SC-RQ Reinterview Questionnaire (English)

§8,?-¤

OMB No. 0607-0368

Special Census
Reinterview Questionnaire

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

REINTERVIEW
Ask questions 1 - 7 during reinterview.

1.

Hello, I’m (name) from the U.S. Census Bureau (show ID).
May I speak to (original respondent name)?
Yes
No – Ask when the original respondent will be available. If
unable to interview the original respondent, interview a
knowledgeable proxy.

2.
ORIGINAL RESPONDENT INFORMATION

I’m contacting you to check on the quality of our Special
Census interview. It should take less than 10 minutes.
Were you recently interviewed for the Special Census
about (address)?

Use original questionnaire to complete OR1 - OR4.

OR1.

Yes

Original Respondent’s Name
First Name

No – Conduct a full interview using the SC-Q questionnaire.
MI

Don’t know – Conduct a full interview using the SC-Q
questionnaire.

3.

Last Name(s)

Did anyone live or stay at (address) on (Special Census
Day)?
Yes – SKIP to question 5.

OR2.

Original Respondent Telephone Number
–

OR3.

–

No

4.

On (Special Census Day), was this unit
Vacant? – End reinterview.

Original Respondent Type
Live or stay in this [house/apartment/mobile home] on
(Special Census Day)
Move in to this [house/apartment/mobile home] after
(Special Census Day)

Not a housing unit – End reinterview.

5.

Not live or stay in this [house/apartment/mobile home]
(neighbor or other proxy)

OR4.

Address of Neighbor or Proxy

We need to count people where they live and sleep most
of the time. (Hand respondent an Information Sheet.) Please
read the WHO TO COUNT section on the Information
Sheet. Based on these instructions, how many people
were living or staying in this [house/apartment/mobile
home] on (Special Census Day)?
Number of people =

6.

Were there any additional people staying here on
(Special Census Day) that you did not include in the count
in the previous question? For example:
Mark I
K all that apply. Include any additional people on
J
the next page.
Children, related or unrelated, such as newborn babies,
grandchildren, or foster children
Relatives, such as adult children, cousins, or in-laws
Nonrelatives, such as roommates or live-in babysitters
People staying here temporarily
No additional people

FORM

SC-RQ

23113012

(03/10/2023 ) Draft

§8,?5¤
7.

I need to make a list of the people who lived or stayed at (address) on (Special Census Day). Please tell me your name first
and then the names of everyone else who was living or staying here on (Special Census Day).
First Name

MI

Last Name(s)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

REINTERVIEW RECORD OF CONTACT
Month

Type
In-Person

Day

Hour

Minute

/

:

Month

Day

Hour

Minute

/

Telephone
Month
In-Person
Telephone

:
Day

Hour

:

OUTCOME CODES: NV = Left Notice of Visit

Day

Hour

/

Minute

Month
In-Person

:

p.m.

Telephone
Outcome

Day

p.m.

Month

a.m.

In-Person

p.m.

Telephone

RE = Refusal

Hour

/

Minute

CI = Conducted Interview

p.m.

Hour

/

Outcome
a.m.

:
Day

Outcome
a.m.

Telephone
Outcome

NC = No Contact

Month

In-Person

a.m.

Minute

/

Type

p.m.

Telephone
In-Person

Outcome
a.m.

Minute

Outcome
a.m.

:

p.m.

OT = Other

CERTIFICATION
I certify that the entries I have made on this questionnaire are true and correct to the best of my knowledge.
Field Representative’s Signature

Month

Day

Employee ID

Year

Field Supervisor
Initials

FSA Number

Month

Year

Day

REINTERVIEW STATUS
If you select "Defer to Supervisor" write a detailed reason for deferring this RI in the
NOTES section of this form.
Clerk Office Review - Initial ➜

Pass

Defer to Supervisor

Supervisor Review - Final ➜

Pass

Soft Fail

Month
Hard Fail

Notes:

FORM SC-RQ (03/10/2023 ) Draft

Clerk Initials

23113020

Non-interview

Day

Year