SC-RQ Reinterview Questionnaire (English)

Special Census Program

DRAFT_Reinterview Questionnaire_SC-RQ_100722n

Special Census Program

OMB: 0607-0368

Document [pdf]
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§8,?-¤

OMB No. XXXX-XXXX

Special Census
Reinterview Questionnaire

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

REINTERVIEW
Ask questions 1-7 during reinterview.

1. Hello, I’m (name) from the U.S. Census Bureau (show ID).
May I speak to (original respondent name)?
Yes
No – Ask when the original respondent will be available. If
unable to interview the original respondent, interview a
knowledgeable proxy.

2. I’m contacting you to check on the quality of our Special
Census interview. It should take less than 10 minutes.
Were you recently interviewed for the Special Census
about (address)?

ORIGINAL RESPONDENT INFORMATION

Yes

Use original questionnaire to complete OR1 - OR4.

OR1.

Original Respondent’s Name

No – Conduct a full interview using the SC-Q questionnaire.
MI

Don’t know – Conduct a full interview using the SC-Q
questionnaire.

T

First Name

3.

Did anyone live or stay at (address) on (Special Census
Day)?

AF

Last Name(s)

Yes – SKIP to question 5.

Original Respondent Telephone Number
–

OR3.

–

Original Respondent Type

No

4.

On (Special Census Day), was this unit

R

OR2.

Vacant? – End reinterview.

D

Lived or stayed in this [house/apartment/mobile home] on
(Special Census Day)
Moved into this [house/apartment/mobile home] after
(Special Census Day)

Did not live or stay in this [house/apartment/mobile home]
(neighbor or other proxy)

OR4.

Address of Neighbor or Proxy

Not a housing unit – End reinterview.

5.

We need to count people where they live and sleep most
of the time. (Hand respondent an Information Sheet.) Please
read the WHO TO COUNT section on the Information
Sheet. Based on these instructions, how many people
were living or staying in this [house/apartment/mobile
home] on (Special Census Day)?
Number of people =

6. Were there any additional people staying here on
(Special Census Day) that you did not include in the count
in the previous question? For example:
Mark I
K all that apply. Include any additional people on
J
the next page.
Children, related or unrelated, such as newborn babies,
grandchildren, or foster children
Relatives, such as adult children, cousins, or in-laws
Nonrelatives, such as roommates or live-in babysitters
People staying here temporarily
No additional people
FORM

SC-RQ

23113012

(10-07-2022) Notional Draft D4

§8,?5¤
7.

I need to make a list of the people who lived or stayed at (address) on (Special Census Day). Please tell me your name first
and then the names of everyone else who was living or staying here on (Special Census Day).
First Name

MI

Last Name(s)

1.
2.
3.
4.
5.
6.
7.
8.

10.

T

9.

REINTERVIEW RECORD OF CONTACT
Month

In-Person

Day

Hour

Minute

/

:

Telephone
Month
In-Person

Day

Hour

/

Type

In-Person

p.m.

Telephone

Outcome

In-Person

Hour

/

:

Outcome

OUTCOME CODES: NV = Left Notice of Visit

In-Person

p.m.

Telephone

NC = No Contact

/

Minute

RE = Refusal

Outcome
a.m.

:

p.m.
Day

Hour

/

Minute

Outcome
a.m.

:

p.m.

Month

a.m.

D

Telephone

Minute

Hour

Telephone

R

Day

Day

Month

p.m.

Month

Month

a.m.

a.m.

:

Telephone
In-Person

Minute

Outcome

AF

Type

Day

Hour

/

CI = Conducted Interview

Minute

Outcome
a.m.

:

p.m.

OT = Other

CERTIFICATION

I certify that the entries I have made on this questionnaire are true and correct to the best of my knowledge.
Field Representative’s Signature

Month

Day

Employee ID

Year

Field Supervisor
Initials

FSA Number

Month

Year

Day

REINTERVIEW STATUS
If you select "Defer to Supervisor" write a detailed reason for deferring this RI in the
NOTES section of this form.
Clerk Office Review - Initial ᇉ

Pass

Defer to Supervisor

Supervisor Review - Final ᇉ

Pass

Soft Fail

Month

Hard Fail

Notes:

FORM SC-RQ (09-26-2022)

Clerk Initials

23113020

Non-interview

Day

Year


File Typeapplication/pdf
File TitleSC_RQ_23_p01.pdf
AuthorOneFormUser
File Modified2022-10-07
File Created2022-09-26

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