Various Pretesting Activities (see attached list)

OMB No. 0607-XXXX: Approval Expires XX/XX/XXXX

DX-1301

U.S. DEPARTMENT OF COMMERCE

PERSON FOLLOWUP QUESTIONNAIRE

FORM
(10-31-2008)

Economics and Statistics Administration

U.S. CENSUS BUREAU

CENSUS COVERAGE MEASUREMENT
2008 Census Dress Rehearsal
CLUSTER NO.
CCM
Block

LCO
MSN

WMSN

CENSUS
Block

CMSN

CID

Possible Reasons for Followup:
• The last time we were here, we didn’t get enough detailed information
to know where some household members should have been counted
in the census.
• We have two names and we aren’t sure if they refer to the same
person or different people.
• We need more detailed address information about where some of the
household members stayed during 2008 – things like street address.

CCM Roster – PI interview day:

Census Roster – Census Day: April 1, 2008

1.

1.

2.

2.

3.

3.

4.

4.

5.

5.

6.

6.

7.

7.

8.

8.

9.

9.

10.

10.

11.

11.

12.

12.

Crew Leader name

FR code

Interviewer name

FR code

Reassignment reason

Notes
NOTICE

If found, please either call 1–301–763–3301 collect
to arrange for pickup or mail to:
Census Coverage Measurement
U.S. Census Bureau
4600 Silver Hill Rd
Washington, DC 20233-5700

2

Section A – INTRODUCTION
Hello, I’m (Your name) from the U.S. Census Bureau. Here is my identification. As part of the census, we are contacting households to make sure we counted everyone correctly. Here is a
letter explaining our interview and information we will refer to later.
Followup for

1a. Do you know (name) well enough to answer questions
about where he/she was living in 2008 and other
places where he/she stayed?

1. Have you heard of
?

1

Yes – Go to NEXT PAGE.

1

Yes – Go to 1a.

2

No – Go to 1b.

2

Yes, respondent is (name) –
Go to NEXT PAGE.

3

Deceased – When did (name) die?

3

Age

Print corrected name if needed

OE

1c. (Do not ask) Is the next page another
Section A?
Yes – Go to NEXT PAGE.
No – Try to find someone who
knows more about the
followup person(s) when
finished with the current
respondent.

(If he/she moved out, ASK – When did he/she move?)

M M D D Y Y Y Y
Date of death
If deceased, ASK – Is it okay if I ask questions about
him/her?

No – Go to 2.

CL

1b. How have you heard of this person?

1

Yes – Go to NEXT PAGE

2

No – Mark this person’s outcome code:
Complete (Valid skip).

CL

Move-out date

M M

D D

Y Y Y Y

NOTES

OE

2a. Respondent type
2. Do you know who lived at
(1)

on

?
1

Yes – What is your name and address?
Address

Name

2b. (Do not ask) Is the next page another
Section A?

4

Resident
2
Neighbor
Other – Specify

3

Landlord

Yes – Go to NEXT PAGE.
No – Try to find someone who
knows more about the
followup person(s) when
finished with the current
respondent.

No – SKIP to 2b.
(2)

2

Yes – What is your name and address?
Address

Name

4

Landlord
Neighbor 3
Other – Specify

No – SKIP to 2b.
(3)

2

Yes – What is your name and address?
Address

Name

4

Landlord
Neighbor 3
Other – Specify

No – SKIP to 2b.
NONINTERVIEW
ASSESSMENT
Mark (X) ONE.

1
2
3

FORM DX-1301 (10-31-2008)

Someone verified that this person existed, but no one knew enough to complete the interview.
I talked to at least three people (listed in 2) who knew who lived at the address and no one heard of this person.
Mark person’s outcome code: Complete (Unknown to KR).
I was not able to locate anyone who knows who lived at this address.

4

Other – Please explain
CL

OE

3

Section B – POSSIBLE MATCH/DUPLICATE
1. We are trying to find out if the names we have refer to the same person.

2. What is the relationship between them?
1

Are

2
3

and
the same person?
1
2
3

4

Yes, same person – Complete Section C for first person only.
No, different people – Go to 2
DK/REF – Complete Section C for person Respondent knows.

5

CL

OE
6

Notes

FORM DX-1301 (10-31-2008)

Jr/Sr, Father/Son, Mother/Daughter . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Twins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Neighbors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other – Specify

DK – Describe how Respondent knows they are different people

REF

⎫
⎬
⎭

Complete Section C
for both people.

4

Section C – PERSON QUESTIONS
Now, we’ll talk about

.

1. Did you/

1g. Please look at the calendar (on the back
of the letter). When did you/he/she live or
stay at this address?
Please provide as specific dates as possible.

live or stay at
anytime in 2008?

1

Yes – Skip to 1g

2

No – Go to 1a
DK/REF – Go to next known
person. If last person,
end interview.

FROM

TO

CL
3

1a. At what address did you/he/she
live in 2008?
1

Same
as

1h. (Ask or verify) During 2008, did you/he/she
live at this address all year, move, or go
back and forth between addresses?

SKIP
to 1g

1

Number and street

1d. Is that place a house or
apartment or another type of
place like those shown on the
list I gave you? (The list is on
the back of the letter.)

Apt/Unit #
City

1
ZIP Code

State

2
2

DK/REF – Probe for street, city, state.

1b. (Ask or verify) Is that place more than
1 mile away from

3
4
5
6
7
8
9

1
2
3

Yes, more than a mile away
No, less than a mile away
DK/REF

1
CL
FORM DX-1301 (10-31-2008)

OE

DK/REF

1e. What are the names of any
other people who lived with
you/him/her at this address?
First name

}

DK/REF

NOTES

2

Last name

House/Apartment/Mobile home/
First name
Last name
Condo/Townhouse
College dorm/Residence hall/
Sorority/Fraternity house . . .
DK/REF
1
Military barracks/Ship . . . . .
Nursing home . . . . . . . . . . SKIP 1f. What are the names of
neighbors who lived nearby?
Skilled nursing unit in AL . . . to
1g
First name
Last name
Independent/Assisted Living .
Correctional facility . . . . . .
First name
Last name
Group home . . . . . . . . . .
Other – Specify
1
DK/REF
SKIP
to 1g

10

1c. What are the landmarks or cross
streets closest to that place?

OE

3

1

Before 4/1

2

On 4/1

3

After 4/1

1

Before

2

On

3

After

Go back and forth

1i. (Ask or verify) Did you/he/she stay at this address:
Mark (X) all that apply.
1
2
3
4

Most of the time?
Half of the time?
Less than half the time?
Short stays?

5
6

Daytime only,
didn’t spend nights?
Certain days of week?
Su
Th

M
F

1j. (Ask or verify) Were you/Was he/she at this
address on Tuesday, April 1st?
1

Go to 1g at top of next column.

All year
Move – Was the move

2
3

Yes
No
DK/REF

Tu
Sa

W

5

Section C – PERSON QUESTIONS – Continued
2a. What is the address of that place?
2. Did you/
1

live anywhere else in 2008?
1
2
3

Same as

Name’s location

2c. What are the landmarks or
cross streets closest to
that place?

SKIP
to 2g

Number and street
1

Yes – Go to 2a
No
SKIP to 3
DK/REF

Apt/Unit #

}

2e. What are the names of any
other people who lived with
you/him/her at that place?
First name

Last name

First name

Last name

DK/REF
1

DK/REF

2d. Is that place a house or
apartment or another type
2f. What are the names of
of place like those shown
neighbors who lived nearby?
on the list I gave you?
ZIP Code
State
First name
Last name
1
House/Apartment/Mobile home/
Condo/Townhouse
First name
Last name
2
College dorm/Residence hall/
Sorority/Fraternity
house
.
.
.
2
DK/REF – Probe for street, city, state.
3
Military barracks/Ship . . . .
1
DK/REF
2b. (Ask or verify) Is that place more than
SKIP
4
Nursing
home
.
.
.
.
.
.
.
.
.
1 mile away from
to
5
Skilled nursing unit in AL . . 2g
6
Independent/Assisted Living
7
Correctional facility . . . . . .
Group home . . . . . . . . . . .
8
9
Other – Specify
1
Yes – more than a mile away
Notes
No – less than a mile away
2
DK/REF
10
DK/REF
3
City

}

CL

OE

3. During 2008, did you/

3a. What is the address where
you/he/she lived while in college?

attend college?
1
2
3

3c. What are the landmarks or
cross streets closest to the
place where you/he/she lived?

SKIP
to 4

1

First name

Last name

First name

Last name

Number and street

Yes – Go to 3a
No
SKIP to 4
DK/REF

}

Apt/Unit #

1

State

ZIP Code
1

2

DK/REF – Probe for street, city, state.

2
3

3b. What is the name of the college or
university?

CL

OE

1

DK/REF

1

3d. Is that place a dormitory,
residence hall, sorority or
fraternity house?

City

FORM DX-1301 (10-31-2008)

3e. What are the names of any
other people who lived with
you/him/her at that place?

DK/REF

}

Yes, dorm or residence hall SKIP
Yes, sorority/fraternity house to 3g
No, other college
housing – Specify

First name

Last name

First name

Last name

No, not college housing
DK/REF

TO

2h. (Ask or verify) Did you/he/she move or go back
and forth between places?
1
Move – Was
After 4/1
On 4/1 3
the move
1
Before 4/1 2
Before

1
2

2

On

3

After

Back and forth

2i. (Ask or verify) Did you/he/she stay at that place:
Mark (X) all that apply.
5
Daytime only,
1
Most of the time?
didn’t spend nights?
Half of the time?
2
Certain days of the week?
Less than half the time? 6
3
4
Short stays?
Tu
W
M
Su
Th
F
Sa
2j. (Ask or verify) Were you/Was he/she there
on Tuesday, April 1st?
Yes

1

2

No

3

DK/REF

3g. During 2008, when did you/he/she live or stay at
that place? Please provide as specific dates as possible.
FROM

TO

3h. (Ask or verify) Did you/he/she stay at that place:
Mark (X) all that apply.

2
3
4
5

DK/REF
Notes

5

FROM

1

DK/REF

3f. What are the names of
neighbors who lived nearby?

1
4

2g. During 2008, when did you/he/she live or stay at
that place? Please provide as specific dates as possible.

Winter Semester
6
2007–2008?
Spring Semester 2008? 7
Summer Semester 2008?
Fall Semester 2008?
Winter Semester
2008–2009?

Daytime only,
didn’t spend nights?
Certain days of the week?
Su
Th

M
F

Tu
Sa

W

6

Section C – PERSON QUESTIONS – Continued
A1. What is the address of that place?

(Other than addresses
already mentioned for
you/this person)

Same
as

1

During 2008, did you/

Name’s location

SKIP
to F1

Number and street

1

Apt/Unit #

4. Live or stay part of the
time with another
relative?
1
Yes – Go to A1
No
2
Go to 5
DK/REF
3

}

5. Live or stay someplace
else because of
military service?
1
Yes – Go to A1 or A2
2
No
3
DK/REF Go to 6

}

6. Live or stay someplace
else because of a job?
1
Yes – Go to A1 or A2
No
2
DK/REF Go to 7
3

}

2
3

2
3

City

3
4
ZIP Code

State

5
6
7

DK/REF – Probe for street, city, state.

2

B1. What are the landmarks or cross
streets closest to that place?

8
9

.
.
.
.
.
.
.

}

SKIP
to
F1

10

A2. What is the address of that place?
Same
as

1

Name’s location

SKIP
to F2

Last name

1

2

E1. What are the names of
neighbors who lived nearby?
First name

Last name

First name

Last name

3

State

ZIP Code

5
6

2

DK/REF – Probe for street, city, state.

B2. What are the landmarks or cross
streets closest to that place?

7
8
9

House/Apartment/Mobile
home/Condo/Townhouse
College dorm/Residence hall
Sorority/Fraternity house . . .
Military barracks/Ship . . . . .
Nursing home . . . . . . . . . .
Skilled nursing unit in AL . . .
Independent/Assisted Living .
Correctional facility . . . . . . .
Group home . . . . . . . . . . .
Other – Specify

.
.
.
.
.
.
.

}

SKIP
to
F2

D2. What are the names of any
other people who lived with
you/him/her at that place?
First name

Last name

First name

Last name

1

10

DK/REF
Notes

1

FORM DX-1301 (10-31-2008)

OE

DK/REF

DK/REF

E2. What are the names of
neighbors who lived nearby?
First name

Last name

First name

Last name

1

CL

DK/REF

TO

G1. (Ask or verify) Did you/he/she move or go back
and forth between places?
1

DK/REF

DK/REF

C2. Is that place a house or
apartment or another type of
place like those shown on the
list I gave you?

4

}

First name

FROM

Move – Was
the move
Back and forth

1

Before 4/1

2

On 4/1

3

After 4/1

H1. (Ask or verify) Did you/he/she stay at that place:
Mark (X) all that apply.
5
Daytime only,
1
Most of the time?
didn’t spend nights?
Half of the time?
2
Certain days of the week?
Less than half the time? 6
3
4
Short stays?
Tu
W
M
Su
Th
F
Sa
I1. (Ask or verify) Were you/Was he/she there on
Tuesday, April 1st?
1

City

Yes – Go to A1 or A2
No
DK/REF Go to 9

Last name

F1. During 2008, when did you/he/she live or stay at
that place? Please provide as specific dates as possible.

Yes

2

No

3

DK/REF

Notes

2

}

First name

DK/REF

1

Apt/Unit #

Yes – Go to A1 or A2
No
Go to 8
DK/REF

D1. What are the names of any
other people who lived with
you/him/her at that place?

1

1

8. Was there any other place
you/he/she stayed often?
1

2

House/Apartment/Mobile
home/Condo/Townhouse
College dorm/Residence hall
Sorority/Fraternity house . . .
Military barracks/Ship . . . . .
Nursing home . . . . . . . . . .
Skilled nursing unit in AL . . .
Independent/Assisted Living .
Correctional facility . . . . . . .
Group home . . . . . . . . . . .
Other – Specify

Number and street

7. Have a seasonal or
second home?
1

C1. Is that place a house or
apartment or another type of
place like those shown on the
list I gave you?

DK/REF

F2. During 2008, when did you/he/she live or stay at
that place? Please provide as specific dates as possible.
FROM

TO

G2. (Ask or verify) Did you/he/she move or go back
and forth between places?
1
Move – Was
the move
1
Before 4/1 2
On 4/1 3
After 4/1
2
Back and forth
H2. (Ask or verify) Did you/he/she stay at that place:
Mark (X) all that apply.
5
Daytime only,
1
Most of the time?
didn’t spend nights?
Half of the time?
2
Certain days of the week?
Less than half the time? 6
3
4
Short stays?
Tu
W
M
Su
Th
F
Sa
I2. (Ask or verify) Were you/Was he/she there on
Tuesday, April 1st?
1

Yes

2

No

3

DK/REF

7

Section C – PERSON QUESTIONS – Continued
9. Please look at the list again.
Even if you/

9a. What is the name and address of
that place?
Name

did not live there, did you/he/she
spend even one night in any of
those types of places around
April 1st?
1
2
3

Number and street
Apt/Unit #
City

Yes – Go to 9a
No
Go to 10
DK/REF

}

ZIP Code

State

DK/REF – Probe for street, city, state.

1

9b. What are the landmarks or cross
streets closest to that place?

CL

OE

10a. (Ask or verify) What is your name,
address and phone number?

10. DO NOT ASK
Which one of the following best
describes the respondent?
1
Respondent is

3
4
5
6

7

}

Respondent’s name is on front
cover of form
Respondent lives at address on front of
form, but his/her name is not on cover
Relative/Caregiver
Neighbor
Landlord (superintendent, rental office,
owner, etc. for places with fewer than
10 units)
Other – Specify

First name

TO

9e. (Ask or verify) Were you/Was he/she there on
Tuesday, April 1st?
1
2
3

Yes
No
DK/REF

Notes

10b. Miscellaneous questions

CL

OE

Last name

Notes
Number and street
Apt/Unit #
City
State

ZIP Code
Number

Area code

–

–

—

FINAL PERSON-LEVEL OUTCOME CODE
1
2

FORM DX-1301 (10-31-2008)

FROM

Same as previous
respondent – Go to next section
Go to
next
section

2

9d. During 2008, when did you/he/she stay at that
place? Please provide as specific dates as possible.

DK/REF

14

DK/REF

1

9c. What type of place was it?
College housing
1
Dormitory or residence hall
Sorority/Fraternity house
2
Military housing
3
Military barracks
Military ship
4
Other group facilities
5
Nursing home
6
A 24-hour skilled nursing care unit within an assisted living facility
7
Independent or assisted living facility
Correctional facility
8
Group home
9
Emergency shelter
10
11
Residential school for people with disabilities
Psychiatric hospital
12
13
Other – Specify

3

Complete
Complete (Valid skip)
Complete (Unknown to KR)

4
5
6

Partial
Refusal
Other

CREW LEADER ASSESSMENT
1
2
CL

OE

3

Knowledgeable Respondent found and interview Complete/Partial
Case closed – 3 Knowledgeable Respondents found, no interview conducted
Case closed – unable to locate 3 Knowledgeable Respondents

4

Other – Specify

Section D – APRIL 1 OCCUPANCY

8

To be completed by the Interviewer

PI Household

Census Household

DO NOT READ THIS TO RESPONDENT
Two earlier interviews have reported two different households living at this address. Based on what you have
learned, what do you think the true situation is? Mark (X) as many boxes as you think apply AND write detailed
notes in the NOTES section.

NOTES

1
2

PI household is unknown
Census household is unknown

3

Only PI household lived at
on April 1, 2008

4

Only Census household lived at
on April 1, 2008

5

Neither household listed above lived at
on April 1, 2008

6

Both PI and Census households lived at
in separate housing units (i.e., different living spaces with separate entrances) on April 1, 2008

7

Both PI and Census households lived at
and shared a housing unit (i.e., shared living space) on April 1, 2008
Other – Explain in NOTES section

8

CL
FORM DX-1301 (10-31-2008)

OE

9

Section E – GEOCODING
Notes

1. On Tuesday, April 1, 2008, was there a housing unit at
?
1
2

Yes – Go to 2
No – Explain
CL

OE

2. DO NOT ASK:
Is
1
2

located in block

Yes – Go to 3
No – Specify the state, county, and block number for this address.
State

County

Block

CL

3. What is your name?
Last name

First name

4. What is your phone number?
Number

Area code

–

–

5. DO NOT ASK: Indicate outcome of this section.
1
2

Completed section with household member
Completed section with nonhousehold member
Nonhousehold member was:
1
2
3
4

3
4

?

Relative/Caregiver
Neighbor
Landlord (Superintendent, rental office, owner, etc.)
Other – Specify

Noninterview – Refusal
Noninterview – Other – Specify

FORM DX-1301 (10-31-2008)

OE

10

RECORD OF VISITS
Line
No.

Date
(a)

Month Day

Time

Respondent name, address, and telephone number

(b)

Attempt type

FR code

(c)

(d)

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

a.m.
p.m.

2

Crew Leader
signature
FORM DX-1301 (10-31-2008)

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2

Personal visit
Telephone

1
2

Non-proxy
Proxy

1
2
3

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

2

3
1

10

1

3
1

9

Personal visit
Telephone

3
1

8

2

3
1

7

1

3
1

6

Non-proxy
Proxy

3
1

5

2

3
1

4

1

3
1

3

Personal visit
Telephone

3
1

2

FR code
Month

M M

Day

D D

FR code
Month

M M

Day

D D

Final outcome
201
203
216
218
219

Complete
Partial
No one home
Refusal
Other

Visit
outcome

Comments

(g)

(h)

(f)

(e)
1

1

R Type

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Complete
Partial
No one home

4

Respondent classification
1
2
3

Non-proxy (single respondent)
Proxy (single respondent)
Multiple respondents

5
6

5
6

5
6

5
6

5
6

5
6

5
6

5
6

5
6

5
6

Refusal
Callback
Other
Refusal
Callback
Other
Refusal
Callback
Other
Refusal
Callback
Other
Refusal
Callback
Other
Refusal
Callback
Other
Refusal
Callback
Other
Refusal
Callback
Other
Refusal
Callback
Other

In what language
was most of the
interview
conducted?
1
2

CL/QI
initials

Refusal
Callback
Other

3

English
Spanish
Other – Specify

QA USE ONLY
1
2
3
4
5
6
7

Not eligible
Not selected
Selected
Pass
Fail (Includes No and DK fails)
Noninterview–Unresolved
Noninterview–Refused