SC-CQ-TL Transitory Unit Continuation Questionnaire (English)

§8)?2¤

OMB No. XXXX-XXXX

Special Census Transitory Unit
Continuation Questionnaire

U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU

Enter the 12-digit Case ID number for this household. This number is found below the SC-Q-TL barcode label.
–

FOR NPC
USE ONLY

–

SCID

State

of

questionnaire(s)

T

Questionnaire

D

R

AF

Unit/Site Number

TL Name

TL Block

TL Tract

AA

Copy transitory unit
information and TL Name
from the Transitory Location
Listing Sheet (SC-693.2)➜

County

CONTINUATION QUESTIONNAIRE
FOR SPECIAL CENSUS
TRANSITORY UNITS

FORM

SC-CQ-TL

23083017

(10-07-2022) Notional Draft

§8)?:¤
1. What is the name of

Person

6.

?

Print name below and verify the spelling.
First Name

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J

MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

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

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Japanese

Chamorro

T

2.

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

Asian Indian

AF

3.

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

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

Female

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

Some other race – Print race or origin. C

R

4. What was this person’s age on (Special Census Day)? 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.

years

Print numbers in boxes.
Month
Day
Year of birth

D

Age on (Special Census Day)

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

5.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.

2

23083025

§8)?B¤
1. What is the name of

Person

6.

?

Print name below and verify the spelling.
First Name

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J

MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

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

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Japanese

Chamorro

T

2.

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

Asian Indian

AF

3.

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

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

Female

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

Some other race – Print race or origin. C

R

4. What was this person’s age on (Special Census Day)? 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.

years

Print numbers in boxes.
Month
Day
Year of birth

D

Age on (Special Census Day)

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

5.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.

3

23083033

§8)?J¤
1. What is the name of

Person

6.

?

Print name below and verify the spelling.
First Name

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J

MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

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

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Japanese

Chamorro

T

2.

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

Asian Indian

AF

3.

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

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

Female

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

Some other race – Print race or origin. C

R

4. What was this person’s age on (Special Census Day)? 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.

years

Print numbers in boxes.
Month
Day
Year of birth

D

Age on (Special Census Day)

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

5.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.

4

23083041

§8)?[¤
1. What is the name of

Person

6.

?

Print name below and verify the spelling.
First Name

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J

MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

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

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Japanese

Chamorro

T

2.

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

Asian Indian

AF

3.

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

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

Female

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

Some other race – Print race or origin. C

R

4. What was this person’s age on (Special Census Day)? 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.

years

Print numbers in boxes.
Month
Day
Year of birth

D

Age on (Special Census Day)

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

5.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.

5

23083058

§8)?c¤
1. What is the name of

Person

6.

?

Print name below and verify the spelling.
First Name

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J

MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

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

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Japanese

Chamorro

T

2.

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

Asian Indian

AF

3.

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

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

Female

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

Some other race – Print race or origin. C

R

4. What was this person’s age on (Special Census Day)? 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.

years

Print numbers in boxes.
Month
Day
Year of birth

D

Age on (Special Census Day)

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

5.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.

6

23083066

§8)?k¤
1. What is the name of

Person

6.

?

Print name below and verify the spelling.
First Name

Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J

MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Last Name(s)

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

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

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

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Japanese

Chamorro

T

2.

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

Asian Indian

AF

3.

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

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

Female

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

Some other race – Print race or origin. C

R

4. What was this person’s age on (Special Census Day)? 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.

years

Print numbers in boxes.
Month
Day
Year of birth

D

Age on (Special Census Day)

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

5.

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If needed, continue with the next person on another
Continuation Questionnaire (SC-CQ-TL) and update
the number of continuation questionnaires on page 8
of the SC-Q-TL and page 1 of the SC-CQ-TL
questionnaires.

7

23083074

AF

T

§8)?s¤

D

R

This page intentionally left blank.

8

23083082

OMB No. XXXX-XXXX