SC-116 Group Quarters Enumeration Control Record

Attachment F
OMB No. XXXX-XXXX
FORM SC-116
(04-09-2012) Draft 10

SC ID

U.S. DEPARTMENT OF COMMERCE

State

County

Tract

Economics and Statistics Administration

U.S. CENSUS BUREAU

Block

GQ ENUMERATION
CONTROL RECORD

AA

Map Spot

Barcode ID

Special Census
APPLY PREPRINTED LABEL HERE

THIS LISTING CONTAINS INFORMATION,
THE RELEASE OF WHICH IS PROHIBITED
BY TITLE 13, U.S.C.
ADDED GQ ADDRESS or ADDRESS CHANGES
Is this an added GQ or is
there a change to the
preprinted address label?
Yes – Enter the full
address in the address
change section ➔

Facility Name

GQ Name

GQ Type

No
Street Number

Mark box with a Letter:
R (Rural Route)
L (Location Description)

(R or L)

Street name

Write either Rural Route or Location Description in the box below.

1. Contact name

2. Contact telephone number

D1

Not a GQ

D2

Does not exist

4. Listing used for completion

§!1+0¤

Administrative
records

D3

No LQ

D4

Duplicate

GEO Change

D5

5. Total SC-2s
Resident
listing

Other – Specify

Person
Number

Person Name

Room/Bed
Number

Complete

(a)

(b)

(c)

(d)

00161015

3. Delete reason

Zip Code

Person Name

Room/Bed
Number

Complete

(a)

(b)

(c)

(d)

00161026

§!1+;¤

Person
Number

Form SC-116 (04-09-2012) Draft 10