GQ Enumeration Materials

Special Census Program

GQ Enumeration Materials

OMB: 0607-0368

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Draft 2 (8-12-2022)

DC
FOR
PARA

La Oficina del Censo está realizando el Censo Especial.
Para garantizar la precisión de este censo, es
importante que todos sean contados. Por favor,
complete el cuestionario del censo adjunto. Ponga el
cuestionario completado en este sobre y ciérrelo.

The Census Bureau is conducting the Special Census.
To ensure the accuracy of this census, it is important
that everyone be counted. Please complete the
enclosed census questionnaire. Put the completed
questionnaire in this envelope and seal.

SU RESPUESTA AYUDA A SU COMUNIDAD.

YOUR RESPONSE HELPS YOUR COMMUNITY.

Return To:

Entregar a:

Return By Date:

Entréguelo antes
de esta fecha:

DO NOT MAIL. Return as instructed.

For Oﬃcial Use Only
Para uso oﬁcial solamente

SC-E-GE(E/S) (8-2022)

Envelope 9 x 12 with no window

NO LO ENVÍE POR CORREO. Envíelo como se indica.

AF
T
R
D

Your Answers Are Confidential.

Sus respuestas son confidenciales.

The U.S. Census Bureau is required by law to protect your informaon
(Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to
publicly release your responses in a way that could identify anyone. We
are conducting the Special Census under the authority of Title 13, U.S.
Code, Section 196. By law, the Census Bureau can only use your
responses to produce statistics. For more informaon about how we
protect your information, please visit our Web site at census.gov and
click on "Data Protection and Privacy Policy" at the boom of the
home page.

La Oficina del Censo de los EE. UU. está obligada por ley a proteger su
información (Sección 9 del Título 13 del Código de los EE. UU.). A la
Oﬁcina del Censo no se le permite divulgar sus respuestas de manera
que nadie pudiera ser identificado. Estamos realizando el Censo
Especial en conformidad con las Sección 196 del Título 13 del Código
de los EE. UU. Por ley, la Oﬁcina del Censo solo puede usar sus
respuestas para producir estadísticas. Para obtener más información
sobre cómo protegemos su información, visite nuestro sio web
census.gov y haga clic en “Data Protecon and Privacy Policy” (Normas
de protección de datos y privacidad) en la parte inferior de la página
principal.

Thank you for your cooperation. The Census Bureau appreciates your
help.

Gracias por su cooperación. La Oficina del Censo agradece su ayuda.

SC-E-GE(E/S) (BACK)

OMB No.

DC
U.S. Census Bureau
Washington, DC 20233-0001
Oﬃce of the Director

To Facility Manager:
The U.S. Census Bureau is conducting a Special Census and we need your help to count everyone by providing
basic information about all the people living or staying at this facility. The Special Census includes people who
live or stay in group quarters, such as college or university residence halls, nursing/skilled-nursing facilities,
group homes, residential treatment centers, workers’ group living quarters, and correctional facilities.

R
AF

A Census Bureau worker will contact you soon to:
• Verify the name of this facility, its address, phone number, and business email address.
• Collect information about the residents who live, stay, or receive services at your facility.
• Schedule an enumeration appointment.
• Answer any questions you may have about the Special Census.
Your participation in the Special Census is voluntary, but extremely important. The informaon the Special Census
receives from you ensures the completeness and accuracy of the results. Tribal, state, and local governments use
census data to make a wide variety of decisions to improve their communities.
The Census Bureau collects data in compliance with privacy rules and regulations. The Health Insurance
Portability and Accountability Act of 1996 (HIPAA) permits a covered entity to disclose protected health
information to the Census Bureau to the extent required by Title 13.

The Census Bureau collects data in compliance with the Family Educational Rights and Privacy Act (FERPA). For
students who do not respond, FERPA permits colleges and universities to disclose appropriately designated
directory information from students’ education records to the Census Bureau without the consent of the
student. Depending on the institution’s directory information policy, directory information could include a
student’s name, date of birth, address, and dates of attendance. For questions about this permitted disclosure
under FERPA, school officials may email .
The Census Bureau is required by law to protect this information (Title 13, U.S. Code, Section 9). The Census
Bureau is not permitted to publicly release your responses in a way that could identify anyone. We are conducting
the Special Census under the authority of Title 13, U.S. Code, Section 196. By law, the Census Bureau can only use
responses to produce statistics.
Thank you for your cooperation, and we look forward to working with you.
Sincerely,

Robert L. Santos
Director

census.gov

SC-LFM-GE(E/S)

Draft (09-26-2022)

Núm. de OMB No.

DC
U.S. Census Bureau
Washington, DC 20233-0001
Oﬃce of the Director

Estimado(a) Administrador(a) de esta instalación:
La Oficina del Censo de los EE. UU. realiza un Censo Especial y necesitamos su ayuda para contar a todos en los
Estados Unidos al proveer información básica sobre todas las personas que viven, se quedan o reciben servicios
en esta instalación. Para el Censo Especial, necesitamos incluir a las personas que viven o se quedan en
alojamientos de grupo, tales como residencias universitarias, hogares de ancianos o centros de atención médica
especializada, hogares de grupo, centros de tratamiento residenciales, alojamientos de grupo para trabajadores e
instalaciones correccionales.

Un empleado de la Oficina del Censo se comunicará con usted para:
• Verificar erificar el nombre de esta instalción, la información de la dirección, el número de teléfono y la
dirección de correo electrónico de la empresa.
• Reecopilar información sobre los residentes que viven, se quedan o reciben servicios en su instalación.
• Hacer o confirmar una cita para la enumeración.
• Responder a cualquier pregunta que usted pueda tener sobre el Censo Especial.

Su participación en el Censo Especial es voluntaria, pero sumamente importante. La información que el Censo
Especial recibe de usted garantiza que los resultados estén completos y sean precisos. Los gobiernos tribales,
estatales y locales usan los datos del censo para tomar una amplia variedad de decisiones a fin de mejorar sus
comunidades.

La Oficina del Censo recopila datos conforme a las reglas y regulaciones de privacidad. La Ley de Portabilidad y
Responsabilidad de Seguros de Salud de 1996 (HIPAA, por sus siglas en inglés) permite que una entidad cubierta
revele información protegida sobre la salud a la Oficina del Censo en la medida que lo requiera el Título 13.
La Oficina del Censo recopila información en cumplimiento con la Ley de Derechos Educacionales y Privacidad de las
Familias (FERPA, por sus siglas en inglés). Para los estudiantes que no respondan, FERPA permite a las universidades
divulgar información de directorio de los archivos de los estudiantes designada según corresponda a la Oficina del
Censo sin el consentimiento previo de los estudiantes. Según la norma de la institución, la información de directorio
puede incluir el nombre, la fecha de nacimiento, la dirección y fechas de asistencia de un estudiante. Para
preguntas acerca de esta divulgación permitida por FERPA, los funcionarios de la escuela pueden enviar un correo
electrónico a .
La Oficina del Censo está obligada por ley a proteger su información (Sección 9 del Título 13 del Código de los EE.
UU.). A la Oficina del Censo no se le permite divulgar sus respuestas de manera que usted o su hogar pudieran ser
identificados. Estamos realizando el Censo Especial en conformidad con la Seccion 196 del Título 13 del Código de
los EE. UU. Por ley, la Oficina del Censo solo puede usar sus respuestas para producir estadísticas.
Gracias por su cooperación, y esperamos poder trabajar con usted.
Atentamente,

Robert L. Santos
Director
census.gov

SC-LFM-GE(E/S)

Draft (09-26-2022)

Draft 4 (9-23-2022)

FORM

SC-116 (9-23-2022)

OMB NO. xxxx-xxxx Approval Expires:
xx/xx/xxxx
U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU

GROUP QUARTERS CONTROL RECORD
Special Census
THIS LISTING CONTAINS INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C.

H. Zip Code: C

State: C

Barcode placeholder

Words deleted after design approval
I.

County: C

AA: C

L. Tract: C

Block: C

Location Description: C

Building Name: C

Building Number: C

GQ Type Code: C

A. Case ID:C

B. SCID/GU Name: C
Map Spot: C

C. GQ Name: C

D. Facility Name: C

Street Address: C

City: C

Section A – Group Quarters Facility Contact Information
Conﬁrm, update or collect the GQ Contact information. (Complete Items 1 to 3)
Question 1, SC-351

Question 2, SC-351

1. Contact Name:

2. Contact Title:
Cell

3. Telephone Number(s), including
area code and extension:

(

)

–

Ext.

Home/Other

(

–

)

Section B – Group Quarters Information
Question 3, SC-351

Question 4, SC-351

8. Is GQ Type
Code correct?

4. GQ Name:

1
2

YES
NO

New GQ
Type Code:

(Only MINOR spelling corrections are allowed)
Question 5, SC-351

5. Street Name:

9. Max Pop:
Question 6, SC-351

6. Facility Name:
7. Potential Duplicate:

YES

GQ operating on
10. Special Census Date: 1

Continued on next page

YES

Don’t know

Section B – Group Quarters Information – Continued
Question 7, SC-351

Question 8, SC-351

11. Expected Pop:

12. 1

Male

Female

Both
Question 9b, SC-351

Question 9a, SC-351

13. Records with requested information:

YES

14. Type of Records:

Paper

Computer

Both

Question 9c, SC-351

15. Records available to Census worker:
Question 10a and 10b, SC-351

16. Enumeration Method:

Administrative Records

In Person Interview

Drop Off/Pick Up

Question 11, SC-351

17. Approximate number of persons at TNSOL:
Question 12, SC-351

18. Other Languages:

①

YES (List Languages)

②

Question 13, SC-351

19. Specific instructions
Question 14, Questions
15b and 15e, SC-351

Month/Day/Year

20. Enumeration Appointment:
Question 15a, SC-351

Question 15b, SC-351

22. Client arrival time:

Time

am
pm

am
pm
Time

am
pm

Time

21a. Shelter Opening Time:

Time

Question 15c, SC-351

Time

23. Latest time clients can enter shelter:

Question 15d, SC-351

am
pm

21b. Shelter Closing Time:

am
pm

Question 16a, SC-351

24. Procedures when clients enter
the shelter C

25a. Enumeration contact same as facility contact: 1

YES 2

Contact name
Contact title
Contact phone No.
Question 16b, SC-351

(

–

)

Question 17, SC-351

25b. Staff helping with enumeration?

YES 2

26. GQ Contact responsible for additional locations?

1
2

YES
NO

27. Status code for the GQAC interview (Select one):
1

Complete

Cannot Locate

Closed on Special Census Day

Housing Unit

Demolished/Burned Out

Transitory Location

Duplicate Survivor ID #

Uninhabitable (Open to the Elements/
Condemned/Under Construction)

Out of Enumeration Area

Refusal

Dangerous Address

Nonresidential

Military or Maritime Vessel

Unresolved (Cannot reach by phone)

Notes

Page 2

Continued on next page

FORM SC-116 (9-23-2022)

Section C – Enumeration Information
Month/Day/Year

Print Field Representative’s Name

28. Assigned to

29. Date Assigned:

Month/Day/Year

30. Date Enumeration completed:

31. Total ICQs:

(Total Pop)

Certiﬁcation
Field Representative – I certify that the entries made on this form are true and correct to the best of my knowledge.
32. Field Representative Signature

33. Date Signed

For Supervisory Use Only
34. Zero Pop. reason (Mark (X) only ONE):
1

Refusal

Nonresidential

Duplicate Survivor ID #

Occupied As of Special Census Day but no one there as of Enumeration Date

Military or Maritime Vessel

Dangerous Address

Out of Enumeration Area

Demolished/Burned Out

Cannot Locate

Uninhabitable (Open to the Elements/Condemned/Under Construction)

For SCO Use Only
35. Our records show our Census Field Representative visited your facility on
(transcribe date from Item 20 above) to count your residents/clients. Is this correct?
1

YES (Go to item 36.)

NO – Thank the respondent
and end the interview. Record response hereC

I don’t know (Go to item 36.)

36. What is the approximate number of residents/clients you think were counted as a result of that visit? This
number might be different than the maximum number of persons you could have at at your facility.
Number of residents/clients

I don’t know

37. SCO Clerk Signature:
Month/Day/Year

39. Date Signed:

38. Clerk ID:

For Supervisor Use Only – RI Result
1

Pass

Soft Fail

Hard Fail

Non-Interview

Notes

FORM SC-116 (9-23-2022)

Page 3

Draft 1 (9-13-2022)

Page

Pages

OMB No. xxx-xxxx Approval Expires XX/XX/XXXX

THIS LISTING CONTAINS INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C.
U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU

GROUP QUARTERS CONTROL RECORD
CONTINUATION PAGE
Special Census
SECTION D: List of Residents/Clients for Enumeration Continuation Page
Room/Bed Number

Person Name

(1)

FORM

(2)

Participant Number

Checked in
Mark (X) if received

(3)

(4)

Barcode ID

Case ID

GQ Name

SCID/GU Name

Field Representative Name

Supervisor Name

Block

Tract

Map Spot

SC-116(CP)

(9-13-2022)

Mark (X) one
(5)

Incomplete

Complete

SECTION D: List of Residents/Clients for Enumeration Continuation Page
Room/Bed Number
(1)

Page 2

Person Name
(2)

Participant Number
(3)

Checked in
Mark (X) if received
(4)

Mark (X) one
(5)

Incomplete

Complete

FORM SC-116(CP) (9-13-2022)

FORM SC-351

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

SPECIAL CENSUS

GROUP QUARTERS ADVANCE CONTACT

R
AF

SCRIPT

FORM SC-351

301
401
402
403
404
405
501
502
601
602
701
702
704
706
703
801
802
900
901
902
903
999

201
202
203

R
AF

101
102
103
104
105
106

GQ Type Codes and Descriptions
Description
Correctional Facilities for Adults
Federal Detention Centers
Federal Prisons
State Prisons
Local Jails and Other Municipal Confinement Facilities
Correctional Residential Facilities
Military Disciplinary Barracks and Jails
Juvenile Facilities
Group Homes for Juveniles (non-correctional)
Residential Treatment Centers for Juveniles (non-correctional)
Correctional Facilities Intended for Juveniles
Nursing Facilities/Skilled-Nursing Facilities
Nursing Facilities/Skilled-Nursing Facilities
Other Institutional Group Quarters
Mental (Psychiatric) Hospitals and Psychiatric Units in Other Hospitals
Hospitals with Patients Who Have No Usual Home Elsewhere
In-Patient Hospice Facilities
Military Treatment Facilities with Assigned Patients
Residential Schools for People with Disabilities
College/University Student Housing
College/University Student Housing (owned/leased/managed by a college/university)
College/University Student Housing (owned/leased/managed by a private company/agency)
Military Quarters
Military Quarters
Military Ships**
Service-Based Enumeration (SBE)
Emergency and Transitional Shelters (with Sleeping Facilities) for People Experiencing Homelessness
Soup Kitchens
Regularly Scheduled Mobile Food Vans
Targeted Non-Sheltered Outdoor Locations
Other Non-Institutional Group Quarters
Domestic Violence Shelters**
Group Homes Intended for Adults (non-correctional)
Residential Treatment Centers for Adults (non-correctional)
Maritime/Merchant Vessels**
Workers’ Group Living Quarters and Job Corps Centers
Religious Group Quarters
Living Quarters for Victims of Natural Disaster
Unknown

Code

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

* Special procedures required
**Note: Not part of Special Census operations

Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

1. Hello. My name is (Your name). May I speak with (Say the contact’s name located on the SC-116)? I am
from the U.S. Census Bureau. We are conducting a special census for this area. I need to talk with someone
about this facility and to schedule an appointment to count your residents/clients. Are you the contact
person for this location?
If this person is still serving as the contact person, verify their phone number and title as shown on the SC-116.
If their phone number or title has changed, enter the Items 2 and 3 on the SC-116.
If the contact person has changed, ask for the right person. Once you are speaking with the right person, repeat
the introduction and enter their information in the spaces provided in Items 1,2 and 3 on SC-116.
Go to QUESTION 2.
2. We estimate this interview will take approximately 15 minutes.
Before we start, this is our confidentiality statement.

R
AF

(If this is a phone interview, read the statement as shown below. If this is an in-person interview, hand
the contact person a copy of the Confidentiality Notice – SC-CN(E/S) and allow them time to read it.)
The U.S. Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The
Census Bureau is not permitted to publicly release your responses in a way that could identify you or your
household. We are conducting the Special Census under the authority of Title 13, U.S. Code, Section 196. By
law, the Census Bureau can only use your responses to produce statistics.

Title 13 of the U.S. Code protects the confidentiality of all your information. Violating the conﬁdentiality of
a respondent is a federal crime with serious penalties, including a federal prison sentence of up to five years,
a fine of up to $250,000, or both. Only authorized individuals have access to the stored data, and the
information you provide to the Census Bureau may only be used by a restricted number of authorized
individuals who are sworn for life to protect the conﬁdentiality of your individual responses. Your answers
cannot be used against you by any government agency or court.
For more information about how we protect your information, please visit our Web site at census.gov and
click on "Data Protection and Privacy Policy" at the bottom of the home page. This page also includes
information about the collection, storage, and use of these records. Click on "System of Records Notices
(SORN)" and look for Privacy Act System of Records Notice COMMERCE/CENSUS-3, Special Censuses,
Surveys, and Other Studies.
Although the individual responses are voluntary, the information the Special Census receives from you
ensures the completeness and accuracy of the results. Tribal, state, and local governments use census data to
make a wide variety of decisions to improve their communities. The Census Bureau estimates that
completing the questionnaire will take 10 minutes on average.
Thank you for your cooperation. The Census Bureau appreciates your help.
Go to QUESTION 3.

1
1/26/22

Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

3. Now I am going to read you a summary of the group quarters information I have. Please let me know if
anything is incorrect, or if any information is missing.
(Read all the information for the GQ on the top of the SC-116 and/or information handwritten on the SC-116 to
the contact person, spelling the GQ Name, Facility Name, and Street Name, Location Description, Building
Name or Building number.
If GQ or Facility Name is incorrect or missing, make changes in the Items 4 and 6 on the SC-116. The only
other change you can make are minor misspellings of Street Name and you update that in Item 5. Go to
Question 4.
If no updates to the street name or only minor misspellings of the street name, mark ‘No’ for ‘Potential
Duplicate’ in Item 7 and then go to QUESTION 4.
If any of the other address fields have changed or there are major changes to the street name, complete an
INFO-COMM to collect the new information. End the interview with the following:

We will check to see if your new location is in the Special Census area. Mark ‘Yes’ for ‘Potential Duplicate’
in Item 7 for this address and then skip to QUESTION 19.

R
AF

NOTE: If the case is a military GQ, you must write or update the military installation name in the Facility
Name field.
4. We currently have the group quarters at this address identified as the following:
Read the GQ Type description from the “GQ Type Code Job Aid” for the GQ Type code shown at the top of the
SC-116. Is that correct? Mark the appropriate answer in Item 8 on the SC-116 and follow the instructions
below based on the answer given.

Yes, go to Question 5.

No, different GQ Type: Use “GQ Type Code Job Aid” to update GQ Type Code.
Write the new type code chosen from the job aid in Item 8 of the SC - 116 and then go to Question 5:
If the GQ Type Code is 706, Targeted Nonsheltered Outdoor Locations, go to Question 11.
If not an GQ or this location is a Domestic Violence Shelter/Military or Maritime Vessel, follow the instructions
below based on status of the address.
DVS or Military/Maritime Vessel: Then end the interview by saying:
Thank you very much for your time and participation. This is the all the information I need.
Then go to Item 27 and mark the appropriate status code. NOTE: Use 27a for the phone interview and 27b
for the in-field interview.
Transitory Location: End the interview by saying:
Thank you very much for your time and participation. This is the all the information that I need.
Someone from the Census office will contact you to complete an interview for this specific location.

2
1/26/22

Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

Write down all the information you have about the TL on an INFO-COMM and provide it to your
supervisor. Then go to Item 27 and mark the appropriate status code. NOTE: Use 27a for the phone
interview and 27b for the in-field interview.
Housing Unit: End the interview by saying:
Thank you very much for your time and participation. This is the all the information I need. We will
send a Special Census worker to conduct an in-person interview for each person who was living or staying at
this location on the Special Census Day.
Then go to Item 27 and mark the appropriate status code. NOTE: Use 27as for the phone interview and 27b
for the in-field interview.
Nonresidential Then end the interview by saying: Thank you very much for your time and participation.
This is the all the information I need.

Then go to Item 27 and mark the appropriate status code. NOTE: Use 27a for the phone interview and 27b
for the in-field interview.

R
AF

5. What is the maximum number of people who can live or stay here at this group quarters?
Write the contact’s answer in Item 9 on the SC-116. Remember if the:

•
•

GQ Type Code is 501, 502, 701, 801, 802, 901, 902 and 903, the max pop must include any staff who live
or stay at the GQ.
GQ Type is 901, and the GQ is a separate staff quarter, the max pop includes staff only.
GQ Type is 901 and the GQ is a Job Corp Centers, Workers Group Living Quarters, or vocation
training facility, the max pop includes staff and residents in the maximum number.

Go to QUESTION 6.

•

6. Will this facility be operating on (Special Census Date)? Mark the appropriate answer in Item 10.
Yes, go to QUESTION 7.
No. Then say: This facility will not be counted during the Special Census. Someone from the Special Census
Office may contact you by telephone to verify that we spoke with you about counting the people residing
in this facility. Enter 0 into Expected Pop in Item 11 of the SC-116. Skip to QUESTION 17.
Don’t Know Go to QUESTION 7.

7. What is the expected population at this facility on (Special Census Date)? If you do not know the exact
number right now, please provide an estimate. Enter the answer in Item 11 on the SC-116.

3
1/26/22

Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

•
•
•

GQ Type Code is 501, 502, 701, 801, 802, 901, 902 and 903: include any staff who live or stay at the GQ
in this number.
GQ Type is 901, and the GQ is a separate staff quarter, include in the expected pop number staff only.
If GQ Type is 901 and the GQ is a Job Corp Centers, Workers Group Living Quarters, or vocation
training facility, include staff and residents in the expected pop number.

Expected pop cannot be greater than Max Pop in Item 9. If it is greater, change the max pop to equal the expected
pop.
Go to QUESTION 8.

8. Does this group quarters serve males only, females only, or both males and females?
Mark the appropriate box in Item 12 on the SC-116 and then go to QUESTION 9a.

9a. Does your facility keep records that provide demographic information such as age, race, Hispanic
origin, and/or sex of your residents and/or clients? (Note: If the contact person has most of these items, mark
Yes below.)

R
AF

Mark the appropriate box in Item 13 on the SC-116. Based on the answer, go to the next appropriate question.
NOTE: If the Facility contact says they only have some of the information, that is acceptable.
Yes – Go to Question 9b.
No - Go to Question 10b.

Paper
Computer
Both

9b. Are these paper records, computer records, or both?
Mark the appropriate box in Item 14 on the SC-116 and then go to Question 9c.

9c. If requested, could you make these records available to the Special Census worker?
Mark the appropriate box in Item 15 on the SC-116. Based on the answer, go to the next appropriate question.
Yes -Go to Question 10a.
No -Go to Question 10b.
10a. Since you have records or a listing of your clients/residents you are willing to share with the Special
Census worker, you can select from the following enumeration methods.
Administrative Records.
A Special Census worker will visit your facility and using your records, fill out a separate Census
questionnaire for each person that was served or stayed at your facility on the (Special Census Date).
In-Person Interview

4
1/26/22

Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

You will need to provide a list of persons who were served or stayed at your facility on the (Special
Census Date). The Special Census worker will conduct a face-to-face, in-person interview with each
person on your list.
Drop Off/Pick Up of Questionnaire

You will need to provide a list of persons who were served or stayed at your facility on the (Special
Census Date). A Special Census worker will leave census questionnaires with you to distribute to each
person who was staying at this facility on the (Special Census Date). You will be sure that each person
completes and returns the questionnaires, and then a Special Census worker will pick up the completed
questionnaires from the you at an agreed-upon time.
Mark the appropriate Enumeration Method in Item 16 on the SC-116. Go to Question 12.
10b. Since you do not have a listing or do not want to share a listing with all the information, you can select
from the following enumeration methods.

In-Person Interview

R
AF

Drop Off/Pick Up of Questionnaire

Mark the appropriate Enumeration Method in Item 16 on the SC-116. Go to Question 12.
11. Approximately, how many people will be here on (Special Census Date) from 12:00 midnight to 6:00
am?
Enter the number given in Item 17 on the SC-116.Go to Question 12.
12: Are there any people at this location that do not speak or understand English?
Mark the appropriate answer in Item 18 on the SC-116and follow the instructions below.
Yes, then ask: What languages do they speak? List the languages in Item 18 on the SC-116. For example,
Spanish, Vietnamese, Korean, etc
No

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Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

Go to Question 13.
13. Are there any specific instructions that the Special Census workers need to know in order to count the
people at this location? (For example, if need to enter a certain door, stay in one area during the counting
process, parking options.)
Yes, list the instructions in Item 19 on the SC-116,
No
If the GQ Type Code is:
-- 701, Emergency and Transitional Shelters, go to Question 15a.
--706, Targeted Nonsheltered Outdoor Locations, mark ‘In Person’ for Enumeration Method and go to
Question 18.
All other GQ Type Codes, go to Question 14.

14. What is the best date and time for us to conduct the interviews at this location between (Special Census

Dates)? Enter the date and time in Item 20 on the SC-116 and circle ‘am’ or ‘pm’ as appropriate.

R
AF

Go to Question 16a
15a. What time does the shelter open and close for clients? Enter the times in Item 21a and 21b on the SC116 and circle ‘am’ or ‘pm’ as appropriate.
Go to Question 15b.

15b. How early do the clients arrive? Enter the time in Item 22 and Item 20 on the SC-116 and circle ‘am’ or
‘pm’ as appropriate.

Go to Question 15c.

15c. What is the latest time clients can enter the shelter? Enter the time in Item 23 on the SC-116 and circle
‘am’ or ‘pm’ as appropriate.
Go to Question 15d.
15d. What are the general procedures clients follow when they enter the shelter? Enter the answer in Item
24 on the SC-116.
Go to Question 15e.
15e. What is the best date for us to conduct the interviews at this location between (Special Census Dates)?
Enter the date in Item 20 on the SC-116.
Go to Question 16.
16a. When the Special Census worker comes to conduct the count, are you the person they should speak
with? Mark the appropriate answer in Item 25a and follow instruction based on the answer.
Yes - Go to Question 16b

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Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

No – Ask for the name of the person to contact as well as their title and phone number and enter the
information in Item 25a on the SC-116.
16b: Will you or a staff member be helping with the enumeration? Mark the appropriate answer in Item 25b.
Yes
No
Go to Question 17.
17. If GQ Type is 501, 502, 601,701, 801, 802, or 901-903, ask: Are you responsible for any additional
facilities, either at this address or elsewhere?
If GQ Type is 101-106, 201-203, 301, or 401-405, ask: Are you responsible for any additional facilities,
either at this address or elsewhere? Include workers group living quarters' that staff use as their usual
residence.
Mark the appropriate answer in Item 26 and follow instructions based on the answer.

R
AF

Yes Complete an INFO COMM for each additional facility. Be sure to ask that these addresses are NOT
housing units – you should only list potential group quarters.
NOTE: If contact tells you they are not responsible for other facilities but know their organization has other
facilities, document those on an INFO-COMM as well.
Once you have collected the information, say: We will check our current address file to see if we have these
facilities and will call you at another time to complete an interview for each one. Now let us continue.
No

If the GQ contact has facilities that will be enumerated, go to QUESTION 18.
If the GQ contact does not have facilities that will be enumerated, end the interview saying:
That is all the information I need. If you have any additional questions, please call the Special Census Office
at (Please provide the SCO telephone number).
Thank you very much for your time and participation.
18. Special Census workers will arrive at your facility at the scheduled date and time.
We ask that you let the residents/clients know that there will be a Special Census at that time and encourage
their cooperation. All data we collect are protected by law and kept confidential. Someone from the Special
Census staff will contact you before your appointment as a reminder and to discuss further details about
counting your residents. We appreciate your cooperation.
To learn more about our privacy policy and data protection, please visit our website at census.gov and click
on “Data Protection and Privacy Policy” at the bottom of the home page.

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Form SC-351
Special Census Group Quarters Contact Script
Special Census Group Quarters
________________________________________________________________________________________________

Go to QUESTION 19.
19. If you have any additional questions, call the Special Census Office at (Please provide the SCO telephone
number).
That is all the information I need. If we need further information, we may call you. Thank you very much
for your time and participation.

R
AF

Then go to Item 27 and mark the appropriate status code. NOTE: Use 27a is for the phone interview and
27b for the in-field interview.

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File Type	application/pdf
Author	OneFormUser
File Modified	2022-10-13
File Created	2022-10-13