6 Questionnaire ID1

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

11184017

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

This is the 2024 Census National Survey questionnaire for this address.
It is quick and easy to respond, and your answers are protected by law.

Para completar el cuestionario en español, dele la vuelta y complete el lado verde.
FOR
OFFICIAL
USE ONLY

117870992226050507

TO RESIDENT AT
101 MAIN ST
ANYTOWN, ST 99997-9999

Census ID

1178-7099-2226

Start here

OR go online at www.census.gov/2024survey to complete your 2024 National Census Survey
questionnaire.
Use a blue or black pen.

2. Were there any additional people staying here on

Before you answer Question 1, count the people living in this
house, apartment, or mobile home using our guidelines.

October 1, 2024 that you did not include in Question
1?Mark I
J
K all that apply.
Children, related or unrelated, such as newborn babies,
grandchildren, or foster children

Ⴠ Count all people, including babies, who live and sleep
here most of the time.
Ⴠ If no one lives and sleeps at this address most of the time,
go online at www.census.gov/2024survey or call the number
on page 8.

Relatives, such as adult children, cousins, or in-laws
Nonrelatives, such as roommates or live-in babysitters
People staying here temporarily

The census must also include people without a permanent
place to live, so:
Ⴠ If someone who does not have a permanent place to live
is staying here on October 1, 2024, count that person.

No additional people

3. Is this house, apartment, or mobile home — Mark I
K ONE box.
J
Owned by you or someone in this household with a mortgage
or loan? Include home equity loans.

The Census Bureau also conducts counts in institutions and
other places, so:
Ⴠ Do not count anyone living away from here, either at
college or in the Armed Forces.
Ⴠ Do not count anyone in a nursing home, jail, prison, detention
facility, etc., on October 1, 2024.
Ⴠ Leave these people off your questionnaire, even if they will
return to live here after they leave college, the nursing home,
the military, jail, etc. Otherwise, they may be counted twice.

Owned by you or someone in this household free and clear
(without a mortgage or loan)?
Rented?
Occupied without payment of rent?

4. What is your telephone number?
We will only contact you if needed for official Census Bureau
business.
Telephone Number

1.

How many people were living or staying in this house,
apartment, or mobile home on October 1, 2024?
Number of people =

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FORM

D4F-Q4-XA(E/S)

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F
A
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(DRAFT 04-02-2024) D4

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