Maricopa County - Self Response

23

Questionnaire Content Document for the Enumerator Instrument

October 24, 2014

Question name	VERIFY DIALED NUMBER
Question wording for telephone housing unit respondent	Hello. My name is (your name) and I am from the U.S. Census Bureau. Have I reached <insert phone number selected from NUMBER CALLED>?
Spanish question wording for telephone housing unit respondent	Buenos días (Buenas tardes). Mi nombre es (your name)y soy de la Oficina del Censo de los Estados Unidos. ¿Me he comunicado con el <insert phone number selected from NUMBER CALLED>?

Question name	INTRO PHONE
Question wording for telephone housing unit respondent	IF OUTBOUND CALL DISPLAY: I am calling about a very important survey. IF INBOUND CALL DISPLAY: Thank you for returning my call. My name is <fill enumerator name> from the U.S. Census Bureau. I contacted your household concerning a very important survey. Both: Are you the lady or gentleman of the house? May I speak with someone at least 15 years old who lives here and knows about the people in the household? Would that be you?
Spanish question wording for telephone housing unit respondent	If OUTBOUND CALL DISPLAY:: Estoy llamando acerca de una encuesta muy importante. IF INBOUND CALL DISPLAY: Gracias por devolverme la llamada. Mi nombre es <fill enumerator name> de la Oficina del Censo de los Estados Unidos. Le llamo en relación con una encuesta muy importante. Both: ¿Es usted la señora o el señor de la casa? ¿Puedo hablar con alguien que tenga al menos 15 años de edad que viva aquí y conozca a las personas del hogar? ¿Sería usted la persona indicada?

Question name	ADDRESS VERIFY
Question wording for telephone housing unit respondent	I’m calling to complete a Census questionnaire for <PARTIALADDRESS>. This survey is authorized by Title 13 of the United States Code and your response is required by law. Our approval number from the Office of Management and Budget is XXXX-XXXX. All of the information you provide will remain confidential. The interview will take about 10 minutes. Is this: <fill CENSUSADDRESS>?
Spanish question wording for telephone housing unit respondent	Estoy llamando para completar un cuestionario del Censo para <PARTIALADDRESS>. Esta encuesta está autorizada por el Título 13 del Código de los Estados Unidos y su respuesta es requerida por la ley. Nuestro número de aprobación de la Oficina de Administración y Presupuesto es XXXX-XXXX. Toda la información que usted proporcione se mantendrá confidencial. La entrevista tomará alrededor de 10 minutos . ¿Es esta: <fill CENSUSADDRESS>?

Question name	KNOW ADDRESS
Question wording for in person housing unit respondent	Do you know where <FULLCENSUSADDRESS> is?
Spanish question wording for in person housing unit respondent	¿Sabe usted dónde es <FULLCENSUSADDRESS>?

Question name	PHONE INBOUND
Question wording for telephone housing unit respondent	In case we get disconnected, what phone number are you calling from?
Spanish question wording for telephone housing unit respondent	En caso de que se desconecte la llamada, ¿de qué número de teléfono está llamando?

Question name	INTRO
Question wording for in person housing unit respondent	Hello, I’m (your name) from the U.S. Census Bureau. (Show ID). I’m here to complete a Census questionnaire for <PARTIALADDRESS>. The interview should take about 10 minutes. (Hand respondent Confidentiality Notice.) This notice explains that your answers are confidential. Is this <PARTIALADDRESS>? May I speak with someone at least 15 years old who lives here and knows about the people in the household? Would that be you?
Spanish question wording for in person housing unit respondent	Buenos días (Buenas tardes), soy (your name) de la Oficina del Censo de los Estados Unidos. (Show ID). Estoy aquí para completar un cuestionario del Censo para <PARTIALADDRESS>. La entrevista deberá tomar alrededor de 10 minutos. (Hand respondent Confidentiality Notice.) Esta nota explica que sus respuestas son confidenciales. ¿Es esta la dirección <PARTIALADDRESS>?

Screen name	INTRO PROXY
Question wording for in person proxy respondent	Hello, I’m (your name) from the U.S. Census Bureau. (Show ID). I’m here to complete a Census questionnaire for <PARTIALADDRESS>. The interview should take about 10 minutes. (Hand respondent Confidentiality Notice.) This notice explains that your answers are confidential. May I ask you some questions about <PARTIALADDRESS>?
Question wording for telephone proxy respondent	Inbound: Hello, I’m (your name)from the U.S. Census Bureau. Thank you for returning my call. I was previously calling to complete a Census questionnaire for <PARTIALADDRESS>. This survey is authorized by Title 13 of the United States Code and your response is required by law. Our approval number from the Office of Management and Budget is XXXX-XXXX. All of the information you provide will remain confidential. The interview will take about 10 minutes. May I ask you some questions about <PARTIALADDRESS>? Outbound: I’m calling to complete a Census questionnaire for <PARTIALADDRESS>. This survey is authorized by Title 13 of the United States Code and your response is required by law. Our approval number from the Office of Management and Budget is XXXX-XXXX. All of the information you provide will remain confidential. The interview will take about 10 minutes. May I ask you some questions about <PARTIALADDRESS>?
Spanish question wording for in person proxy respondent	Buenos días (Buenas tardes), soy (your name)de la Oficina del Censo de los Estados Unidos. (Show ID). Estoy aquí para completar un cuestionario del Censo para <PARTIALADDRESS>. La entrevista deberá tomar alrededor de 10 minutos. (Hand respondent Confidentiality Notice.) Esta nota explica que sus respuestas son confidenciales. ¿Puedo hacerle unas preguntas sobre <PARTIALADDRESS>?
Spanish question wording for telephone proxy respondent	Inbound: Buenos días (Buenas tardes), soy (your name) de la Oficina del Censo de los Estados Unidos. Gracias por contestar mi llamada. Le había llamadoantes para completar un cuestionario del Censo para <PARTIALADDRESS>. Esta encuesta está autorizada en conformidad con el Título 13 del Código de los Estados Unidos y su respuesta es requerida por ley. Nuestro número de aprobación de la Oficina de Administración y Presupuesto es XXXX-XXXX. Toda la información que usted nos dé será confidencial. La entrevista tomará alrededor de 10 minutos . ¿Puedo hacerle algunas preguntas sobre <PARTIALADDRESS>? Outbound: Estoy llamando para completar un cuestionario del Censo para <PARTIALADDRESS>. La encuesta está autorizada en conformidad con el Título 13 del Código de los Estados Unidos y su respuesta es requerida por ley. Nuestro número de aprobación de la Oficina de Administración y Presupuesto es XXXX-XXXX. Toda la información que usted nos dé será confidencial. La entrevista tomará alrededor de 10 minutos . ¿Puedo hacerle algunas preguntas sobre <PARTIALADDRESS>?

Question name	INTRO PARTIAL
Question wording for in person housing unit respondent	Hello, I’m (your name) from the U.S. Census Bureau. (Show ID). May I speak to <RESP NAME>?
Spanish question wording for in person housing unit respondent	Buenos días (Buenas tardes). Soy (your name) de la Oficina del Censo de los Estados Unidos. (Show ID) ¿Podría hablar con <RESP NAME>?

Question name	PARTIAL REVIEW
Question wording for in person housing unit respondent	We previously completed some of the Census questionnaire for <PARTIAL CENSUS ADDRESS>. So far you have told me about: <List each person on the roster>. We will now resume where we left off.
Spanish question wording for in person housing unit respondent	Previamente se completó una parte del cuestionario del Censo para < PARTIAL CENSUS ADDRESS >. Hasta ahora usted me ha dicho sobre: < List each person on the roster >. Ahora vamos a continuar donde lo dejamos.

Question name	ADDRESS
Question wording for in person housing unit respondent	On <CENSUSDAY>, were you living or staying at <PARTIALADDRESS>?
Spanish question wording for in person housing unit respondent	El <CENSUSDAY>, ¿vivía o se quedaba usted en <PARTIALADDRESS>?

Screen name	RESP NAME
Question wording for in person housing unit respondent	What is your name?
Spanish question wording for in person housing unit respondent	¿Cuál es su nombre?

Screen name	RESP PHONE
Question wording for in person housing unit respondent	What is the best phone number to reach you?
Spanish question wording for in person housing unit respondent	¿Cuál es el mejor número de teléfono para comunicarnos con usted?

Screen name	ANYONE
Question wording for in person housing unit respondent	Did anyone live at this address on <CENSUSDAY>?
Question wording for telephone housing unit respondent	Did anyone live at that address on <CENSUSDAY>?
Question wording for in person proxy respondent	Did anyone live at that address on <CENSUSDAY>?
Response options	(Radio buttons) Yes No
Spanish question wording for in person housing unit respondent	¿Vivía alguien en esta dirección el <CENSUSDAY>?
Spanish question wording for telephone housing unit respondent	¿Vivía alguien en esa dirección el <CENSUSDAY>?
Spanish question wording for in person proxy respondent	¿Vivía alguien en esa dirección el <CENSUSDAY>?
Spanish response options	(Radio buttons) Sí No

Question name	OCCUPANCY
Question wording for in person housing unit respondent	On <CENSUSDAY>, was this unit vacant or occupied by a different household?
Question wording for in person proxy respondent	On <CENSUSDAY>, was <PARTIALADDRESS> vacant or occupied by a different household?
Spanish question wording for in person housing unit respondent	El <CENSUSDAY>, ¿estaba vacante esta unidad o estaba ocupada por otro hogar?
Spanish question wording for in person proxy respondent	El <CENSUSDAY>, ¿estaba <PARTIALADDRESS> vacante o estaba ocupada por otro hogar?

Question name	VACANT DESCRIPTION
Question wording for in person housing unit respondent	Which category best describes this vacant unit as of <CENSUSDAY>?
Spanish question wording for in person housing unit respondent	¿Qué categoría describe mejor esta unidad vacante al <CENSUSDAY>?

Screen name	WHO
Question wording for in person housing unit respondent	Do you know who lived at <PARTIALADDRESS> on <CENSUS DAY>?
Spanish question wording for in person housing unit respondent	¿Sabe usted quién vivía en <PARTIALADDRESS> el <CENSUS DAY>?

Screen name	OTHERS
Question wording for in person housing unit respondent	On <CENSUS DAY>, was there anyone else living or staying at <partial address>?
Spanish question wording for in person housing unit respondent	¿Había alguien más viviendo o quedándose en <partial address> el <CENSUSDAY>?

Screen name	PEOPLE
Question wording for in person housing unit respondent	Besides you, what are the names of the other people who were living or staying here on <CENSUSDAY>? Enter a name on each screen until you have listed everybody everyone who was living or staying there.
Question wording for telephone housing unit respondent	Besides you, what are the names of the other people who were living or staying there on <CENSUSDAY>?
Question wording for in person proxy respondent	What are the names of the people who were living or staying there on <CENSUSDAY>?
Question wording for telephone proxy respondent	What are the names of the people who were living or staying there on <CENSUSDAY>?
Spanish question wording for in person housing unit respondent	Por favor, mencione los nombres de todas las personas que estaban viviendo o quedándose en <PARTIALADDRESS> el <CENSUSDAY>. Enter a name on each screen until you have listed everybody who was living or staying there, then click next.

Screen name	BABIES
Question wording for in person housing unit respondent	On <CENSUS DAY>, were there any additional people staying <here/there> who you did not mention yet? For example, babies, foster children, other relatives, roommates, or other people not related to you. So far you have told me about the following people: <List of names>
Spanish question wording for in person housing unit respondent	Translation pending

Screen name	NO PERMANENT PLACE
Question wording for in person housing unit respondent	Was there anyone else staying here on <CENSUSDAY>who had no permanent place to live? So far you have told me about the following people: <List of names>
Response options	(Radio buttons) Yes No If “Yes”, prompt respondent for a name. Text boxes: First Name: 20-character text box ****Middle Name: 20-character text box**** Last Name: 20-character text box Then ask “Was there anyone else staying here on <CENSUSDAY> who had no permanent place to live?” If yes, prompt respondent for another name. Then ask “Was there anyone else staying here on <CENSUSDAY> who had no permanent place to live?” Ask for another name until the response to “Was there anyone else staying here on <CENSUSDAY> who had no permanent place to live?” is “No”
Spanish question wording for in person housing unit respondent	¿Había alguien más que se quedaba aquí el <CENSUSDAY> que no tuviera un lugar permanente donde vivir?
Spanish response options	(Radio buttons) Sí No If “Sí”, prompt respondent for a name. Textboxes: Nombre: 20-character text box ****Segundo nombre: 20-character text box**** Apellido: 20-character text box Then ask “¿Alguien más?” If yes, prompt respondent for another name. Then ask “¿Alguien más?” Ask for another name until the response to “¿Alguien más?” is “No”

Screen name	ROSTER_REVIEW
Question wording for in person housing unit respondent	Based on what you’ve told me so far, the names I have listed are: <names> Is this list correct? You will not be able to change this list later.
Spanish question wording for in person housing unit respondent	Translation pending

Screen name	ROSTER_EDIT
Question wording for in person housing unit respondent	What type of correction needs to be made? You can change spelling, add additional people, or remove someone from the list.
Response options	(Check boxes) Change spelling Add additional people Remove someone
Spanish question wording for in person housing unit respondent	Translation pending
Spanish Response options	Translation pending

Screen name	ROSTER_REVIEW2
Question wording for in person housing unit respondent	Based on what you’ve told me so far, the names I have listed are: <names> Is this updated list correct? You will not be able to change this list later.
Response options	(Radio buttons) Yes No
Spanish question wording for in person housing unit respondent	Translation pending
Spanish Response Options	Translation pending

Screen name	HOME
Question wording for in person housing unit respondent	Do you or does someone in this household own this house, apartment, or mobile home with a mortgage or loan (including home equity loans), own it free and clear, rent it, or occupy it without having to pay rent?
Response options	(Radio buttons) Owned by you or someone in this household with a mortgage or loan. Include home equity loans. Owned by you or someone in this household free and clear (without a mortgage or loan) Rented Occupied without payment of rent
Question wording for in person proxy respondent	Does someone in this household own this house, apartment, mobile home with a mortgage or loan (including home equity loans), own it free and clear, rent it, or occupy it without having to pay rent?
Spanish question wording for in person housing unit respondent	Es esta casa, este apartamento o esta casa móvil propiedad suya o de alguna otra persona en este hogar con una hipoteca o préstamo (incluyendo préstamos sobre el valor líquido de la propiedad), propiedad libre y sin deuda; alquilada; u ocupada sin pago de alquiler?
Spanish response options	(Radio buttons) Propiedad suya o de alguna otra persona en este hogar con una hipoteca o préstamo. Incluya préstamos sobre el valor líquido de la propiedad. Propiedad suya o de alguna otra persona en este hogar libre y sin deuda (sin hipoteca o préstamo) Alquilada Ocupada sin pago de alquiler
Spanish question wording for in person proxy respondent	¿Es esta casa, este apartamento o esta casa móvil propiedad de alguien en este hogar con una hipoteca o préstamo (incluyendo préstamos sobre el valor líquido de la propiedad), propiedad libre y sin deuda, alquilada u ocupada sin pago de alquiler

Screen name	OWNER
Question wording for in person housing unit respondent	Of the people who lived at <PARTIALADDRESS>, who owned the house, apartment, or mobile home on <CENSUSDAY>?
Response options	Check boxes where each name from the roster (all names from PEOPLE or, if a 1-person HH, the name from RESP NAME AND any names added from BABIES, Error! Reference source not found.NO PERMANENT PLACE, or ROSTER_EDIT) is assigned to a check box. <roster name 1> <roster name 2-n (if applicable)> None of the above
Spanish question wording for in person housing unit respondent	De las personas que vivían en <PARTIAL ADDRESS>, ¿quién era el dueño de la casa, el apartamento o la casa móvil el <CENSUSDAY>?
Spanish response options	Check boxes where each name from the roster (all names from PEOPLE or, if a 1-person HH, the name from RESP NAME AND any names added from BABIES, , NO PERMANENT PLACE, or ROSTER_EDIT) is assigned to a check box. <roster name 1> <roster name 2-n (if applicable)> Ninguno de los anteriores

Screen name	RENTER
Question wording for in person housing unit respondent	Of the people who lived at <PARTIALADDRESS>, who rented the house, apartment, or mobile home on <CENSUSDAY>?
Response options	Check boxes where each name from the roster (all names from PEOPLE or, if a 1-person HH, the name from RESP NAME AND any names added from BABIES, , NO PERMANENT PLACE, or ROSTER_EDIT) is assigned to a check box. <roster name 1> <roster name 2-n (if applicable)> None of the above
Spanish question wording for in person housing unit respondent	De las personas que vivían en <PARTIALADDRESS>, ¿quién alquiló la casa, el apartamento o la casa móvil el <CENSUSDAY>?
Spanish response options	Check boxes where each name from the roster (all names from PEOPLE or, if a 1-person HH, the name from RESP NAME AND any names added from BABIES, NO PERMANENT PLACE, or ROSTER_EDIT) is assigned to a check box. <roster name 1> <roster name 2-n (if applicable)> Ninguno de los anteriores

Question name	RELATIONSHIP RESP
Question wording for in person housing unit respondent	Next, we need to record each person’s relationship to you. Looking at the screen, <roster name> is your _______. Interviewer Note – Show screen to respondent or read if necessary
Response options	(Radio buttons) Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Same-sex husband/wife/spouse Same-sex unmarried partner Son or daughter Brother or sister Father or mother Grandchild Other
Spanish question wording for in person housing unit respondent	Translation pending
Spanish Response Options	Translation pending

Question name	SONDAU RESP
Question wording for in person housing unit respondent	Is <Roster name> your biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Response options	Radio Buttons. Biological son or daughter Adopted son or daughter Stepson or stepdaughter Foster child
Question wording for telephone housing unit respondent	Is <Roster name> your biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Question wording for in person proxy respondent	Is < Roster name > <Reference person>’s biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Question wording for telephone proxy respondent	Is < Roster name > < Reference person >’s biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Spanish question wording for in person housing unit respondent	Translation pending
Spanish question wording for in person proxy respondent	Translation pending
Spanish question wording for telephone proxy respondent	Translation pending

Question name	OTHER RESP
Question wording for in person housing unit respondent	Which of these best describes <Roster name’s> relationship to you? Read categories as necessary.
Response options	7 Radio Buttons. Parent-in-law Son-in-law or daughter-in-law Other relative Roomer or boarder Housemate or roommate Foster child Other nonrelative
Spanish question wording for in person housing unit respondent	Translation pending
Spanish Response options	Translation pending

Question name		RELATIONSHIP OTHER
Question wording for in person housing unit respondent		Next, we need to record each person’s relationship to <reference person>. Looking at the screen, <you are/roster name is> <reference person>’s _______.
Response options		(Radio buttons) Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Same-sex husband/wife/spouse Same-sex unmarried partner Son or daughter Brother or sister Father or mother Grandchild Other
Spanish question wording for in person housing unit respondent		Translation pending
Question name	SONDAU OTHER
Question wording for in person housing unit respondent	Are you/Is < Roster name > <REFERENCE PERSON>’s biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Response options	Radio Buttons. Biological son or daughter Adopted son or daughter Stepson or stepdaughter Foster child
Question wording for telephone housing unit respondent	Is <Roster name> <REFERENCE PERSON>’s biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Question wording for in person proxy respondent	Is < Roster name > <REFERENCE PERSON>’s biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Question wording for telephone proxy respondent	Is < Roster name > <REFERENCE PERSON>’s biological son or daughter, adopted son or daughter, OR stepson or stepdaughter?
Spanish question wording for in person housing unit respondent	Translation pending
Spanish question wording for telephone housing unit respondent	Translation pending
Spanish question wording for in person proxy respondent	Translation pending
Spanish question wording for telephone proxy respondent	Translation pending

Question name	OTHER
Question wording for in person housing unit respondent	Which of these best describes <your/roster name’s> relationship to <Reference person>? Read categories as necessary.
Response options	7 Radio Buttons. Parent-in-law Son-in-law or daughter-in-law Other relative Roomer or boarder Housemate or roommate Foster child Other nonrelative
Question wording for in person proxy respondent	Which of these best describes [Roster person]’s relationship to [Reference Person]? Read categories as necessary.
Question wording for telephone proxy respondent	Which of these best describes [Roster person]’s relationship to [Reference Person]? Read categories as necessary.
Spanish question wording for in person housing unit respondent	Translation pending
Spanish question wording for in person proxy respondent	Translation pending
Spanish question wording for telephone proxy respondent	Translation pending

Question name	SEX
Question wording for in person housing unit respondent	Are you male or female?
Response options	(Radio buttons) Male Female
Spanish question wording for in person housing unit respondent	¿Es usted del sexo masculino o del sexo femenino?
Spanish response options	(Radio buttons) Masculino Femenino

Question name	RELCONFIRM RESP
Question wording for in person housing unit respondent	Let me confirm that I have your answers correct. I recorded that <Roster name> is your <opposite-sex husband/wife/spouse; opposite-sex unmarried partner; same-sex husband/wife/spouse; same-sex unmarried partner>. Is that correct?
Response options	Two radio buttons: Yes No
Spanish question wording for in person housing unit respondent	Translation pending
Spanish Response Oprtions	Translation pending

Question name	RELCONFIRM OTHER
Question wording for in person housing unit respondent	Let me confirm that I have your answers correct. I recorded that <You are/Roster name is> <reference person>’s <opposite-sex husband/wife/spouse; opposite-sex unmarried partner; same-sex husband/wife/spouse; same-sex unmarried partner>. Is that correct?
Response options	Two radio buttons: Yes No
Spanish question wording for in person housing unit respondent	Translation pending

Question name	SEXCONFIRM REF
Question wording for in person housing unit respondent	I recorded that <you/REFERENCE PERSON> are/is <male/female>. Is that correct?
Response options	Two radio buttons Yes No
Question wording for telephone housing unit respondent	I recorded that <you/REFERENCE PERSON> is/are <male/female>. Is that correct?
Question wording for in person proxy respondent	I recorded that <REFERENCE PERSON> is <male/female>. Is that correct?
Question wording for telephone proxy respondent	I recorded that <REFERENCE PERSON> is <male/female>. Is that correct?
Spanish question wording for in person housing unit respondent	Translation pending
Spanish question wording for telephone housing unit respondent	Translation pending
Spanish question wording for in person proxy respondent	Translation pending
Spanish question wording for telephone proxy respondent	Translation pending

Question name	SEXCONFIRM SPPTR
Question wording for in person housing unit respondent	I recorded that <ROSTER NAME> is <male/female>. Is that correct?
Question wording for telephone housing unit respondent	I recorded that <ROSTER NAME> is <male/female>. Is that correct?
Question wording for in person proxy respondent	I recorded that <ROSTER NAME> is <male/female>. Is that correct?
Question wording for telephone proxy respondent	I recorded that <ROSTER NAME> is <male/female>. Is that correct?
Spanish question wording for in person housing unit respondent	Translation pending
Spanish question wording for telephone housing unit respondent	Translation pending
Spanish question wording for in person proxy respondent	Translation pending
Spanish question wording for telephone proxy respondent	Translation pending

Question name	DATE OF BIRTH
Question wording for in person housing unit respondent	What is <your/ roster name’s> date of birth?
Response options	For user selectable elements, the default text before an answer is selected is left blank. Month user selectable element containing only the name of the month (i.e., January, February, etc.) in chronological order (starts with December and goes to January). User selectable elements containing: 01-31 as the default if no month is selected 01-30 if month = April, June, September, or November 01-31 if month = January, March, May, July, August, October, December 01-28 if month = February and year is 1900 or not divisible by 4 01-29 if month = February and year is divisible by 4 and not 1900 Year drop down box: Starts with 2015 and goes to 1889. Note: Mouse scroll wheel should be locked for all DOB response options If month or year are changed after initial response, causing the selected day to be invalid then day drop down should revert to “day” and appropriate answer selections displayed. (For example, if January 31 is initially selected, and then month is changed to April, day drop down should revert to “day” with 1-30 displayed in the drop down. If, however, January 15 is initially selected, and then month is changed to April, keep day selection of “15.)”
Spanish question wording for in person housing unit respondent	¿Cuál es la fecha de nacimiento de <usted/roster name>?
Spanish response options	For drop-down boxes, in which the words “Mes/Día/Año” appear as the default text before an answer is selected. Month drop down box containing only the name of the month (i.e., enero, febrero, etc.) in chronological order. Day drop down box containing: 01-31 as the default if no month is selected 01-30 if month = abril, junio, septiembre, or noviembre 01-31 if month = enero, marzo, mayo, julio, agosto, octubre, diciembre 01-29 if month = febrero Year drop down box: Starts with 2015 and goes to 1889.

Question name	AGE
Question wording for in person housing unit respondent	What was <your/roster name’s> age on <CENSUSDAY>? If you don’t know the exact age, please estimate.
Response options	Write-in Box: [3] [this screen should only allow numeric entries. ] Label above the write-in box that reads “Age on <CENSUSDAY>” Example: Age on <CENSUSDAY> [ 3 ]
Spanish question wording for in person housing unit respondent	¿Cuál era la edad de <usted/roster name> el <CENSUSDAY>? Optional Text – Si no sabe la edad exacta, por favor indique la edad aproximada.
Spanish response options	Write-in Box: [3] Label above the write-in box that reads “Edad el <CENSUSDAY>” Example: Edad el <CENSUSDAY> [ 3 ]

Question name	CONFIRM AGE
Question wording for in person housing unit respondent	For the Census, we need to record age as of <CENSUSDAY>. So, just to confirm <you were/ ROSTER NAME was> <AGE/less than one year old> on <CENSUSDAY>?
Response options	(Radio Buttons) Yes No
Spanish question wording for in person housing unit respondent	Para el Censo, necesitamos registrar la edad cumplida al <CENSUSDAY>. De modo que, solo para confirmar, ¿tenía <usted/roster name> <AGE años/menos de un año> el <CENSUSDAY>?
Response options	(Radio Buttons) Yes No

Question name	CHANGE AGE
Question wording for in person housing unit respondent	What was <your/ROSTERNAME’s> age on <CENSUSDAY>? If you don’t know the exact age, please estimate. Enter CORRECT age. Make sure the respondent gives the CORRECT age in completed years as of <CENSUSDAY>. Do not round up. Do not enter age in months. For babies less than 1 year old enter 0 as the age.
Response options	Write-in Box: [3] Label above the write-in box that reads “Age on <CENSUSDAY>” Example: Age on <CENSUSDAY> [ 3 ]
Spanish question wording for in person housing unit respondent	¿Cuál era la edad de <usted/roster name> el <CENSUSDAY>? Si no sabe la edad exacta, por favor indique la edad aproximada. Enter CORRECT age. Make sure the respondent gives the CORRECT age in completed years as of <CENSUSDAY>. Do not round up. Do not enter age in months. For babies less than 1 year old enter 0 as the age.
Spanish response options	Write-in Box: [3] Label above the write-in box that reads “Edad el <CENSUSDAY>” Example: Edad el <CENSUSDAY> [ 3 ]
Question name	CHANGE DATE OF BIRTH
Question wording for in person housing unit respondent	Since <your/ROSTERNAME’s> age as of <CENSUSDAY> was <CHANGE AGE>, can you help me correct <your/ROSTERNAME’s> date of birth? I have <DOB – Convert to Month Day, Year>. What should it be? Enter CORRECT date of birth.
Response options	Example: [ Month] [Day] [ Year] Month user selectable element containing only the name of the month (i.e., January, February, etc.) in chronological order. Day drop down box containing: 01-31 as the default if no month is selected 01-30 if month = April, June, September, or November 01-31 if month = January, March, May, July, August, October, December 01-28 if month = February and year is 1900 or not divisible by 4 01-29 if month = February and year is divisible by 4 and not 1900 Year user selectable element: Starts with 2015 and goes to 1889. Note: Mouse scroll wheel should be locked for all DOB response options If month or year are changed after initial response, causing the selected day to be invalid then day drop shown should revert to “day” and appropriate answer selections displayed. (For example, if January 31 is initially selected, and then month is changed to April, day drop down should revert to “day” with 1-30 displayed in the drop down. If, however, January 15 is initially selected, and then the month is changed to April, keep day selection of “15.)”
Spanish question wording for in person housing unit respondent	Como <su edad/ la edad de ROSTERNAME> el <CENSUSDAY> era <CHANGE AGE>, ¿puede ayudarme a corregir su fecha de nacimiento? Tengo el <DOB – Convert to Month Day, Year>. ¿Cuál debe ser la fecha? Enter CORRECT date of birth.

Spanish response options

Example: [ Month] [Day] [ Year] Month user selectable element containing only the name of the month (i.e., enero, febrero, etc.) in chronological order. Day drop down box containing: 01-31 as the default if no month is selected 01-30 if month = abril, junio, septiembre, or noviembre 01-31 if month = enero, marzo, mayo, julio, agosto, octubre, diciembre 01-28 if month = febrero and year is 1900 or not divisible by 4 01-29 if month = febrero and year is divisible by 4 and not 1900 Year user selectable element: Starts with 2015 and goes to 1889. Note: Mouse scroll wheel should be locked for all DOB response options If month or year are changed after initial response, causing the selected day to be invalid then day drop shown should revert to “day” and appropriate answer selections displayed. (For example, if “enero” 31 is initially selected, and then month is changed to “abril”, day drop down should revert to “day” with 1-30 displayed in the drop down. If, however, “enero” 15 is initially selected, and then the month is changed to “abril”, keep day selection of “15.”

Question name	BABY FLAG
Question wording for in person housing unit respondent	For the Census, we need to record age as of <CENSUSDAY>. So, just to confirm, <ROSTER NAME> was born after <CENSUSDAY>?
Response options	(Radio Buttons) Yes No
Spanish question wording for in person housing unit respondent	Para el censo, necesitamos registrar la edad al <CENSUSDAY>. De modo que, solo para confirmar, ¿<ROSTER NAME> nació después del <CENSUSDAY>?
Spanish response options	(Radio buttons) Sí No

Question name	RELATIONSHIP CHECK
Question wording for in person housing unit respondent	Respondent is Reference Person -- I have recorded that <ROSTER NAME> is your < Father or mother /Parent-in-law>. Is that correct? Respondent is not reference person and asking about relationship of other roster person to reference person -- I have recorded that <ROSTER NAME > is <REFERENCE PERSON>’s <Father or mother/Parent-in-law>. Is that correct? Respondent is not reference person and asking about relationship of respondent to reference person -- I have recorded that you are <REFERENCE PERSON>’s < Father or mother /Parent-in-law>. Is that correct?
Response options	(Radio Buttons) Yes No
Question wording for in person proxy respondent	Respondent is not Reference Person and asking about relationship to Proxy I have recorded that <ROSTER NAME > is <REFERENCE PERSON>’s <Father or mother/Parent-in-law>. Is that correct?
Spanish question wording for in person housing unit respondent	Respondent is Reference Person -- He anotado que <ROSTER NAME> es su <Padre o madre/suegro(a)>. ¿Es eso correcto? Respondent is not Reference Person and asking about relationship to other household person Non-Respondent – OR Proxy) – He anotado que <ROSTER NAME > es <el padre o la madre/el suegro o la suegra> de<REFERENCE PERSON>. ¿Es eso correcto? Respondent is not Reference Person and asking about Respondent) – He anotado que usted es <el padre o la madre/el suegro o la suegra> de<REFERENCE PERSON>. ¿Es eso correcto?
Spanish question wording for telephone proxy respondent	Respondent is not Reference Person and asking about relationship to Proxy) – He anotado que <ROSTER NAME > es <el padre o la madre/el suegro o la suegra> de<REFERENCE PERSON>. ¿Es eso correcto?
Spanish response options	(Radio buttons) Sí No

Question name	CHANGE RELATIONSHIP
Question wording for in person housing unit respondent	Looking at the screen, <you are/roster person is> <reference person>’s _______. Show screen to respondent or read if necessary
Response options	(Radio buttons) Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law Son-in-law or daughter-in-law Other relative Roomer or boarder Housemate or roommate Foster child Other nonrelative
Spanish question wording for in person housing unit respondent	Mirando a la pantalla, <usted/roster person> es el(la) _______de <reference person>. Show screen to respondent or read if necessary
Spanish response options	(Radio buttons) Esposo/esposa del sexo opuesto Pareja no casada del sexo opuesto Esposo/esposa del mismo sexo Pareja no casada del mismo sexo Hijo(a) biológico(a) Hijo(a) adoptivo(a) Hijastro(a) Hermano(a) Padre o madre Nieto(a) Suegro(a) Yerno o nuera Otro pariente Inquilino(a) Compañero(a) de casa o de cuarto Hijo(a) de crianza del programa Foster del gobierno Otra persona que no es pariente

Question name	RACE
Question wording for in person housing unit respondent	I’m going to read you a list of categories. You may choose one or more. <Is ROSTER NAME/Are you> White; Hispanic, Latino, or Spanish; Black or African American; Asian; American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander; or Some other race or origin?
Response options	(Check boxes) White Hispanic, Latino, or Spanish Black or African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Some other race or origin
Spanish question wording for in person housing unit respondent	Le voy a leer una lista de categorías. Puede elegir una o más categorías. ¿Es <NAME/usted> blanco(a); hispano(a), latino(a), o español(a); negro(a) o afroamericano(a); asiático(a); indígena de las Américas o nativo(a) de Alaska; nativo(a) de Hawaii u otra de las islas del Pacífico; o de alguna otra raza u origen?
Spanish response options	(Check boxes) Blanco(a) Hispano(a) , latino(a) o español(a) Negro(a) o afroamericano(a) Asiático(a) Indígena de las Américas o nativo(a) de Alaska Nativo(a) de Hawaii o de otra de las islas del Pacífico Alguna otra raza u origen

Question name	DETAILED ORIGIN
Question wording for in person housing unit respondent	You said <ROSTER NAME is/you are> White. What is that specific origin? For example, German, Irish, English, Italian, Lebanese, Egyptian, and so on. You said <ROSTER NAME is/you are> Hispanic, Latino, or Spanish. What is that specific origin? For example, Mexican or Mexican American, Puerto Rican, Cuban, Dominican, Salvadoran, Colombian, and so on. You said <ROSTER NAME is/you are> Black or African American. What is that specific origin? For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Ghanaian, and so on. You said <ROSTER NAME is/you are> Asian. What is that specific origin? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, and so on. You said <ROSTER NAME is/you are> American Indian or Alaska Native. What is <ROSTER NAME’s/your> enrolled or principal tribe? For example, Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, Mayan, Doyon, Native Village of Barrow Inupiat Traditional Government, and so on. You said <ROSTER NAME is/you are> Native Hawaiian or Other Pacific Islander. What is that specific origin? For example, Native Hawaiian, Samoan, Guamanian or Chamorro, Tongan, Fijian, Marshallese, and so on. You said <ROSTER NAME is/you are> some other race or origin. What is that specific race or origin?
Spanish Question wording for in person housing unit respondent	Usted dijo que <ROSTER NAME/usted> es blanco. ¿Cuál es su origen específico? Por ejemplo, alemán, irlandés, inglés, italiano, libanés, egipcio, etc. Usted dijo que <ROSTER NAME/usted> es hispano, latino o español. ¿Cuál es su origen específico? Por ejemplo, mexicano o mexicano americano, puertorriqueño, cubano, dominicano, salvadoreño, colombiano, etc. Usted dijo que <ROSTER NAME/usted> es negro o afroamericano(a) ¿Cuál es su origen específico? Por ejemplo, africano americano, jamaiquino, haitiano, nigeriano, etíope, ghanés, etc. Usted dijo que <ROSTER NAME/usted> es asiático. ¿Cuál es su origen específico? Por ejemplo, chino, filipino, indio asiático, vietnamita, koreano, japonés, etc. Usted dijo que <ROSTER NAME/usted> es indígena de las Américas o nativo de Alaska. ¿Cuál es la tribu en la que <ROSTER NAME/usted> está inscrito o la tribu principal? Por ejemplo, Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, maya, Doyon, Native Village of Barrow Inupiat Traditional Government, etc. Usted dijo que <ROSTER NAME/usted> es nativo de Hawaii o de otra de las islas del Pacífico. ¿Cuál es su origen específico? Por ejemplo, nativo de Hawaii, samoano, guameño o Chamorro, tongano, fiyiano, de las islas Marshall, etc. Usted dijo que <ROSTER NAME /usted> es de alguna otra raza u origen. ¿Cuál es esa raza u origen específico?

Screen name	RELATIVES
Question wording for in person housing unit respondent	Some people live or stay in more than one place and we would like to make sure everyone is only counted once. Around <CENSUS DAY>, did you <,NAME2, NAME3, or NAME4, ETC.> sometimes live or stay somewhere else with a parent, grandparent, or other person?
Response options	(Radio buttons) Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>
Question wording for in person proxy respondent	Some people live or stay in more than one place, and we would like to make sure everyone is only counted once. Around <Census Day>, did <NAME1, NAME2, NAME3, or NAME4, ETC.> sometimes live or stay somewhere else with a parent, grandparent, or other person?
Spanish question wording for in person housing unit respondent	¿Vive o se queda alguien a veces en otro lugar con el padre o la madre, el abuelo o la abuela o alguna otra persona?
Spanish response options	(Radio buttons) Sí No Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>
Spanish question wording for in person proxy respondent	(Some people live or stay in more than one place, and we would like to make sure everyone is only counted once. Around <Census Day>, did <NAME1, NAME2, NAME3, or NAME4, ETC.> sometimes live or stay somewhere else with a parent, grandparent, or other person?

Screen name	COLLEGE HOUSING
Question wording for in person housing unit respondent	Around <CENSUSDAY>, were you <, NAME2, NAME3, or NAME4, etc.> living or staying somewhere else while attending college?
Response options	(Radio buttons) Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>
Question wording for in person proxy respondent	Around <CENSUSDAY>, was <NAME1, NAME2, NAME3, or NAME4 etc.> living or staying somewhere else while attending college?
Spanish question wording for in person housing unit respondent	¿Se quedaba alguien en otro lugar que no fuera <partial address> mientras vivía en una residencia universitaria, dentro o fuera del campus?
Spanish response options	(Radio buttons) Sí No Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	JOB
Question wording for in person housing unit respondent	Around <CENSUSDAY>, were you <, NAME2, NAME3, or NAME4 etc> sometimes living or staying somewhere else to be closer to a job (including military assignments)?
Response options	(Radio buttons) Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>
Question wording for in person proxy respondent	Around <CENSUSDAY>, was <NAME1, NAME2, NAME3, or NAME4 etc> sometimes living or staying somewhere else to be closer to a job (including military assignments)?
Spanish question wording for in person housing unit respondent	¿Se quedaba alguien en otro lugar que no fuera <partial address> para estar más cerca del trabajo (incluyendo asignaciones militares)?
Spanish response options	(Radio buttons) Sí No Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	NURSING/GROUP HOME
Question wording for in person housing unit respondent	Around <CENSUSDAY>, did you <NAME2, NAME3, or NAME 4 etc>sometimes stay in a place like a nursing home or a group home?
Response options	(Radio buttons) Yes No Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>
Question wording for in person proxy respondent	Around <CENSUSDAY>, did <NAME1, NAME2, NAME3, or NAME 4 etc> sometimes stay in a place like a nursing home or a group home?
Spanish question wording for in person housing unit respondent	¿Se queda alguien a veces en un lugar como un hogar de convalecencia o un hogar de grupo?
Spanish response options	(Radio buttons) Sí No Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	JAIL/PRISON
Question wording for in person housing unit respondent	Around <CENSUSDAY>, were you, < NAME2, NAME3, or NAME 4 etc> staying in a jail or prison?
Response options	(Radio buttons) Yes No [Note: If “Yes, display the following] Who? Check all that apply. <roster name 1> <roster name 2-n (if applicable)>
Question wording for in person proxy respondent	Around <CENSUSDAY>, was <NAME1, NAME2, NAME3, or NAME4, etc> staying in a jail or prison?
Spanish question wording for in person housing unit respondent	¿Estuvo alguien en la cárcel o la prisión?
Spanish response options	(Radio buttons) Sí No Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	SEASONAL
Question wording for in person housing unit respondent	Do you <, NAME2, NAME 3, or NAME4, etc > sometimes live or stay at another home, like a seasonal or second residence? < Read if necessary> Do not include situations you have already told me about related to stays with parents, grandparents, or other persons, college housing, jobs, military service, or staying at nursing homes, prisons, or jails.
Response options	(Radio buttons) Yes No [Note: If “Yes”, display the following] Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>
Question wording for in person proxy respondent	Does <NAME1, NAME2, NAME 3, or NAME4, etc > sometimes live or stay at another home, like a seasonal or second residence? < Read if necessary> Do not include situations you have already told me about related to stays with parents, grandparents, or other persons, college housing, jobs, military service, or staying at nursing homes, prisons, or jails.
Spanish response options	(Radio buttons) Sí No Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	ANOTHER REASON
Question wording for in person housing unit respondent	Around <CENSUSDAY>, did you <name2, name3, name4, etc>sometimes live somewhere elsefor any reason other than those just mentioned? < Read if necessary> Do not include situations you have already told me about related to, stays with parents, grandparents, or other persons, college housing, jobs, military service, seasonal or second residences, or staying at nursing homes, prisons, or jails.
Response options	(Radio buttons) Yes No [Note: If “Yes, display the following] Who? Check all that apply. Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>
Question wording for in person proxy respondent	Around <CENSUSDAY>, did <name1, name2, name3, or name4, etc> sometimes live somewhere else for any reason other than those just mentioned? < Read if necessary> Do not include situations you have already told me about related to stays with parents, grandparents, or other persons, college housing, jobs, military service, seasonal or second residences, or staying at nursing homes, prisons, or jails.
Spanish question wording for in person housing unit respondent	¿Vive alguien a veces en otro lugar que no sea <PARTIALADDRESS> por alguna otra razón además de las que se han mencionado? Sí No [Note: If “Sí, display the following] ¿Quién? Check all that apply. <roster name 1> <roster name 2-n (if applicable)>
Spanish question wording for in person proxy respondent	Around <CENSUSDAY>, did <name1, name2, name3, or name4, etc> sometimes live somewhere else for any reason other than those just mentioned? < Read if necessary> Do not include situations you have already told me about related to stays with parents, grandparents, or other persons, college housing, jobs, military service, seasonal or second residences, or staying at nursing homes, prisons, or jails.
Spanish response options	Yes/No Radio buttons Sí No Check boxes – where the roster names are the response options <roster name 1> <roster name 2-n (if applicable)>

Screen name	MOST
Question wording for in person housing unit respondent	Where does <person> live and sleep most of the time?
Response options	(Radio buttons) <Reference Partial Address> The address with a parent, grandparent, or other person The College Housing address The Job address The Nursing/Group Home address The Jail or Prison address The Seasonal address The Other address Equal time at all places Some other place [Restrict response options to those that apply to <person>; always show <Reference Partial Address>, Equal time at all places, and Some other place]
Spanish question wording for in person housing unit respondent	¿Dónde vive y duerme <person> la mayor parte del tiempo?
Spanish response options	Translation pending

Screen name	WHERE
Question wording for in person housing unit respondent	Where was <person> staying on <CENSUSDAY>?
Response options	(Radio buttons) <Reference Partial Address> The address with a parent, grandparent, or other person The College Housing address The Job address The Nursing/Group Home address The Jail or Prison address The Seasonal address The Other address Some other place [Restrict response options to those that apply to <person>; always show <Reference Partial Address>, and Some other place]
Spanish question wording for in person housing unit respondent	¿Dónde se estaba quedando <person> el <CENSUSDAY>?
Spanish response options	Translation pending

Screen name	EMAIL
Question wording for in person housing unit respondent	“Please provide an email address where we can contact you about this household” Enter address: Repeat back the email address to the respondent to confirm it was entered correctly.
Spanish question wording for in person housing unit respondent	“Por favor provea una dirección de correo electrónico donde podamos comunicarnos con usted acerca de este hogar.” Enter address: Repeat back the email address to the respondent to confirm it was entered correctly.

Question name	REVIEW
Question wording for in person housing unit respondent	I am going to read you a summary of the information I have recorded. Please let me know if anything is incorrect. (Select each box that contains incorrect information.). Let’s start with <you/reference person>. – Note: Only display this for the first roster person. For second and additional roster persons: How about <roster name>? Name: <ROSTER NAME> ***(Just above checkboxes)***
Response options	Checkboxes: Relationship to <REFERENCE PERSON>: <RELATIONSHIP> (if person is the reference person, this row will not be displayed) Sex: <SEX> Date of Birth: <DOBMONTH/DOBDAY/DOBYEAR> Age (on <CENSUS DAY>): <AGE> Race: <RACE>, <DETAILED ORIGIN> No change necessary (Don’t read)
Spanish question wording for in person housing unit respondent

Question name	REV RELATIONSHIP RESP
Question wording for in person housing unit respondent	Looking at the screen, <roster name> is your _______. Interviewer Note – Show screen to respondent or read if necessary
Response options	(Radio buttons) Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law Son-in-law or daughter-in-law Other relative Roomer or boarder Housemate or roommate Foster child Other nonrelative
Spanish question wording for in person housing unit respondent	A continuación, necesitamos indicar el parentesco de cada persona con usted. Mirando a la pantalla, <roster person> es su ____________. Show screen to respondent or read if necessary
Spanish response options	(Radio buttons) Esposo/esposa del sexo opuesto Pareja no casada del sexo opuesto Esposo/esposa del mismo sexo Pareja no casada del mismo sexo Hijo(a) biológico(a) Hijo(a) adoptivo(a) Hijastro(a) Hermano(a) Padre o madre Nieto(a) Suegro(a) Yerno o nuera Otro pariente Inquilino(a) Compañero(a) de casa o de cuarto Hijo(a) de crianza del programa Foster del gobierno Otra persona que no es pariente

Question name	REV RELATIONSHIP OTHER
Question wording for in person housing unit respondent	Looking at the screen, <you are/roster person is> <reference person>’s _______. Interviewer Note – Show screen to respondent or read if necessary
Response options	(Radio buttons) Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law Son-in-law or daughter-in-law Other relative Roomer or boarder Housemate or roommate Foster child Other nonrelative
Spanish question wording for in person housing unit respondent	A continuación, necesitamos indicar el parentesco de cada persona con <reference person>. Mirando a la pantalla, <usted/roster person> es la/el ____________ de <reference person> Interviewer Note – Show screen to respondent or read if necessary
Spanish response options	Esposo/esposa del sexo opuesto Pareja no casada del sexo opuesto Esposo/esposa del mismo sexo Pareja no casada del mismo sexo Hijo(a) biológico(a) Hijo(a) adoptivo(a) Hijastro(a) Hermano(a) Padre o madre Nieto(a) Suegro(a) Yerno o nuera Otro pariente Inquilino(a) Compañero(a) de casa o de cuarto Hijo(a) de crianza del programa Foster del gobierno Otra persona que no es pariente

Question name	REV SEX
Question wording for in person housing unit respondent	Are you/Is <roster name> male or female?
Response options	(Radio buttons) Male Female
Spanish question wording for in person housing unit respondent	¿Cuál es el sexo de <usted/roster name>?
Spanish response options	(Radio buttons) Masculino Femenino

Question name	REV DATE OF BIRTH
Question wording for in person housing unit respondent	What is <your/ roster name’s> date of birth?
Response options	Scroll wheel for Month, Day, and Year allowing only valid responses (Ex. Won’t show February, 30 etc.) Note: Valid years are 1889-2015
Spanish question wording for in person housing unit respondent	¿Cuál es la fecha de nacimiento de <usted/roster name>?
Spanish response options	For drop-down boxes, use the National Survey of College Graduates as a template in which the words “Mes/Día/Año” appear as the default text before an answer is selected. Month drop down box containing only the name of the month (i.e., enero, febrero, etc.) in chronological order. Day drop down box containing: 01-31 as the default if no month is selected 01-30 if month = abril, junio, septiembre, or noviembre 01-31 if month = enero, marzo, mayo, julio, agosto, octubre, diciembre 01-29 if month = febrero Year drop down box: Starts with 2015 and goes to 1889.

Question name	REV AGE
Question wording for in person housing unit respondent	What was <your/roster name’s> age on <CENSUSDAY>? If you don’t know the exact age, please estimate.
Spanish question wording for in person housing unit respondent	¿Cuál era la edad de <usted/roster name> el <CENSUSDAY>? Optional Text – Si no sabe la edad exacta, por favor indique la edad aproximada.

Question name	REV RACE
Question wording for in person housing unit respondent	I’m going to read you a list of categories. You may choose one or more. <Is ROSTER NAME/Are you> White; Hispanic, Latino, or Spanish; Black or African American; Asian; American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander; or Some other race or origin?
Response options	(Check boxes) White Hispanic, Latino, or Spanish Black or African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Some other race or origin
Spanish question wording for in person housing unit respondent	Le voy a leer una lista de categorías. Puede elegir una o más categorias. ¿Es <NAME/usted> blanco(a); hispano(a), latino(a), o español(a); negro(a) o afroamericano(a); asiático(a); indígena de las Américaso nativo(a) de Alaska; nativo(a) de Hawaii u otra de las islas del Pacífico; o de alguna otra raza u origen?
Spanish response options	(Check boxes) Blanco/a Hispano/a, latino/a o español/a Negro/a o africano/a americano/a Asiático/a Indígena de las Américas o nativo/a de Alaska Nativo/a de Hawaii o de otra de las islas del Pacífico Alguna otra raza u origen

Question name	REV DETAILED ORIGIN
Question wording for in person housing unit respondent	You said <ROSTER NAME is/you are> White. What is that specific origin? For example, German, Irish, English, Italian, Lebanese, Egyptian, and so on. You said <ROSTER NAME is/you are> Hispanic, Latino, or Spanish. What is that specific origin? For example, Mexican or Mexican American, Puerto Rican, Cuban, Dominican, Salvadoran, Colombian, and so on. You said <ROSTER NAME is/you are> Black or African American. What is that specific origin? For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, and so on. You said <ROSTER NAME is/you are> Asian. What is that specific origin? For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, and so on. You said <ROSTER NAME is/you are> American Indian or Alaska Native. What is <ROSTER NAME’s/your> enrolled or principal tribe? For example, Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, Mayan, Doyon, Native Village of Barrow Inupiat Traditional Government, and so on. You said <ROSTER NAME is/you are> Native Hawaiian or Other Pacific Islander. What is that specific origin? For example, Native Hawaiian, Samoan, Guamanian or Chamorro, Tongan, Fijian, Marshallese, and so on. You said <ROSTER NAME is/you are> some other race or origin. What is that specific race or origin?
Spanish question wording for in person housing unit respondent	Usted dijo que <ROSTER NAME/usted> es blanco/a. ¿Cuál es su origen específico? Por ejemplo, alemán, irlandés, inglés, italiano, libanés, egipcio, etc Usted dijo que <ROSTER NAME/usted> es hispano, latino o español. ¿Cuál es su origen específico? Por ejemplo, mexicano o mexicano americano, puertorriqueño, cubano, dominicano, salvadoreño, colombiano, etc. Usted dijo que <ROSTER NAME/usted> es negro o africano/a americano/a ¿Cuál es su origen específico? Por ejemplo, africano americano, jamaiquino, haitiano, nigeriano, etíope, somalí, etc. Usted dijo que <ROSTER NAME/usted> es asiático. ¿Cuál es su origen específico? Por ejemplo, chino, filipino, indio asiático, vietnamita, koreano, japonés, etc. Usted dijo que <ROSTER NAME/usted> es indígena de las Américaso nativo/a de Alaska. ¿Cuál es la tribu en la que <ROSTER NAME/usted> está inscrito o la tribu principal? Por ejemplo, Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, maya, Doyon, Native Village of Barrow Inupiat Traditional Government, etc. Usted dijo que <ROSTER NAME/usted> es nativo/a de Hawaii o de otra de las islas del Pacífico. ¿Cuál es su origen específico? Por ejemplo, nativo de Hawaii, samoano, guameño o Chamorro, , tongano, fiyiano, de las islas Marshall, etc. Usted dijo que <ROSTER NAME is/you are> es de alguna otra raza u origen. ¿Cuál es esa raza u origen específico?

Question name	WHO TO CALL
Question wording for in person housing unit respondent	Whom should I ask for when I call back?
Spanish question wording for in person housing unit respondent	¿Por quién debo preguntar cuando vuelva a llamar?

Question name	APPOINTMENT PHONE
Question wording for in person housing unit respondent	What is the best number for me to call back on?
Spanish question wording for in person housing unit respondent	¿Cuál es mejor número para llamarlo de nuevo?

Question name	APPOINTMENT DATE
Question wording for in person housing unit respondent	What is the best date and time <fill>?
Spanish question wording for in person housing unit respondent	¿Cuál es el mejor día y la mejor hora <fill>?

Question name	APPOINTMENT TIME
Question wording for in person housing unit respondent	What is the best date and time <fill>?
Spanish question wording for in person housing unit respondent	¿Cuál es el mejor día y la mejor hora <fill>?

Question name	Language Barrier phone
Question wording for in person housing unit respondent	Please give me your phone number and someone may contact you?
Spanish question wording for in person housing unit respondent

Question name	PROXY NAME
Question wording for in person housing unit respondent	My final questions are about you, in case I or someone else from the Census Bureau needs to contact you again for additional information. Ask or confirm. What is your name?
Spanish question wording for in person proxy respondent	Mis preguntas finales son sobre usted, en caso de que yo o alguna otra persona de la Oficina del Censo necesite comunicarse con usted para obtener información adicional. Ask or confirm. ¿Cuál es su nombre?

Question name	PROXY PHONE
Question wording for in person housing unit respondent	What is the best phone number to reach you?
Spanish question wording for in person proxy respondent	¿Cuál es el mejor número de teléfono para comunicarnos con usted?

Question name	Best Time
Question wording for in person housing unit respondent	Another Census employee may contact you to evaluate my work. When would be the best day and time to contact you? Mark all that apply.
Spanish question wording for in person housing unit respondent	Es posible que otro empleado del Censo se comunique con usted para evaluar mi trabajo. ¿Cuál sería el mejor día y la mejor hora para comunicarnos con usted? Mark all that apply.

Question name	GOOD BYE
Question wording for in person housing unit respondent	That completes the interview. Thank you for your time and cooperation.
Spanish question wording for in person housing unit respondent	Con esto termina la entrevista. Gracias por su tiempo y su cooperación.