D-CQ-RA Continuation Enumerator Questionnaire Remote Alaska

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

TM

Enumerator Continuation Questionnaire

FOR NPC
USE ONLY

State

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Block

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Map Spot

County

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

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APPLY LABEL HERE

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questionnaire(s)

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Questionnaire

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CONTINUATION QUESTIONNAIRE FOR

D

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ENUMERATOR QUESTIONNAIRES

FORM

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

11900016

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1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

At a seasonal or
second residence
For another reason

For a job or business

No

In a nursing home

Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

Some other race – Print race or origin. C

N

4.

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

ip

In a jail or prison

For college

ci
tiz
en
sh

With a parent or other relative

For a military assignment

3.

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

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

o

2.

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

Female

T:

5. What will this person’s age be on April 1, 2020? What is this

AF

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

Print numbers in boxes.
Month
Day

Year of birth

years

D

R

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

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

2

11900024

§,{!A¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

In a jail or prison

For college

At a seasonal or
second residence

No

In a nursing home

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

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

o

Opposite-sex husband/wife/spouse

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

N

Some other race – Print race or origin. C

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

Female

T:

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

AF

5.

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

For another reason

For a job or business

4.

ip

With a parent or other relative

For a military assignment

3.

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

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

ci
tiz
en
sh

2.

Age on April 1, 2020

Print numbers in boxes.
Month
Day

Year of birth

years

D

R

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

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

3

11900032

§,{!I¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

At a seasonal or
second residence
For another reason

For a job or business

No

In a nursing home

Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

Some other race – Print race or origin. C

N

4.

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

ip

In a jail or prison

For college

ci
tiz
en
sh

With a parent or other relative

For a military assignment

3.

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

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

o

2.

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

Female

T:

5. What will this person’s age be on April 1, 2020? What is this

AF

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

Print numbers in boxes.
Month
Day

Year of birth

years

D

R

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

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

4

11900040

§,{!Z¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

In a jail or prison

For college

At a seasonal or
second residence

No

In a nursing home

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

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

o

Opposite-sex husband/wife/spouse

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

N

Some other race – Print race or origin. C

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

Female

T:

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

AF

5.

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

For another reason

For a job or business

4.

ip

With a parent or other relative

For a military assignment

3.

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

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

ci
tiz
en
sh

2.

Age on April 1, 2020

Print numbers in boxes.
Month
Day

Year of birth

years

D

R

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

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

5

11900057

§,{!b¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

At a seasonal or
second residence
For another reason

For a job or business

No

In a nursing home

Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

Some other race – Print race or origin. C

N

4.

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

ip

In a jail or prison

For college

ci
tiz
en
sh

With a parent or other relative

For a military assignment

3.

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

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

o

2.

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

Female

T:

5. What will this person’s age be on April 1, 2020? What is this

AF

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

Print numbers in boxes.
Month
Day

Year of birth

years

D

R

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

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

6

11900065

§,{!j¤
1.

What is the name of

Person

?

7.

Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

In a jail or prison

For college

At a seasonal or
second residence

No

In a nursing home

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

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

o

Opposite-sex husband/wife/spouse

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

N

Some other race – Print race or origin. C

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

Female

T:

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

AF

5.

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

For another reason

For a job or business

4.

ip

With a parent or other relative

For a military assignment

3.

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

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

ci
tiz
en
sh

2.

Age on April 1, 2020

Print numbers in boxes.
Month
Day

Year of birth

years

D

R

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

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

7

11900073

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

ci
tiz
en
sh

ip

§,{!r¤

D

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AF

T:

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o

This page intentionally left blank.

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11900081