D-806 IA Reinterview and Reconciliation Questionnaire

FORM D-806 IA U.S. DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS REINTERVIEW AND RECONCILIATION QUESTIONAIRRE Census 2010 – Island Areas

Section 1 – IDENTIFICATION

1. LCO 2. County 3. Block 4. AA 5. Map Spot 6. Unit ID

7. MAILING ADDRESS/LOCATION DESCRIPTION

House No.

Street or Road name

Apartment No.

Notice – Response to this inquiry is required by law (Title 13, U.S. Code). By the same law, your report to the Census Bureau is confidential. It may be seen only by sworn Census employees and may be used only for statistical purposes.

Physical description/Location

Development/Building name or Subdivision Place name or Estate name

District/Island/Municipality/Village

Zip Code

Section 2 – ORIGINAL ENUMERATOR INFORMATION

Section 3 – TELEPHONE INTRODUCTION- READ BOLD ONLY

8. METHOD OF COMPLETION 1. Personal Visit 2. Telephone

A. Hello, my name is (Your name) and I’m calling from the Local Census Office. May I speak to (Original respondent in section 2, item 9a). If the original household respondent (9d is marked 1 or 2) is not available, ask to speak to a household member who is at least 15 years old. Then, read the Confidentiality Notice. If the original proxy (9d is marked 3) is not available, ask what time would be best to call back. Do not continue with B2 until/unless you reach the original proxy. If Item 9d is marked 1 or 2 – READ: B1. Have I reached (Read address in section 1, item 7)? If NO- Excuse me. I might have dialed the wrong number. Is this (Read area code and phone number in section 2, item 9b)? Respondent phone number and address do not agree- Ask if respondent has ever lived at the address in section 1, item 7. If NO, end phone interview, and send to Personal Reinterview. If YES, go to item C. If item 9d is marked 3 – READ: B2. I’m calling in reference to information provided for (Read address in section 1, item 7). C. We are checking the accuracy of the Census, and I’d like to ask you a few questions. This interview should take about 6 minutes. Continue to Section 4.

9a. Original respondent’s name (Last, First, MI)

b. Telephone

Area Code

Number

No Phone Number

c. Best time to call 1. Day E vening 3 . Either

d . Respondent – Lived here on April 1, 2010 Moved in after April 1, 2010 Neighbor or other proxy

10. Enumerator’s name (Last, First, MI) N otes

Section 4 – REINTERVIEW INFORMATION

11. Were you or someone in your household recently interviewed by the Census Bureau about (read address in section 1, item 7)? Yes No

14. TYPE OF REINTERVIEW – Six telephone attempts must be made before any personal visits. Telephone Personal visit

12a. Reinterview respondent’s name (Last, First, MI)

Date

Time

Date

Time

Month

Day

Year

Month

Day

Year

b. Telephone

Area Code

Number

No Phone Number

a.m. p.m.

a.m. p.m.

a.m. p.m.

a.m. p.m.

13. Who is the reinterview respondent? Mark (X) ONE Box. Original household respondent Different household respondent Original neighbor or other proxy Other

a.m. p.m.

a.m. p.m.

a.m. p.m.

If unable to contact a knowledgeable person after six telephone and three personal visit attempts, skip to item 19.

a.m. p.m.

a.m. p.m.

Section 5 – REINTERVIEW
Part A – REINTERVIEW RESPONSE
15. On April 1, 2010, was this unit – 1. Occupied? Ask 16 and 17. Vacant? Skip to 18. 3 . Not a living quarters? Skip to 18.		Person 3 First name Middle initial		Age as of April 1, 2010
		Last name
16. Did you or anyone in this household live here on April 1, 2010? Ask only if 9d is marked 1 or 2. Yes 2. No		Person 4 First name Middle initial		Age as of April 1, 2010
		Last name
17. What is each person’s name who lived here on April 1, 2010? Start with the name of someone living here who owns, is buying, or rents this living quarters. What was each person’s age on April 1, 2010? Please report babies as age 0 when the child is less than 1 year old.		Person 5 First name Middle initial		Age as of April 1, 2010
		Last name
Person 1 First name Middle initial	Age as of April 1, 2010	Person 6 First name Middle initial		Age as of April 1, 2010
Last name		Last name
Person 2 First name Middle initial	Age as of April 1, 2010	Note: If there are more than six people in the household, complete the roster for the first six names provided.
Last name		18. Thank the respondent and conclude the interview. Complete items 19-21 under Results.
Part B – RESULTS
19. REINTERVIEW STATUS 1. Complete Noninterview 2. Refusal 3. Unable to locate 4. Other- Explain in “Remarks” section below.
2 0. Reinterview’s name (Print)
21. CERTIFICATION a. Reinterviewer’s signature I certify that the entries I have made on this questionnaire are true and correct to the best of my knowledge.			b. Date
Remarks
Reinterview Results – Office Use Only
FINAL OUTCOME Pass Soft Fail Hard Fail Unable to Contact