D-CQ-TLPR Continuation Transitory Locations Questionnaire Puerto R

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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

Transitory Locations Continuation Questionnaire

FOR NPC
USE ONLY

TL Control Number

ACO

Municipio

ns
h

Map Spot

➤

➤

APPLY LABEL HERE

Block

ip

Tract

of

questionnaire(s)

ze

Questionnaire

Address Number

iti

Unit Designation

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)

C

Street Name / Carretera / Ramal

Building Number and Apartment Number (if applicable)

o

Urbanización (if applicable)

ZIP Code

N

Municipio

ra

ft:

Location Description (if applicable)

D

CONTINUATION QUESTIONNAIRE FOR
TRANSITORY LOCATIONS

FORM

D-CQ-TLPR (02-05-2019) Draft 11

11920014

§,}!7¤
1.

What is the name of

Person

?

6.

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)

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

ns
h

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

C

Female

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

Year of birth

N

Age on April 1, 2020
years

ft:

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

ra

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

D

5.

Vietnamese

ze

Chinese

Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

2

11920022

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

4.

ip

Opposite-sex husband/wife/spouse

iti

3.

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

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

o

2.

Some other race – Print race or origin. C

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

§,}!?¤
8.

Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.

9.

What is the full address of the place where this person lives
or stays most of the time?

ip

Address Number
For example: 5007 (in the address 5007 Av. Martínez)

ns
h

Street Name / Carretera / Ramal
For example: Calle Santana, Av. Martínez, Carr 480, or Ramal 7415

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)
For example: BO Tibes, BDA La Perla, or SECT Hevia

iti

C

Building Number and Apartment Number (if applicable)
For example: Torre B Apto 23 or Apto 5

ze

Urbanización (if applicable)
For example: URB Los Reyes

Municipio (Please provide city if in the United States)

ZIP Code

N

o

PR or U.S. State

➜ NOTE: Please provide a location description below if there is no

D

ra

ft:

address (such as a KM/HM marker) or if this is a facility.

➜ If more people were counted in Question S5 on the
D-Q-TLPR, continue with the next person on the next
page.

3

11920030

§,}!Q¤
1.

What is the name of

Person

?

6.

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)

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

ns
h

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

C

Female

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

Year of birth

N

Age on April 1, 2020
years

ft:

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

ra

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

D

5.

Vietnamese

ze

Chinese

Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

4

11920048

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

4.

ip

Opposite-sex husband/wife/spouse

iti

3.

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

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

o

2.

Some other race – Print race or origin. C

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

§,}!X¤
8.

Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.

9.

What is the full address of the place where this person lives
or stays most of the time?

ip

Address Number
For example: 5007 (in the address 5007 Av. Martínez)

ns
h

Street Name / Carretera / Ramal
For example: Calle Santana, Av. Martínez, Carr 480, or Ramal 7415

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)
For example: BO Tibes, BDA La Perla, or SECT Hevia

iti

C

Building Number and Apartment Number (if applicable)
For example: Torre B Apto 23 or Apto 5

ze

Urbanización (if applicable)
For example: URB Los Reyes

Municipio (Please provide city if in the United States)

ZIP Code

N

o

PR or U.S. State

➜ NOTE: Please provide a location description below if there is no

D

ra

ft:

address (such as a KM/HM marker) or if this is a facility.

➜ If more people were counted in Question S5 on the
D-Q-TLPR, continue with the next person on the next
page.

5

11920055

§,}!‘¤
1.

What is the name of

Person

?

6.

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)

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

ns
h

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

C

Female

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

Year of birth

N

Age on April 1, 2020
years

ft:

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

ra

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

D

5.

Vietnamese

ze

Chinese

Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

6

11920063

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

4.

ip

Opposite-sex husband/wife/spouse

iti

3.

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

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

o

2.

Some other race – Print race or origin. C

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

§,}!h¤
8.

Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.

9.

What is the full address of the place where this person lives
or stays most of the time?

ip

Address Number
For example: 5007 (in the address 5007 Av. Martínez)

ns
h

Street Name / Carretera / Ramal
For example: Calle Santana, Av. Martínez, Carr 480, or Ramal 7415

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)
For example: BO Tibes, BDA La Perla, or SECT Hevia

iti

C

Building Number and Apartment Number (if applicable)
For example: Torre B Apto 23 or Apto 5

ze

Urbanización (if applicable)
For example: URB Los Reyes

Municipio (Please provide city if in the United States)

ZIP Code

N

o

PR or U.S. State

➜ NOTE: Please provide a location description below if there is no

D

ra

ft:

address (such as a KM/HM marker) or if this is a facility.

➜ If more people were counted in Question S5 on the
D-Q-TLPR, continue with the next person on the next
page.

7

11920071

§,}!z¤
1.

What is the name of

Person

?

6.

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)

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

ns
h

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

C

Female

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

Year of birth

N

Age on April 1, 2020
years

ft:

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

ra

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

D

5.

Vietnamese

ze

Chinese

Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

8

11920089

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

4.

ip

Opposite-sex husband/wife/spouse

iti

3.

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

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

o

2.

Some other race – Print race or origin. C

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

§,}!¿¤
8.

Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.

9.

What is the full address of the place where this person lives
or stays most of the time?

ip

Address Number
For example: 5007 (in the address 5007 Av. Martínez)

ns
h

Street Name / Carretera / Ramal
For example: Calle Santana, Av. Martínez, Carr 480, or Ramal 7415

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)
For example: BO Tibes, BDA La Perla, or SECT Hevia

iti

C

Building Number and Apartment Number (if applicable)
For example: Torre B Apto 23 or Apto 5

ze

Urbanización (if applicable)
For example: URB Los Reyes

Municipio (Please provide city if in the United States)

ZIP Code

N

o

PR or U.S. State

➜ NOTE: Please provide a location description below if there is no

D

ra

ft:

address (such as a KM/HM marker) or if this is a facility.

➜ If more people were counted in Question S5 on the
D-Q-TLPR, continue with the next person on the next
page.

9

11920097

§,}"&¤
1.

What is the name of

Person

?

6.

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)

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

ns
h

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

C

Female

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

Year of birth

N

Age on April 1, 2020
years

ft:

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

ra

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

D

5.

Vietnamese

ze

Chinese

Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

10

11920105

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

4.

ip

Opposite-sex husband/wife/spouse

iti

3.

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

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

o

2.

Some other race – Print race or origin. C

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

§,}".¤
8.

Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.

9.

What is the full address of the place where this person lives
or stays most of the time?

ip

Address Number
For example: 5007 (in the address 5007 Av. Martínez)

ns
h

Street Name / Carretera / Ramal
For example: Calle Santana, Av. Martínez, Carr 480, or Ramal 7415

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)
For example: BO Tibes, BDA La Perla, or SECT Hevia

iti

C

Building Number and Apartment Number (if applicable)
For example: Torre B Apto 23 or Apto 5

ze

Urbanización (if applicable)
For example: URB Los Reyes

Municipio (Please provide city if in the United States)

ZIP Code

N

o

PR or U.S. State

➜ NOTE: Please provide a location description below if there is no

D

ra

ft:

address (such as a KM/HM marker) or if this is a facility.

➜ If more people were counted in Question S5 on the
D-Q-TLPR, continue with the next person on the next
page.

11

11920113

§,}"6¤
1.

What is the name of

Person

?

6.

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)

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

ns
h

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

C

Female

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

Year of birth

N

Age on April 1, 2020
years

ft:

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

ra

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

D

5.

Vietnamese

ze

Chinese

Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

12

11920121

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

4.

ip

Opposite-sex husband/wife/spouse

iti

3.

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

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

o

2.

Some other race – Print race or origin. C

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

§,}"H¤
8.

Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.

9.

What is the full address of the place where this person lives
or stays most of the time?

ip

Address Number
For example: 5007 (in the address 5007 Av. Martínez)

ns
h

Street Name / Carretera / Ramal
For example: Calle Santana, Av. Martínez, Carr 480, or Ramal 7415

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)
For example: BO Tibes, BDA La Perla, or SECT Hevia

iti

C

Building Number and Apartment Number (if applicable)
For example: Torre B Apto 23 or Apto 5

ze

Urbanización (if applicable)
For example: URB Los Reyes

Municipio (Please provide city if in the United States)

ZIP Code

N

o

PR or U.S. State

➜ NOTE: Please provide a location description below if there is no

D

ra

ft:

address (such as a KM/HM marker) or if this is a facility.

➜ If more people were counted in Question S5 on the
D-Q-TLPR, continue with the next person on the next
page.

13

11920139

§,}"P¤
1.

What is the name of

Person

?

6.

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)

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

ns
h

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

C

Female

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

Year of birth

N

Age on April 1, 2020
years

ft:

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

ra

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

D

5.

Vietnamese

ze

Chinese

Yes, Puerto Rican
Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

14

11920147

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

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

4.

ip

Opposite-sex husband/wife/spouse

iti

3.

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

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

o

2.

Some other race – Print race or origin. C

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

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8.

Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.

9.

What is the full address of the place where this person lives
or stays most of the time?

ip

Address Number
For example: 5007 (in the address 5007 Av. Martínez)

ns
h

Street Name / Carretera / Ramal
For example: Calle Santana, Av. Martínez, Carr 480, or Ramal 7415

Barrio / Barriada / Sector / Parcela / Comunidad (if applicable)
For example: BO Tibes, BDA La Perla, or SECT Hevia

iti

C

Building Number and Apartment Number (if applicable)
For example: Torre B Apto 23 or Apto 5

ze

Urbanización (if applicable)
For example: URB Los Reyes

Municipio (Please provide city if in the United States)

ZIP Code

N

o

PR or U.S. State

➜ NOTE: Please provide a location description below if there is no

D

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ft:

address (such as a KM/HM marker) or if this is a facility.

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

15

11920154

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iti

ze

ns
h

ip

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

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ft:

N

o

C

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