SC-1(PHONE/WYC) Special Census Telephone Questionnaire

4

OMB No. 0607-0368: Approval Expires 05/31/2005

COVERAGE

FORM

SC ID

State

SCO

County

Tract

Block

(7-14-2003)

U.S. DEPARTMENT OF COMMERCE

C1. I need to make sure I have counted everyone who lived or stayed here on (Special Census date). Did I miss —
–
–
–
–

SC-1(Phone/WYC)
Economics and Statistics Administration

any children, including foster children?
anyone away on business or vacation?
any roomers or housemates?
anyone else who had no other home?
Yes – Add person(s) to question 1, mark the "Add" box, and ask questions 2—6. Correct the POP count in question S5 on the front cover.
No – Continue with C 2.

AA

U.S. CENSUS BUREAU

PHONE/WYC
QUESTIONNAIRE

Map Spot

Unit ID

APPLY LABEL HERE
House No.

Street name, Rural route and box, or PO box

Special Census
Apt. No. or Location

C2.

Continuation form(s) attached
On (Special Census date), were any of the people you told me about —
– away at college?
– away in the Armed Forces?
– in a nursing home?
– in a correctional facility?
Yes – Delete person(s) from question 1 by marking the "Cancel" box. Correct the POP count in question S5 on the front cover.
No – Continue with H1.

Number of continuation
forms for this address

Location description

ZIP Code

ADDRESS CHANGES
House No.

Street name, Rural route and box, or PO box

Apartment No.

Location description

HOUSING
H1. Is this (house/apartment/mobile home) —
Owned by someone in this household with a mortgage or loan,
Owned by someone in this household free and clear (without a mortgage or loan),
Rented for cash rent, or
Occupied without payment of cash rent?

RECORD OF CONTACT
Type

Day

Month

R2. In case we need to contact you,

R3. Respondent —

what is your telephone number
and the best time to call?

First Name

Area code

Last Name

Lived here on
Special Census Day

Telephone number

–

Moved in after
Special Census Day

–

Outcome

Phone

:

a.m.

:

a.m.

Phone

a.m.

Phone

:

RESPONDENT INFORMATION
R1. Enter respondent’s name.

Time

OUTCOME CODES:

RE = Refusal

Evening

Either

Transcribed (PHONE/WYC response altered original
Pop count)
Not transcribed (original questionnaire still in field)

p.m.

Not transcribed (PHONE/WYC response matches
original questionnaire)

p.m.

Not transcribed (PHONE/WYC response outside
SC area)

OT = Other

TR = Transcribed information to labelled SC-1

NT = No transcription

INTRODUCTION

Is neighbor or other
Day

Day

Transcribed (PHONE/WYC HU added to SC)

p.m.

CI = Conducted interview

Month

S1. Thank you for calling the Census Bureau. My name is . . . May I help you?
Yes – Respondent indicates they want to fill out their questionnaire over the phone – Continue with S2.

INTERVIEW SUMMARY
A. Status on Special Census Day

1 = Occupied
2 = Occupied – Continuation
3 = Vacant – Regular
4 = Vacant – Usual home elsewhere
5 = Uninhabitable/No longer exists
6 = Cannot locate/Outside boundary
7 = Duplicate
8 = Nonresidential
9 = Other

B.

POP on Special
Census Day

S2. Completing a questionnaire for your household takes about 7 minutes. A Privacy Act Notice was left at

C. VACANT — Which category best

described this vacant unit as of
(Special Census date)?
For rent
For sale only

01–97 = Total persons
00 = Vacant
98 = Delete
99 = POP unknown

D. PI

E. REP

F. CO

G. REF

your door by an enumerator (WYC version: The Privacy Act Notice was printed in the newspaper) and
explains that your answers are confidential. Did you receive (or read) this notice? (If the respondent answers
"no" or is not clear on what you are describing, read the Privacy Act Notice to them over the phone).
What is your exact address? (fill label area above, including location description if necessary)
Did you or anyone in your household live at this address on (Special Census date)?

Rented or sold, not occupied
For seasonal, recreational,
or occasional use
For migrant workers

H. JIC1

Yes – Continue with question S3

I. JIC2

household?
Yes Skip to items A, B, and C in the "Interview
Summary" block and refer to Card D.

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

Employee ID code

Skip to question S5

S3. Is this (house/apartment/mobile home) a vacation or seasonal home, or only occasionally occupied by your

Other vacant

CERTIFICATION
Enumerator’s signature

No

Month

Day

No

Skip to S5

S4. On (Special Census date) was this unit —
Crew Leader’s
Month
initials

Day

CLD number

Vacant Skip to items A, B, and C in the
"Interview Summary" block.

S5. How many people were living or staying in this (house/apartment/mobile home) on (Special Census date)?
Number of people

FORM SC-1(Phone/WYC) (7-14-2003)

Occupied by a different household? Using a knowledgeable
respondent, complete this questionnaire for the Special Census
Day household.

2
ENUMERATOR NOTE: For questions 2 through 6, prompt respondent with names if needed, for example, "Let’s start with Bob."
1. What is each person’s name? Start with the name of a
2. (Show Card A.) Which of these categories best describes how each person is
3. What is each
person who owns, is buying, or rents this
(house/apartment/mobile home).

person’s sex?
Mark  ONE box.

related to (Read name of Person 1)?

Person 1

4.

What was each person’s
age on (Special Census date)?
Print numbers in boxes.

Male

 Person 1

First Name

3

Age

MI

Female
What is this person’s
date of birth?

Last Name
Month

ENUMERATOR NOTE: It is important to ask BOTH questions 5 and 6 and show Cards B and C.

5. Are any of the persons that I have listed Mexican, Puerto
Rican, Cuban, or of another Hispanic or Latino group?
No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?

Day

Cancel

Person 2
MI

Last Name

Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister

Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.

Male
Age

Female
What is this person’s
date of birth?
Month

Cancel

NONRELATIVE:
Roomer/boarder
Housemate/roommate

Add

Person 3
First Name

MI

Last Name

Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister

NONRELATIVE:
Roomer/boarder
Housemate/roommate

Add

Person 4
First Name

MI

Last Name

Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister

Unmarried partner
Foster child

Other
nonrelative

Cancel

Add

Person 5
First Name

MI

Last Name

Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.

Male
Age

Female
What is this person’s
date of birth?

Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/sister

Add

NONRELATIVE:
Roomer/boarder
Housemate/roommate

No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?

Day

Unmarried partner
Foster child

Other
nonrelative

Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?

Native Hawaiian





Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race

Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.

Male
Age

Female
What is this person’s
date of birth?

No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?

Day

Unmarried partner
Foster child

Other
nonrelative

Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Other relative – Specify relationship.

Filipino
Japanese
Korean
Vietnamese
Other Asian





Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race

What is this race?





Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race





Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race





Guamanian/
Chamorro
Samoan
Other Pacific
Islander
Some other race

Native Hawaiian

White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?

Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?

Native Hawaiian

White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?

Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?

Native Hawaiian

Year of
birth

Male
Age

Female
What is this person’s
date of birth?

Day

Unmarried partner
Foster child

White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?

Year of
birth

Month

Cancel

White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?

Year of
birth

Month

NONRELATIVE:
Roomer/boarder
Housemate/roommate

No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?

Day

Month

Cancel

does each person consider himself/herself to be?

Year of
birth

Add

First Name

6. Now choose one or more races for each person. Which race or races

Other
nonrelative

FORM SC-1(Phone/WYC) (7-14-2003)

ENUMERATOR NOTE: Refer to S5 on the cover. If the number of people is more than 5, add additional household members to Form SC-1(SUPP), Continuation Form.

Year of
birth

No, not Spanish/Hispanic /Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino –
What is this group?

White
Black, African Am., or Negro
Asian Indian
Chinese
American Indian or Alaska
Native – What is the name
of (your/. . .’s) enrolled or
principal tribe?

Filipino
Japanese
Korean
Vietnamese
Other Asian
What is this race?

Native Hawaiian