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OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
TM
Transitory Locations Continuation Questionnaire
FOR NPC
USE ONLY
TL Control Number
ACO
State
ns
h
Map Spot
➤
➤
APPLY LABEL HERE
Block
ip
Tract
County
of
questionnaire(s)
ze
Questionnaire
Unit Designation
iti
Address Number
C
Street Name or Rural Route Address
City
N
ra
ft:
Location Description
ZIP Code
o
State
D
CONTINUATION QUESTIONNAIRE FOR
TRANSITORY LOCATIONS
FORM
D-CQ-TLRA (02-05-2019) Draft 11
11890019
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1.
What is the name of
Person
?
6.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
ns
h
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
C
Female
What will this person’s age be on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
Year of birth
N
Age on April 1, 2020
years
ft:
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
ra
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
D
5.
Vietnamese
ze
Chinese
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
2
11890027
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark K
J ONE box.
I
Male
4.
ip
Opposite-sex husband/wife/spouse
iti
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Please read the RELATIONSHIP section on the Information
Sheet.
How is this person related to Person 1? Mark K
J ONE box.
I
o
2.
Some other race – Print race or origin. C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
§,z!D¤
8.
Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.
9.
What is the full address of the place where this person lives
or stays most of the time?
ip
Address Number (For example: 5007)
ns
h
Street Name (For example: N Maple Ave)
ze
Apt/Unit (For example: Apt A or Lot 3)
iti
Rural Route Address (if there is no street address)
ZIP Code
o
State
C
City
➜ NOTE: Please provide a location description if there is no address
D
ra
ft:
N
or if this is a facility.
➜ If more people were counted in Question S4 on the
D-Q-TLRA, continue with the next person on the next
page.
3
11890035
§,z!L¤
1.
What is the name of
Person
?
6.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
ns
h
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
C
Female
What will this person’s age be on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
Year of birth
N
Age on April 1, 2020
years
ft:
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
ra
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
D
5.
Vietnamese
ze
Chinese
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
4
11890043
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark K
J ONE box.
I
Male
4.
ip
Opposite-sex husband/wife/spouse
iti
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Please read the RELATIONSHIP section on the Information
Sheet.
How is this person related to Person 1? Mark K
J ONE box.
I
o
2.
Some other race – Print race or origin. C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
§,z!S¤
8.
Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.
9.
What is the full address of the place where this person lives
or stays most of the time?
ip
Address Number (For example: 5007)
ns
h
Street Name (For example: N Maple Ave)
ze
Apt/Unit (For example: Apt A or Lot 3)
iti
Rural Route Address (if there is no street address)
ZIP Code
o
State
C
City
➜ NOTE: Please provide a location description if there is no address
ra
D
11890050
ft:
N
or if this is a facility.
➜ If more people were counted in Question S4 on the
D-Q-TLRA, continue with the next person on the next
page.
5
11890050
§,z!e¤
1.
What is the name of
Person
?
6.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
ns
h
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
C
Female
What will this person’s age be on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
Year of birth
N
Age on April 1, 2020
years
ft:
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
ra
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
D
5.
Vietnamese
ze
Chinese
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
6
11890068
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark K
J ONE box.
I
Male
4.
ip
Opposite-sex husband/wife/spouse
iti
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Please read the RELATIONSHIP section on the Information
Sheet.
How is this person related to Person 1? Mark K
J ONE box.
I
o
2.
Some other race – Print race or origin. C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
§,z!m¤
8.
Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.
9.
What is the full address of the place where this person lives
or stays most of the time?
ip
Address Number (For example: 5007)
ns
h
Street Name (For example: N Maple Ave)
ze
Apt/Unit (For example: Apt A or Lot 3)
iti
Rural Route Address (if there is no street address)
ZIP Code
o
State
C
City
➜ NOTE: Please provide a location description if there is no address
D
ra
ft:
N
or if this is a facility.
➜ If more people were counted in Question S4 on the
D-Q-TLRA, continue with the next person on the next
page.
7
11890076
§,z!u¤
1.
What is the name of
Person
?
6.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
ns
h
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
C
Female
What will this person’s age be on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
Year of birth
N
Age on April 1, 2020
years
ft:
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
ra
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
D
5.
Vietnamese
ze
Chinese
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
8
11890084
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark K
J ONE box.
I
Male
4.
ip
Opposite-sex husband/wife/spouse
iti
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Please read the RELATIONSHIP section on the Information
Sheet.
How is this person related to Person 1? Mark K
J ONE box.
I
o
2.
Some other race – Print race or origin. C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
§,z!}¤
8.
Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.
9.
What is the full address of the place where this person lives
or stays most of the time?
ip
Address Number (For example: 5007)
ns
h
Street Name (For example: N Maple Ave)
ze
Apt/Unit (For example: Apt A or Lot 3)
iti
Rural Route Address (if there is no street address)
ZIP Code
o
State
C
City
➜ NOTE: Please provide a location description if there is no address
D
ra
ft:
N
or if this is a facility.
➜ If more people were counted in Question S4 on the
D-Q-TLRA, continue with the next person on the next
page.
9
11890092
§,z"!¤
1.
What is the name of
Person
?
6.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
ns
h
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
C
Female
What will this person’s age be on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
Year of birth
N
Age on April 1, 2020
years
ft:
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
ra
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
D
5.
Vietnamese
ze
Chinese
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
10
11890100
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark K
J ONE box.
I
Male
4.
ip
Opposite-sex husband/wife/spouse
iti
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Please read the RELATIONSHIP section on the Information
Sheet.
How is this person related to Person 1? Mark K
J ONE box.
I
o
2.
Some other race – Print race or origin. C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
§,z"3¤
8.
Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.
9.
What is the full address of the place where this person lives
or stays most of the time?
ip
Address Number (For example: 5007)
ns
h
Street Name (For example: N Maple Ave)
ze
Apt/Unit (For example: Apt A or Lot 3)
iti
Rural Route Address (if there is no street address)
ZIP Code
o
State
C
City
➜ NOTE: Please provide a location description if there is no address
D
ra
ft:
N
or if this is a facility.
➜ If more people were counted in Question S4 on the
D-Q-TLRA, continue with the next person on the next
page.
11
11890118
§,z";¤
1.
What is the name of
Person
?
6.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
ns
h
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
C
Female
What will this person’s age be on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
Year of birth
N
Age on April 1, 2020
years
ft:
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
ra
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
D
5.
Vietnamese
ze
Chinese
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
12
11890126
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark K
J ONE box.
I
Male
4.
ip
Opposite-sex husband/wife/spouse
iti
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Please read the RELATIONSHIP section on the Information
Sheet.
How is this person related to Person 1? Mark K
J ONE box.
I
o
2.
Some other race – Print race or origin. C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
§,z"C¤
8.
Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.
9.
What is the full address of the place where this person lives
or stays most of the time?
ip
Address Number (For example: 5007)
ns
h
Street Name (For example: N Maple Ave)
ze
Apt/Unit (For example: Apt A or Lot 3)
iti
Rural Route Address (if there is no street address)
ZIP Code
o
State
C
City
➜ NOTE: Please provide a location description if there is no address
D
ra
ft:
N
or if this is a facility.
➜ If more people were counted in Question S4 on the
D-Q-TLRA, continue with the next person on the next
page.
13
11890134
§,z"K¤
1.
What is the name of
Person
?
6.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
ns
h
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
C
Female
What will this person’s age be on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
Year of birth
N
Age on April 1, 2020
years
ft:
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
ra
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
D
5.
Vietnamese
ze
Chinese
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
14
11890142
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark K
J ONE box.
I
Male
4.
ip
Opposite-sex husband/wife/spouse
iti
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Please read the RELATIONSHIP section on the Information
Sheet.
How is this person related to Person 1? Mark K
J ONE box.
I
o
2.
Some other race – Print race or origin. C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
§,z"\¤
8.
Does this person usually live or stay somewhere else, other
than this location?
Yes
No – Skip to the next person, if there is another person.
9.
What is the full address of the place where this person lives
or stays most of the time?
ip
Address Number (For example: 5007)
ns
h
Street Name (For example: N Maple Ave)
ze
Apt/Unit (For example: Apt A or Lot 3)
iti
Rural Route Address (if there is no street address)
ZIP Code
o
State
C
City
➜ NOTE: Please provide a location description if there is no address
D
ra
ft:
N
or if this is a facility.
➜ If needed, continue with the next person on another
Continuation Questionnaire (D-CQ-TLRA) and update
the number of continuation questionnaires on page 1
of both D-Q-TLRA and D-CQ-TLRA questionnaires.
15
11890159
§,z"d¤
iti
ze
ns
h
ip
OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx
D
ra
ft:
N
o
C
This page intentionally left blank.
16
11890167
| File Type | application/pdf |
| File Modified | 2019-02-08 |
| File Created | 2019-01-23 |