SC-Q-TL Transitory Unit Questionnaire (English)

OMB No. 0607-0368

23023013

Special Census
Transitory Units Questionnaire

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

FOR NPC
USE ONLY

SCID

State

AA
–

TL Case ID:

County

TL Tract

TL Block

–

UNIT ADDRESS
Copy transitory unit
information from the
Transitory Location
Listing Sheet (SC-693.2) ➜

Write the full address of
the transitory unit and/or
a location description ➜

Unit/Site Number (column A)

TU Tract

TU Block

Address Number (example: 5007)

Street or Road Name (example: N Maple Ave)

ZIP Code

Rural Route
Location Description
Rural Route or Location Description (if applicable)

S1.

Hello, I am (name) from the U.S. Census Bureau (show ID).
Are you currently living or staying in this
[RV/boat/room/unit]? If respondent says no, ask, “Is there
someone available that I can talk to who currently lives or
stays in this [RV/boat/room/unit]?” and then end interview.

S3.

Is this [RV/boat/room/unit]
Mark I
K ONE box.
J
Owned by you or someone in this household with a
mortgage or loan, including home equity loans?
Owned by you or someone in this household free and
clear, without a mortgage or loan?

Respondent confirmed that he or she lives or stays in this
[RV/boat/room/unit].

Rented?

S2.

I am here to complete a Special Census questionnaire for
this [RV/boat/room/unit]. It should take about 10 minutes
(hand respondent a confidentiality notice). This notice
explains that your answers are confidential. Do all of the
people who are staying in this [RV/boat/room/unit] have
another place where they usually live?

Occupied without payment of rent?

S4.

Yes – End interview.

Please read the WHO TO COUNT section on the
Information Sheet (hand respondent an information sheet,
and pause to allow the respondent to read it). Based on
these instructions, how many people were living
or staying in this [RV/boat/room/unit] who have no other
place where they usually live?

No
Number of people =

FORM

SC-Q-TL

(05/30/2023 )

§8#?.¤

23023021

Person 1
1.

5.

Now I am going to ask you questions about each person
who is currently living or staying in this [RV/boat/room/unit]
and has no other place where they usually live. If one of
those people pays the rent or owns this
[RV/boat/room/unit], I would like to start by listing him or
her as Person 1. If not, I can start by listing any adult.

Please read the RACE section on the Information Sheet.
What is Person 1’s race?
Mark I
K one or more boxes AND print origins.
J
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

What is Person 1’s name?
Print name below and verify the spelling.
First Name

MI

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

Last Name(s)
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

2.

Is Person 1 male or female? Mark I
K ONE box.
J
Male

3.

Female

What was Person 1’s age on (Special Census Day)? What is
Person 1’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)

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

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

Print numbers in boxes.
Month
Day
Year of birth

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

years
➜ NOTE: Please answer BOTH the question about Hispanic

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

4.

Some other race – Print race or origin. C

Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is Person 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

➜ If more people were counted in Question S4 on the
front page, continue with Person 2 on the next page.

2

§8#?6¤

23023039

Person 2
1.

6.

What is Person 2’s name?
Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

2.

3.

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

Chinese

Vietnamese

Native Hawaiian

Adopted son or daughter

Roommate or housemate

Filipino

Korean

Samoan

Stepson or stepdaughter

Foster child

Asian Indian

Japanese

Chamorro

Brother or sister

Other nonrelative

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

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

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

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

4.

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

Female

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)

Some other race – Print race or origin.

C

Print numbers in boxes.
Month
Day
Year of birth

years
➜ NOTE: Please answer BOTH the question about Hispanic

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

5.

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

➜ If more people were counted in Question S4 on the
front page, continue with Person 3 on the next page.

3

§8#?H¤

23023047

Person 3
1.

6.

What is Person 3’s name?
Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

2.

3.

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

Chinese

Vietnamese

Native Hawaiian

Adopted son or daughter

Roommate or housemate

Filipino

Korean

Samoan

Stepson or stepdaughter

Foster child

Asian Indian

Japanese

Chamorro

Brother or sister

Other nonrelative

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

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

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

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

4.

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

Female

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)

Some other race – Print race or origin.

C

Print numbers in boxes.
Month
Day
Year of birth

years
➜ NOTE: Please answer BOTH the question about Hispanic

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

5.

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

➜ If more people were counted in Question S4 on the
front page, continue with Person 4 on the next page.

4

§8#?P¤

23023054

Person 4
1.

6.

What is Person 4’s name?
Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

2.

3.

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

Chinese

Vietnamese

Native Hawaiian

Adopted son or daughter

Roommate or housemate

Filipino

Korean

Samoan

Stepson or stepdaughter

Foster child

Asian Indian

Japanese

Chamorro

Brother or sister

Other nonrelative

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

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

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

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

4.

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

Female

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)

Some other race – Print race or origin.

C

Print numbers in boxes.
Month
Day
Year of birth

years
➜ NOTE: Please answer BOTH the question about Hispanic

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

5.

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

➜ If more people were counted in Question S4 on the
front page, continue with Person 5 on the next page.

5

§8#?W¤

23023062

Person 5
1.

6.

What is Person 5’s name?
Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

2.

3.

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

Chinese

Vietnamese

Native Hawaiian

Adopted son or daughter

Roommate or housemate

Filipino

Korean

Samoan

Stepson or stepdaughter

Foster child

Asian Indian

Japanese

Chamorro

Brother or sister

Other nonrelative

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

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

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

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

4.

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

Female

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)

Some other race – Print race or origin.

C

Print numbers in boxes.
Month
Day
Year of birth

years
➜ NOTE: Please answer BOTH the question about Hispanic

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

5.

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

➜ If more people were counted in Question S4 on the
front page, continue with Person 6 on the next page.

6

§8#?_¤

23023070

Person 6
1.

6.

What is Person 6’s name?
Print name below and verify the spelling.
First Name

MI

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

Last Name(s)

2.

3.

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

Chinese

Vietnamese

Native Hawaiian

Adopted son or daughter

Roommate or housemate

Filipino

Korean

Samoan

Stepson or stepdaughter

Foster child

Asian Indian

Japanese

Chamorro

Brother or sister

Other nonrelative

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

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

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

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

4.

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

Female

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)

Some other race – Print race or origin.

C

Print numbers in boxes.
Month
Day
Year of birth

years
➜ NOTE: Please answer BOTH the question about Hispanic

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

5.

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

➜ If more than 6 people were counted in Question S4,
continue with the next person on the Continuation
Questionnaire (SC-CQ-TL), and update number of
continuation questionnaires on page 8.

7

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OMB No. 0607-0368

23023088

RESPONDENT INFORMATION

R1.

R2.

What is your name? Print name below and verify the spelling.
First Name

MI

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

–

Last Name(s)

R3.

To confirm: Do you
Currently live or stay in this [RV/boat/room/unit]?
Not live or stay in this [RV/boat/room/unit]
(neighbor or other proxy)?

INTERVIEW SUMMARY

C.

A.

Language Code =

B.

Number of people listed on questionnaire(s) =

Are there any continuation questionnaires for this address?
Yes ➜ Number of continuation questionnaires =
No

01 – 99 = Total people
JIC1

JIC2

RECORD OF CONTACT
Month

Type

✗ In-Person

Day

Hour

/

OUTCOME CODES: NV = Left Notice of Visit

Minute

:

Type

Outcome
a.m.

✗ In-Person

p.m.

NC = No Contact

Month

RE = Refusal

Day

Hour

/

Minute

:

CI = Conducted Interview

Outcome
a.m.
p.m.

OT = Other

CONFIRM TRANSITORY LOCATION NAME
Copy TL Name from the Transitory Location Listing Sheet (SC-693.2)

CERTIFICATION
I certify that the entries I have made on this questionnaire are true and correct to the best of my knowledge.
Employee ID

Field Representative’s Signature

Month

Day

Year

8

Field Supervisor
Initials

FSA Number

Month

Year

Day

§8#?y¤