SC-CQ HU Enumerator Continuation Questionnaire (English)

OMB No. 0607-0368

23043011

Special Census
Continuation Questionnaire

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

FOR NPC
USE ONLY

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

–

SCID

State

AA

County

Tract

Questionnaire

Block

of

questionnaire(s)

CONTINUATION QUESTIONNAIRE
FOR SPECIAL CENSUS
QUESTIONNAIRES

FORM

SC-CQ (05/30/2023 )

§8%?,¤

23043029

1.

What is the name of Person

➜ NOTE: Please answer BOTH the question about Hispanic

?

origin and the question about race. For this census, Hispanic
origin is not a race.

Print name below and verify the spelling.
First Name

6.

MI

Last Name(s)

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

2.

Does this person usually live or stay somewhere else?
For example – Read the examples to respondent.
Mark I
K all that apply.
J
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment

For another reason

For a job or business

No

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

7.

In a nursing home

3.

4.

5.

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

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

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

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

Female

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

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

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

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.
Age on (Special Census Day)

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

Print numbers in boxes.
Month
Day
Year of birth
Some other race – Print race or origin.

years

➜

2

C

If more people were counted in Question S6 on the
SC-Q, continue with the next person on the next page.

§8%?>¤

23043037

1.

What is the name of Person

➜ NOTE: Please answer BOTH the question about Hispanic

?

origin and the question about race. For this census, Hispanic
origin is not a race.

Print name below and verify the spelling.
First Name

6.

MI

Last Name(s)

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

2.

Does this person usually live or stay somewhere else?
For example – Read the examples to respondent.
Mark I
K all that apply.
J
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment

For another reason

For a job or business

No

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

7.

In a nursing home

3.

4.

5.

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

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

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

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

Female

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

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

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

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.
Age on (Special Census Day)

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

Print numbers in boxes.
Month
Day
Year of birth
Some other race – Print race or origin.

years

➜

3

C

If more people were counted in Question S6 on the
SC-Q, continue with the next person on the next page.

§8%?F¤

23043045

1.

What is the name of Person

➜ NOTE: Please answer BOTH the question about Hispanic

?

origin and the question about race. For this census, Hispanic
origin is not a race.

Print name below and verify the spelling.
First Name

6.

MI

Last Name(s)

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

2.

Does this person usually live or stay somewhere else?
For example – Read the examples to respondent.
Mark I
K all that apply.
J
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment

For another reason

For a job or business

No

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

7.

In a nursing home

3.

4.

5.

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

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

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

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

Female

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

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

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

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.
Age on (Special Census Day)

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

Print numbers in boxes.
Month
Day
Year of birth
Some other race – Print race or origin.

years

➜

4

C

If more people were counted in Question S6 on the
SC-Q, continue with the next person on the next page.

§8%?N¤

23043052

1.

What is the name of Person

➜ NOTE: Please answer BOTH the question about Hispanic

?

origin and the question about race. For this census, Hispanic
origin is not a race.

Print name below and verify the spelling.
First Name

6.

MI

Last Name(s)

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

2.

Does this person usually live or stay somewhere else?
For example – Read the examples to respondent.
Mark I
K all that apply.
J
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment

For another reason

For a job or business

No

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

7.

In a nursing home

3.

4.

5.

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

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

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

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

Female

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

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

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

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.
Age on (Special Census Day)

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

Print numbers in boxes.
Month
Day
Year of birth
Some other race – Print race or origin.

years

➜

5

C

If more people were counted in Question S6 on the
SC-Q, continue with the next person on the next page.

§8%?U¤

23043060

1.

What is the name of Person

➜ NOTE: Please answer BOTH the question about Hispanic

?

origin and the question about race. For this census, Hispanic
origin is not a race.

Print name below and verify the spelling.
First Name

6.

MI

Last Name(s)

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

2.

Does this person usually live or stay somewhere else?
For example – Read the examples to respondent.
Mark I
K all that apply.
J
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment

For another reason

For a job or business

No

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

7.

In a nursing home

3.

4.

5.

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

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

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

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

Female

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

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

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

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.
Age on (Special Census Day)

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

Print numbers in boxes.
Month
Day
Year of birth
Some other race – Print race or origin.

years

➜

6

C

If more people were counted in Question S6 on the
SC-Q, continue with the next person on the next page.

§8%?]¤

23043078

1.

What is the name of Person

➜ NOTE: Please answer BOTH the question about Hispanic

?

origin and the question about race. For this census, Hispanic
origin is not a race.

Print name below and verify the spelling.
First Name

6.

MI

Last Name(s)

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

2.

Does this person usually live or stay somewhere else?
For example – Read the examples to respondent.
Mark I
K all that apply.
J
With a parent or other relative

In a jail or prison

For college

At a seasonal or
second residence

For a military assignment

For another reason

For a job or business

No

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

7.

In a nursing home

3.

4.

5.

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

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

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

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

Female

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

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

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

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.
Age on (Special Census Day)

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

Print numbers in boxes.
Month
Day
Year of birth
Some other race – Print race or origin.

years

C

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

7

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23043086

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8

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OMB No. 0607-0368