Special Census Program

OMB No.

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

To Whom It May Concern:
The U.S. Census Bureau is conducng a Special Census and we need your help to count everyone. The Special
Census includes people who live or stay in nontraditional living situations such as RV parks, marinas,
campgrounds, racetracks, carnivals, and hotels/motels.
Please allow the Census Bureau interviewers access to your locaon so that they may aempt to speak with
people living or staying here. Census Bureau interviewers will work efficiently with minimal disruptions. Each
interview will take approximately 10 minutes.

R
AF

T

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 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.

Robert L. Santos
Director

D

Sincerely,

census.gov

SC-LFM-TL(E/S)

Draft (08-26-2022)

Núm. de OMB No.

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

A quien corresponda:
La Oficina del Censo de los EE. UU. realiza un Censo Especial y necesitamos su ayuda para contar a todos. El Censo
Especial incluye personas que viven o se quedan en situaciones de vivienda no tradicionales, tales como parques
para RV, marinas, áreas de acampar, hipódromos, ferias y hoteles/moteles.

R
AF

T

Por favor permita que los entrevistadores de la Oficina del Censo tengan acceso a su lugar para que puedan tratar
de hablar con las personas que están viviendo o quedándose aquí. Los entrevistadores de la Oficina del Censo
trabajarán de manera eficiente, causando molestias mínimas. Cada entrevista tomará aproximadamente 10
minutos.
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.

D

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.
Muchas gracias por su cooperación, y esperamos poder trabajar con usted.
Atentamente,

Robert L. Santos
Director

census.gov

SC-LFM-TL(E/S)

Draft (08-26-2022)

DC

Your Answers Are Confidenal

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 permied 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. Violang the confidenality 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 informaon 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.
Disclosure of the information provided to us is permitted under the Privacy Act of 1974 (Title 5, U.S. Code, Section 552a) and may be shared with other
Census Bureau staff for the work-related purposes. 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. Click on "System of Records Notices (SORN)" or visit
. This page also includes information about the collection, storage, disclosure and published
routine uses of Privacy Act System of Records Notice COMMERCE/CENSUS-3, Demographic Survey Collection (Census Bureau Sampling Frame) (name change
from COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other Studies, pending publication in the Federal Register).
Although the individual responses are voluntary, 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
estimates that completing the questionnaire will take 10 minutes on average.
Thank you for your cooperation. The Census Bureau appreciates your help.
This collection of information has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number
that appears at the bottom right of this notice confirms this approval. If this number were not displayed, we could not conduct the Special
Census. Send any comments concerning this collection by email to and use "Paperwork Reducon
Project XXXX-XXXX" as the subject.

Para ver esta información en español, véase al dorso. (For a copy of this information in Spanish, see the reverse side.)

SC-CN(E/S) (10-5-2022)

Draft 11

DC

OMB No. xxxx-xxxx

Your Answers Are Confidenal

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 permied 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. Violang the confidenality 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 informaon 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.
Disclosure of the information provided to us is permitted under the Privacy Act of 1974 (Title 5, U.S. Code, Section 552a) and may be shared with other
Census Bureau staff for the work-related purposes. 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. Click on "System of Records Notices (SORN)" or visit
. This page also includes information about the collection, storage, disclosure and published
routine uses of Privacy Act System of Records Notice COMMERCE/CENSUS-3, Demographic Survey Collection (Census Bureau Sampling Frame) (name change
from COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other Studies, pending publication in the Federal Register).
Although the individual responses are voluntary, 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
estimates that completing the questionnaire will take 10 minutes on average.
Thank you for your cooperation. The Census Bureau appreciates your help.
This collection of information has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number
that appears at the bottom right of this notice confirms this approval. If this number were not displayed, we could not conduct the Special
Census. Send any comments concerning this collection by email to and use "Paperwork Reducon
Project XXXX-XXXX" as the subject.

Para ver esta información en español, véase al dorso. (For a copy of this information in Spanish, see the reverse side.)

SC-CN(E/S) (10-5-2022)

Draft 11

OMB No. xxxx-xxxx

DC

Sus respuestas son confidenciales

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 usted o su hogar pudieran ser identificados. Estamos realizando el Censo Especial en conformidad con
la 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.
El Título 13 del Código de los EE. UU. protege la confidencialidad de toda su información. Violar la confidencialidad de una persona encuestada es un delito federal con
serias sanciones, incluyendo una condena de hasta cinco años en una prisión federal, una multa de hasta $250,000 o ambas. Solo personas autorizadas tienen acceso
a los datos recopilados, y la información que usted proporcione a la Oficina del Censo puede ser usada solamente por un número limitado de personas autorizadas
que han jurado de por vida proteger la confidencialidad de sus respuestas individuales. Sus respuestas no pueden ser usadas en su contra por ninguna agencia o
tribunal del gobierno.
La divulgación de la información que se nos proporciona está autorizada en conformidad con la Ley sobre la Privacidad de 1974 (Título 5, Código de los EE.
UU., Sección 552a). La información puede ser compartida con personal de la Oficina del Censo para fines relacionados con sus tareas. Para obtener más
información sobre cómo protegemos su información, visite nuestro sitio web en census.gov y haga clic en “Data Protecon and Privacy Policy” (Normas de
Privacidad y Protección de Datos) en la parte inferior de la página principal. Haga clic en “System of Records Notices (SORN)” (Avisos sobre el Sistema de
Registros) o visite . Esta página también incluye información sobre la recopilación, el
almacenamiento, la divulgación y los usos habituales publicados del Privacy Act System of Records Notice (Aviso sobre el Sistema de Registros de la Ley sobre la
Privacidad) COMMERCE/CENSUS-3, Demographic Survey Collection (Census Bureau Sampling Frame) (Recopilación de Encuestas Demográficas [Marco de
Muestreo de la Oficina del Censo]). Este es un cambio de nombre al anteriormente llamado COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other
Studies (Censos Especiales, Encuestas y Otros Estudios), y está pendiente de publicación en el Registro Federal.
Si bien las respuestas individuales son voluntarias, 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 calcula que completar el cuestionario tomará 10 minutos como promedio.
Gracias por su cooperación. La Oficina del Censo agradece su ayuda.
Esta recopilación de información ha sido aprobada por la Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés). El
número de aprobación de ocho dígitos de la OMB que aparece en la parte inferior derecha de este aviso confirma la aprobación. De no
mostrarse este número, no podríamos realizar el Censo Especial. Los comentarios sobre el cálculo de empo y esfuerzo o cualquier otro
aspecto relacionado deben dirigirse por correo electrónico a . Use "Paperwork Reduction Project
XXXX-XXXX" como asunto.

For a copy of this information in English, see the reverse side. (Para ver esta información en inglés, véase al dorso.)
SC-CN(E/S) (10-5-2022)

DC

Núm. de OMB xxxx-xxxx

Sus respuestas son confidenciales

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 usted o su hogar pudieran ser identificados. Estamos realizando el Censo Especial en conformidad con
la 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.
El Título 13 del Código de los EE. UU. protege la confidencialidad de toda su información. Violar la confidencialidad de una persona encuestada es un delito federal con
serias sanciones, incluyendo una condena de hasta cinco años en una prisión federal, una multa de hasta $250,000 o ambas. Solo personas autorizadas tienen acceso
a los datos recopilados, y la información que usted proporcione a la Oficina del Censo puede ser usada solamente por un número limitado de personas autorizadas
que han jurado de por vida proteger la confidencialidad de sus respuestas individuales. Sus respuestas no pueden ser usadas en su contra por ninguna agencia o
tribunal del gobierno.
La divulgación de la información que se nos proporciona está autorizada en conformidad con la Ley sobre la Privacidad de 1974 (Título 5, Código de los EE.
UU., Sección 552a). La información puede ser compartida con personal de la Oficina del Censo para fines relacionados con sus tareas. Para obtener más
información sobre cómo protegemos su información, visite nuestro sitio web en census.gov y haga clic en “Data Protecon and Privacy Policy” (Normas de
Privacidad y Protección de Datos) en la parte inferior de la página principal. Haga clic en “System of Records Notices (SORN)” (Avisos sobre el Sistema de
Registros) o visite . Esta página también incluye información sobre la recopilación, el
almacenamiento, la divulgación y los usos habituales publicados del Privacy Act System of Records Notice (Aviso sobre el Sistema de Registros de la Ley sobre la
Privacidad) COMMERCE/CENSUS-3, Demographic Survey Collection (Census Bureau Sampling Frame) (Recopilación de Encuestas Demográficas [Marco de
Muestreo de la Oficina del Censo]). Este es un cambio de nombre al anteriormente llamado COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other
Studies (Censos Especiales, Encuestas y Otros Estudios), y está pendiente de publicación en el Registro Federal.
Si bien las respuestas individuales son voluntarias, 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 calcula que completar el cuestionario tomará 10 minutos como promedio.
Gracias por su cooperación. La Oficina del Censo agradece su ayuda.
Esta recopilación de información ha sido aprobada por la Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés). El
número de aprobación de ocho dígitos de la OMB que aparece en la parte inferior derecha de este aviso confirma la aprobación. De no
mostrarse este número, no podríamos realizar el Censo Especial. Los comentarios sobre el cálculo de empo y esfuerzo o cualquier otro
aspecto relacionado deben dirigirse por correo electrónico a . Use "Paperwork Reduction Project
XXXX-XXXX" como asunto.

For a copy of this information in English, see the reverse side. (Para ver esta información en inglés, véase al dorso.)
SC-CN(E/S) (10-5-2022)

Núm. de OMB xxxx-xxxx

Draft 8 (10-05-2022)

SC-NV(E/S) (10-05-2022)

OMB No. xxxx-xxxx

DC

NOTICE OF VISIT

The Census Bureau is conducting a Special Census. I stopped by today to complete an
interview for your household, but you were not home. Please call me to discuss when we
can complete this interview. Otherwise, I may stop by again.

First Name

SC-NV(E/S) (10-05-2022)

OMB No. xxxx-xxxx

DC

NOTICE OF VISIT

The Census Bureau is conducting a Special Census. I stopped by today to complete an
interview for your household, but you were not home. Please call me to discuss when we
can complete this interview. Otherwise, I may stop by again.

MI

First Name

Last Name

MI

Last Name
(

Best me to call

From:

–
a.m.

To:

p.m.

a.m.
p.m.

(

Best me to call

From:

–
a.m.

To:

p.m.

a.m.
p.m.

Although the individual responses are voluntary, 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. For more information, please visit
https://www.census.gov/programs-surveys/specialcensus.html.

AF

Although the individual responses are voluntary, 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. For more information, please visit
https://www.census.gov/programs-surveys/specialcensus.html.

)–

Phone Number

T

)–

Phone Number

The Census Bureau estimates that completing the interview will take 10 minutes on
average. This collecon of informaon has been approved by the Office of
Management and Budget (OMB). The eight-digit OMB approval number XXXX-XXXX
confirms this approval. If this number were not displayed, we could not conduct the
Special Census.

The 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 conducng
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.

The 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 conducng
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.

Disclosure of the information provided to us is permitted under the Privacy Act of 1974
(Title 5, U.S. Code, Section 552a) and may be shared with other Census Bureau staff for
the work-related purposes. For more informaon about how we protect your
information, please visit our Web site at census.gov and click on "Data Protecon and
Privacy Policy" at the bottom of the home page. Click on "System of Records Noces
(SORN)" or visit . This
page also includes information about the collection, storage, disclosure and published
routine uses of Privacy Act System of Records Notice COMMERCE/CENSUS-3,
Demographic Survey Collection (Census Bureau Sampling Frame) (name change from
COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other Studies, pending
publication in the Federal Register).

Disclosure of the information provided to us is permitted under the Privacy Act of 1974
(Title 5, U.S. Code, Section 552a) and may be shared with other Census Bureau staff for
the work-related purposes. For more informaon about how we protect your
information, please visit our Web site at census.gov and click on "Data Protecon and
Privacy Policy" at the bottom of the home page. Click on "System of Records Noces
(SORN)" or visit . This
page also includes information about the collection, storage, disclosure and published
routine uses of Privacy Act System of Records Notice COMMERCE/CENSUS-3,
Demographic Survey Collection (Census Bureau Sampling Frame) (name change from
COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other Studies, pending
publication in the Federal Register).

D

R

The Census Bureau estimates that completing the interview will take 10 minutes on
average. This collecon of informaon has been approved by the Office of
Management and Budget (OMB). The eight-digit OMB approval number XXXX-XXXX
confirms this approval. If this number were not displayed, we could not conduct the
Special Census.

OFFICIAL USE ONLY
Case ID

SC-920, Address List Page

Base prints black (100%)

Line No.

SC-921, Add Page

Overlay prints purple #253 (10%, 20% and 100%)

OFFICIAL USE ONLY
Case ID

SC-920, Address List Page

Base prints black (100%)

Line No.

SC-921, Add Page

Overlay prints purple #253 (10%, 20% and 100%)

SC-NV(E/S) (10-05-2022)

Núm. de OMB xxxx-xxxx

DC

AVISO DE VISITA

La Oficina del Censo de los EE. UU. realiza un Censo Especial. Pasé por su casa hoy para
completar la entrevista para su hogar, pero usted no estaba. Por favor, llámeme para hablar
sobre cuándo podemos completar esta entrevista. De otro modo, es posible que regrese.

Nombre

Inicial

Núm. de OMB xxxx-xxxx

DC

AVISO DE VISITA

La Oficina del Censo de los EE. UU. realiza un Censo Especial. Pasé por su casa hoy para
completar la entrevista para su hogar, pero usted no estaba. Por favor, llámeme para hablar
sobre cuándo podemos completar esta entrevista. De otro modo, es posible que regrese.

Nombre

Apellido(s)

Inicial

Apellido(s)
(

Desde:

) –
a. m.

–

(

Número de teléfono
a. m.

Hasta:

p. m.

Mejor horario
para llamar

p. m.

) –
a. m.

–
Hasta:

p. m.

a. m.
p. m.

Si bien las respuestas individuales son voluntarias, 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. Para obtener más información, visite
https://www.census.gov/programs-surveys/specialcensus.html.

AF

Si bien las respuestas individuales son voluntarias, 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. Para obtener más información, visite
https://www.census.gov/programs-surveys/specialcensus.html.

Desde:

T

Número de teléfono
Mejor horario
para llamar

SC-NV(E/S) (10-05-2022)

La Oficina del Censo calcula que completar la entrevista tomará 10 minutos como promedio.
Esta recopilación de información ha sido aprobada por la Oficina de Administración y
Presupuesto (OMB, por sus siglas en inglés). El número de aprobación de ocho dígitos de la
OMB xxxx-xxxx confirma la aprobación. De no mostrarse este número, no podríamos realizar
el Censo Especial.

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.

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.

La divulgación de la información que se nos proporciona está autorizada en conformidad con
la Ley sobre la Privacidad de 1974 (Título 5, Código de los EE. UU., Sección 552a). La
información puede ser comparda con personal de la Oficina del Censo para fines
relacionados con sus tareas. Para obtener más información sobre cómo protegemos su
información, visite nuestro sitio web en census.gov y haga clic en “Data Protecon and Privacy
Policy” (Normas de Privacidad y Protección de Datos) en la parte inferior de la página
principal. Haga clic en “System of Records Notices (SORN)” (Avisos sobre el Sistema
de Registros) o visite . Esta
página también incluye información sobre la recopilación, el almacenamiento, la divulgación
y los usos habituales publicados del Privacy Act System of Records Notice (Aviso sobre el
Sistema de Registros de la Ley sobre la Privacidad) COMMERCE/CENSUS-3, Demographic Survey
Collection (Census Bureau Sampling Frame) (Recopilación de Encuestas Demográficas [Marco de
Muestreo de la Oficina del Censo]). Este es un cambio de nombre al anteriormente llamado
COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other Studies (Censos Especiales,
Encuestas y Otros Estudios), y está pendiente de publicación en el Registro Federal.

La divulgación de la información que se nos proporciona está autorizada en conformidad con
la Ley sobre la Privacidad de 1974 (Título 5, Código de los EE. UU., Sección 552a). La
información puede ser comparda con personal de la Oficina del Censo para fines
relacionados con sus tareas. Para obtener más información sobre cómo protegemos su
información, visite nuestro sitio web en census.gov y haga clic en “Data Protecon and Privacy
Policy” (Normas de Privacidad y Protección de Datos) en la parte inferior de la página
principal. Haga clic en “System of Records Notices (SORN)” (Avisos sobre el Sistema
de Registros) o visite . Esta
página también incluye información sobre la recopilación, el almacenamiento, la divulgación
y los usos habituales publicados del Privacy Act System of Records Notice (Aviso sobre el
Sistema de Registros de la Ley sobre la Privacidad) COMMERCE/CENSUS-3, Demographic Survey
Collection (Census Bureau Sampling Frame) (Recopilación de Encuestas Demográficas [Marco de
Muestreo de la Oficina del Censo]). Este es un cambio de nombre al anteriormente llamado
COMMERCE/CENSUS-3, Special Censuses, Surveys, and Other Studies (Censos Especiales,
Encuestas y Otros Estudios), y está pendiente de publicación en el Registro Federal.

D

R

La Oficina del Censo calcula que completar la entrevista tomará 10 minutos como promedio.
Esta recopilación de información ha sido aprobada por la Oficina de Administración y
Presupuesto (OMB, por sus siglas en inglés). El número de aprobación de ocho dígitos de la
OMB xxxx-xxxx confirma la aprobación. De no mostrarse este número, no podríamos realizar
el Censo Especial.

PARA USO OFICIAL SOLAMENTE
Núm. de línea

Idenficación de caso
SC-920, Página de Lista de Direcciones
(Address List Page)

Base prints black (100%)

SC-921, Página para Añadir
(Add Page)

Overlay prints green #320 (10%, 20% and 100%)

PARA USO OFICIAL SOLAMENTE
Núm. de línea

Idenficación de caso
SC-920, Página de Lista de Direcciones
(Address List Page)

Base prints black (100%)

SC-921, Página para Añadir
(Add Page)

Overlay prints green #320 (10%, 20% and 100%)

SC-IS-TL

OMB No. XXXX-XXXX

(10-05-2022)

DC

INFORMATION SHEET
RELATIONSHIP

WHO TO COUNT

Do include:

• People who have some
other place where they
usually live.

• Babies and children,
including foster children,
who are staying here and
have no other place
where they usually live.

• Armed Forces personnel
who live away from this
location.
• People currently staying in
a nursing home, mental
hospital, etc.
• People currently in jail,
prison, detention facility,
etc.

D
R

Do NOT include:

• College students who live
away from this location
most of the year.

T

How is this person related to Person 1? Mark J
K
I ONE box.
Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

AF

We need to count the people
staying here who do NOT have a
usual home elsewhere.

• Relatives, roommates, or
other nonrelatives who
are staying here and have
no other place where
they usually live.
• Any other people
currently staying here
who have no other place
where they usually live.

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

OMB No. XXXX-XXXX

DC

INFORMATION SHEET
RACE

HISPANIC ORIGIN
Is this person of Hispanic, Latino, or Spanish origin?

What is this person’s race?
Mark J
K
I one or more boxes AND print origins.

No, not of Hispanic, Latino, or Spanish origin

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

T

Yes, Mexican, Mexican Am., Chicano

Yes, Cuban

D
R

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

AF

Yes, Puerto Rican

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

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

Asian Indian

Japanese

Chamorro

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

Some other race – Print race or origin.

SC-IS-TL 10-05-2022

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

C

SC-IS-TL(S) (10-06-2022)

DC

Núm. de OMB XXXX-XXXX

HOJA INFORMATIVA
A QUIÉN CONTAR

PARENTESCO

• Las personas que tengan
otro lugar donde
habitualmente viven.
• Estudiantes universitarios
que no viven en este lugar
la mayor parte del año.
• Personal de las Fuerzas
Armadas que vive fuera de
este lugar.
• Personas que estaban
actualmente en un hogar de
ancianos o nursing home, un
hospital psiquiátrico, etc.
• Personas que estaban
actualmente en una cárcel,
una prisión, un centro de
detención, etc.

Incluya:

• Bebés y niños, incluyendo a
hijos de crianza (foster), que
se quedan aquí y no tienen
otro lugar donde
generalmente viven.

D
R

NO incluya:

T

¿Cómo está esta persona relacionada con la Persona 1?
K
I UNA casilla.
Marque J
Esposo(a) del sexo opuesto

Padre o madre

Pareja no casada del sexo opuesto

Nieto(a)

Esposo(a) del mismo sexo

Suegro(a)

Pareja no casada del mismo sexo

Yerno o nuera

Hijo(a) biológico(a) o de sangre

Otro pariente

Hijo(a) adoptivo(a)

Roommate o compañero(a) de casa

Hijastro(a)

Hijo(a) foster

Hermano(a)

Otra persona que no es pariente

AF

Necesitamos contar a las personas que
se están quedando aquí que NO tengan
una residencia habitual en otro lugar

• Parientes, compañeros de
casa o cuarto, u otras
personas que no son
parientes que se están
quedando aquí y no tienen
otro lugar donde
generalmente viven.

• Algunas otras personas que
se quedan aquí
actualmente y que no
tienen un lugar permanente
donde vivir.

Núm. de OMB XXXX-XXXX

DC

HOJA INFORMATIVA
ORIGEN HISPANO

RAZA
¿Cuál es la raza de esta persona?
Marque J
K
I una o más casillas Y escriba los orígenes.

¿Es esta persona de origen hispano, latino o español?
No, no es de origen hispano, latino o español

Blanca – Escriba, por ejemplo, alemán, irlandés, inglés, italiano,
libanés, egipcio, etc. C

T

Sí, mexicano, mexicanoamericano, chicano

Sí, cubano

AF

Sí, puertorriqueño

D
R

Sí, de otro origen hispano, latino o español – Escriba, por ejemplo,
salvadoreño, dominicano, colombiano, guatemalteco, español,
ecuatoriano, etc. C

Negra o afroamericana – Escriba, por ejemplo, afroamericano,
jamaiquino, haitiano, nigeriano, etíope, somalí, etc. C

Indígena de las Américas o nativa de Alaska – Escriba el
nombre de la(s) tribu(s) en la(s) que está inscrita o la(s) tribu(s)
principal(es), por ejemplo, Navajo Nation, Blackfeet Tribe, maya,
azteca, Native Village of Barrow Inupiat Traditional Government,
Nome Eskimo Community, etc. C

China

Vietnamita

Nativa de Hawái

Filipina

Coreana

Samoana

India asiática

Japonesa

Chamorra

Otra asiática –
Escriba, por
ejemplo, pakistaní,
camboyano,
hmong, etc. C

Otra de las islas del
Pacífico – Escriba, por
ejemplo, tongano,
fiyiano, de las Islas
Marshall, etc. C

Alguna otra raza – Escriba la raza o el origen.

SC-IS-TL(S) (10-06-2022)

C

Draft 2 (9-23-2022)

FORM

SC-117 (9-23-2022)

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

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

I.

Barcode Placeholder
Words deleted after design approval

K.
L.

J. AA:

TL Type Code:
Tract:
Block:

A.

Case ID:

M.

Map Spot:

B.

SCID/GU Name:

N.
O.

List Additional Blocks in TL in Same AA:

C.

TL Name:

D.

Street
Address:

E.

City:

F.

Zip Code:

H.

County:

Location Description:

(Print Field Representative’s name)

/

G. State:

P.

Assigned to:

Q.

Date Assigned:

R.

Date Returned:

SECTION A: – TRANSITORY LOCATION FACILITY CONTACT INFORMATION
Confirm, update or collect the TL Contact information. (Complete Items 1 to 3)
Question 1, SC-688

Question 2, SC-688

1. Contact Name:

2. Contact Title:

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

Cell

(

)

Home/Other

–

(

)

Ext.

–

SECTION A1: – TRANSITORY LOCATION ADVANCE CONTACT INFORMATION
Question 3, SC-688

Question 6 and 9b, SC-688

8. Type of spaces or units: (Mark (X) all that apply).
4. TL Name:
(Only MINOR spelling corrections are allowed)

5. Street Name:
6. Will you be open between (Special Census Dates)?
YES

3

Don’t know

Sites 2

RV Pads 3

5

Units 6

Other, Describe:

2

NO (Mark (X) Closed on Special
Census Day in Section A2)

9. Maximum Number of Spaces or Units at
Location:
Question 8, and 9c, SC-688

7. TL Type Code:
3
5
7

Rooms

10. Average Number of Occupied Units:
(For Housing Units, enter # of people)C

Question 5, SC-688

1

Slips 4

Question 7 and 9a, SC-688

Question 4, SC-688

1

1

10-Campground 2
4
30-Marina
50-Racetrack
6
90-Other, Describe:

20-RV Park
40-Hotel/Motel(Mark Rooms in item 8)
60-Circus/Carnival/Fair

Continued on next page

SECTION A1: – TRANSITORY LOCATION ADVANCE CONTACT INFORMATION – Continued
Question 9b, SC-688

11. Are there any people who live or stay at this hotel/motel on an extended basis?
1

YES

NO (End the interview)

2

Question 10, SC-688

12. What is the best day and time to conduct the Special Census at this location?
Date: (Mo, D, Yr)

/

Time

13. Appointment Scheduled?

2

YES

1

am
pm

1

:

/

NO

2

Question 11, SC-688

14. Are there any specific instructions that Special Census staff need to know to count the people at this location?
1

YES: Mark (X) all that apply or describe)

4

Other - Describe:

Gated community

2

3

Locked entrance

5

NO

Question 12, SC-688

15. Are there any people at this location who do not speak or understand English?
1

YES - Write the language(s) spoken

2

Question 13, SC-688

16. TL site maps:

NO

Question 14, SC-688

1

YES 2

17. TL Contact responsible for additional location(s):

NO

1

YES - Complete an SC-225, INFO-COMM, and notify your supervisor. 2

NO

SECTION A2: – TLAC STATUS
18.

1

Complete - ETL Appointment Scheduled (include appointments for Housing Units) OR

2

Out of Enumeration Area

3

Duplicate: Survivor ID #

4

Dangerous Address

5

Housing Unit, No Appointment

7

Closed on Special Census Day

8

Demolished/Burned out

6

Group Quarter

9

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

10

Closed/Not Operating/Vacant

11

Refusal

13

Cannot Locate

14

Other

12

Nonresidential

SECTION B: – ENUMERATION AT TRANSITORY LOCATIONS INFORMATION
Month/Day/Year

Print Field Representative’s Name

19. Assigned to:

/

20. Date Assigned:

/

Month/Day/Year

21. Date Enumeration completed:

/

/
Certification

Field Representative – I certify that the entries made on this form are true and correct to the best of my knowledge.
Month/Day/Year

22. Field Representative Signature:

23. Date Signed:

/

/

Section B1 – ETL Summary
24.

A) Total Number of Units

E) Total Number of First No Contacts (NC1)

B) Total Number of Occupied Units

F) Total Number of Second No Contacts (NC2)

C) Total Number of Permanent Structures
(Mobile Homes/Housing Units)

G) Total Number of Completed EQs
H) TL POPULATION COUNT

D) Total Number of Refusals
Page 2

Continued on next page

FORM SC-117 (9-23-2022)

SECTION B2: – ETL STATUS
25.

1

Complete or Zero POP Reason: Mark (X) only one

8

Refusal

2

Out of Enumeration Area

9

3

Duplicate: Survivor ID#

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

4

Dangerous Address

5
6
7

Group Quarter

10

Nonresidential

Demolished/Burned Out

11

Cannot Locate

Vacant

12

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

NOTES

FORM SC-117 (9-23-2022)

Page 3

FORM

Field Representative Name:

SC-693.2(ETL) (8-23-2022)

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

TRANSITORY LOCATION LISTING SHEET
ENUMERATION AT TRANSITORY LOCATIONS
Special Census
This form contains confidential information, including Title 13 and Personally Identifiable Information (PII), the release of which is protected by the Privacy Act of 1974.

Print unit/site number in column (A) and indicate whether the site is occupied in column (B). If a permanent structure (PS) or mobile home (MH) occupies the unit/site, mark (X) column (C). If the site is
occupied (’Yes’ in column (B)), approach the unit/site and begin the interview using the Form SC-1, Transitory Location Questionnaire (EQ).
IS THIS UNIT/SITE OCCUPIED?
Yes or No

PS/MH

REFUSAL

NC1
(1st No contact)

NC2
(2nd No contact)

EQ
COMPLETE
AND LABELED

(B)

(C)

(D)

(E)

(F)

(G)

NC1

NC2

Yes

NC1

NC2

Yes

NC1

NC2

Yes

R

NC1

NC2

Yes

R

NC1

NC2

Yes

R

NC1

NC2

Yes

R

NC1

NC2

Yes

(A)

No – END

PS/MH

R

Yes

No – END

PS/MH

R

Yes

No – END

PS/MH

R

Yes

No – END

PS/MH

Yes

No – END

PS/MH

Yes

No – END

PS/MH

Yes

No – END

PS/MH

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

Yes

No – END

PS/MH

R

NC1

NC2

Yes

R

AF

T

Yes

D

PRINT THE UNIT/SITE
NUMBER

(H)

TOTALS FOR THIS PAGE
Units

Yes

No

PS/MH

R

NC1

NC2

NAME OF RESPONDENT
(First Name, Initial, Last Name)

Yes

To the designer – please include all the standard items in the header and footers.
SC-688(TLAC)

OMB No. xxxx-xxxx
Approval Expires xx/xx/xxxx1

SPECIAL CENSUS

D

R
AF

T

TRANSITORY LOCATION ADVANCE CONTACT
IN-FIELD SCRIPT

INTRODUCTION
#
Hello. My name is (Your name).
I am representing the U.S. Census Bureau (show your ID badge). We are currently
conducting the Special Census in your area. To make sure we count everyone during the
Special Census, we visit places like hotels, motels, RV parks, campgrounds, and marinas.
I have some questions to ask about (Say the TL NAME on the Form SC-117) at (Say the
ADDRESS NUMBER and STREET NAME on the Form SC-117).
If a TL Name or Street Name is not listed, read the LOCATION DESCRIPTION.

T

May I speak to (Say the CONTACT PERSON’S name in Section A, item 1 of the Form SC117, if the name is provided)?
• Verify the spelling of the CONTACT PERSON’s name, title, and telephone number and
make corrections, if necessary, in the fields provided.
• GO TO QUESTION 2 OF THIS SCRIPT
(If no CONTACT PERSON name in Section A, item 1, ask:)

R
AF

May I speak to the person who would be able to answer my questions about this location?
(When the correct person is available, repeat the introduction, if necessary, then ask:)
May I have your name, title, and a telephone number at which you can be reached?
• Enter the person’s name, title, and telephone number(s) on the SC 117, Section A, items 1,
2, and 3.
•

If no one is available who can answer questions about the location:
o Ask for the name and telephone number of the contact person and record the
information on the SC-117, Section A, items 1, 2, and 3.
o Ask for a time you can return to conduct the interview with the contact person and
record that information in the NOTES section of the SC-117.
o End the interview.
If this is a Housing Unit (HU):
o SKIP TO QUESTION 9a OF THIS SCRIPT.
If this is a Group Quarters (GQ):
o Try to obtain the name, telephone number and any other information about the
GQ, if possible.
o Say, “Thank you, that is all the information that I need. Someone from the Census
Bureau may call you later to complete an interview for this location.”
o End the interview.
o On the SC-117:
▪ In Section A2, TLAC Status section, mark (X) Group Quarter.
▪ Write the name, telephone number and any other information about the
GQ in the NOTES section and contact your supervisor.

D

1

Question

•
•

INTERVIEW
Question

#
2

To prepare for the Special Census, I need to collect some information about this location. I have
just a few questions to ask you. We estimate this interview will take about ten minutes.
All the information that you provide will remain confidential. We are conducting the Special
Census under the authority of Title 13, U.S. Code, Section 196. Your answers will be used for
statistical purposes only.
Hand the Contact Person the Confidentiality Notice and TL Facility Manager Letter.
Read if necessary:
The U.S. Census Bureau is conducting this Special Census to provide your local government
current population and housing counts for this area. Your participation in the Special Census is
extremely important. Although the individual responses are voluntary, the information the
Special Census receives from you ensures the completeness and accuracy of the results. The U.S.
Census Bureau and your local government appreciate your help.

I am going to read you a summary of the location information that I have. Please let me know if
anything is incorrect, or if any information is missing.

R
AF

3

T

GO TO QUESTION 3 OF THIS SCRIPT.

D

Refer to the Form SC-117 and read/spell out the information printed in the header section:
TL Name
Address Number
Street Name
City
ZIP Code
OR LOCATION DESCRIPTION
• If ALL the information is CORRECT, GO TO QUESTION 4 OF THIS SCRIPT.
• If only the TL Name is different:
o On the SC-117, Section A1, write the corrected TL NAME in item 4, “TL Name.”
• If the STREET NAME is different:
o You may make only minor spelling corrections to the STREET NAME.
o On the SC-117, Section A1, write the MINOR changes to the street name in item 4, “Street
Name.”
o GO TO QUESTION 4 OF THIS SCRIPT.
• If any other address fields have changed (street number, street name, or ZIP Code):
o On the SC-117, TLAC NOTES section:
▪ Write the corrected full STREET ADDRESS and complete an SC-225, INFOCOMM.
▪ Say, “Thank you, that is all the information that I need. Someone from the Census
Bureau may call you later to complete an interview for this location.”
▪ End the interview.
▪ In Section A2, TLAC Status section, mark (X) OTHER and write “ADDRESS
CHANGE.”

INTERVIEW
#

Question

Will you be open between (Say the Special Census dates)?
• If YES, mark (X) YES in Section A1, item 5 of the SC-117 and GO TO QUESTION 5 OF
THIS SCRIPT.
• If NO, mark (X) NO in Section A1, item 5 of the SC-117, and:
o Say: “Thank you very much for your time and participation. That is all the
information that I need.”
o End the interview.
o In Section A2, TLAC Status, mark (X) Closed on Special Census Day.
• If DON’T KNOW, mark (X) DON’T KNOW in Section A1, item 5 of the SC-117 and GO
TO QUESTION 5 OF THIS SCRIPT.

5

Is this location primarily a (Ask or verify):
Campground (10)
RV park (20)
Marina (30)
Hotel/Motel (40)
Racetrack (50)
Carnival/Circus (60)
Other (90)

•

On the SC-117, Section A1, item 6, mark (X) only one TL Type.
o If most of the units at the TL fall within ONE TL Type Code, apply that TL Type
Code to the entire TL.
o If most of the units at the TL DO NOT fall within one TL Type Code, then assign the
lowest TL Type Code value to the TL.
If the contact person says that none of the options describes the location, mark (X) OTHER
and ask for and write the description in the space provided for item 6, SC-117.

R
AF

•

T

4

GO TO QUESTION 6 OF THIS SCRIPT.

•

If this is a Group Quarter:
o Say, “Thank you, that is all the information that I need. Someone from the Census
Bureau may call you later to complete an interview for this location.”
o End the interview.
o On the SC-117:
▪ In Section A2, TLAC Status section, mark (X) Group Quarter.
▪ Write the name, telephone number and any other information about the GQ
in the NOTES section and contact your supervisor.
If this is a Hotel/Motel, SKIP TO QUESTION 9b OF THIS SCRIPT.

•

D

•

INTERVIEW
#

Question

6

What types of Spaces or Units are at this location?
Read the following options:
Sites
Pads
Slips
Rooms
Units
Other – Describe____________________________
•
•

What is the MAXIMUM number of spaces or units at this location? (Include all types of
spaces or units at the location).
•
•

8

R
AF

7

T

•

On the SC-117, Section A1, item 7, mark (X) as many of the Types of Spaces or Units that
apply.
If the contact person says that none of the options describe the location, mark (X) OTHER
and ask for and write the description in the space provided for item 7, SC-117.
GO TO QUESTION 7 OF THIS SCRIPT.

On the SC-117, Section A1, item 8, enter the maximum number in the space provided.

GO TO QUESTION 8 OF THIS SCRIPT.

We will conduct the Special Census from (Say the Special Census Dates for your area).

•
•

9a

D

What is the AVERAGE number of OCCUPIED spaces or units at this location during that
time frame?
On the SC-117, Section A1, item 9, enter the average number in the space provided. For
Housing Units, enter the number of PEOPLE.
SKIP TO QUESTION 10 OF THIS SCRIPT

Hand the Contact Person the Confidentiality Notice.
Including yourself, how many people will be living or staying at (Say the ADDRESS
NUMBER and STREET NAME on the SC-117) on (Say the Special Census Date for your
area)?
Another Census worker will come here to conduct an in-person interview for each person
living or staying at this location on Special Census Day.
•

•

On the SC-117, Section A1 item 9, enter the number of people in the space provided.
SKIP TO QUESTION 10 OF THIS SCRIPT.

INTERVIEW
#
9b

Question
For this Hotel/Motel:
Are there any people who live or stay at this hotel/motel on an extended basis, such as
weekly basis or a monthly basis?
•

9c

R
AF

T

•

If YES:
o On the SC-117, Section A1:
▪ In item 10, mark YES.
▪ In item 6, verify or mark (X) TL Type Code 40, HOTEL/MOTEL (if not
already marked)
▪ In item 7, verify or mark (X) ‘Rooms.’
▪ GO TO QUESTION 9C OF THIS SCRIPT.
If NO:
o On the SC-117:
▪ In item 10, mark NO.
▪ In Section A2, TLAC Status section, mark (X) Nonresidential.
▪ Say: “Thank you for your time. That is all the information I need.
Someone from the Census Bureau may call you later to complete an
interview for this location.”
▪ End the interview.

We will conduct the Special Census (Say the Special Census dates for your area).
For this Hotel/Motel:

•
•
10

D

What is the average number of occupied rooms where people live or stay on an extended
basis, such as a weekly basis or a monthly basis during that time frame?
On the SC-117, Section A1 item 9, enter the number of rooms occupied by long term guests.
GO TO QUESTION 10 OF THIS SCRIPT.

What is the best day and time to conduct the Special Census at this location between (Say
the Special Census Dates in your area)?
•
•

On the SC-117, Section A1, item 11, enter the date and time, circle a.m. or p.m., and then
mark (X) YES or NO in item 12.
GO TO QUESTION 11 OF THIS SCRIPT.

INTERVIEW
#

Are there any specific instructions that Census Bureau staff need to know to be able to
count the people at this location; for example, are there gated communities, locked
entrances, etc.?
•
•

Are there any people at this location that do not speak or understand English?
•

•
•
13

Do you have a printed site map for us to use?
•

On the SC-117, Section A1:
o If YES, mark (X) YES in item 15. ASK FOR 5 MAPS.
o If NO, mark (X) NO in item 15.
o GO TO QUESTION 14 OF THIS SCRIPT.

On (say the DATE/TIME scheduled in item 11 of the SC-117), Special Census staff will
arrive at your location and present an official Special Census photo ID badge.

D

14

On the SC-117, Section A1:
o If YES: Mark (X) YES in item 14, then ask, “What languages do they speak?”
(For example, Spanish, Vietnamese, Korean) and write the language(s) spoken in
the space provided.
o If NO: Mark (X) NO in item 14.
GO TO QUESTION 13 OF THIS SCRIPT.
If a housing unit, SKIP TO QUESTION 14 OF THIS SCRIPT.

T

12

On the SC-117, Section A1:
o If YES: Mark (X) YES in item 13, and then mark (X) all the situations that apply.
o If NO, mark (X) NO in item 13.
GO TO QUESTION 12 OF THIS SCRIPT.

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11

Question

We ask that you let the people living or staying here know that the Census Bureau will be
conducting the Special Census at that time and encourage their cooperation. Someone
from the Special Census Office will contact you before to the appointment as a reminder
and to discuss further details. We appreciate your cooperation.
If a Housing Unit, say: That is all the information I need. Thank you very much for your
time and participation. If you have any additional questions, please call the Special
Census Office at (provide telephone number) or visit our website at census.gov/programssurveys/specialcensus.html.
•

Otherwise, ask: Are you responsible for any additional locations, either at this address
or elsewhere?
o If YES, on the SC-117, Section A1, mark (X) YES in item 16 and GO TO
QUESTION 15 OF THIS SCRIPT.
o If NO, on the SC-117, Section A1, mark (X) NO in item 16 and end the interview.

INTERVIEW
#

What is the name and address of the other location(s) you are responsible for?

****MAKE NO OTHER ENTRIES ON THE SC-117
BELOW SECTION A2, TLAC STATUS SECTION****

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•

If the case is in your workload (you have an SC-117 with the TL NAME and ADDRESS),
use this script (SC-688) and the other SC-117 to complete an interview for that additional
transitory location.
If the case is NOT in your workload (you do NOT have an SC-117 for the additional TL):
o Write the additional TL NAME/ADDRESS/CONTACT NAME/TELEPHONE
NUMBER in the NOTES section of the SC-117.
o Say, “Thank you for this information. We will check our files to see if we have
these locations and may contact you another time to complete an interview for each
location.”
o End the interview.
o Complete an SC-225, INFO-COMM with the new TL information and notify your
supervisor.

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D

15

Question