No, not a U.S. citizen
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

NOTE: Please answer BOTH Question 4
about Hispanic origin and Question 5
about race. For this survey, Hispanic
origins are not races.

9 a. At any time IN THE LAST 3 MONTHS, have

you attended school or college? Include
only nursery or preschool, kindergarten,
elementary school, home school, and schooling
which leads to a high school diploma or a
college degree.
No, have not attended in the last 3
months ➔ SKIP to question 10
Yes, public school, public college
Yes, private school, private college,
home school

b. What grade or level were you attending?
Mark (X) ONE box.
Some other race – Print race or origin. C

Nursery school, preschool
Kindergarten

4

Grade 1 through 12 – Specify
grade 1 - 12

Are you of Hispanic, Latino, or Spanish
origin?
No, not of Hispanic, Latino, or
Spanish origin
Yes, Mexican, Mexican Am., Chicano

6 Where were you born?
In the United States – Print name of state.

Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish
origin – Print, for example, Salvadoran,
Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

2

§.;!6¤

Outside the United States – Print name
of foreign country, or Puerto Rico,
Guam, etc.

College undergraduate years (freshman
to senior)
Graduate or professional school beyond
a bachelor’s degree (for example: MA or
PhD program, or medical or law school)

13260039

10 What is the highest degree or level of
school you have COMPLETED? Mark (X)
ONE box. If currently enrolled, mark the
previous grade or highest degree received.

12 What is your ancestry or ethnic origin?

15 IN THE PAST 12 MONTHS, did you receive

benefits from the Food Stamp Program
or SNAP (the Supplemental Nutrition
Assistance Program)? Do NOT include WIC,
the School Lunch Program, or assistance from
food banks.

NO SCHOOLING COMPLETED
(For example: Italian, Jamaican, African Am.,
Cambodian, Cape Verdean, Norwegian,
Dominican, French Canadian, Haitian, Korean,
Lebanese, Polish, Nigerian, Mexican, Taiwanese,
Ukrainian, and so on.)

No schooling completed
NURSERY OR PRESCHOOL THROUGH GRADE 12

Nursery school
Kindergarten

13 a. Do you speak a language other than

Yes
No

16 Are you CURRENTLY covered by any of the

following types of health insurance or
health coverage plans? Mark "Yes" or "No"
for EACH type of coverage in items a – h.

English at home?

Grade 1 through 11 – Specify
grade 1 – 11

Yes
a. Insurance through a current
or former employer or union
(of yours or another family
member)

No ➔ SKIP to question 14a
b. What is this language?
12th grade – NO DIPLOMA
HIGH SCHOOL GRADUATE

c. How well do you speak English?

GED or alternative credential

Well

Some college credit, but less than 1 year of
college credit
1 or more years of college credit, no degree
Associate’s degree (for example: AA, AS)
Bachelor’s degree (for example: BA, BS)
AFTER BACHELOR’S DEGREE

Master’s degree (for example: MA, MS,
MEng, MEd, MSW, MBA)
Professional degree beyond a bachelor’s
degree (for example: MD, DDS, DVM, LLB,
JD)
Doctorate degree (for example: PhD, EdD)

B

c. Medicare, for people 65 and
older, or people with certain
disabilities

Very well

COLLEGE OR SOME COLLEGE

No

b. Insurance purchased directly
from an insurance company
(by you or another family
member)

For example: Korean, Italian, Spanish, Vietnamese

Regular high school diploma

Yes

d. Medicaid, Medical Assistance,
or any kind of governmentassistance plan for those with
low incomes or a disability

Not well
Not at all

14 a. Did you live at this address 1 year ago?
e. TRICARE or other
military health care

Person is under 1 year old ➔ SKIP to
question 16
Yes, at this address ➔ SKIP to
question 15
No, outside the United States and
Puerto Rico – Print name of foreign
country, or U.S. Virgin Islands, Guam,
etc., below; then SKIP to question 15

f. VA (enrolled for VA
health care)
g. Indian Health Service
h. Any other type of health
insurance or health coverage
plan – Specify

No, at a different address in the
United States or Puerto Rico
Answer question 11 if you have a bachelor’s
degree or higher. Otherwise, SKIP to
question 12.

b. Where did you live 1 year ago?
Address (Number and street name)

Answer question 17a if you are covered by
health insurance. Otherwise, SKIP to
question 18a.

17 a. Is there a premium for this plan?

11 This question focuses on your BACHELOR’S
DEGREE. Please print below the specific
major(s) of any BACHELOR’S DEGREES you
have received. (For example: chemical
engineering, elementary teacher education,
organizational psychology)

C

Name of city, town, post office, military
installation, or base

A premium is a fixed amount of money paid
on a regular basis for health coverage. It
does not include copays, deductibles, or
other expenses such as prescription costs.
Yes

Name of U.S. county or
municipio in Puerto Rico

No ➔ SKIP to question 18a
b. Do you or another family member receive
a tax credit or subsidy based on family
income to help pay the premium?

Name of U.S. state or
Puerto Rico

ZIP Code

Yes
No

§.;!H¤

3

13260047

18 a. Are you deaf or do you have serious

21 What is your marital status?

27 Have you ever served on active duty in the
U.S. Armed Forces, Reserves, or National
Guard? Mark (X) ONE box.

difficulty hearing?
Now married
Yes

Widowed

No

Divorced
Separated

b. Are you blind or do you have serious
difficulty seeing even when wearing
glasses?
Yes

Never married ➔ SKIP to F

22 In the PAST 12 MONTHS, did you get –
Yes

No

D

Answer question 19a – c if you are 5 years
old or over. Otherwise, SKIP to J on
page 7 for further instructions; do not
answer any more questions.

Never served in the military ➔ SKIP to
question 30a
Only on active duty for training in the
Reserves or National Guard ➔ SKIP to
question 29a

On active duty in the past, but not now

No

a. Married?

28 When did you serve on active duty in the

b. Widowed?

U.S. Armed Forces? Mark (X) a box for EACH
period in which you served, even if just for part
of the period.

c. Divorced?

23 How many times have you been married?
Once
Three or more times

24 In what year did you last get married?

No
b. Do you have serious difficulty walking
or climbing stairs?
Yes
No
c. Do you have difficulty dressing or
bathing?

Korean War (July 1950 to January 1955)
January 1947 to June 1950

F

Answer question 25 if you are female and
15 – 50 years old. Otherwise, SKIP to
question 26a.

25 In the PAST 12 MONTHS, have you given

29 a. Do you have a VA service-connected

Yes

Yes

Yes (such as 0%, 10%, 20%, ... , 100%)

No

No

No ➔ SKIP to question 30a

Answer question 20 if you are 15 years old
or over. Otherwise, SKIP to J on page 7
for further instructions; do not answer any
more questions.

20 Because of a physical, mental, or emotional
condition, do you have difficulty doing
errands alone such as visiting a doctor’s
office or shopping?
Yes
No

grandchildren under the age of 18
living in this place?

§.;!P¤

b. What is your service-connected
disability rating?

Yes

0 percent

No ➔ SKIP to question 27

10 or 20 percent

b. Are you currently responsible for most
of the basic needs of any grandchildren
under the age of 18 who live in this
place?
Yes
No ➔ SKIP to question 27
c. How long have you been responsible
for these grandchildren? If you are
financially responsible for more than one
grandchild, answer the question for the
grandchild for whom you have been
responsible for the longest period of time.
Less than 6 months

3 or 4 years

6 to 11 months

5 or more
years

1 or 2 years

4

World War II (December 1941 to
December 1946)
November 1941 or earlier

disability rating?

birth to any children?

26 a. Do you have any of your own

E

Vietnam Era (August 1964 to April 1975)
February 1955 to July 1964

Year

Yes

September 2001 or later
August 1990 to August 2001 (including
Persian Gulf War)
May 1975 to July 1990

Two times

19 a. Because of a physical, mental, or

emotional condition, do you have
serious difficulty concentrating,
remembering, or making decisions?

Now on active duty

30 or 40 percent
50 or 60 percent
70 percent or higher

13260054

30 a. LAST WEEK, did you work for pay at a
job (or business)?

G

Yes ➔ SKIP to question 31

Answer question 33 if you marked "Car,
truck, or van" in question 32. Otherwise,
SKIP to question 34.

37 During the LAST 4 WEEKS, have you been
ACTIVELY looking for work?
Yes
No ➔ SKIP to question 39

No – Did not work (or retired)
b. LAST WEEK, did you do ANY work for
pay, even for as little as one hour?

33 How many people, including yourself,

usually rode to work in the car, truck, or
van LAST WEEK?
Person(s)

Yes

38 LAST WEEK, could you have started a job if
offered one, or returned to work if recalled?
Yes, could have gone to work

No ➔ SKIP to question 36a

No, because of own temporary illness

31 At what location did you work LAST
WEEK? If you worked at more than one
location, print where you worked most
last week.

No, because of all other reasons
(in school, etc.)

34 LAST WEEK, what time did your trip to
work usually begin?
Hour

a. Address (Number and street name)

39 When did you last work, even for a

Minute

:

few days?

a.m.

Within the past 12 months

p.m.

If the exact address is not known, give a
description of the location such as the building
35 How many minutes did it usually take
name or the nearest street or intersection.

1 to 5 years ago ➔ SKIP to I
Over 5 years ago or never worked ➔ SKIP
to question 43

you to get from this address to work
LAST WEEK?

b. Name of city, town, post office, military
installation, or base

Minutes

40 a. During the PAST 12 MONTHS (52 weeks),
did you work EVERY week? Count paid
vacation, paid sick leave, and military
service as work.

c. Is the work location inside the limits of
that city or town?
Yes

H

No, outside the city/town limits

Yes ➔ SKIP to question 41
Answer questions 36 – 39 if you did NOT
work last week. Otherwise, SKIP to
question 40a.

No
b. During the PAST 12 MONTHS (52 weeks),
how many WEEKS did you work? Include
paid time off and include weeks when
you only worked for a few hours.

d. Name of county

36 a. LAST WEEK, were you on layoff from

Weeks

a job?
e. Name of U.S. state or foreign country

Yes ➔ SKIP to question 36c
No
b. LAST WEEK, were you TEMPORARILY
absent from a job or business?

f. ZIP Code

32 How did you usually get to work LAST
WEEK? Mark ONE box for the method of
transportation used for most of the distance.
Car, truck, or van

Taxicab

Bus

Motorcycle

Subway or
elevated rail

Bicycle

Long-distance train
or commuter rail
Light rail, streetcar,
or trolley
Ferryboat

Walked

41 During the PAST 12 MONTHS, in the WEEKS

Yes, on vacation, temporary illness,
maternity leave, other family/personal
reasons, bad weather, etc. ➔ SKIP to
question 39

WORKED, how many hours did you usually
work each WEEK?
Usual hours worked each WEEK

No ➔ SKIP to question 37
c. Have you been informed that you will be
recalled to work within the next 6 months
OR been given a date to return to work?
Yes ➔ SKIP to question 38
No

Worked from this
address ➔ SKIP
to question 40a
Other method

§.;!W¤

5

13260062

I

Answer questions 42a – 42f if you worked
in the past 5 years. Otherwise, SKIP to
question 43.

f. Describe your most important activities
or duties. (For example: instruct and evaluate
students and create lesson plans, assemble and
install pipe sections and review building plans
for work details)

d. Did you receive any Social Security or
Railroad Retirement income in the PAST
12 MONTHS?
Yes ➔ What was the amount?
Total amount - Dollars

42 DESCRIPTION OF EMPLOYMENT
The next series of questions is about the type
of employment you had last week.
If you had more than one job, describe the one
at which the most hours were worked. If you
did not work last week, describe the most
recent employment in the past five years.
a. Which one of the following best
43 INCOME IN THE PAST 12 MONTHS
describes your employment last week
or the most recent employment in the
Mark (X) the "Yes" box for each type of income
past 5 years? Mark (X) ONE box.
you received, and give your best estimate of the
PRIVATE SECTOR EMPLOYEE
TOTAL AMOUNT during the PAST 12 MONTHS.
(NOTE: The "past 12 months" is the period from
For-profit company or organization
today’s date one year ago up through today.)
Non-profit organization (including
Mark (X) the "No" box to show types of income
tax-exempt and charitable organizations)
NOT received.
GOVERNMENT EMPLOYEE
Local government (for example: city or
If your net income was a loss, mark the "Loss"
box to the right of the dollar amount.
county school district)
State government (including state
For income received jointly, report only your
colleges/universities)
share of the amount received or earned.
Active duty U.S. Armed Forces or
a. Did you receive any wages, salary,
Commissioned Corps
commissions, bonuses, or tips in the
Federal government civilian employee
PAST 12 MONTHS?
SELF-EMPLOYED OR OTHER
Owner of non-incorporated business,
professional practice, or farm
Owner of incorporated business,
professional practice, or farm
Worked without pay in a for-profit
family business or farm for 15 hours or
more per week
b. What was the name of your employer,
business, agency, or branch of the
Armed Forces?

c. What kind of business or industry was
this? Include the main activity, product, or
service provided at the location where
employed. (For example: elementary school,
residential construction)

Yes ➔ What was the amount from
all jobs before deductions for
taxes, bonds, dues, or other
items?
Total amount - Dollars

$

,

,

.00

$

e. Did you receive any Supplemental
Security Income (SSI) in the PAST 12
MONTHS?
Yes ➔ What was the amount?
Total amount - Dollars

$

f. Did you receive any public assistance or
welfare payments from the state or local
welfare office in the PAST 12 MONTHS?
Yes ➔ What was the amount?
Total amount - Dollars

$

Yes ➔ What was the net income
after business expenses?
Total amount - Dollars
Loss

,

g. Did you receive any retirement income,
pensions, survivor or disability income in
the PAST 12 MONTHS? Include income from
a previous employer or union, or any regular
withdrawals or distributions from IRA, Roth
IRA, 401(k), 403(b), or other accounts
specifically designed for retirement. Do not
include Social Security.

.00

$

h. Did you have any other sources of income
received regularly such as Veterans’ (VA)
payments, unemployment compensation,
child support, or alimony in the PAST 12
MONTHS? Do NOT include lump sum
payments such as money from an inheritance
or sale of a home.
Yes ➔ What was the amount?
Total amount - Dollars

d. Was this mainly – Mark (X) ONE box.
wholesale trade?
retail trade?
other (agriculture, construction, service,
government, etc.)?
e. What was your main occupation?
(For example: 4th grade teacher, entry-level
plumber)

c. Did you receive any interest, dividends,
net rental income, royalty income, or
income from estates and trusts in the
PAST 12 MONTHS? Report even small
amounts credited to an account.
Yes ➔ What was the amount?
Total amount - Dollars
Loss

$
No

6

§.;!_¤

,

,

.00

,

No

No
manufacturing?

.00

,

No

Yes ➔ What was the amount?
Total amount - Dollars

b. Did you have any self-employment
income from own nonfarm businesses
or farm businesses, including
proprietorships and partnerships,
in the PAST 12 MONTHS?

,

.00

,

No

No

$

.00

,

No

.00

$

.00

,

No

44 What was your total income during the

PAST 12 MONTHS? Add entries 43a to 43h;
subtract any losses. If net income was a loss,
enter the amount and mark (X) the "Loss" box
next to the dollar amount.
Total amount - Dollars

None
OR

$

,

,

Loss

.00

13260070

J Thank you very much for your

participation.
Place the questionnaire in the
envelope and HOLD for your Census
Bureau Representative to pick up.

The Census Bureau estimates that this form will take about 25 minutes to complete, including the time for reviewing the instructions and answers. Send
comments regarding this burden estimate, including suggestions for reducing this burden, to: Paperwork Reduction Project, U.S. Census Bureau,
4600 Silver Hill Road, ADDC-4H277, Washington, DC 20233. You may email comments to [email protected]; use "Paperwork Project" as
the subject.
Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of Management and
Budget. This 8-digit number appears in the bottom right on the front cover of this form.

§.;!g¤
ACS-1GQ, Page 7, Base (Black)

7
ACS-1GQ, Page 7, Blue Pantone 313 (15, 50%)

13260088

CENSUS USE ONLY
1. Who answered the questions on this form? Mark (X) one box.
Sample resident
Proxy respondent
SSS individual
A combination of sources
Don’t know

2. How were the questions on this form completed? Mark (X) one box.
By self-response
By personal interview - Specify reason

3. Were administrative records used to complete any of the questions on this form?
Mark (X) one box.
No
Yes, Some administrative record information was used
Yes, All responses were obtained from administrative record information
Don’t know

Reason (code 219 or 243):

Final Outcome Codes
Mark (X) ONE of the codes below to indicate
the final outcome of the case. If code 219 or 243
is marked, explain reason in the space provided.

Interview
201
203

Out of scope

Noninterview
213
214
215
217
218
219
233
241
243

Other – Specify
I have reviewed the questionnaire for completeness.
FR’s name
Username

8

§.;!y¤

Date of interview

13260096

CENSUS USE ONLY
1. ¿Quién contestó las preguntas de este cuestionario? Marque (X) una casilla.
Residente en la muestra
Individuo con poder o autorización para responder en nombre del
residente en la muestra
Individuo con clasificación de empleado especial juramentado
Una combinación de fuentes
No sabe

2. ¿Cómo se completaron las preguntas de este cuestionario? Marque (X) una casilla.
Por auto-respuesta
Por medio de una entrevista en persona – Especifique la razón

3. ¿Se usaron registros administrativos para completar cualquiera de las preguntas de este
cuestionario? Marque (X) una casilla.
No
Sí, se usó alguna información de registros administrativos para completar este cuestionario
Sí, todas las respuestas de este cuestionario se obtuvieron de información de registros administrativos
No sabe

Códigos de Resultado Final

Razón (código 219 ó 243):

Marque (X) UNO de los códigos a continuación para
indicar el resultado final del caso. Si marcó el código
219 ó 243, explique la razón en el espacio a continuación.

Interview
201
203

Fuera de la muestra

Noninterview
213
214
215
217
218
219
233
241
243

Otra, especifique

I have reviewed the questionnaire for completeness.
FR’s name
Username

8

§.;!£¤

Date of interview

13260104

J Muchas gracias por su

participación.
Coloque el cuestionario en el
sobre y GUÁRDELO hasta que
su Representante de la Oficina
del Censo lo recoja.

La Oficina del Censo estima que le tomará 25 minutos completar este cuestionario, incluyendo el tiempo para repasar las instrucciones y respuestas.
Los comentarios sobre el estimado del tiempo, incluyendo sugerencias para reducir el tiempo que toma, deben dirigirse a: Paperwork Reduction Project,
U.S. Census Bureau, 4600 Silver Hill Road, ADDC-4H277, Washington, DC 20233. Puede enviar sus comentarios por correo electrónico a
[email protected]: escriba "Paperwork Project" en el espacio para el tema.
No se requiere que las personas respondan a ninguna recopilación de información a menos que ésta tenga un número válido aprobado de la Oficina de
Administración y Presupuesto. Este número de 8 dígitos se encuentra en la parte inferior derecha de la cubierta de este cuestionario.

§.;"%¤
ACS-1GQ, Page 7, Base (Black)

7
ACS-1GQ, Page 7, Green Pantone 354 (10, 20, 40, 50%)

13260112

I

42

d. ¿Recibió usted algún ingreso de Seguro
Social o ingreso de retiro para personal de
los ferrocarriles en los PASADOS 12 MESES?

f. Describa su actividades o deberes más
importantes. (Por ejemplo: dar clases y evaluar
a los estudiantes y planificar lecciones, montar e
instalar tramos de tubería y revisar los planes de
construcción para las especificaciones del trabajo)

Conteste las preguntas 42a – 42f sólo si
usted trabajó durante los últimos 5 años.
De lo contrario, PASE a la pregunta 43.

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

DESCRIPCIÓN DEL EMPLEO
La serie de preguntas que sigue es sobre el tipo de
empleo que usted tenía la semana pasada.

No

Si usted tenía más de un empleo, describa el empleo
en el cual trabajó más horas. Si usted no trabajó la
semana pasada, describa el empleo más reciente en
los últimos cinco años.
a. ¿Cuál de las siguientes opciones describe
mejor su empleo de la semana pasada o
su empleo más reciente en los últimos 5
años? Marque (X) UNA casilla.

43

Compañía u organización con fines de lucro

Gobierno local (por ejemplo: distrito escolar
de la ciudad o condado)
Gobierno estatal (incluso universidades
estatales)
Servicio activo en las Fuerzas Armadas de
los EE. UU. o en el Cuerpo de Comisionados
Empleado civil del gobierno federal
EMPLEADO POR CUENTA PROPIA U OTRO
Propietario(a) de un negocio, una práctica
profesional o una finca no incorporada

INGRESO EN LOS ÚLTIMOS 12 MESES

b. ¿Cuál era el nombre de su empleador, negocio,
agencia o rama de las Fuerzas Armadas?

c. ¿Qué tipo de negocio o industria era este?
Incluya la actividad, producto o servicio principal
que se ofrecía en el lugar de empleo. (Por ejemplo:
escuela primaria, construcción residencial)

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

Marque (X) la casilla "Sí" por cada tipo de ingreso que
recibió y anote el mejor estimado de la CANTIDAD
TOTAL recibida durante los ÚLTIMOS 12 MESES.
(NOTA: Los "últimos 12 meses" es el período desde la
fecha de hoy hace un año hasta hoy.)

No

Si el ingreso neto fue una pérdida, marque la casilla
"Pérdida" a la derecha de la cantidad en dólares.

a. ¿Recibió usted jornales, salarios, comisiones,
bonos o propinas en los PASADOS 12 MESES?

No

Cantidad total – Dólares

,

.00

No

No

Sí ➔ ¿Cuál fue el ingreso neto después de
descontar los gastos de negocio?
Pérdida

,

.00

No
d. ¿Era este(a) principalmente de –
Marque (X) UNA casilla.
manufactura?
comercio al por mayor?
comercio al por menor?

c. ¿Recibió usted intereses, dividendos, ingreso
neto por rentas, ingreso por derechos de autor,
o ingreso por herencias y fideicomisos en los
PASADOS 12 MESES? Informe cantidades
acreditadas a una cuenta aunque sean pequeñas.
Sí ➔ ¿Cuál fue la cantidad?

otro (agricultura, construcción, servicio,
gobierno, etc.)?
e. ¿Cuál era su ocupación principal?
(Por ejemplo: maestro(a) de 4to grado, plomero(a)
principiante)

No

Pérdida

$
No

,

,

.00

§.;"-¤

$

.00

,

¿Cuál fue su ingreso total en los PASADOS 12
MESES? Sume las cantidades anotadas en las preguntas
43a–43h; reste cualquier pérdida. Si el ingreso neto fue
una pérdida, anote la cantidad y marque (X) la casilla
"Pérdida" al lado de la cantidad.
Cantidad total – Dólares

Ninguno
Ó

6

.00

,

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

44

Cantidad total – Dólares

$

h. ¿Tuvo usted alguna otra fuente de ingreso
recibido regularmente, tal como pagos de la
Administración de Veteranos (VA),
compensación por desempleo, pensión para
hijos menores, pensión alimenticia, o pensión
de su ex pareja en los PASADOS 12 MESES?
NO incluya pagos de mayor cantidad recibidos una
sola vez, tal como dinero de una herencia o de la
venta de una casa.

Cantidad total – Dólares

,

.00

,

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

b. ¿Tuvo usted algún ingreso de empleo por
cuenta propia en su negocio no agrícola o finca
comercial, ya sea como propietario(a) único(a)
o en sociedad en los PASADOS 12 MESES?

$

$

g. ¿Recibió usted algun ingreso por retiro,
pensiónes, ingreso por discapacidad o por ser
esposo(a) sobreviviente en los PASADOS 12
MESES? Incluya ingresos de un empleador o
sindicato previo, retiros o distribuciones periódicas
de una cuenta individual de retiro (IRA, por sus
siglas en inglés), una IRA no deducible (Roth IRA),
un plan 401(k), 403(b) u otras cuentas diseñadas
específicamente para la jubilación. No incluya el
Seguro Social.

Sí ➔ ¿Cuál fue la cantidad de todos los
empleos antes de aplicarse las
deducciones por impuestos, bonos,
cuotas u otras cosas?

,

.00

,

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

Para ingreso recibido en conjunto, sólo informe la
parte que le corresponde a usted.

$

$

f. ¿Recibió usted algún pago de asistencia o
bienestar público (welfare) de la oficina de
bienestar estatal o local en los PASADOS 12
MESES?

Marque (X) la casilla "No" para mostrar los tipos de
ingresos NO recibidos.

Propietario(a) de un negocio, una práctica
profesional o una finca incorporada
Trabajó sin paga en un negocio o finca de la
familia con fines de lucro 15 horas o más a
la semana

.00

,

e. ¿Recibió usted algún ingreso de Seguridad de
Ingreso Suplementario (SSI) en los PASADOS
12 MESES?

EMPLEADO DEL SECTOR PRIVADO

Organización sin fines de lucro (incluso las
organizaciones exentas de impuestos y las
organizaciones caritativas)
EMPLEADO DEL GOBIERNO

$

$

,

,

Pérdida

.00

13260120

30 a. LA SEMANA PASADA, ¿hizo usted
algún trabajo por paga en un empleo
(o negocio)?

G

Conteste la pregunta 33 si marcó
"Automóvil, camión o van" en la pregunta
32. De lo contrario, PASE a la pregunta 34.

Sí ➔ PASE a la pregunta 31
No – No trabajó (o está retirado(a))

33 ¿Cuántas personas, incluyéndolo(a) a

usted, usualmente viajaron al trabajo en
el automóvil, camión o van LA SEMANA
PASADA?
Persona(s)

Sí
No ➔ PASE a la pregunta 36a

No ➔ PASE a la pregunta 39

38 LA SEMANA PASADA, ¿hubiera podido
usted comenzar un empleo si se le hubiera
ofrecido uno, o hubiera podido regresar al
trabajo si se le hubiera llamado de nuevo?
Sí, hubiera podido ir a trabajar

31 ¿En qué lugar trabajó usted LA SEMANA
34 LA SEMANA PASADA ¿a qué hora

usualmente comenzó usted su viaje al
trabajo?

a. Dirección (Número y nombre de la calle)

Hora

Minutos

:
Si no sabe la dirección exacta, dé una
descripción de la localización, tal como el
nombre del edificio o la calle o intersección
más cercana.

estado usted buscando trabajo
ACTIVAMENTE?
Sí

b. LA SEMANA PASADA, ¿hizo usted
CUALQUIER trabajo por paga, incluso
aunque fuese por una hora?

PASADA? Si trabajó en más de un lugar,
escriba en letra de molde la dirección donde
usted trabajó la mayor parte de la semana.

37 Durante las ÚLTIMAS 4 SEMANAS, ¿ha

a.m.
p.m.

No, debido a una enfermedad
temporal propia
No, debido a otras razones (en la
escuela, etc.)

39 ¿Cuándo trabajó usted por última vez,
aunque fuera por unos pocos días?
En los últimos 12 meses

35 ¿Cuántos minutos le tomó a usted

usualmente ir de esta dirección al trabajo
LA SEMANA PASADA?

b. Nombre de la ciudad, pueblo, oficina
de correos, instalación o base militar

Minutos

Hace 1 a 5 años ➔ PASE a la sección

I

Hace más de 5 años o nunca
trabajó ➔ PASE a la pregunta 43

40 a. ¿Durante los ÚLTIMOS 12 MESES (52
c. ¿Está localizado el lugar de trabajo
dentro de los límites de esa ciudad o
pueblo?

H

Sí
No, fuera de los límites de la
ciudad/pueblo
d. Nombre del condado

Conteste las preguntas 36 – 39 si usted NO
trabajó la semana pasada. De lo contrario,
PASE a la pregunta 40a.

36 a. LA SEMANA PASADA, ¿estuvo usted

e. Nombre del estado de los EE.UU. o país
extranjero

Sí ➔ PASE a la pregunta 36c
No
b. LA SEMANA PASADA, ¿estuvo usted
ausente TEMPORALMENTE de su empleo
o negocio?

f. Código Postal

32 ¿Cómo llegó usualmente usted al trabajo
LA SEMANA PASADA? Marque (X) UNA
casilla para el medio de transporte que utilizó
por más distancia.

Tren subterráneo
o elevado
Tren de viajes largos
o de cercanías
Tren ligero, tranvía
o tranvía eléctrico
Lancha (ferry)

Sí ➔ PASE a la pregunta 41
No

suspendido(a) (on layoff) o lo(a)
descansaron de un empleo?

Automóvil, camión
o van
Autobús

semanas), ¿trabajó usted TODAS las
semanas? Incluya como trabajo vacaciones
pagadas, licencia por enfermedad pagada
y servicio en las Fuerzas Armadas.

Taxi
Motocicleta
Bicicleta

Sí, de vacaciones, enfermedad temporal,
licencia por maternidad, otras razones
personales o relacionadas con la
familia, mal tiempo, etc. ➔ PASE a la
pregunta 39

b. Durante los ÚLTIMOS 12 MESES (52
semanas), ¿cuántas SEMANAS trabajó
usted? Incluya vacaciones o licencias
pagadas e incluya semanas en que usted
solo trabajó por unas pocas horas.
Semanas

41 En las SEMANAS TRABAJADAS durante los
ÚLTIMOS 12 MESES, ¿cuántas horas trabajó
usualmente usted cada SEMANA?
Horas usualmente trabajadas cada SEMANA

No ➔ PASE a la pregunta 37
c. ¿Se le ha informado a usted que será
llamado(a) de nuevo a trabajar dentro
de los próximos 6 meses O se le ha dado
una fecha para regresar al trabajo?

Caminó

Sí ➔ PASE a la pregunta 38

Trabajó en esta
dirección ➔ PASE
a la pregunta 40a

No

Otro método

§.;"5¤

5

13260138

18 a. ¿Es usted sordo(a) o tiene una

21 ¿Cuál es su estado civil?

27 ¿Ha estado usted alguna vez en el servicio
militar activo en las Fuerzas Armadas, la
Reserva Militar o la Guardia Nacional de
los Estados Unidos? Marque (X) UNA casilla.

dificultad seria para oír?
Casado(a) actualmente
Sí

Viudo(a)

No

Divorciado(a)
Separado(a)

b. ¿Es usted ciego(a) o tiene una dificultad
seria para ver aunque lleve puestos
espejuelos o lentes?
Sí

Nunca se ha casado ➔ PASE a la sección F

22 En los PASADOS 12 MESES, ¿usted –
Sí

No

D

Conteste las preguntas 19a – c si usted tiene
5 años de edad o más. De lo contrario,
PASE a la sección J en la página 7 para
instrucciones adicionales; no conteste más
preguntas.

En servicio activo ahora

No

En servicio activo en el pasado, pero no
ahora

a. se casó?
b. enviudó?

28 ¿Cuándo estuvo usted en servicio militar
activo en las Fuerzas Armadas de los
Estados Unidos? Marque (X) una casilla para
CADA período durante el cual usted estuvo en
servicio militar, aunque fuera sólo por parte
del período.

c. se divorció?

23 ¿Cuántas veces ha estado usted casado(a)?
Una vez

19 a. Debido a una condición física, mental o
emocional, ¿tiene usted una dificultad
seria para concentrarse, recordar o
tomar decisiones?

Nunca estuvo en el servicio militar ➔ PASE
a la pregunta 30a
Servicio activo solamente para
entrenamiento de la Reserva Militar o la
Guardia Nacional ➔ PASE a la pregunta 29a

Dos veces

Septiembre del 2001 ó después

Tres veces o más

Agosto del 1990 a agosto del 2001
(incluyendo la Guerra del Golfo Pérsico)
Mayo del 1975 a julio del 1990

24 ¿En qué año se casó usted la última vez?
Año

Sí

Época de Vietnam (agosto del 1964 a
abril del 1975)
Febrero del 1955 a julio del 1964

No
b. ¿Tiene usted una dificultad seria para
caminar o subir las escaleras?
Sí

F

Guerra de Corea (julio del 1950 a enero
del 1955)
Enero del 1947 a junio del 1950

Conteste la pregunta 25 si usted es del sexo
femenino y tiene de 15 a 50 años de edad.
De lo contrario, PASE a la pregunta 26a.

No
c. ¿Tiene usted dificultad para vestirse o
bañarse?
Sí
No

Segunda Guerra Mundial (diciembre del
1941 a diciembre del 1946)
Noviembre del 1941 ó antes

25 ¿En los ÚLTIMOS 12 MESES, ¿ha dado a luz
usted?
Sí

29 a. ¿Tiene usted una clasificación de

No

26 a. ¿Tiene usted algún nieto menor de 18

E

Conteste la pregunta 20 si usted tiene 15
años de edad o más. De lo contrario,
PASE a la sección J en la página 7 para
instrucciones adicionales; no conteste más
preguntas.

20 Debido a una condición física, mental o

emocional, ¿tiene usted dificultad para
hacer diligencias o mandados solo(a), tal
como ir al consultorio de un médico o ir de
compras?
Sí
No

años que viva en este lugar?

4

§.;"G¤

Sí (tal como 0%, 10%, 20%, ... 100%)
No ➔ PASE a la pregunta 30a

Sí
No ➔ PASE a la pregunta 27
b. ¿Es usted actualmente responsable de la
mayoría de las necesidades básicas de
algunos de sus nietos menores de 18 años
que viven en este lugar?

b. ¿Qué por ciento de incapacidad
relacionada con el servicio militar tiene
usted?
0 por ciento
10 ó 20 por ciento

Sí
No ➔ PASE a la pregunta 27
c. ¿Cuánto tiempo hace que usted es
responsable de este(os) nieto(s)? Si
usted es responsable económicamente de más
de un nieto, conteste la pregunta para el nieto
del cual haya sido responsable por más tiempo.
Menos de 6 meses

3 ó 4 años

6 a 11 meses

5 años o más

1 ó 2 años

incapacidad de la VA relacionada con el
servicio?

30 ó 40 por ciento
50 ó 60 por ciento
70 por ciento o más

13260146

10

¿Cuál es el título o nivel escolar más alto que
usted ha COMPLETADO? Marque (X) UNA casilla.
Si está matriculado(a) actualmente, marque el grado
escolar anterior o el título más alto recibido.

12

¿Cuál es su ascendencia u origen étnico?

15

NO HA COMPLETADO NINGÚN GRADO
No ha completado ningún grado

(Por ejemplo: italiana, jamaicana, africana americana,
camboyana, de Cabo Verde, noruega, dominicana,
franco-canadiense, haitiana, coreana, libanesa, polaca,
nigeriana, mexicana, taiwanesa, ucraniana, entre otras.)

PRE-ESCOLAR O PRE-KINDER HASTA GRADO 12
Pre-escolar o pre-kinder
Kindergarten

13

a. En su hogar, ¿habla usted un idioma
que no sea inglés?

Sí
No

16

Sí

Grado 1 al 11 – Especifique
grado 1-11

No ➔ PASE a la pregunta 14a
b. ¿Qué idioma es ese?

Grado 12, SIN DIPLOMA

c. ¿Cuán bien habla usted el inglés?

Diploma de escuela secundaria o preparatoria

Bien

UNIVERSIDAD O ALGUNOS CRÉDITOS
UNIVERSITARIOS
Algunos créditos universitarios, pero menos de
1 año de créditos universitarios
1 año o más de créditos universitarios, sin título
Título asociado universitario (por ejemplo:
AA, AS)
Título de licenciatura universitaria (por ejemplo:
BA, BS)
DESPUÉS DEL TÍTULO DE LICENCIATURA
UNIVERSITARIA

c. Medicare, para personas que
tienen 65 años o más, o personas
con ciertos impedimentos

Muy bien

GED o examen equivalente

No bien

d. Medicaid, Medical Assistance
o cualquier tipo de plan de
asistencia gubernamental
para esas personas con un
ingreso bajo o incapacidad

No habla inglés

14

a. ¿Vivía usted en esta dirección hace 1 año?
Persona es menor de 1 año de edad ➔
PASE a la pregunta 16

e. TRICARE u otro seguro de
salud militar

Sí, en esta dirección ➔ PASE a la pregunta 15

f. VA (se ha registrado en el
sistema de cuidado de salud
militar de la VA)

No, fuera de los Estados Unidos y
Puerto Rico – Escriba en letra de molde
continuación el nombre del país extranjero o
las Islas Vírgenes de los EE.UU., Guam, etc.;
luego PASE a la pregunta 15

g. Servicio de Salud Indio
(Indian Health Service)
h. Cualquier otro tipo de seguro de
salud o plan de cobertura de
seguro de salud – Especifique

Título de maestría (por ejemplo: MA, MS, MEng,
MEd, MSW, MBA)
Título profesional más allá de un título de
licenciatura universitaria (por ejemplo: MD, DDS,
DVM, LLB, JD)
Título de doctorado (por ejemplo: PhD, EdD)

No, en una dirección diferente en los
Estados Unidos o Puerto Rico
b. ¿Dónde vivía usted hace 1 año?
Dirección
(Número y nombre de la calle)

B

11

C

Conteste la pregunta 17a si usted tiene
seguro de salud. De lo contrario, PASE a la
pregunta 18a.

17

a. ¿Tiene este plan una prima o cuota?
Una prima o cuota es una cantidad fija de
dinero que se paga regularmente para la
cobertura de salud. No incluye los copagos,
deducibles ni otros gastos, tales como los
costos de las medicinas recetadas.

Conteste la pregunta 11 si tiene un título
de licenciatura universitaria o más alto.
De lo contrario, PASE a la pregunta 12.

Esta pregunta se enfoca en su TÍTULO DE
LICENCIATURA UNIVERSITARIA. Por favor, escriba
en letra de molde el título específico de la
concentración de estudio de cualquier TÍTULO DE
LICENCIATURA UNIVERSITARIA específico(s) que
usted recibió. (Por ejemplo: ingeniería química,
enseñanza de educación primaria, o psicología
organizacional)

¿Tiene usted cobertura ACTUALMENTE de
cualquiera de los siguientes tipos de seguros de
salud o planes de cobertura de seguro de salud?
Marque “Sí” o “No” para CADA tipo de cobertura en
las respuestas a-h.
Sí
No
a. Seguro a través de su
empleador o sindicato
(union), actual o previo,
(de usted o de cualquier
otro miembro de la familia)
b. Seguro adquirido directamente
de una compañía de seguro
(por usted o por cualquier otro
miembro de la familia)

Por ejemplo: coreano, italiano, español, vietnamés

GRADUADO(A) DE ESCUELA SECUNDARIA
O PREPARATORIA

EN LOS ÚLTIMOS 12 MESES, ¿recibió usted
beneficios del gobierno por medio del Programa
de Cupones de Alimentos o SNAP (el Programa de
Asistencia Nutricional Suplementaria)? NO incluya
WIC, ni el Programa de Almuerzos Escolares, ni ayuda
de bancos de alimentos.

Nombre de la ciudad, pueblo, oficina de
correos, instalación o base militar

Nombre del condado de los Estados Unidos
o municipio en Puerto Rico

Nombre del estado
de los Estados Unidos
o anote Puerto Rico

Código Postal

Sí
No ➔ PASE a la pregunta 18a
b. ¿Recibe usted o algún otro miembro de la
familia un crédito fiscal o subsidio basado en
su ingreso como ayuda para pagar la prima o
cuota?
Sí
No

§.;"O¤

3

13260153

1

¿Cuál es su nombre? Escriba su nombre en
letra de molde. Incluya su número de
teléfono y la fecha de hoy. Solo nos
comunicaremos con usted si es necesario
para asuntos oficiales de la Oficina el Censo.
Apellido

Nombre

Inicial

5 ¿Cuál es su raza? Marque (X) una o más
casillas Y escriba los orígenes.

7 ¿Es usted ciudadano(a) de los Estados Unidos?
Sí, nació en los Estados Unidos ➔ PASE
a la pregunta 9a
Sí, nació en Puerto Rico, Guam, las Islas
Vírgenes de los Estados Unidos o las Islas
Marianas del Norte
Sí, nació en el extranjero de padre o
madre que es ciudadano(a) de los EE.UU.
Sí, es ciudadano(a) de los Estados Unidos
por naturalización. Escriba el año de
naturalización

Blanca – Escriba, por ejemplo, alemán,
irlandés, inglés, italiano, libanés,
egipcio, etc. C

Negra o afroamericana – Escriba, por
ejemplo, afroamericano, jamaiquino,
haitiano, nigeriano, etíope, somalí, etc. C

Código de área y número de teléfono
—
Fecha
Mes

2

Día

Femenino

¿Cuál es su edad y su fecha de nacimiento?
Para bebés menores de un año, no escriba la
edad en meses. Solo escriba 0.
Edad
(en años)

A

No, no es ciudadano(a) de los Estados Unidos

8 ¿Cuándo vino usted a vivir a los
Estados Unidos? Si usted vino a vivir a los
Estados Unidos más de una vez, escriba el último año.

Año

¿Cuál es su sexo? Marque (X) UNA casilla.
Masculino

3

Año

Indígena de las Américas o nativa de
Alaska – Escriba el nombre de la(s)
tribu(s) en la(s) que está inscrito(a) o
la(s) tribu(s) principal(es), por ejemplo,
Navajo Nation, Blackfeet Tribe, maya,
azteca, Native Village of Barrow Inupiat
Traditional Government, Nome Eskimo
Community, etc. C

Escriba los números en las casillas.
Año de
Mes
Día
nacimiento

NOTA: Por favor, conteste la Pregunta
4 sobre origen hispano Y la Pregunta 5
sobre raza. Para esta encuesta, origen
hispano no es una raza.

China

Japonesa

Filipina

Nativa de Hawái

India asiática

Samoana

Vietnamita

Chamorra

Coreana

Otra de las islas
del Pacífico –
Escriba, por
ejemplo,
tongano,
fiyiano, de
las Islas
Marshall, etc. C

Otra asiática –
Escriba, por
ejemplo,
pakistaní,
camboyano,
hmong, etc. C

9 a. En cualquier momento DURANTE LOS

ÚLTIMOS 3 MESES, ¿ha estudiado usted en
una escuela o universidad? Incluya sólo
pre-escolar o pre-kinder, kindergarten, escuela
elemental, enseñanza en el hogar y escuela
que conduce a un diploma de escuela
secundaria o un título universitario.
No, no ha estudiado durante los últimos
3 meses ➔ PASE a la pregunta 10
Escuela o universidad pública
Escuela o universidad privada o
enseñanza en el hogar

b. ¿A qué grado o nivel escolar asistía usted?
Marque (X) UNA casilla.
Pre-escolar o pre-kinder

4

¿Es usted de origen hispano, latino o
español?
No, no es de origen hispano, latino
o español
Sí, mexicano, mexicanoamericano,
chicano
Sí, puertorriqueño

Alguna otra raza – Escriba la raza o el
origen. C

Grado 1 al 12 – Especifique
grado 1-12

6 ¿Dónde nació usted?
En los Estados Unidos – Escriba en letra de
molde el nombre del estado.

Sí, cubano
Sí, otro origen hispano, latino o español –
Escriba, por ejemplo, salvadoreño,
dominicano, colombiano, guatemalteco,
español, ecuatoriano, etc. C

2

§.;"V¤

Kindergarten

Fuera de los Estados Unidos – Escriba en
letra de molde el nombre del país
extranjero, o Puerto Rico, Guam, etc.

Estudios universitarios al nivel de
licenciatura (freshman a senior)
Escuela graduada o profesional más
allá de una licenciatura universitaria
(por ejemplo, un programa de Maestría
o Doctorado o una escuela de medicina
o leyes)

13260161

DC

La Encuesta sobre la
Comunidad Estadounidense

This questionnaire is available in either English or Spanish.
Este cuestionario está disponible en español o en inglés.
To complete the Spanish questionnaire, begin on
page 2. To complete the English questionnaire, flip
this over and complete the blue side.

Para completar el cuestionario en español, comience
en la página 2. Para completar el cuestionario en
inglés, vírelo y complete el lado azul.

Please complete this form as soon as possible.
Place it in the envelope provided and HOLD it for a
census representative to return to pick it up.

Por favor, complete este cuestionario tan
pronto sea posible. Colóquelo en el sobre que se
provee y GUÁRDELO hasta que un representante del
censo lo venga a recoger.

If you need help or have questions about
completing this form, call the number that our
census representative has given you.

Si necesita ayuda o tiene preguntas sobre cómo
completar este cuestionario, llame al número de
teléfono que le ha dado nuestro representante del
censo.

For more information about the American
Community Survey, visit our web site at:
http://www.census.gov/acs

Para obtener más información sobre la Encuesta
sobre la Comunidad Estadounidense, vaya a nuestra
página en la Internet: http://www.census.gov/acs

ACS-1(GQ)(2020)

FORM
(03-26-2019) Draft 4

OMB No. 0607-0810

§.;"^¤
ACS-1GQ, Page 1, Base (Black)

ACS-1GQ, Page 1, Blue Pantone 313 (15%)

ACS-1GQ, Page 1, green Pantone 354 (20%)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Dear Resident:
The U.S. Census Bureau is conducting a very important survey called the American
Community Survey (ACS). The ACS is separate from the 2020 Census. This year, some
residents will be contacted by representatives from both the ACS and the 2020 Census. Your
response is required by U.S. law (Title 13, United States Code (U.S.C.), Sections 141, 193,
221,and 223).
An ACS field representative from the Census Bureau will conduct a personal interview with
you or you may complete the survey questionnaire yourself. We estimate this survey will take
about 25 minutes of your time. If you fill out the questionnaire yourself, please place it in the
envelope that the ACS field representative gave you. The field representative will arrange for a
convenient time to pick it up.
The ACS produces critical, up-to-date information that is used to meet the needs of
communities across the United States. For example, results from this survey may be used to
decide where new schools, hospitals, and fire stations are needed. The ACS estimates are
used by federal, tribal, state, and local governments to make decisions and to develop
programs that will provide healthcare, education, and transportation services that affect you
and your community.
The Census Bureau is required by law to keep your information confidential. We are not
permitted to publicly release your responses in a way that could identify you. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data. The Census Bureau can only use
your responses to produce statistics. The enclosed brochure provides answers to frequently
asked questions about the ACS.
If you have access to the Internet and want to learn more about the ACS, please visit the
Census Bureau’s Web site at: census.gov/acs. Thank you for your help.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-17(LZ)(GQ)(2020) (2-13-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Estimado señor o señora,
La Oficina del Censo de los EE. UU. está realizando una encuesta nacional muy importante
conocida como la Encuesta sobre la Comunidad Estadounidense (ACS, por sus siglas
en inglés). La ACS es una encuesta independiente del Censo del 2020. Este año, algunos
residentes serán contactados por representantes de la ACS y del Censo del 2020. Su respuesta
es requerida por la ley de los EE. UU. (Título 13 del Código de los EE. UU., Secciones 141, 193,
221 y 223).
Un representante de la Encuesta sobre la Comunidad Estadounidense realizará una entrevista
en persona con usted, o usted mismo puede completar el cuestionario de la encuesta.
Estimamos que esta encuesta tomará aproximadamente 25 minutos de su tiempo. Si usted
mismo contesta el cuestionario, por favor, échelo en el sobre que le entregó el representante de
la Encuesta sobre la Comunidad Estadounidense. El representante acordará con usted el mejor
momento para recogerlo.
La Encuesta sobre la Comunidad Estadounidense produce información actual y crítica que se
utiliza para satisfacer las necesidades de comunidades en todo los Estados Unidos. Por ejemplo,
puede que los resultados de esta encuesta se usen para decidir dónde se necesitan nuevas
escuelas, hospitales y estaciones de bomberos. El gobierno federal, los gobiernos de las tribus y
los gobiernos estatales y locales usan los estimados de la ACS para tomar decisiones y elaborar
programas que brinden atención médica, educación y servicios de transporte que le atañen a
usted y a su comunidad.
La Oficina del Censo de los EE. UU. está obligada por ley a mantener confidencial su
información. A la Oficina del Censo no se le permite divulgar sus respuestas de manera que
usted pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de seguridad
cibernética mediante los controles aplicados a los sistemas que trasmiten su información
(sección 9 del título 13 del Código de los Estados Unidos). Por ley, la Oficina del Censo
solamente puede usar sus respuestas para producir estadísticas. El folleto adjunto proporciona
respuestas a las preguntas más frecuentes acerca de la Encuesta sobre la Comunidad
Estadounidense.
Si tiene acceso a lnternet y desea obtener más información acerca de la Encuesta sobre la
Comunidad Estadounidense, visite el sitio de la Oficina del Censo por Internet en
census.gov/acs. Gracias por su ayuda.
Atentamente,

Steven D. Dillingham
Director
Documentos adjuntos

ACS-17(LZ)(GQ)(S)(2020) (2-20-2019)

census.gov

American Community Survey
Your Answers Are Confidential
The U.S. Census Bureau is conducting the American Community Survey. We appreciate your participation
and cooperation.
Your answers are required and confidential by law (Title 13, United States Code, Sections 9, 141, 193,
214, and 221). The U.S. Census Bureau is required by law to protect your information. The
Census Bureau is not permitted to publicly release your responses in a way that could identify you.
The Census Bureau estimates that this form will take about 25 minutes to complete, including the time for reviewing the instructions
and answers. Send comments regarding this burden estimate or any other aspect of this burden, to: Paperwork Reduction Project,
U.S. Census Bureau, 4600 Silver Hill Road, ADDC-4H277, Washington, DC 20233. You may e-mail comments to
[email protected]; use "Paperwork Project" as the subject.
Respondents are not required to respond to any information collection unless a valid approval number has been assigned by the
Officeof Management and Budget. The approval number for the American Community Survey is: OMB No. 0607-0810.

Thank you for your cooperation. The Census Bureau appreciates your help.
Para la traducción al español, véase al dorso. (For a Spanish translation, see the reverse side.)
ACS-21(GQ)

(12-2018)

Encuesta sobre la Comunidad Estadounidense
Sus Respuestas son Confidenciales
La Oficina del Censo de los EE.UU. está llevando a cabo la Encuesta sobre la Comunidad Estadounidense.
Agradecemos su participación y cooperación.
Sus respuestas son obligatorias y confidenciales por ley (secciones 9, 141,193, 214 y 221 del título 13 del
Código de los EE.UU.). La Oficina del Censo de los EE.UU. está obligada por ley a mantener confidencial
su información. A la Oficina del Censo no se le permite divulgar sus respuestas de manera que usted
pudiera ser identificado.
La Oficina del Censo estima que le tomará aproximadamente 25 minutos completar este cuestionario, incluyendo el tiempo para
repasar las instrucciones y respuestas. Si tiene algún comentario sobre el tiempo que toma completar este cuestionario o cualquier
otro aspecto de la recopilación debe enviarlo a: Paperwork Reduction Project, U.S. Census Bureau, 4600 Silver Hill Road,
ADDC-4H277, Washington, DC 20233. Puede dirigir sus comentarios por correo electrónico a [email protected]; y use como
referencia “Paperwork Project”.
No se requiere que las personas respondan a ninguna recopilación de información a menos que la Oficina de Administración y
Presupuesto le asigne un número de aprobación válido. El número de aprobación para la Encuesta sobre la Comunidad
Estadounidense es: Núm. de OMB 0607-0810.

Gracias por su cooperación. La Oficina del Censo agradece su ayuda.
For an English translation, see the reverse side. (Para la traducción al inglés, véase al dorso.)
ACS-21(GQ)

(12-2018)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Dear Resident:

On behalf of the U.S. Census Bureau, I thank you for participating in the American
Community Survey. The success of the survey depends upon cooperation from you
and the other residents selected for the survey. The U.S. Census Bureau is required
by law to keep your information confidential. The Census Bureau is not permitted to
publicly release your responses in a way that could identify you. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity
risks through screening of the systems that transmit your data.
Federal, tribal, state, and local governments will use summarized information from this
survey to make decisions that affect you and your community, and to develop
programs that will provide many goods and services, including health care, education,
and transportation. To learn more about the American Community Survey and to
review the survey results, visit our Web site at census.gov/acs.
Your participation is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(R)(2020) (2-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Estimado(a) residente:

En nombre de la Oficina del Censo de los EE. UU., le agradezco su participación en
la Encuesta sobre la Comunidad Estadounidense. EI éxito de esta encuesta depende
de la cooperación que recibimos de usted y de los residentes seleccionados para esta
encuesta. La Oficina del Censo de los EE. UU. está obligada por ley a mantener
confidencial su información. No se nos permite divulgar sus respuestas de manera
que usted pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento
de la Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los
riesgos de seguridad cibernética mediante los controles aplicados a los sistemas que
trasmiten su información.
El gobierno federal y los gobiernos tribales, estatales, y locales usarán información
resumida de esta encuesta para tomar decisiones que les conciernen a usted y su
comunidad, y para elaborar programas que proporcionarán muchos bienes y servicios,
incluso atención médica, educación y transporte. Para obtener más información
acerca de la Encuesta sobre la Comunidad Estadounidense y para revisar los
resultados de la encuesta, visite nuestro sitio en Internet en census.gov/acs.
Le agradecemos mucho su participación.
Atentamente,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(R)(2020) (2-2019)
census.gov

DC
Your Guide for
THE

American
Community
Survey
Group Quarters
This guide gives helpful information on completing
your survey form. This guide is bilingual. The Spanish
text begins on the back cover of this booklet. If you
need more help, call the number that the Census Field
Representative provided for you. After you have
completed your survey form, please place the form
in the envelope we have provided. A Census Field
Representative will return to pick it up.
Esta guía está disponible en español e inglés. Para
la versión en español, vire la guía y comience en la
parte posterior.

ACS-30(GQ)(2020) (8-2018)

Page
Your Answers are Con dential and Required by Law

3

What the Survey is About — Some Questions and Answers

4

Why the Census Bureau Asks Certain Questions

4

How to Fill Out the American Community Survey Form

5

Examples of Printed and Marked Entries

5

Instructions for Completing the Survey Questions

5

Your Answers are Con dential and Required by Law
The U.S. Census Bureau is required by law to keep your information
con dential. The Census Bureau is not permitted to publicly release your
responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data.
The same law that protects the con dentiality of your answers requires
that you provide the information asked in this survey to the best of your
knowledge.

ACS-30(GQ)(2019) (8-2018)

Page 3

What the Survey is About – Some Questions
and Answers
Why are we taking a survey?
The Census Bureau is conducting the American Community Survey to provide
more timely data than data we typically collect only once every 10 years
during the decennial census.
What does the Census Bureau do with the information you provide?
The American Community Survey will be the source of summarized data that
we make available to federal, state, and local governments, and also to the
public. The data will enable your community leaders from government,
business, and non-pro t organizations to plan more effectively.
Why did you select this Group Quarters (GQ) facility and how
did I get selected?
Group quarters facilities are randomly selected each year from a sample list
of all group quarters in your area. The larger the group quarters, the greater
the probability that it will be selected to participate in the survey one or
more times each year. From a list provided by the GQ contact person of all
residents currently staying at the GQ, eld representatives randomly select
residents to take part in this survey. One of the advantages of a random
sample is that we can use it to measure the whole population without
having to actually interview every person at every GQ. But in order for it to
work, we cannot substitute sampled facilities or individuals -- the sample has
to be truly random. Your participation is very important to us to be able to
produce accurate information from this survey.

Why the Census Bureau Asks Certain Questions
Here are reasons we ask some of the questions on the survey.
Name
Names help make sure that we don’t duplicate persons selected at this place for
the survey. Individual identities are kept con dential.
Place of birth
This question provides information used to study long-term trends about where
people move and to study migration patterns and differences in growth patterns.
Job
Answers to the questions about the jobs people hold provide information on the
extent and types of employment in different areas of the country. From this
information, communities can develop training programs, and business and local
governments can determine the need for new employment opportunities.
Income
Income helps determine how well families or persons live. Income information
makes it possible to compare the economic levels of different areas, and how
economic levels for a community change over time. Funding for many government
programs is based on the answers to these questions.
Education
Responses to the education questions in the survey help to determine the number of
new public schools, education programs, and daycare services required in a community.
Disability
Questions about disability provide the means to allocate federal funding for
healthcare services and new hospitals in many communities.
ACS-30(GQ)(2019) (8-2018)

Page 4

How to Fill Out the American Community Survey Form
Use blue or black ink to complete the form. Please mark the category or
categories as they apply to you. Some questions ask you to print the information.
See examples below.
Make sure you answer all the questions that apply to you. Read these instructions
and also follow the instructions provided throughout the questionnaire. These
instructions will help you understand the questions and to answer them correctly.
If you need assistance, call the number that the eld representative has provided
to you.

Examples of Printed and Marked Entries
13

a. Do you speak a language other than
English at home?

X

Yes

No ➜ SKIP to question 14a

b. What is this language?

Korean
For example: Korean, Italian, Spanish,
Vietnamese
23 In what year did you last get married?
Year

2 0 0 8

Instructions for Completing the Survey Questions
The questionnaire is a bilingual form. One side is in English and
the other is in Spanish.
1. Print your Last Name, First Name, and Middle Initial (MI) in the spaces
provided.
Enter your telephone number, including area code, and today’s date in
the boxes provided.
2. Mark one box to indicate your biological sex.
3. Print your age and month, day, and year of birth. Print your age at your last
birthday. Do not round your age up if you are close to having a birthday. If you
do not know your exact age, provide an estimate. Print "0" for babies less than
1 year old.
ACS-30(GQ)(2019) (8-2018)

Page 5

Please answer BOTH question 4 about Hispanic origin and
question 5 about race. For this survey, Hispanic origins are not
races.
4. You are of Hispanic, Latino, or Spanish origin if your origin (ancestry) is Mexican,
Mexican American, Chicano, Puerto Rican, Cuban, Argentinean, Colombian,
Costa Rican, Dominican, Ecuadorian, Guatemalan, Honduran, Nicaraguan,
Peruvian, Salvadoran, from other Spanish-speaking countries of Central or South
America or from Spain.
The term Mexican Am. refers to persons of Mexican-American origin or
ancestry.
If you mark the "Yes, another Hispanic, Latino, or Spanish origin" box,
print the name of the speci c origin.
If you are not of Hispanic, Latino, or Spanish origin, answer this question by
marking the "No, not of Hispanic, Latino, or Spanish origin" box.
This question should be answered by all individuals.
5. Mark all boxes for the appropriate races.
The concept of race, as used by the Census Bureau, re ects self-identi cation
by individuals according to the race or races with which they identify.
The instruction before question 4, "For this survey, Hispanic origins are not
races" re ects the federal government’s treatment of Hispanic origin and
race as separate and distinct concepts. People who identify their origin as
Hispanic, Latino, or Spanish may be of any race.
People may choose to provide two or more races either by marking two or
more race response boxes, by providing multiple write-in responses, or by
some combination of marking boxes and writing in responses.
If you mark the "American Indian or Alaska Native" box, print the name
of your enrolled or principal tribe(s) in the space provided (for example,
Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, Mayan, Doyon,
Native Village of Barrow Inupiat Traditional Government, and so on).
If you mark the "Other Asian" box, print the name of the speci c Asian
group(s) in the space provided (for example, Pakistani, Cambodian, Hmong,
Thai, Laotian, Bangladeshi, and so on).
If you mark the "Other Paci c Islander" box, print the name of the speci c
Paci c Islander group(s) in the space provided (for example, Tongan, Fijian,
Marshallese, Palauan, Tahitian, Papua New Guinean, and so on).
If you mark the "Some other race" box, print the name of the speci c
group(s) in the space provided.
This question should be answered by all individuals.

ACS-30(GQ)(2019) (8-2018)

Page 6

6.

For people born in the United States:
Mark the "In the United States" box and then print the name of the state
in which you were born. If you were born in Washington, D.C., print
"District of Columbia."
For people born outside the United States:
Mark the "Outside the United States" box, and then print the name of
the foreign country or Puerto Rico, Guam, etc. where you were born. Use
current boundaries, not boundaries at the time of your birth. For example,
specify Czech Republic or Slovakia, not Czechoslovakia; North or South
Korea, not Korea. Specify the particular country, not region. For example,
specify Jamaica, not West Indies; Kenya, not East Africa.

7.

If you were born in the United States (50 states and the District of Columbia),
mark the "Yes, born in the United States" box. If you were born in
Puerto Rico, Guam, the U.S. Virgin Islands, or Northern Marianas, mark the
"Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or Northern
Marianas" box. Although not listed, if you were born in American Samoa,
mark "Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or
Northern Marianas" box. If you were born outside the United States (50
states and the District of Columbia) or at sea and had at least one parent who
was a U.S. citizen at the time of your birth, mark the "Yes, born abroad of
U.S. citizen parent or parents" box. Mark the "Yes, U.S. citizen by
naturalization" box only if you were born outside the United States (50
states and the District of Columbia) and have completed the naturalization
process and are now a United States citizen. In the box below "Print year of
naturalization," enter the four-digit year you completed the formal
naturalization process. If you are not a U.S. citizen, mark the "No, not a U.S.
citizen" box. Legal Permanent Residents (LPRs) or "green card" holders, or
other non-naturalized immigrants or visitors to the U.S. are not citizens of the
United States and therefore should mark the "No, not a U.S. citizen" box.

9a.

A public school is any school or college that is supported and controlled
primarily by a local, county, state, or federal government. Schools are private
if supported and controlled primarily by religious organizations or other
private groups. Home school applies to parental guided education outside of
a public or private school for grades 1–12.

9b.

Only record grades that you attended in the LAST 3 MONTHS. If this is
currently a summer month, do not record grades you will attend in the
future.

ACS-30(GQ)(2019) (8-2018)

Page 7

10. Mark only ONE box to indicate the highest grade or level of schooling you
have COMPLETED or the highest degree you have received.
Report schooling completed in foreign or ungraded schools as the equivalent
level of schooling in the regular American school system.
Mark the "GED or alternative credential" box if you did not receive a
regular high school diploma but completed high school by receiving a GED or
other formal recognition of high school completion from a school or
governmental authority.
If you have not completed any college courses for credit, mark the highest
level completed below college level. If you have not completed enough credit
to be counted as a sophomore, mark the "Some college credit, but less
than 1 year of college credit" box.
For the "Professional degree beyond a bachelor’s degree" category, do
not include certi cates or diplomas for training in speci c trades or
occupations, such as computer and electronics technology, medical assistant,
or cosmetology. DO NOT include post-bachelor’s certi cates that are related
to occupational training in such elds as teaching, accounting, or engineering.
11. Answer this question only if you have a bachelor’s degree or higher and
print the speci c major of your BACHELOR’S DEGREE. If you have more
than one bachelor’s degree or more than one major, print the names of
the speci c majors for all of your bachelor’s degree(s).
12. Print your ancestry group(s). Ancestry refers to your ethnic origin or
descent, "roots," or heritage. Ancestry may also refer to your country of
birth or that of your parents or ancestors before their arrival in the United
States. This question should be answered by all individuals, regardless of
race, Hispanic origin, or place of birth.
Do not report a religious group as your ancestry.
You may report two ancestry groups (for example: German, Irish).
13a. Mark the "Yes" box if you sometimes or always speak a language
other than English at home.
Mark the "No" box if you speak only English, or if a non-English language is
spoken only at school or is limited to a few expressions or slang.
13b. If you speak more than one non-English language and cannot determine
which is spoken more often, report the one you rst learned to speak.

ACS-30(GQ)(2019) (8-2018)

Page 8

14a. If you did not live in the United States or Puerto Rico one year ago, mark
the "No, outside the United States and Puerto Rico" box and print the
name of the foreign country, or U.S. Virgin Islands, Guam, etc., where you
lived. Be speci c when printing the name of the foreign country; for
example, specify Czech Republic or Slovakia, not Czechoslovakia; North or
South Korea, not Korea. Specify the particular country, not region. For
example, specify Jamaica, not West Indies; Kenya, not East Africa. Then SKIP
to question 15.
If you lived somewhere else in the United States or Puerto Rico one year ago,
mark the "No, at a different address in the United States or
Puerto Rico" box.
14b. Include the house or structure number; street name; street type (for
example, St., Road, Ave.); and the street direction (if a direction such as
"North" is part of the address). For example, print 1239 N. Main St.
or 1239 Main St., N.W., not just 1239 Main. If you lived in Puerto Rico, the
address should also include the name of the development or building.
If the only known address is a post of ce box, give a description of the
location. For example, print the name of the building where you lived, the
nearest intersection, the name of a military base or installation, or the
nearest street where the building was located, etc. DO NOT give a post
of ce box number.
Print the name of the U.S. county or the name of the municipio in Puerto
Rico. If you lived in Louisiana, print the parish name in the "Name of U.S.
county or municipio in Puerto Rico" space. If you lived in Alaska, print
the borough or census area name, if known. If you lived in New York City
and the county name is not known, print the borough name. If you lived in
an independent city (not in any county) or in Washington, D.C., leave the
"Name of U.S. county or municipio in Puerto Rico" space blank.
15.

On October 1, 2008, the federal Food Stamp Program was renamed SNAP
(Supplemental Nutrition Assistance Program). Some states may have their
own speci c name for this program. If you received bene ts from the
government to buy food for your family using a bene t card, mark the
"Yes" box.

16.

Mark the "Yes" or "No" box for each part of question 16.
If you report any other type of coverage plan in question 16h, specify the
type of coverage or name of the plan in the write-in box. DO NOT include
plans that cover only one type of health care (such as dental plans) or plans
that only cover a person in case of an accident or disability.

17a–17b.
If you have more than one type of health insurance, answer these questions
while thinking about your primary health insurance.

ACS-30(GQ)(2019) (8-2018)

Page 9

Answer questions 19a through 19c if you are 5 years old or over.
19a–19c.
Mark the "Yes" or "No" box to indicate if you have serious dif culty with
any of the activities listed in parts a, b, and c because of a physical, mental,
or emotional condition.

Answer questions 20 through 44 if you are 15 years old or over.
21.

Mark the "Now married" box if you are married regardless of whether
you are living with your spouse, unless you are separated. If your only
marriage was annulled, mark the "Never married" box. Mark the
"Divorced" box only if you have received a divorce decree.

22.

Mark the "Yes" box only if you have received a divorce decree in the
PAST 12 MONTHS.

23.

Do not count marriages that ended in annulment.

24.

Enter the four-digit year when you last got married, even if you are now
widowed, divorced, or separated.

Answer question 25 if you are female and 15–50 years old.
25.

Mark the "Yes" box if you have given birth to at least one child born alive
in the PAST 12 MONTHS, even if the child died or no longer lives with you.
Do not consider miscarriages, or stillborn children, or any adopted, foster, or
stepchildren.

27.

Active duty means full-time service as a member of the Army, Navy, Air
Force, Marine Corps, Coast Guard, or as a commissioned of cer of the Public
Health Service or the National Oceanic and Atmospheric Administration, or
its predecessors, the Coast and Geodetic Survey or Environmental Science
Service Administration. Active duty does not include active duty for training.
For service in the military Reserves or National Guard, mark the “Only on
active duty for training in the Reserves or National Guard" box if you
have never been called up for active duty, mobilized, or deployed. For
service only as a civilian employee or civilian volunteer for the Red Cross,
USO, Public Health Service, or War or Defense Department, mark the
"Never served in the military" box. For Merchant Marine service, count
only the service during World War II as active duty and no other period of
service.

28.

Mark as many responses as apply.

29a. Mark the "Yes" box if you have a Department of Veterans Affairs (VA)
service-connected disability rating.
29b. Mark the "0 percent" box if you have received a service-connected disability
rating of zero. DO NOT mark the box showing "0 percent" to indicate no
rating.

ACS-30(GQ)(2019) (8-2018)

Page 10

30a–30b.
Count as work – Mark the "Yes" box if you performed:
● Work for someone else for wages, salary, piece rate, commission, tips, or
payments "in kind" (for example, food or lodging received as payment
for work performed).
● Work in own business, professional practice, or farm.
● Any work in a family business or farm, paid (for any amount of time) or
without pay (for 15 or more hours per week).
● Any part-time work including babysitting, paper routes, etc.
● Active duty in Armed Forces.
Do not count as work – Mark the "No" box if your activities
were limited to the following:
● Housework or yard work at home.
● Unpaid volunteer work.
● School work done as a student.
● Work done as a resident or inmate of an institutional facility (like a
nursing facility or correctional facility).
31.

Include the building or structure number; street name; street type (for
example, St., Road, Ave.); and the street direction (if a direction such as
"North" is part of the address). For example, print 1239 N. Main St. or 1239
Main St., N.W. not just 1239 Main.
If the only known address is a post of ce box, give a description of the
work location. For example, print the name of the building or shopping
center where you work, the nearest intersection, or the nearest street
where the workplace is located, etc. DO NOT give a post of ce box
number.
If you worked at a military installation or military base that has no street
address, report the name of the military installation or base, and a
description of the work location (such as building number, building name,
nearest street or intersection).
If you worked at several locations, but reported to the same location each
day to begin work, print the street address of the location where you
reported. If you did not report to the same location each day to begin
work, print the address of the location where you worked most of the
time last week.
If your employer operates in more than one location (such as a grocery
store chain or public school system), print the street address of the location
or branch where you worked. If the street address of a school is not
known, print the name of the school, and a description of the location
(such as the nearest street or intersection).
If you worked on a college or university campus and the street address
of the workplace is not known, print the name of the building where
you worked, and a description of the location (such as the nearest
street or intersection).
If you worked in a foreign country or Puerto Rico, Guam, etc., print the
name of the country on the state or foreign country line.

ACS-30(GQ)(2019) (8-2018)

Page 11

32.

Mark only one box to indicate the method of transportation used to travel
the longest distance to work LAST WEEK.
● Mark the "Car, truck, or van" box if you drove a station wagon,
company car, light truck of 1-ton capacity or less, truck cab, mini bus, or
private limousine (NOT for hire).
● Mark the "Subway or elevated rail" box if you took a subway, or
other vehicle that operates on tracks or rails with complete separation
from other vehicle and pedestrian traf c.
● Mark the "Long-distance train or commuter rail" box if you took
long distance rail service such as Amtrak, or a commuter train (also called
metropolitan rail, regional rail, or suburban rail) that operates between a
central city and surrounding suburbs or other central cities. This does not
include rail systems that predominantly offer intercity rail service, which is
often referred to as subway, metro, or heavy rail.
● Mark the "Light rail, streetcar, or trolley" box if you rode light rail,
streetcar, trolley, cable car, tramway or other vehicle that operates on
tracks or rails. Such vehicles are often driven electrically via overhead wires.
● Mark the "Taxicab" box if you took a limousine such as an airport
limousine for which a fare is charged.
● Mark the "Motorcycle" box if you rode a motorbike, moped, motor
scooter, or similar vehicle that is motor driven.
● Mark the "Bicycle" box if you rode a bicycle or other vehicle that is
pedaled.
● Mark the "Walked" box ONLY if you walked all the way to work and
used no other means of transportation.
● Mark the "Worked from this address" box if you worked on a farm
where you live, or an of ce or shop in your own home.
● Mark the "Other method" box if you took an airplane, helicopter,
horse, horse and buggy, boat (other than public ferries), large motor
home, dog sled, large truck or truck rig, All-Terrain Vehicle (ATV), snow
machine/snowmobile, Segway® or other self-balancing electric vehicle,
skateboard, inline skates, or motorized chair.

Answer question 33 if you marked "Car, truck, or van" in
question 32.
33.

If you were driven to work by someone who then drove back home or to a
non-work destination, enter "1" in the box labeled "Person(s)."
DO NOT include persons who rode to school or some other non-work
destination in the count of persons who rode in the vehicle.

34.

Give the time of day your trip to work usually begins. DO NOT give
the time that you usually began your work.
If you usually left to go to work sometime between 12:00 o’clock
midnight and 12:00 o’clock noon, mark "a.m."
If you usually left to go to work sometime between 12:00 o’clock noon and
12:00 o’clock midnight, mark "p.m."

35.

Travel time is from door to door. Enter a one-way commute time for your
usual daily commute to work LAST WEEK. Include time waiting for public
transportation or picking up passengers in a carpool.
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Answer questions 36 through 39 if you did NOT work last
week.
36a. You are on layoff if you are waiting to be recalled to a job from which
you were temporarily separated for business-related reasons.
36b. If you work only during certain seasons or on a day-by-day basis when work
is available, mark the "No" box.
36c. If you were informed by your employer, either formally or informally, that
you will be recalled within the next 6 months, mark the "Yes" box. Also
mark the "Yes" box if you have been given, formally or informally, a
speci c date to return to work, even if that date is more than 6 months
away.
37.

Mark the "Yes" box if you tried to get a job or start a business or
professional practice at any time in the LAST 4 WEEKS; for example,
registered at a public or private employment of ce, went to a job interview,
placed or answered employment ads, or did anything toward starting a
business or professional practice.

38.

If you were expecting to report to a job within 30 days, mark the
"Yes, could have gone to work" box.
Mark the "No, because of own temporary illness" box only if you expect
to be able to work within 30 days.
If you could not have gone to work because you were going to school,
taking care of children, etc., mark the "No, because of all other reasons
(in school, etc.)" box.

39.

Refer to the instructions for questions 30a–30b to determine what to
count as work. Mark the "Over 5 years ago or never worked" box if
you: (1) never worked at any kind of job or business, either full or part
time, (2) never worked, with or without pay, in a family business or
farm, and (3) never served on active duty in the Armed Forces.

40a–40b.
Refer to the instructions for questions 30a–30b to determine what to count
as work. Include paid vacation, paid sick leave, and military service. Count
every week in which you worked at all, even for an hour.
41.

If the hours worked each week varied considerably in the PAST 12
MONTHS, give an approximate average of the hours worked each week.

Answer questions 42a through 42f if you worked in the past
5 years.
42a. If you worked for a cooperative, credit union, mutual insurance company, or
similar organization, mark the "Non-pro t organization (including
tax-exempt and charitable organizations)" box.
If you worked for a public school, college or university, mark the appropriate
government category. For example, mark the "Local government (for
example: city or county school district)" box for a county-run community
college or city-run public school. Mark the "State government (including
state colleges/universities)" box for a state university.
Employees of foreign governments, the United Nations, and other
international organizations should mark the "Federal government civilian
employee" box.
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42b. If you worked for a company, business, or government agency, print the
name of the company, not the name of your supervisor. If you worked for
an individual or a business that had no company name, print the name of
the individual you worked for. If you worked in your own un-named
business, print "self-employed." If you marked "Active duty U.S. Armed
Forces or Commissioned Corps," print the name of the branch of the
Armed Forces. For Commissioned Corps, enter U.S. Public Health Service or
NOAA Commissioned Corps.
42c. Describe the business, industry, or individual employer named in question
42b. If there is more than one activity, describe only the major activity at
the place where you worked. Describe what is made, what is sold, or what
service is given.
Enter descriptions like the following: urgent care center, certi ed public
accounting rm, of ce supplies manufacturing company.
42d. Mark one box to indicate the main type of business or industry where
you work or worked.
42e. Describe the kind of work you did. If you were a trainee, apprentice, or
helper, include that in the description.
Enter descriptions like the following: registered nurse, human resources
manager, industrial engineer.
If possible, avoid single words such as: nurse, manager, or engineer.
42f. Describe the most important activities or duties you performed for your job.
Enter descriptions like the following: coordinate patient care and
administer medications, direct hiring policies and advise supervisors on
employee relations matters, design control systems to ensure product
quality.

Answer questions 43 through 44 if you are 15 years old
or over.
Mark the "Yes" or "No" box for each type of income, and enter the amount
received IN THE PAST 12 MONTHS for each "Yes" response.
If income from any source was received jointly, report the amount you earned
or received, not the total amount you and the other person received jointly.
DO NOT include the following as income in any item:
●
●
●
●
●
●
43a.

Refunds or rebates of any kind
Withdrawals from savings of any kind
Capital gains or losses from the sale of homes, shares of stock, etc.
Inheritances or insurance settlements
Any type of loan
Pay in-kind such as food, free rent

Include wages and salaries before deductions from all jobs. Be sure to
include any tips, commissions, or bonuses. Owners of incorporated businesses
should enter their salary here. Military personnel should include base pay plus
cash housing and/or subsistence allowance, ight pay, uniform allotments,
reenlistment bonuses.

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43b. Report income from incorporated businesses under wages and salary
(question 43a), and not under self-employment. Include nonfarm pro t (or
loss) from self-employment in sole proprietorships and partnerships. Mark the
"Loss" box if there is a loss. Exclude pro t (or loss) of incorporated
businesses you own.
Include farm pro t (or loss) from self-employment in sole proprietorships and
partnerships. Mark the "Loss" box if there is a loss. Exclude pro t (or loss) of
incorporated farm businesses you own. Also exclude amounts from land
rented for cash but include amounts from land rented for shares.
43c. Include interest received or credited to checking and saving accounts, money
market funds, certi cates of deposit (CDs), IRAs, KEOGHs, and government
bonds.
Include dividends received, credited, or reinvested from ownership of stocks
or mutual funds.
Include pro t (or loss) from royalties and the rental of land, buildings or real
estate, or from roomers or boarders. Mark the "Loss" box if there is a loss.
Income received by self-employed persons whose primary source of income is
from renting property or from royalties should be included in 43b. Include
regular payments from an estate or trust fund.
43d. Include amounts, before Medicare deductions, of Social Security and/or
Railroad Retirement payments you received as a retired person, as a
dependent of deceased insured workers, and as a disabled worker.
43e. Include Supplemental Security Income (SSI) received as an elderly, blind, or
disabled person.
43f. Include any public assistance or welfare payments you received by check or
electronic transfer from the state or local welfare of ce, even if received
for only one month or less than a year. Include bene ts received on behalf
of children. These payments are sometimes referred to as Temporary
Assistance for Needy Families (TANF), Aid to Families with Dependent
Children (AFDC), Aid to Dependent Children (ADC), Welfare or welfare to
work, General Assistance, General Relief, Emergency Assistance, and
Diversion Payments. Do not include assistance received from private
charities.
Do not include Supplemental Security Income (SSI), food assistance (such as
food stamps and bene ts from Supplemental Nutrition Assistance Program,
or SNAP), rental assistance, education assistance, child care assistance,
transportation assistance, or assistance with heating or cooling costs or
any other energy assistance (such as Low Income Home Energy Assistance
Program, or LIHEAP).
43g. Include regular income from a company pension, union pension, Federal
government pension, state government pension, local government pension,
U.S. Railroad pension, KEOGH retirement plan, SEP (Simpli ed Employee
Pension), U.S. military pension or any other type of pension, retirement
account or annuity such as IRA, Roth IRA, 401(k) or 403(b).
Include survivor income paid to spouses or children of a deceased person.
Include regular income from a disability pension paid to those who are
unable to work due to a disability.
Do not include Social Security or income that is “rolled over” or reinvested
in another retirement account.
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43h. Include Veterans’ (VA) disability compensation and educational assistance
payments (VEAP); unemployment compensation, worker’s compensation,
child support or alimony; and all other regular payments such as Armed
Forces transfer payments, assistance from private charities, regular
contributions from persons not living with you.
44.

Add the total entries (subtracting losses) for 43a through 43h for the
PAST 12 MONTHS and enter that number in the space provided. Mark
the "Loss" box if there is a loss. Print the total amount in dollars.

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DC
Su guía para
LA

Encuesta Sobre
La Comunidad
Estadounidense
Alojamientos de grupo
Esta guía provee información que le ayudará a
completar el cuestionario. Esta guía es bilingüe. El
texto en español empieza en la contracubierta de
este folleto. Si necesita más ayuda, llame al número
de teléfono que el Representante del Censo le
indicó. Después de que haya completado el
cuestionario, por favor, devuélvalo en el sobre
que le hemos provisto. Un Representante del Censo
regresará a recogerlo.
This guide is available in Spanish and English. For
the English version, ip the guide over and begin
on the back page.

ACS-30(GQ)(2020) (8-2018)

Página
Sus Respuestas son Con denciales y Requeridas por Ley

3

De Qué Trata la Encuesta – Algunas Preguntas y Respuestas 4
Por Qué la O cina del Censo Hace Ciertas Preguntas

4

Cómo Completar el Cuestionario para la Encuesta
Sobre la Comunidad Estadounidense

5

Ejemplos de Entradas Escritas y Marcadas

5

Instrucciones para Completar las Preguntas de la Encuesta

5

Sus Respuestas son Con denciales y Requeridas por Ley
La O cina del Censo de los EE.UU. está obligada por ley a mantener
con dencial su información. A la O cina del Censo no se le permite
divulgar sus respuestas de manera que usted pudiera ser identi cado.
En conformidad con la Ley para el Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus datos están protegidos contra los
riesgos de seguridad cibernética mediante los controles aplicados a los
sistemas que trasmiten su información.
La misma ley que protege la con dencialidad de sus respuestas requiere
que usted provea la información que se le pide según su mejor
conocimiento.

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Página 3

De Qué Trata la Encuesta – Algunas Preguntas y Respuestas
¿Por qué hacemos una encuesta?
La O cina del Censo está llevando a cabo la Encuesta sobre la Comunidad
Estadounidense para proveer datos más actualizados que los que generalmente
se recopilan sólo una vez cada 10 años durante el censo decenal.

¿Qué hace la O cina del Censo con la información que usted provee?
La Encuesta sobre la Comunidad Estadounidense será la fuente de datos resumidos
que ponemos a la disposición del gobierno federal, los gobiernos estatales y
locales, y del público. Los datos ayudarán a los líderes de su comunidad en el
gobierno, negocios y organizaciones sin nes de lucro a planear e cazmente.

¿Por qué se seleccionó este Alojamiento de Grupo (GQ) y cómo fue
seleccionado?
Cada año, se seleccionan al azar las instalaciones de alojamientos de grupo (GQ)
basada en una lista de muestra de todos los alojamientos de grupo de su área.
Mientras más grande es el alojamiento de grupo, mayor es la probabilidad de ser
seleccionado para participar en la encuesta una o más veces cada año. La persona
contacto del GQ suministra una lista de todos los residentes que se quedan
actualmente en el GQ. De esta lista, los representantes del Censo seleccionan
residentes al azar para participar en esta encuesta. Una de las ventajas de la
muestra al azar es que nos permite medir la población total sin tener que
entrevistar a cada persona en cada GQ. Para que esto funcione, no podemos
sustituir instalaciones o a individuos en la muestra; la muestra tiene que ser
verdaderamente al azar. Su participación es muy importante para nosotros,
porque nos permite producir información precisa de esta encuesta.

Por Qué la O cina del Censo Hace Ciertas Preguntas
A continuación se indican las razones por las cuales hacemos algunas de las
preguntas en la encuesta.

Nombre
Los nombres ayudan a asegurar que las personas seleccionadas en este lugar para
la encuesta no se listen dos veces. Las identidades de los individuos se mantienen
con denciales.

Lugar de nacimiento
Esta pregunta provee información que se usa para estudiar tendencias a largo
plazo de la movilidad de las personas y para estudiar patrones de migración y
diferencias en el aumento de la población.

Empleo
Las respuestas a las preguntas sobre el empleo de las personas proveen
información sobre la variedad y los tipos de empleo en las diferentes áreas del
país. Utilizando esta información, las comunidades pueden desarrollar programas
de entrenamiento, y los negocios y gobiernos locales pueden determinar la
necesidad de nuevas oportunidades de empleo.

Ingreso
El ingreso ayuda a determinar cuán bien viven las familias o las personas. La
información sobre ingreso hace posible comparar los niveles económicos de
diferentes áreas y cómo los niveles económicos de una comunidad cambian a
través del tiempo. Los fondos para muchos programas gubernamentales se basan
en las respuestas a estas preguntas.
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Página 4

Educación
Las respuestas a las preguntas sobre educación en la encuesta ayudan a
determinar el número de escuelas públicas, programas de educación y servicios de
cuidado diurno nuevos que se requieren en una comunidad.

Impedimentos
Las preguntas sobre impedimentos proveen los medios de asignar fondos
federales para servicios de salud y nuevos hospitales en muchas comunidades.

Cómo Completar el Cuestionario para la Encuesta Sobre la
Comunidad Estadounidense
Use un bolígrafo de tinta azul o negra para completar el cuestionario. Por favor,
marque la categoría o categorías según le apliquen a usted. Algunas preguntas le
piden que escriba la información en letra de molde. Vea los Ejemplos a continuación.
Cerciórese de contestar todas las preguntas que le apliquen a usted. Lea las
instrucciones y siga los pasos mientras completa el cuestionario. Estas instrucciones
le ayudarán a comprender las preguntas y contestarlas correctamente. Si necesita
ayuda, llame al número de teléfono que el representante del Censo le indicó.
Ejemplos de Entradas Escritas y Marcadas
13

a. En su hogar, ¿habla usted un idioma
que no sea inglés?

X

Si
No ➜ PASE a la pregunta 14a

b. ¿Qué idioma es ese?

coreano
Por ejemple: coreano, italiano, español,
vietnamés

23 ¿En qué año se casó usted la última vez?
Año

2 0 0 8

Instrucciones para Completar las Preguntas de la Encuesta
Este cuestionario es un formulario bilingüe. Un lado está en español y el otro
lado está en inglés.
1. Escriba en letra de molde su apellido, nombre e inicial (MI) en los espacios
que se proveen.
Entre su número de teléfono, incluyendo el código de área, y la fecha de
hoy en las casillas que se proveen.
2. Marque una casilla para indicar su sexo biológico.
3. Escriba su edad y el mes, día y año de nacimiento. Escriba su edad en su
último cumpleaños. No redondee su edad si está a punto de cumplir años. Si
usted no sabe su edad exacta, provea un estimado. Escriba “0” para los bebés
que tengan menos de 1 año de edad.
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Página 5

Por favor, conteste la pregunta 4 sobre origen hispano y la pregunta 5
sobre raza. Para esta encuesta, origen hispano no es una raza.
4. Usted es de origen hispano, latino o español si su origen (ascendencia) es
mexicano, mexicano americano, chicano, puertorriqueño, cubano, argentino,
colombiano, costarricense, dominicano, ecuatoriano, guatemalteco,
hondureño, nicaragüense, peruano, salvadoreño, de otros países
hispanohablantes de Centro o Sudamérica, o de España.
El término mexicano americano se re ere a las personas de origen o
ascendencia mexicana.
Si usted marca la casilla "Sí, otro origen hispano, latino o español",
escriba en letra de molde el nombre del grupo especí co.
Si usted no es de origen hispano, latino o español, conteste esta pregunta
marcando la casilla "No, no es de origen hispano, latino o español".
Esta pregunta debe ser contestada por todos los individuos.
5. Marque todas las casillas para las razas apropiadas.
El concepto de raza, de acuerdo con el uso de la O cina del Censo, re eja la
auto-identi cación de las personas con la raza o las razas con las cuales se
identi can.
La explicación que precede a la pregunta 4,"Para esta encuesta, origen
hispano no es una raza", re eja la manera en que el gobierno federal trata
el origen hispano y la raza como dos conceptos separados y distintos. Las
personas que identi can su origen como hispano, latino o español pueden
ser de cualquier raza.
Las personas pueden optar por proporcionar dos razas o más, ya sea
marcando las casillas de respuesta de dos razas o más, escribiendo múltiples
respuestas o mediante la combinación de marcar las casillas y escribir las
respuestas.
Si usted marca la casilla "India americana o nativa de Alaska", escriba en
el espacio provisto el nombre de la tribu o las tribus en las que está inscrito,
o la tribu principal (por ejemplo, Navajo Nation, Blackfeet Tribe, Muscogee
(Creek) Nation, Maya, Doyon, Native Village of Barrow Inupiat Traditional
Government, etc.).
Si usted marca la casilla "Otra asiática", escriba el nombre del grupo o los
grupos especí cos en el espacio provisto (por ejemplo, paquistaní,
camboyano, hmong, tailandés, laosiano, bangladesí, etc.).
Si usted marca la casilla "Otra de las islas del Pací co", escriba el nombre
del grupo o los grupos especí cos en el espacio provisto (por ejemplo,
tongano, yiano, de las Islas Marshall, palauano, tahitiano, papú
neoguineano, etc.).
Si usted marca la casilla "Alguna otra raza", escriba el nombre del grupo o
los grupos especí cos en el espacio provisto.
Esta pregunta debe ser contestada para todos los individuos.

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6.

Para las personas que nacieron en los Estados Unidos:
Marque la casilla "En los Estados Unidos" y luego escriba en letra de
molde el nombre del estado donde usted nació. Si nació en Washington,
D.C., escriba en letra de molde "Distrito de Columbia".
Para las personas que nacieron fuera de los Estados Unidos:
Marque la casilla "Fuera de los Estados Unidos" y luego escriba en letra
de molde el nombre del país extranjero o Puerto Rico, Guam, etc. donde
usted nació. Use las fronteras actuales, no las fronteras que existían cuando
usted nació. Por ejemplo, especi que República Checa o Eslovaquia, no
Checoslovaquia; Corea del Norte o Corea del Sur, no Corea. Especi que el
país particular, no la región. Por ejemplo, especi que Jamaica, no Antillas;
Kenia, no África Oriental.

7.

Si usted nació en los Estados Unidos (los 50 estados y el Distrito de
Columbia), marque la casilla “Sí, nació en los Estados Unidos”. Si
usted nació en Puerto Rico, Guam, las Islas Vírgenes de los Estados
Unidos o las Islas Marianas del Norte, marque la casilla "Sí, nació en
Puerto Rico, Guam, las Islas Vírgenes de los Estados Unidos o las
Islas Marianas del Norte". Aunque no esté listada, si usted nació en
Samoa Americana, marque la casilla "Sí, nació en Puerto Rico, Guam,
las Islas Vírgenes de los Estados Unidos o las Islas Marianas del
Norte". Si usted nació fuera de los Estados Unidos (los 50 estados y el
Distrito de Columbia) o en altamar y tiene por lo menos un padre o la
madre era ciudadano(a) de los Estados Unidos cuando usted nació,
marque la casilla "Sí, nació en el extranjero de padre o madre que
es ciudadano(a) de los EE.UU.". Marque la casilla "Sí, es
ciudadano(a) de los Estados Unidos por naturalización" si usted
nació fuera de los Estados Unidos (50 estados y el Distrito de Columbia),
ha completado el proceso de naturalización y ahora es ciudadano(a) de
los Estados Unidos. En la casilla a continuación escriba el año de cuatro
dígitos en el cual usted completó el proceso formal de naturalización. Si
usted no es cuidadano(a) de los Estados Unidos, marque la casilla “No,
no es ciudadano(a) de los Estados Unidos”. Los Residentes
Permanentes Legales (LPR) o que tienen tarjeta de residencia, u otros
inmigrantes no naturalizados o visitantes a los EE.UU. no son ciudadanos
de los Estados Unidos, por lo tanto usted debe marcar la casilla "No, no
es ciudadano(a) de los Estados Unidos".

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9a.

Una escuela pública es cualquier escuela o universidad que está mantenida
y administrada principalmente por el gobierno local, del condado, estatal o
federal. Las escuelas son privadas si son mantenidas y administradas principalmente por organizaciones religiosas o grupos privados. La enseñanza en
el hogar se aplica a la educación guiada por los padres fuera de una
escuela pública (home school) o privada para los grados del 1 al 12.

9b.

Solamente marque los grados a los cuales asistió en los ÚLTIMOS 3 MESES.
Si el mes actual es un mes del verano, no marque los grados a los cuales
asistirá en el futuro.

10.

Marque UNA sola casilla para indicar el grado o nivel escolar más alto
que usted ha COMPLETADO o el título más alto que ha recibido.
Informe educación completada en un país extranjero o en escuelas
sin grados, como el nivel equivalente de educación en el sistema regular
estadounidense de educación.
Marque la casilla "GED o examen equivalente” si usted no recibió un
diploma regular de escuela secundaria o preparatoria (High School) pero sí
completó la escuela secundaria o preparatoria aprobando un examen de
Equivalencia de Escuela Secundaria o preparatoria (GED, por sus siglas en
inglés) u otro reconocimiento formal de una escuela o autoridad
gubernamental por haber completado la escuela secundaria o preparatoria.
Si usted no ha completado ningún curso universitario con crédito, marque
el nivel más alto completado por debajo del nivel universitario. Si usted no
ha completado su cientes créditos para ser contado(a) como que está en el
segundo año, marque la casilla "Algunos créditos universitarios, pero
menos de 1 año de créditos universitarios".
Para la categoría "Título profesional más allá de un título de
licenciatura universitaria", no incluya certi cados o diplomas por
entrenamiento en o cios especí cos u ocupaciones tales como tecnología
de computadoras y electrónica, asistente médico o cosmetología. NO
incluya certi cados adquiridos de la licenciatura universitaria que están
relacionados con entrenamientos ocupacionales en campos tales como la
enseñanza, contabilidad e ingeniería.

11.

Conteste esta pregunta solamente si usted tiene un título de licenciatura
universitaria o uno más alto. Escriba en letra de molde el título especí co
de la concentración de estudio de su LICENCIATURA UNIVERSITARIA. Si
usted tiene más de un título de licenciatura universitaria o más de una
concentración de estudio, escriba en letra de molde los nombres especí cos
de todas las concentraciones de estudios de cada título de licenciatura
universitaria que usted tiene.

12.

Escriba en letra de molde su ascendencia. La ascendencia se re ere a su
origen étnico o descendencia, "raíces" o herencia. La ascendencia también
puede referirse al país donde usted o sus padres o antepasados nacieron
antes de su llegada a Puerto Rico. Conteste esta pregunta sin tener en
cuenta su clasi cación de raza, origen, hispano o lugar de nacimiento.
No informe un grupo religioso como su ascendencia.
Usted puede informar dos grupos de ascendencia (por ejemplo: alemán,
irlandés).
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13a. Marque la casilla "Sí" si usted a veces o siempre habla en su hogar un
idioma que no sea inglés.
Marque la casilla "No" si usted sólo habla inglés, o si sólo habla un idioma
que no sea inglés en la escuela o está limitado a algunas expresiones o
jergas en ese otro idioma.
13b. Si usted habla más de un idioma que no sea inglés y tiene di cultad en
determinar cuál se habla más, informe el idioma que usted aprendió a
hablar primero.
14a. Si usted no vivía en los Estados Unidos y Puerto Rico hace un año,
marque la casilla "No, fuera de los Estados Unidos y Puerto Rico"
y escriba en letra de molde el nombre del país extranjero Islas
Virgenes de los Estados Unidos, Guam, etc., donde viva usted. Sea
especí co cuando escribía el nombre del país extranjero; por ejemplo,
especi que República Checa Eslovaquia, no Checoslovaquia; Corea del
Norte o del Sur, no Corea. Especi que el país particular, no la región.
Por ejemplo, especi que Jamaica, no Antillas; Kenia, no África
Oriental. Luego, PASE a la pregunta 15.
Si usted vivía en algún otro lugar en los Estados Unidos o Puerto Rico hace
un año, marque la casilla "No, en una dirección diferente en los
Estados Unidos o Puerto Rico".
14b. Incluya el número de la casa o de la estructura, el nombre de la calle, el
tipo de calle (por ejemplo, calle, carretera, avenida); y la dirección de la
calle (si la orientación tal como “Norte” es parte de la dirección). Por
ejemplo, escriba en letra de molde 1239 N. Main St. o 1239 Main St. N.W.,
no sólo 1239 Main. Si usted vivía en Puerto Rico, la dirección también debe
incluir el nombre de la urbanización o del edi cio.
Si la única dirección que es conocida es de un apartado postal, dé una
descripción del lugar. Por ejemplo, escriba en letra de molde el nombre del
edi cio en el cual usted vivía, la intersección más cercana, el nombre de la
instalación o base militar, o la calle más cercana, etc. NO escriba el
número de un apartado postal.
Escriba en letra de molde el nombre del condado de los Estados Unidos o el
nombre del municipio si usted estaba en Puerto Rico. Si usted vivía en
Louisiana, escriba en letra de molde el nombre de la parroquia en el
espacio “Nombre del condado de los Estados Unidos o municipio en
Puerto Rico“. Si vivía en Alaska, escriba en letra de molde el nombre del
distrito o área censal, si lo sabe. Si vivía en la ciudad de Nueva York y no
conoce el nombre del condado, escriba en letra de molde el nombre del
distrito. Si usted vivía en una ciudad independiente (no en un condado), o
en Washington, D.C., deje en blanco el espacio "Nombre del condado de
los Estados Unidos o municipio en Puerto Rico".

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15.

El 1 de octubre de 2008, al programa federal de Cupones para Alimentos se
le dio el nombre de Programa de Asistencia Nutricional Suplementaria
(SNAP). Algunos estados tendrán nombres especí cos para este programa.
Si usted recibe bene cios del gobierno para comprar alimentos para su
familia usando una tarjeta de bene cios, marque la casilla "Sí".

16.

Marque la casilla “Sí” o “No” para cada parte de la pregunta 16.
Si usted informa cualquier otro tipo de plan de cobertura en 16h, especi que
el tipo de cobertura o el nombre del plan en el espacio que se provee. NO
incluya planes que cubran un solo tipo de cuidado médico (como planes
dentales) o planes que solamente cubran a una persona en caso de un
accidente o impedimento.

17a–17b.
Si usted tiene más de un tipo de seguro médico, responda a estas preguntas
pensando en su seguro médico principal.
Conteste las preguntas 19a a la 19c si usted tiene 5 años de edad o más.
19a–19c.
Marque la casilla "Sí" o "No" en las partes a, b y c de la pregunta 19 para
indicar si usted tiene una di cultad para llevar a cabo algunas de las
actividades listadas debido a una condición física, mental o emocional.
Conteste las preguntas 20 a la 44 si usted tiene 15 años de edad o más.
21.

Marque la casilla "Casado(a) actualmente" si usted está casado(a), sin
importar si su esposo o esposa vive en el hogar, a menos que estén
separados. Si su único matrimonio fue anulado, marque la casilla "Nunca
se ha casado". Marque la casilla "Divorciado(a)" solamente si usted ha
recibido una sentencia de divorcio.

22.

Marque la casilla "Sí" solamente si usted ha recibido una sentencia de
divorcio en los PASADOS 12 MESES.

23. No cuente matrimonios que fueron anulados.
24.

Anote los cuatro digitos del año en que usted se casó por última vez,
incluso si usted ahora ha enviudado, se ha divorciado o se ha separado.

Conteste la pregunta 25 si usted es be sexo femenino y tiene entre 15 y 50
años de edad.
25.

Marque la casilla "Sí" si usted ha dado a luz a un hijo vivo en los ÚLTIMOS
12 MESES, aun si el hijo falleció o si ya no vive con usted. No considere
abortos naturales o hijos nacidos muertos, ni ningún hijo adoptivo, hijo de
crianza (foster) o hijastro.

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27.

El servicio militar activo signi ca servicio a tiempo completo como miembro
del Ejército, la Fuerza Naval, la Fuerza Aérea, el Cuerpo de la Marina, los
Guardacostas o como o cial nombrado de Servicios de Salud Pública o de la
Administración Nacional Oceánica y Atmosférica, o sus predecesores, el
Servicio Costero y Geodésico o la Administración de Servicios de Ciencias
Ambientales. El servicio militar activo no incluye entrenamiento en servicio
militar activo. El servicio activo también se re ere a los cadetes que asisten a
una de las cinco Academias del Servicio Militar de los EE.UU. Para servicio
militar en la Guardia Nacional o en la Reserva Militar, marque la casilla
"Servicio activo solamente para entrenamiento de la Reserva Militar
o la Guardia Nacional" si nunca ha sido movilizado, desplegado o llamado
a servicio activo. Para servicio solamente como empleado(a) civil o voluntario
(a) civil de la Cruz Roja, USO, Servicio de Salud Pública o Departamento de
Defensa o Guerra, marque la casilla "Nunca estuvo en el servicio
militar". Para servicio en la Marina Mercante, cuente solamente como
servicio activo el servicio durante la Segunda Guerra Mundial y no otro
período de servicio.

28. Marque todas las respuestas que apliquen.
29a. Marque la casilla "Sí" si usted tiene una clasi cación de incapacidad
relacionada con su servicio por el Departamento de Asuntos de
Veteranos (VA).
29b. Marque la casilla "0 por ciento" si usted ha recibido una clasi cación de
incapacidad relacionada con el servicio de cero. NO marque la casilla de
"0 por ciento" para indicar que no recibió ninguna clasi cación.
30a–30b.
Cuente como trabajo – Marque la casilla "Sí" si usted hizo:

● Trabajo para otra persona por salario, sueldo, pago a destajo, comisión,
●
●
●
●

propinas o pagos en especie (por ejemplo, comida o albergue recibido
como pago por trabajo hecho).
Trabajo en su propio negocio, práctica profesional o nca.
Cualquier trabajo en un negocio o nca de la familia, pagado o no,
durante 15 horas o más a la semana.
Cualquier trabajo a tiempo parcial, incluyendo el cuidar niños, repartir
periódicos, etc.
Servicio activo en las Fuerzas Armadas.

No cuente como trabajo – Marque la casilla "No" si sus actividades se
limitaban a lo siguiente:

●
●
●
●

Quehaceres domésticos o jardinería en el hogar.
Trabajo voluntario sin paga.
Tareas completadas como estudiante.
Trabajo desempeñado como residente o recluso de una institución (como
un hogar de convalecencia o asilo o una instalación correcional).

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31.

Incluya el número del edi cio o de la estructura; el nombre de la calle; el
tipo de calle (por ejemplo, Calle, Carretera, Avenida); y la dirección de la calle
(si la dirección, tal como “Norte”, es parte de la dirección). Por ejemplo,
escriba 1239 Calle Principal o 1239 Calle Principal, N.W. no solamente 1239
Calle Principal.
Si la única dirección que es conocida es de un apartado postal, dé una
descripción del lugar de trabajo. Por ejemplo, escriba en letra de molde el
nombre del edi cio o centro comercial en el cual usted trabaja, la
intersección más cercana, o la calle más cercana de donde se encuentra su
lugar de trabajo, etc. NO de un número de apartado postal.
Si usted trabajó en una instalación o base militar que no tiene una
dirección de calle, informe el nombre de la instalación o base militar y una
descripción del lugar de trabajo (tal como el número del edi cio, el nombre
del edi cio, la calle o intersección más cercana).
Si usted trabajó en varios lugares pero iba al mismo lugar cada día para
empezar a trabajar, escriba en letra de molde la dirección de calle del lugar
donde iba. Si usted no iba al mismo lugar cada día para empezar a
trabajar, escriba en letra de molde la dirección del lugar donde trabajó la
mayor parte del tiempo durante la semana anterior.
Si su empleador opera en más de un lugar (tal como una cadena de
supermercados o sistema de escuelas públicas), escriba en letra de molde la
dirección de calle del lugar o sucursal donde usted trabajó. Si no sabe la
dirección de calle de una escuela, escriba en letra de molde el nombre de la
escuela y una descripción del lugar (tal como la calle o intersección más
cercana).
Si usted trabajó en un recinto de un colegio o universidad y no sabe la
dirección de calle del lugar de trabajo, escriba en letra de molde el nombre
del edi cio donde trabajó y una descripción del lugar (tal como la calle o
intersección más cercana).
Si usted trabajó en un país extranjero o Puerto Rico, Guam, etc., escriba en
letra de molde el nombre del país en la línea para el nombre del estado o
país extranjero.

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32.

Marque solamente una casilla para indicar el método de transporte que usó
utilizó para viajar la distancia más larga al trabajo LA SEMANA PASADA.
Marque la casilla "Automóvil, camión o van" si usted manejó un
station wagon, un automóvil de una compañía, camioneta ligera con
capacidad para una tonelada o menos, cabina de camión, minibús o
limusina privada (NO de alquiler).
Marque la casilla "Tren subterráneo o elevado" si usted viajó en el tren
subterráneo o cualquier otro vehículo que opere sobre rieles o carriles y
esté completamente separado de otro tránsito de vehículos o peatones.
Marque la casilla "Tren de viajes largos o de cercanías" si usted viajó en
un servicio de trenes de viajes largos, como Amtrak, o un tren de cercanías
(conocido también como tren metropolitano, tren regional o tren
suburbano) que opere entre una ciudad central y los alrededores u otras
ciudades centrales. Esto no incluye los sistemas de trenes que ofrecen
principalmente servicio dentro de las ciudades, los cuales se conocen
generalmente como subterráneo, metro o tren urbano.
Marque la casilla "Tren ligero, tranvía o tranvia eléctrico" si usted viajó
en tren ligero, tranvía, trolebús, tranvía de tracción por cable (tramway) o
cualquier otro vehículo que opere en rieles o carriles. Estos vehículos con
frecuencia operan con electricidad a través de cables elevados.
Marque la casilla "Taxi" si usted viajó en limusina, tal como una limusina
del aeropuerto por la cual hay que pagar.
Marque la casilla "Motocicleta" si usted viajó en motocicleta pequeña,
ciclomotor, motora o un vehículo similar que funciona con un motor.
Marque la casilla "Bicicleta" si usted viajó en bicicleta o cualquier otro
vehículo con pedales.
Marque la casilla "Caminó" SÓLO si usted caminó todo el camino al
trabajo y no usó otro medio de transporte.
Marque la casilla "Trabajó en esta dirección" si usted trabajó en una
nca donde usted vive, o en una o cina o tienda de su propia casa.
Marque la casilla "Otro método" si usted viajó en avión, helicóptero, a
caballo, en carruaje con caballo, embarcación (que no sea una lancha
pública), casa motorizada grande, trineo guiado por perros, camión
grande, Vehículo Todo Terreno (ATV), moto para la nieve, Segway® u otro
vehículo eléctrico con auto balance, patineta, patines o silla motorizada.

Conteste la pregunta 33 si usted marco "Automóvil, camión o van"
en la pregunta 32.
33.

Si otra persona lo llevó al trabajo y luego regresó al hogar o condujo a un
destino que no fuera el trabajo, entre “1” en la casilla para "Persona(s)".
NO incluya en el recuento de personas que viajaron en el vehículo a las
personas que viajaron a la escuela u otro destino que no fuera el trabajo.

34.

Dé la hora del día en que comienza su viaje al trabajo habitualmente.
NO DÉ la hora a la que empieza a trabajar habitualmente.
Si usted usualmente salía para ir al trabajo en algún momento entre las 12
de la medianoche y las 12 del mediodía, marque "a.m."
Si usted usualmente salía para ir al trabajo en algún momento entre las 12
del mediodía y las 12 de la medianoche, marque "p.m."
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35.

El tiempo de viaje es de puerta a puerta. Entre el tiempo de viaje al
trabajo en una sola dirección para el viaje día LA SEMANA PASADA.
Incluya la cantidad de tiempo que le tomo esperar por el transporte
público o para recoger a pasajeros en un "carpool".

Conteste las preguntas 36 a la 39 si usted no trabajó la
semana pasada.
36a. Usted está suspendido (on layoff) o en cesantía si está esperando que lo
llamen para regresar a un trabajo del que estaba temporalmente separado
por motivos relacionados con la empresa.
36b. Si usted sólo trabaja durante ciertas temporadas o los días cuando hay
trabajo disponible, marque la casilla "No".
36c. Marque la casilla "Sí" si su empleador le informó, formal o informalmente,
que sería llamado de nuevo dentro de los próximos 6 meses. También
marque "Sí" si le han indicado, formal o informalmente, una fecha
especí ca para regresar al trabajo, aunque esa fecha esté seis meses en el
futuro.
37. Marque la casilla "Sí" si usted intentó conseguir un trabajo o empezar un
negocio o una práctica profesional durante cualquier momento en las
ÚLTIMAS 4 SEMANAS; por ejemplo, si está registrado(a) en una o cina de
empleo, fue a una entrevista de trabajo, puso o respondió a anuncios de
empleo, o hizo algo para empezar un negocio o práctica profesional.
38.

Si usted tenía intenciones de comenzar un trabajo dentro de 30 días,
marque la casilla "Sí, hubiera podido ir a trabajar".
Marque la casilla "No, debido a una enfermedad temporal propia"
sólo si usted esperaba trabajar dentro de 30 días.
Si usted no hubiera podido ir al trabajo porque asistía a la escuela, cuidaba
a niños, etc., marque la casilla "No, debido a otras razones (en la
escuela, etc.)".

39.

Re érase a las instrucciones para las preguntas 30a–30b para determinar
qué considerar como trabajo. Marque la casilla "Hace más de 5 años o
nunca trabajó" si usted: (1) nunca trabajó en ningún tipo de trabajo o
negocio, a tiempo completo o parcial, (2) nunca trabajó, con o sin paga, en
un negocio o nca de la familia y (3) nunca estuvo en servicio activo en las
Fuerzas Armadas.

40a–40b.
Re érase a las instrucciones para las preguntas 30a–30b para determinar
qué considerar como trabajo. Incluya días de vacaciones pagados, días por
enfermedad pagados y servicio militar. Cuente toda semana durante la cual
la persona trabajó, aun si fuera por una hora.
41.

Si las horas trabajadas cada semana di rieron considerablemente durante
los ÚLTIMOS 12 MESES, dé un promedio aproximado de las horas
trabajadas cada semana.

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Conteste las preguntas 42a a la 42f si usted trabajó en los
ultimos 5 años.
42a. Si usted trabajó para una cooperativa, cooperativa de crédito, compañía de
seguros mutuos o una organización similar, marque la casilla "Organización
sin nes de lucro (incluso las organizaciones exentas de impuestos y las
organizaciones caritativas)".
Si usted trabajó en una escuela pública, colegio universitario o universidad,
marque la categoría apropiada para gobierno. Por ejemplo, marque la
casilla "Gobierno local (por ejemplo: distrito escolar de la ciudad o
condado)" para colegio comunitario administrado por el condado o escuela
pública administrada por la ciudad. Marque la casilla "Gobierno estatal
(incluso universidades estatales)" para una universidad estatal.
Los empleados de gobiernos extranjeros, las Naciones Unidas y otras
organizaciones internacionales deben marcar la casilla "Empleado(a) civil
del gobierno federal".
42b. Si usted trabajó para una compañía, empresa o agencia gubernamental,
escriba en letra de molde el nombre de la compañía, no el nombre de su
supervisor. Si trabajó para un individuo o una empresa que no tiene un
nombre de compañía, escriba en letra de molde el nombre del individuo
para el cual trabajó. Si trabajó en su propia empresa que no tiene nombre,
escriba en letra de molde "empleado(a) por cuenta propia". Si usted marcó
"Servicio activo en las Fuerzas Armadas de los EE. UU."o en el Cuerpo de
Comisionados", escriba el nombre de la rama de las Fuerzas Armadas. Para
los Cuerpos Comisionados, escriba Servicio de Salud Pública de los EE. UU. o
Cuerpos Comisionados de NOAA.
42c. Describa la empresa, industria o empleador individual que se anotó en la
pregunta 42b. Si hay más de una actividad, sólo describa la actividad
principal en el lugar donde usted trabajó. Anote lo que se confecciona, lo
que se vende o qué tipo de servicio se provee.
Anote descripciones como las siguientes: centro de cuidados de
urgencia, rma de contabilidad pública certi cada, compañía de fabricación
de artículos de o cina.
42d. Marque una casilla para indicar el principal tipo de negocio o industria
donde trabaja o trabajó esta persona.
42e. Describa el tipo de trabajo que usted desempeñó. Si estaba en
entrenamiento, era aprendiz o asistente, inclúyalo en la descripción.
Anote descripciones como las siguientes: enfermera graduada, gerente
de recursos humanos, ingeniero industrial.
Si es posible, evite escribir una sola palabra, como: enfermera, gerente, o
ingeniero.
42f. Describa las tareas o actividades más importantes que usted realizó en su
trabajo.
Anote descripciones como las siguientes: coordinar la atención a los
pacientes y administrar los medicamentos, dirigir las políticas de contratación
y asesorar a los supervisores sobre asuntos de relacionados con los empleados,
diseñar sistemas de control para garantizar la calidad de los productos.
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Conteste las preguntas 43 a la 44 si usted tiene 15 años de
edad o más.
Marque la categoría "Sí" o "No" para cada parte de las preguntas sobre
ingreso y anote la cantidad recibida en los ÚLTIMOS 12 MESES para cada
respuesta "Sí".
Si recibió ingreso de cualquier fuente en conjunto con otra persona,
informe la cantidad que usted ganó o recibió; no la cantidad total que
usted y la otra persona recibieron en conjunto.
NO incluya lo siguiente como ingreso en ninguna pregunta:
Reembolsos o descuentos de cualquier tipo
Retiros de cuentas de ahorros de cualquier tipo
Plusvalías o minusvalías de la venta de casas o acciones
Herencias o acuerdos con seguros
Cualquier tipo de préstamo
Pagos en especie, tales como comida o alquiler gratuito
43a. Incluya jornales y salarios antes de aplicarse las deducciones de todos los
trabajos. Asegúrese de incluir cualquier propina, comisión o bono. Los
propietarios de negocios constituidos en sociedad (incorporados) deben
anotar sus salarios aquí. El personal militar debe incluir su paga básica más
la asignación de dinero para vivienda o subsistencia, pago por tiempo de
vuelo, asignaciones de dinero para uniformes y bonos por volver a alistarse.
43b. Indique el ingreso obtenido de negocios incorporados bajo la categoría de
jornales, sueldos y salarios (pregunta 43a), y no bajo empleo por cuenta
propia. Incluya ganancias (o pérdidas) de un empleo por cuenta propia en
un negocio no agrícola de propiedad única o en sociedad. Marque la casilla
"Pérdida" si hay alguna pérdida. No incluya ganancias (o pérdidas) de
negocios incorporados que son propiedad suya.
Incluya las ganancias (o pérdidas) agrícolas de empleo por cuenta propia
en empresas individuales o en sociedad. Marque la casilla "Pérdida" si hay
alguna pérdida. No incluya ganancias (o pérdidas) de negocios agrícolas
incorporados que son propiedad suya. Tampoco incluya cantidades por
terreno alquilado pordinero en efectivo, pero incluya cantidades por
terreno alquilado en aparcería.
43c. Incluya intereses recibidos o acreditados a cuentas corrientes y cuentas de
ahorros, fondos del mercado monetario (money market), certi cados de
depósito (CD), cuentas de retiro individual (IRA), planes KEOGH y bonos del
gobierno.
Incluya dividendos recibidos, acreditados o reinvertidos de la propiedad de
acciones o fondos comunes de inversión.
Incluya ingresos (o pérdidas) de derechos de autor, alquiler de terreno,
edi cios o bienes raíces, o de inquilinos o pupilos. Marque la casilla
"Pérdida" si hay alguna pérdida. El ingreso recibido por personas
empleadas por cuenta propia cuya fuente principal de ingreso es el alquiler
de propiedad o por derechos de autor debe incluirse 43b. Incluya pagos
regulares de una herencia o de un fondo de deicomiso.

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43d. Incluya las cantidades, antes de las deducciones por Medicare, pagos del
Seguro Social o retiro para personal de los ferrocarriles, dependientes de
empleados asegurados fallecidos y empleados incapacitados.
43e. Incluya ingreso de Seguridad de Ingreso Suplementario (SSI) que recibió
por ser una persona de edad avanzada, ciega o impedida.
43f. Incluya cualquier pago de asistencia pública o bienestar público (welfare)
que usted a recibido de la o cina de bienestar del gobierno estatal o del
condado. A veces nos referimos a estos pagos como (TANF) Ayuda Temporal
a Familias Necesitadas, (AFDC) Ayuda a Familias con Niños Dependientes,
(ADC) Ayuda a Niños Dependientes, el Bienestar o el Programa de
Asistencia Social al Trabajo, Asistencia General, Ayuda General, Asistencia
de Emergencia, y Pagos Adicionales para Necesidades Inmediatas. No
incluya la asistencia recibida de instituciones bené cas privadas.
No incluya Seguridad de Ingreso Suplementario (SSI), asistencia para el
pago de alimentos (tales como cupones de alimentos y bene cios del
Programa de Asistencia Nutricional Suplementario o SNAP), asistencia para
el pago de alquiler, asistencia para la educación, asistencia para el
cuidado de niños, asistencia para pago de transportación o asistencia con
los costos de calefacción o aire acondicionado o cualquier otra asistencia
de energía [tal como el Programa de Asistencia de Energía para Hogares
de Bajos Ingresos (LIHEAP)].
43g. Incluya ingresos regulares de la pensión de una compañía, pensión de un
sindicato, pensión del gobierno federal, pensión del gobierno estatal,
pensión de un gobierno local, pensión de los trabajadores ferroviarios de
los EE. UU., plan de retiro KEOGH, SEP (Pensión Simpli cada para
Empleado) pensiones de las Fuerzas Armadas de los EE. UU. o cualquier otro
tipo de pensión, cuenta de retiro o anualidad como IRA, Roth IRA, 401(k) o
403(b).
Incluya ingresos de sobrevivientes que se pagan a los cónyuges e hijos de
la persona fallecida. Incluya ingresos regulares de una pensión por
discapacidad que se paga a las personas que no pueden trabajar debido a
una discapacidad.
No incluya el Seguro Social ni el ingreso que se "pasa a otra cuenta" o
se reinvierte en otra cuenta de retiro.
43h. Incluya compensaciones de la Administración de Veteranos (VA) y el
Programa de Asistencia Educativa para Veteranos (VEAP), compensación por
desempleo, compensación laboral, pensión para hijos menores, pensiones
alimenticias o pensión de su ex pareja, y todos los otros pagos recibidos
regularmente, tales como pagos de transferencia de personal de las Fuerzas
Armadas, asistencia de instituciones bené cas privadas, y contribuciones
regulares de personas que no viven con usted.
44.

Sume las cantidades totales (restando las pérdidas) en 43a a 43h para los
ÚLTIMOS 12 MESES y anote esta cantidad en el espacio que se provee.
Marque la casilla de "Pérdida" si hay alguna pérdida. Escriba la cantidad
total en dólares.

ACS-30(GQ)(2019) (8-2018)

Página 17

Esta página se ha dejado en blanco
intencionalmente

ACS-30(GQ)(2019) (8-2018)

Página 18

fold

fold

How do I get more information about
the American Community Survey?

How will the Census Bureau use
the information that I provide?

The American
Community Survey

For more information about the American
Community Survey, or to obtain survey
results from past years, we encourage you to
visit our Web site at:

By law, the Census Bureau can only use
your responses to produce statistics.
The Census Bureau is not permitted to
publicly release your responses in a way
that could identify you. Per the Federal
Cybersecurity Enhancement Act of 2015,
your data are protected from
cybersecurity risks through screening of
the systems that transmit your data. The
Census Bureau will also use this
information to improve the American
Community Survey, ultimately resulting in
even better data for your community and
the nation.

Group Quarters

census.gov/acs
or contact us by mail at the following
address:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500

You can also telephone the Census Bureau’s
regional office nearest you as listed below:

The American Community
Survey brings you
estimates every year
about . . .

Census Bureau Regional Offices
Atlanta, GA
1-800-424-6974 (ext. 53955)

education, children,
hildren,
families, employment,
ployment,
income, immigration,
igration,
race and Hispanic
panic origin,
housing, group
up quarters,
rural life, commuting
mmuting
patterns, and
d military
service.

Chicago, IL
1-800-865-6384 (ext. 1)
Denver, CO
1-888-209-7659
Los Angeles, CA
1-800-992-3530 (ext. 1)
New York, NY
1-800-991-2520 (ext. 1)
Philadelphia, PA
1-866-238-1374

Issued September 2018
ACS-50(GQ)

fold

ACS-50GQ_September_2018.indd 1

fold

Connect with us @uscensusbureau

8/2/2018 1:50:07 PM

What is the American Community
Survey?
The American Community Survey (ACS)
provides current demographic, social,
economic, and housing characteristics
every year. In the past, this information
was only available every 10 years when
the decennial census was conducted.
Estimates from the American Community
Survey helps communities make informed
decisions and is a key to their future.
Only a small sample of addresses is
selected to participate in the American
Community Survey and represent other
addresses in the community. In addition
to this household sample, the U.S. Census
Bureau selects a sample of group quarters
(GQ) facilities from a sample of all GQs
in your area each year. Individuals from
sampled GQs are randomly selected to
participate in the ACS. A Census Bureau
representative will contact the sample GQs
and individuals and conduct a personal
interview. If a personal interview is not
possible, the Census Bureau representative
may collect your information over the
telephone or ask that you complete the
survey questionnaire. If you complete
the survey yourself, a Census Bureau
representative will arrange for a day and
time to return to the GQ to pick up the
completed questionnaire.

Do the sampled group quarters
and individuals have to answer
the questions on the American
Community Survey?
Yes. Your response to this survey is
required by law (Title 13, United States
Code, Sections 141, 193 and 221).

ACS-50GQ_September_2018.indd 2

The Census Bureau estimates the survey
will take about 25 minutes to complete.
Send comments regarding this burden
estimate or any other aspect of this
collection of information, including
suggestions for reducing this burden, to:
Paperwork Reduction Project, U.S. Census
Bureau, 4600 Silver Hill Road, ADDC-4H277,
Washington, DC 20233. You may e-mail
comments to acso.pra@ census.gov; use
“Paperwork Project” as the subject.
The U.S. Office of Management and Budget
(OMB) approved this survey and gave it
OMB approval No. 0607-0810. Displaying
this number shows that the Census Bureau
is authorized to conduct this survey. Please
use this number in any correspondence
concerning this survey. Respondents are
not required to respond to any information
collection unless it displays a valid
approval number from the OMB.

How will my participation help me
and my community?
Billions of government and business dollars
are distributed among states, communities,
and population groups based on the social,
economic, housing, and GQ information
available for that area.

The information you provide will help you
and other individuals, local governments,
nongovernmental organizations, and
businesses to:
•

Distribute resources to communities.

•

Improve your community by deciding
where in your town new highways,
schools, and hospitals can do the most
good.

•

Measure changes in the well-being of
children, families, and senior citizens to
plan for future programs.

•

Plan for emergency situations that
might affect your community, such as
floods, fires, and other natural disasters.

Is the information I provide
confidential?
Yes. The U.S. Census Bureau is required by
law to keep your information confidential.
The Census Bureau is not permitted to
publicly release your responses in a way
that could identify you. Per the Federal
Cybersecurity Enhancement Act of 2015,
your data are protected from cybersecurity
risks through screening of the systems that
transmit your data.

8/2/2018 1:50:23 PM

How will the Census Bureau use
the information that I provide?
The Census Bureau will compile and publish
estimates for geographical areas, such as,
for the nation, states, counties and Puerto
Rico municipios. The Census Bureau will not
publish or release information that would
identify a facility, or its residents. Estimates
are then available for use by a variety of
programs supporting your community.

Is the information I provide
strictly confidential?
Yes. The U.S. Census Bureau is required by
law to keep your information confidential.
The Census Bureau is not permitted to
publicly release your responses in a way that
could identify you. Per the Federal
Cybersecurity Enhancement Act of 2015,
your data are protected from cybersecurity
risks through screening of the systems that
transmit your data.

When will the results of the
survey be available?
The previous years’ results of the American
Community Survey are released every Fall.
Survey estimates are released each year for
areas of 65,000 or more people. For smaller
areas, results are available in the form of
3-year and 5-year estimates.

Where can I get assistance or
find more information about the
American Community Survey in
Alaska?
For questions or assistance with completing
this survey, telephone the Census Bureau’s
Los Angeles Regional Office at 1-800-992-3530
(ext. 1).
For more information about the American
Community Survey, we encourage you to visit
our Web site at:
census.gov/acs
or contact us by mail at the following address:

American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500

The American
Community
Survey brings
you estimates
every year about . . .
education, children,
families, employment,
income, veterans,
commuting patterns,
and housing.

Will American Indians and Alaska
Natives be recruited for jobs?
The Census Bureau has always relied on the
help of American Indians and Alaska Natives
to make the census work and will do the
same to make the American Community
Survey work.

Issued March 2019
ACS-51(GQ)RA
Connect with us @uscensusbureau

The American
Community Survey
Group Quarters

What Is the American
Community Survey?
The American Community Survey (ACS) provides
current demographic, social, economic, and
housing characteristics every year. In the past,
this information was only available every 10 years
when the decennial census was conducted.
Estimates from the American Community Survey
help communities make informed decisions and
are a key to their future.
Only a small sample of addresses is selected to
participate in the American Community Survey
and represent other addresses in the community.
In addition to household sample, the U.S. Census
Bureau selects a sample of group quarters (GQ)
facilities from a sample of all GQs in your area
each year. Individuals from sampled GQs are
randomly selected to participate in the ACS.
A Census Bureau representative will contact
the sample GQs and individuals and conduct a
personal interview. If a personal interview is not
possible, the Census Bureau representative may
collect your information over the telephone or
ask that you complete the survey questionnaire.
If you complete the survey yourself, a Census
Bureau representative will arrange for a day
and time to return to the GQ to pick up the
completed questionnaire.

Do the sampled group quarters
and individuals have to answer
the questions on the American
Community Survey?
Yes. Your response to this survey is required by
law (Title 13, United States Code, Sections 141,
193 and 221). The Census Bureau estimates the
survey will take about 25 minutes to complete.
Send comments regarding this burden estimate
or any other aspect of this collection of
information, including suggestions for reducing

this burden, to: Paperwork Reduction Project,
U.S. Census Bureau, 4600 Silver Hill Road,
ADDC-4H277, Washington, DC 20233. You may
e-mail comments to [email protected]; use
“Paperwork Project” as the subject.
The U.S. Office of Management and Budget
(OMB) approved this survey and gave it OMB
approval Number 0607-0810. Displaying this
number shows that the Census Bureau is
authorized to conduct this survey. Please use
this number in any correspondence concerning
this survey. Respondents are not required to
respond to any information collection unless it
displays a valid approval number from the OMB.

How will my participation help me
and my community?
Billions of dollars are allocated among states,
communities, villages, and population groups
based on the social, economic, housing, and GQ
information available for that area.
The information you provide will help you
and other individuals, local governments,
nongovernmental organizations, and businesses
to:
• Ensure fair distribution of tax dollars
and other resources.

• Evaluate programs to increase their
effectiveness and target specific needs.
• Improve your community’s quality of life by
building new roads, improving airstrips,
schools, and hospitals, and deciding where in
your town they can do the most good.
• Observe change over time in such key
areas as the well-being of children, families,
and senior citizens.
• Help communities plan for emergency
situations that might affect you or your
neighbors, such as floods, fires, and
other natural disasters.
• Help village leaders and Alaska Native
corporations plan for better education
and health services.

What about my tribe or my village?
The use of American Community Survey
estimates could result in improved utility
services, new housing, job training, better
school facilities, or a new or improved health
clinic that benefits you, your family, or your
village. For example, the Workforce Investment
Act of 1998 requires information about
American Indian and Alaska Native households
to support training and employment activities.
Your participation in the American Community
Survey will provide this critically important
information.

8-17-2017

6-1/16 x 11.5" with 3 x 5" open window

U.S. Census Bureau
Washington, DC 20233
Office of the Director

Se Incluye el Cuestionario
de la Encuesta
SU RESPUESTA
ES REQUERIDA POR LEY
Survey Form Enclosed

YOUR RESPONSE IS
REQUIRED BY LAW

DC

6385-46(GQ) (12-2018)

13280011

DC

The Puerto Rico Community Survey

PLACE LABEL
HERE

This questionnaire is available in either English or Spanish.
Este cuestionario está disponible en español o en inglés.
To complete the English questionnaire, begin on
page 2. To complete the Spanish questionnaire, flip
this over and complete the yellow side.

Para completar el cuestionario en inglés, comience
en la página 2. Para completar el cuestionario en
español, vírelo y complete el lado amarillo.

Please complete this form as soon as possible.
Place it in the envelope provided and HOLD it for a
census representative to return to pick it up.

Por favor, complete este cuestionario tan
pronto sea posible. Colóquelo en el sobre que se
provee y GUÁRDELO hasta que un representante del
censo lo venga a recoger.

If you need help or have questions about
completing this form, call the number that our
census representative has given you.

Si necesita ayuda o tiene preguntas sobre cómo
completar este cuestionario, llame al número de
teléfono que le ha dado nuestro representante del
censo.

For more information about the Puerto Rico
Community Survey, visit our web site at:
http://www.census.gov/acs

CENSUS USE ONLY

Para obtener más información sobre la Encuesta
sobre la Comunidad de Puerto Rico, vaya a nuestra
página en la Internet: http://www.census.gov/acs

How was this form completed?
English

Spanish

ACS-1(GQ)(PR)(2020)

FORM
(03-26-2019) Draft 4

OMB No. 0607-0810

§.=!,¤
ACS-1GQ(PR), Page 1, Base (Black)

ACS-1GQ(PR), Page 1, Purple Pantone 253 (15%)

ACS-1GQ(PR), Page 1, yellow Pantone 129 (20%)

13280029

1

What is your name? Please print your name.
Include your telephone number, and today’s
date. We will only contact you if needed for
official Census Bureau business.
Last Name

First Name

MI

5 What is your race? Mark (X) one or more
boxes AND print origins.

7 Are you a citizen of the United States?
Yes, born in Puerto Rico ➔ SKIP to
question 9a
Yes, born in a U.S. State, District of
Columbia, Guam, the U.S. Virgin Islands,
or Northern Marianas

White – Print, for example, German, Irish,
English, Italian, Lebanese, Egyptian, etc. C

Yes, born abroad of U.S. citizen parent or
parents
Yes, U.S. citizen by naturalization – Print
year of naturalization

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

Area Code + Number
—
Today’s Date
Month
Day

Year

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

No, not a U.S. citizen

8 When did you come to live in Puerto Rico?
If you came to live in Puerto Rico more than
once, print latest year.

Year

2

What is your sex? Mark (X) ONE box.
Male

3

Female

What is your age and what is your date of
birth? For babies less than 1 year old, do not
write the age in months. Write 0 as the age.
Print numbers in boxes.
Age (in years) Month Day
Year of birth

Chinese

Japanese

Filipino

Native Hawaiian

Asian Indian

Samoan

Vietnamese

Chamorro

Korean

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

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

A

4

NOTE: Please answer BOTH Question 4
about Hispanic origin and Question 5
about race. For this survey, Hispanic
origins are not races.

you attended school or college? Include
only nursery or preschool, kindergarten,
elementary school, home school, and schooling
which leads to a high school diploma or a
college degree.
No, have not attended in the last 3
months ➔ SKIP to question 10
Yes, public school, public college
Yes, private school, private college,
home school

b. What grade or level were you attending?
Mark (X) ONE box.
Some other race – Print race or origin. C

Nursery school, preschool
Kindergarten

Are you of Hispanic, Latino, or Spanish
origin?
No, not of Hispanic, Latino, or
Spanish origin
Yes, Mexican, Mexican Am., Chicano

6 Where were you born?

Yes, Cuban
Yes, another Hispanic, Latino, or Spanish
origin – Print, for example, Salvadoran,
Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

§.=!>¤

Grade 1 through 12 – Specify
grade 1 - 12

In the United States – Print name of state.

Yes, Puerto Rican

2

9 a. At any time IN THE LAST 3 MONTHS, have

Outside the United States – Print
Puerto Rico or name of foreign country,
or U.S. Virgin Islands, Guam, etc.

College undergraduate years (freshman
to senior)
Graduate or professional school beyond
a bachelor’s degree (for example: MA or
PhD program, or medical or law school)

13280037

10 What is the highest degree or level of
school you have COMPLETED? Mark (X)
ONE box. If currently enrolled, mark the
previous grade or highest degree received.

12 What is your ancestry or ethnic origin?

15 IN THE PAST 12 MONTHS, did you receive

benefits from the Nutritional Assistance
Program? Do NOT include WIC, the School
Lunch Program, or assistance from food banks.

NO SCHOOLING COMPLETED

No schooling completed
NURSERY OR PRESCHOOL THROUGH GRADE 12

Nursery school
Kindergarten
Grade 1 through 11 – Specify
grade 1 – 11

Yes

(For example: Italian, Jamaican, African Am.,
Cambodian, Cape Verdean, Norwegian,
Dominican, French Canadian, Haitian, Korean,
Lebanese, Polish, Nigerian, Mexican, Taiwanese,
Ukrainian, and so on.)

13 a. Do you speak a language other than

No

16 Are you CURRENTLY covered by any of the

following types of health insurance or
health coverage plans? Mark "Yes" or "No"
for EACH type of coverage in items a – h.

English at home?
Yes

No ➔ SKIP to question 14a

a. Insurance through a current
or former employer or union
(of yours or another family
member)

b. What is this language?
12th grade – NO DIPLOMA
HIGH SCHOOL GRADUATE

Regular high school diploma
GED or alternative credential

Yes

No

b. Insurance purchased directly
from an insurance company
(by you or another family
member)

For example: Korean, Italian, Spanish, Vietnamese

c. How well do you speak English?
Very well

c. Medicare, for people 65 and
older, or people with certain
disabilities

Well

COLLEGE OR SOME COLLEGE

Not well
Some college credit, but less than 1 year of
Not at all
college credit
14 a. Did you live at this address 1 year ago?
1 or more years of college credit, no
degree
Person is under 1 year old ➔ SKIP to
Associate’s degree (for example: AA, AS)
question 16
Yes, at this address ➔ SKIP to
Bachelor’s degree (for example: BA, BS)
question 15
AFTER BACHELOR’S DEGREE
No, outside Puerto Rico and the
United States – Print name of foreign
Master’s degree (for example: MA, MS,
country, or U.S. Virgin Islands, Guam,
MEng, MEd, MSW, MBA)
etc., below; then SKIP to question 15
Professional degree beyond a bachelor’s
degree (for example: MD, DDS, DVM, LLB,
JD)
Doctorate degree (for example: PhD, EdD)
No, at a different address in the
United States or Puerto Rico

d. Medicaid, Medical Assistance,
or any kind of governmentassistance plan for those with
low incomes or a disability
e. TRICARE or other
military health care
f. VA (enrolled for VA
health care)
g. Indian Health Service
h. Any other type of health
insurance or health coverage
plan – Specify

b. Where did you live 1 year ago?

B

Answer question 11 if you have a bachelor’s
degree or higher. Otherwise, SKIP to
question 12.

Address
Development or condominium name
Number and street name

Answer question 17a if you are covered by
health insurance. Otherwise, SKIP to
question 18a.

17 a. Is there a premium for this plan?

11 This question focuses on your BACHELOR’S
DEGREE. Please print below the specific
major(s) of any BACHELOR’S DEGREES you
have received. (For example: chemical
engineering, elementary teacher education,
organizational psychology)

C

Name of city, town, post office, military
installation, or base

A premium is a fixed amount of money paid
on a regular basis for health coverage. It
does not include copays, deductibles, or
other expenses such as prescription costs.
Yes

Name of municipio in Puerto Rico
or U.S. county

No ➔ SKIP to question 18a
b. Do you or another family member receive
a tax credit or subsidy based on family
income to help pay the premium?

Enter Puerto Rico or
name of U.S. state

ZIP Code

Yes
No

§.=!F¤

3

13280045

18 a. Are you deaf or do you have serious

21 What is your marital status?

27 Have you ever served on active duty in the
U.S. Armed Forces, Reserves, or National
Guard? Mark (X) ONE box.

difficulty hearing?
Now married
Yes

Widowed

No

Divorced
Separated

b. Are you blind or do you have serious
difficulty seeing even when wearing
glasses?
Yes

Never married ➔ SKIP to F

22 In the PAST 12 MONTHS, did you get –
Yes

No

D

Answer question 19a – c if you are 5 years
old or over. Otherwise, SKIP to J on
page 7 for further instructions; do not
answer any more questions.

Never served in the military ➔ SKIP to
question 30a
Only on active duty for training in the
Reserves or National Guard ➔ SKIP to
question 29a

On active duty in the past, but not now

No

a. Married?

28 When did you serve on active duty in the

b. Widowed?

U.S. Armed Forces? Mark (X) a box for EACH
period in which you served, even if just for part
of the period.

c. Divorced?

23 How many times have you been married?
Once

May 1975 to July 1990

Three or more times

24 In what year did you last get married?

No
b. Do you have serious difficulty walking
or climbing stairs?
Yes
No
c. Do you have difficulty dressing or
bathing?

Korean War (July 1950 to January 1955)
January 1947 to June 1950

F

Answer question 25 if you are female and
15 – 50 years old. Otherwise, SKIP to
question 26a.

25 In the PAST 12 MONTHS, have you given

29 a. Do you have a VA service-connected

Yes

Yes

Yes (such as 0%, 10%, 20%, ... , 100%)

No

No

No ➔ SKIP to question 30a

Answer question 20 if you are 15 years old
or over. Otherwise, SKIP to J on page 7
for further instructions; do not answer any
more questions.

20 Because of a physical, mental, or emotional
condition, do you have difficulty doing
errands alone such as visiting a doctor’s
office or shopping?
Yes
No

grandchildren under the age of 18
living in this place?

§.=!N¤

b. What is your service-connected
disability rating?

Yes

0 percent

No ➔ SKIP to question 27

10 or 20 percent

b. Are you currently responsible for most
of the basic needs of any grandchildren
under the age of 18 who live in this
place?
Yes
No ➔ SKIP to question 27
c. How long have you been responsible
for these grandchildren? If you are
financially responsible for more than one
grandchild, answer the question for the
grandchild for whom you have been
responsible for the longest period of time.
Less than 6 months

3 or 4 years

6 to 11 months

5 or more
years

1 or 2 years

4

World War II (December 1941 to
December 1946)
November 1941 or earlier

disability rating?

birth to any children?

26 a. Do you have any of your own

E

Vietnam Era (August 1964 to April 1975)
February 1955 to July 1964

Year

Yes

September 2001 or later
August 1990 to August 2001 (including
Persian Gulf War)

Two times

19 a. Because of a physical, mental, or

emotional condition, do you have
serious difficulty concentrating,
remembering, or making decisions?

Now on active duty

30 or 40 percent
50 or 60 percent
70 percent or higher

13280052

30 a. LAST WEEK, did you work for pay at a
job (or business)?

G

Yes ➔ SKIP to question 31

Answer question 33 if you marked "Car,
truck, or van" in question 32. Otherwise,
SKIP to question 34.

37 During the LAST 4 WEEKS, have you been
ACTIVELY looking for work?
Yes
No ➔ SKIP to question 39

No – Did not work (or retired)
b. LAST WEEK, did you do ANY work for
pay, even for as little as one hour?

33 How many people, including yourself,

usually rode to work in the car, truck, or
van LAST WEEK?
Person(s)

Yes

38 LAST WEEK, could you have started a job if
offered one, or returned to work if recalled?
Yes, could have gone to work

No ➔ SKIP to question 36a

No, because of own temporary illness

31 At what location did you work LAST WEEK?
If you worked at more than one location, print
where you worked most last week.

No, because of all other reasons
(in school, etc.)

34 LAST WEEK, what time did your trip to
work usually begin?

a. Address
Development or condominium name
Number and street name

Hour

39 When did you last work, even for a

Minute

:

few days?

a.m.

Within the past 12 months

p.m.

1 to 5 years ago ➔ SKIP to I

If the exact address is not known, give a
description of the location such as the building 35 How many minutes did it usually take
name or the nearest street or intersection.
you to get from this address to work

Over 5 years ago or never worked ➔ SKIP
to question 43

LAST WEEK?

b. Name of city, town, post office, military
installation, or base

Minutes

40 a. During the PAST 12 MONTHS (52 weeks),
did you work EVERY week? Count paid
vacation, paid sick leave, and military
service as work.

c. Is the work location inside the limits of
that city or town?

H

Yes
No, outside the city/town limits
d. Name of municipio in Puerto Rico
or U.S. county

Yes ➔ SKIP to question 41
Answer questions 36 – 39 if you did NOT
work last week. Otherwise, SKIP to
question 40a.

No
b. During the PAST 12 MONTHS (52 weeks),
how many WEEKS did you work? Include
paid time off and include weeks when
you only worked for a few hours.

36 a. LAST WEEK, were you on layoff from

Weeks

a job?
Yes ➔ SKIP to question 36c
e. Enter Puerto Rico or name of U.S. state
or foreign country

No
b. LAST WEEK, were you TEMPORARILY
absent from a job or business?

41 During the PAST 12 MONTHS, in the WEEKS

Yes, on vacation, temporary illness,
maternity leave, other family/personal
reasons, bad weather, etc. ➔ SKIP to
question 39

f. ZIP Code

WORKED, how many hours did you usually
work each WEEK?
Usual hours worked each WEEK

No ➔ SKIP to question 37

32 How did you usually get to work LAST
WEEK? Mark ONE box for the method of
transportation used for most of the distance.
Car, truck, or van

Taxicab

Bus

Motorcycle

Subway or
elevated rail

Bicycle

Long-distance train
or commuter rail

c. Have you been informed that you will be
recalled to work within the next 6 months
OR been given a date to return to work?
Yes ➔ SKIP to question 38
No

Walked

Carro público

Worked from this
address ➔ SKIP to
question 40a

Ferryboat

Other method

§.=!U¤

5

13280060

I

Answer questions 42a – 42f if you worked
in the past 5 years. Otherwise, SKIP to
question 43.

f. Describe your most important activities
or duties. (For example: instruct and evaluate
students and create lesson plans, assemble and
install pipe sections and review building plans
for work details)

d. Did you receive any Social Security or
Railroad Retirement income in the PAST
12 MONTHS?
Yes ➔ What was the amount?
Total amount - Dollars

42 DESCRIPTION OF EMPLOYMENT
The next series of questions is about the type
of employment you had last week.
If you had more than one job, describe the one
at which the most hours were worked. If you
did not work last week, describe the most
recent employment in the past five years.
a. Which one of the following best
43 INCOME IN THE PAST 12 MONTHS
describes your employment last week
or the most recent employment in the
Mark (X) the "Yes" box for each type of income
past 5 years? Mark (X) ONE box.
you received, and give your best estimate of the
PRIVATE SECTOR EMPLOYEE
TOTAL AMOUNT during the PAST 12 MONTHS.
(NOTE: The "past 12 months" is the period from
For-profit company or organization
today’s date one year ago up through today.)
Non-profit organization (including
Mark (X) the "No" box to show types of income
tax-exempt and charitable organizations)
NOT received.
GOVERNMENT EMPLOYEE
Local government (for example: city,
If your net income was a loss, mark the "Loss"
box to the right of the dollar amount.
county, or municipio)
State government (including school
For income received jointly, report only your
districts and state universities)
share of the amount received or earned.
Active duty U.S. Armed Forces or
a. Did you receive any wages, salary,
Commissioned Corps
commissions, bonuses, or tips in the
Federal government civilian employee
PAST 12 MONTHS?
SELF-EMPLOYED OR OTHER
Owner of non-incorporated business,
professional practice, or farm
Owner of incorporated business,
professional practice, or farm
Worked without pay in a for-profit
family business or farm for 15 hours or
more per week
b. What was the name of your employer,
business, agency, or branch of the
Armed Forces?

c. What kind of business or industry was
this? Include the main activity, product, or
service provided at the location where
employed. (For example: elementary school,
residential construction)

Yes ➔ What was the amount from
all jobs before deductions for
taxes, bonds, dues, or other
items?
Total amount - Dollars

$

,

,

.00

$

e. Did you receive any Supplemental
Security Income (SSI) in the PAST 12
MONTHS?
Yes ➔ What was the amount?
Total amount - Dollars

$

f. Did you receive any public assistance or
welfare payments from the state or local
welfare office in the PAST 12 MONTHS?
Yes ➔ What was the amount?
Total amount - Dollars

$

Yes ➔ What was the net income
after business expenses?
Total amount - Dollars
Loss

,

g. Did you receive any retirement income,
pensions, survivor or disability income in
the PAST 12 MONTHS? Include income from
a previous employer or union, or any regular
withdrawals or distributions from IRA, Roth
IRA, 401(k), 403(b), or other accounts
specifically designed for retirement. Do not
include Social Security.

.00

$

h. Did you have any other sources of income
received regularly such as Veterans’ (VA)
payments, unemployment compensation,
child support, or alimony in the PAST 12
MONTHS? Do NOT include lump sum
payments such as money from an inheritance
or sale of a home.
Yes ➔ What was the amount?
Total amount - Dollars

d. Was this mainly – Mark (X) ONE box.
wholesale trade?
retail trade?
other (agriculture, construction, service,
government, etc.)?
e. What was your main occupation?
(For example: 4th grade teacher, entry-level
plumber)

c. Did you receive any interest, dividends,
net rental income, royalty income, or
income from estates and trusts in the
PAST 12 MONTHS? Report even small
amounts credited to an account.
Yes ➔ What was the amount?
Total amount - Dollars
Loss

$
No

6

§.=!]¤

,

,

.00

,

No

No
manufacturing?

.00

,

No

Yes ➔ What was the amount?
Total amount - Dollars

b. Did you have any self-employment
income from own nonfarm businesses
or farm businesses, including
proprietorships and partnerships,
in the PAST 12 MONTHS?

,

.00

,

No

No

$

.00

,

No

.00

$

.00

,

No

44 What was your total income during the

PAST 12 MONTHS? Add entries 43a to 43h;
subtract any losses. If net income was a loss,
enter the amount and mark (X) the "Loss" box
next to the dollar amount.
Total amount - Dollars

None
OR

$

,

,

Loss

.00

13280078

J Thank you very much for your

participation.
Place the questionnaire in the
envelope and HOLD for your Census
Bureau Representative to pick up.

The Census Bureau estimates that this form will take about 25 minutes to complete, including the time for reviewing the instructions and answers. Send
comments regarding this burden estimate, including suggestions for reducing this burden, to: Paperwork Reduction Project, U.S. Census Bureau,
4600 Silver Hill Road, ADDC-4H277, Washington, DC 20233. You may email comments to [email protected]; use "Paperwork Project" as
the subject.
Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of Management and
Budget. This 8-digit number appears in the bottom right on the front cover of this form.

§.=!o¤
ACS-1GQ(PR), Page 7, Base (Black)

7
ACS-1GQ(PR), Page 7, Purple Pantone 253 (15, 50%)

13280086

CENSUS USE ONLY
1. Who answered the questions on this form? Mark (X) one box.
Sample resident
Proxy respondent
SSS individual
A combination of sources
Don’t know

2. How were the questions on this form completed? Mark (X) one box.
By self-response
By personal interview - Specify reason

3. Were administrative records used to complete any of the questions on this form?
Mark (X) one box.
No
Yes, Some administrative record information was used
Yes, All responses were obtained from administrative record information
Don’t know

Reason (code 219 or 243):

Final Outcome Codes
Mark (X) ONE of the codes below to indicate
the final outcome of the case. If code 219 or 243
is marked, explain reason in the space provided.

Interview
201
203

Out of scope

Noninterview
213
214
215
217
218
219
233
241
243

Other – Specify
I have reviewed the questionnaire for completeness.
FR’s name
Username

8

§.=!w¤

Date of interview

13280094

CENSUS USE ONLY
1. ¿Quién contestó las preguntas de este cuestionario? Marque (X) una casilla.
Residente en la muestra
Individuo con poder o autorización para responder en nombre del
residente en la muestra
Individuo con clasificación de empleado especial juramentado
Una combinación de fuentes
No sabe

2. ¿Cómo se completaron las preguntas de este cuestionario? Marque (X) una casilla.
Por auto-respuesta
Por medio de una entrevista en persona – Especifique la razón

3. ¿Se usaron registros administrativos para completar cualquiera de las preguntas de este
cuestionario? Marque (X) una casilla.
No
Sí, se usó alguna información de registros administrativos para completar este cuestionario
Sí, todas las respuestas de este cuestionario se obtuvieron de información de registros administrativos
No sabe

Códigos de Resultado Final

Razón (código 219 ó 243):

Marque (X) UNO de los códigos a continuación para
indicar el resultado final del caso. Si marcó el código
219 ó 243, explique la razón en el espacio a continuación.

Interview
201
203

Fuera de la muestra

Noninterview
213
214
215
217
218
219
233
241
243

Otra, especifique

I have reviewed the questionnaire for completeness.
FR’s name
Username

8

§.=!¡¤

Date of interview

13280102

J Muchas gracias por su

participación.
Coloque el cuestionario en el
sobre y GUÁRDELO hasta que
su Representante de la Oficina
del Censo lo recoja.

La Oficina del Censo estima que le tomará 25 minutos completar este cuestionario, incluyendo el tiempo para repasar las instrucciones y respuestas.
Los comentarios sobre el estimado del tiempo, incluyendo sugerencias para reducir el tiempo que toma, deben dirigirse a: Paperwork Reduction Project,
U.S. Census Bureau, 4600 Silver Hill Road, ADDC-4H277, Washington, DC 20233. Puede enviar sus comentarios por correo electrónico a
[email protected]: escriba "Paperwork Project" en el espacio para el tema.
No se requiere que las personas respondan a ninguna recopilación de información a menos que ésta tenga un número válido aprobado de la Oficina de
Administración y Presupuesto. Este número de 8 dígitos se encuentra en la parte inferior derecha de la cubierta de este cuestionario.

§.="#¤
ACS-1GQ(PR), Page 7, Base (Black)

7
ACS-1GQ(PR), Page 7, Yellow Pantone 129 (20, 50%)

13280110

I

42

d. ¿Recibió usted algún ingreso de Seguro
Social o ingreso de retiro para personal de
los ferrocarriles en los PASADOS 12 MESES?

f. Describa su actividades o deberes más
importantes. (Por ejemplo: dar clases y evaluar
a los estudiantes y planificar lecciones, montar e
instalar tramos de tubería y revisar los planes de
construcción para las especificaciones del trabajo)

Conteste las preguntas 42a – 42f sólo si
usted trabajó durante los últimos 5 años.
De lo contrario, PASE a la pregunta 43.

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

DESCRIPCIÓN DEL EMPLEO
La serie de preguntas que sigue es sobre el tipo de
empleo que usted tenía la semana pasada.

No

Si usted tenía más de un empleo, describa el empleo
en el cual trabajó más horas. Si usted no trabajó la
semana pasada, describa el empleo más reciente en
los últimos cinco años.
a. ¿Cuál de las siguientes opciones describe
mejor su empleo de la semana pasada o
su empleo más reciente en los últimos 5
años? Marque (X) UNA casilla.

43

Compañía u organización con fines de lucro

Gobierno local (por ejemplo: ciudad,
condado o municipio)
Gobierno estatal (incluso distritos escolares
y universidades estatales)
Servicio activo en las Fuerzas Armadas de
los EE. UU. o en el Cuerpo de Comisionados
Empleado civil del gobierno federal
EMPLEADO POR CUENTA PROPIA U OTRO
Propietario(a) de un negocio, una práctica
profesional o una finca no incorporada

INGRESO EN LOS ÚLTIMOS 12 MESES

b. ¿Cuál era el nombre de su patrono, negocio,
agencia o rama de las Fuerzas Armadas?

c. ¿Qué tipo de negocio o industria era este?
Incluya la actividad, producto o servicio principal
que se ofrecía en el lugar de empleo. (Por ejemplo:
escuela primaria, construcción residencial)

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

Marque (X) la casilla "Sí" por cada tipo de ingreso que
recibió y anote el mejor estimado de la CANTIDAD
TOTAL recibida durante los ÚLTIMOS 12 MESES.
(NOTA: Los "últimos 12 meses" es el período desde la
fecha de hoy hace un año hasta hoy.)

No

Si el ingreso neto fue una pérdida, marque la casilla
"Pérdida" a la derecha de la cantidad en dólares.

a. ¿Recibió usted jornales, salarios, comisiones,
bonos o propinas en los PASADOS 12 MESES?

No

Cantidad total – Dólares

,

.00

No

No

Sí ➔ ¿Cuál fue el ingreso neto después de
descontar los gastos de negocio?
Pérdida

,

.00

No
d. ¿Era este(a) principalmente de –
Marque (X) UNA casilla.
manufactura?
comercio al por mayor?
comercio al detal?

c. ¿Recibió usted intereses, dividendos, ingreso
neto por rentas, ingreso por derechos de autor,
o ingreso por herencias y fideicomisos en los
PASADOS 12 MESES? Informe cantidades
acreditadas a una cuenta aunque sean pequeñas.
Sí ➔ ¿Cuál fue la cantidad?

otro (agricultura, construcción, servicio,
gobierno, etc.)?
e. ¿Cuál era su ocupación principal?
(Por ejemplo: maestro(a) de 4to grado, plomero(a)
principiante)

No

Pérdida

$
No

,

,

.00

§.="+¤

$

.00

,

¿Cuál fue su ingreso total en los PASADOS 12
MESES? Sume las cantidades anotadas en las preguntas
43a–43h; reste cualquier pérdida. Si el ingreso neto fue
una pérdida, anote la cantidad y marque (X) la casilla
"Pérdida" al lado de la cantidad.
Cantidad total – Dólares

Ninguno
Ó

6

.00

,

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

44

Cantidad total – Dólares

$

h. ¿Tuvo usted alguna otra fuente de ingreso
recibido regularmente, tal como pagos de la
Administración de Veteranos (VA),
compensación por desempleo, pensión para
hijos menores, pensión alimenticia, o pensión
de su ex pareja en los PASADOS 12 MESES?
NO incluya pagos de mayor cantidad recibidos una
sola vez, tal como dinero de una herencia o de la
venta de una casa.

Cantidad total – Dólares

,

.00

,

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

b. ¿Tuvo usted algún ingreso de empleo por
cuenta propia en su negocio no agrícola o finca
comercial, ya sea como propietario(a) único(a)
o en sociedad en los PASADOS 12 MESES?

$

$

g. ¿Recibió usted algun ingreso por retiro,
pensiónes, ingreso por discapacidad o por ser
esposo(a) sobreviviente en los PASADOS 12
MESES? Incluya ingresos de un patrono o sindicato
previo, retiros o distribuciones periódicas de una
cuenta individual de retiro (IRA, por sus siglas en
inglés), una IRA no deducible (Roth IRA), un plan
401(k), 403(b) u otras cuentas diseñadas
específicamente para la jubilación. No incluya el
Seguro Social.

Sí ➔ ¿Cuál fue la cantidad de todos los
empleos antes de aplicarse las
deducciones por impuestos, bonos,
cuotas u otras cosas?

,

.00

,

Sí ➔ ¿Cuál fue la cantidad?
Cantidad total – Dólares

Para ingreso recibido en conjunto, sólo informe la
parte que le corresponde a usted.

$

$

f. ¿Recibió usted algún pago de asistencia o
bienestar público (welfare) de la oficina de
bienestar estatal o local en los PASADOS 12
MESES?

Marque (X) la casilla "No" para mostrar los tipos de
ingresos NO recibidos.

Propietario(a) de un negocio, una práctica
profesional o una finca incorporada
Trabajó sin paga en un negocio o finca de la
familia con fines de lucro 15 horas o más a
la semana

.00

,

e. ¿Recibió usted algún ingreso de Seguridad de
Ingreso Suplementario (SSI) en los PASADOS
12 MESES?

EMPLEADO DEL SECTOR PRIVADO

Organización sin fines de lucro (incluso las
organizaciones exentas de impuestos y las
organizaciones caritativas)
EMPLEADO DEL GOBIERNO

$

$

,

,

Pérdida

.00

13280128

30 a. LA SEMANA PASADA, ¿hizo usted
algún trabajo por paga en un empleo
(o negocio)?

G

Conteste la pregunta 33 si marcó
"Automóvil, camión o van" en la pregunta
32. De lo contrario, PASE a la pregunta 34.

Sí ➔ PASE a la pregunta 31

33 ¿Cuántas personas, incluyéndolo(a) a

usted, usualmente viajaron al trabajo en
el automóvil, camión o van LA SEMANA
PASADA?
Persona(s)

Sí
No ➔ PASE a la pregunta 36a

34 LA SEMANA PASADA ¿a qué hora

usualmente comenzó usted su viaje al
trabajo?
Hora

Minutos

:
Si no sabe la dirección exacta, dé una
descripción de la localización, tal como el
nombre del edificio o la calle o intersección
más cercana.

No ➔ PASE a la pregunta 39

38 LA SEMANA PASADA, ¿hubiera podido
usted comenzar un empleo si se le hubiera
ofrecido uno, o hubiera podido regresar al
trabajo si se le hubiera llamado de nuevo?
Sí, hubiera podido ir a trabajar

31 ¿En qué lugar trabajó usted LA SEMANA
PASADA? Si trabajó en más de un lugar,
escriba en letra de molde la dirección donde
usted trabajó la mayor parte de la semana.
a. Dirección
Nombre de urbanización o condominio
Número y nombre de la calle

estado usted buscando trabajo
ACTIVAMENTE?
Sí

No – No trabajó (o está retirado(a))
b. LA SEMANA PASADA, ¿hizo usted
CUALQUIER trabajo por paga, incluso
aunque fuese por una hora?

37 Durante las ÚLTIMAS 4 SEMANAS, ¿ha

a.m.
p.m.

No, debido a una enfermedad
temporera propia
No, debido a otras razones (en la
escuela, etc.)

39 ¿Cuándo trabajó usted por última vez,
aunque fuera por unos pocos días?
En los últimos 12 meses

35 ¿Cuántos minutos le tomó a usted

usualmente ir de esta dirección al trabajo
LA SEMANA PASADA?

b. Nombre de la ciudad, pueblo, oficina de
correos, instalación o base militar

Minutos

Hace 1 a 5 años ➔ PASE a la sección

I

Hace más de 5 años o nunca
trabajó ➔ PASE a la pregunta 43

40 a. ¿Durante los ÚLTIMOS 12 MESES (52
c. ¿Está localizado el lugar de trabajo
dentro de los límites de esa ciudad o
pueblo?

H

Sí

Conteste las preguntas 36 – 39 si usted NO
trabajó la semana pasada. De lo contrario,
PASE a la pregunta 40a.

36 a. LA SEMANA PASADA, ¿estuvo usted
suspendido(a) (on layoff) o en cesantía
de un empleo?
Sí ➔ PASE a la pregunta 36c

e. Anote Puerto Rico o nombre del estado
de los Estados Unidos o país extranjero

No
b. LA SEMANA PASADA, ¿estuvo usted
ausente TEMPORERAMENTE de su empleo
o negocio?

f. Código Postal

32 ¿Cómo llegó usualmente usted al trabajo
LA SEMANA PASADA? Marque (X) UNA casilla
para el medio de transportación que utilizó por
más distancia.

Tren urbano
Tren de viajes largos
o de cercanías

Sí ➔ PASE a la pregunta 41
No

No, fuera de los límites de la
ciudad/pueblo
d. Nombre del municipio en Puerto Rico o
condado de los Estados Unidos

Automóvil, camión
o van
Autobús

semanas), ¿trabajó usted TODAS las
semanas? Incluya como trabajo vacaciones
pagadas, licencia por enfermedad pagada
y servicio en las Fuerzas Armadas.

Taxi
Motocicleta
Bicicleta
Caminó

Carro público

Trabajó en esta
dirección ➔ PASE
a la pregunta 40a

Lancha (ferry)

Otro método

§.="=¤

Sí, de vacaciones, enfermedad
temporera, licencia por maternidad,
otras razones personales o relacionadas
con la familia, mal tiempo, etc. ➔ PASE
a la pregunta 39

b. Durante los ÚLTIMOS 12 MESES (52
semanas), ¿cuántas SEMANAS trabajó
usted? Incluya vacaciones o licencias
pagadas e incluya semanas en que usted
solo trabajó por unas pocas horas.
Semanas

41 En las SEMANAS TRABAJADAS durante los
ÚLTIMOS 12 MESES, ¿cuántas horas trabajó
usualmente usted cada SEMANA?
Horas usualmente trabajadas cada SEMANA

No ➔ PASE a la pregunta 37
c. ¿Se le ha informado a usted que será
llamado(a) de nuevo a trabajar dentro
de los próximos 6 meses O se le ha dado
una fecha para regresar al trabajo?
Sí ➔ PASE a la pregunta 38
No

5

13280128

18 a. ¿Es usted sordo(a) o tiene una

21 ¿Cuál es su estado civil?

27 ¿Ha estado usted alguna vez en el servicio
militar activo en las Fuerzas Armadas, la
Reserva Militar o la Guardia Nacional de los
Estados Unidos? Marque (X) UNA casilla.

dificultad seria para oír?
Casado(a) actualmente
Sí

Viudo(a)

No

Divorciado(a)
Separado(a)

b. ¿Es usted ciego(a) o tiene una dificultad
seria para ver aunque lleve puestos
espejuelos o lentes?
Sí

Conteste las preguntas 19a – c si usted tiene
5 años de edad o más. De lo contrario,
PASE a la sección J en la página 7 para
instrucciones adicionales; no conteste más
preguntas.

Servicio activo solamente para
entrenamiento de la Reserva Militar o la
Guardia Nacional ➔ PASE a la pregunta 29a

Nunca se ha casado ➔ PASE a la sección F

22 En los PASADOS 12 MESES, ¿usted –
Sí

No

D

Nunca estuvo en el servicio militar ➔ PASE
a la pregunta 30a

En servicio activo ahora

No

En servicio activo en el pasado, pero no
ahora

a. se casó?
b. enviudó?

28 ¿Cuándo estuvo usted en servicio militar

c. se divorció?

activo en las Fuerzas Armadas de los
Estados Unidos? Marque (X) una casilla para
CADA período durante el cual usted estuvo en
servicio militar, aunque fuera sólo por parte
del período.

23 ¿Cuántas veces ha estado usted casado(a)?
Una vez
Dos veces

19 a. Debido a una condición física, mental o
emocional, ¿tiene usted una dificultad
seria para concentrarse, recordar o
tomar decisiones?

Septiembre del 2001 ó después

Tres veces o más

Agosto del 1990 a agosto del 2001
(incluyendo la Guerra del Golfo Pérsico)
Mayo del 1975 a julio del 1990

24 ¿En qué año se casó usted la última vez?
Año

Sí

Época de Vietnam (agosto del 1964 a
abril del 1975)
Febrero del 1955 a julio del 1964

No
b. ¿Tiene usted una dificultad seria para
caminar o subir las escaleras?
Sí

F

Conteste la pregunta 25 si usted es del sexo
femenino y tiene de 15 a 50 años de edad.
De lo contrario, PASE a la pregunta 26a.

Guerra de Corea (julio del 1950 a
enero del 1955)
Enero del 1947 a junio del 1950

No

Segunda Guerra Mundial (diciembre del
1941 a diciembre del 1946)
Noviembre del 1941 ó antes

25 ¿En los ÚLTIMOS 12 MESES, ¿ha dado a luz
c. ¿Tiene usted dificultad para vestirse o
bañarse?
Sí

usted?
Sí

29 a. ¿Tiene usted una clasificación de

No

No

26 a. ¿Tiene usted algún nieto menor de 18

E

años que viva en este lugar?
Conteste la pregunta 20 si usted tiene 15
años de edad o más. De lo contrario,
PASE a la sección J en la página 7 para
instrucciones adicionales; no conteste más
preguntas.

20 Debido a una condición física, mental o
emocional, ¿tiene usted dificultad para
hacer diligencias solo(a), tal como ir al
consultorio de un médico o ir de compras?

Sí (tal como 0%, 10%, 20%, ... 100%)
No ➔ PASE a la pregunta 30a

Sí
No ➔ PASE a la pregunta 27
b. ¿Es usted actualmente responsable de la
mayoría de las necesidades básicas de
algunos de sus nietos menores de 18 años
que viven en este lugar?

§.="=¤

0 por ciento
10 ó 20 por ciento

No ➔ PASE a la pregunta 27

30 ó 40 por ciento

c. ¿Cuánto tiempo hace que usted es
responsable de este(os) nieto(s)? Si
usted es responsable económicamente de más
de un nieto, conteste la pregunta para el nieto
del cual haya sido responsable por más tiempo.
Menos de 6 meses

3 ó 4 años

6 a 11 meses

5 años o más

1 ó 2 años

4

b. ¿Qué por ciento de incapacidad
relacionada con el servicio militar tiene
usted?

Sí

Sí
No

incapacidad de la VA relacionada con el
servicio?

50 ó 60 por ciento
70 por ciento o más

13280144

10

¿Cuál es el título o nivel escolar más alto que
usted ha COMPLETADO? Marque (X) UNA casilla.
Si está matriculado(a) actualmente, marque el grado
escolar anterior o el título más alto recibido.

12

¿Cuál es su ascendencia u origen étnico?

15

NO HA COMPLETADO NINGÚN GRADO

PRE-ESCOLAR O PRE-KINDER HASTA GRADO 12
Pre-escolar o pre-kinder

Sí

(Por ejemplo: italiana, jamaicana, africana americana,
camboyana, de Cabo Verde, noruega, dominicana,
franco-canadiense, haitiana, coreana, libanesa, polaca,
nigeriana, mexicana, taiwanesa, ucraniana, entre otras.)

No ha completado ningún grado

13

Kindergarten

a. En su hogar, ¿habla usted un idioma
que no sea inglés?

No

16

Sí

Grado 1 al 11 – Especifique
grado 1-11

No ➔ PASE a la pregunta 14a
b. ¿Qué idioma es ese?

Grado 12, SIN DIPLOMA

Diploma de escuela superior

Muy bien

GED o examen equivalente

Algunos créditos universitarios, pero menos de
1 año de créditos universitarios

c. Medicare, para personas que
tienen 65 años o más, o personas
con ciertos impedimentos

Bien

UNIVERSIDAD O ALGUNOS CRÉDITOS
UNIVERSITARIOS

No bien

d. Medicaid, Medical Assistance,
o cualquier tipo de plan de
asistencia gubernamental para
esas personas con un ingreso
bajo o incapacidad

No habla inglés

14

1 año o más de créditos universitarios, sin título
Título asociado universitario (por ejemplo:
AA, AS)
Título de bachillerato universitario (por ejemplo:
BA, BS)
DESPUÉS DEL TÍTULO DE BACHILLERATO
UNIVERSITARIO

a. ¿Vivía usted en esta dirección hace 1 año?
Persona es menor de 1 año de edad ➔
PASE a la pregunta 16

e. TRICARE u otro seguro de salud
militar

Sí, en esta dirección ➔ PASE a la pregunta 15

f. VA (se ha registrado en el
sistema de cuidado de salud
militar de la VA)

No, fuera de Puerto Rico y los
Estados Unidos – Escriba en letra de molde
continuación el nombre del país extranjero o
las Islas Vírgenes de los EE.UU., Guam, etc.;
luego PASE a la pregunta 15

g. Servicio de Salud Indio
(Indian Health Service)
h. Cualquier otro tipo de seguro de
salud o plan de cobertura de
seguro de salud – Especifique

Título de maestría (por ejemplo: MA, MS, MEng,
MEd, MSW, MBA)
Título profesional más allá de un título de
bachillerato universitario (por ejemplo: MD, DDS,
DVM, LLB, JD)
Título de doctorado (por ejemplo: PhD, EdD)

B

Conteste la pregunta 11 si tiene un título
de bachillerato universitario o más alto.
De lo contrario, PASE a la pregunta 12.

11

Esta pregunta se enfoca en su TÍTULO DE
BACHILLERATO UNIVERSITARIO. Por favor, escriba
en letra de molde el título específico de la
concentración de estudio de cualquier TÍTULO DE
BACHILLERATO UNIVERSITARIO específico(s) que
usted recibió. (Por ejemplo: ingeniería química,
enseñanza de educación primaria, o psicología
organizacional)

¿Tiene usted cobertura ACTUALMENTE de
cualquiera de los siguientes tipos de seguros de
salud o planes de cobertura de seguro de salud?
Marque “Sí” o “No” para CADA tipo de cobertura en
las respuestas a-h.
Sí
No
a. Seguro a través de su
patrono o sindicato
(unión), actual o previo,
(de usted o de cualquier
otro miembro de la familia)
b. Seguro adquirido directamente
de una compañía de seguro
(por usted o por cualquier otro
miembro de la familia)

Por ejemplo: coreano, italiano, español, vietnamés
c. ¿Cuán bien habla usted el inglés?

GRADUADO(A) DE ESCUELA SUPERIOR

EN LOS ÚLTIMOS 12 MESES, ¿recibió usted
beneficios del gobierno por medio del Programa
de Asistencia Nutricional? NO incluya WIC, ni el
Programa de Almuerzos Escolares, ni ayuda de bancos
de alimentos.

No, en una dirección diferente en los
Estados Unidos o Puerto Rico
b. ¿Dónde vivía usted hace 1 año?
Dirección
Nombre de urbanización o condominio
Número y nombre de la calle

Nombre de la ciudad, pueblo, oficina
de correos, instalación o base militar

Nombre del municipio en Puerto Rico
o condado de los Estados Unidos

Anote Puerto Rico o el
nombre del estado de
los Estados Unidos

Código Postal

C

Conteste la pregunta 17a si usted tiene
seguro de salud. De lo contrario, PASE a la
pregunta 18a.

17

a. ¿Tiene este plan una prima o cuota?
Una prima o cuota es una cantidad fija de
dinero que se paga regularmente para la
cobertura de salud. No incluye los copagos,
deducibles ni otros gastos, tales como los
costos de las medicinas recetadas.
Sí
No ➔ PASE a la pregunta 18a
b. ¿Recibe usted o algún otro miembro de la
familia un crédito fiscal o subsidio basado en
su ingreso como ayuda para pagar la prima o
cuota?
Sí
No

§.="M¤

3

13280151

1

¿Cuál es su nombre? Escriba su nombre en
letra de molde. Incluya su número de
teléfono y la fecha de hoy. Solo nos
comunicaremos con usted si es necesario
para asuntos oficiales de la Oficina el Censo.
Apellido

Nombre

Inicial

5 ¿Cuál es su raza? Marque (X) una o más
casillas Y escriba los orígenes.

7 ¿Es usted ciudadano(a) de los Estados Unidos?
Sí, nació en Puerto Rico ➔ PASE a la
pregunta 9a
Sí, nació en los Estados Unidos, el Distrito de
Columbia, Guam, las Islas Vírgenes de los
Estados Unidos o las Islas Marianas del Norte
Sí, nació en el extranjero de padre o
madre que es ciudadano(a) de los EE.UU.
Sí, es ciudadano(a) de los Estados Unidos
por naturalización. Escriba el año de
naturalización

Blanca – Escriba, por ejemplo, alemán,
irlandés, inglés, italiano, libanés,
egipcio, etc. C

Negra o afroamericana – Escriba, por
ejemplo, afroamericano, jamaiquino,
haitiano, nigeriano, etíope, somalí, etc. C

Código de área y número de teléfono
—
Fecha
Mes

2

Día

Femenino

¿Cuál es su edad y su fecha de nacimiento?
Para bebés menores de un año, no escriba la
edad en meses. Solo escriba 0.
Edad
(en años)

A

No, no es ciudadano(a) de los
Estados Unidos

8 ¿Cuándo vino usted a vivir a Puerto Rico?
Si usted vino a vivir a Puerto Rico más de una
vez, escriba el último año.

Año

¿Cuál es su sexo? Marque (X) UNA casilla.
Masculino

3

Año

Indígena de las Américas o nativa de
Alaska – Escriba el nombre de la(s)
tribu(s) en la(s) que está inscrito(a) o
la(s) tribu(s) principal(es), por ejemplo,
Navajo Nation, Blackfeet Tribe, maya,
azteca, Native Village of Barrow Inupiat
Traditional Government, Nome Eskimo
Community, etc. C

Escriba los números en las casillas.
Año de
Mes
Día
nacimiento

NOTA: Por favor, conteste la Pregunta
4 sobre origen hispano Y la Pregunta 5
sobre raza. Para esta encuesta, origen
hispano no es una raza.

China

Japonesa

Filipina

Nativa de Hawái

India asiática

Samoana

Vietnamita

Chamorra

Coreana

Otra de las islas
del Pacífico –
Escriba, por
ejemplo,
tongano,
fiyiano, de
las Islas
Marshall, etc. C

Otra asiática –
Escriba, por
ejemplo,
pakistaní,
camboyano,
hmong, etc. C

9 a. En cualquier momento DURANTE LOS

ÚLTIMOS 3 MESES, ¿ha estudiado usted en
una escuela o universidad? Incluya sólo
pre-escolar o pre-kinder, kindergarten, escuela
elemental, enseñanza en el hogar y escuela
que conduce a un diploma de escuela superior
o un título universitario.
No, no ha estudiado durante los últimos
3 meses ➔ PASE a la pregunta 10
Escuela o universidad pública
Escuela o universidad privada o
enseñanza en el hogar (home school)

b. ¿A qué grado o nivel escolar asistía usted?
Marque (X) UNA casilla.
Pre-escolar o pre-kinder

4

¿Es usted de origen hispano, latino o
español?
No, no es de origen hispano, latino
o español
Sí, mexicano, mexicanoamericano,
chicano
Sí, puertorriqueño

Alguna otra raza – Escriba la raza o el
origen. C

Grado 1 al 12 – Especifique
grado 1-12

6 ¿Dónde nació usted?
En los Estados Unidos – Escriba en letra de
molde el nombre del estado.

Sí, cubano
Sí, otro origen hispano, latino o español –
Escriba, por ejemplo, salvadoreño,
dominicano, colombiano, guatemalteco,
español, ecuatoriano, etc. C

2

§.="T¤

Kindergarten

Fuera de los Estados Unidos – Escriba en
letra de molde Puerto Rico o el nombre del
país extranjero, o de las Islas Virgenes de
los EE.UU., Guam, etc.

Estudios universitarios al nivel de
bachillerato (freshman a senior)
Escuela graduada o profesional más
allá de un bachillerato universitario (por
ejemplo, un programa de Maestría o
Doctorado o una escuela de medicina
o leyes)

13280169

DC

La Encuesta sobre la
Comunidad de Puerto Rico

This questionnaire is available in either English or Spanish.
Este cuestionario está disponible en español o en inglés.
To complete the Spanish questionnaire, begin on
page 2. To complete the English questionnaire, flip
this over and complete the purple side.

Para completar el cuestionario en español, comience
en la página 2. Para completar el cuestionario en
inglés, vírelo y complete el lado lila.

Please complete this form as soon as possible.
Place it in the envelope provided and HOLD it for a
census representative to return to pick it up.

Por favor, complete este cuestionario tan
pronto sea posible. Colóquelo en el sobre que se
provee y GUÁRDELO hasta que un representante del
censo lo venga a recoger.

If you need help or have questions about
completing this form, call the number that our
census representative has given you.

Si necesita ayuda o tiene preguntas sobre cómo
completar este cuestionario, llame al número de
teléfono que le ha dado nuestro representante del
censo.

For more information about the Puerto Rico
Community Survey, visit our web site at:
http://www.census.gov/acs

Para obtener más información sobre la Encuesta
sobre la Comunidad de Puerto Rico, vaya a nuestra
página en la Internet: http://www.census.gov/acs

ACS-1(GQ)(PR)(2020)

FORM
(03-26-2019) Draft 4

OMB No. 0607-0810

§.="f¤
ACS-1GQ(PR), Page 1, Base (Black)

ACS-1GQ(PR), Page 1, Purple Pantone 253 (15%)

ACS-1GQPR, Page 1, Yellow Pantone 129 (20%)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Dear Resident:
The U.S. Census Bureau is conducting a very important national survey called the
Puerto Rico Community Survey (PRCS). The PRCS is separate from the 2020 Census.
This year, some residents will be contacted by representatives from both the PRCS and the
2020 Census. Your response is required by U.S. law (Title 13, United States Code (U.S.C.),
Sections 141, 193, 221, and 223).
A PRCS field representative from the Census Bureau will conduct a personal interview with
you, or you may complete the survey questionnaire yourself. We estimate this survey will take
about 25 minutes of your time. If you fill out the questionnaire yourself, please place it in the
envelope that the PRCS field representative gave you. The field representative will arrange for
a convenient time to pick it up.
The Puerto Rico Community Survey paints a picture of life in Puerto Rico—education, housing,
jobs, and more. Every year, this survey provides up-to-date information to community leaders
as well as federal, Puerto Rico, and municipio governments. This information can be used to
identify the services and programs your community needs. For example, this survey can
provide information to plan services for the elderly, emergency services, and federal aid.
The Census Bureau is required by law to keep your information confidential. We are not
permitted to publicly release your responses in a way that could identify you. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data. The Census Bureau can only use
your responses to produce statistics. The enclosed brochure provides answers to frequently
asked questions about the PRCS.
If you have access to the Internet and want to learn more about the PRCS, please visit the
Census Bureau’s Web site at: census.gov/acs. Thank you for your help.
Sincerely,

Steven D. Dillingham
Director
Enclosure

ACS-17(LZ)(GQ)(PR)(2020) (2-25-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Estimado señor o señora,
La Oficina del Censo de los EE. UU. está realizando una encuesta nacional muy importante
llamada Encuesta sobre la Comunidad de Puerto Rico (PRCS, por sus siglas en
inglés). La PRCS es una encuesta independiente del Censo del 2020. Este año, algunos
residentes serán contactados por representantes tanto de la PRCS como del Censo del 2020.
Su respuesta es requerida por la ley de los EE. UU. (Título 13 del Código de los
EE. UU., Secciones 141, 193, 221 y 223).
Un representante de la Encuesta sobre la Comunidad de Puerto Rico realizará una entrevista
en persona con usted, o usted mismo puede completar el cuestionario de la encuesta.
Estimamos que esta encuesta tomará aproximadamente 25 minutos de su tiempo. Si usted
mismo contesta el cuestionario, por favor, échelo en el sobre que le entregó el representante
de la Encuesta sobre la Comunidad de Puerto Rico. El representante acordará con usted el
mejor momento para recogerlo.
La Encuesta sobre la Comunidad de Puerto Rico ofrece un panorama de la vida en
Puerto Rico: la educación, la vivienda, los empleos y más. Todos los años, esta encuesta
proporciona información actualizada a los líderes de la comunidad, así como al gobierno
federal, al de Puerto Rico y a los de los municipios. Esta información puede usarse para
identificar los servicios y programas que su comunidad necesita. Por ejemplo, esta encuesta
puede proporcionar información para planificar servicios para las personas de la tercera edad,
servicios de emergencia y asistencia federal.
La Oficina del Censo de los EE. UU. está obligada por ley a mantener confidencial su
información. A la Oficina del Censo no se le permite divulgar sus respuestas de manera que
usted pudiera ser identificado. En conformidad con la Ley para el Fortalecimiento de la
Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de
seguridad cibernética mediantelos controles aplicados a los sistemas que trasmiten su
información (sección 9 del título 13 del Código de los Estados Unidos). Por ley, la Oficina del
Censo solamente puede usar sus respuestas para producir estadísticas. El folleto adjunto
proporciona respuestas a las preguntas más frecuentes acerca de la Encuesta sobre la
Comunidad de Puerto Rico.
Si tiene acceso a la Internet y desea obtener más información acerca de la Encuesta sobre la
Comunidad de Puerto Rico, visite el sitio de la Oficina del Censo por la Internet en
census.gov/acs. Gracias por su ayuda.
Atentamente,

Steven D. Dillingham
Director
Documentos adjuntos

ACS-17(LZ)(GQ)(PR)(2020) (2-25-2019)

census.gov

DC
Encuesta sobre la Comunidad de Puerto Rico
Sus Respuestas son Confidenciales
La Oficina del Censo de los EE. UU. está llevando a cabo la Encuesta sobre la Comunidad de Puerto Rico del
2006. Agradecemos su participación y cooperación.
Sus respuestas son obligatorias y confidenciales por ley (secciones 9, 141, 193, 214 y 221 del título
13 del Código de los EE. UU.). La Oficina del Censo de los EE. UU. está obligada por ley a mantener
confidencial su información. A la Oficina del Censo no se le permite divulgar sus respuestas de manera
que usted pudiera ser identificado.
La Oficina del Censo estima que le tomará aproximadamente 25 minutos completar este cuestionario, incluyendo el tiempo para
repasar las instrucciones y respuestas. Si tiene algún comentario sobre el tiempo que toma completar este cuestionario o cualquier
otro aspecto de la recopilación debe enviarlo a: Paperwork Reduction Project, U.S. Census Bureau, 4600 Silver Hill Road,
ADDC-4H277, Washington, DC 20233. Puede dirigir sus comentarios por correo electrónico a [email protected]; y use como
referencia “Paperwork Project".
No se requiere que las personas respondan a ninguna recopilación de información a menos que la Oficina de Administración y
Presupuesto le asigne un número de aprobación válido. El número de aprobación para la Encuesta sobre la Comunidad de
Puerto Rico del 2006 es: Núm. de OMB 0607-0810.

Gracias por su cooperación. La Oficina del Censo agradece su ayuda.
For an English translation, see the reverse side. (Para la traducción al inglés, véase al dorso.)
ACS-21(GQ)(PR) (3-22-2019)

DC
Puerto Rico Community Survey
Your Answers Are Confidential
The U.S. Census Bureau is conducting the Puerto Rico Community Survey. We appreciate your
participation and cooperation.
Your answers are required and confidential by law (Title 13, United States Code, Sections 9, 141, 193,
214, and 221). The U.S. Census Bureau is required by law to protect your information. The Census
Bureau is not permitted to publicly release your responses in a way that could identify you.
The Census Bureau estimates that this form will take about 25 minutes to complete, including the time for reviewing the instructions
and answers. Send comments regarding this burden estimate or any other aspect of this burden, to: Paperwork Reduction Project,
U.S. Census Bureau, 4600 Silver Hill Road, ADDC-4H277, Washington, DC 20233. You may e-mail comments to
[email protected]; use "Paperwork Project" as the subject.
Respondents are not required to respond to any information collection unless a valid approval number has been assigned by the Office
of Management and Budget. The approval number for the Puerto Rico Community Survey is: OMB No. 0607-0810.

Thank you for your cooperation. The Census Bureau appreciates your help.
Para la traducción al español, véase al dorso. (For a Spanish translation, see the reverse side.)
ACS-21(GQ)(PR) (3-22-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Dear Resident:

On behalf of the U.S. Census Bureau, I thank you for participating in the Puerto Rico
Community Survey. The success of the survey depends upon cooperation from you
and the other residents selected for the survey. The U.S. Census Bureau is required
by law to keep your information confidential. We are not permitted to publicly release
your responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks through
screening of the systems that transmit your data.
Puerto Rico and local governments will use summarized information from this survey
to make decisions that affect you and your community, and to develop programs that
will provide many goods and services, including health care, education, and
transportation. To learn more about the Puerto Rico Community Survey and to review
the survey results, visit our Web site at census.gov/acs.
Your participation is greatly appreciated.
Sincerely,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(PR)(R)(2020) (2-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Estimado(a) residente:

En nombre de la Oficina del Censo de los EE. UU., le agradezco su participación en
la Encuesta sobre la Comunidad de Puerto Rico. El éxito de esta encuesta depende
de la cooperación que recibimos de usted y de los otros residentes seleccionados
para esta encuesta. La Oficina del Censo de los EE. UU. está obligada por ley a
mantener confidencial su información. A la Oficina del Censo no se le permite divulgar
sus respuestas de manera que usted pudiera ser identificado. En conformidad con la
Ley para el Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos
están protegidos contra los riesgos de seguridad cibernética mediante los controles
aplicados a los sistemas que trasmiten su información.
El gobierno de Puerto Rico y los gobiernos locales usarán información resumida de
esta encuesta para tomar decisiones que les conciernen a usted y su comunidad, y
para elaborar programas que proporcionarán muchos bienes y servicios, incluso
atención médica, educación y transportación. Para obtener más información acerca de
la Encuesta sobre la Comunidad de Puerto Rico y para revisar los resultados de la
encuesta, visite nuestro sitio en la Internet en census.gov/acs.
Le agradecemos mucho su participación.
Atentamente,

Steven D. Dillingham
Director

ACS-26(L)(GQ)(PR)(R)(2020) (2-2019)
census.gov

DC
Your Guide for
THE

Puerto Rico
Community
Survey
Group Quarters
This guide gives helpful information on completing
your survey form. This guide is bilingual. The Spanish
text begins on the back cover of this booklet. If you
need more help, call the number that the Census Field
Representative provided for you. After you have
completed your survey form, please place the form
in the envelope we have provided. A Census Field
Representative will return to pick it up.
Esta guía está disponible en español e inglés. Para
la versión en español, vire la guía y comience en la
parte posterior.

ACS-30(GQ)(PR)(2020) (8-2018)

Page
Your Answers are Con dential and Required by Law

3

What the Survey is About Some Questions and Answers

4

Why the Census Bureau Asks Certain Questions

4

How to Fill Out the Puerto Rico Community Survey Form 5
Examples of Printed and Marked Entries

5

Instructions for Completing the Survey Questions

5

Your Answers are Con dential and Required by Law
The U.S. Census Bureau is required by law to keep your information
con dential. The Census Bureau is not permitted to publicly release your
responses in a way that could identify you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks
through screening of the systems that transmit your data.
The same law that protects the con dentiality of your answers requires
that you provide the information asked in this survey to the best of your
knowledge.

ACS-30(GQ)(PR)(2019) (8-2018)

Page 3

What the Survey is About Some Questions and Answers
Why are we taking a survey?
The Census Bureau is conducting the Puerto Rico Community Survey to
provide more timely data than data we typically collect only once every 10
years during the decennial census.
What does the Census Bureau do with the information you provide?
The Puerto Rico Community Survey will be the source of summarized data that
we make available to federal, Puerto Rico, and local governments, and also to
the public. The data will enable your community leaders from government,
business, and non-pro t organizations to plan more effectively.
Why did you select this Group Quarters (GQ) facility and how
did I get selected?
Group quarters facilities are randomly selected each year from a sample list
of all group quarters in your area. The larger the group quarters, the greater
the probability that it will be selected to participate in the survey one or
more times each year. From a list provided by the GQ contact person of all
residents currently staying at the GQ, eld representatives randomly select
residents to take part in this survey. One of the advantages of a random
sample is that we can use it to measure the whole population without
having to actually interview every person at every GQ. But in order for it to
work, we cannot substitute sampled facilities or individuals -- the sample has
to be truly random. Your participation is very important to us to be able to
produce accurate information from this survey.

Why the Census Bureau Asks Certain Questions
Here are reasons we ask some of the questions on the survey.
Name
Names help make sure that we don’t duplicate persons selected at this place for
the survey. Individual identities are kept con dential.
Place of Birth
This question provides information used to study long-term trends about where
people move and to study migration patterns and differences in growth patterns.
Job
Answers to the questions about the jobs people hold provide information on the
extent and types of employment in different areas of Puerto Rico. From this
information, communities can develop training programs, and business and local
governments can determine the need for new employment opportunities.
Income
Income helps determine how well families or persons live. Income information
makes it possible to compare the economic levels of different areas, and how
economic levels for a community change over time. Funding for many government
programs is based on the answers to these questions.
Education
Responses to the education questions in the survey help to determine the number of
new public schools, education programs, and daycare services required in a community.
Disability
Questions about disability provide the means to allocate federal funding for
healthcare services and new hospitals in many communities.
ACS-30(GQ)(PR)(2019) (8-2018)

Page 4

How to Fill Out the Puerto Rico Community Survey Form
Use blue or black ink to complete the form. Please mark the category or
categories as they apply to you. Some questions ask you to print the information.
See examples below.
Make sure you answer all the questions that apply to you. Read these instructions
and also follow the instructions provided throughout the questionnaire. These
instructions will help you understand the questions and to answer them correctly.
If you need assistance, call the number that the eld representatives has provided
to you.

Examples of Printed and Marked Entries
13

a. Do you speak a language other than
English at home?

X

Yes

No

SKIP to question 14a

b. What is this language?

Korean
For example: Korean, Italian, Spanish, Vietnamese

23 In what year did you last get married?
Year

2 0 0 8

Instructions for Completing the Survey Questions
The questionnaire is a bilingual form. One side is in Spanish and
the other is English.
1. Print your Last Name, First Name, and Middle Initial (MI) in the spaces
provided.
Enter your telephone number, including area code, and today’s date in the
boxes provided.
2. Mark one box to indicate your biological sex.
3. Print your age and month, day, and year of birth. Print your age at your last
birthday. Do not round your age up if you are close to having a birthday. If
you do not know your exact age, provide an estimate. Print "0" for babies
less than 1 year old.

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Please answer BOTH question 4 about Hispanic origin and
question 5 about race. For this survey, Hispanic origins are not
races.
4. You are of Hispanic, Latino, or Spanish origin if your origin (ancestry) is
Mexican, Mexican American, Chicano, Puerto Rican, Cuban, Argentinean,
Colombian, Costa Rican, Dominican, Ecuadorian, Guatemalan, Honduran,
Nicaraguan, Peruvian, Salvadoran, from other Spanish-speaking countries of
Central or South America or from Spain.
The term Mexican Am. refers to persons of Mexican-American origin or
ancestry.
If you mark the "Yes, another Hispanic, Latino, or Spanish origin" box,
print the name of the speci c origin.
If you are not of Hispanic, Latino, or Spanish origin, answer this question by
marking the "No, not of Hispanic, Latino, or Spanish origin" box.
This question should be answered by all individuals.
5. Mark all boxes for the appropriate races.
The concept of race, as used by the Census Bureau, re ects self-identi cation
by individuals according to the race or races with which they identify.
The instruction before question 4, "For this survey, Hispanic origins are not
races" re ects the federal government’s treatment of Hispanic origin and
race as separate and distinct concepts. People who identify their origin as
Hispanic, Latino, or Spanish may be of any race.
People may choose to provide two or more races either by marking two or
more race response boxes, by providing multiple write-in responses, or by
some combination of marking boxes and writing in responses.
If you mark the "American Indian or Alaska Native" box, print the name
of your enrolled or principal tribe(s) in the space provided (for example,
Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, Mayan, Doyon,
Native Village of Barrow Inupiat Traditional Government, and so on).
If you mark the "Other Asian" box, print the name of the speci c Asian
group(s) in the space provided (for example, Pakistani, Cambodian, Hmong,
Thai, Laotian, Bangladeshi, and so on).
If you mark the "Other Paci c Islander" box, print the name of the speci c
Paci c Islander group(s) in the space provided (for example, Tongan, Fijian,
Marshallese, Palauan, Tahitian, Papua New Guinean, and so on).
If you mark the "Some other race" box, print the name of the speci c
group(s) in the space provided.
This question should be answered by all individuals.

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6. For people born in the United States:
Mark the "In the United States" box and then print the name of the state
in which you were born. If you were born in Washington, D.C., print
"District of Columbia."
For people born outside the United States:
Mark the "Outside the United States" box, and then print Puerto Rico or
the name of the foreign country or area where you were born. Use current
boundaries, not boundaries at the time of your birth. For example, specify
Czech Republic or Slovakia, not Czechoslovakia; North or South Korea, not
Korea. Specify the particular country, not region. For example, specify
Jamaica, not West Indies; Kenya, not East Africa.
7. If you were born in Puerto Rico, mark the "Yes, born in Puerto Rico" box. If
you were born in a U.S. state, the District of Columbia, Guam, the U.S. Virgin
Islands, or Northern Marianas, mark the "Yes, born in a U.S. State, District
of Columbia, Guam, the U.S. Virgin Islands, or Northern Marianas" box.
Although not listed, if you were born in American Samoa, mark "Yes, born
in a U.S. State, District of Columbia, Guam, the U.S. Virgin Islands, or
Northern Marianas" box. If you were born outside the United States (50
states and the District of Columbia) or at sea and had at least one parent who
was a U.S. citizen at the time of your birth, mark the "Yes, born abroad of
U.S. citizen parent or parents" box. Mark the "Yes, U.S. citizen by
naturalization" box only if you were born outside the United States (50
states and the District of Columbia), and have completed the naturalization
process and are now a United States citizen. In the box below Print year of
naturalization, enter the four-digit year you completed the formal
naturalization process. If you are not a U.S. citizen, mark the "No, not a U.S.
citizen" box. Legal Permanent Residents (LPRs) or "green card" holders, or
other non-naturalized immigrants or visitors to the U.S. are not citizens of the
United States and therefore should mark the "No, not a U.S. citizen" box.
9a. A public school is any school or college that is supported and controlled
primarily by the Puerto Rico government or federal government. Schools
are private if supported and controlled primarily by religious
organizations or other private groups. Home school applies to parental
guided education outside of a public or private school for grades 1 12.
9b. Only record grades that you attended in the LAST 3 MONTHS. If this is
currently a summer month, do not record grades that you will attend in
the future.

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10. Mark only ONE box to indicate the highest grade or level of schooling you
have COMPLETED or the highest degree you have received.
Report schooling completed in foreign or ungraded schools as the
equivalent level of schooling in the regular American school system.
Mark the "GED or alternative credential" box if you did not receive a
regular high school diploma but completed high school by receiving a GED or
other formal recognition of high school completion from a school or
governmental authority.
If you have not completed any college courses for credit, mark the highest
level completed below college level. If you have not completed enough
credit to be counted as a sophomore, mark the "Some college credit,
but less than 1 year of college credit" box.
For the "Professional degree beyond a bachelor’s degree" category, do
not include certi cates or diplomas for training in speci c trades or
occupations, such as computer and electronics technology, medical assistant, or
cosmetology. DO NOT include post-bachelor’s certi cates that are related to
occupational training in such elds as teaching, accounting, or engineering.
11. Answer this question only if you have a bachelor’s degree or higher and
print the speci c major of your BACHELOR’S DEGREE. If you have more
than one bachelor’s degree or more than one major, print the names of the
speci c majors for all of your bachelor’s degree(s).
12. Print your ancestry group(s). Ancestry refers to your ethnic origin or descent,
"roots," or heritage. Ancestry may also refer to your country of birth or that
of your parents or ancestors before their arrival in Puerto Rico. This question
should be answered by all individuals, regardless of race, Hispanic origin, or
place of birth.
Do not report a religious group as your ancestry.
You may report two ancestry groups (for example: German, Irish).
13a. Mark the "Yes" box if you sometimes or always speak a language other
than English at home.
Mark the "No" box if you speak only English, or if a non-English language is
spoken only at school or is limited to a few expressions or slang.
13b. If you speak more than one non-English language and cannot determine
which is spoken more often, report the one you rst learned to speak.

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14a. If you did not live in Puerto Rico or the United States one year ago, mark the
"No, outside Puerto Rico and the United States" box and print the
name of the foreign country, or U.S. Virgin Islands, or Guam, etc., where you
lived. Be speci c when printing the name of the foreign country; for
example, Czech Republic or Slovakia, not Czechoslovakia; North or South
Korea, not Korea. Specify the particular country, not region. For example,
specify Jamaica, not West Indies; Kenya, not East Africa. Then SKIP to
question 15.
If you lived somewhere else in Puerto Rico or the United States one year
ago, mark the "No, at a different address in the United States or
Puerto Rico" box.
14b. Include the house or structure number; street name; street type (for example, St.,
Road, Ave.); and the street direction (if a direction such as "North" is part of the
address). For example, print 1239 N. Main St. or 1239 Main St., N.W., not just
1239 Main. If you lived in Puerto Rico, the address should also include the name
of the development or building.
If the only known address is a post of ce box, give a description of the location.
For example, print the name of the building where you lived, the nearest
intersection, the name of a military base or installation, or the nearest street
where the building is located, etc. DO NOT give a post of ce box number.
Print the name of municipio in Puerto Rico or U.S. county. If you lived in
Louisiana, print the parish name in the "Name of municipio in Puerto Rico or
U.S. county" space. If you lived in Alaska, print the borough or census area
name, if known. If you lived in New York City and the county name is not
known, print the borough name. If you lived in an independent city (not in any
county) or in Washington, D.C., leave the "Name of municipio in Puerto Rico
or U.S. county" space blank.
15.

If you received bene ts from the government to buy food using a bene t card,
mark the "Yes" box.

16.

Mark the "Yes" or "No" box for each part of question 16.
If you report any other type of coverage plan in question 16h, specify the type
of coverage or name of the plan in the write-in box. DO NOT include plans that
cover only one type of health care (such as dental plans) or plans that only cover
a person in case of an accident or disability.

17a-17b.
If you have more than one type of health insurance, answer these questions
while thinking about your primary health insurance.

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Answer questions 19a through 19c if you are 5 years old or over.
19a–19c.
Mark the "Yes" or "No" box to indicate if you have serious dif culty with any
of the activities listed in parts a, b, and c because of a physical, mental, or
emotional condition.
Answer questions 20 through 44 if you are 15 years old or over.
21. Mark the "Now married" box if you are married regardless of whether you are
living with your spouse, unless you are separated. If your only marriage was
annulled, mark the "Never married" box. Mark the "Divorced" box only if you
have received a divorce decree.
22. Mark the "Yes" box only if you have received a divorce decree in the PAST 12
MONTHS.
23.

Do not count marriages that ended in annulment.

24. Enter the four-digit year when you last got married, even if you are now
widowed, divorced, or separated.
Answer question 25 if you are female and 15–50 years old.
25. Mark the "Yes" box if you have given birth in the PAST 12 MONTHS to at least
one child born alive, even if the child died or no longer lives with you. Do not
consider miscarriages, or stillborn children, or any adopted, foster, or stepchildren.
27. Active duty means full-time service as a member of the Army, Navy, Air Force,
Marine Corps, Coast Guard, or as a commissioned of cer of the Public Health
Service or the National Oceanic and Atmospheric Administration, or its
predecessors, the Coast and Geodetic Survey or Environmental Science Service
Administration. Active duty does not include active duty for training. Active duty
also applies to cadets attending one of the ve United States Military Service
Academies. For service in the military Reserves or National Guard, mark the
“Only on active duty for training in the Reserves or National Guard" box
if you have never been called up for active duty, mobilized, or deployed. For
service only as a civilian employee or civilian volunteer for the Red Cross, USO,
Public Health Service, or War or Defense Department, mark the "Never served
in the military" box. For Merchant Marine service, count only the service during
World War II as active duty and no other period of service.
28. Mark as many responses as apply.
29a. Mark the "Yes" box if you have a Department of Veterans Affairs (VA)
service-connected disability rating.
29b. Mark the "0 percent" box if you have received a service-connected
disability rating of zero. DO NOT mark the box showing "0 percent" to
indicate no rating.

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30a–30b.
Count as work – Mark the "Yes" box if you performed:
● Work for someone else for wages, salary, piece rate, commission, tips, or
payments "in kind" (for example, food or lodging received as payment
for work performed).
● Work in own business, professional practice, or farm.
● Any work in a family business or farm, paid (for any amount of time) or
without pay (for 15 or more hours per week).
● Any part-time work including babysitting, paper routes, etc.
● Active duty in the Armed Forces.
Do not count as work – Mark the "No" box if your activities were limited to
the following:
● Housework or yard work at home.
● Unpaid volunteer work.
● School work done as a student.
● Work done as a resident or inmate of an institutional facility (like a
nursing facility or correctional facility).
31.

Include the building or structure number; street name; street type (for example,
St., Road, Ave.); and the street direction (if a direction such as "North" is part
of the address). For example, print 1239 Main St. or 1239 Main St., N.W., not
just 1239 Main.
If the only known address is a post of ce box, give a description of the work
location. For example, print the name of the building or shopping center where
you work, the nearest intersection, or the nearest street where the workplace is
located, etc. DO NOT give a post of ce box number.
If you worked at a military installation or military base that has no street
address, report the name of the military installation or base, and a description
of the work location (such as building number, building name, nearest street
or intersection).
If you worked at several locations, but reported to the same location each day
to begin work, print the street address of the location where you reported. If
you did not report to the same location each day to begin work, print the
address of the location where you worked most of the time last week.
If your employer operates in more than one location (such as a grocery store
chain or public school system), print the street address of the location or branch
where you worked. If the street address of a school is not known, print the
name of the school, and a description of the location (such as the nearest
street or intersection).
If you worked on a college or university campus and the street address of the
workplace is not known, print the name of the building where you worked,
and a description of the location (such as the nearest street or intersection).
If you worked, in a foreign country or Guam, U.S. Virgin Islands, etc., print the
name of the country on the state or foreign country line.

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32.

Mark only one box to indicate the method of transportation used to travel
the longest distance to work LAST WEEK.
● Mark the "Car, truck, or van" box if you drove a station wagon,
company car, light truck of 1-ton capacity or less, truck cab, mini bus, or
private limousine (NOT for hire).
● Mark the "Subway or elevated rail" box if you took a subway, or
other vehicle that operates on tracks or rails with complete separation
from other vehicle and pedestrian traf c.
● Mark the "Long-distance train or commuter rail" box if you took
long distance rail service such as Amtrak, or a commuter train (also called
metropolitan rail, regional rail, or suburban rail) that operates between a
central city and surrounding suburbs or other central cities. This does not
include rail systems that predominantly offer intercity rail service, which is
often referred to as subway, metro, or heavy rail.
● Mark the "Carro público" box if you rode a car, truck, or van used for
public transportation or xed routes. These are operated by private
companies.
● Mark the "Taxicab" box if you took a limousine such as an airport
limousine for which a fare is charged.
● Mark the "Motorcycle" box if you rode a motorbike, moped, motor
scooter, or similar vehicle that is motor driven.
● Mark the "Bicycle" box if you rode a bicycle or other vehicle that is
pedaled.
● Mark the "Walked" box ONLY if you walked all the way to work and
used no other means of transportation.
● Mark the "Worked from this address" box if you worked on a farm
where you live, or an of ce or shop in your own home.
● Mark the "Other method" box if you took an airplane, helicopter,
horse, horse and buggy, boat (other than public ferries), large motor
home, dog sled, large truck or truck rig, All-Terrain Vehicle (ATV), snow
machine/snowmobile, Segway® or other self-balancing electric vehicle,
skateboard, inline skates, or motorized chair.

Answer question 33 if you marked "Car, truck, or van" in
question 32.
33.

If you were driven to work by someone who then drove back home or to a
non-work destination, enter "1" in the box labeled "Person(s)."
DO NOT include persons who rode to school or some other non-work
destination in the count of persons who rode in the vehicle.

34.

Give the time of day your trip to work usually begins. DO NOT give
the time that you usually began your work.
If you usually left to go to work sometime between 12:00 o’clock
midnight and 12:00 o’clock noon, mark "a.m."
If you usually left to go to work sometime between 12:00 o’clock noon and
12:00 o’clock midnight, mark "p.m."

35.

Travel time is from door to door. Enter a one-way commute time for your
usual daily commute to work LAST WEEK. Include time waiting for public
transportation or picking up passengers in a carpool.

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Answer questions 36 through 39 if you did NOT work last week.
36a. You are on layoff if you are waiting to be recalled to a job from which you
were temporarily separated for business-related reasons.
36b. If you work only during certain seasons or on a day-by-day basis when work
is available, mark the "No" box.
36c. If you were informed by your employer, either formally or informally, that
you will be recalled within the next 6 months, mark the "Yes" box. Also
mark the "Yes" box if you have been given, formally or informally, a speci c
date to return to work, even if that date is more than 6 months away.
37.

Mark the "Yes" box if you tried to get a job or start a business or
professional practice at any time in the LAST 4 WEEKS; for example,
registered at a public or private employment of ce, went to a job interview,
placed or answered employment ads, or did anything toward starting a
business or professional practice.

38.

If you were expecting to report to a job within 30 days, mark the
"Yes, could have gone to work" box.
Mark the "No, because of own temporary illness" box only if you expect
to be able to work within 30 days.
If you could not have gone to work because you were going to school,
taking care of children, etc., mark the "No, because of all other reasons
(in school, etc.)" box.

39.

Refer to the instructions for questions 30a–30b to determine what to
count as work. Mark the "Over 5 years ago or never worked" box if
you: (1) never worked at any kind of job or business, either full or part
time, (2) never worked, with or without pay, in a family business or farm,
and (3) never served on active duty in the Armed Forces.

40a–40b.
Refer to the instructions for questions 30a–30b to determine what to count
as work. Include paid vacation, paid sick leave, and military service. Count
every week in which you worked at all, even for an hour.
41.

If the hours worked each week varied considerably in the PAST 12
MONTHS, give an approximate average of the hours worked each week.

Answer questions 42a through 42f if you worked in the past 5 years.
42a. If you worked for a cooperative, credit union, mutual insurance
company, or similar organization, mark the "Non-pro t organization
(including tax-exempt and charitable organizations)" box.
If you worked for a municipio agency, mark the "Local government (for
example: city, county or municipio)" box. If you worked for a public school,
college or university, mark the "State government (including school districts
and state universities)" box.
Employees of foreign governments, the United Nations, and other
international organizations should mark the "Federal government civilian
employee" box.

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42b. If you worked for a company, business, or government agency, print the
name of the company, not the name of your supervisor. If you worked for
an individual or a business that had no company name, print the name of
the individual you worked for. If you worked in your own un-named
business, print "self-employed." If you marked "Active duty U.S. Armed
Forces or Commissioned Corps," print the name of the branch of the Armed
Forces. For Commissioned Corps, enter U.S. Public Health Service or NOAA
Commissioned Corps.
42c. Describe the business, industry, or individual employer named in question
42b. If there is more than one activity, describe only the major activity at
the place where you worked. Describe what is made, what is sold, or what
service is given.
Enter descriptions like the following: urgent care center, certi ed public
accounting rm, of ce supplies manufacturing company.
42d. Mark one box to indicate the main type of business or industry where
you work or worked.
42e. Describe the kind of work you did. If you were a trainee, apprentice, or
helper, include that in the description.
Enter descriptions like the following: registered nurse, human
resources manager, industrial engineer.
If possible, avoid single words such as: nurse, manager, or engineer.
42f. Describe the most important activities or duties you performed for your job.
Enter descriptions like the following: coordinate patient care and
administer medications, direct hiring policies and advise supervisors on
employee relations matters, design control systems to ensure product
quality.
Answer questions 43 through 44 if you are 15 years old or over.
Mark the "Yes" or "No" box for each type of income, and enter the
amount received IN THE PAST 12 MONTHS for each "Yes" response.
If income from any source was received jointly, report the amount you earned
or received, not the total amount you and the other person received jointly.
DO NOT include the following as income in any item:
● Refunds or rebates of any kind
● Withdrawals from savings of any kind
● Capital gains or losses from the sale of homes, shares of stock, etc.
● Inheritances or insurance settlements
● Any type of loan
● Pay in-kind such as food, free rent
43a. Include wages and salaries before deductions from all jobs. Be sure to
include any tips, commissions, or bonuses. Owners of incorporated
businesses should enter their salary here. Military personnel should include
base pay plus cash housing and/or subsistence allowance, ight pay, uniform
allotments, reenlistment bonuses.

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43b. Report income from incorporated businesses under wages and salary
(question 43a), and not under self-employment. Include nonfarm pro t (or
loss) from self-employment in sole proprietorships and partnerships. Mark
the "Loss" box if there is a loss. Exclude pro t (or loss) of incorporated
businesses you own.
Include farm pro t (or loss) from self-employment in sole proprietorships
and partnerships. Mark the "Loss" box if there is a loss. Exclude pro t
(or loss) of incorporated farm businesses you own. Also exclude amounts
from land rented for cash but include amounts from land rented for shares.
43c. Include interest received or credited to checking and saving accounts, money
market funds, certi cates of deposit (CDs), IRAs, KEOGHs, and government
bonds.
Include dividends received, credited, or reinvested from ownership of stocks
or mutual funds.
Include pro t (or loss) from royalties and the rental of land, buildings or real
estate, or from roomers or boarders. Mark the "Loss" box if there is a loss.
Income received by self-employed persons whose primary source of income is
from renting property or from royalties should be included in 43b. Include
regular payments from an estate or trust fund.
43d. Include amounts, before Medicare deductions, of Social Security and/or
Railroad Retirement payments you received as a retired person, as a
dependent of deceased insured workers, and as a disabled worker.
43e. Include Supplemental Security Income (SSI) received as an elderly, blind, or
disabled person. Note: SSI is a nationwide U.S. assistance program administered
by the Social Security Administration that guarantees a minimum level of
income for needy aged, blind, or disabled individuals. The Puerto Rico
Community Survey questionnaire asks about the receipt of SSI; however, SSI is
not a federally-administered program in Puerto Rico. The only way a resident
of Puerto Rico can appropriately report SSI is if they lived in the United States
at anytime during the past 12-month reference period and received SSI.
43f. Include any public assistance or welfare payments you received by check or
electronic transfer from the Puerto Rico government or the municipio
welfare of ce, even if received for only one month or less than a year.
Include bene ts received on behalf of children. These payments are
sometimes referred to as Temporary Assistance for Needy Families (TANF),
Aid to Families with Dependent Children (AFDC), Aid to Dependent Children
(ADC), Welfare or welfare to work, General Assistance, General Relief,
Emergency Assistance, and Diversion Payments. Do not include assistance
received from private charities.
Do not include Supplemental Security Income (SSI), food assistance (such as
food stamps and bene ts from the Nutritional Assistance Program [PAN], or
the Supplemental Nutrition Assistance Program [SNAP]), rental assistance,
education assistance, child care assistance, transportation assistance, or
assistance with heating or cooling costs or any other energy assistance (such
as Low Income Home Energy Assistance Program, or LIHEAP).

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43g. Include regular income from a company pension, union pension, Federal
government pension, state government pension, Puerto Rico and municipio
government pensions, U.S. military pension, U.S. Railroad pension, KEOGH
retirement plan, SEP (Simpli ed Employee Pension) or any other type of
pension, retirement account or annuity such as IRA, Roth IRA, 401(k) or
403(b).
Include survivor income paid to spouses or children of a deceased person.
Include regular income from a disability pension paid to those who are
unable to work due to a disability.
Do not include Social Security or income that is “rolled over” or reinvested
in another retirement account.
43h. Include Veterans’ (VA) disability compensation and educational assistance
payments (VEAP); unemployment compensation, worker’s compensation,
child support or alimony; and all other regular payments such as Armed
Forces transfer payments, assistance from private charities, regular
contributions from persons not living with you.
44.

Add the total entries (subtracting losses) for 43a through 43h for the
PAST 12 MONTHS and enter that number in the space provided. Mark the
"Loss" box if there is a loss. Print the total amount in dollars.

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DC
Su guía para
LA

Encuesta Sobre
La Comunidad
De Puerto Rico
Alojamientos de grupo
Esta guía provee información que le ayudará a
completar el cuestionario. Esta guía es bilingüe. El
texto en español empieza en la contracubierta de
este folleto. Si necesita más ayuda, llame al número
de teléfono que el Representante del Censo le
indicó. Después de que haya completado el
cuestionario, por favor, devuélvalo en el sobre
que le hemos provisto. Un Representante del Censo
regresará a recogerlo.
This guide is available in Spanish and English. For the
English version, ip the guide over and begin on the
back page.

ACS-30(GQ)(PR)(2020) (8-2018)

Página
Sus Respuestas son Con denciales y Requeridas por Ley

3

De Qué Trata la Encuesta Algunas Preguntas y Respuestas

4

Por Qué la O cina del Censo Hace Ciertas Preguntas

4

Cómo Completar el Cuestionario para la Encuesta
Sobre la Comunidad de Puerto Rico

5

Ejemplos de Entradas Escritas y Marcadas

5

Instrucciones para Completar las Preguntas de la Encuesta

5

Sus Respuestas son Con denciales y Requeridas por Ley
La O cina del Censo de los EE. UU. está obligada por ley a mantener
con dencial su información. A la O cina del Censo no se le permite
divulgar sus respuestas de manera que usted pudiera ser identi cado. En
conformidad con la Ley para el Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus datos están protegidos contra los
riesgos de seguridad cibernética mediante los controles aplicados a los
sistemas que trasmiten su información.
La misma ley que protege la con dencialidad de sus respuestas
requiere que usted provea la información que se le pide según su
mejor conocimiento.

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De Qué Trata la Encuesta - Algunas Preguntas y Respuestas
¿Por qué hacemos una encuesta?
La O cina del Censo está llevando a cabo la Encuesta sobre la Comunidad de
Puerto Rico para proveer datos más actualizados que los que generalmente se
recopilan sólo una vez cada 10 años durante el censo decenal.
¿Qué hace la O cina del Censo con la información que usted provee?
La Encuesta sobre la Comunidad de Puerto Rico será la fuente de datos resumidos
que ponemos a la disponibilidad del público y del gobierno federal, el gobierno
de Puerto Rico y los gobiernos locales. Los datos ayudarán a los líderes de su
comunidad en el gobierno, negocios y organizaciones sin nes de lucro a planear
e cazmente.
¿Por qué se seleccionó este alojamiento de grupo (GQ) y cómo fue
seleccionado?
Cada año, se seleccionan al azar las instalaciones de alojamientos de grupo (GQ)
basada en una lista de muestra de todos los alojamientos de grupo de su área.
Mientras más grande es el alojamiento de grupo, mayor es la probabilidad de
ser seleccionado para participar en la encuesta una o más veces cada año. La
persona contacto del GQ suministra una lista de todos los residentes que se
quedan actualmente en el GQ. De esta lista, los representantes del Censo
seleccionan residentes al azar para participar en esta encuesta. Una de las
ventajas de la muestra al azar es que nos permite medir la población total sin
tener que entrevistar a cada persona en cada GQ. Para que esto funcione, no
podemos sustituir instalaciones o a individuos en la muestra; la muestra tiene
que ser verdaderamente al azar. Su participación es muy importante para
nosotros, porque nos permite producir información precisa de esta encuesta.

Por Qué la O cina del Censo Hace Ciertas Preguntas
A continuación se indican las razones por las cuales hacemos algunas de las
preguntas en la encuesta.
Nombre
Los nombres ayudan a asegurar que las personas seleccionadas en este lugar para
la encuesta no se listen dos veces. Las identidades de los individuos se mantienen
con denciales.
Lugar de nacimiento
Esta pregunta provee información que se usa para estudiar tendencias a largo
plazo de la movilidad de las personas y para estudiar patrones de migración y
diferencias en el aumento de la población.
Empleo
Las respuestas a las preguntas sobre el empleo de las personas proveen
información sobre la variedad y los tipos de empleo en las diferentes áreas del
país. Utilizando esta información, las comunidades pueden desarrollar programas
de entrenamiento, y los negocios y gobiernos locales pueden determinar la
necesidad de nuevas oportunidades de empleo.
Ingreso
El ingreso ayuda a determinar cuán bien viven las familias o las personas. La
información sobre ingreso hace posible comparar los niveles económicos de
diferentes áreas y cómo los niveles económicos de una comunidad cambian a
través del tiempo. Los fondos para muchos programas gubernamentales se basan
en las respuestas a estas preguntas.
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Educación
Las respuestas a las preguntas sobre educación en la encuesta ayudan a
determinar el número de escuelas públicas, programas de educación y servicios de
cuidado diurno nuevos que se requieren en una comunidad.
Impedimentos
Las preguntas sobre impedimentos proveen los medios de asignar fondos
federales para servicios de salud y nuevos hospitales en muchas comunidades.
Cómo Completar el Cuestionario para la Encuesta Sobre la Comunidad
de Puerto Rico
Use un bolígrafo de tinta azul o negra para completer el cuestionario. Por favor,
marque la categoría o categorías según le apliquen a usted. Algunas preguntas le
piden que escriba la información en letra de molde. Vea los Ejemplos a continuación.
Cerciórese de contestar todas las preguntas que le apliquen a usted. Lea las
instrucciones y siga los pasos mientras completa el cuestionario. Estas instrucciones
le ayudarán a comprender las preguntas y contestarlas correctamente. Si necesita
ayuda, llame al número de teléfono que el representante del Censo le indicó.
Ejemplos de Entradas Escritas y Marcadas
13

a. En su hogar, ¿habla usted un idioma
que no sea inglés?
X

Sí
No

PASE a la pregunta 14a

b. ¿Qué idioma es ese?

coreano
Por ejemplo: coreano, italiano, español,
vietnamés

23 ¿En qué año se casó usted la última vez?
Año

2 0 0 8

Instrucciones para Completar las Preguntas de la Encuesta
Este cuestionario es un formulario bilingüe. Un lado está en español y el otro lado
está en inglés.
1. Escriba en letra de molde su apellido, nombre e inicial (MI) en los espacios
que se proveen.
Entre su número de teléfono, incluyendo el código de área, y la fecha de
hoy en las casillas que se proveen.
2. Marque una de las dos casillas para indicar su sexo biológico.
3. Escriba su edad y el mes, día y año de nacimiento. Escriba su edad en su último
cumpleaños. No redondee su edad si está a punto de cumplir años. Si usted no
sabe su edad exacta, provea un estimado. Escriba "0" para los bebés que
tengan menos de 1 año de edad.
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Por favor, conteste la pregunta 4 sobre origen hispano y la pregunta 5
sobre raza. Para esta encuesta, origen hispano no es una raza.
4. Usted es de origen hispano, latino o español si su origen (ascendencia) es
mexicano, mexicano americano, chicano, puertorriqueño, cubano, argentino,
colombiano, costarricense, dominicano, ecuatoriano, guatemalteco,
hondureño, nicaragüense, peruano, salvadoreño, de otros países
hispanohablantes de Centro o Sudamérica, o de España.
El término mexicano americano se re ere a las personas de origen o
ascendencia mexicana.
Si marca la casilla "Sí, otro origen hispano, latino o español", escriba en
letra de molde el nombre del grupo especí co.
Si usted no es de origen hispano, latino o español, conteste esta pregunta
marcando la casilla "No, no es de origen hispano, latino o español".
Esta pregunta debe ser contestada por todos los individuos.
5. Marque todas las casillas para las razas apropiadas.
El concepto de raza, de acuerdo con el uso la O cina del Censo, re eja la
auto-identi cación de las personas con la raza o las razas con las cuales se
identi can.
La explicación que precede a la pregunta 4,"Para esta encuesta, origen
hispano no es una raza", re eja la manera en que el gobierno federal trata
el origen hispano y la raza como dos conceptos separados y distintos. Las
personas que identi can su origen como hispano, latino o español pueden
ser de cualquier raza.
Las personas pueden optar por proporcionar dos razas o más, ya sea
marcando las casillas de respuesta de dos razas o más, escribiendo múltiples
respuestas o mediante la combinación de marcar las casillas y escribir las
respuestas.
Si usted marca la casilla "India americana o nativa de Alaska", escriba
en el espacio provisto el nombre de la tribu o las tribus en las que está
inscrito, o la tribu principal (por ejemplo, Navajo Nation, Blackfeet Tribe,
Muscogee (Creek) Nation, Maya, Doyon, Native Village of Barrow Inupiat
Traditional Government, etc.).
Si usted marca la casilla "Otra asiática", escriba el nombre del grupo o los
grupos especí cos en el espacio provisto (por ejemplo, paquistaní, camboyano,
hmong, tailandés, laosiano, bangladesí, etc.).
Si usted marca la casilla "Otra de las islas del Pací co", escriba el nombre
del grupo o los grupos especí cos en el espacio provisto (por ejemplo,
tongano, yiano, de las Islas Marshall, palauano, tahitiano, papú
neoguineano, etc.).
Si usted marca la casilla "Alguna otra raza", escriba el nombre del grupo o
los grupos especí cos en el espacio provisto.
Esta pregunta debe ser contestada para todos los individuos.

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6. Para las personas que nacieron en los Estados Unidos:
Marque la casilla "En los Estados Unidos" y luego escriba en letra de molde
el nombre del estado donde usted nació. Si nació en Washington, D.C., escriba
en letra de molde "Distrito de Columbia".
Para las personas que nacieron fuera de los Estados Unidos:
Marque la casilla "Fuera de los Estados Unidos" y luego escriba en letra de
molde el nombre del país extranjero o Puerto Rico, donde usted nació. Use las
fronteras actuales, no las fronteras que existían cuando usted nació. Por
ejemplo, especi que República Checa o Eslovaquia, no Checoslovaquia; Corea
del Norte o Corea del Sur, no Corea. Especi que el país particular, no la
región. Por ejemplo, especi que Jamaica, no Antillas; Kenia, no África Oriental.
7. Si usted nació en Puerto Rico, marque la casilla "Sí, nació en Puerto Rico".
Si usted nació en los Estados Unidos, el Distrito de Columbia, Guam, las Islas
Vírgenes de los Estados Unidos o las Islas Marianas del Norte, marque la
casilla "Sí, nació en los Estados Unidos, el Distrito de Columbia, Guam,
las Islas Vírgenes de los Estados Unidos o las Islas Marianas del
Norte". Aunque no esté listada, si usted nació en Samoa Americana, marque
la casilla "Sí, nació en los Estados Unidos, el Distrito de Columbia,
Guam, las Islas Vírgenes de los Estados Unidos o las Islas Marianas
del Norte". Si usted nació fuera de los Estados Unidos (los 50 estados y el
Distrito de Columbia) o en altamar y tiene por lo menos un padre o la madre
era ciudadano(a) de los EE.UU. cuando usted nació, marque la casilla "Sí,
nació en el extranjero de padre o madre que es ciudadano(a) de los
EE.UU.". Marque la casilla "Sí, es ciudadano(a) de los Estados Unidos
por naturalización" sólo si usted nació fuera de los Estados Unidos
(50 estados y el Distrito de Columbia) y ha completado el proceso de
naturalización y ahora es ciudadano(a) de los Estados Unidos. En la casilla a
continuación escriba el año de cuatro dígitos en el cual usted completó el
proceso formal de naturalización. Si usted no es ciudadano de los Estados
Unidos, marque la casilla "No, no es ciudadano(a) de los Estados
Unidos". Los Residentes Permanentes Legales (LPR) o personas que tienen
una tarjeta de residente, u otros inmigrantes no naturalizados, o los
visitantes a los EE.UU. no son ciudadanos de los Estados Unidos.
9a. Una escuela pública es cualquier escuela o universidad que está mantenida y
administrada por el gobierno de Puerto Rico o el gobierno federal. Las
escuelas son privadas si son mantenidas y administradas principalmente por
organizaciones religiosas o grupos privados. La enseñanza en el hogar (home
school) se aplica a la educación guiada por los padres fuera de una escuela
pública o privada para los grados del 1 al 12.
9b. Solamente marque los grados a los cuales asistió en los ÚLTIMOS 3 MESES.
Si el mes actual es un mes del verano, no marque los grados a los cuales
asistirá en el futuro.

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10. Marque UNA sola casilla para indicar el grado o nivel escolar más alto que
usted ha COMPLETADO o el título más alto que ha recibido.
Informe educación completada en un país extranjero o en escuelas sin
grados, como el nivel equivalente de educación en el sistema regular
estadounidense de educación.
Marque la casilla "GED o examen equivalente" si usted no recibió un
diploma regular de escuela superior pero completó la escuela superior
aprobando un examen de Equivalencia de Escuela Superior (GED, por sus
siglas en inglés) u otro reconocimiento formal por una escuela superior o
autoridad gubernamental.
Si usted no ha completado ningún curso universitario con crédito, marque el
nivel más alto completado por debajo del nivel universitario. Si usted no ha
completado su cientes créditos para ser contado(a) como que está en el
segundo año, marque la casilla "Algunos créditos universitarios, pero
menos de 1 año de créditos universitarios".
Para la categoría "Título profesional más allá de un título de
bachillerato universitario", no incluya certi cados o diplomas por
adiestramiento en o cios especí cos u ocupaciones tales como tecnología de
computadoras y electrónica, asistente médico o cosmetología. NO incluya
certi cados adquiridos después del bachillerato universitario que están
relacionados con adiestramiento ocupacionales en campos tales como la
enseñanza, contabilidad e ingeniería.
11. Conteste esta pregunta solamente si usted tiene un título de bachillerato
universitario o uno más alto. Escriba en letra de molde el título especí co de la
concentración de estudio de su BACHILLERATO UNIVERSITARIO. Si usted tiene
más de un título de bachillerato universitario o más de una concentración de
estudio, escriba en letra de molde los nombres especí cos de todas las
concentraciones de estudios de cada título de bachillerato universitario que
usted tiene.
12. Escriba en letra de molde su ascendencia. La ascendencia se re ere a su
origen étnico o descendencia, "raíces" o herencia. La ascendencia también
puede referirse al país donde usted o sus padres o antepasados nacieron
antes de su llegada a Puerto Rico. Conteste esta pregunta sin tener en
cuenta su clasi cación de raza, origen, hispano o lugar de nacimiento.
No informe un grupo religioso como su ascendencia.
Usted puede informar dos grupos de ascendencia (por ejemplo: alemán,
irlandés).
13a. Marque la casilla "Sí" si usted a veces o siempre habla en su hogar un
idioma que no sea inglés.
Marque la casilla "No" si usted sólo habla inglés, o si sólo habla un idioma
que no sea inglés en la escuela o está limitado a algunas expresiones o jerga
en ese otro idioma.
13b. Si usted habla más de un idioma que no sea inglés y tiene di cultad en
determinar cuál se habla más, informe el idioma que usted aprendió a
hablar primero.
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14a. Si usted no vivía en Puerto Rico o los Estados Unidos hace un año, marque la
casilla "No, fuera de Puerto Rico y los Estados Unidos" y escriba en letra
de molde el nombre del país extranjero, Islas Virgenes de los Estados Unidos,
Guam, etc., donde vivía usted. Sea especí co cuando escribía el nombre del
país extranjero; por ejemplo, especi que República Checa o Eslovaquia, no
Checoslovaquia; Corea del Norte o del Sur, no Corea. Especi que el país
particular, no la región. Por ejemplo, especi que Jamaica, no Antillas; Kenia,
no África Oriental. Luego, PASE a la pregunta 15.
Si usted vivía en algún otro lugar en los Estados Unidos o Puerto Rico hace
un año, marque la casilla "No, en una dirección diferente en los Estados
Unidos o Puerto Rico".
14b. Incluya el número de la casa o de la estructura, el nombre de la calle, el tipo
de calle (por ejemplo, calle, carretera, avenida); y la dirección de la calle (si la
orientación tal como "Norte" es parte de la dirección). Por ejemplo, escriba
1239 N. Main St. o 1239 Main St. N.W., solamente 1239 Main. Si usted vivía
en Puerto Rico, la dirección también debe incluir el nombre de la
urbanización o del edi cio.
Si la única dirección que es conocida es de un apartado postal, dé una
descripción del lugar. Por ejemplo, escriba en letra de molde el nombre del
edi cio en el cual usted vivía, la intersección más cercana, el nombre de la
instalación o base militar, o la calle más cercana, etc. NO escriba el número
de un apartado postal.
Escriba en letra de molde el nombre del municipio si usted estaba en
Puerto Rico. Si usted vivía en Louisiana, escriba en letra de molde el nombre
de la parroquia en el espacio "Nombre del municipio en Puerto Rico o
condado de los Estados Unidos". Si vivía en Alaska, escriba en letra de
molde el nombre del distrito o área censal, si lo sabe. Si vivía en la ciudad de
Nueva York y no sabe el nombre del condado, escriba en letra de molde el
nombre del distrito. Si usted vivía en una ciudad independiente (no en un
condado), o en Washington, D.C., deje en blanco el espacio "Nombre del
municipio en Puerto Rico o condado de los Estados Unidos".
15. Si usted recibió bene cios del gobierno para comprar alimentos utilizando
una tarjeta de bene cios, marque la casilla "Sí".
16. Marque la casilla "Sí" o "No" para cada parte de la pregunta 16.
Si usted reporta cualquier otro tipo de plan de cobertura en la pregunta 16h,
especi que el tipo de cobertura o el nombre del plan en el espacio que se
provee. NO incluya planes que cubran un solo tipo de cuidado médico (como
planes dentales) o planes que solamente cubran a una persona en caso de un
accidente o impedimento.
17a–17b.
Si usted tiene más de un tipo de seguro médico, responda a estas preguntas
pensando en su seguro médico principal.

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Conteste las preguntas 19a a la 19c si usted tiene 5 años de edad
o más.
19a–19c.
Marque la casilla "Sí" o "No" en las partes a, b y c de la pregunta 19 para
indicar si usted tiene una di cultad para llevar a cabo algunas de las
actividades listadas debido a una condición física, mental o emocional.
Conteste las preguntas 20 a la 44 si usted tiene 15 años de edad
o más.
21. Marque la casilla "Casado(a) actualmente" si usted está casado(a), sin
importar si su esposo o esposa vive en el hogar, a menos que estén
separados. Si su único matrimonio fue anulado, marque la casilla "Nunca se
ha casado". Marque la casilla "Divorciado(a)" solamente si usted ha
recibido una sentencia de divorcio.
22. Marque la casilla "Sí" solamente si usted ha recibido una sentencia de divorcio
en los PASADOS 12 MESES.
23. No cuente matrimonios que fueron anulados.
24. Anote los cuatro digitos del año en que usted se casó por última vez, incluso si
usted ahora ha enviudado, se ha divorciado o se ha separado.
Conteste la pregunta 25 si usted es de sexo femenino y tiene entre
15 y 50 años de edad.
25. Marque la casilla "Sí" si usted ha dado a luz a un hijo vivo en los ÚLTIMOS
12 MESES, aun si el hijo falleció o si ya no vive con usted. No considere
abortos naturales o hijos nacidos muertos, ni cualquier niño adoptado,
menor en el hogar por el programa de hogares de crianza o hijastro.
27. El servicio militar activo signi ca servicio a tiempo completo como miembro
del Ejército, la Fuerza Naval, la Fuerza Aérea, el Cuerpo de la Marina, los
Guardacostas o como o cial nombrado de Servicios de Salud Pública o de la
Administración Nacional Oceánica y Atmosférica, o sus predecesores, el
Servicio Costero y Geodésico o la Administración de Servicios de Ciencias
Ambientales. El servicio militar activo no incluye entrenamiento en servico
militar activo. El servicio activo también se re ere a los cadetes que asisten a
una de las cinco Academias del Servicio Militar de los EE.UU. Para servicio
militar en la Guardia Nacional o en la Reserva Militar, marque la casilla
"Servicio activo solamente para entrenamiento para la Reserva Militar
o la Guardia Nacional"si nunca ha sido movilizado, desplegado o llamado a
servicio activo. Para servicio solamente como empleado(a) civil o voluntario(a)
civil de la Cruz Roja, USO, Servicio de Salud Pública o Departamento de
Defensa o Guerra, marque la casilla "Nunca estuvo en el servicio militar".
Para servicio en la Marina Mercante, cuente solamente como servicio activo el
servicio durante la Segunda Guerra Mundial y no otro período de servicio.
28. Marque todas las respuestas que apliquen.
29a. Marque la casilla "Sí" si usted tiene una clasi cación de incapacidad relacionada
con su servicio por el Departamento de Asuntos de Veteranos (VA).
29b. Marque la casilla "0 por ciento" si usted ha recibido una clasi cación de
incapacidad relacionada con el servicio de cero. NO marque la casilla de "0
por ciento" para indicar que no recibió ninguna clasi cación.
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30a–30b.
Cuente como trabajo – Marque la casilla "Sí" si usted hizo:
● Trabajo para otra persona por salario, sueldo, pago a destajo, comisión,
propinas o pagos en especie (por ejemplo, comida o albergue recibido
como pago por trabajo hecho).
● Trabajo en su propio negocio, práctica profesional o nca.
● Cualquier trabajo en un negocio o nca de la familia, pagado o no,
durante 15 horas o más a la semana.
● Cualquier trabajo a tiempo parcial, incluyendo el cuidar niños, repartir
periódicos, etc.
● Servicio activo en las Fuerzas Armadas.
No cuente como trabajo – Marque la casilla "No" si sus actividades se
limitaban a lo siguiente:
● Quehaceres domésticos o jardinería en el hogar.
● Trabajo voluntario sin paga.
● Tareas completadas como estudiante.
● Trabajo desempeñado como residente o recluso de una institución (como un
hogar de convalecencia o asilo o una instalación correcional).
31. Incluya el número del edi cio o de la estructura; el nombre de la calle; el
tipo de calle (por ejemplo, Calle, Carretera, Avenida); y la direción de la calle
(si la direción, tal como "Norte", es parte de la dirección). Por ejemplo,
escriba 1239 Calle Principal o 1239 Calle Principal, N.W. no solamente 1239
Calle Principal.
Si la única dirección que es conocida es de un apartado postal, dé una
descripción del lugar de trabajo. Por ejemplo, escriba en letra de molde el
nombre del edi cio o centro comercial en el cual usted trabaja,
la intersección más cercana, o la calle más cercana de donde se encuentra su
lugar de trabajo, etc. NO de un número de apartado postal.
Si usted trabajó en una instalación o base militar que no tiene una dirección de
calle, informe el nombre de la instalación o base militar y una descripción del
lugar de trabajo (tal como el número del edi cio, el nombre del edi cio,
la calle o intersección más cercana).
Si usted trabajó en varios lugares pero iba al mismo lugar cada día para
empezar a trabajar, escriba en letra de molde la dirección de calle del lugar
donde iba. Si usted no iba al mismo lugar cada día para empezar a trabajar,
escriba en letra de molde la dirección del lugar donde trabajó la mayor parte
del tiempo durante la semana anterior.
Si su empleador opera en más de un lugar (tal como una cadena de
supermercados o sistema de escuelas públicas), escriba en letra de molde la
dirección de calle del lugar o sucursal donde usted trabajó. Si no sabe la
dirección de calle de una escuela, escriba en letra de molde el nombre de la
escuela y una descripción del lugar (tal como la calle o intersección más
cercana).
Si usted trabajó en un recinto de un colegio o universidad y no sabe la
dirección de calle del lugar de trabajo, escriba en letra de molde el nombre
del edi cio donde trabajó y una descripción del lugar (tal como la calle o
intersección más cercana).
Si usted trabajó en los Estados Unidos o en un país extranjero, Guam, etc.,
escriba en letra de molde el nombre del país extranjero.
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32.

Marque solamente una casilla para indicar el método de transportación que
usó para viajar la distancia más larga al trabajo LA SEMANA PASADA.

● Marque la casilla "Automóvil, camión o van" si usted manejó un

●
●

●
●

station wagon, un automóvil de una compañía, camioneta ligera con
capacidad para una tonelada o menos, cabina de camión, minibús o
limusina privada (NO de alquiler).
Marque la casilla "Tren urbano" si usted viajó en el tren subterráneo o
cualquier otro vehículo que opere sobre rieles o carriles y esté
completamente separado de otro tránsito de vehículos o peatones.
Marque la casilla "Tren de viajes largos o de cercanías" si usted viajó en
un servicio de trenes de viajes largos, como Amtrak, o un tren de cercanías
(conocido también como tren metropolitano, tren regional o tren
suburbano) que opere entre una ciudad central y los alrededores u otras
ciudades centrales. Esto no incluye los sistemas de trenes que ofrecen
principalmente servicio dentro de las ciudades, los cuales se conocen
generalmente como subterráneo, metro o tren urbano.
Marque la casilla "Carro público" si usted viajó en automóvil, camión o
van usado para transportación pública en rutas jas. Estos son operados por
compañías privadas.
Marque la casilla "Taxi" si usted viajó en limusina, tal como una limusina
del aeropuerto por la cual hay que pagar.

● Marque la casilla "Motocicleta" si usted viajó en motocicleta pequeña,
ciclomotor, motora o un vehículo similar que funciona con un motor.

● Marque la casilla "Bicicleta" si usted viajó en bicicleta o cualquier otro
vehículo con pedales.

● Marque la casilla "Caminó" SÓLO si usted caminó todo el camino al
trabajo y no usó otro medio de transporte.

● Marque la casilla "Trabajó en esta dirección" si usted trabajó en una
nca donde usted vive, o en una o cina o tienda de su propia casa.

● Marque la casilla "Otro método" si usted viajó en avión, helicóptero, a

caballo, en carruaje con caballo, embarcación (que no sea una lancha
pública), casa motorizada grande, trineo guiado por perros, camión
grande, Vehículo Todo Terreno (ATV), moto para la nieve, Segway® u otro
vehículo eléctrico con auto balance, patineta, patines o silla motorizada.

Conteste la pregunta 33 si usted marcó "Automóvil, camión o van" en
la pregunta 32.
33. Si otra persona lo llevó al trabajo y luego regresó al hogar o condujo a un
destino que no fuera el trabajo, entre "1" en la casilla para "Persona(s)".
NO incluya en el recuento de personas que viajaron en el vehículo a las
personas que viajaron a la escuela u otro destino que no fuera el trabajo.
34. Dé la hora del día en que comienza su viaje al trabajo habitualmente.
NO DÉ la hora a la que empieza a trabajar habitualmente.
Si usted usualmente salía para ir al trabajo en algún momento entre las 12 de
la medianoche y las 12 del mediodía, marque "a.m."
Si usted usualmente salía para ir al trabajo en algún momento entre las 12
del mediodía y las 12 de la medianoche, marque "p.m."
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35. El tiempo de viaje es de puerta a puerta. Entre el tiempo de viaje al trabajo
LA SEMANA PASADA. Incluya la cantidad de tiempo que le tomo esperar
por la transportación pública o para recoger a pasajeros en una sola
dirección para el viaje "carpool".
Conteste las preguntas 36 a la 39 si usted no trabajó la semana
pasada.
36a. Usted está suspendido (on layoff) o en cesantía si está esperando que lo llamen
para regresar a un trabajo del que estaba temporeramente separado por
motivos relacionados con la empresa.
36b. Si usted sólo trabaja durante ciertas temporadas o los días cuando hay
trabajo disponible, marque la casilla "No".
36c. Marque la casilla "Sí" si su patrono le informó, formal o informalmente, que
sería llamado de nuevo dentro de los próximos 6 meses. También marque
"Sí" si le han indicado, formal o informalmente, una fecha especí ca para
regresar al trabajo, aunque esa fecha esté seis meses en el futuro.
37. Marque la casilla "Sí" si usted intentó conseguir un trabajo o empezar un
negocio o una práctica profesional durante cualquier momento en las
ÚLTIMAS 4 SEMANAS; por ejemplo, si está registrado(a) en una o cina de
empleo, fue a una entrevista de trabajo, puso o respondió a anuncios de
empleo, o hizo algo para empezar un negocio o práctica profesional.
38. Si usted tenía intenciones de comenzar un trabajo dentro de 30 días, marque
el cuadrado "Sí, hubiera podido ir a trabajar".
Marque la casilla "No, debido a una enfermedad temporera propia" sólo
si usted espera trabajar dentro de 30 días.
Si usted no hubiera podido ir al trabajo porque asistía a la escuela, cuidaba a
niños, etc., marque la casilla "No, debido a otras razones (en la escuela,
etc.)".
39. Re érase a las instrucciones para las preguntas 30a–30b para determinar
qué considerar como trabajo. Marque la casilla "Hace más de 5 años o
nunca trabajó" si usted: (1) nunca trabajó en ningún tipo de trabajo o
negocio, a tiempo completo o parcial, (2) nunca trabajó, con o sin paga, en
un negocio o nca de la familia y (3) nunca estuvo en servicio activo en las
Fuerzas Armadas.
40a–40b.
Re érase a las instrucciones para las preguntas 30a–30b para determinar qué
considerar como trabajo. Incluya días de vacaciones pagados, días por
enfermedad pagados y servicio militar. Cuente toda semana durante la cual la
persona trabajó, aun si fuera por una hora.
41. Si las horas trabajadas cada semana di rieron considerablemente durante los
ÚLTIMOS 12 MESES, dé un promedio aproximado de las horas trabajadas
cada semana.

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Conteste las preguntas 42a a la 42f si usted trabajó en los últimos
5 años.
42a. Si usted trabajó para una cooperativa, cooperativa de crédito, compañía de
seguros mutuos o una organización similar, marque la casilla "Organización
sin fines de lucro (incluso las organizaciones exentas de impuestos y las
organizaciones caritativas)".
Si usted trabajó para una agencia de un municipio, marque la casilla
"Gobierno local (por ejemplo: ciudad, condado o municipio)". Si usted
trabajó en una escuela pública, colegio universitario o universidad, marque
la casilla "Gobierno estatal (incluso distritos escolares y universidades
estatales)."
Los empleados de gobiernos extranjeros, las Naciones Unidas y otras
organizaciones internacionales deben marcar la casilla "Empleado(a) civil
del gobierno federal".
42b. Si usted trabajó para una compañía, empresa o agencia gubernamental,
escriba en letra de molde el nombre de la compañía, no el nombre de su
supervisor. Si trabajó para un individuo o una empresa que no tiene un
nombre de compañía, escriba en letra de molde el nombre del individuo
para el cual trabajó. Si trabajó en su propia empresa que no tiene nombre,
escriba en letra de molde "empleado(a) por cuenta propia". Si usted marcó
"Servicio activo en las Fuerzas Armadas de los EE. UU."o en el Cuerpo de
Comisionados", escriba el nombre de la rama de las Fuerzas Armadas. Para
los Cuerpos Comisionados, escriba Servicio de Salud Pública de los EE. UU. o
Cuerpos Comisionados de NOAA.
42c. Describa la empresa, industria o empleador individual que se anotó en la
pregunta 42b. Si hay más de una actividad, sólo describa la actividad
principal en el lugar donde usted trabajó. Anote lo que se confecciona, lo
que se vende o qué tipo de servicio se provee.
Anote descripciones como las siguientes: centro de cuidados de
urgencia, rma de contabilidad pública certi cada, compañía de fabricación
de artículos de o cina.
42d. Marque una casilla para indicar el principal tipo de negocio o industria
donde trabaja o trabajó esta persona.
42e. Describa el tipo de trabajo que usted desempeñó. Si estaba en
entrenamiento, era aprendiz o asistente, inclúyalo en la descripción.
Anote descripciones como las siguientes: enfermera graduada, gerente
de recursos humanos, ingeniero industrial.
Si es posible, evite escribir una sola palabra, como: enfermera, gerente, o
ingeniero.
42f. Describa las tareas o actividades más importantes que usted realizó en su
trabajo.
Anote descripciones como las siguientes: coordinar la atención a los
pacientes y administrar los medicamentos, dirigir las políticas de contratación
y asesorar a los supervisores sobre asuntos de relacionados con los empleados,
diseñar sistemas de control para garantizar la calidad de los productos.

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Conteste las preguntas 43 a la 44 si usted tiene 15 años de edad o
más.
Marque la categoría "Sí" o "No" para cada parte de las preguntas sobre ingreso
y entre la cantidad recibida en los ÚLTIMOS 12 MESES para cada respuesta "Sí".
Si se recibió en conjunto ingreso de cualquier fuente, informe la cantidad que
usted ganó o recibió; no la cantidad total que usted y la otra persona recibieron
en conjunto.
NO incluya lo siguiente como ingreso en ninguna pregunta:
●
●
●
●
●
●

Reembolsos o descuentos de cualquier tipo
Retiros de cuentas de ahorros de cualquier tipo
Plusvalías o minusvalías de la venta de casas o acciones
Herencias o acuerdos con seguros
Cualquier tipo de préstamo
Pagos en especie, tales como comida o alquiler gratuito

43a. Incluya jornales y salarios antes de aplicarse las deducciones de todos los
trabajos. Asegúrese de incluir cualquier propina, comisión o bono. Los
propietarios de negocios constituidos en sociedad (incorporados) deben
anotar sus salarios aquí. El personal militar debe incluir su paga básica más la
asignación de dinero para vivienda o subsistencia, pago por tiempo de vuelo,
asignaciones de dinero para uniformes y bonos por volver a alistarse.
43b. Indique el ingreso obtenido de negocios incorporados bajo la categoria de
jornales, sueldos y salarios (la pregunta 43a), y no bajo empleo por cuenta
propia. Incluya ganancias (o pérdidas) de un empleo por cuenta propia en un
negocio no agrícola de propiedad única o en sociedad. Marque la casilla
"Pérdida" si hay alguna pérdida. No incluya ganancias (o pérdidas) de
negocios incorporados que son propiedad suya.
Incluya las ganancias (o pérdidas) agrícolas de empleo por cuenta propia en
empresas individuales o en sociedad. Marque la casilla "Pérdida" si hay alguna
pérdida. No incluya ganancias (o pérdidas) de negocios agrícolas incorporados
que son propiedad suya. Tampoco incluya cantidades por terreno alquilado por
dinero en efectivo, pero incluya cantidades por terreno alquilado en aparcería.
43c. Incluya intereses recibidos o acreditados a cuentas corrientes y cuentas de
ahorros, fondos del mercado monetario (money market), certi cados de
depósito (CD), cuentas de retiro individual (IRA), planes KEOGH y bonos del
gobierno.
Incluya dividendos recibidos, acreditados o reinvertidos de la propiedad de
acciones o fondos comunes de inversión.
Incluya ingresos (o pérdidas) de derechos de autor, alquiler de terreno,
edi cios o bienes raíces, o de inquilinos o pupilos. Marque la casilla "Pérdida"
si hay alguna pérdida. El ingreso recibido por personas empleadas por cuenta
propia cuya fuente principal de ingreso es el alquiler de propiedad o por
derechos de autor debe incluirse en 43b. Incluya pagos regulares de una
herencia o de un fondo de deicomiso.
43d. Incluya las cantidades, antes de las deducciones por Medicare, pagos del
Seguro Social o retiro para personal de los ferrocarriles, dependientes de
empleados asegurados fallecidos y empleados incapacitados.
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43e. Incluya ingreso de Seguridad de Ingreso Suplemental (SSI) que recibió por ser
una persona de edad avanzada, ciega o impedida. Nota: SSI [Seguridad de
Ingreso Suplementario] es un programa nacional de asistencia de los Estados
Unidos administrado por la Administración de Seguro Social que garantiza un
nivel mínimo de ingreso para las personas con necesidades de edad
avanzada, ciegas o con impedimentos. El cuestionario de la Encuesta sobre la
Comunidad de Puerto Rico tiene la pregunta sobre el recibo de SSI; sin
embargo, el SSI no es un programa administrado por el gobierno federal en
Puerto Rico. La única manera que un residente de Puerto Rico puede reportar
adecuadamente la SSI es si vivió en los Estados Unidos en cualquier momento
durante los últimos 12 meses y recibió SSI.
43f. Incluya cualquier pago de asistencia pública o bienestar público (welfare) que
usted recibido de la o cina de bienestar del gobierno de Puerto Rico o del
municipio. A veces nos referimos a estos pagos como TANF (Ayuda Temporal a
Familias Necesitadas), AFDC (Ayuda a Familias con Niños Dependientes), ADC
(Ayuda a Niños Dependientes, el Bienestar o el Programa de Asistencia Social al
Trabajo), Asistencia General, Ayuda General, Asistencia de Emergencia, y Pagos
Adicionales para Necesidades Inmediatas. No incluya la asistencia recibida de
instituciones bené cas privadas.
No incluya Seguridad de Ingreso Suplementario (SSI), asistencia para el pago
de alimentos (tales como cupones de alimentos y bene cios del Programa de
Asistencia Nutricional [PAN], o el Programa de Asistencia Nutricional
Suplementario [SNAP]), asistencia para el pago de alquiler, asistencia para la
educación, asistencia para el cuidado de niños, asistencia para pago de
transportación o asistencia con los costos de calefacción o aire acondicionado
o cualquier otra asistencia de energía [tal como el Programa de Asistencia
de Energía para Hogares de Bajos Ingresos (LIHEAP)].
43g. Incluya ingresos regulares de la pensión de una compañia, pensión de un
sindicato, pensión del gobierno federal, pensiónes del gobierno de Puerto
Rico y de los gobiernos de los municipios, pensión de las Fuerzas Armadas
de los EE. UU., pensión de los trabajadores ferroviarios de los EE. UU., plan
de retiro KEOGH, SEP (Pensión Simplificada para Empleado) o cualquier otro
tipo de pensión, cuenta de retiro o anualidad como IRA, 401(k) 0 403(b).
Incluya ingresos de sobrevivientes que se pagan a los cónyuges e hijos de la
persona fallecida. Incluya ingresos regulares de una pensión por discapacidad
que se paga a las personas que no pueden trabajar debido a una
discapacidad.
No incluya el Seguro Social ni el ingreso que se "pasa a otra cuenta" o
se reinvierte en otra cuenta de retiro.
43h. Incluya compensaciones de la Administración de Veteranos (VA) y el
Programa de Asistencia Educativa para Veteranos (VEAP), compensación por
desempleo, compensación laboral, pensión para hijos menores, pensiones
alimenticias o pensión de su ex pareja, y todos los otros pagos recibidos
regularmente, tales como pagos de transferencia de personal de las Fuerzas
Armadas, asistencia de instituciones benéficas privadas, y contribuciones
regulares de personas que no viven con usted.
44. Sume las cantidades totales (restando las pérdidas) en 43a a 43h para los
ÚLTIMOS 12 MESES y anote esta cantidad en el espacio que se provee.
Marque la casilla de "Pérdida" si hay alguna pérdida. Escriba la cantidad
total en dólares.
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The Puerto Rico Community Survey
Group Quarters

What is the Puerto Rico
Community Survey?
The Puerto Rico Community Survey
is part of the decennial census
program. It is a survey that collects
and produces ­statistical information
about the current social, economic,
and housing characteristics of Puerto
Rico. The Puerto Rico Community
Survey provides this information each
year. Previously, this information was
available only once every 10 years when
the U.S. Census Bureau conducted the
decennial census.

Do the sampled group
quarters and individuals
have to answer the questions on
the Puerto Rico Community
Survey?
Yes. Your facility participation and
your response to this survey is
required by law (Title 13, United
States Code, Sections 141, 193, and
221). The Census Bureau estimates
the survey will take about 25 minutes
to complete. Send comments
regarding this burden estimate or
any other aspect of this collection of
information, including suggestions for
reducing this burden, to: Paperwork
Reduction Project, U.S. Census
Bureau, 4600 Silver Hill Road,
ADDC-4H277, Washington, DC 20233.
You may e-mail comments to
[email protected]; use “Paperwork
Project” as the subject.

The U.S. Office of Management and
Budget (OMB) approved this survey
and gave it OMB approval No. 06070810. Displaying this number shows
that the Census Bureau is authorized
to conduct this survey. Please use
this number in any correspondence
concerning this survey. Respondents
are not required to respond to any
information collection unless it
displays a valid approval number from
the OMB.

Do I have to answer these
questions every year?
A random sample of group quarters
(GQ) facilities in Puerto Rico and
a random sample of the people
staying at these sampled facilities
are selected each year to participate
in the Puerto Rico Community
Survey. You will not be asked to
complete the Puerto Rico Community
Survey GQ questionnaire every
year. You will be asked to complete
the survey information only when
you are randomly selected from all
people staying at a sampled GQ.
It is important that each sampled
person respond to this mandatory
survey so that the Census Bureau can
produce characteristics about the GQ
populations in your community and in
Puerto Rico each year.

Why did you select this group
quarters facility, and how did I
get selected?
This GQ was selected from a sample
of all GQs in your area. The GQ and
individuals are randomly selected
from this list each year, so we
cannot substitute another GQ for

this one. One of the advantages of
a random sample is that we can use
it to measure the whole population
without having to actually interview
every person at every GQ. But in order
for it to work, we cannot substitute
sampled facilities or individuals; the
sample has to be truly random. Your
participation is very important if we’re
going to be able to produce accurate
statistics from this survey.

By responding to the Puerto Rico
Community Survey questionnaire,
you are helping your community
establish community goals, identify
community problems and solutions,
locate facilities and programs,
and measure the performance of
programs.

The Puerto Rico Community Survey
estimates are used by:

How will the Census Bureau use
the information that I
provide?

•

By law, the Census Bureau can only
use your responses to produce
statistics. The Census Bureau is not
permitted to publicly release your
responses in a way that could identify
you. Per the Federal Cybersecurity
Enhancement Act of 2015, your data
are protected from cybersecurity risks
through screening of the systems that
transmit your data. The Census
Bureau will also use this information
to improve the Puerto Rico
Community Survey, ultimately
resulting in even better data for your
community and the nation.

How do I benefit by answering
the Puerto Rico Community
Survey?
Federal agencies and communities
in Puerto Rico say that they do not
have the up-to-date information they
need to better understand community
issues, respond to needs, and allocate
programs and resources. As one
community leader stated, “Guessing
is always fun, but seldom effective.”

Local governments for bud-
geting, evaluating programs,
and planning for community
development projects.

•

Community programs, such as
those for the elderly, scouts,
libraries, banks, hospitals, and 
other community organizations 
to provide services to the community and to locate buildings,
services, and programs.

•

Transportation planners who 
use journey-to-work information
when deciding to build new
roads or add capacity t o existing
roads and to develop transit
systems, such as light rail or
subways, by projecting future
ridership.

When will the results of the
survey be available?
The previous years’ results of the
Puerto Rico Community Survey are
released every Fall. Survey estimates
are released each year for areas of
65,000 or more people. For smaller
areas, results are available in the
form of 3-year and 5-year estimates.

Will the Census Bureau keep my
information confidential?
Yes. Your answers are confidential
by law under Title 13, United States
Code, Section 9. This law specifies
that the Census Bureau can use the
information provided by the facility
and residents for statistical purposes
only and cannot publish or release
information that would identify any
group quarters or individual.

Where can I get assistance or
find more information about the
Puerto Rico Community Survey?
For questions or assistance with
completing this survey, telephone
the Census Bureau’s New York
Regional Office at 1-800-991-2520
(ext.1).
For more information about the
Puerto Rico Community Survey,
we encourage you to visit our Web
site at:
census.gov/acs
or contact us by mail at the following
address:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500

Issued March, 2019
ACS-51(GQ)PR
Connect with us @uscensusbureau

La Encuesta sobre la Comunidad 
de Puerto Rico
Alojamientos de Grupo

¿Qué es la Encuesta sobre la
Comunidad de Puerto Rico?
La Encuesta sobre la Comunidad de
Puerto Rico es parte del Programa
del Censo Decenal del 2010. Es una
encuesta que recopila y produce
información estadística acerca de las
características sociales, económicas y
de vivienda actuales de Puerto Rico.
La Encuesta sobre la Comunidad de
Puerto Rico proporciona esta información cada año. Previamente, esta
información estaba disponible únicamente una vez cada 10 años, cuando
la Oficina del Censo de los Estados
Unidos realizaba el censo decenal.

¿Tienen los Alojamientos de
Grupo (GQ) y las personas en
la muestra que contestar las
preguntas que se hacen en la
Encuesta sobre la Comunidad de
Puerto Rico?
Sí. La ley requiere la participación de
su institución y su respuesta a esta
encuesta (secciones 141, 193 y 221 del
título 13 del Código de los Estados
Unidos). La Oficina del Censo calcula
que tomará aproximadamente
25 minutos completar la encuesta.
Envíe comentarios sobre el estimado
de tiempo o cualquier otro aspecto
relacionado con la recopilación de
esta información a: Paperwork Reduction Project, U.S. Census Bureau,
4600 Silver Hill Road, ADDC-4H277,
Washington, DC 20233. Usted puede
enviar sus comentarios por correo
electrónico a
[email protected]; use “Paperwork
Project” como el tema.



La Oficina de Administración y
Presupuesto (OMB) de los Estados
Unidos aprobó esta encuesta y le
asignó el número de aprobación de
OMB Número 0607-0810. Al mostrar
este número se indica que la Oficina
del Censo está autorizado para llevar
a cabo esta encuesta. Por favor, use
este número en cualquier correspondencia relacionada con esta encuesta.
No se requiere que las personas
respondan a ninguna recopilación de
información a menos que ésta tenga
un número de aprobación válido de
la Oficina de Administración y Presupuesto (OMB).

¿Tengo que contestar estas
preguntas cada año?


Cada año se selecciona una muestra
al azar de las instalaciones de GQ en
Puerto Rico y una muestra al azar de
las personas que se quedan en las
instalaciones seleccionadas para que
participen en la Encuesta sobre la
Comunidad de Puerto Rico. No se le
pedirá que complete el cuestionario
de la Encuesta sobre la Comunidad
de Puerto Rico cada año. Se le pedirá
que complete la información de la encuesta sólo cuando sea seleccionado
al azar entre todas las personas que
se quedan en el alojamiento de grupo
seleccionado. Es importante que cada
persona en la muestra responda a
esta encuesta obligatoria para que
la Oficina del Censo pueda producir
características de la población de los
GQ en su comunidad y en Puerto Rico
cada año.

¿Por qué seleccionó este GQ y
cómo fui seleccionado?
Este GQ fue seleccionado de una
muestra de todos los GQ en su área.
Los GQ y las personas se seleccionan
al azar cada año de esta lista. Por esta
razón no podemos sustituir otro GQ
por éste. Una de las ventajas de una
selección al azar es que podemos usarla para medir toda la población sin
tener que entrevistar a cada persona
en cada GQ. Para que esto funcione,
no podemos sustituir instalaciones o
a individuos en la muestra; la muestra
tiene que ser verdaderamente al azar.
Su participación es muy importante si
vamos a producir estadísticas precisas
de esta encuesta.

¿Cómo utilizará la Oficina del
Censo la información que les
doy?
Por ley, la Oficina del Censo solamente puede usar las respuestas para
producir estadísticas. La Oficina del
Censo de los EE. UU. está obligada
por ley a mantener confidencial la
información. A la Oficina del Censo no
se le permite divulgar las respuestas
de manera que un individuo pudiera
ser identificado. En conformidad con
la Ley para el Fortalecimiento de la
Seguridad Cibernética Federal del
2015, los datos están protegidos
contra los riesgos de seguridad
cibernética mediante los controles
aplicados a los sistemas que trasmiten
la información.

¿De qué manera me beneficia
el contestar las preguntas de la
Encuesta sobre la Comunidad de
Puerto Rico?


Las agencias federales, Puerto Rico
y las comunidades indican que no
tienen la información actualizada que
necesitan para entender mejor los
asuntos comunitarios, responder a
las necesidades y asignar programas
y recursos. Como indicó un líder
comunitario, “adivinar es divertido,
pero rara vez efectivo”.

trabajo para proyectar el
número de pasajeros y así
tomar decisiones de construir
nuevas carreteras o ensanchar
carreteras existentes, y para
desarrollar sistemas de tránsito,
tales como trenes livianos o
subterráneos.

¿Cuándo estarán disponibles
los resultados de la
encuesta?

Al contestar el cuestionario de la
Encuesta sobre la Comunidad de
Puerto Rico, usted está ayudando
a su comunidad a establecer metas
para la comunidad, identificar problemas de la comunidad y soluciones,
establecer instalaciones y programas
y evaluar el funcionamiento de programas. Los estimados de la Encuesta sobre la Comunidad de Puerto
Rico los usan:

Los resultados del año anterior de
la Encuesta sobre la Comunidad de
Puerto Rico se publican cada año
entre agosto y noviembre. Los estimados de la encuesta se publican
cada año para áreas con 65,000
personas o más. Para áreas más
pequeñas, los resultados están
disponibles en forma de estimados
de 3 años y de 5 años.

•

Gobiernos locales para preparar
presupuestos, evaluar programas
y planificar proyectos de desarrollo comunitario.

 Mantendrá la Oficina del
¿
Censo la información que
proporciono estrictamente
confidencial?

•

Programas comunitarios, tales
como para las personas de edad
avanzada, para niños y niñas 
escuchas, bibliotecas, bancos, 
hospitales, y otras organizaciones comunitarias para proveer
servicios a la comunidad y para
planificar o establecer edificios,
servicios y programas.

•

Planificadores de transportación
usan la información sobre viaje al

¿Cómo puedo conseguir
ayuda o más información
acerca de la Encuesta sobre la
Comunidad de Puerto Rico?
Para preguntas o pedir ayuda para
completar esta encuesta, llame
por teléfono a la Oficina Regional
de la Oficina del Censo en New
York al 1-800-991-2520 (ext.1).
Para obtener más información
acerca de la Encuesta sobre la
Comunidad de Puerto Rico, le
exhortamos a que visite nuestra
página en la Internet en:
census.gov/acs
o, comuníquese por correo con
nosotros a la siguiente dirección:
American Community Survey
U.S. Census Bureau
4600 Silver Hill Road
Washington, DC 20233-7500

Sí. La sección 9 del título 13 del Código de los Estados Unidos estipula
que sus respuestas son confidenciales. Esta ley especifica que la
Oficina del Censo puede usar la información provista por la facilidad
y los residentes para propósitos
estadísticos solamente no puede
publicar o divulgar información que
pueda identificar algún alojamiento
de grupo o individuo.



Publicado en marzo de 2019
ACS-51(GQ)PR
Connect with us @uscensusbureau

Page |1

ACS Group Quarters Centralized Reinterview Instrument

Page |2

Block:

FAQs

Variable Name:

H_GQTYPE

Info Pane:
Group Quarters Type Codes and Descriptions
[ Fill: GQTYPE]

Skip Instructions:

Block:

FAQs

Variable Name:

RIREASON

[return to reinterview]

Info Pane:
Reinterview Help Menu
♦

Press F8 to proceed to the reinterview.

 1. Why are you calling me again?
 2. Are you calling everyone or am I just lucky?
 3. Don't you have anything better to do with my tax dollars?
I'm too busy to answer your questions again.
 4. Are you "checking up" on me? I told you the truth the first time you called.
 5. Do I have to answer your questions?
 6. Return to reinterview.

Skip Instructions:

<1>
<2>
<3>
<4>
<5>
<6>

Block:

FAQs

Variable Name:

RIREF1

Info Pane:

[go to RIREF1]
[go to RIREF2]
[go to RIREF3]
[go to RIREF4]
[go to RIREF5]
[return to reinterview]

Page |3

Why are you calling me again?
Like any business, we're interested in maintaining the quality of our product, so each month we
reinterview a few facilities who are in the survey to ensure we are efficiently and accurately
collecting data.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

Block:

FAQs

Variable Name:

RIREF2

Info Pane:
Are you calling everyone or am I just lucky?
We are able to get a reliable measure of data quality by reinterviewing only a small percentage of
the total facilities interviewed in the survey.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

Block:

FAQs

Variable Name:

RIREF3

Info Pane:
Don't you have anything better to do with my tax dollars?
I am too busy to answer your questions again.
[Fill: RIREF3_DESCR]
 1. Continue
 2. Back to Reinterview Help Menu

Page |4

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON]

Block:

FAQs

Variable Name:

RIREF4

Info Pane:
Are you “checking up” on me?
I told you the truth the first time you called.
The purpose of reinterview is not to check up on respondents. In order to ensure that we are efficiently
and accurately collecting data, we reinterview a few facilities who are in the survey.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to RIREASON

Block:

FAQs

Variable Name:

RIREF5

Info Pane:
Do I have to answer your questions?
Your participation in this survey is voluntary. However, the information you provide will help us
to ensure the efficiency and accuracy of our data collection procedures. Like any business, we’re
interested in maintaining the quality of our product.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

Block:

FAQs

Variable Name:

H_PURPOSE

Info Pane:

[return to reinterview]
[go to RIREASON]

Page |5

Choose from the following topics of frequently asked questions:

♦

Press F8 to proceed to the reinterview.

 1.
 2.
 3.
 4.
 5.
 6.

What is the American Community Survey?
I have not heard of the ACS. How long have you been conducting it?
How can I see the results of the survey?
When will the results of the survey be available?
How do I benefit by answering the American Community Survey?
Does the sampled GQ and individual have to answer the questions on the American
Community Survey?
 7. Why did you select this facility and how did I get selected?
 8. How will the Census Bureau use the information that I provide?
 9. Will the Census Bureau keep my information confidential?
 10. Can the police, the local government, or other regulatory agencies see my answers
to the survey?
 11. I am elderly, disabled, or otherwise unable to complete the American Community
Survey questionnaire. What do I do?
 12. Do I have to answer these questions every year?
 13. Why does the American Community Survey ask one question about race and another
question about Hispanic origin?
 14. Where can I find more information about the American Community Survey or get
assistance?
 15. Return to Interview

Skip Instructions:

<1>

[goto H_PURPOSE1]

<2>

[goto H_PURPOSE2]

<3>

[goto H_PURPOSE3]

<4>

[goto H_PURPOSE4]

<5>

[goto H_PURPOSE5]

<6>

[goto H_PURPOSE6]

<7>

[goto H_PURPOSE7]

<8>

[goto H_PURPOSE8]

<9>

[goto H_PURPOSE9]

<10>

[goto H_PURPOSE10]

<11>

[goto H_PURPOSE11]

<12>

[goto H_PURPOSE12]

<13>

[goto H_PURPOSE13]

<14>

[goto H_PURPOSE14]

<15>

[return to reinterview]

Page |6

Block:

FAQs

Variable Name:

HPURPOSE1

Info Pane:
What is the American Community Survey?
The American Community Survey is a survey conducted by the U.S. Census Bureau in every county,
American Indian and Alaska Native Area, and Hawaiian Home Land. It replaced the long form in the
decennial census and greatly simplified operations so that the focus of the decennial census is solely on
counting the population.
The American Community Survey provides current demographic, social, economic, and housing
characteristics every year. In the past, this information was only available every 10 years when the
decennial census was conducted. Estimates from the American Community Survey help communities
make informed decisions and is key to their future.
The American Community Survey does not count the population, but it does provide information that
reflects what the population looks like and how it lives. That information is vital for states and local
communities in determining how to plan for schools, roads, senior citizen centers, and other goods and
services.
The U.S. Office of Management and Budget (OMB) approved this survey and gave is OMB approval
No. 0607-0810. Please use this number in any correspondence concerning this survey. Respondents
are not required to respond to any information collection unless it displays a valid approval number
from O
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1>
<2>

[return to reinterview]
[go to HPURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE2

Info Pane:
I have not heard of the American Community Survey. How long have you been conducting it?
The American Community Survey began in 1996 in a sample of counties across the country. Today the
survey is conducted in all U.S. counties and Puerto Rico Municipos.
 1. Continue
 2. Back to Reinterview Help Menu

Page |7

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:
Variable Name:

FAQs
HPURPOSE3

Info Pane:
How can I see the results of the survey?
This information is published on the Census Bureau’s American FactFinder® web site at
. The data are provided in several formats for everyone from beginners
(who may just want to look at the data) to experienced researchers.
American FactFinder® provides
·
Quick Tables that provide an overview of the data quickly.
·
Geographic Comparison Tables that compare data for different places.
·
Detailed Tables that provide more extensive data for more detailed research.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:
Variable Name:

FAQs
HPURPOSE4

Info Pane:
When will the results of the survey be available?
The results of the American Community Survey are released every summer. Survey results are
released each year for areas of 65,000 or more persons. For smaller areas, results are available in the
form of 3-year and 5-year averages.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Page |8

Block:

FAQs

Variable Name:

HPURPOSE5

Info Pane:
How do I benefit by answering the American Community Survey?
Federal agencies, states, and communities say that they do not have the up-to-date information they
need to better understand community issues, respond to needs, and allocate programs and resources.
By responding to the American Community Survey questionnaire, you are helping your community
establish community goals, identify community problems and solutions, locate facilities and programs,
and measure the performance of programs.
The American Community Survey data are used by:
·
Local governments for budgeting, evaluating programs, and planning for community
development projects;
·

Community programs, such as those for the elderly, scout programs, libraries, banks,
hospitals, and other community organizations, to provide services to the community
and to locate buildings, services, and programs; and

·

Transportation planners use journey to work information to make decisions to build
new roads or add capacity to existing roads; and to develop transit systems, such as
light rail or subways by projecting future ridership.

 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE6

Info Pane:
Does the sampled GQ and individual have to answer the questions on the American Community
Survey?
Yes, your response to this survey is required by law (Title 13, United States Code, Sections 141, 193
and 221). Title 13 as changed by Title 18, imposes a penalty for not responding. The survey is
approved by the Office of Management and Budget. We estimate that the facility level survey will take
about 15 minutes to complete and the questionnaire survey will take about 25 minutes to complete.
 1. Continue
 2. Back to Reinterview Help Menu

Page |9

Skip Instructions

<1> (return to interview at last question displayed)
<2> (goto PURPOSE)

Block:

FAQs

Variable Name:

HPURPOSE7

Info Pane:
Why did you select this facility and how did I get selected?
This GQ was selected from a sample of all GQs in your area. The GQ and individuals are randomly
selected from this list each year, so we can not substitute another GQ for this one. One of the
advantages of a random sample is that we can use it to measure the whole population without having to
actually interview every person at every GQ. But in order for it to work, we cannot substitute sampled
facilities or individuals – the sample has to be truly random. Your participation is very important if
we’re going to be able to produce accurate statistics from this survey.
 1. Continue
 2. Back to Reinterview Help Menu
Skip Instructions

<1> (return to interview at last question displayed)
<2> (goto PURPOSE)

Block:

FAQs

Variable Name:

HPURPOSE8

Info Pane:
How will the Census Bureau use the information that I provide?
The Census Bureau can only use the information you provide for statistical purposes and cannot
publish or release information that would identify you. Your information will be used in combination
with information from other individuals to produce statistical data for your community. Similar
statistics will be produced for communities across the United States.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions

<1> (return to interview at last question displayed)
<2> (goto PURPOSE)

Block:

FAQs

Variable Name:

HPURPOSE9

Info Pane:

P a g e | 10

Will the Census Bureau keep my information confidential?
Yes. Your answers are confidential by law under Title 13, United States Code, Section 9. This law
specifies that the Census Bureau can use the information provided by individuals for statistical
purposes only and cannot publish or release information that would identify any individual.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE10

Info Pane:
Can the police, the local government, or other regulatory agencies see my answers to the survey?
No. The Census Bureau protects your information. The police cannot see it; no other government or
regulatory agency can see it; and no court of law can see it. No one can see or use your individual
responses to enforce any type of law.
If any Census Bureau employee were to violate these provisions, he or she would be subject to severe
criminal sanctions imposed by Congress - up to 5 years’ imprisonment and/or up to a $250,000 fine, for
any Census Bureau employee who violates those provisions (13 U.S.C., Section 214, as amended by
Title 18 U.S.C., Sections 3559 and 3571).
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE11

Info Pane:

P a g e | 11

I am elderly, disabled, or otherwise unable to complete the American Community Survey
questionnaire. What do I do?
You may designate another person to help you or a Census Bureau representative may call you or may
come to your house and assist you in completing the survey. Respondents may call 1-800-354-7271 for
assistance. To produce the most accurate results, it is very important that every person selected for the
survey participate.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE12

Info Pane:
Do I have to answer these questions every year?
No. Only a small sample of GQs is selected to participate in the American Community Survey. These
GQs are selected at random and represent other GQs in the community. That is why it is so important
that every sampled person from these sampled GQs respond to the survey.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE13

P a g e | 12

Info Pane:
Why does the American Community Survey ask one question about race and another question about
Hispanic origin?
Race and Hispanic origin (or ethnicity) are considered distinct concepts and, therefore, require separate
questions in censuses and surveys. Hispanics or Latinos may be of any race. The Office of
Management and Budget issues the standards governing the collection of data on race and ethnicity and
all federal agencies, including the Census Bureau, must follow these standards.
 1. Continue
 2. Back to Reinterview Help Menu

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

HPURPOSE14

Info Pane:
Where can I find more information about the American Community Survey or get assistance?
There are several ways to obtain information about the American Community Survey:
For detailed information, we encourage you to visit our Web site at:
www.census.gov/acs/www or call the Census Bureau’s Regional Office nearest to you as listed below:
Atlanta, GA
Chicago, IL
Denver, CO
Los Angeles, CA
New York, NY
Philadelphia, PA

1-800-424-6974
1-800-865-6384
1-888-209-7659
1-800-992-3530
1-800-991-2520
1-866-238-1374

If you need more information or have further questions about the survey, please call our Customer
Services Center on 1-800-923-8282 or 301-763-INFO (4636).
 1. Continue
 2. Back to Reinterview Help Menu

P a g e | 13

Skip Instructions:

<1> [return to reinterview]
<2> [goto H_PURPOSE]

Block:

FAQs

Variable Name:

KEY_REF

Info Pane:
F1
F2
F3
F4
F5
F6
F7
F8
F9
F10
F11
F12

Function Key Settings
Item Specific Help

Shift-F1
Shift-F2
Shift-F3
Shift-F4
Shift-F5
Shift-F6
Shift-F7
Shift-F8
Shift-F9
Shift-F10
Shift-F11
Shift-F12
Ctrl-D
Ctrl-K
Ctrl-R
Ctrl_F3
Ctrl-F7
Ctrl-H
Ctrl-M
Ctrl-S
Ctrl-F

Jump Menu

Item notes/remarks
Return from skip
Exit-skip to END
Calculator
Copy

Skip Instructions:

Block:

FAQs

Variable Name:

H_ABBREV1

Original Interview FAQs
Reinterview FAQs

View Remarks/Items Notes

Display function keys
Standard abbreviation list
Original CAPI notes
Don’t know (D)
Function key description
Refusal (R)
Reinterview notes
Show Info
Show Don’t Know & Refusals
Save
Search

[return to reinterview]

Info Pane:
Standard Abbreviation List
[Display the standard abbreviation list]
NOTE: This screen can be accessed at any time during the reinterview by pressing "Shift F11."

P a g e | 14

Skip Instructions:

Block:

FAQs

Variable Name:

FIN

[return to reinterview]

Info Pane:
This case is not completed.
Enter 1 to continue,

Skip Instructions:

<1>

[goto APPT]

Block:

FAQs

Variable Name:

START

Info Pane:

American Community Survey
Group Quarters Reinterview
Date: [Fill: RIDATE]

Time: [Fill: TIME_C]

Reinterview Case Status: [Fill: OUTCOME and OUTCOME’s description]
Original Interview Date: [Fill: INTDATE]
Original FR Code - Name: [Fill: ORIFR] "-" [Fill: FR_NAME]
Original Outcome: [Fill: ORIOUT and ORIOUT’s description]
[Fill: TYPEA_SP / TYPEB_SP / TYPEC_SP /blank]
GQ Name: [Fill: GQNAME]
GQ Contact 1 Name: [Fill: CP1NAME] GQ Contact Title : [Fill: CP1TITL]
GQ Contact 2 Name: [Fill: CP2NAME] GQ Contact Title : [Fill: CP2TITL]
GQ Phone:
[Fill: AREA]) [Fill: PREFIX]-[Fill: SUFFIX], ext.[Fill:
EXTN] ([Fill: PHTYP])
[Fill: "Second Phone:" SPHONE (SPHTYP) / blank]
GQ Address: [Fill: ADDRESS1 /
ADDRESS2 /
ADDRESS3 /
ADDRESS4]

P a g e | 15

GQ Type: [Fill: GQTYPE and GQTYPE’s description]
[Fill: "Best Time to Contact:" BESTTIME’s description / "Best Time to Contact:"
BESTTIM2 / blank]
[Fill: "Or" BESTTIM2 / blank]
[Fill: Spanish speaking@ / blank]
1. Continue
2. Quit - Attempt later
Skip Instructions:

<1>
<2>

[If ORIOUT_RSLT = B or C [goto CAPI_FRONT.START_1]
[go to CAPI_Back.WRAP_UP].

Block:

CATI_Front

Variable Name:

REACTOCAPI_RI_CT

Info Pane:

Skip Instructions:

<1>

[go to CATI_Back.SHOW_CTRL]

Block:

CATI_Front

Variable Name:

HELLO_TC_CT

Info Pane:
Hello, This is ... from the U.S. Census Bureau. May I please speak to [Fill: CP1NAME]?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. This is correct person, or correct person called to the phone.
 2. Person not available now. Call back later.
 3. Person cannot be reached. Speak with another employee?
 4. Person unknown at this number.
 5. Person no longer works here.
 6. Person deceased.
 7. Person can be reached at another number.
 8. Reinterview Noninterview

Skip Instructions:

<1>
<2>
<3, 5, 6, 7>
<4>
<8>

[go to CATI_Front.INTRO_TC_CT].
[go to CATI_Back.THANK_NONEMP].
[go to CATI_Front.CP1_NAME_CT].
[go to CATI_Front.VERTELE_CT].
[go to CATI_Front.HELLO_PRB_RI_CT].

P a g e | 16

Block:

CATI_Front

Variable Name:

HELLO_TCX_CT

Hello. This is ... from the U.S. Census Bureau.
Our records show that one of our interviewers recently contacted your facility.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another employee answer a few questions to help us evaluate the interviewer’s work?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. Yes
 2. No
 3. Inconvenient time; schedule an appointment to callback.

Skip Instructions:

<1>
<2>
<3>

[go to CATI_Front.ADDVER_CT].
[go to CATI_Front.HELLO_PRB_RI_CT].
[go to CATI_Back.APPT].

Block:

CATI_Front

Variable Name:

HELLO_TN_CT

Info Pane:
Hello, This is ... from the U.S. Census Bureau. May I please speak to [Fill: CP1NAME]?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. This is correct person, or correct person called to the phone.
 2. Person not available now. Call back later.
 3. Person cannot be reached. Speak with another employee?
 4. Person unknown at this number.
 5. Person no longer works there.
 6. Person deceased.
 7. Person can be reached at another number.
 8. Reinterview Noninterview

Skip Instructions:

<1>
<2>
<3, 5, 6, 7>

[go to CATI_Front.INTRO_TN_CT].
[go to CATI_Back.THANK_NONEMP].
[go to CATI_Front.CP1_NAME_CT].

P a g e | 17

<4>
<8>

[go to CATI_Front.VERTELE_CT].
[go to CATI_Front.HELLO_PRB_RI_CT].

Block:

CATI_Front

Variable Name:

HELLO_TNX_CT

Info Pane:
Hello. I'm ... from the U.S. Census Bureau.
Our records show that one of our interviewers recently contacted your facility to verify the status of:
[Fill: GQNAME]
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another employee answer a few questions to help us evaluate the interviewer’s work?
Status: [Fill: ]

Cutoff Date: [Fill] :

 1. Yes
 2. No
 3. Inconvenient time; schedule an appointment to callback.

Skip Instructions:

<1>
<2>
<3>

[go to CATI_Front.INTROB_RI_CT].
[go to CATI_Front.HELLO_PRB_RI_CT].
[go to CATI_Back.APPT].

Block:

CATI_Front

Variable Name:

INTRO_TC_CT

Info Pane:
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
Is your address: [Fill:

ADDRESS1]?

 1. Yes
 2. No
 3. Refused to verify Address

Skip Instructions:

< 1, 2, 3 >

Block:

CATI_Front

[go to CATI_Front.INTROB_RI_CT].

P a g e | 18

Variable Name:

INTRO_TN_CT

Info Pane:
Thank you for recently helping us verify the status of: [Fill: GQNAME]
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
 1. Continue

Skip Instructions:

<1>

[go to CATI_Front.INTROB_RI_CT].

Block:

CATI_Front

Variable Name:

INTROB_RI_CT

Info Pane:
This call may be recorded for quality assurance purposes. Do I have permission to record this call?
♦

If the respondent does not wish to be recorded:
Click on the NICE stop recording button.
Read: I appreciate your concern. I am turning off the recording.

 1. Yes; continue with the interview.
 2. Inconvenient time; schedule an appointment to callback.
 3. No; recording is turned off. Continue interview.

Skip Instructions: <1, 3> If ORIOUT_RSLT = ‘INT’, then [go to CAPI_Middle.RIRESP].
Else if ORIOUT_RSLT = B or C,
then [go to CAPI_Middle.CONTACT_N].
<2> [go to CATI_Back.APPT].
Block:

CATI_Front

Variable Name:

VERTELE_CT

Info Pane:
Excuse me. I need to verify your telephone number again.
Have I reached area code [Fill: (AREA) PREFIX-SUFFIX, ext. EXTN] / [CPPHON, ext. CPEXT]?
 1. Yes
 2. No. Exit instrument and redial.

P a g e | 19

 3. Refused to verify

Skip Instructions:

<1>

If (HELLO_TC_CT = 4 ) [go to CAPI_Front.ADDVER_CT].
Else if (HELLO_TN_CT=4) [go to
CAPI_Front.ADDVER_N_CT].
<2> [go to CAPI_Back.THANK_SORRY].
<3> [go to CAPI_Back.THANK_REF]

Block:

CATI_Front

Variable Name:

ADDVER_CT

Info Pane:
I need to verify the name and address of your facility:
[Fill:
[Fill:

GQNAME]
ADDRESS1]

 1. Same Address.
 2. Not same Address.
 3. Refused to verify.

Skip Instructions:

<1>
<2>
<3>

If (HELLO_TC_CT = 4) then [go to CATI_Front.CP1_NAME].
Else [go to CATI_Front.INTROB_RI_CT].
[go to CAPI_Back.THANK_SORRY].
[go to CAPI_Back.THANK_REF].

Block:

CATI_Front

Variable Name:

CP1_NAME _CT

Info Pane:
Perhaps you can help me.
Our records show that one of our interviewers recently contacted your facility to verify the status of :
[Fill:

GQNAME].

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes

P a g e | 20

 2. No

Skip Instructions:

<1> [go to CATI_Front.INTROB_RI_CT].
<2, R> [go to CATI_Back.THANK_REF].
If (HELLO_TC_CT = 5) then
go to CATI_Front.HELLO_PRB_RI_CT].

Block:

CATI_Front

Variable Name:

ADDVER_N_CT

Info Pane:
Perhaps you can help me. I’m trying to find out information about:
[Fill: GQNAME].
Can you or someone else help me?
 1. Yes
 2. Inconvenient time; schedule an appointment to callback.
 3. No, but I have the phone number of someone who can.
 4. No.

Skip Instructions: <1> If HELLO_TN_CT = 4, then [go to
CATI_Front.INTROB_RI_CT].
<2> [go to CAPI_Back.APPT].
<3> [go to CAPI_Front._INTRO_].
<4> [go to CAPI_Back.THANK_YOU].

Block:

CATI_Front

Variable Name:

HELLO_PRB_RI_CT

Info Pane:
Thank you for your cooperation. You’ve been very helpful.
♦

Problem reinterviewing facility – Group Quarters not available or another problem
Make several attempts before selecting choice 8 or 9. Then contact your supervisor.

 1. Hard refusal.
 2. Respondent can’t remember.
 3. GQ converted to a permanent business/storage

P a g e | 21

 4.
 5.
 6.
 7.

GQ converted to residential housing
GQ moved to a different location
GQ does not exist
Other problems with reinterview

Skip Instructions:

<1-6> [go to CAPI_Back.FALSIF].
<7> [go to CATI_Back.SHOW_CTRL].

Block:

CAPI_Front

Variable Name:

START

Info Pane:
[Fill: SURVEY_NAME]
GROUP QUARTERS QUALITY CONTROL REINTERVIEW
Date: [Fill: RIDATE]

Time: [Fill: TIME_C]

Reinterview Case Status:

[Fill: OUTCOME ] - [Fill: OUTCOME_DESCRIP]

Original Interview Date:

[Fill: INTDATE]

Original James Bond ID:

[Fill: ORIUSERID]

Original Outcome:

[Fill: ORIOUT] “-” [Fill: ORIOUT_DESCRIP]

GQ Name:
GQ Contact 1 Name
GQ Contact 2 Name

[Fill: GQNAME]
([Fill: CP1NAME] ,GQ Contact Title [FILL: CP1TITLE]
([Fill: CP2NAME] ,GQ Contact Title [FILL: CP2TITLE]

GQ Phone
GQ Address:

[Fill: CP1PHONE1
Fill: "Second Phone:" SPHONE (SPHTYP) / blank]
[Fill: ADDRESS1]

GQ Type

[[Fill: GQTYPE]

 1. Continue
 2. Quit – Attempt later

Skip Instructions:

<1>
<2>

Block:

CAPI_Front

Variable Name:

START_1

Info Pane:

[go to CAPI_Front.START_1]
[go to CAPI_Back.WRAP_UP].

P a g e | 22

CONTACT PERSON INFORMATION
GQ Contact Name: [Fill: CPNAME]
Title: [Fill: CPTITL]
Phone: [Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT])
Address: [Fill: ADDRESS1
ADDRESS2
ADDRESS3
ADDRESS4]
Fill: NO CONTACT PERSON INFORMATION IS AVAILABLE@ / blank]
 1. Continue

Skip Instructions:

goto METHOD

Block:

CAPI_Front

Variable Name:

METHOD

Info Pane:
♦ Choose one of the following options to continue:
 1. Telephone Reinterview
 2. Personal Visit Reinterview
 3. Quit - Attempt later
 4. Reinterview Noninterview
 5. RO/HQ Discretion – Type A (Contact Supervisor)

Skip Instructions:

<1>
<2>
<3>
<4>
<5>

Block:

CAPI_Front

Variable Name:

DIAL

Info Pane:

[go to CAPI_Front.DIAL].
[go to CAPI_Front.CKSUP].
[go to CAPI_Back.WRAP_UP].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.RO_DISC].

P a g e | 23

Contact Name:
Contact Address:

♦

[Fill: CPNAME]
[Fill: CPADD1
CPADD2
CPPO, CPST, CPZP5-CPZP4]

Dial this number:
([Fill: AREA]) [Fill: PREFIX]-[Fill: SUFFIX], ext. [Fill: EXTN] ([Fill: PHTYP’s
description]) /
[Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT’s description])

 1. Someone answers
 2. Enter new telephone number
 3. Reinterview noninterview
 4. Quit - Attempt later

Skip Instructions:

<1>

If (ORIOUT_RSLT = INT and CP1NAME empty)
then [go to CAPI_Front.HELLO_TCX].
If (ORIOUT_RSLT = INT and CP1NAME not empty)
then [go to CAPI_Front.HELLO_TC].
If (ORIOUT_RSLT = B or C and CP1NAME empty)
then [go to CAPI_Front.HELLO_TNX].
If (ORIOUT_RSLT = B or C and CP_NAME not empty) then [go
to CAPI_Front.HELLO_TN]

<2>
<3>
<4>

[go to CAPI_Front._INTRO_].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.WRAP_UP].

Block:

CAPI_Front

Variable Name:

_INTRO_

Info Pane:
♦

Enter 1 to update the telephone number.

Enter a text of at most 1 characters

Skip Instructions:

If (ORIOUT_RSLT = INT) then [go to CAPI_Front.NEWNUMBER_A].
Else [go to CAPI_Front.NEWNUMBER_CP].

P a g e | 24

Block:

CAPI_Front

Variable Name:

NEWNUMBER_A

Info Pane:
♦

Record new number.

In Area Code: [Fill: AREA]
♦ Edit area code or press Enter for same.
New Number: [Fill: PREFIX]-[Fill: SUFFIX]
EXT: [Fill: EXTN]
Enter a text of at most 3 characters

Skip Instructions:

<100 - 999>

[go to CAPI_Front.NEWNUMBER_P

Block:

CAPI_Front

Variable Name:

NEWNUMBER_P

Info Pane:
♦

Record new number.

In Area Code: [Fill: NEWNUMBER_A]
New Number: [Fill: PREFIX]-[Fill: SUFFIX]
EXT: [Fill: EXTN]

♦

Edit prefix or press Enter for same.

Enter a text of at most 3 characters

Skip Instructions:

<100 - 999>

[go to CAPI_Front.NEWNUMBER_S].

Block:

CAPI_Front

Variable Name:

NEWNUMBER_S

Info Pane:
♦

Record new number.

In Area Code: [Fill: NEWNUMBER_A]
New Number: [Fill: NEWNUMBER_P]-[Fill: SUFFIX] ♦ Edit suffix or press Enter for same.
EXT: [Fill: EXTN]
Enter a text of at most 4 characters

Skip Instructions:

<0000 - 9999>

[go to CAPI_Front.NEWNUMBER_E].

P a g e | 25

Block:

CAPI_Front

Variable Name:

NEWNUMBER_E

Info Pane:
♦

Record new number.

In Area Code:
New Number:
EXT:

[Fill: NEWNUMBER_A]
[Fill: NEWNUMBER_P]-[Fill: NEWNUMBER_S]
[Fill: EXTN] ♦ Edit extension or press Enter for same.

Enter a text of at most 5 characters

Skip Instructions:

<00000 - 99999, blank>

Block:

CAPI_Front

Variable Name:

NEWNUMBER_CP

[go to CAPI_Front._END_]

Info Pane:
♦

Record new number.

New Number: [Fill: CPPHON]
EXT: [Fill: CPEXT]

♦

Edit phone number or press Enter for same.

Enter the 10-digit phone number, using no hyphens (-).

Skip Instructions:

<1001000000 - 9999999999> [go to CAPI_Front.NEWNUMBER_CE].

Block:

CAPI_Front

Variable Name:

NEWNUMBER_CE

Info Pane:
♦

Record new number.

New Number: [Fill: NEWNUMBER_CP]
EXT: [Fill: CPEXT] ♦ Edit extension or press Enter for same.
Enter a text of at most 5 characters

Skip Instructions:

<00000 - 99999, blank>

[go to CAPI_Front._END_].

P a g e | 26

Block:

CAPI_Front

Variable Name:

_END_

Info Pane:
♦

Enter 1 to go back to Dial screen.

♦

You may have to press Enter twice to update the phone number entries.

 1. Redial.
Skip Instructions:

<1>

[go to CAPI_Front.DIAL].

Block:

CAPI_Front

Variable Name:

CKSUP

Info Pane:
♦

Contact your supervisor for authorization before conducting a personal visit.

 1. Personal visit reinterview authorized
 2. Quit - Attempt later

Skip Instructions:

<1>

<2>

If (ORIOUT_RSLT = INT and CP1NAME empty)
then [go to CAPI_Front.HELLO_PCX].
If (ORIOUT_RSLT = INT and CP1NAME not empty)
then [go to CAPI_Front.HELLO_PC].
If (ORIOUT_RSLT = B or C and CP_NAME = empty)
then [go to CAPI_Front.HELLO_PNX].
If (ORIOUT_RSLT = B or C and CP_NAME = not empty)
[go to CAPI_Front.HELLO_PN].
[go to CAPI_Back.WRAP_UP].

Block:

CAPI_Front

Variable Name:

HELLO_TC

Info Pane:

P a g e | 27

Hello, I'm ... from the U.S. Census Bureau.
May I speak to [Fill: CP1NAME]?
 1. This is correct person, or correct person called to the phone.
 2. Person not available now. Call back later.
 3. Person cannot be reached. Speak with another employee.
 4. Person unknown at this number.
 5. Person no longer works there.
 6. Person deceased.
 7. Person can be reached at another number.
 8. Reinterview Noninterview.

Skip Instructions:
<1>
<2>
<3, 5, or 6>
<4>
<7>
<8>

[go to CAPI_Front.INTRO_TC].
[go to CAPI_Back.THANK_NONEMP].
[go to CAPI_ Front.CP1NAME].
[go to CAPI_ Front.VERTEL].
[go to CAPI_Back._INTRO_]
[go to CAPI_Back.STATUS_RI]

Block:

CAPI_Front

Variable Name:

HELLO_TCX

Info Pane:
Hello. This is ... from the U.S. Census Bureau.
Our records show that one of our interviewers recently contacted your facility.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another employee answer a few questions to help us evaluate the interviewer’s work?

 1. Yes
 2. No
 3. Inconvenient time; schedule an appointment to callback.

Skip Instructions:

<1>
<2>
<3>

[go to CAPI_Front.ADDVER].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.APPT].

P a g e | 28

Block:

CAPI_Front

Variable Name:

VERTELE

Info Pane:
Have I reached area code [Fill: (AREA) PREFIX-SUFFIX, ext. EXTN] / [CPPHON, ext. CPEXT]?
 1. Yes
 2. No
 3. Refused to verify

Skip Instructions:

<1>
<2>
<3>

[go to CAPI_Front.ADDVER].
[go to CAPI_Front.WRNUM].
[go to CAPI_Front.REFNUM].

Block:

CAPI_Front

Variable Name:

INTRO_TC

Info Pane:
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
Is your address: [Fill:

ADDRESS1]?

 1. Yes
 2. No
 3. Refused to verify Address

Skip Instructions:

<1, 2, 3>

Block:

CAPI_Front

Variable Name:

WRNUM

[go to CAPI_Middle.RIRESP].

Info Pane:
I'm sorry. I must have dialed incorrectly. I'll try again.
♦

Enter 1 to go back to Dial screen.

P a g e | 29

♦

You may have to press Enter twice to go back to Dial screen.

 1. Redial.

Skip Instructions:

<1>

[go to CAPI_Front.DIAL].

Block:

CAPI_Front

Variable Name:

REFNUM

Info Pane:
I'm sorry. I'll dial again to be sure I've dialed correctly.
 1. After several attempts, wrap up case.
 2. Redial

Skip Instructions:

<1>
<2>

[go to CAPI_Back.THANK_REF].
[go to CAPI_Front.DIAL].

Block:

CAPI_Front

Variable Name:

HELLO_TN

Info Pane:
Hello, I’m... from the U.S. Census Bureau.
May I speak to [Fill: CPNAME]?
 1. This is correct person, or correct person called to the phone.
 2. Person not available now.
 3. Person unknown at this number.
 4. Person no longer works there.
 5. Person deceased.
 6. Person can be reached at another number.
 7. Reinterview Noninterview

Skip Instructions:

<1>
<2>
<3>
<4, 5>
<6>
<7>

[go to CAPI_Front.INTRO_TN].
[go to CAPI_Back.THANK_NONEMP].
[go to CAPI_Front.VERTELE].
[go to CAPI_Front.CP1_NAME].
[go to CAPI_Front._INTRO_].
[go to CAPI_Back.STATUS_RI].

P a g e | 30

Block:

CAPI_Front

Variable Name:

HELLO_TNX

Info Pane:
Hello. I'm ... from the U.S. Census Bureau.
Our records show that one of our interviewers recently contacted your location to verify the status of:
[Fill: ADDRESS1]
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
 3. Inconvenient time; schedule an appointment to callback.

Skip Instructions:

<1>
<2>
<3>

[go to CAPI_Middle.CONTACT_N].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

INTRO_TN

Info Pane:
Thank you for recently helping us verify the status of:
[Fill: ADDRESS1]
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
♦ Enter 1 to continue.
 1. Continue

Skip Instructions:

<1>

Block:

CAPI_Front

Variable Name:

HELLO_PC

Info Pane:

[go to CAPI_Middle.CONTACT_N].

P a g e | 31

Hello. I’m ... from the U.S. Census Bureau. Here is my identification card.
♦

Show ID card.

May I speak to [FILL: CP1NAME]?
 1. Correct person available.
 2. Person not available now.
 3. Person unknown at this address.
 4. Person no longer works there.
 5. Person deceased.
 6. Reinterview Noninterview.

Skip Instructions: <1>
<2, 4, 5>
<3>
<6>

[go to CAPI_Front.INTRO_PC].
[go to CAPI_Front.CP1_NAME].
[go to CAPI_Front.ADDVER].
[go to CAPI_Back.STATUS_RI].

Block:

CAPI_Front

Variable Name:

HELLO_PCX

Info Pane:
Hello, I'm ... from the U.S. Census Bureau. Here is my identification card.
♦

Show ID card.

Our records show that one of our interviewers recently contacted your facility.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another employee answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
 3. Inconvenient time; schedule an appointment to callback.
 4. No one lives at this address.
Skip Instructions:

<1>
[go to CAPI_Front.ADDVER].
<2, 4> [go to CAPI_Back.STATUS_RI].
<3>
[go to CAPI_Back.APPT].

P a g e | 32

Block:

CAPI_Front

Variable Name:

INTRO_PC

Info Pane:
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
Is your address: [Fill: ADDRESS1]?
 1. Yes
 2. No
 3. Refused to verify address

Skip Instructions:

<1, 2, 3>

Block:

CAPI_Front

Variable Name:

HELLO_PN

[go to CAPI_Middle.RIRESP].

Info Pane:
Hello. I’m... from the U.S. Census Bureau. Here is my identification card.
♦

Show ID card.

May I speak to [Fill: CP1NAME]?
 1. Correct person available.
 2. Person not available now.
 3. Person unknown at this address.

Skip Instructions: <1>
<2, 4, 5>
<3>
<6>

[go to CAPI_Front.INTRO_PN].
[go to CAPI_Front.CP1_NAME].
[go to CAPI_Front.ADDVER_N].
[go to CAPI_Back.STATUS_RI].

Block:

CAPI_Front

Variable Name:

HELLO_PNX

Info Pane:

 4. Person no longer works there.
 5. Person deceased.
 6. Reinterview Noninterview.

P a g e | 33

Hello, I’m... from the U.S. Census Bureau. Here is my identification card.
♦

Show ID card.

Our records show that one of our interviewers recently contacted this location to verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
 3. Inconvenient time; schedule an appointment to callback.

Skip Instructions:

<1>
<2>
<3>

[go to CAPI_Middle.CONTACT_N].
[go to CAPI_Back.STATUS_RI].
[go to CAPI_Back.APPT].

Block:

CAPI_Front

Variable Name:

ADDVER

Field Description:

Address verification

Info Pane:
I need to verify that the address is:
[Fill: ADDRESS1]
 1. Same Address.
 2. Not same Address.
 3. Refused to verify.

Skip Instructions:

<1>
<2>
<3>

Block:

If HELLO_TN=3 then [go to CAPI_Front.ADDVER_N]
Else [go to CAPI_Middle.RIRESP]
[go to CAPI_Back.THANK_SORRY]
[go to CAPI_Back.THANK_REF]

CAPI_Front

P a g e | 34

Variable Name:

INTRO_PN

Info Pane:
Thank you for recently helping us verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check, that may last 5 to 10 minutes, to make sure our
interviewers are following correct procedures.
♦

Enter 1 to continue.

 1. Continue

Skip Instructions:

[go to CAPI_Middle.CONTACT_N].

Block:

CAPI_Front

Variable Name:

CP1_NAME

Info Pane:

Perhaps you can help me.
Our records show that one of our interviewers recently contacted your facility to verify the status of :
[Fill:

GQNAME].

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No

Skip Instructions:

<1>

<2, R>

If ORIOUT_RSLT = INT then [go to CAPI_Middle.RIRESP].
If ORIOUT_RSLT = B or C
then [go to CAPI_Middle.CONTACT_N].
[go to CATI_Back.APPT].

Block:

CAPI_Front

Variable Name:

ADDVER_N

Info Pane:

P a g e | 35

Perhaps you can help me.
I’m trying to find out information about: [Fill: GQNAME]
Can you or someone else help me?
 1. Yes
 2. Inconvenient time; schedule an appointment to callback.
 3. No, but I have the phone number of someone who can.
 4. No.

Skip Instructions:

<1>
<2>
<3>
<4>

[go to CAPI_Middle.CONTACT_N].
[go to CAPI_Back.APPT].
[go to CAPI_Front._INTRO_].
[go to CAPI_Back.THANK_YOU]

Block:

CAPI_Middle

Variable Name:

RIRESP

Info Pane:
Line No.

GQ Contact
Name

GQ Type

Max
Capacity

[Fill: LNO]

[Fill:
CP1NAME]

[Fill: GQ
Type]

[Fill: Max
Capaity]

•
•

•
•

•
•

•
•

♦ Ask if necessary
♦ With whom am I speaking?
♦ Enter line of person you are speaking to (0) if person is not on roster.

Skip Instructions:

<0 - maximum line number>

Block:

CAPI_Middle

Variable Name:

RIRESPB_RI_CT

Info Pane:
This call may be recorded for quality assurance. Do I have permission to record this
call?

P a g e | 36

♦

If the respondent does not wish to be recorded:
- Click on the NICE stop recording button.
- Read: I appreciate your concern. I am turning off the recording.

 1. Continue
 2. Inconvenient time; schedule an appointment to callback.
 3. No; recording is turned off. Continue interview
Skip Instructions:

<1,3> If (CONTACT_N=1 or CONTACT_C=1)
then [go to CAPI.middle.PROX_PRESENT].
<2> [go to CAPI.back.APPT].

Block:

CAPI_Middle

Variable Name:

CONTACT_C

Info Pane:
Did an interviewer contact you on or about [Fill: INTDATE] ] and ask questions about this Group
Quarters?
 1. Yes
 2. No

Skip Instructions:
<1> If [MODE = 1 and (HELLO_TCX_CT =1 or HELLO_TNX_CT =1 or HELLO_TCX =1
or HELLO_PCX =1 or HELLO_TNX=1 or HELLO_PNX =1) and (CONTACT_C = 1, 2, D or
CONTACT_N=1) or SPEAKTO=1]
then go CAPI.Middle.PROX_PRESENT
Else [goto CAPI.Middle.ORMODE]
<2, D> [(INTRO_TC=1,2,3) or (INTRO_PC=1,2,3)] [goto CAPI.Middle.SOMEONE_ELSE]
Else goto CAPI.Middle.MAXCAP_1
Block:

CAPI_Middle

Variable Name:

ORMODE

Info Pane:

P a g e | 37

Did the interviewer conduct the interview in person or over the telephone?
 1. Personal visit only
 2. Telephone call only
 3. Both - Interviewer visited and called

Skip Instructions:

<1, 2, 3, D>

Block:

CAPI_Middle

Variable Name:

POLITE

[go to CAPI_Middle.POLITE].

Info Pane:

Was the interviewer polite and professional?
 1. Yes
 2. No

Skip Instructions:

<1, D, R >

<2>
Block:

CAPI_Middle

Variable Name:

PO_NOTES

[If (CONTACT_C = 1 and (ORMODE = 2, D, or R)
goto CAPI.Middle.MAXCAP_1]
[If ORMODE = 1 or 3 goto CAPI.Middle.LAPTOP]
[If ORIOUT_RSLT= B or C goto CAPI.Middle.STATUS]
[goto PO_NOTES]

Info Pane:
♦

Enter comments from the reinterview respondent here.

Skip Instructions:
[If (CONTACT_C = 1 and (ORMODE = 2 or D) goto CAPI.Middle.MAXCAP_1]
[If ORMODE = 1 or 3 goto CAPI.Middle.LAPTOP]

P a g e | 38

[If ORIOUT_RSLT= B or C goto CAPI.Middle.STATUS]

Block:

CAPI_Middle

Variable Name:

LAPTOP

Info Pane:

Did the interviewer use a laptop computer?
 1. Yes
 2. No

Skip Instructions:
<1, 2, D, or R>

[If CONTACT_C = 1 goto CAPI_Middle MAXCAP_1] OR
[If ORIOUT_RSLT = B or C goto CAPI_Middle STATUS]

Block:

CAPI_Middle

Variable Name:

MAXCAP_1

Info Pane:
Line No.

GQ Contact
Name

GQ Type

Maximum
Capacity

[Fill:
LNO]

[Fill:
CP1NAME]

[Fill:
GQ TYPE]

[Fill:
MAXCAP]

•

[Fill:
CP2NAME]
•

•

•

•

•

•

•

•

•

•

•

•

•

•

Our records indicate that ♦Read maximum capacity in blue ♦ was the maximum number of people
who could live or stay at:
[FILL: ADDRESS1]
Is this correct?
 1. Yes
 2. No

Skip Instructions:

<1, D, R>
<2>

[go to CAPI_Middle.GQTYPE_1].
[go to CAPI_Middle.MAXCAP_2].

P a g e | 39

Block:

CAPI_Middle

Variable Name:

MAXCAP_2

Info Pane:
Line No.

GQ Contact
Name

GQ Type

Maximum
Capacity

[Fill:
LNO]

[Fill:
CP1NAME]

[Fill:
GQ TYPE]

[Fill:
MAXCAP]

•

[Fill:
CP2NAME]
•

•

•

•

•

•

•

•

•

•

•

•

•

•

What was the maximum capacity of [Fill:GQNAME] on [Fill:INTDATE]?
[FILL: ADDRESS1]
Is this correct?
 1. Yes
 2. No

Skip Instructions:

<1, D, R>

[go to CAPI_Middle.GQTYPE_1].

Block:

CAPI_Middle

Variable Name:

GQTYPE_1

Info Pane:
Line No.

GQ Contact
Name

GQ Type

Maximum
Capacity

[Fill:
LNO]

[Fill:
CP1NAME]

[Fill:
GQ TYPE]

[Fill:
MAXCAP]

•

[Fill:
CP2NAME]

•

•

•

•

•

We recorded that [Fill: GQNAME] is a [Fill: GQTYPE1 and GQTYPE1’s description] [Fill: GQTYPE2 and
GQTYPE2's description] [Fill: GQTYPE3 and GQTYPE3's description]. Is this correct?
There could be up to three GQ types for a facility. If there are more than one GQ type, be sure to read all of the types to the
respondent. There will be blank space if there is only one type.

 1. Yes
 2. No

Skip Instructions:

<1, D, R>

[go to CAPI_Middle.THANK_YOU]

P a g e | 40

<2>

[go to CAPI_Middle.GQTYPE_2]

Block:

CAPI_Middle

Variable Name:

GQTYPE_2

Info Pane:
Line No.

GQ Contact
Name

GQ Type

Maximum
Capacity

[Fill:
LNO]

[Fill:
CP1NAME]

[Fill:
GQ TYPE]

[Fill:
MAXCAP]

•

[Fill:
CP2NAME]

•

•

•

•

•

This is a list of places were people live, could live, or stay and/or receive services. Please select ONLY ONE category that best
describes [Fill:GQNAME].
(Need radio buttons and numbers beside each category)
1. Educational Facility
2. Correectional Facility
3. Group Home

4. Health Care or Treatment Facility
5. Military
6. Other Group Living Facility (include write in box)

Add additional notes about the specific GQ Type by pressing Ctrl-F7.

Skip Instructions:

<1, D, R>

[go to CAPI_Middle.THANK_YOU]

Block:

CAPI_Middle

Variable Name:

PROX_PRESENT

Info Pane:
Were you present during the original interview?
 1. Yes
 2. No

Skip Instructions:

<1>
<2, D, R>

[go to CAPI.Middle.ORMODE].
If (CONTACT_C = 1) then [go to
CAPI_Middle.MAXCAP_1]
If (ORIOUT_RSLT = B or C) then [go
to CAPI_Middle.STATUS]

Block:

CAPI_Middle

Variable Name:

SOMEONE_ELSE

P a g e | 41

Info Pane:

Could the interviewer have spoken to another person at [Fill:GQNAME]?
 1. Yes
 2. No

Skip Instructions: <1> [go to CAPI_Middle.SPEAKTO]
<2, D, R> If CONTACT_C = 2 or D [goto CAPI_Middle.MAXCAP_1]
If ORIOUT_RSLT = B or C [goto CAPI_Middle.STAT_PROBE]

Block:

CAPI_Middle

Variable Name:

SPEAKTO

Info Pane:

May I speak to that person?
 1. Yes
 2. No

Skip Instructions: <1> If (CONTACT_C = 2 or D) [go to CAPI_Middle.RIRESP]
<2, D, R> If ((CONTACT_C = 2 or D) and ORIOUT_RSLT=INT)
[go to CAPI_Middle.MAXCAP_1] else
If (ORIOUT_RSLT=B or C) [go to CAPI_Middle.STAT_PROBE].
Block:

CAPI_Middle

Variable Name:

CONTACT_N

Info Pane:
Did an interviewer visit or call regarding:
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]?
 1. Yes
 2. No

P a g e | 42

Skip Instructions:

<1>

If MODE=1 and (INTROB_RI_CT=empty or NEWRESP = 1)
[go to CAPI_Middle.RIRESPB_RI_CT]
Else if (HELLO_TNX = 1) OR (HELLO_PNX = 1) OR
then [go to CAPI_Middle.PROX_PRESENT].
Else [go to CAPI_Middle.ORMODE].

<2, D, R> If (ORIOUT_RSLT = B or C))
go to CAPI_Middle.STAT_PROBE].
Else [go to CAPI_Middle.SOMEONE_ELSE].
Block:

CAPI_Middle

Variable Name:

STATUS

Info Pane:
Our records show that on [Fill: INTDATE], [Fill: GQNAME] was [Fill: ORIOUT’s description].
Is this information correct?
 1. Yes
 2. No

Skip Instructions: <1>
<2, D, R>

[go to CAPI_Back.THANK_YOU].
[go to CAPI_Middle.STAT_PROBE

Block:

CAPI_Middle

Variable Name:

STAT_PROBE

Info Pane:
Original Outcome:

[Fill: ORIOUT] - [Fill: ORIOUT’s description]
[Fill: TYPEB_SP / TYPEC_SP / blank]

Original Interview Date: [Fill: INTDATE]
What was the status of [Fill: GQNAME] on or about [Fill: INTDATE]?
♦

Enter reported status.

♦

Explain any discrepancy between reported status and original outcome.

Skip Instructions:

[go to CAPI_Back.THANK_YOU].

P a g e | 43

Block:

CAPI_Back

Variable Name:

THANK_SORRY

Info Pane:

I'm sorry. I have the wrong address or telephone number. Thank you for your help.
♦ Attempt to contact the correct [Fill GQ Name] now or at a later time.
 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.STATUS_RI].

Block:

CAPI_Back

Variable Name:

THANK_YOU

Info Pane:

Thank you for your cooperation. You've been very helpful.
 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.RI_OUTCM].

Block:

CAPI_Back

Variable Name:

THANK_REF

Info Pane:

I’m sorry to have bothered you.
 1. Continue

Skip Instructions:

<1>

Block:

CAPI_Back

Variable Name:

THANK_NONEMP

Info Pane:

[go to CAPI_Back.RI_OUTCM] .

P a g e | 44

Thank you for your help, but I need to speak to an employee. I'll try back later.
♦

Enter 1 to continue.

 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.STATUS_RI].

Block:

CAPI_Back

Variable Name:

APPT

Info Pane:

I would like to schedule a date to complete the quality check. What Date and Time would be
best to call or visit?
Today is: [Fill: RIDATE].
♦

Enter (2) to add a Date and Time

♦

Enter (1) if you don’t intend to follow up on this case.
1. Will not followup on this case
2. Add appointment date and time

Skip Instructions:

<1> [go to CAPI_Back.RI_OUTCM].
<2> [go to CAPI_Back.APPTDATE].

Block:

CAPI_Back

Variable Name:

APPTDATE

Info Pane:
What Date and Time would be best to contact [Fill: CPNAME] in order to conduct the quality check?
Today is: [Fill: RIDATE]
♦

Enter Appointment Date

Make appointment for better time
Appointment Date
Appointment Time
Appointment Notes

P a g e | 45

Skip Instructions:

[go to CAPI_Back.APPTTIME].

Block:

CAPI_Back

Variable Name:

APPTTIME

Info Pane:
What Date and Time would be best to contact [Fill: CPNAME] in order to conduct the quality check?
Today is: [Fill: RIDATE]
♦

Enter Appointment Date

Make appointment for better time
Appointment Date
Appointment Time
Appointment Notes

Skip Instructions:

[go to CAPI_Back.APPTNOTES].

Block:

CAPI_Back

Variable Name:

APPTNOTES

Info Pane:
I would like to schedule a date to complete the quality check. What Date and Time would be
best to call or visit?
Today is: [Fill: RIDATE].
♦

Enter Date and Time

♦

Enter (1) if you don’t intend to follow up on this case.

Skip Instructions:

[go to CAPI_Back.RI_OUTCM].

P a g e | 46

Block:

CAPI_Back

Variable Name:

CBTHANK

Info Pane:

Thank you for your help.
We will call or visit again at the time suggested.
 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.READYWRAP

Block:

CAPI_Back

Variable Name:

STATUS_RI

Info Pane:
This case is not completed.
♦

Make several attempts to contact respondent/contact person before selecting reinterview
noninterview.

 1. Quit - Complete later
 2. Reinterview Noninterview

Skip Instructions: <1>
<2>

[go to CAPI_Back.READYWRAP].
[go to CAPI_Back.NONINT].

Block:

CAPI_Back

Variable Name:

RI_OUTCM

Info Pane:

P a g e | 47

Original Outcome:

[FILL: ORIOUT] - [FILL: ORIOUT’s description]
[Fill: TYPEA_SP/TYPEB_SP/TYPEC_SP/blank]

Original Interview Date:

[FILL: INTDATE].

♦ Was the original outcome correct?
 1. Yes
 2. No
 3. Reinterview Noninterview

Skip Instructions:

1
2
3

[goto CAPI_Back.FALSIF]
[goto CAPI_Back.FALSIF]
[goto goto CAPI_Back.NONINT]

Block:

CAPI_Back

Variable Name:

RIOUT_NOTES

Skip Instructions:

If [(DISCREPANCY[1] = 1) or (DISCREPANCY[5] = 5) or
(DISCREPANCY[10] = 10)], then [go to CAPI_Back.FALSIF2].
Else [go to CAPI_Back.FALSIF].

Block:

CAPI_Back

Variable Name:

NONINT

Info Pane:
♦

Which outcome describes this reinterview case?

 1. Type A Noninterview.
 2. Type B Noninterview.
 3. Type C Noninterview.

Skip Instructions:

<1>
<2>
<3>

Block:

CAPI_Back

Variable Name:

NONINT

Info Pane:

[go to CAPI_Back.TYPEA].
[go to CAPI_Back.TYPEB]
[go to CAPI_Back.TYPEC].

P a g e | 48

♦

Which outcome describes this reinterview case?

 1. Type A Noninterview.
 2. Type B Noninterview.
 3. Type C Noninterview.

Skip Instructions:

<1>
<2>
<3>

[go to CAPI_Back.TYPEA].
[go to CAPI_Back.TYPEB]
[go to CAPI_Back.TYPEC].

Block:

CAPI_Back

Variable Name:

TYPEA

Pane:
♦ Which Type A outcome describes this reinterview case?
1.
2.
3.
4.

GQ Refusal ~ GQ Contact cites Legal Restrictions.
Unable to locate GQ.
GQ Refusal ~ All Other Non-Legal Issues
Other Type A - Specify in the Reinterview Notes.

Skip Instructions:

<1-4> [go to CAPI_Back.FALSIF].

Block:

CAPI_Back

Variable Name:

TYPEB

Info Pane:
♦

Which Type B outcome describes this reinterview case?

1.Natural Disaster

Skip Instructions:

1

Block:

CAPI_Back

Variable Name:

TYPEC

Info Pane:

[go to CAPI_Back.FALSIF].

P a g e | 49

♦

Which Type C outcome describes this reinterview case?

1. GQ No Longer Exists
2. GQ Converted To HU(S)
3. Domestic Violence Shelter
4. No Residents In GQ During Survey Period.
5. GQ Out Of Scope ~ Other Specify In The Interview Notes.

Skip Instructions:

<1-5>

[go to CAPI_Back.FALSIF].

Block:

CAPI_Back

Variable Name:

FALSIF

Info Pane:
[Fill:

“Your reinterview indicates the following discrepancies:”
code and description of each code listed in DISCREPANCY array /
“Your reinterview did not indicate any discrepancies.”]

♦

Do you suspect falsification?

 1. Yes
 2. No
 3. Unable to determine

Skip Instructions:

<1>

If (HELLO_PRB_RI_CT = <1-7>) OR (RI_OUTCM = 2 or 3) OR
(RI_OUTCM = 1 and only one element in DISCREPANCY array
≥1)] then [go to CAPI_Back. READYWRAP].
Else if (RI_OUTCM = 1 and all elements in DISCREPANCY
array blank) then [go to CAPI_Back.NO_DISCREP].
Else if (RI_OUTCM = 1 and two or more elements in
DISCREPANCY array ≥1) then [go to CAPI_Back.SF_RIDISP].

<2>

If(HELLO_PRB_RI_CT = <1-7>) OR (RI_OUTCM = 1 and all
elements in DISCREPANCY array blank) OR (RI_OUTCM = 1
and one element in DISCREPANCY array AND
(DISCREPANCY [6] empty) and[(DISCREPANCY[1] empty)
and (DISCREPANCY[5] empty) and DISCREPANCY[10]
empty)] OR
(RI_OUTCM = 2 and ORIOUT_RSLT = (B or C)) OR
(RI_OUTCM = 3) then [go to CAPI_Back READYWRAP].
Else [go to CAPI_Back.DISCREP_NOTES]

P a g e | 50

<3>

If (HELLO_PRB_RI_CT = <1-7>) OR
(RI_OUTCM = 2 and ORIOUT_RSLT = (B or C)) OR
(RI_OUTCM = 3) OR (RI_OUTCM = 2 and RIOUT_RSLT=INT
and DISCREPANCY[2] = 2 and all other elements in
DISCREPANCY array blank) OR
(RI_OUTCM = 2 and ORIOUT_RSLT=INT and only one element
in DISCREPANCY array ≥1) OR
(RI_OUTCM = 1 and all elements in DISCREPANCY array
blank) OR If (RI_OUTCM = 1 and only one element in
DISCREPANCY array ≥1) OR (NONINT = (1, 2, 3, or 4) and
RI_OUTCM blank) then [go to CAPI_Back. READYWRAP].
Else [go to CAPI_Back.NSF_RIDISP].

Block:

CAPI_Back

Variable Name:

FALSIF2

Info Pane:
[Fill: “Your reinterview indicates the following discrepancies:”
code and description of each code listed in DISCREPANCY array]
♦

Falsification is suspected. Be sure to enter all proper notes explaining the situation.

 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.READYWRAP]

Block:

CAPI_Back

Variable Name:

DISCREP_NOTES

Info Pane:
[Fill: DISCREP_NTS]

If (only one element in array DISCREPANCY ≥ 1)
then [go to CAPI_Back. READYWRAP].
Else [go to CAPI_Back.NSF_RIDISP].

Skip Instructions:

<1>

Block:

CAPI_Back

P a g e | 51

Variable Name:

NSF_RIDISP

Info Pane:
Your reinterview detected multiple discrepancies.
♦ Enter the code of the detected discrepancy below which best describes this case.

1.
2.
3.
4.
5.

The reinterview respondent said no one contacted this facility regarding this survey.
The original status was incorrect.
The group quarter type(s) were incorrect.
This case was a Type A in the original interview. The original status was incorrect.
This case was a Type B or Type C noninterview when it should have been an Interview or
Type A.
6. The reinterview respondent indicated that the original status was incorrect.
7. The maximum capacity was incorrect.
8. Not all survey questions were asked during the interview.
9. The FR conducted a telephone interview instead of a personal visit interview, as required.

10. The FR did not use a laptop.
11. The FR entered a bad telephone number for this case.
Skip Instructions:

<2-4, 6-11>

Block:

CAPI_Back

Variable Name:

RO_DISC

[go to CAPI_Back.READYWRAP

Info Pane:
♦ Caution: Obtain supervisor's permission before selecting an option below.
♦ Which of the following options describes this reinterview case?
 1. Hard to interview original case
 2. More than 50 miles from nearest reinterviewer and no phone number
 3. Observed during the original interview
 4. Personal visit needed, but not authorized
 5. Case management or ROSCO problems - Obtain HQ approval
 6. Sample adjustment - Obtain HQ approval
 7. Other RO discretion - Specify in the Reinterview Notes

Skip Instructions:

<1-7> [go to CAPI_Back.READYWRAP_UP].

Block:

CAPI_Back

P a g e | 52

Variable Name:

NO_DISCREP

Info Pane:
♦

Explain why you suspect falsification in the Reinterview Notes now.

♦

Press Ctrl-F7 to access Reinterview Notes.

♦

Enter 1 when done with your explanation in the Reinterview Notes

 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.READYWRAP

Block:

CAPI_Back

Variable Name:

SF_RIDISP

Info Pane:
Your reinterview detected multiple discrepancies.
♦

Enter the code of the discrepancy below which best describes the primary reason you suspect
falsification.

1. The reinterview respondent said no one contacted this facility regarding this survey.
2. The original status was incorrect.
3. The group quarter type(s) were incorrect.
4. This case was a Type A in the original interview. The original status was incorrect.
5. This case was a Type B or Type C noninterview when it should have been an Interview or
Type A.
6. The reinterview respondent indicated that the original status was incorrect.
7. The maximum capacity was incorrect.
8. Not all survey questions were asked during the interview.
9. The FR conducted a telephone interview instead of a personal visit interview, as required.

10. The FR did not use a laptop.
11. The FR entered a bad telephone number for this case.
Skip Instructions:

<1-11> [go to CAPI_Back.READYWRAP_UP].

Block:

CAPI_Back

Variable Name:

READYWRAP

Info Pane:

P a g e | 53

This case is complete and ready to be transmitted. [fill: READY]
 1. Continue

Skip Instructions:

<1>

[go to CAPI_Back.WRAP_UP].

Block:

CAPI_Back

Variable Name:

WRAP_UP

Info Pane:
OUTCOME: [fill: OUTCOME]
RI_DISP: [fill: RI_DISP]
 1. Continue

Skip Instructions:

<1>

[exit instrument]

Document Metadata:USBC-2018-0014-DRAFT-0002

Document Details
Docket ID:

USBC-2018-0014

Docket Title:

The American Community Survey

Document File:
Docket Phase:

Notice

Phase Sequence:

1

Original Document ID:

USBC-2018-0014-DRAFT-0002

Current Document ID:

USBC-2018-0014-DRAFT-0002

Title:

Comment from Clint Summers

Number of Attachments:

0

Document Type:

PUBLIC SUBMISSIONS

Comment on Document ID:

USBC-2018-0014-0001

Comment on Document Title: The American Community Survey Federal Register Notice
Status:

Pending_Post

Received Date:

10/16/2018

Date Posted:
Posting Restriction:

No restrictions

Submission Type:

Web

Number of Duplicate
Submissions:

1

Document Optional Details
Status Set Date:

10/16/2018

Current Assignee:

Casey, Troy (USBC)

Status Set By:

Public

Tracking Number:

1k2-960n-l4yy

Total Page Count
Including Attachments:

1

Submitter Info
Comment:

I think it would help to add more people to the survey, if the
response rate is as low as you say. Also, it might help to add
an online response option to decrease the burden on the
responders.

First Name:

Clint

Last Name:

Summers

Mailing Address:
Mailing Address 2:
City:

Tulsa

Country:

United States

State or Province:

Oklahoma

ZIP/Postal Code:

74104

Email Address:
Phone Number:
Organization Name:
Cover Page:

December 17, 2018
Ms. Jennifer Jessup
Departmental Paperwork Clearance Officer
Department of Commerce
Room 6616
14th and Constitution Avenue, NW
Washington, DC 20230
Submitted via http://www.regulations.gov (Docket # USBC-2018-0014)
RE: Comments on The American Community Survey
Dear Ms. Jessup,
On behalf of the Arab American Institute (AAI), we are pleased to provide comments in response
to the Federal Register notice (the “Notice”). The Notice asks for comments on three issue areas
important to Arab Americans and other communities across the country: changing the race and
ethnicity question to match the 2020 Census, the reliance on technology in filling out the American
Community Survey (ACS), and ways to generally minimize the burden on respondents while
maintaining the integrity of the data.
As an organization, AAI seeks to nurture and encourage the direct participation of Arab Americans
in political and civic life in the United States. AAI represents the policy and community interests of
Arab Americans and strives to promote Arab American participation in the U.S. electoral system.
Serving as a central resource to policy makers, the media, political leaders, and community groups on
a variety of public policy issues that concern Arab Americans, AAI has been engaged in support of
an accurate census count since its founding in 1985. AAI currently hosts the only Census
Information Center tasked with dissemination of data about Arab Americans. We have been actively
working with the Census Bureau (the Bureau), coalition groups, and a working group that we cofounded and lead, in preparation for the 2020 Census. It has been of mutual interest for AAI and
the Bureau to find the best way to ensure a fair and accurate count for Arab Americans and other
MENA populations for the upcoming Census.
AAI views the ACS as an important part of maintaining accurate data on Arab Americans.
Considering the decennial is every 10 years, the ACS provides more timely insight and updated data
that can be used to understand various communities in the United States. Further, given the ACS
asks questions not on the decennial census, for many, including Arab Americans. It is the only
source of data about our communities.
1600 K Street, NW Suite 601 Washington, DC 20006 | (202) 429-9210 | Fax (202) 429-9214 | www.aaiusa.org

To improve the quality of the data on the ACS, AAI would urge the Bureau to include the tested
combined question format, which would result in the implementation of the MENA category.
The combined question format was introduced with the intention of providing more granular and
accurate data across all racial and ethnic groups. Research done by the Bureau found that “the
strategy to combine the race and Hispanic origin questions into one item resulted in dramatically
lower item nonresponse compared to the separate race and Hispanic origin questions.”1 The
addition of the combined question allows for granular data about race and ethnicity in the United
States while increasing the likelihood of valid responses on the form because of the plurality of
options presented to individuals across the country. The 2015 National Content Test: Race and Ethnicity
Analysis Report showed that the combined question format allowed for reliability in responses and
allowed for diversity in responses by individuals who identify with more than one race or ethnicity. 2
It is within this combined question format that a MENA category could be included to ensure a
more accurate count.
AAI supports the inclusion of a distinct MENA category, as the Arab American community, one of
several benefiting from the addition of a MENA category, has long suffered from a census
undercount. This undercounting of members of our community has resulted in a lack of data to
accurately assess community needs, possible denial of government services, and the potential of
political underrepresentation. The lack of access to basic services and rights can range from language
assistance at polling places to greater access to health information and research. During the 1997
review of federal standards to measure race and ethnicity in the United States, the Office of
Management and Budget (OMB) concluded that further research was needed on an Arab or Middle
Eastern ethnic category. 3 Since then, AAI has been working closely with the Bureau to explore ways
to better reach, enumerate, and study these growing and complex population groups. It was field
testing done on the National Content Test that showed the benefits of adding a MENA category in
efforts to get more accurate census data.4 As it currently stands the Arab American community is
severely undercounted. Federal statistics estimate there are 1.96 million Arab Americans living in the
United States, a gross underestimate of the community. Research done by AAI suggests a more
accurate estimate is around 3.66 million Arab Americans. 5
While it was reassuring that research from the Bureau supported the addition of a MENA category
to address an undercount, AAI was not provided with a credible rationale as to why the category
United States. Department of Commerce. Census Bureau. 2010 CENSUS PLANNING MEMORANDA SERIES. By
Burton Reist. 2nd ed. Vol. 211. Washington, DC: Census Bureau, 2013. 1-151.
https://www.census.gov/2010census/pdf/2010_Census_Race_HO_AQE.pdf
2 United States. Department of Commerce. Census Bureau. 2015 National Content Test Race and Ethnicity Analysis Report.
By Kelly Mathews. 1st ed. Washington, DC: Census Bureau, 2017.
https://apps.npr.org/documents/document.html?id=4316468-2015nct-Race-Ethnicity-Analysis.
3 "Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity." U.S. Census Bureau.
October 30, 1997. https://www.whitehouse.gov/wp-content/uploads/2017/11/Revisions-to-the-Standards-for-theClassification-of-Federal-Data-on-Race-and-Ethnicity-October30-1997.pdf.
4 United States. Census Bureau. National Advisory Committee on Racial, Ethnic and Other Populations. National
Advisory Committee on Racial, Ethnic and Other Populations Fall Meeting Notes. Suitland, MD: Census Bureau, 2016. 111.https://www2.census.gov/cac/nac/meetings/2016-11/2017-03-29-census-response.pdf.
5 Arab American Institute. "National Demographic Profile 2014." National Demographic Profile 2014. 2014.
https://d3n8a8pro7vhmx.cloudfront.net/aai/pages/9843/attachments/original/1460668240/National_Demographic_
Profile_2014.pdf?1460668240.
1

1600 K Street, NW Suite 601 Washington, DC 20006 | (202) 429-9210 | Fax (202) 429-9214 | www.aaiusa.org

was not being implemented for 2020, contrary to prior planning and testing. Through a request
pursuant to the Freedom of Information Act, AAI obtained documents from OMB, yet none of the
documents provide an explanation for the MENA category’s omission. The omission of the MENA
category, which was tested and proven to be beneficial to ensure an accurate count, generates
concern among stakeholders, who do not understand why the Bureau is not moving forward with a
tested category that would improve the count. Though the MENA category might not be included
on the decennial Census, AAI still finds that this addition would lead to much more accurate data,
more accurate than that was obtained during the Census enumeration.
Since the Bureau did not move forward with the addition of the MENA category, the ACS is the
only place that Arab Americans and other communities within the MENA designation would be
able to get data on our communities. As it currently stands, the ACS is the only way that Arab
Americans are able to get any understanding of the increase in population, the diversity within the
community, and the growth of the population. Through the ACS we are able to get a snapshot of
various aspects of parts of the Arab American community—from levels of educational attainment,
employment, and income levels we are able to see how to better inform our efforts to assist all Arab
Americans in their daily lives. Data attained by the ACS gives us the only insight into the diversity of
the Arab American community, their needs, and the growth patterns of the community. It is vital to
organizations like AAI who rely on the ACS to get better quality data about the community to
ensure that the ACS continues to ask and collect data on ancestry that is then made available to the
public through data tools like American Fact Finder.
As a community-based organization with a long-held vested interest in accurate federal data, we are
troubled by the various ways that this data has been put at stake for our community. Actions that
compromise the accurate, constitutionally mandated collection of data will harm communities across
the country, including Arab Americans. It is imperative that federal officials act at this time to (1)
add a MENA category, (2) continue asking about ancestry and (3) work to ensure the integrity of
Census Bureau data and ensure all people are counted. These recommendations will uphold the
commitment of the Census Bureau to gather accurate data that can be used as a snapshot for the
larger American public through the American Community Survey.
Thank you for the opportunity to comment on the upcoming Census and for taking these concerns
seriously. If you have any further questions about the comments provided here, please feel free to
contact Suher Adi at 202-429-9210 or [email protected].
Sincerely,

Maya Berry
Executive Director

1600 K Street, NW Suite 601 Washington, DC 20006 | (202) 429-9210 | Fax (202) 429-9214 | www.aaiusa.org

From: Jean Public
Sent: Tuesday, October 16, 2018 3:49 PM
To: docpra ; [email protected]; [email protected]; [email protected];
[email protected]
Subject: Fw: public comment on federa reglatister
no way shoudl this survey be done the same year as a ten year census. of course it is confusing. the
information is not that necessary that you need to hit the american citizenry with two huge surveys
in one year. this needs to be held off for 3 years or 2 year, bu tnnot in the same year. there is no need
for this to happen in teh same years. put it off. use your sense so that you do get information.
this comment is for th eupbilc record. please receipt. jean publiee jean [email protected]

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau ...
Your household has been randomly selected to complete a very important national survey, the
American Community Survey. The U.S. Census Bureau conducts this survey to give our
country an up-to-date picture of how we live—our education, employment, housing, and more.
The American Community Survey is not the 2020 Census. This survey asks questions about
topics not on the 2020 Census, such as veteran status, transportation, and internet access. Your
response to the American Community Survey is required by law.
Using the enclosed instructions, please complete the survey online as soon as possible at:
https://respond.census.gov/acs
The Census Bureau is using the Internet to collect this information in an effort to conserve natural
resources, save taxpayers’ money, and process your data more efficiently. If you are unable to
complete the survey online, there is no need to contact us. We will send you a paper
questionnaire in a few weeks.
The American Community Survey collects critical information used to meet the needs of
communities across the United States. For example, results from this survey are used to decide
where new schools, hospitals, and fire stations are needed. This information also helps
communities plan for the kinds of emergency situations that might affect you and your neighbors,
such as floods and other natural disasters.
If you need help completing the survey, please call our toll-free number (1–800–354–7271).
Thank you.
Sincerely,

Steven D. Dillingham
Enclosures

ACS-13(LZ)(2020) (03-04-2019)

census.gov

Is the American Community Survey the same as the 2020 Census?
No, the American Community Survey (ACS) is different from the 2020 Census.
The ACS shows how we live-our education, housing, jobs, and more. The ACS provides
information about the social and economic needs of your community every year.
The census is conducted once every 10 years to provide an official count of the entire U.S.
population to Congress.
Can you use my 2020 Census answers for the American Community Survey?
Your answers to the 2020 Census cannot be used for the American Community Survey (ACS).
The ACS includes questions about topics not on the 2020 Census, such as education,
employment, internet access, and transportation.
Will my response be confidential?
Yes. The U.S. Census Bureau is required by law to protect this information. The Census Bureau
is not permitted to publicly release your responses in a way that could identify you. We are
conducting this survey under the authority of Title 13, United States Code, Sections 141 and 193.
Federal law protects your privacy and keeps your answers confidential (Title 13, United States
Code, Section 9). Per the Federal Cybersecurity Enhancement Act of 2015, your data are
protected from cybersecurity risks through screening of the systems that transmit your data.
Am I required to fill out the survey?
Yes. Your response to this survey is required by law (Title 13, U.S. Code, Sections 141, 193, and
221). Title 13, as changed by Title 18, imposes a penalty for not responding. As a randomly
selected representative of your community, you are the voice of your neighbors and peers. To
create an accurate picture of your community, it is critical that you respond.
How will the Census Bureau use the information I provide?
By law, the Census Bureau can only use your responses to produce statistics. Your information
will be used in combination with information from other households to produce data for your
community. Similar data will be produced for communities across Puerto Rico and the United
States.
We may combine your answers with information that you gave to other agencies to enhance the
statistical uses of these data. This information will be given the same protections as your survey
information. Based on the information that you provide, you may be asked to participate in other
Census Bureau surveys that are voluntary.

ACS-13(LZ)(2020) (03-04-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau...
About two weeks ago, the U.S. Census Bureau sent instructions for completing the American
Community Survey to your address. We asked you to help us with this very important survey by
completing it online. But we have not received your response yet.
If you have already completed the American Community Survey, thank you very much. If you
have not, please complete the survey soon using ONE of the following two options.
Option 1: Go to https://respond.census.gov/acs to complete the survey online.
Option 2: Fill out and mail back the enclosed questionnaire.
This year, the Census Bureau is also conducting the 2020 Census. The American Community
Survey is different from the 2020 Census. Your response to the American Community Survey
is required by U.S. law.
The American Community Survey is so important that a Census Bureau representative may
attempt to contact you by telephone or personal visit if we do not receive your response.
The information collected in this survey will help decide where new schools, hospitals, and fire
stations are needed. The information also is used to develop programs to reduce traffic
congestion, provide job training, and plan for the health care needs of the elderly.
If you need help completing the survey, please call our toll–free number (1–800–354–7271).
Thank you.
Sincerely,

Steven D. Dillingham
Enclosures

ACS-14(LZ)(2020) (03-04-2019)

census.gov

Is the American Community Survey the same as the 2020 Census?
No, the American Community Survey (ACS) is different from the 2020 Census.
The ACS shows how we live-our education, housing, jobs, and more. The ACS provides
information about the social and economic needs of your community every year.
The census is conducted once every 10 years to provide an official count of the entire U.S.
population to Congress.
Can you use my 2020 Census answers for the American Community Survey?
Your answers to the 2020 Census cannot be used for the American Community Survey (ACS).
The ACS includes questions about topics not on the 2020 Census, such as education,
employment, internet access, and transportation.
Will my response be confidential?
Yes. The U.S. Census Bureau is required by law to protect this information. The Census Bureau
is not permitted to publicly release your responses in a way that could identify you. We are
conducting this survey under the authority of Title 13, United States Code, Sections 141 and 193.
Federal law protects your privacy and keeps your answers confidential (Title 13, United States
Code, Section 9). Per the Federal Cybersecurity Enhancement Act of 2015, your data are
protected from cybersecurity risks through screening of the systems that transmit your data.
Am I required to fill out the survey?
Yes. Your response to this survey is required by law (Title 13, U.S. Code, Sections 141, 193, and
221). Title 13, as changed by Title 18, imposes a penalty for not responding. As a randomly
selected representative of your community, you are the voice of your neighbors and peers. To
create an accurate picture of your community, it is critical that you respond.
How will the Census Bureau use the information I provide?
By law, the Census Bureau can only use your responses to produce statistics. Your information
will be used in combination with information from other households to produce data for your
community. Similar data will be produced for communities across Puerto Rico and the United
States.
We may combine your answers with information that you gave to other agencies to enhance the
statistical uses of these data. This information will be given the same protections as your survey
information. Based on the information that you provide, you may be asked to participate in other
Census Bureau surveys that are voluntary.

ACS-14(LZ)(2020) (03-04-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau...
The U.S. Census Bureau is conducting the American Community Survey. A Census Bureau
representative will contact you to help you complete the survey. The survey will ask you
questions about your household’s characteristics, including topics such as education,
employment, and housing. We would appreciate your help because the success of this survey
depends on you.
The American Community Survey is not the 2020 Census. This survey includes questions that
are not asked by the 2020 Census, such as health insurance, transportation, and internet
access. Your response to the American Community Survey is required by law (Title 13, United
States Code, Sections 141, 193, and 221).
The American Community Survey produces critical up-to-date information that is used to meet
the needs of communities across the United States. For example, results from this survey
maybe used to decide where new schools, hospitals, and fire stations are needed. Survey
data are used by federal, tribal, state, and local governments to make decisions and to
develop programs that will provide health care, education, and transportation services that
affect you and your community. This survey information also helps communities plan for
emergency situations that might affect you and your neighbors.
The Census Bureau chose your address, not you personally, as part of a randomly selected
sample. We estimate this survey will take about 40 minutes of your time.
The Census Bureau is required by law to keep your information confidential. We are not
permitted to publicly release your responses in a way that could identify this household. Per
the Federal Cybersecurity Enhancement Act of 2015, your data are protected from
cybersecurity risks through screening of the systems that transmit your data. By law, the
Census Bureau can only use your responses to produce statistics.
If you have access to the Internet and want to learn more about the American Community
Survey, please visit our Web site at census.gov/acs.
Thank you for your help.
Sincerely,

Steven D. Dillingham

ACS-16(LZ)(3-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Dear Resident:
The U.S. Census Bureau is conducting the Puerto Rico Community Survey. A Census Bureau
representative will contact you to help you complete the survey. The survey will ask you
questions about your household’s characteristics, including topics such as education,
employment, and housing. We would appreciate your help because the success of this survey
depends on you.
The Puerto Rico Community Survey is not the 2020 Census. This survey includes questions
that are not asked by the 2020 Census, such as health insurance, transportation, and internet
access. Your response to the Puerto Rico Community Survey is required by law (Title 13,
United States Code, Sections 141, 193, and 221).
The Puerto Rico Community Survey paints a picture of life in Puerto Rico–education, housing,
jobs, and more. Every year, this survey provides up-to-date information to community leaders
as well as federal, Puerto Rico, and municipio governments. This information can be used to
identify the services and programs your community needs. For example, this survey can
provide information to plan services for the elderly, emergency services, and federal aid.
The Census Bureau chose your address, not you personally, as part of a randomly selected
sample. We estimate this survey will take about 40 minutes of your time.
The Census Bureau is required by law to keep your information confidential. We are not
permitted to publicly release your responses in a way that could identify this household. Per
the Federal Cybersecurity Enhancement Act of 2015, your data are protected from
cybersecurity risks through screening of the systems that transmit your data. By law, the
Census Bureau canonly use your responses to produce statistics.
If you have access to the Internet and want to learn more about the Puerto Rico Community
Survey, please visit our Web site at census.gov/acs.
Thank you for your help.
Sincerely,

Steven D. Dillingham

ACS-16(LZ)(PR)(3-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Un mensaje del Director de la Oficina del Censo de los Estados Unidos ...
La Oficina del Censo de los Estados Unidos está realizando la Encuesta sobre la Comunidad
de Puerto Rico. Un representante de la Oficina del Censo se comunicará con usted para
ayudarlo a completar la encuesta. La encuesta le formulará preguntas sobre características de
su hogar, incluyendo temas, tales como la educación, el empleo y la vivienda. Le agradecería
su ayuda, ya que el éxito de esta encuesta depende de usted.
La Encuesta sobre la Comunidad de Puerto Rico no es el Censo del 2020. Esta encuesta
hace preguntas sobre temas que no aparecen en el Censo del 2020, tales como transporte y
acceso a internet. La ley requiere que usted responda a la Encuesta sobre la Comunidad de
Puerto Rico encuesta (secciones 141, 193 y 221 del título 13 del Código de los Estados
Unidos).
La Encuesta sobre la Comunidad de Puerto Rico ofrece un panorama de la vida en Puerto
Rico: la educación, la vivienda, los empleos y más. Todos los años, esta encuesta
proporciona información actualizada a los líderes de la comunidad, así como al gobierno
federal, al de Puerto Rico y a los de los municipios. Esta información puede usarse para
identificar los servicios y programas que su comunidad necesita. Por ejemplo, esta encuesta
puede proporcionar información para planificar servicios para las personas de la tercera edad,
servicios de emergencia y asistencia federal.
La Oficina del Censo no lo escogió a usted personalmente, sino su dirección particular
comoparte de una muestra al azar. Calculamos que esta encuesta tomará aproximadamente
40 minutos de su tiempo.
La Oficina del Censo está obligada por ley a mantener confidencial su información. A nosotros
no se nos permite divulgar sus respuestas de manera que este hogar pudiera ser identificado.
En conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del
2015, sus datos están protegidos contra los riesgos de seguridad cibernética mediante los
controles aplicados a los sistemas que trasmiten su información. Por ley, la Oficina del Censo
puede usarsus respuestas solo para producir estadísticas.
Si tiene acceso a la Internet y desea obtener más información acerca de la Encuesta sobre la
Comunidad de Puerto Rico, visite nuestro sitio de Internet en census.gov/acs.
Gracias por su ayuda.
Atentamente,

Steven D. Dillingham

ACS-16(LZ)(PR)(3-2020) (2-2019)

census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

Un mensaje del Director de la Oficina del Censo de los Estados Unidos ...
La Oficina del Censo de los Estados Unidos está realizando la Encuesta sobre la Comunidad
Estadounidense. Un representante de la Oficina del Censo se comunicará con usted para
ayudarlo a completar la encuesta. La encuesta le formulará preguntas sobre características de
su hogar, incluyendo temas, tales como la educación, el empleo y la vivienda. Le agradecería
su ayuda, ya que el éxito de esta encuesta depende de usted.
La Encuesta sobre la Comunidad Estadounidense no es el Censo del 2020. Esta encuesta
hace preguntas sobre temas que no aparecen en el Censo del 2020, tales como transporte y
acceso a internet. Todas las personas cuyos domicilios resultan seleccionados están obligadas
por ley a responder a esta encuesta (Título 13, Código de los Estados Unidos, Secciones 141,
193 y 221).
La Encuesta sobre la Comunidad Estadounidense obtiene información actual y crítica que se
utiliza para satisfacer las necesidades de comunidades en todo Estados Unidos. Por ejemplo,
puede que los resultados de esta encuesta se usen para decidir dónde se necesitan nuevas
escuelas, hospitales y estaciones de bomberos. El gobierno federal y los gobiernos estatales y
locales usan los datos de la encuesta para tomar decisiones y elaborar programas que brinden
atención médica, educación y servicios de transporte que los conciernen a usted y a su
comunidad. La información de esta encuesta también ayuda a dichas comunidades a formular
planes de respuesta en situaciones de emergencia que pudieran afectarlo a usted y a sus
vecinos.
La Oficina del Censo no lo escogió a usted personalmente, sino su dirección particular
comoparte de una muestra al azar. Calculamos que esta encuesta tomará aproximadamente
40 minutos de su tiempo.
La Oficina del Censo está obligada por ley a mantener confidencial su información. A nosotros
no se nos permite divulgar sus respuestas de manera que este hogar pudiera ser identificado.
En conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del
2015, sus datos están protegidos contra los riesgos de seguridad cibernética mediante los
controles aplicados a los sistemas que trasmiten su información. Por ley, la Oficina del Censo
puede usar sus respuestas solo para producir estadísticas.
Si tiene acceso a la Internet y desea obtener más información acerca de la Encuesta sobre la
Comunidad Estadounidense, visite nuestro sitio de Internet en census.gov/acs.
Gracias por su ayuda.
Atentamente,

Steven D. Dillingham
ACS-16(LZ)(Spanish)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(Arabic)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(French)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(Haitian Creole)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(Korean)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(Polish)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(Portuguese)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(Russian)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(S.Chinese)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

ACS-16(LZ)(Vietnamese)(3-2020) (3-2019)
census.gov

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau ...
A few days ago, you should have received instructions for completing the American
Community Survey online. Some households, including yours, will receive both the American
Community Survey and the 2020 Census this year.
Your response to the American Community Survey is required by law. If you have not
already responded, please do so now.
Respond now at https://respond.census.gov/acs
Log in using this user ID:
If we do not receive your response online, we will mail a paper questionnaire to your address.
Your response is critically important to your local community and your country. Local
communities depend on information from this survey to decide where schools, highways,
hospitals, and other important services are needed.
Responding promptly will prevent you from receiving additional reminder mailings, phone calls,
or personal visits from Census Bureau interviewers.
If you need help completing the survey or have questions, please call 1–800–354–7271.
Thank you in advance for your prompt response.
Sincerely,

Steven D. Dillingham

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132-0001
OFFICIAL BUSINESS
Penalty for Private Use $300

U.S. Census Bureau
American Community Survey

ACS-20(LZ)(2020) (03-07-2019)

DC
U.S. Census Bureau
Washington, DC 20233
Office of the Director

A message from the Director, U.S. Census Bureau ...
Within the last few weeks, the U.S. Census Bureau mailed an American Community Survey
questionnaire package to your address. You are required by U.S. law to respond to
the American Community Survey. The Census Bureau is required by law to keep your
information confidential. If you have already responded, thank you. If you have not, please
complete the questionnaire and send it now, or complete the survey online.
Respond now at https://respond.census.gov/acs
Log in using this user ID:
Your response is critically important to your local community and to your
country. If you do not respond, a Census Bureau interviewer may contact you by personal
visit to complete the survey.
If you would like to complete the survey by telephone or need assistance, please call our
toll-free number (1–800–354–7271).
Thank you.
Sincerely,

Steven D. Dillingham

census.gov

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E 10th Street
Jeffersonville IN 47132
OFFICIAL BUSINESS
Penalty for Private Use $300

U.S. Census Bureau
American Community Survey

ACS-23(LZ)(2020) (03-01-2019)

Draft 4 (3/1/19)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

DC

U.S. Census Bureau

U.S. Census Bureau

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132

OFFICIAL BUSINESS
Penalty for Private Use $300

OFFICIAL BUSINESS
Penalty for Private Use $300

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

Draft 4 (3/1/19)

DC

DC

A message from the Director, U.S. Census Bureau . . .

A message from the Director, U.S. Census Bureau . . .

Within the last few weeks, the U.S. Census Bureau sent you several requests to complete
the American Community Survey. Now is the time to complete the survey if you
have not already done so. Please complete the questionnaire and return it now OR
go to https://respond.census.gov/acs to respond online.

Within the last few weeks, the U.S. Census Bureau sent you several requests to complete
the American Community Survey. Now is the time to complete the survey if you
have not already done so. Please complete the questionnaire and return it now OR
go to https://respond.census.gov/acs to respond online.

Your response to the American Community Survey is required by U.S. law.
If you do not respond, a Census Bureau interviewer may contact you to complete the
survey. Local and national leaders use the information from this survey for planning
schools, hospitals, roads, and other community needs.

Your response to the American Community Survey is required by U.S. law.
If you do not respond, a Census Bureau interviewer may contact you to complete the
survey. Local and national leaders use the information from this survey for planning
schools, hospitals, roads, and other community needs.

If you need help completing the American Community Survey or have questions, please
call our toll-free number (1–800–354–7271).

If you need help completing the American Community Survey or have questions, please
call our toll-free number (1–800–354–7271).

Thank you.

Thank you.

Sincerely,

Sincerely,

Steven D. Dillingham

ACS-29(Z)(2020) (03-01-2019)

Steven D. Dillingham

ACS-29(Z)(2020) (03-01-2019)

DC

DC

A message from the Director, U.S. Census Bureau . . .

A message from the Director, U.S. Census Bureau . . .

Within the last few weeks, the U.S. Census Bureau sent you several requests to complete
the American Community Survey. Now is the time to complete the survey if you
have not already done so. Please complete the questionnaire and return it now OR
go to https://respond.census.gov/acs to respond online.

Within the last few weeks, the U.S. Census Bureau sent you several requests to complete
the American Community Survey. Now is the time to complete the survey if you
have not already done so. Please complete the questionnaire and return it now OR
go to https://respond.census.gov/acs to respond online.

Your response to the American Community Survey is required by U.S. law.
If you do not respond, a Census Bureau interviewer may contact you to complete the
survey. Local and national leaders use the information from this survey for planning
schools, hospitals, roads, and other community needs.

Your response to the American Community Survey is required by U.S. law.
If you do not respond, a Census Bureau interviewer may contact you to complete the
survey. Local and national leaders use the information from this survey for planning
schools, hospitals, roads, and other community needs.

If you need help completing the American Community Survey or have questions, please
call our toll-free number (1–800–354–7271).

If you need help completing the American Community Survey or have questions, please
call our toll-free number (1–800–354–7271).

Thank you.

Thank you.

Sincerely,

Sincerely,

Steven D. Dillingham

ACS-29(Z)(2020) (03-01-2019)

Steven D. Dillingham

ACS-29(Z)(2020) (03-01-2019)

DC

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

U.S. Census Bureau
National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132
OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

U.S. Census Bureau

American Community Survey

ACS-46(IMZ)(2020) (2-1-2019)

DC
U.S. Census Bureau

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

The American Community Survey
Form Enclosed

National Processing Center
1201 E. 10th St.
Jeffersonville, IN 47132
OFFICIAL BUSINESS
Penalty for Private Use $300

YOUR RESPONSE IS
REQUIRED BY LAW

ACS-46(Z)(2020) (2-1-2019)

The American Community Survey
and the 2020 Census

I already answered the 2020 Census. Is this the same thing?
The American Community Survey is different from the 2020 Census.
How is the American Community Survey different from the 2020 Census?
The American Community Survey (ACS) shows how we live–our education,
housing, jobs, and more. The ACS provides information about the social and
economic needs of your community every year. For example, results may be used
to decide where new schools, hospitals, and fire stations are needed.
The census is conducted once every 10 years to provide an official count of the
entire U.S. population to Congress.
Do I have to answer the American Community Survey?
Yes, you are required by law to answer the American Community Survey (Title 13,
U.S. Code).
Your response will help your community get its fair share of federal funding.
The data help determine how more than $675 billion is distributed to states and
communities every year.
Can you use my 2020 Census answers for the American Community Survey?
No, your answers to the 2020 Census cannot be used for the American Community
Survey (ACS). The ACS asks questions about topics not on the 2020 Census, such
as education, employment, and transportation.
Why was I chosen for the American Community Survey?
The U.S. Census Bureau chose this address, not you personally, as part of a
randomly selected sample.

Thank you for your participation!

Connect with us @uscensusbureau

The American Community Survey

Each year, a random sample of addresses
completes the American Community Survey.
Respond online at
respond.census.gov/acs

or

Respond by mail
using the paper form
13190012

DC

The American Community Survey

Start Here
You have two ways to respond:

➜

Respond online today at:
https://respond.census.gov/acs

Please print the name and telephone number of the
person who is filling out this form. We will only
contact you if needed for official Census Bureau business.
Last Name

OR
Complete this form and mail it
back as soon as possible.

First Name

Your response is required by law.
The American Community Survey is
conducted by the U.S. Census Bureau.
This survey is one of only a few
surveys for which all recipients are
required by law to respond. The
U.S. Census Bureau is required by
law to protect your information.

MI

Area Code + Number

—

➜

How many people are living or staying at this address?
• INCLUDE everyone who is living or staying here for more
than 2 months.
• INCLUDE yourself if you are living here for more than 2
months.
• INCLUDE anyone else 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 or
someone in the Armed Forces on deployment.

If you need help or have
questions about completing
this form, please call
1-800-354-7271.

Number of people

Telephone Device for the Deaf (TDD):
Call 1–800–582–8330.
¿NECESITA AYUDA? Llame sin cargo
alguno al 1-877-833-5625.
For more information about the American
Community Survey, visit our website at:
https://www.census.gov/acs

➜

Fill out pages 2, 3, 4, 5, 6, and 7 for everyone,
including yourself, who is living or staying at this
address for more than 2 months. Then complete the
rest of the form.

ACS-1(X)(2020)

FORM
(02-20-2019) Draft 3

OMB No. xxxx-xxxx

§.4!-¤

The American Community Survey asks questions
about topics not on the 2020 Census, such as
education, employment, and transportation.

Connect with us @uscensusbureau

The Puerto Rico Community Survey
and the 2020 Census
I already answered the 2020 Census. Is this the
same thing?

Respond to the Survey
13170014

DC

The Puerto Rico Community Survey

The Puerto Rico Community Survey (PRCS) is
different from the 2020 Census. The PRCS provides
information about the social and economic needs
of your community every year. For example, this
survey can provide information to plan services for
the elderly, emergency services, and federal aid.
The census is conducted once every 10 years
to provide an official count of the entire U.S.15
population to Congress.
Do I have to answer the American Community
Survey?
Yes, you are required by law to answer the Puerto
Rico Community Survey (Title 13, U.S. Code).
Your response will help your community plan for
the future. The data help leaders, businesses and
non-profit organizations know what programs and
services your community needs.

Start Here
➜
Pleae complete this form and
return it as soon as possible after
receiving it in the mail.

Please print today’s date.
Month

➜

This form asks for information about
the people who are living or staying
at the address on the mailing label
and about the house, apartment, or
mobile home located at the address
on the mailing label.

Day

Year

Please print the name and telephone number of the
person who is filling out this form. We will only contact
you if needed for official Census Bureau business.
Last Name

First Name

MI

Area Code + Number

—
If you need help or have
questions about completing
this form, please call
1-800-717-7381.
The telephone call is free.

➜

¿NECESITA AYUDA? Si usted habla
español y necesita ayuda para completar
su cuestionario, llame sin cargo alguno al
1-800-814-8385.
For more information about the
Puerto Rico Community Survey, visit our
web site at: https://www.census.gov/acs

How many people are living or staying at this address?
• INCLUDE everyone who is living or staying here for
more than 2 months.
• INCLUDE yourself if you are living here for more than
2 months.
• INCLUDE anyone else 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 or someone in the Armed Forces on deployment.

Telephone Device for the Deaf (TDD):
Call 1–800–786–9448. The telephone call
is free.

Number of people

➜

Fill out pages 2, 3, 4, 5, 6, and 7 for everyone, including
yourself, who is living or staying at this address for more
than 2 months. Then complete the rest of the form.

ACS-1PR(2020)

FORM
(02-16-2019) Draft 4

§.2!/¤

Can you use my 2020 Census answers for the
Puerto Rico Community Survey?

OMB No. xxxx-xxxx

No, your answers to the 2020 Census cannot
be used for the Puerto Rico Community Survey
(PRCS). The PRCS asks questions about topics
not on the 2020 Census, such as education,
employment, and transportation.
Why was I chosen for the Puerto Rico Community
Survey?
The U.S. Census Bureau chose this address, not you
personally, as part of a randomly selected sample.

Thank you for your participation!

Connect with us @uscensusbureau

La Encuesta sobre la Comunidad de
Puerto Rico y el Censo 2020
Ya respondí al Censo del 2020. ¿Esto es lo mismo?

Responda a la Encuesta

El censo se realiza una vez cada 10 años para
proporcionar al Congreso un recuento oficial de toda
la población de los EE. UU.

13180013

DC

La Encuesta sobre la Comunidad de Puerto Rico
(PRCS, por sus siglas en inglés) es diferente del Censo
del 2020. La PRCS proporciona información sobre las
necesidades sociales y económicas de su comunidad
todos los años. Por ejemplo, esta encuesta puede
proporcionar información para planificar servicios
para las personas de la tercera edad, servicios de
emergencia y asistencia federal.

La Encuesta sobre la
Comunidad de Puerto Rico

¿Tengo que responder a la Encuesta sobre la
Comunidad de Puerto Rico?
Sí, la ley requiere que usted responda a la Encuesta
sobre la Comunidad de Puerto Rico (Título 13 del
Código de los EE. UU.). Su respuesta ayudará a su
comunidad a planificar para el futuro. Los datos ayudan
a que líderes, empresas y organizaciones sin fines de
lucro sepan qué programas y servicios necesita su
comunidad.

Comience Aquí
Por favor, complete este cuestionario ➜
y devuélvalo tan pronto como sea
posible después de recibirlo por
correo.

➜
Este cuestionario pide información sobre
las personas que viven o se quedan en la
dirección en la etiqueta. También pide
información sobre la casa, apartamento o
casa móvil ubicada en la dirección que se
indica en la etiqueta.

Si necesita ayuda o si tiene
alguna pregunta sobre cómo
completar este cuestionario,
por favor, llame al
1-800-814-8385. La llamada
telefónica es gratis.

Por favor, escriba en letra de molde el nombre y número
de teléfono de la persona que está completando este
cuestionario. Nos comunicaremos con usted solo si es
necesario para asuntos oficialesde la Oficina del Censo.
Apellido

Nombre

Inicial

Código de área y número de teléfono

—

➜

Aparato telefónico para las personas con
impedimentos auditivos (TDD, por sus
siglas en inglés):

¿Cuántas personas están viviendo o quedándose en esta
dirección?

• INCLUYA a todas las personas que viven o se quedan aquí
por más de 2 meses.
• INCLÚYASE a usted mismo si vive aquí por más de 2 meses.
• INCLUYA a cualquier otra persona que se queda aquí que no tiene
otro lugar donde quedarse, aunque esté aquí por 2 meses o menos.
• NO INCLUYA a cualquier persona que viva en otro lugar por
más de 2 meses, tal como un estudiante universitario que vive
en otro lugar o personal de las Fuerzas Armadas que se ha
activado.

Llame al 1-800-786-9448. La llamada telefónica
es gratis.
NEED HELP? If you speak English and need
help completing this form, call toll-free
1-800-717-7381. You can also request a
questionnaire in English, or complete your
interview over the phone with an Englishspeaking interviewer.
Para más información sobre la Encuesta sobre la
Comunidad de Puerto Rico, vaya a nuestra página
en la Internet: https://www.census.gov/acs

Por favor, escriba la fecha de hoy en letra de molde.
Mes
Día
Año

Número de personas

➜

Complete las páginas 2, 3, 4, 5, 6 y 7 para todas las
personas, incluyéndose austed mismo, que estén viviendo
o quedándose en esta dirección pormás de 2 meses.
Luego, complete el resto del cuestionario.

ACS-1PR(SP)(2020)

FORM
(02-16-2019) Draft 1

Núm. de OMB xxxx-xxxx

§.3!.¤

¿Pueden usarse mis respuestas al Censo del 2020
para la Encuesta sobre la Comunidad de Puerto
Rico?
No, sus respuestas al Censo del 2020 no pueden
usarse para la Encuesta sobre la Comunidad de Puerto
Rico (PRCS, por sus siglas en inglés). La PRCS hace
preguntas sobre temas que no aparecen en el Censo
del 2020, tales como educación, empleo y transporte.
¿Por qué me eligieron para la Encuesta sobre la
Comunidad de Puerto Rico?
La Oficina del Censo de los EE. UU. escogió
residentes de esta instalación como parte de una
muestra seleccionada al azar.

¡Gracias por su participación!

Departamento de Comercio de los EE. UU.
Administración de Economía y Estadísticas
OFICINA DEL CENSO DE LOS EE. UU.
census.gov

Conéctese con nosotros @uscensusbureau

La Encuesta sobre la Comunidad
Estadounidense y el Censo del 2020

Ya respondí al Censo del 2020. ¿Esto es lo mismo?
La Encuesta sobre la Comunidad Estadounidense es diferente del Censo del 2020.
¿En qué se diferencia la Encuesta sobre la Comunidad Estadounidense del Censo
del 2020?
La Encuesta sobre la Comunidad Estadounidense (ACS, por sus siglas en inglés)
muestra cómo vivimos: nuestros empleos, viviendas, educación y más. La ACS
proporciona información sobre las necesidades sociales y económicas de su
comunidad todos los años. Por ejemplo, los resultados pueden usarse para decidir
dónde se necesitan nuevas escuelas, hospitales y estaciones de bomberos.
El censo se realiza una vez cada 10 años para proporcionar al Congreso un recuento
oficial de toda la población de los EE. UU.
¿Tengo que responder a la Encuesta sobre la Comunidad Estadounidense?
Sí, la ley requiere que usted responda a la Encuesta sobre la Comunidad
Estadounidense (Título 13 del Código de los EE. UU.).
Su respuesta ayudará a que su comunidad reciba la parte que le corresponde de los
fondos federales. Los datos ayudan a determinar cómo se distribuyen más de $675
mil millones a los estados y a las comunidades cada año.
¿Pueden usarse mis respuestas al Censo del 2020 para la Encuesta sobre la
Comunidad Estadounidense?
No, sus respuestas al Censo del 2020 no pueden usarse para la Encuesta sobre la
Comunidad Estadounidense (ACS, por sus siglas en inglés). La ACS hace preguntas
sobre temas que no aparecen en el Censo del 2020, tales como educación, empleo y
transporte.
¿Por qué me eligieron para la Encuesta sobre la Comunidad Estadounidense?
La Oficina del Censo de los EE. UU. escogió esta dirección, y no a usted
personalmente, como parte de una muestra seleccionada al azar.

¡Gracias por su participación!

Departamento de Comercio de los EE. UU.
Administración de Economía y Estadísticas
OFICINA DEL CENSO DE LOS EE. UU.
census.gov

Conéctese con nosotros @uscensusbureau

La Encuesta sobre la Comunidad
Estadounidense
Cada año, una muestra al azar
de direcciones completa la Encuesta
sobre la Comunidad Estadounidense.
Responda por internet en
respond.census.gov/acs

o

Responda por correo
usando el formulario
impreso
13160015

DC

La Encuesta sobre la
Comunidad Estadounidense

Comience Aquí
Responda hoy por la Internet en:
https://respond.census.gov/acs
O
Llene y devuelva por correo este
cuestionario tan pronto sea posible.

➜

Por favor, escriba la fecha de hoy en letra de molde.
Mes
Día
Año

➜

Por favor, escriba en letra de molde el nombre y número
de teléfono de la persona que está completando este
cuestionario. Nos comunicaremos con usted solo si es
necesario para asuntos oficialesde la Oficina del Censo.

Este cuestionario pide información sobre
las personas que viven o se quedan en la
dirección en la etiqueta. También pide
información sobre la casa, apartamento o
casa móvil ubicada en la dirección que se
indica en la etiqueta.
Si necesita ayuda o si tiene
alguna pregunta sobre cómo
completar este cuestionario,
por favor, llame al
1-877-833-5625. La llamada
telefónica es gratis.

Apellido

Nombre

—

➜

Aparato telefónico para las personas con
impedimentos auditivos (TDD, por sus
siglas en inglés):

¿Cuántas personas están viviendo o quedándose en esta
dirección?

• INCLUYA a todas las personas que viven o se quedan aquí
por más de 2 meses.
• INCLÚYASE a usted mismo si vive aquí por más de 2 meses.
• INCLUYA a cualquier otra persona que se queda aquí que no tiene
otro lugar donde quedarse, aunque esté aquí por 2 meses o menos.
• NO INCLUYA a cualquier persona que viva en otro lugar por
más de 2 meses, tal como un estudiante universitario que vive
en otro lugar o personal de las Fuerzas Armadas que se ha
activado.

Llame al 1-800-786-9448. La llamada telefónica
es gratis.
NEED HELP? If you speak English and need
help completing this form, call toll-free
1-800-354-7271. You can also complete your
interview over the phone with an
English-speaking interviewer. Or you can
respond online at: https://respond.census.gov/acs
Para más información sobre la Encuesta sobre
la Comunidad Estadounidense, vaya a nuestra
página en la Internet: https://www.census.gov/acs

Inicial

Código de área y número de teléfono

Número de personas

➜

Complete las páginas 2, 3, 4, 5, 6 y 7 para todas las
personas, incluyéndose austed mismo, que estén viviendo
o quedándose en esta dirección pormás de 2 meses.
Luego, complete el resto del cuestionario.

ACS-1(SP)(2020)

FORM
(02-16-2019) Draft 2

Núm. de OMB xxxx-xxxx

§.1!0¤

La Encuesta sobre la Comunidad Estadounidense
hace preguntas sobre temas que no aparecen en
el Censo del 2020, tales como educación,
empleo y transporte.
Departamento de Comercio de los EE. UU.
Administración de Economía y Estadísticas
OFICINA DEL CENSO DE LOS EE. UU.
census.gov

Conéctese con nosotros @uscensusbureau