SC-1(F) Information Sheet

Attachment M
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

List A

INFORMATION SHEET
Special Census
Your Answers Are Confidential
Your answers are confidential and protected by law. All U.S.
Census Bureau employees have taken an oath and are subject
to a jail term, a fine, or both if they disclose any information that
could identify you or your household. Your answers will only be
used for statistical purposes, and no other purpose. Title 13,
Section 196, of the United States Code authorizes the Census
Bureau to conduct this Special Census and Section 9 of this law
assures that your answers will be kept confidential.
The U.S. Census Bureau is conducting this Special Census to
provide your local government current population and housing
counts for this area. Your participation in the Special Census is
extremely important. Although the individual responses are
voluntary, the information the Special Census receives from you
ensures the completeness and accuracy of the results.
Thank you for your cooperation. The U.S. Census Bureau and
your local government appreciate your help.
If you have any comments concerning the time it takes to
complete this form or any other aspect of the collection,
send it to: Paperwork Reduction Project 0607-0368,
U.S. Census Bureau, AMSD – 3K138, 4600 Silver Hill Road,
Washington, DC 20233. You may e-mail comments to
Paperwork@census.gov; use Paperwork Project 0607-0368
as the subject.
Respondents are not required to respond to any information
collected unless a valid approval number has been assigned by
the Office of Management and Budget. The approval number for
the Special Census is: OMB No. 0607-0368.
SC-1(F)

(8-17-2012)

WHO TO COUNT ON
SPECIAL CENSUS DAY
We need to count people where
they live and sleep most of
the time.
Do NOT include:

Do include:

• College students
who live away from
this address most
of the year

• Babies and children
living here, including
foster children

• Armed Forces
personnel who live
away

• Roommates

• People in a nursing
home, mental
hospital, etc. on
Special Census Date
• People in jail, prison,
detention facility, etc.
on Special Census
Date

• Boarders
• People staying here
on Special Census
Date who have no
permanent place to
live

List B
RELATIONSHIP
Husband or wife

List C

List D

HISPANIC, LATINO, OR
SPANISH ORIGIN

RACE
(Choose one or more races.)

No, not of Hispanic, Latino,
or Spanish origin

White
American Indian or Alaska Native

Stepson or stepdaughter

Yes, Mexican, Mexican
American, or Chicano

Brother or sister

Yes, Puerto Rican

Chinese

Father or mother

Yes, Cuban

Filipino

Grandchild

Yes, another Hispanic, Latino,
or Spanish origin –
For example, Argentinean,
Colombian, Dominican,
Nicaraguan, Salvadoran,
Spaniard, and so on.

Japanese

Biological son or daughter
Adopted son or daughter

Parent-in-law
Son-in-law or daughter-in-law
Other relative
Roomer or boarder
Housemate or roommate
Unmarried partner
Other nonrelative

Black or African American
Asian Indian

Korean
Vietnamese
Other Asian – For example,
Hmong, Laotian, Thai, Pakistani,
Cambodian, and so on.
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander – For
example, Fijian, Tongan,
and so on.
Some other race

SC-1(F) (8-17-2012)