D-CQ-MI CNMI Continuation Questionnaire

®

Commonwealth of the
Northern Mariana Islands

§,ƒ!2¤

OMB No. 0607-1006: Approval Expires 11/30/2021

2020 Census of the Commonwealth
of the Northern Mariana Islands

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU

FOR NPC
USE ONLY

Census Office

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

County

BCU

Map Spot

Within Map Spot ID

CONTINUATION QUESTIONNAIRE

FORM

D-CQ-MI (07-26-2019)

11990017

§,ƒ!:¤
1.

What is the name of Person

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

?

Print name below and verify the spelling.
Last Name(s)

6.

First Name

Please read the HISPANIC ORIGIN section on the Flashcard.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

MI

Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican

2.

Does this person usually live or stay somewhere else?
For example –
Mark K
J all that apply.
I
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment
For a job or business

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

For another reason

7.

No

In a nursing home

3.

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

Please read the RELATIONSHIP section on the Flashcard.
How is this person related to Person 1? Mark K
J ONE box.
I
Opposite-sex husband/wife/spouse
Opposite-sex unmarried partner

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

Same-sex husband/wife/spouse
Same-sex unmarried partner
Biological son or daughter

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

Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Chinese

Vietnamese

Native Hawaiian

Parent-in-law

Filipino

Korean

Samoan

Son-in-law or daughter-in-law

Asian Indian

Japanese

Chamorro

Other relative

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

Roommate or housemate

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

Foster child
Other nonrelative

4.

Male

5.

Some other race – Print race or origin. C

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

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

Print numbers in boxes.
Month
Day

➜ If more people were counted in question 1 on the
D-Q-MI, continue with the next person on the next
page. Otherwise, skip to page 7 of the D-Q-MI.

Year of birth

years

2

11990025

§,ƒ!B¤
1.

What is the name of Person

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

?

Print name below and verify the spelling.
Last Name(s)

6.

First Name

Please read the HISPANIC ORIGIN section on the Flashcard.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

MI

Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican

2.

Does this person usually live or stay somewhere else?
For example –
Mark K
J all that apply.
I
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment
For a job or business

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

For another reason

7.

No

In a nursing home

3.

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

Please read the RELATIONSHIP section on the Flashcard.
How is this person related to Person 1? Mark K
J ONE box.
I
Opposite-sex husband/wife/spouse
Opposite-sex unmarried partner

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

Same-sex husband/wife/spouse
Same-sex unmarried partner
Biological son or daughter

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

Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Chinese

Vietnamese

Native Hawaiian

Parent-in-law

Filipino

Korean

Samoan

Son-in-law or daughter-in-law

Asian Indian

Japanese

Chamorro

Other relative

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

Roommate or housemate

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

Foster child
Other nonrelative

4.

Male

5.

Some other race – Print race or origin. C

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

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

Print numbers in boxes.
Month
Day

➜ If more people were counted in question 1 on the
D-Q-MI, continue with the next person on the next
page. Otherwise, skip to page 7 of the D-Q-MI.

Year of birth

years

3

11990033

§,ƒ!J¤
1.

What is the name of Person

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

?

Print name below and verify the spelling.
Last Name(s)

6.

First Name

Please read the HISPANIC ORIGIN section on the Flashcard.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

MI

Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican

2.

Does this person usually live or stay somewhere else?
For example –
Mark K
J all that apply.
I
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment
For a job or business

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

For another reason

7.

No

In a nursing home

3.

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

Please read the RELATIONSHIP section on the Flashcard.
How is this person related to Person 1? Mark K
J ONE box.
I
Opposite-sex husband/wife/spouse
Opposite-sex unmarried partner

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

Same-sex husband/wife/spouse
Same-sex unmarried partner
Biological son or daughter

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

Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Chinese

Vietnamese

Native Hawaiian

Parent-in-law

Filipino

Korean

Samoan

Son-in-law or daughter-in-law

Asian Indian

Japanese

Chamorro

Other relative

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

Roommate or housemate

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

Foster child
Other nonrelative

4.

Male

5.

Some other race – Print race or origin. C

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

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

Print numbers in boxes.
Month
Day

➜ If more people were counted in question 1 on the
D-Q-MI, continue with the next person on the next
page. Otherwise, skip to page 7 of the D-Q-MI.

Year of birth

years

4

11990041

§,ƒ![¤
1.

What is the name of Person

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

?

Print name below and verify the spelling.
Last Name(s)

6.

First Name

Please read the HISPANIC ORIGIN section on the Flashcard.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

MI

Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican

2.

Does this person usually live or stay somewhere else?
For example –
Mark K
J all that apply.
I
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment
For a job or business

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

For another reason

7.

No

In a nursing home

3.

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

Please read the RELATIONSHIP section on the Flashcard.
How is this person related to Person 1? Mark K
J ONE box.
I
Opposite-sex husband/wife/spouse
Opposite-sex unmarried partner

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

Same-sex husband/wife/spouse
Same-sex unmarried partner
Biological son or daughter

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

Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Chinese

Vietnamese

Native Hawaiian

Parent-in-law

Filipino

Korean

Samoan

Son-in-law or daughter-in-law

Asian Indian

Japanese

Chamorro

Other relative

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

Roommate or housemate

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

Foster child
Other nonrelative

4.

Male

5.

Some other race – Print race or origin. C

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

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

Print numbers in boxes.
Month
Day

➜ If more people were counted in question 1 on the
D-Q-MI, continue with the next person on the next
page. Otherwise, skip to page 7 of the D-Q-MI.

Year of birth

years

5

11990058

§,ƒ!c¤
1.

What is the name of Person

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

?

Print name below and verify the spelling.
Last Name(s)

6.

First Name

Please read the HISPANIC ORIGIN section on the Flashcard.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin

MI

Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican

2.

Does this person usually live or stay somewhere else?
For example –
Mark K
J all that apply.
I
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment
For a job or business

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

For another reason

7.

No

In a nursing home

3.

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

Please read the RELATIONSHIP section on the Flashcard.
How is this person related to Person 1? Mark K
J ONE box.
I
Opposite-sex husband/wife/spouse
Opposite-sex unmarried partner

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

Same-sex husband/wife/spouse
Same-sex unmarried partner
Biological son or daughter

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

Adopted son or daughter
Stepson or stepdaughter
Brother or sister
Father or mother
Grandchild

Chinese

Vietnamese

Native Hawaiian

Parent-in-law

Filipino

Korean

Samoan

Son-in-law or daughter-in-law

Asian Indian

Japanese

Chamorro

Other relative

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

Roommate or housemate

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

Foster child
Other nonrelative

4.

Male

5.

Some other race – Print race or origin. C

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

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

Print numbers in boxes.
Month
Day

➜ If more people were counted in question 1 on the front
page of the D-Q-MI, continue with the next person on
an additional continuation questionnaire (D-CQ-MI)
and update the number of continuation questionnaires
on page 1 of the D-Q-MI.

Year of birth

years

6

11990066

§,ƒ!k¤
Person —
8.

12.

Please copy the name of the Person listed on page 2, then
continue answering questions below.

Please read the HIGHEST DEGREE or LEVEL OF SCHOOL
section on the Flashcard.
What is the highest degree or level of school this person has
COMPLETED? Mark K
J ONE box. If currently enrolled, mark
I
the previous grade or highest degree received.

Last Name(s)

NO SCHOOLING COMPLETED
No schooling completed

First Name

NURSERY OR PRESCHOOL THROUGH GRADE 12

MI

Nursery school, preschool or pre-kindergarten
Kindergarten

9.

Where was this person born?

Grade 1 through 11 – Specify grade 1 – 11

C

Commonwealth of the Northern Mariana Islands
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

12th grade – NO DIPLOMA

HIGH SCHOOL GRADUATE
Regular high school diploma

A

Ask question 10 if this person was born outside the
Commonwealth of the Northern Mariana Islands.
Otherwise, SKIP to question 11a.

GED or alternative credential

COLLEGE OR SOME COLLEGE
Some college credit, but less than 1 year of college credit

10.

When did this person come to live in the Commonwealth
of the Northern Mariana Islands?
If this person came to live in the Commonwealth of the
Northern Mariana Islands more than once, print latest year.

1 or more years of college credit, no degree

Year

Bachelor’s degree (for example: BA, BS)

Associate’s degree (for example: AA, AS)

AFTER BACHELOR’S DEGREE
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

11.

a. At any time since February 1, 2020 has this person
attended school or college? Include only nursery or
preschool, pre-kindergarten, kindergarten, elementary
school, home school, and schooling which leads to a
high school diploma or a college degree.
Yes

Professional degree beyond a bachelor’s degree
(for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

B

No ➜ SKIP to question 12

b. Was that a public school or college, a private school or
college, or home school?

Ask question 13 if this person has a bachelor’s degree or
higher. Otherwise, SKIP to question 14.

13.

This question focuses on this person’s BACHELOR’S
DEGREE. What was the specific major or majors of any
BACHELOR’S DEGREES this person has received?
(For example: chemical engineering, elementary teacher
education, organizational psychology.)

14.

Has this person completed requirements for a vocational
training program at a trade school, hospital, or some other
kind of school for occupational training or place of work?
Do not include academic college courses.

Public school or public college
Private school or private college or home school

c. What grade or level was this person attending?
Mark K
J ONE box.
I
Nursery school, preschool, or pre-kindergarten
Kindergarten
Grade 1 through 12 – Specify grade 1 – 12

C

Yes

College undergraduate years (freshman to senior)

No

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

7

11990074

§,ƒ!s¤
Person — (continued)
15.

19.

What was this person’s main reason for moving?
Mark K
J ONE box.
I

What is this person’s ancestry or ethnic origin?

Employment

Family-related

Military

Natural disaster

Housing

Other reason

To attend school

(For example: Italian, Jamaican, African Am., Cambodian,
Cape Verdean, Norwegian, Dominican, French Canadian,
Haitian, Korean, Lebanese, Polish, Nigerian, Mexican,
Taiwanese, Ukrainian, and so on.)

16.

20.

a. Where was this person’s mother born?

Please read the HEALTH INSURANCE section on the
Flashcard.
Is this person 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.

Commonwealth of the Northern Mariana Islands

Yes

No

a. Insurance through a current or former employer
or union (of this person or another family member)

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

b. Insurance purchased directly from an insurance
company (by this person or another family member)
c. Medicare, for people 65 and older, or people
with certain disabilities

b. Where was this person’s father born?
Commonwealth of the Northern Mariana Islands

d. Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

e. TRICARE or other military health care
f. VA (enrolled for VA health care)

17.

a. Does this person speak a language other than English
at home?

g. Indian Health Service
h. Any other type of health insurance or health
coverage plan – Specify C

Yes
No ➜ SKIP to question 18

b. What is this language?

21.

a. Is this person deaf or does he/she have serious difficulty
hearing?

For example: Korean, Italian, Spanish, Vietnamese

Yes

c. How well does this person speak English?

No

Very well

b. Is this person blind or does he/she have serious difficulty
seeing even when wearing glasses?

Well

18.

Not well

Yes

Not at all

No

Did this person live in this house or apartment 5 years ago
(on April 1, 2015)?
Person is under 5 years old ➜ SKIP to question 20
Yes, this house ➜ SKIP to question 20
No, different house in the Commonwealth of the
Northern Mariana Islands
No, outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

8

11990082

§,ƒ!{¤
Person — (continued)

26.

How many times has this person been married?
Once

C

Two times

Ask questions 22a – c if this person is 5 years old or over.
Otherwise, SKIP to the questions for the next person on
page 13.

Three or more times

27.
22.

a. Because of a physical, mental, or emotional condition,
does this person have serious difficulty concentrating,
remembering, or making decisions?

In what year did this person last get married?
Year

Yes
No

E

Ask question 28 if this person is female and 15 years old
or over. Otherwise, SKIP to question 29a.

b. Does this person have serious difficulty walking or
climbing stairs?

28.

Yes

How many babies has this person ever had, not counting
stillbirths? Do not count stepchildren or children she has adopted.

No
None or

Number of children

c. Does this person have difficulty dressing or bathing?

29.

Yes

a. Does this person have any of his/her own grandchildren
under the age of 18 living in this house or apartment?

No

D

Yes
No ➜ SKIP to question 30

Ask question 23 if this person is 15 years old or over.
Otherwise, SKIP to the questions for the next person on
page 13.

23.

b. Is this grandparent currently responsible for most of
the basic needs of any grandchildren under the age
of 18 who live in this house or apartment?

Because of a physical, mental, or emotional condition, does
this person have difficulty doing errands alone such as
visiting a doctor’s office or shopping?

Yes
No ➜ SKIP to question 30

Yes

c. How long has this grandparent been responsible for
these grandchildren? If the grandparent is financially
responsible for more than one grandchild, answer the
question for the grandchild for whom the grandparent
has been responsible for the longest period of time.

No

24.

25.

What is this person’s marital status?
Now married

Less than 6 months

Widowed

6 to 11 months

Divorced

1 or 2 years

Separated

3 or 4 years

Never married ➜ SKIP to E

5 or more years

In the PAST 12 MONTHS did this person get –
Yes

No

a. Married?
b. Widowed?
c. Divorced?

9

11990090

§,ƒ")¤
Person — (continued)
30.

34.

At what location did this person work LAST WEEK?
Commonwealth of the Northern Mariana Islands –
Print name of village below. C

Has this person ever served on active duty in the U.S. Armed
Forces, Reserves, or National Guard?
Mark K
J ONE box.
I
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

Never served in the military ➜ SKIP to question 33a
Only on active duty for training in the Reserves or
National Guard ➜ SKIP to question 32a
Now on active duty

35.

On active duty in the past, but not now

31.

Please read the PERIOD OF SERVICE section on the
Flashcard.
When did this person serve on active duty in the U.S. Armed
Forces? Mark K
J a box for EACH period in which this person
I
served, even if just for part of the period.

Please read the TRANSPORTATION TO WORK section on
the Flashcard.
How did this person usually get to work LAST WEEK?
Mark K
J ONE box for the method of transportation used for
I
most of the distance.
Car, truck, or private van/bus
Public van/bus

September 2001 or later

Taxicab

August 1990 to August 2001 (including Persian Gulf War)

Motorcycle

May 1975 to July 1990

Bicycle

Vietnam Era (August 1964 to April 1975)

Walked

February 1955 to July 1964

Plane or seaplane

Korean War (July 1950 to January 1955)

Boat, ferry, or water taxi

January 1947 to June 1950

Worked from home ➜ SKIP to question 43a

World War II (December 1941 to December 1946)

Other method

November 1941 or earlier

32.

a. Does this person have a VA service-connected
disability rating?
Yes (such as 0%, 10%, 20%, ..., 100%)

F

Ask question 36 if you marked "Car, truck, or private van/bus"
in question 35. Otherwise, SKIP to question 37.

36.

No ➜ SKIP to question 33a

How many people, including this person, usually rode to
work in the car, truck, or private van/bus LAST WEEK?
Person(s)

b. What is this person’s service-connected disability rating?
0 percent
10 or 20 percent

37.

30 or 40 percent

LAST WEEK, what time did this person’s trip to work
usually begin?

50 or 60 percent

Hour

:

70 percent or higher

33.

a. LAST WEEK, did this person work for pay at a job
(or business)?

Minute

38.

No – Did not work (or retired)

b. LAST WEEK, did this person do ANY work for pay,
even for as little as one hour?
Yes
No ➜ SKIP to question 39a

10

p.m.

How many minutes did it usually take this person to get
from home to work LAST WEEK?
Minutes

Yes ➜ SKIP to question 34

a.m.

11990108

§,ƒ"1¤
Person — (continued)

44.

During 2019, in the WEEKS WORKED, how many hours did
this person usually work each WEEK?
Usual hours worked each WEEK

G

Ask questions 39 – 42a if this person did NOT work last week.
Otherwise, SKIP to question 42b.

39.

a. LAST WEEK, was this person on layoff from a job?

H

Yes ➜ SKIP to question 39c

Ask questions 45a – f if this person worked in the past 5 years
(since 2015). Otherwise, SKIP to question 46.

No

b. LAST WEEK, was this person TEMPORARILY absent
from a job or business?

45.

The next series of questions is about the type of employment
this person had last week.

Yes, on vacation, temporary illness, maternity leave,
other family/personal reasons, bad weather,
etc. ➜ SKIP to question 42a

If this person had more than one job, describe the one at
which the most hours were worked. If this person did not
work last week, describe the most recent employment in the
past five years (since 2015).

No ➜ SKIP to question 40

c. Has this person been informed that he or she will be
recalled to work within the next 6 months OR been
given a date to return to work?

a. Please read the TYPE OF WORKER section on the
Flashcard.
Which one of the following best describes this person’s
employment last week or the most recent employment
in the past 5 years (since 2015)? Mark K
J ONE box.
I

Yes ➜ SKIP to question 41
No

40.

DESCRIPTION OF EMPLOYMENT

PRIVATE SECTOR EMPLOYEE

During the LAST 4 WEEKS, has this person been ACTIVELY
looking for work?

For-profit company or organization

Yes

Non-profit organization (including tax-exempt and charitable
organizations)

No ➜ SKIP to question 42a

41.

GOVERNMENT EMPLOYEE

LAST WEEK, could this person have started a job if offered
one, or returned to work if recalled?

Local or territorial government (for example: public
elementary school)

Yes, could have gone to work

Active duty U.S. Armed Forces or Commissioned Corps

No, because of own temporary illness

Federal government civilian employee

SELF-EMPLOYED OR OTHER

No, because of all other reasons (in school, etc.)

42.

Owner of non-incorporated business, professional practice,
or farm

a. When did this person last work, even for a few days?
2020

Owner of incorporated business, professional practice, or farm

2019 ➜ SKIP to question 43a

Worked without pay in a for-profit family business or farm
for 15 hours or more per week

2015 to 2018 ➜ SKIP to H
2014 or earlier, or never worked ➜ SKIP to question 46

b. What was the name of this person’s employer, business,
agency, or branch of the Armed Forces?

b. LAST YEAR, 2019, did this person work at a job or
business at any time?
Yes
No ➜ SKIP to H

43.

a. During 2019 (all 52 weeks), did this person work EVERY
week? Count paid vacation, paid sick leave, and military
service as work.

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 ➜ SKIP to question 44
No

b. During 2019 (all 52 weeks), how many WEEKS did this
person work? Include paid time off and include weeks
when the person only worked for a few hours.
Weeks

11

11990116

§,ƒ"9¤
Person — (continued)

d. Did this person receive any Social Security or
Railroad Retirement benefits in 2019?

d. Was this mainly – Mark I
J
K ONE box.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

manufacturing?
wholesale trade?

$

retail trade?

.00

No

other (agriculture, construction, service, government, etc.)?

e. Did this person receive any Supplemental Security
Income (SSI) payments in 2019?

e. What was this person’s main occupation?
(For example: 4th grade teacher, entry-level plumber)

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

f. Describe this person’s 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)

f. Did this person receive any public assistance or public
welfare payments from the state or local welfare office
in 2019?
Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

46.

g. Did this person receive any retirement income, pensions,
survivor or disability income in 2019? 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.

INCOME IN 2019
The next series of questions is about income received during
2019. If the exact amount is not known, please give your best
estimate. If net income was a loss, please give the dollar
amount of the loss. For income received jointly, report the
appropriate share for each person - or, if that’s not possible,
report the whole amount for only one person. Mark K
J the
I
"No" box for the other person.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

a. Did this person receive any wages, salary, commissions,
bonuses, or tips in 2019?

$

Yes ➜ What was the amount from all jobs before
deductions for taxes, bonds, dues, or other items?

h. Did this person receive income on a regular basis from
any other sources such as Department of Veterans
Affairs (VA) payments, unemployment compensation,
child support or alimony in 2019?

TOTAL AMOUNT – Dollars

$

.00

No

.00

No

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

b. Did this person have any self-employment income from
own nonfarm businesses or farm businesses, including
proprietorships and partnerships, in 2019?

$

.00

No

Yes ➜ What was the net income after business expenses?

47.

TOTAL AMOUNT – Dollars

$

What was this person’s total income for 2019?

.00

No

OR
Loss

None

$

.00
TOTAL AMOUNT for 2019

Loss

c. Did this person receive any interest, dividends, net rental
income, royalty income, or income from estates and trusts
in 2019? Report even small amounts credited to an account.
Yes ➜ What was the amount?

➜ Continue with the questions for the next person on the
next page. If this is the last person, SKIP to page 44
of the D-Q-MI.

TOTAL AMOUNT – Dollars

$
No

.00
Loss

12

11990124

§,ƒ"A¤
Person —
8.

12.

Please copy the name of the Person listed on page 3, then
continue answering questions below.

Please read the HIGHEST DEGREE or LEVEL OF SCHOOL
section on the Flashcard.
What is the highest degree or level of school this person has
COMPLETED? Mark K
J ONE box. If currently enrolled, mark
I
the previous grade or highest degree received.

Last Name(s)

NO SCHOOLING COMPLETED
No schooling completed

First Name

NURSERY OR PRESCHOOL THROUGH GRADE 12

MI

Nursery school, preschool or pre-kindergarten
Kindergarten

9.

Where was this person born?

Grade 1 through 11 – Specify grade 1 – 11

C

Commonwealth of the Northern Mariana Islands
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

12th grade – NO DIPLOMA

HIGH SCHOOL GRADUATE
Regular high school diploma

A

Ask question 10 if this person was born outside the
Commonwealth of the Northern Mariana Islands.
Otherwise, SKIP to question 11a.

GED or alternative credential

COLLEGE OR SOME COLLEGE
Some college credit, but less than 1 year of college credit

10.

When did this person come to live in the Commonwealth
of the Northern Mariana Islands?
If this person came to live in the Commonwealth of the
Northern Mariana Islands more than once, print latest year.

1 or more years of college credit, no degree

Year

Bachelor’s degree (for example: BA, BS)

Associate’s degree (for example: AA, AS)

AFTER BACHELOR’S DEGREE
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

11.

a. At any time since February 1, 2020 has this person
attended school or college? Include only nursery or
preschool, pre-kindergarten, kindergarten, elementary
school, home school, and schooling which leads to a
high school diploma or a college degree.
Yes

Professional degree beyond a bachelor’s degree
(for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

B

No ➜ SKIP to question 12

b. Was that a public school or college, a private school or
college, or home school?

Ask question 13 if this person has a bachelor’s degree or
higher. Otherwise, SKIP to question 14.

13.

This question focuses on this person’s BACHELOR’S
DEGREE. What was the specific major or majors of any
BACHELOR’S DEGREES this person has received?
(For example: chemical engineering, elementary teacher
education, organizational psychology.)

14.

Has this person completed requirements for a vocational
training program at a trade school, hospital, or some other
kind of school for occupational training or place of work?
Do not include academic college courses.

Public school or public college
Private school or private college or home school

c. What grade or level was this person attending?
Mark K
J ONE box.
I
Nursery school, preschool, or pre-kindergarten
Kindergarten
Grade 1 through 12 – Specify grade 1 – 12

C

Yes

College undergraduate years (freshman to senior)

No

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

13

11990132

§,ƒ"I¤
Person — (continued)
15.

19.

What was this person’s main reason for moving?
Mark K
J ONE box.
I

What is this person’s ancestry or ethnic origin?

Employment

Family-related

Military

Natural disaster

Housing

Other reason

To attend school

(For example: Italian, Jamaican, African Am., Cambodian,
Cape Verdean, Norwegian, Dominican, French Canadian,
Haitian, Korean, Lebanese, Polish, Nigerian, Mexican,
Taiwanese, Ukrainian, and so on.)

16.

20.

a. Where was this person’s mother born?

Please read the HEALTH INSURANCE section on the
Flashcard.
Is this person 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.

Commonwealth of the Northern Mariana Islands

Yes

No

a. Insurance through a current or former employer
or union (of this person or another family member)

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

b. Insurance purchased directly from an insurance
company (by this person or another family member)
c. Medicare, for people 65 and older, or people
with certain disabilities

b. Where was this person’s father born?
Commonwealth of the Northern Mariana Islands

d. Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

e. TRICARE or other military health care
f. VA (enrolled for VA health care)

17.

a. Does this person speak a language other than English
at home?

g. Indian Health Service
h. Any other type of health insurance or health
coverage plan – Specify C

Yes
No ➜ SKIP to question 18

b. What is this language?

21.

a. Is this person deaf or does he/she have serious difficulty
hearing?

For example: Korean, Italian, Spanish, Vietnamese

Yes

c. How well does this person speak English?

No

Very well

b. Is this person blind or does he/she have serious difficulty
seeing even when wearing glasses?

Well

18.

Not well

Yes

Not at all

No

Did this person live in this house or apartment 5 years ago
(on April 1, 2015)?
Person is under 5 years old ➜ SKIP to question 20
Yes, this house ➜ SKIP to question 20
No, different house in the Commonwealth of the
Northern Mariana Islands
No, outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

14

11990140

§,ƒ"Z¤
Person — (continued)

26.

How many times has this person been married?
Once

C

Two times

Ask questions 22a – c if this person is 5 years old or over.
Otherwise, SKIP to the questions for the next person on
page 19.

Three or more times

27.
22.

a. Because of a physical, mental, or emotional condition,
does this person have serious difficulty concentrating,
remembering, or making decisions?

In what year did this person last get married?
Year

Yes
No

E

Ask question 28 if this person is female and 15 years old
or over. Otherwise, SKIP to question 29a.

b. Does this person have serious difficulty walking or
climbing stairs?

28.

Yes

How many babies has this person ever had, not counting
stillbirths? Do not count stepchildren or children she has adopted.

No
None or

Number of children

c. Does this person have difficulty dressing or bathing?

29.

Yes

a. Does this person have any of his/her own grandchildren
under the age of 18 living in this house or apartment?

No

D

Yes
No ➜ SKIP to question 30

Ask question 23 if this person is 15 years old or over.
Otherwise, SKIP to the questions for the next person on
page 19.

23.

b. Is this grandparent currently responsible for most of
the basic needs of any grandchildren under the age
of 18 who live in this house or apartment?

Because of a physical, mental, or emotional condition, does
this person have difficulty doing errands alone such as
visiting a doctor’s office or shopping?

Yes
No ➜ SKIP to question 30

Yes

c. How long has this grandparent been responsible for
these grandchildren? If the grandparent is financially
responsible for more than one grandchild, answer the
question for the grandchild for whom the grandparent
has been responsible for the longest period of time.

No

24.

25.

What is this person’s marital status?
Now married

Less than 6 months

Widowed

6 to 11 months

Divorced

1 or 2 years

Separated

3 or 4 years

Never married ➜ SKIP to E

5 or more years

In the PAST 12 MONTHS did this person get –
Yes

No

a. Married?
b. Widowed?
c. Divorced?

15

11990157

§,ƒ"b¤
Person — (continued)
30.

34.

At what location did this person work LAST WEEK?
Commonwealth of the Northern Mariana Islands –
Print name of village below. C

Has this person ever served on active duty in the U.S. Armed
Forces, Reserves, or National Guard?
Mark K
J ONE box.
I
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

Never served in the military ➜ SKIP to question 33a
Only on active duty for training in the Reserves or
National Guard ➜ SKIP to question 32a
Now on active duty

35.

On active duty in the past, but not now

31.

Please read the PERIOD OF SERVICE section on the
Flashcard.
When did this person serve on active duty in the U.S. Armed
Forces? Mark K
J a box for EACH period in which this person
I
served, even if just for part of the period.

Please read the TRANSPORTATION TO WORK section on
the Flashcard.
How did this person usually get to work LAST WEEK?
Mark K
J ONE box for the method of transportation used for
I
most of the distance.
Car, truck, or private van/bus
Public van/bus

September 2001 or later

Taxicab

August 1990 to August 2001 (including Persian Gulf War)

Motorcycle

May 1975 to July 1990

Bicycle

Vietnam Era (August 1964 to April 1975)

Walked

February 1955 to July 1964

Plane or seaplane

Korean War (July 1950 to January 1955)

Boat, ferry, or water taxi

January 1947 to June 1950

Worked from home ➜ SKIP to question 43a

World War II (December 1941 to December 1946)

Other method

November 1941 or earlier

32.

a. Does this person have a VA service-connected
disability rating?
Yes (such as 0%, 10%, 20%, ..., 100%)

F

Ask question 36 if you marked "Car, truck, or private van/bus"
in question 35. Otherwise, SKIP to question 37.

36.

No ➜ SKIP to question 33a

How many people, including this person, usually rode to
work in the car, truck, or private van/bus LAST WEEK?
Person(s)

b. What is this person’s service-connected disability rating?
0 percent
10 or 20 percent

37.

30 or 40 percent

LAST WEEK, what time did this person’s trip to work
usually begin?

50 or 60 percent

Hour

:

70 percent or higher

33.

a. LAST WEEK, did this person work for pay at a job
(or business)?

Minute

38.

No – Did not work (or retired)

b. LAST WEEK, did this person do ANY work for pay,
even for as little as one hour?
Yes
No ➜ SKIP to question 39a

16

p.m.

How many minutes did it usually take this person to get
from home to work LAST WEEK?
Minutes

Yes ➜ SKIP to question 34

a.m.

11990165

§,ƒ"j¤
Person — (continued)

44.

During 2019, in the WEEKS WORKED, how many hours did
this person usually work each WEEK?
Usual hours worked each WEEK

G

Ask questions 39 – 42a if this person did NOT work last week.
Otherwise, SKIP to question 42b.

39.

a. LAST WEEK, was this person on layoff from a job?

H

Yes ➜ SKIP to question 39c

Ask questions 45a – f if this person worked in the past 5 years
(since 2015). Otherwise, SKIP to question 46.

No

b. LAST WEEK, was this person TEMPORARILY absent
from a job or business?

45.

The next series of questions is about the type of employment
this person had last week.

Yes, on vacation, temporary illness, maternity leave,
other family/personal reasons, bad weather,
etc. ➜ SKIP to question 42a

If this person had more than one job, describe the one at
which the most hours were worked. If this person did not
work last week, describe the most recent employment in the
past five years (since 2015).

No ➜ SKIP to question 40

c. Has this person been informed that he or she will be
recalled to work within the next 6 months OR been
given a date to return to work?

a. Please read the TYPE OF WORKER section on the
Flashcard.
Which one of the following best describes this person’s
employment last week or the most recent employment
in the past 5 years (since 2015)? Mark K
J ONE box.
I

Yes ➜ SKIP to question 41
No

40.

DESCRIPTION OF EMPLOYMENT

PRIVATE SECTOR EMPLOYEE

During the LAST 4 WEEKS, has this person been ACTIVELY
looking for work?

For-profit company or organization

Yes

Non-profit organization (including tax-exempt and charitable
organizations)

No ➜ SKIP to question 42a

41.

GOVERNMENT EMPLOYEE

LAST WEEK, could this person have started a job if offered
one, or returned to work if recalled?

Local or territorial government (for example: public
elementary school)

Yes, could have gone to work

Active duty U.S. Armed Forces or Commissioned Corps

No, because of own temporary illness

Federal government civilian employee

SELF-EMPLOYED OR OTHER

No, because of all other reasons (in school, etc.)

42.

Owner of non-incorporated business, professional practice,
or farm

a. When did this person last work, even for a few days?
2020

Owner of incorporated business, professional practice, or farm

2019 ➜ SKIP to question 43a

Worked without pay in a for-profit family business or farm
for 15 hours or more per week

2015 to 2018 ➜ SKIP to H
2014 or earlier, or never worked ➜ SKIP to question 46

b. What was the name of this person’s employer, business,
agency, or branch of the Armed Forces?

b. LAST YEAR, 2019, did this person work at a job or
business at any time?
Yes
No ➜ SKIP to H

43.

a. During 2019 (all 52 weeks), did this person work EVERY
week? Count paid vacation, paid sick leave, and military
service as work.

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 ➜ SKIP to question 44
No

b. During 2019 (all 52 weeks), how many WEEKS did this
person work? Include paid time off and include weeks
when the person only worked for a few hours.
Weeks

17

11990173

§,ƒ"r¤
Person — (continued)

d. Did this person receive any Social Security or
Railroad Retirement benefits in 2019?

d. Was this mainly – Mark I
J
K ONE box.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

manufacturing?
wholesale trade?

$

retail trade?

.00

No

other (agriculture, construction, service, government, etc.)?

e. Did this person receive any Supplemental Security
Income (SSI) payments in 2019?

e. What was this person’s main occupation?
(For example: 4th grade teacher, entry-level plumber)

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

f. Describe this person’s 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)

f. Did this person receive any public assistance or public
welfare payments from the state or local welfare office
in 2019?
Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

46.

g. Did this person receive any retirement income, pensions,
survivor or disability income in 2019? 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.

INCOME IN 2019
The next series of questions is about income received during
2019. If the exact amount is not known, please give your best
estimate. If net income was a loss, please give the dollar
amount of the loss. For income received jointly, report the
appropriate share for each person - or, if that’s not possible,
report the whole amount for only one person. Mark K
J the
I
"No" box for the other person.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

a. Did this person receive any wages, salary, commissions,
bonuses, or tips in 2019?

$

Yes ➜ What was the amount from all jobs before
deductions for taxes, bonds, dues, or other items?

h. Did this person receive income on a regular basis from
any other sources such as Department of Veterans
Affairs (VA) payments, unemployment compensation,
child support or alimony in 2019?

TOTAL AMOUNT – Dollars

$

.00

No

.00

No

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

b. Did this person have any self-employment income from
own nonfarm businesses or farm businesses, including
proprietorships and partnerships, in 2019?

$

.00

No

Yes ➜ What was the net income after business expenses?

47.

TOTAL AMOUNT – Dollars

$

What was this person’s total income for 2019?

.00

No

OR
Loss

None

$

.00
TOTAL AMOUNT for 2019

Loss

c. Did this person receive any interest, dividends, net rental
income, royalty income, or income from estates and trusts
in 2019? Report even small amounts credited to an account.
Yes ➜ What was the amount?

➜ Continue with the questions for the next person on the
next page. If this is the last person, SKIP to page 44
of the D-Q-MI.

TOTAL AMOUNT – Dollars

$
No

.00
Loss

18

11990181

§,ƒ"ƒ¤
Person —
8.

12.

Please copy the name of the Person listed on page 4, then
continue answering questions below.

Please read the HIGHEST DEGREE or LEVEL OF SCHOOL
section on the Flashcard.
What is the highest degree or level of school this person has
COMPLETED? Mark K
J ONE box. If currently enrolled, mark
I
the previous grade or highest degree received.

Last Name(s)

NO SCHOOLING COMPLETED
No schooling completed

First Name

NURSERY OR PRESCHOOL THROUGH GRADE 12

MI

Nursery school, preschool or pre-kindergarten
Kindergarten

9.

Where was this person born?

Grade 1 through 11 – Specify grade 1 – 11

C

Commonwealth of the Northern Mariana Islands
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

12th grade – NO DIPLOMA

HIGH SCHOOL GRADUATE
Regular high school diploma

A

Ask question 10 if this person was born outside the
Commonwealth of the Northern Mariana Islands.
Otherwise, SKIP to question 11a.

GED or alternative credential

COLLEGE OR SOME COLLEGE
Some college credit, but less than 1 year of college credit

10.

When did this person come to live in the Commonwealth
of the Northern Mariana Islands?
If this person came to live in the Commonwealth of the
Northern Mariana Islands more than once, print latest year.

1 or more years of college credit, no degree

Year

Bachelor’s degree (for example: BA, BS)

Associate’s degree (for example: AA, AS)

AFTER BACHELOR’S DEGREE
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

11.

a. At any time since February 1, 2020 has this person
attended school or college? Include only nursery or
preschool, pre-kindergarten, kindergarten, elementary
school, home school, and schooling which leads to a
high school diploma or a college degree.
Yes

Professional degree beyond a bachelor’s degree
(for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

B

No ➜ SKIP to question 12

b. Was that a public school or college, a private school or
college, or home school?

Ask question 13 if this person has a bachelor’s degree or
higher. Otherwise, SKIP to question 14.

13.

This question focuses on this person’s BACHELOR’S
DEGREE. What was the specific major or majors of any
BACHELOR’S DEGREES this person has received?
(For example: chemical engineering, elementary teacher
education, organizational psychology.)

14.

Has this person completed requirements for a vocational
training program at a trade school, hospital, or some other
kind of school for occupational training or place of work?
Do not include academic college courses.

Public school or public college
Private school or private college or home school

c. What grade or level was this person attending?
Mark K
J ONE box.
I
Nursery school, preschool, or pre-kindergarten
Kindergarten
Grade 1 through 12 – Specify grade 1 – 12

C

Yes

College undergraduate years (freshman to senior)

No

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

19

11990199

§,ƒ#(¤
Person — (continued)
15.

19.

What was this person’s main reason for moving?
Mark K
J ONE box.
I

What is this person’s ancestry or ethnic origin?

Employment

Family-related

Military

Natural disaster

Housing

Other reason

To attend school

(For example: Italian, Jamaican, African Am., Cambodian,
Cape Verdean, Norwegian, Dominican, French Canadian,
Haitian, Korean, Lebanese, Polish, Nigerian, Mexican,
Taiwanese, Ukrainian, and so on.)

16.

20.

a. Where was this person’s mother born?

Please read the HEALTH INSURANCE section on the
Flashcard.
Is this person 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.

Commonwealth of the Northern Mariana Islands

Yes

No

a. Insurance through a current or former employer
or union (of this person or another family member)

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

b. Insurance purchased directly from an insurance
company (by this person or another family member)
c. Medicare, for people 65 and older, or people
with certain disabilities

b. Where was this person’s father born?
Commonwealth of the Northern Mariana Islands

d. Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

e. TRICARE or other military health care
f. VA (enrolled for VA health care)

17.

a. Does this person speak a language other than English
at home?

g. Indian Health Service
h. Any other type of health insurance or health
coverage plan – Specify C

Yes
No ➜ SKIP to question 18

b. What is this language?

21.

a. Is this person deaf or does he/she have serious difficulty
hearing?

For example: Korean, Italian, Spanish, Vietnamese

Yes

c. How well does this person speak English?

No

Very well

b. Is this person blind or does he/she have serious difficulty
seeing even when wearing glasses?

Well

18.

Not well

Yes

Not at all

No

Did this person live in this house or apartment 5 years ago
(on April 1, 2015)?
Person is under 5 years old ➜ SKIP to question 20
Yes, this house ➜ SKIP to question 20
No, different house in the Commonwealth of the
Northern Mariana Islands
No, outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

20

11990207

§,ƒ#0¤
Person — (continued)

26.

How many times has this person been married?
Once

C

Two times

Ask questions 22a – c if this person is 5 years old or over.
Otherwise, SKIP to the questions for the next person on
page 25.

Three or more times

27.
22.

a. Because of a physical, mental, or emotional condition,
does this person have serious difficulty concentrating,
remembering, or making decisions?

In what year did this person last get married?
Year

Yes
No

E

Ask question 28 if this person is female and 15 years old
or over. Otherwise, SKIP to question 29a.

b. Does this person have serious difficulty walking or
climbing stairs?

28.

Yes

How many babies has this person ever had, not counting
stillbirths? Do not count stepchildren or children she has adopted.

No
None or

Number of children

c. Does this person have difficulty dressing or bathing?

29.

Yes

a. Does this person have any of his/her own grandchildren
under the age of 18 living in this house or apartment?

No

D

Yes
No ➜ SKIP to question 30

Ask question 23 if this person is 15 years old or over.
Otherwise, SKIP to the questions for the next person on
page 25.

23.

b. Is this grandparent currently responsible for most of
the basic needs of any grandchildren under the age
of 18 who live in this house or apartment?

Because of a physical, mental, or emotional condition, does
this person have difficulty doing errands alone such as
visiting a doctor’s office or shopping?

Yes
No ➜ SKIP to question 30

Yes

c. How long has this grandparent been responsible for
these grandchildren? If the grandparent is financially
responsible for more than one grandchild, answer the
question for the grandchild for whom the grandparent
has been responsible for the longest period of time.

No

24.

25.

What is this person’s marital status?
Now married

Less than 6 months

Widowed

6 to 11 months

Divorced

1 or 2 years

Separated

3 or 4 years

Never married ➜ SKIP to E

5 or more years

In the PAST 12 MONTHS did this person get –
Yes

No

a. Married?
b. Widowed?
c. Divorced?

21

11990215

§,ƒ#8¤
Person — (continued)
30.

34.

At what location did this person work LAST WEEK?
Commonwealth of the Northern Mariana Islands –
Print name of village below. C

Has this person ever served on active duty in the U.S. Armed
Forces, Reserves, or National Guard?
Mark K
J ONE box.
I
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

Never served in the military ➜ SKIP to question 33a
Only on active duty for training in the Reserves or
National Guard ➜ SKIP to question 32a
Now on active duty

35.

On active duty in the past, but not now

31.

Please read the PERIOD OF SERVICE section on the
Flashcard.
When did this person serve on active duty in the U.S. Armed
Forces? Mark K
J a box for EACH period in which this person
I
served, even if just for part of the period.

Please read the TRANSPORTATION TO WORK section on
the Flashcard.
How did this person usually get to work LAST WEEK?
Mark K
J ONE box for the method of transportation used for
I
most of the distance.
Car, truck, or private van/bus
Public van/bus

September 2001 or later

Taxicab

August 1990 to August 2001 (including Persian Gulf War)

Motorcycle

May 1975 to July 1990

Bicycle

Vietnam Era (August 1964 to April 1975)

Walked

February 1955 to July 1964

Plane or seaplane

Korean War (July 1950 to January 1955)

Boat, ferry, or water taxi

January 1947 to June 1950

Worked from home ➜ SKIP to question 43a

World War II (December 1941 to December 1946)

Other method

November 1941 or earlier

32.

a. Does this person have a VA service-connected
disability rating?
Yes (such as 0%, 10%, 20%, ..., 100%)

F

Ask question 36 if you marked "Car, truck, or private van/bus"
in question 35. Otherwise, SKIP to question 37.

36.

No ➜ SKIP to question 33a

How many people, including this person, usually rode to
work in the car, truck, or private van/bus LAST WEEK?
Person(s)

b. What is this person’s service-connected disability rating?
0 percent
10 or 20 percent

37.

30 or 40 percent

LAST WEEK, what time did this person’s trip to work
usually begin?

50 or 60 percent

Hour

:

70 percent or higher

33.

a. LAST WEEK, did this person work for pay at a job
(or business)?

Minute

38.

No – Did not work (or retired)

b. LAST WEEK, did this person do ANY work for pay,
even for as little as one hour?
Yes
No ➜ SKIP to question 39a

22

p.m.

How many minutes did it usually take this person to get
from home to work LAST WEEK?
Minutes

Yes ➜ SKIP to question 34

a.m.

11990223

§,ƒ#@¤
Person — (continued)

44.

During 2019, in the WEEKS WORKED, how many hours did
this person usually work each WEEK?
Usual hours worked each WEEK

G

Ask questions 39 – 42a if this person did NOT work last week.
Otherwise, SKIP to question 42b.

39.

a. LAST WEEK, was this person on layoff from a job?

H

Yes ➜ SKIP to question 39c

Ask questions 45a – f if this person worked in the past 5 years
(since 2015). Otherwise, SKIP to question 46.

No

b. LAST WEEK, was this person TEMPORARILY absent
from a job or business?

45.

The next series of questions is about the type of employment
this person had last week.

Yes, on vacation, temporary illness, maternity leave,
other family/personal reasons, bad weather,
etc. ➜ SKIP to question 42a

If this person had more than one job, describe the one at
which the most hours were worked. If this person did not
work last week, describe the most recent employment in the
past five years (since 2015).

No ➜ SKIP to question 40

c. Has this person been informed that he or she will be
recalled to work within the next 6 months OR been
given a date to return to work?

a. Please read the TYPE OF WORKER section on the
Flashcard.
Which one of the following best describes this person’s
employment last week or the most recent employment
in the past 5 years (since 2015)? Mark K
J ONE box.
I

Yes ➜ SKIP to question 41
No

40.

DESCRIPTION OF EMPLOYMENT

PRIVATE SECTOR EMPLOYEE

During the LAST 4 WEEKS, has this person been ACTIVELY
looking for work?

For-profit company or organization

Yes

Non-profit organization (including tax-exempt and charitable
organizations)

No ➜ SKIP to question 42a

41.

GOVERNMENT EMPLOYEE

LAST WEEK, could this person have started a job if offered
one, or returned to work if recalled?

Local or territorial government (for example: public
elementary school)

Yes, could have gone to work

Active duty U.S. Armed Forces or Commissioned Corps

No, because of own temporary illness

Federal government civilian employee

SELF-EMPLOYED OR OTHER

No, because of all other reasons (in school, etc.)

42.

Owner of non-incorporated business, professional practice,
or farm

a. When did this person last work, even for a few days?
2020

Owner of incorporated business, professional practice, or farm

2019 ➜ SKIP to question 43a

Worked without pay in a for-profit family business or farm
for 15 hours or more per week

2015 to 2018 ➜ SKIP to H
2014 or earlier, or never worked ➜ SKIP to question 46

b. What was the name of this person’s employer, business,
agency, or branch of the Armed Forces?

b. LAST YEAR, 2019, did this person work at a job or
business at any time?
Yes
No ➜ SKIP to H

43.

a. During 2019 (all 52 weeks), did this person work EVERY
week? Count paid vacation, paid sick leave, and military
service as work.

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 ➜ SKIP to question 44
No

b. During 2019 (all 52 weeks), how many WEEKS did this
person work? Include paid time off and include weeks
when the person only worked for a few hours.
Weeks

23

11990231

§,ƒ#R¤
Person — (continued)

d. Did this person receive any Social Security or
Railroad Retirement benefits in 2019?

d. Was this mainly – Mark I
J
K ONE box.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

manufacturing?
wholesale trade?

$

retail trade?

.00

No

other (agriculture, construction, service, government, etc.)?

e. Did this person receive any Supplemental Security
Income (SSI) payments in 2019?

e. What was this person’s main occupation?
(For example: 4th grade teacher, entry-level plumber)

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

f. Describe this person’s 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)

f. Did this person receive any public assistance or public
welfare payments from the state or local welfare office
in 2019?
Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

46.

g. Did this person receive any retirement income, pensions,
survivor or disability income in 2019? 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.

INCOME IN 2019
The next series of questions is about income received during
2019. If the exact amount is not known, please give your best
estimate. If net income was a loss, please give the dollar
amount of the loss. For income received jointly, report the
appropriate share for each person - or, if that’s not possible,
report the whole amount for only one person. Mark K
J the
I
"No" box for the other person.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

a. Did this person receive any wages, salary, commissions,
bonuses, or tips in 2019?

$

Yes ➜ What was the amount from all jobs before
deductions for taxes, bonds, dues, or other items?

h. Did this person receive income on a regular basis from
any other sources such as Department of Veterans
Affairs (VA) payments, unemployment compensation,
child support or alimony in 2019?

TOTAL AMOUNT – Dollars

$

.00

No

.00

No

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

b. Did this person have any self-employment income from
own nonfarm businesses or farm businesses, including
proprietorships and partnerships, in 2019?

$

.00

No

Yes ➜ What was the net income after business expenses?

47.

TOTAL AMOUNT – Dollars

$

What was this person’s total income for 2019?

.00

No

OR
Loss

None

$

.00
TOTAL AMOUNT for 2019

Loss

c. Did this person receive any interest, dividends, net rental
income, royalty income, or income from estates and trusts
in 2019? Report even small amounts credited to an account.
Yes ➜ What was the amount?

➜ Continue with the questions for the next person on the
next page. If this is the last person, SKIP to page 44
of the D-Q-MI.

TOTAL AMOUNT – Dollars

$
No

.00
Loss

24

11990249

§,ƒ#Y¤
Person —
8.

12.

Please copy the name of the Person listed on page 5, then
continue answering questions below.

Please read the HIGHEST DEGREE or LEVEL OF SCHOOL
section on the Flashcard.
What is the highest degree or level of school this person has
COMPLETED? Mark K
J ONE box. If currently enrolled, mark
I
the previous grade or highest degree received.

Last Name(s)

NO SCHOOLING COMPLETED
No schooling completed

First Name

NURSERY OR PRESCHOOL THROUGH GRADE 12

MI

Nursery school, preschool or pre-kindergarten
Kindergarten

9.

Where was this person born?

Grade 1 through 11 – Specify grade 1 – 11

C

Commonwealth of the Northern Mariana Islands
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

12th grade – NO DIPLOMA

HIGH SCHOOL GRADUATE
Regular high school diploma

A

Ask question 10 if this person was born outside the
Commonwealth of the Northern Mariana Islands.
Otherwise, SKIP to question 11a.

GED or alternative credential

COLLEGE OR SOME COLLEGE
Some college credit, but less than 1 year of college credit

10.

When did this person come to live in the Commonwealth
of the Northern Mariana Islands?
If this person came to live in the Commonwealth of the
Northern Mariana Islands more than once, print latest year.

1 or more years of college credit, no degree

Year

Bachelor’s degree (for example: BA, BS)

Associate’s degree (for example: AA, AS)

AFTER BACHELOR’S DEGREE
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

11.

a. At any time since February 1, 2020 has this person
attended school or college? Include only nursery or
preschool, pre-kindergarten, kindergarten, elementary
school, home school, and schooling which leads to a
high school diploma or a college degree.
Yes

Professional degree beyond a bachelor’s degree
(for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

B

No ➜ SKIP to question 12

b. Was that a public school or college, a private school or
college, or home school?

Ask question 13 if this person has a bachelor’s degree or
higher. Otherwise, SKIP to question 14.

13.

This question focuses on this person’s BACHELOR’S
DEGREE. What was the specific major or majors of any
BACHELOR’S DEGREES this person has received?
(For example: chemical engineering, elementary teacher
education, organizational psychology.)

14.

Has this person completed requirements for a vocational
training program at a trade school, hospital, or some other
kind of school for occupational training or place of work?
Do not include academic college courses.

Public school or public college
Private school or private college or home school

c. What grade or level was this person attending?
Mark K
J ONE box.
I
Nursery school, preschool, or pre-kindergarten
Kindergarten
Grade 1 through 12 – Specify grade 1 – 12

C

Yes

College undergraduate years (freshman to senior)

No

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

25

11990256

§,ƒ#a¤
Person — (continued)
15.

19.

What was this person’s main reason for moving?
Mark K
J ONE box.
I

What is this person’s ancestry or ethnic origin?

Employment

Family-related

Military

Natural disaster

Housing

Other reason

To attend school

(For example: Italian, Jamaican, African Am., Cambodian,
Cape Verdean, Norwegian, Dominican, French Canadian,
Haitian, Korean, Lebanese, Polish, Nigerian, Mexican,
Taiwanese, Ukrainian, and so on.)

16.

20.

a. Where was this person’s mother born?

Please read the HEALTH INSURANCE section on the
Flashcard.
Is this person 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.

Commonwealth of the Northern Mariana Islands

Yes

No

a. Insurance through a current or former employer
or union (of this person or another family member)

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

b. Insurance purchased directly from an insurance
company (by this person or another family member)
c. Medicare, for people 65 and older, or people
with certain disabilities

b. Where was this person’s father born?
Commonwealth of the Northern Mariana Islands

d. Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

e. TRICARE or other military health care
f. VA (enrolled for VA health care)

17.

a. Does this person speak a language other than English
at home?

g. Indian Health Service
h. Any other type of health insurance or health
coverage plan – Specify C

Yes
No ➜ SKIP to question 18

b. What is this language?

21.

a. Is this person deaf or does he/she have serious difficulty
hearing?

For example: Korean, Italian, Spanish, Vietnamese

Yes

c. How well does this person speak English?

No

Very well

b. Is this person blind or does he/she have serious difficulty
seeing even when wearing glasses?

Well

18.

Not well

Yes

Not at all

No

Did this person live in this house or apartment 5 years ago
(on April 1, 2015)?
Person is under 5 years old ➜ SKIP to question 20
Yes, this house ➜ SKIP to question 20
No, different house in the Commonwealth of the
Northern Mariana Islands
No, outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

26

11990264

§,ƒ#i¤
Person — (continued)

26.

How many times has this person been married?
Once

C

Two times

Ask questions 22a – c if this person is 5 years old or over.
Otherwise, SKIP to the questions for the next person on
page 31.

Three or more times

27.
22.

a. Because of a physical, mental, or emotional condition,
does this person have serious difficulty concentrating,
remembering, or making decisions?

In what year did this person last get married?
Year

Yes
No

E

Ask question 28 if this person is female and 15 years old
or over. Otherwise, SKIP to question 29a.

b. Does this person have serious difficulty walking or
climbing stairs?

28.

Yes

How many babies has this person ever had, not counting
stillbirths? Do not count stepchildren or children she has adopted.

No
None or

Number of children

c. Does this person have difficulty dressing or bathing?

29.

Yes

a. Does this person have any of his/her own grandchildren
under the age of 18 living in this house or apartment?

No

D

Yes
No ➜ SKIP to question 30

Ask question 23 if this person is 15 years old or over.
Otherwise, SKIP to the questions for the next person on
page 31.

23.

b. Is this grandparent currently responsible for most of
the basic needs of any grandchildren under the age
of 18 who live in this house or apartment?

Because of a physical, mental, or emotional condition, does
this person have difficulty doing errands alone such as
visiting a doctor’s office or shopping?

Yes
No ➜ SKIP to question 30

Yes

c. How long has this grandparent been responsible for
these grandchildren? If the grandparent is financially
responsible for more than one grandchild, answer the
question for the grandchild for whom the grandparent
has been responsible for the longest period of time.

No

24.

25.

What is this person’s marital status?
Now married

Less than 6 months

Widowed

6 to 11 months

Divorced

1 or 2 years

Separated

3 or 4 years

Never married ➜ SKIP to E

5 or more years

In the PAST 12 MONTHS did this person get –
Yes

No

a. Married?
b. Widowed?
c. Divorced?

27

11990272

§,ƒ#q¤
Person — (continued)
30.

34.

At what location did this person work LAST WEEK?
Commonwealth of the Northern Mariana Islands –
Print name of village below. C

Has this person ever served on active duty in the U.S. Armed
Forces, Reserves, or National Guard?
Mark K
J ONE box.
I
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

Never served in the military ➜ SKIP to question 33a
Only on active duty for training in the Reserves or
National Guard ➜ SKIP to question 32a
Now on active duty

35.

On active duty in the past, but not now

31.

Please read the PERIOD OF SERVICE section on the
Flashcard.
When did this person serve on active duty in the U.S. Armed
Forces? Mark K
J a box for EACH period in which this person
I
served, even if just for part of the period.

Please read the TRANSPORTATION TO WORK section on
the Flashcard.
How did this person usually get to work LAST WEEK?
Mark K
J ONE box for the method of transportation used for
I
most of the distance.
Car, truck, or private van/bus
Public van/bus

September 2001 or later

Taxicab

August 1990 to August 2001 (including Persian Gulf War)

Motorcycle

May 1975 to July 1990

Bicycle

Vietnam Era (August 1964 to April 1975)

Walked

February 1955 to July 1964

Plane or seaplane

Korean War (July 1950 to January 1955)

Boat, ferry, or water taxi

January 1947 to June 1950

Worked from home ➜ SKIP to question 43a

World War II (December 1941 to December 1946)

Other method

November 1941 or earlier

32.

a. Does this person have a VA service-connected
disability rating?
Yes (such as 0%, 10%, 20%, ..., 100%)

F

Ask question 36 if you marked "Car, truck, or private van/bus"
in question 35. Otherwise, SKIP to question 37.

36.

No ➜ SKIP to question 33a

How many people, including this person, usually rode to
work in the car, truck, or private van/bus LAST WEEK?
Person(s)

b. What is this person’s service-connected disability rating?
0 percent
10 or 20 percent

37.

30 or 40 percent

LAST WEEK, what time did this person’s trip to work
usually begin?

50 or 60 percent

Hour

:

70 percent or higher

33.

a. LAST WEEK, did this person work for pay at a job
(or business)?

Minute

38.

No – Did not work (or retired)

b. LAST WEEK, did this person do ANY work for pay,
even for as little as one hour?
Yes
No ➜ SKIP to question 39a

28

p.m.

How many minutes did it usually take this person to get
from home to work LAST WEEK?
Minutes

Yes ➜ SKIP to question 34

a.m.

11990280

§,ƒ#¥¤
Person — (continued)

44.

During 2019, in the WEEKS WORKED, how many hours did
this person usually work each WEEK?
Usual hours worked each WEEK

G

Ask questions 39 – 42a if this person did NOT work last week.
Otherwise, SKIP to question 42b.

39.

a. LAST WEEK, was this person on layoff from a job?

H

Yes ➜ SKIP to question 39c

Ask questions 45a – f if this person worked in the past 5 years
(since 2015). Otherwise, SKIP to question 46.

No

b. LAST WEEK, was this person TEMPORARILY absent
from a job or business?

45.

The next series of questions is about the type of employment
this person had last week.

Yes, on vacation, temporary illness, maternity leave,
other family/personal reasons, bad weather,
etc. ➜ SKIP to question 42a

If this person had more than one job, describe the one at
which the most hours were worked. If this person did not
work last week, describe the most recent employment in the
past five years (since 2015).

No ➜ SKIP to question 40

c. Has this person been informed that he or she will be
recalled to work within the next 6 months OR been
given a date to return to work?

a. Please read the TYPE OF WORKER section on the
Flashcard.
Which one of the following best describes this person’s
employment last week or the most recent employment
in the past 5 years (since 2015)? Mark K
J ONE box.
I

Yes ➜ SKIP to question 41
No

40.

DESCRIPTION OF EMPLOYMENT

PRIVATE SECTOR EMPLOYEE

During the LAST 4 WEEKS, has this person been ACTIVELY
looking for work?

For-profit company or organization

Yes

Non-profit organization (including tax-exempt and charitable
organizations)

No ➜ SKIP to question 42a

41.

GOVERNMENT EMPLOYEE

LAST WEEK, could this person have started a job if offered
one, or returned to work if recalled?

Local or territorial government (for example: public
elementary school)

Yes, could have gone to work

Active duty U.S. Armed Forces or Commissioned Corps

No, because of own temporary illness

Federal government civilian employee

SELF-EMPLOYED OR OTHER

No, because of all other reasons (in school, etc.)

42.

Owner of non-incorporated business, professional practice,
or farm

a. When did this person last work, even for a few days?
2020

Owner of incorporated business, professional practice, or farm

2019 ➜ SKIP to question 43a

Worked without pay in a for-profit family business or farm
for 15 hours or more per week

2015 to 2018 ➜ SKIP to H
2014 or earlier, or never worked ➜ SKIP to question 46

b. What was the name of this person’s employer, business,
agency, or branch of the Armed Forces?

b. LAST YEAR, 2019, did this person work at a job or
business at any time?
Yes
No ➜ SKIP to H

43.

a. During 2019 (all 52 weeks), did this person work EVERY
week? Count paid vacation, paid sick leave, and military
service as work.

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 ➜ SKIP to question 44
No

b. During 2019 (all 52 weeks), how many WEEKS did this
person work? Include paid time off and include weeks
when the person only worked for a few hours.
Weeks

29

11990298

§,ƒ$’¤
Person — (continued)

d. Did this person receive any Social Security or
Railroad Retirement benefits in 2019?

d. Was this mainly – Mark I
J
K ONE box.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

manufacturing?
wholesale trade?

$

retail trade?

.00

No

other (agriculture, construction, service, government, etc.)?

e. Did this person receive any Supplemental Security
Income (SSI) payments in 2019?

e. What was this person’s main occupation?
(For example: 4th grade teacher, entry-level plumber)

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

f. Describe this person’s 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)

f. Did this person receive any public assistance or public
welfare payments from the state or local welfare office
in 2019?
Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

46.

g. Did this person receive any retirement income, pensions,
survivor or disability income in 2019? 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.

INCOME IN 2019
The next series of questions is about income received during
2019. If the exact amount is not known, please give your best
estimate. If net income was a loss, please give the dollar
amount of the loss. For income received jointly, report the
appropriate share for each person - or, if that’s not possible,
report the whole amount for only one person. Mark K
J the
I
"No" box for the other person.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

a. Did this person receive any wages, salary, commissions,
bonuses, or tips in 2019?

$

Yes ➜ What was the amount from all jobs before
deductions for taxes, bonds, dues, or other items?

h. Did this person receive income on a regular basis from
any other sources such as Department of Veterans
Affairs (VA) payments, unemployment compensation,
child support or alimony in 2019?

TOTAL AMOUNT – Dollars

$

.00

No

.00

No

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

b. Did this person have any self-employment income from
own nonfarm businesses or farm businesses, including
proprietorships and partnerships, in 2019?

$

.00

No

Yes ➜ What was the net income after business expenses?

47.

TOTAL AMOUNT – Dollars

$

What was this person’s total income for 2019?

.00

No

OR
Loss

None

$

.00
TOTAL AMOUNT for 2019

Loss

c. Did this person receive any interest, dividends, net rental
income, royalty income, or income from estates and trusts
in 2019? Report even small amounts credited to an account.
Yes ➜ What was the amount?

➜ Continue with the questions for the next person on the
next page. If this is the last person, SKIP to page 44
of the D-Q-MI.

TOTAL AMOUNT – Dollars

$
No

.00
Loss

30

11990306

§,ƒ$/¤
Person —
8.

12.

Please copy the name of the Person listed on page 6, then
continue answering questions below.

Please read the HIGHEST DEGREE or LEVEL OF SCHOOL
section on the Flashcard.
What is the highest degree or level of school this person has
COMPLETED? Mark K
J ONE box. If currently enrolled, mark
I
the previous grade or highest degree received.

Last Name(s)

NO SCHOOLING COMPLETED
No schooling completed

First Name

NURSERY OR PRESCHOOL THROUGH GRADE 12

MI

Nursery school, preschool or pre-kindergarten
Kindergarten

9.

Where was this person born?

Grade 1 through 11 – Specify grade 1 – 11

C

Commonwealth of the Northern Mariana Islands
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

12th grade – NO DIPLOMA

HIGH SCHOOL GRADUATE
Regular high school diploma

A

Ask question 10 if this person was born outside the
Commonwealth of the Northern Mariana Islands.
Otherwise, SKIP to question 11a.

GED or alternative credential

COLLEGE OR SOME COLLEGE
Some college credit, but less than 1 year of college credit

10.

When did this person come to live in the Commonwealth
of the Northern Mariana Islands?
If this person came to live in the Commonwealth of the
Northern Mariana Islands more than once, print latest year.

1 or more years of college credit, no degree

Year

Bachelor’s degree (for example: BA, BS)

Associate’s degree (for example: AA, AS)

AFTER BACHELOR’S DEGREE
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

11.

a. At any time since February 1, 2020 has this person
attended school or college? Include only nursery or
preschool, pre-kindergarten, kindergarten, elementary
school, home school, and schooling which leads to a
high school diploma or a college degree.
Yes

Professional degree beyond a bachelor’s degree
(for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

B

No ➜ SKIP to question 12

b. Was that a public school or college, a private school or
college, or home school?

Ask question 13 if this person has a bachelor’s degree or
higher. Otherwise, SKIP to question 14.

13.

This question focuses on this person’s BACHELOR’S
DEGREE. What was the specific major or majors of any
BACHELOR’S DEGREES this person has received?
(For example: chemical engineering, elementary teacher
education, organizational psychology.)

14.

Has this person completed requirements for a vocational
training program at a trade school, hospital, or some other
kind of school for occupational training or place of work?
Do not include academic college courses.

Public school or public college
Private school or private college or home school

c. What grade or level was this person attending?
Mark K
J ONE box.
I
Nursery school, preschool, or pre-kindergarten
Kindergarten
Grade 1 through 12 – Specify grade 1 – 12

C

Yes

College undergraduate years (freshman to senior)

No

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

31

11990314

§,ƒ$7¤
Person — (continued)
15.

19.

What was this person’s main reason for moving?
Mark K
J ONE box.
I

What is this person’s ancestry or ethnic origin?

Employment

Family-related

Military

Natural disaster

Housing

Other reason

To attend school

(For example: Italian, Jamaican, African Am., Cambodian,
Cape Verdean, Norwegian, Dominican, French Canadian,
Haitian, Korean, Lebanese, Polish, Nigerian, Mexican,
Taiwanese, Ukrainian, and so on.)

16.

20.

a. Where was this person’s mother born?

Please read the HEALTH INSURANCE section on the
Flashcard.
Is this person 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.

Commonwealth of the Northern Mariana Islands

Yes

No

a. Insurance through a current or former employer
or union (of this person or another family member)

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

b. Insurance purchased directly from an insurance
company (by this person or another family member)
c. Medicare, for people 65 and older, or people
with certain disabilities

b. Where was this person’s father born?
Commonwealth of the Northern Mariana Islands

d. Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

e. TRICARE or other military health care
f. VA (enrolled for VA health care)

17.

a. Does this person speak a language other than English
at home?

g. Indian Health Service
h. Any other type of health insurance or health
coverage plan – Specify C

Yes
No ➜ SKIP to question 18

b. What is this language?

21.

a. Is this person deaf or does he/she have serious difficulty
hearing?

For example: Korean, Italian, Spanish, Vietnamese

Yes

c. How well does this person speak English?

No

Very well

b. Is this person blind or does he/she have serious difficulty
seeing even when wearing glasses?

Well

18.

Not well

Yes

Not at all

No

Did this person live in this house or apartment 5 years ago
(on April 1, 2015)?
Person is under 5 years old ➜ SKIP to question 20
Yes, this house ➜ SKIP to question 20
No, different house in the Commonwealth of the
Northern Mariana Islands
No, outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

32

11990322

§,ƒ$?¤
Person — (continued)

26.

How many times has this person been married?
Once

C

Ask questions 22a – c if this person is 5 years old or over.
Otherwise, skip to the questions for the next person on page 7
of an additional D-CQ-MI. If this is the last person, SKIP to
page 44 of the D-Q-MI.

Two times
Three or more times

27.

In what year did this person last get married?
Year

22.

a. Because of a physical, mental, or emotional condition,
does this person have serious difficulty concentrating,
remembering, or making decisions?
Yes

E

No

b. Does this person have serious difficulty walking or
climbing stairs?

Ask question 28 if this person is female and 15 years old
or over. Otherwise, SKIP to question 29a.

28.

Yes

How many babies has this person ever had, not counting
stillbirths? Do not count stepchildren or children she has adopted.
None or

No

c. Does this person have difficulty dressing or bathing?

29.

Yes

Number of children

a. Does this person have any of his/her own grandchildren
under the age of 18 living in this house or apartment?
Yes

No

No ➜ SKIP to question 30

D

b. Is this grandparent currently responsible for most of
the basic needs of any grandchildren under the age
of 18 who live in this house or apartment?

Ask question 23 if this person is 15 years old or over.
Otherwise, skip to the questions for the next person on page 7
of an additional D-CQ-MI. If this is the last person, SKIP to
page 44 of the D-Q-MI.

23.

Yes
No ➜ SKIP to question 30

Because of a physical, mental, or emotional condition, does
this person have difficulty doing errands alone such as
visiting a doctor’s office or shopping?

c. How long has this grandparent been responsible for
these grandchildren? If the grandparent is financially
responsible for more than one grandchild, answer the
question for the grandchild for whom the grandparent
has been responsible for the longest period of time.

Yes
No

Less than 6 months

24.

What is this person’s marital status?

6 to 11 months

Now married

1 or 2 years

Widowed

3 or 4 years

Divorced

5 or more years

Separated
Never married ➜ SKIP to E

25.

In the PAST 12 MONTHS did this person get –
Yes

No

a. Married?
b. Widowed?
c. Divorced?

33

11990330

§,ƒ$Q¤
Person — (continued)
30.

34.

At what location did this person work LAST WEEK?
Commonwealth of the Northern Mariana Islands –
Print name of village below. C

Has this person ever served on active duty in the U.S. Armed
Forces, Reserves, or National Guard?
Mark K
J ONE box.
I
Outside the Commonwealth of the Northern Mariana Islands –
Print name of U.S. state, U.S. territory, or foreign country below. C

Never served in the military ➜ SKIP to question 33a
Only on active duty for training in the Reserves or
National Guard ➜ SKIP to question 32a
Now on active duty

35.

On active duty in the past, but not now

31.

Please read the PERIOD OF SERVICE section on the
Flashcard.
When did this person serve on active duty in the U.S. Armed
Forces? Mark K
J a box for EACH period in which this person
I
served, even if just for part of the period.

Please read the TRANSPORTATION TO WORK section on
the Flashcard.
How did this person usually get to work LAST WEEK?
Mark K
J ONE box for the method of transportation used for
I
most of the distance.
Car, truck, or private van/bus
Public van/bus

September 2001 or later

Taxicab

August 1990 to August 2001 (including Persian Gulf War)

Motorcycle

May 1975 to July 1990

Bicycle

Vietnam Era (August 1964 to April 1975)

Walked

February 1955 to July 1964

Plane or seaplane

Korean War (July 1950 to January 1955)

Boat, ferry, or water taxi

January 1947 to June 1950

Worked from home ➜ SKIP to question 43a

World War II (December 1941 to December 1946)

Other method

November 1941 or earlier

32.

a. Does this person have a VA service-connected
disability rating?
Yes (such as 0%, 10%, 20%, ..., 100%)

F

Ask question 36 if you marked "Car, truck, or private van/bus"
in question 35. Otherwise, SKIP to question 37.

36.

No ➜ SKIP to question 33a

How many people, including this person, usually rode to
work in the car, truck, or private van/bus LAST WEEK?
Person(s)

b. What is this person’s service-connected disability rating?
0 percent
10 or 20 percent

37.

30 or 40 percent

LAST WEEK, what time did this person’s trip to work
usually begin?

50 or 60 percent

Hour

:

70 percent or higher

33.

a. LAST WEEK, did this person work for pay at a job
(or business)?

Minute

38.

No – Did not work (or retired)

b. LAST WEEK, did this person do ANY work for pay,
even for as little as one hour?
Yes
No ➜ SKIP to question 39a

34

p.m.

How many minutes did it usually take this person to get
from home to work LAST WEEK?
Minutes

Yes ➜ SKIP to question 34

a.m.

11990348

§,ƒ$X¤
Person — (continued)

44.

During 2019, in the WEEKS WORKED, how many hours did
this person usually work each WEEK?
Usual hours worked each WEEK

G

Ask questions 39 – 42a if this person did NOT work last week.
Otherwise, SKIP to question 42b.

39.

a. LAST WEEK, was this person on layoff from a job?

H

Yes ➜ SKIP to question 39c

Ask questions 45a – f if this person worked in the past 5 years
(since 2015). Otherwise, SKIP to question 46.

No

b. LAST WEEK, was this person TEMPORARILY absent
from a job or business?

45.

The next series of questions is about the type of employment
this person had last week.

Yes, on vacation, temporary illness, maternity leave,
other family/personal reasons, bad weather,
etc. ➜ SKIP to question 42a

If this person had more than one job, describe the one at
which the most hours were worked. If this person did not
work last week, describe the most recent employment in the
past five years (since 2015).

No ➜ SKIP to question 40

c. Has this person been informed that he or she will be
recalled to work within the next 6 months OR been
given a date to return to work?

a. Please read the TYPE OF WORKER section on the
Flashcard.
Which one of the following best describes this person’s
employment last week or the most recent employment
in the past 5 years (since 2015)? Mark K
J ONE box.
I

Yes ➜ SKIP to question 41
No

40.

DESCRIPTION OF EMPLOYMENT

PRIVATE SECTOR EMPLOYEE

During the LAST 4 WEEKS, has this person been ACTIVELY
looking for work?

For-profit company or organization

Yes

Non-profit organization (including tax-exempt and charitable
organizations)

No ➜ SKIP to question 42a

41.

GOVERNMENT EMPLOYEE

LAST WEEK, could this person have started a job if offered
one, or returned to work if recalled?

Local or territorial government (for example: public
elementary school)

Yes, could have gone to work

Active duty U.S. Armed Forces or Commissioned Corps

No, because of own temporary illness

Federal government civilian employee

SELF-EMPLOYED OR OTHER

No, because of all other reasons (in school, etc.)

42.

Owner of non-incorporated business, professional practice,
or farm

a. When did this person last work, even for a few days?
2020

Owner of incorporated business, professional practice, or farm

2019 ➜ SKIP to question 43a

Worked without pay in a for-profit family business or farm
for 15 hours or more per week

2015 to 2018 ➜ SKIP to H
2014 or earlier, or never worked ➜ SKIP to question 46

b. What was the name of this person’s employer, business,
agency, or branch of the Armed Forces?

b. LAST YEAR, 2019, did this person work at a job or
business at any time?
Yes
No ➜ SKIP to H

43.

a. During 2019 (all 52 weeks), did this person work EVERY
week? Count paid vacation, paid sick leave, and military
service as work.

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 ➜ SKIP to question 44
No

b. During 2019 (all 52 weeks), how many WEEKS did this
person work? Include paid time off and include weeks
when the person only worked for a few hours.
Weeks

35

11990355

§,ƒ$‘¤
Person — (continued)

d. Did this person receive any Social Security or
Railroad Retirement benefits in 2019?

d. Was this mainly – Mark I
J
K ONE box.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

manufacturing?
wholesale trade?

$

retail trade?

.00

No

other (agriculture, construction, service, government, etc.)?

e. Did this person receive any Supplemental Security
Income (SSI) payments in 2019?

e. What was this person’s main occupation?
(For example: 4th grade teacher, entry-level plumber)

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

f. Describe this person’s 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)

f. Did this person receive any public assistance or public
welfare payments from the state or local welfare office
in 2019?
Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

$

.00

No

46.

g. Did this person receive any retirement income, pensions,
survivor or disability income in 2019? 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.

INCOME IN 2019
The next series of questions is about income received during
2019. If the exact amount is not known, please give your best
estimate. If net income was a loss, please give the dollar
amount of the loss. For income received jointly, report the
appropriate share for each person - or, if that’s not possible,
report the whole amount for only one person. Mark K
J the
I
"No" box for the other person.

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

a. Did this person receive any wages, salary, commissions,
bonuses, or tips in 2019?

$

Yes ➜ What was the amount from all jobs before
deductions for taxes, bonds, dues, or other items?

h. Did this person receive income on a regular basis from
any other sources such as Department of Veterans
Affairs (VA) payments, unemployment compensation,
child support or alimony in 2019?

TOTAL AMOUNT – Dollars

$

.00

No

.00

No

Yes ➜ What was the amount?
TOTAL AMOUNT – Dollars

b. Did this person have any self-employment income from
own nonfarm businesses or farm businesses, including
proprietorships and partnerships, in 2019?

$

.00

No

Yes ➜ What was the net income after business expenses?

47.

TOTAL AMOUNT – Dollars

$

What was this person’s total income for 2019?

.00

No

OR
Loss

None

$

.00
TOTAL AMOUNT for 2019

Loss

c. Did this person receive any interest, dividends, net rental
income, royalty income, or income from estates and trusts
in 2019? Report even small amounts credited to an account.
Yes ➜ What was the amount?

➜ Continue with the questions for the next person on
page 7 of an additional D-CQ-MI. If this is the last
person, SKIP to page 44 of the D-Q-MI.

TOTAL AMOUNT – Dollars

$
No

.00
Loss

36

11990363