UE Paper Materials 09052019

2020 Census

UE Paper Materials 09052019

OMB: 0607-1006

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D-IS-UERA

(8-5-2019)

OMB No. 0607-1006: Approval Expires 11/30/2021

INFORMATION SHEET
WHO TO COUNT

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
April 1, 2020.
● People in jail, prison,
detention facility, etc.
on April 1, 2020.

● Boarders.
● People staying here
on April 1, 2020 who
have no permanent
place to live.

RELATIONSHIP

How is this person related to Person 1? Mark I
K ONE box.
J
Opposite-sex husband/wife/spouse

Father or mother

Opposite-sex unmarried partner

Grandchild

Same-sex husband/wife/spouse

Parent-in-law

Same-sex unmarried partner

Son-in-law or daughter-in-law

Biological son or daughter

Other relative

Adopted son or daughter

Roommate or housemate

Stepson or stepdaughter

Foster child

Brother or sister

Other nonrelative

OMB No. 0607-1006: Approval Expires 11/30/2021

INFORMATION SHEET
HISPANIC ORIGIN

Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano

RACE
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C

Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C

Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C

American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C

Chinese

Vietnamese

Native Hawaiian

Filipino

Korean

Samoan

Asian Indian

Japanese

Chamorro

Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C

Some other race – Print race or origin.

D-IS-UERA (8-5-2019)

Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C

Your Answers Are Con dential

The U.S. Census Bureau is required by law to protect your information (Title 13, U.S. Code, Section 9). The Census Bureau is not permitted to
publicly release your responses in a way that could identify you or your household. We are conducting the 2020 Census under the authority of
Title 13, U.S. Code, Sections 141, 193 and 221. By law, the Census Bureau can only use your responses to produce statistics. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your
data. All web data submissions are encrypted in order to protect your privacy.
Title 13 of the U.S. Code protects the con dentiality of all your information. Violating the con dentiality of a respondent is a federal crime with
serious penalties, including a federal prison sentence of up to ve years, a ne of up to $250,000, or both. Only authorized individuals have
access to the stored data, and the information you provide to the Census Bureau may only be used by a restricted number of authorized
individuals who are sworn for life to protect the con dentiality of your individual responses. Your answers cannot be used against you by any
government agency or court.
For more information about how we protect your information, please visit our Web site at census.gov and click on "Data Protection and Privacy
Policy" at the bottom of the home page. This page also includes information about the collection, storage, and use of these records. Click on
"System of Records Notices (SORN)" and look for Privacy Act System of Records Notice COMMERCE/CENSUS-5, Decennial Census Program.
Thank you for your cooperation. The Census Bureau appreciates your help.

AF
T

You are required by law to respond to the 2020 Census (Title 13, U.S. Code, Sections 141 and 193). The Census Bureau
estimates that completing the questionnaire will take 10 minutes on average. This collection of information has been approved by
the Office of Management and Budget (OMB). The eight-digit OMB approval number that appears at the bottom left of this notice
confirms this approval. If this number were not displayed, we could not conduct the census.
Send comments regarding this burden estimate or any other aspect of this burden to: Paperwork Reduction Project XXXX-XXXX,
U.S. Census Bureau, DCMD-2H174, 4600 Silver Hill Road, Washington, DC 20233. You may email comments to
<2020.census.paperwork@census.gov>. Use "Paperwork Reduction Project XXXX-XXXX" as the subject.

D-CN (6-7-2018)

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

Your Answers Are Con dential

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

D-CN (6-7-2018)

Draft 7 (7-5-2018)

D-NV-UERA (7-5-2018)

OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx

2020 CENSUS VISIT

OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx

2020 CENSUS VISIT

The Census Bureau is conducting the 2020 Census. I stopped by
today to complete an interview for your household, but you were not
home. Please call me to discuss when we can complete this interview.
Otherwise, I may stop by again.

First Name

Last Name

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T

D-NV-UERA (7-5-2018)

First Name

Last Name

)–

Phone Number

(

Best time to call

From:

–
a.m.

To:

p.m.

a.m.

Phone Number

(

Best time to call

From:

)–

p.m.

–
a.m.

To:

p.m.

a.m.
p.m.

You are required by law to respond to the 2020 Census (Title 13, U.S.
Code, Sections 141 and 193). The Census Bureau estimates that
completing the interview will take 10 minutes on average. This collection
of information has been approved by the Office of Management and
Budget (OMB). The eight-digit OMB approval number xxxx-xxxx confirms
this approval. If this number were not displayed, we could not conduct
the census.

The Census Bureau is required by law to protect your information (Title 13,
U.S. Code, Section 9). The Census Bureau is not permitted to publicly
release your responses in a way that could identify you or your household.
We are conducting the 2020 Census under the authority of Title 13, U.S.
Code, Sections 141, 193 and 221. By law, the Census Bureau can only
use your responses to produce statistics. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity
risks through screening of the systems that transmit your data.

For more information about how we protect your information, please visit
our Web site at census.gov and click on "Data Protection and Privacy
Policy" at the bottom of the home page. This page also includes information
about the collection, storage, and use of these records. Click on "System
of Records Notices (SORN)" and look for Privacy Act System of Records
Notice COMMERCE/CENSUS-5, Decennial Census Program.

Please visit 2020census.gov to learn more about the 2020 Census.

ENUMERATOR USE ONLY
Case ID

ACO No.
CFS Area No.

Base prints black (100%)

ENUMERATOR USE ONLY

Map Spot No.

Case ID

ACO No.
Block No.

Overlay prints cyan #6 (10%, 20% and 100%)

CFS Area No.

Map Spot No.

Block No.

OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx
TM

Language Identification Card

I work for the U.S. Census Bureau. Is someone here now who speaks English and can help us?
If not, someone may contact you who speaks________.
Español (Spanish 01)
Trabajo para la Oficina del Censo de los EE. UU. ¿Se encuentra alguien que hable
inglés y pueda ayudarnos? Si no, alguien que habla español podría comunicarse con usted.
普通话、广东话 (Chinese simplified)

我是美国人口普查局的工作人员。请问您这里有没有会说英语的人可以帮助我们？
(Mandarin 02): 如果没有，可能会有会讲普通话的人与您联系。
(Cantonese 03): 如果没有，可能会有会讲广东话的人与您联系。

如果您閱讀繁體中文，請參閱第2頁（普通話或廣東話） (Chinese traditional on pg 2)
Tiếng Việt (Vietnamese 04)

한국어 (Korean 05)

AF
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Tôi làm việc cho Cục Thống Kê Dân Số Hoa Kỳ. Hiện có ai ở đây biết nói tiếng Anh và có thể giúp quý vị
và tôi không? Nếu không, một nhân viên nói tiếng Việt có thể sẽ liên lạc với quý vị.
저는 미국 인구조사국에서 일하고 있습니다. 여기 계신 분 중에서, 영어를 하실 수 있어서 저희를 도와주실 수
있는 분이 혹시 계신지요? 없으시면, 한국어를 하시는 분이 연락을 드릴 수도 있습니다.

‫( العربية‬Arabic 07)

Русский (Russian 06)
Я представляю Бюро переписи населения СШA. Присутствует здесь кто‐нибудь, кто говорит
по‑английски и мог бы помочь нам? Если нет, то тогда возможно, с Вами свяжется наш
сотрудник, говорящий по‐русски.

‫ هل يوجد شخص هنا يتكلّم اإلنجليزية و ميكنه ان يساعدنا اآلن؟‬.‫أنا أعمل ملكتب التعداد السكاين األمرييك‬
.‫ فقد يتصل بكم شخص يتكلّم اللغة العربية‬،‫إذا ال‬

Tagalog (Tagalog 08)
Nagtatrabaho ako para sa Kawanihan ng Senso ng U.S. Mayroon ba rito ngayong nagsasalita ng Ingles at
maaaring tumulong sa amin? Kung wala, maaaring may kumontak sa inyo na nagsasalita ng Tagalog.
Polski (Polish 09)
Jestem pracownikiem Urzędu Spisu Ludności USA. Czy w tej chwili jest tu ktoś, kto mówi po angielsku
i może nam pomóc? Jeżeli nie, może skontaktować się z Państwem ktoś, kto mówi po polsku.
Français (French 10)
Je travaille pour le Bureau de Recensement des États-Unis. Y a‐t‐il quelqu’un ici qui parle anglais et qui
pourrait nous aider? Sinon, quelqu’un qui parle français pourrait vous contacter.
Kreyòl Ayisyen (Haitian Creole 11)
Mwen travay pou Biwo Resansman Etazini. Èske gen yon moun la ki pale anglè ki ka ede nou?
Si pa genyen, yon moun isit la ki pale kreyòl ka rele ou.
Português (Portuguese 12)
Trabalho para a Agência do Censo dos EUA. Há alguém aqui, agora, que fale inglês e que possa nos
ajudar? Caso não haja, uma pessoa que fala português poderá entrar em contato com você.
日本語 (Japanese 13)
私はアメリカ合衆国国勢調査局の係員です。
こちらには英語を理解でき この調査にご協力いただける方
がいらっしゃいますか？もしいない場合は、
日本語を話す係員があなたに連絡をすることがあります。

Shqip (Albanian 14)
Unë punoj për Byronë e Regjistrimit të Popullsisë së SHBA-së. A ka njeri këtu tani që flet anglisht dhe
mund të na ndihmojë? Nëse jo, dikush që flet shqip mund t’ju kontaktojë.
አማርኛ (Amharic 15)
እኔ በዩናይትድ ስቴትስ የህዝብ ቆጠራ ቢሮ ሰራተኛ ነኝ። እንግሊዝኛ የሚናገርና ሊረዳን የሚችል ሰው አለ?
ከሌለ አማርኛ የሚችል ሰው ሊያነጋግርዎ ይችላል።

Հայերեն (Armenian 16)
Ես աշխատում եմ ԱՄՆ մարդահամարի բյուրոյի համար: Ներկա՞ է այստեղ այժմ որևէ մեկը, ով խոսում է
անգլերեն և կարող է օգնել մեզ: Եթե ոչ, ապա հայերեն խոսող որևէ մեկը կարող է կապվել Ձեզ հետ:
বাংলা

(Bengali 17)

আমি যু ক্তরাষ্ট্রের আদমশুমারি ব্যুর�োতে কাজ করি। এখানে এখন কি এমন কেউ আছেন যিনি ইংরেজি বলতে
পারেন এবং আমাদের সাহায্য করতে পারবেন? না থাকলে বাংলা বলতে পারেন এমন কেউ আপনার সাথে
য�োগায�োগ করতে পারেন।
Босански/ Bosanski (Bosnian 18)

AF
T

Ја радим за Амерички биро за попис становништва. Има ли овдје некога ко говори енглески
и може нам помоћи? Ако нема, с Вама би могао контактирати неко ко говори босански.
Ja radim za Američki biro za popis stanovništva. Ima li ovdje nekoga ko govori engleski i može nam
pomoći? Ako nema, s Vama bi mogao kontaktirati neko ko govori bosanski.
Български (Bulgarian 19)

ြမန်မာဘာသာ (Burmese 20)

Служител съм на Бюрото по преброяване на населението на САЩ. Има ли тук някой, който
говори английски и би могъл да ни помогне? Ако няма, с вас може да се свърже някой от
нашите служители, който говори български.

က)န်ေတာ်က အေမရိကန် သန်းေခါင်စာရင်းအင်းဗျ67ိ8အတွက ် အလ8ပ်လပ
8 ်ပါတယ်။ ဒီမာ@

အဂBလပ
ိ ်စကားေြပာတတ်Cပီး က)န်ေတာ်တကိ
ိ8 ့ 8 ကEညG
ီ င
ိ8 သ
် H
E ိပ
@ ါသလား။ မH@ိဘးE ဆိရ
8 င်ေတာ ့
ြမန်မာစကားေြပာတတ်သတ
E စ်ဦးက လEKကီးမင်းကိ 8 ဆက်သယ
ွ ပ
် ါလိမ်မ
့ ယ်။

普通話、廣東話 (Chinese traditional)

我是美國人口普查局的工作人員。請問您這裡有沒有會說英語的人可以幫助我們？
(Mandarin 02): 如果沒有，可能會有會講普通話的人與您聯絡。
(Cantonese 03): 如果沒有，可能會有會講廣東話的人與您聯絡。

Hrvatski (Croatian 21)
Ja radim za američki Ured za popis stanovništva. Ima li trenutno ovdje nekoga tko govori engleski
i tko bi nam mogao pomoći? Ako nema, mogao bi Vas kontaktirati netko tko govori hrvatski.
Čeština (Czech 22)
Pracuji pro Americký úřad pro sčítání lidu. Je zde někdo, kdo hovoří anglicky a může nám pomoci?
Pokud ne, je možné, že Vás bude kontaktovat někdo, kdo hovoří česky.

Nederlands (Dutch 23)
Ik werk voor het Amerikaans Bureau voor de volkstelling. Is er hier iemand die Engels spreekt en
ons kan helpen? Zo niet, dan kan iemand contact met u opnemen die Nederlands spreekt.

‫( فارسی‬Farsi 24)
‫ آیا هم‌اکنون اینجا کسی هست که به زبان انگلیسی‬.‫من برای اداره سرشماری ایاالت متحده کار می‌کنم‬
‫ در این صورت احتمال دارد یک نفر از اداره‬،‫حرف بزند و بتواند به من و شما کمک کند؟ اگر نیست‬
.‫سرشماری که به زبان فارسی صحبت می‌کند با شما تماس بگیرید‬
Deutsch (German 25)
Ich arbeite für das Bundesbüro zur Durchführung von Volkszählungen. Kann ich mit jemandem
sprechen, der Englisch spricht und der uns helfen kann? Wenn nicht, kann jemand, der Deutsch
spricht, Kontakt mit Ihnen aufnehmen.
Ελληνικά (Greek 26)

ગુજરાતી (Gujarati 27)

AF
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Εργάζομαι στην Υπηρεσία Απογραφής των ΗΠΑ. Είναι κανείς εδώ αυτή τη στιγμή που μιλάει
Αγγλικά να μας εξυπηρετήσει; Αν όχι, μπορεί κάποιος να επικοινωνήσει μαζί σας στα ελληνικά.

હુ ં યુ.એસ. સેન્સસ બ્યૂરો માટે કામ કરું છુ ં . શું હાલમાં અહીં એવી કોઈ વ્યક્તિ છે જે અંગ્રેજી બોલી શકે અને અમને મદદ કરી
શકે? જો કોઈ ના હોય તો, ગુજરાતી બોલતી કોઈપણ વ્યક્તિ તમારી સાથે સંપર્ક કરી શકે છે .

‫ האם נמצא כאן עכשיו מישהו שמדבר אנגלית‬.‫אני עובד עבור משרד מפקד האוכלוסין של ארה”ב‬
.‫ ישנה אפשרות שייצור אתכם קשר מישהו שמדבר עברית‬,‫ויכול לעזור לנו? במידה ולא‬

‫( עברית‬Hebrew 28)

हिदं ी (Hindi 29)

मैं यूएस जनगणना ब्यूरो के लिए काम करता हूं। क्या यहां अभी कोई ऐसा है जो अंग्रेज़ी बोलता हो और हमारी मदद कर सकता हो? अगर
नही ं तो, कोई आपसे सं पर्क करेगा जो हिदं ी में बात करता हो।
Hmoob (Hmong 30)

Kuv ua hauj lwm rau Teb Chaws Asmeskas Koom Haum Suav Txheeb Pej Xeem. Puas muaj leej twg tam
sim no txawj hais lus Askiv thiab yuav pab tau peb? Yog tsis muaj, muaj neeg hais Lus Hmoob yuav hu
rau koj.
Magyar (Hungarian 31)
Az Egyesült Államok Népszámlálási Hivatalánál dolgozom. Van a közelben valaki, aki beszél angolul,
és segíteni tud most nekünk? Ha nincs, akkor lehet, hogy egy magyarul beszélő munkatársunk fel
fogja venni Önnel a kapcsolatot.
Igbo (Igbo 32)
Anà m̀ àrụ́rụ́ ndị Ụlọọrụ U.S. Nā-ahụ maka Ịgụ Ọnụ ọrụ. È nwèrè onye nọ ebe à ugbu, a bụ onye na-asụ
Igbo nwere ike inyere anyị aka? Ọ bụrụ nà è nweghì,̀ otù onye nā-asụ Igbo nwèrè ike ịkpọtụrụ gị.
3

Ilokano (Ilocano 33)
Agtrabtrabahoak para iti U.S. Census Bureau. Adda kadi ditoy ita iti siasinoman a makapagsao iti Ingles
ken makatulong kadakami? No awan, adda maysa a mangkontak kadakayo a makapagsao iti Ilokano.
Bahasa Indonesia (Indonesian 34)
Saya bekerja untuk Biro Sensus A.S. Apakah di sini ada yang bisa berbahasa Inggris dan dapat membantu
kami? Jika tidak, seseorang yang berbahasa Indonesia mungkin menghubungi Anda.
Italiano (Italian 35)
Lavoro per conto del Census Bureau degli Stati Uniti. C’è qualcuno qui adesso che parli inglese e possa
aiutarci? In caso contrario, qualcuno che parli italiano potrebbe contattarla.
ខ្មែ រ (Khmer 36)
ខ្ញុំធ្វ ើការឲ្យការ ិយាល័យជំរ�ឿនប្រជាជនសហរដ្ឋ អាមេរ ិក។ ត�ើនៅ�ទីនេះ មាននរណាម្នាក់ ចេះនិយាយភាសា
អង់គ្លេ ស ហ�ើយអាចជួ យយ�ើងខ្ញុំបានទេ? ប�ើសិនជាគ្មានទេ នោ�ះនឹងមានគេដែលចេះនិយាយភាសាខ្មែ រ
ទាក់ទងទៅ�លោ�កអ្ន ក។

Lietuvių (Lithuanian 38)

AF
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ພາສາລາວ (Lao 37)
ຂ້ າພະເຈົ້າເຮັດວຽກຢູ ່ ຫ້ອງການສໍາຫຼວດພົນລະເມືອງແຫ່ ງສະຫະລັດອາເມລິກາ. ຕອນນີ້ມີໃຜຢູ ່ ທີ່ນ້ີ ທີ່ສາມາດເວົ້າ
ພາສາອັງກິດ ແລະ ຊ່ ວຍເຫື ຼ ອພວກເຮົາໄດ້ ບໍ? ຖ້ າບໍ່ມີ, ຈະມີຄົນທີ່ເວົ້າພາສາລາວໄດ້ ຕິດຕ່ໍ ຫາທ່ ານ
Aš esu iš JAV gyventojų surašymo biuro. Ar čia dabar yra kas nors, kas kalba angliškai ir galėtų man ir
jums padėti? Jei ne, su jumis gali susisiekti lietuviškai kalbantis asmuo.
മലയാളം (Malayalam 39)

मराठी (Marathi 40)

ഞാൻ യു.എസ്. സെൻസസ് ബ്യൂറ�ോയിൽ ജ�ോലിചെയ്യുന്നു. ഇപ്പോൾ ഇംഗ്ല ീഷ്
ഭാഷ സംസാരിക്കുന്ന, ‍ഞങ്ങളെ സഹായിക്കാൻ കഴിയുന്ന ഒരാൾ ഇവിടെ
ഉണ്ടോ? ഇല്ലെങ്കിൽ, മലയാളം സംസാരിക്കുന്ന ആരെങ്കിലും നിങ്ങളുമായി
ബന്ധപ്പെട്ടേക്കാം.

मी यू.एस. जनगणना ब्यूरोसाठी काम करतो. इथे आता कु णी अशी व्यक्ती आहे का जी इं ग्रजी बोलते व आम्हाला मदत करू शके ल? नसेल तर, कु णी मराठी
बोलणारी व्यक्ती आपल्याला सं पर्क करू शके ल.

नेपाली (Nepali 42)

म अमेरिकी जनगणना ब्यूरोमा काम गर्छु । के अहिले यहाँ अंग्रेजी बोल्न जान्ने र हामीलाई मद्दत गर्नसक्ने कोही मान्छे छ? यदि छै न भने,
तपाईसँ ग नेपाली भाषामा कु रा गर्ने कसैले सम्पर्क गर्न सक्दछ।
ਪੰਜਾਬੀ (Punjabi 43)
ਮੈਂ ਯੂ.ਐੱਸ. ਜਨਗਣਨਾ ਬਿਊਰੋ ਲਈ ਕੰਮ ਕਰਦਾ ਹਾਂ। ਕੀ ਇਥੇ ਹੁਣ ਕੋਈ ਅੰਗਰੇਜ਼ੀ ਬੋਲਣ ਅਤੇ ਸਾਡੀ ਮਦਦ ਕਰਨ
ਵਾਲਾ ਵਿਅਕਤੀ ਹੈ? ਜੇਕਰ ਨਹੀਂ, ਤਾਂ ਤੁਹਾਡੇ ਨਾਲ ਪੰਜਾਬੀ ਬੋਲਣ ਵਾਲਾ ਵਿਅਕਤੀ ਸੰਪਰਕ ਕਰੇਗਾ।

Română (Romanian 44)
Lucrez pentru Biroul de Recensământ al S.U.A. Aveți pe cineva lângă dumneavoastră care vorbește
limba engleză și ne poate ajuta? Dacă nu aveți pe nimeni, este posibil să fiți contactat(ă) de o altă
persoană care vorbește limba română.
Српски / Srpski (Serbian 45)
Ја радим за Амерички биро за попис становништва. Да ли овде има некога ко говори енглески
и може да нам помогне? Ако нема, постоји могућност да са Вама контактира особа која говори
српски језик.
Ja radim za Američki biro za popis stanovništva. Da li ovde ima nekoga ko govori engleski i može da
nam pomogne? Ako nema, postoji mogućnost da sa Vama kontaktira osoba koja govori srpski jezik.
සිංහල (Sinhala 46)
මම ඇමෙරිකා එක්සත් ජනපදයේ සංගණන කාර්යාංශයේ සේවයේ යෙදී සිටිමි. ඉංසි
භාෂාව කථා කරන, අපට උදව් කළ හැකි අයෙක් මේ අවස්ථාවේ මෙහි සිටී ද? එසේ
න�ොමැති නම් සිංහල භාෂාව කථා කරන අයෙක් අපිව අමතන්න.
Slovenčina (Slovak 47)

Soomaali (Somali 48)

AF
T

Pracujem pre Americký úrad pre sčítanie ľudu. Je tu teraz niekto, kto hovorí po anglicky a môže nám
pomôcť? Ak nie, možno Vás bude kontaktovať niekto, kto hovorí po slovensky.
Waxaan u shaqeeyaa waaxda tiro koobka ee Mareykanka. Miyaa hada uu halkaan joogaa qof yaqaana
Ingiriis oo na caawin kara? Hadii uusan joogin, waxaa kula soo xiriiri kara qof ku hadla Soomaali.
Kiswahili (Swahili 49)

தமிழ் (Tamil 50)

Ninafanya kazi na Shirika la Sensa ya Marekani. Je, kuna mtu hapa ambaye anazungumza Kiingereza na
anaweza kutusaidia? Ikiwa hamna, mtu anaweza kuwasiliana nawe anayezungumza Kiswahili.

நான் யூ.எஸ் சென்சஸ் பீர�ோவிற் காக வேலை செய் கிறேன் . இங் கே இப�்போது
யாராவது ஆங் கிலம் பேசுபவர் இருக்கிறாரா மேலும் அவரால் நமக்கு உதவி
செய் ய முடியுமா? இல் லையென்றால் யாராவது தமிழ் பேசும் ஒருவர் உங் களை
த�ொடர்புக�ொள் ளலாம் .

తెలుగు (Telugu 51)
నేను యు.ఎస్. సెన్సస్ బ్యూరో కోసం పని చేసతు ్న్నాను. ప్రసతు ్తం ఇక్కడ ఆంగ్ల ములో మాట్లాడే వారు
ఎవర�ైనా ఉన్నారా మరియు మాకు సహాయం చేయగలరా? లేకపో తే, తెలుగు మాట్లాడే వారు ఎవర�ైనా
మిమ్మల్ని సంప్రదిస్తా రు.
ไทย (Thai 52)
ฉั นท�ำงานให ้กับส�ำนักงานส�ำมะโนประชากรแห่งสหรัฐฯ ตอนนีท
้ น
ี่ ม
ี่ ใี ครทีพ
่ ด
ู ภาษาอังกฤษได ้และสามารถ
ชว่ ยเราแปลได ้หรือไม่ หากไม่ม ี อาจมีคนทีพ
่ ด
ู ภาษาไทยได ้ติดต่อกับท่านในภายหลัง
ትግርኛ (Tigrinya 53)
ንዩ.ኤስ ቤት ፅሕፈት እስታቲስቲክስ እየ ዝሰርሕ። ኣብዚ ሕዚ ቋንቋ እንግሊዝ ዝፈልጥን ክሕግዘና ዝኽእልን
ሰብ ኣሎዶ? ተዘየለ ካሊእ ትግርኛ ዝፈልጥ ከዛርበኩም ይኽእል እዩ።
5

Türkçe (Turkish 54)
A.B.D. İstatistik Bürosu’ndanım. Orada İngilizce konuşan ve bize yardımcı olabilecek birisi var mı?
Yoksa, Türkçe konuşan biri sizinle irtibata geçebilir.
Twi (Twi/Akan 55)
Me ne U.S. Census Bureau a wɔyɛ nnipa ho akenkan ne nhwehwɛmu na ɛyɛ adwuma. Obi a ɔka Brɔfo
kasa a ɔbɛtumi aboa yɛn wɔ ha seesei anaa? Sɛ obiara nni ha saa a, yɛbɛma obi a ɔka Twi ne mo
abɛkasa.
Українська (Ukrainian 56)
Я представляю Бюро перепису населення США. Поряд із Вам є будь-яка особа, що розмовляє
англійською мовою і зможе нам допомогти? Якщо ні, можливо, до Вас звернеться наш
представник, що розмовляє українською мовою.

AF
T

‫( اردو‬Urdu 57)
‫ کیا ابھی یہاں کوئی ایسا شخص ہے جو انگریزی بول سکتا ہو‬.‫میں امریکی مردم شامری بیورو کے لئے کام کرتا ہوں‬
.‫ تو کوئی شخص آپ سے رابطہ کرے گا جو اردو میں بات کرے گا‬،‫اور ہامری مدد کر سکتا ہو؟ اگر نہیں‬
‫( ייִ דיש‬Yiddish 58)
‫דא אין דער הײם‬
ָ ‫ איז עמעצער איצט‬.‫שטאטן ֿפון ַאמעריקע‬
ַ
‫ֿפאראײניקטע‬
ַ ‫ביורא ֿפון די‬
ָ
‫ֿפאר דעם צענזוס‬
ַ ‫איך ַארבעט‬
.‫נטאקטירן‬
ַ ‫קא‬
ָ ‫אײך אֿפשר‬
ַ ‫װאס רעדט ייִ דיש‬
ָ ‫ װעט עמעצער‬,‫װאס רעדט ענגליש און קען אונדז העלֿפן? אױב נישט‬
ָ
Yorùbá (Yoruba 59)

Mo nbá Ilé-Iṣẹ́ Ètò Ìkànìyàn Ilẹ̀ Amẹrika ṣiṣẹ́. Njẹ́ ẹnìkan wà ni ́bi ́ yìi ́ ni ́sisìyi ́ tí ó nsọ
Èdè Gẹ̀ ẹ́sì tí ó sì lè ràn wá lọ́wọ́? Bi ́ bẹ́ẹ̀kọ́, ẹnìkan lè kàn si ́ ọ tí ó nsọ èdè Yorùbá.

Draft 5 (10-26-2018)

FORM

D-ARCP-UE/D-ARQA-UE (10-26-2018)

OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx

This listing contains conﬁdential information, including Title 13 and Personally Identiﬁable Information (PII), the release of which is protected by the Privacy Act of 1974.
U.S. DEPARTMENT OF COMMERCE 1. IDENTIFICATION
Economics and Statistics Administration
U.S. CENSUS BUREAU

APPLY LABEL HERE
a. Block number

BLOCK BINDER COVER PAGE
OPERATION: UPDATE ENUMERATE

b. Area Census Office Name

Code

c. County

Code

d. State

Code

2020 Census

2. ASSIGNMENT INFORMATION
Name and CFS Area Number – Please Print

Employee
ID Number

Telephone number

Certiﬁcation statement – I certify that the information is
true to the best of my knowledge and the work completed
according to Census procedures.
Signature: Note – All Enumerators must sign the Certification
Assigned Completed
statement.
Date

CFS
(1) Enumerator
(2) Reassigned
Enumerator
(3) Reassigned
Enumerator

3. ENUMERATOR DAILY PROGRESS RECORD
a. Date
Housing Units
Enumerated

b. Today
c. To date

d. Call backs outstanding
Remarks

Total HUs

Occupied HUs

Total GQs

Vacant HUs

Total TLs

Total HU POP

4. OFFICE USE ONLY
Date of Office Review

Initials
The contents of this Block Binder are conﬁdential by law
(Title 13, U.S. Code). It may be seen only by sworn persons with
a need to know and used solely for statistical purposes.

FORM

D-ARQA-UE (10-26-2018)

Section A – QUESTIONNAIRE REVIEW CHECKLIST

QUALITY ASSURANCE REVIEW CHECKLIST
Section C – OFFICE REVIEW CRITICAL ERRORS

1st Review
Tally

1.
2.
3.
4.

Housing information Question S5 completed.
The total number of people living or staying at the unit in Question S6.
Coverage Question S7 completed.
Separate person information in Questions 1 through 5 on page 2, and Questions 1 through 7 on
pages 3 through 7 for the total number of persons identified in Question S6 and, if the information
is not entered the reason why it is not provided.
5. Coverage Question 2 answered for all persons listed as household members.
6. Questions R1, R2, and R3 completed.
7. A ’Unit Status’ entered in the Item A.
8. Correct Unit Status in Item A selected for deletes.
9. An entry in Item B for vacant units.
10. A total population count (01 99) in Item C for occupied housing units.
11. An entry of 00 in Item C for vacant units.
12. An ’X’ in ’REF’ in Item E when the final outcome for a case is ’RE’ in the ’Record of Contact’ section.
13. Entry for the type of interview, date, time, and outcome code in the ’Record of Contact’ section.
14. The enumerator signed, dated, and entered the Employee ID in the ’Certification’ section.
15. The CFS entered the CFS’s initials, the CFS Area number, and date in the ’Certification’ section.

1. The questionnaire is unlabeled.
2. Use a blank questionnaire because the address is not located within the enumerator’s Block.
3. The address information for the UHE or MOV household is printed in Label Box on the front
of the questionnaire.
4. Do not list the UHE or MOV address on the Add Page.
Section B – BLOCK BINDER AND MAP REVIEW
Is the enumerator generally
1. Accurately canvassing the Block?
2. Making entries on the Address List Page and Add Page in a legible manner?
3. Entering complete address information on the Address List Page and Add Page?
4. Putting an action code in the appropriate column on the Address List Page for each HU?
5. Map spotting each unit added according to instructions?

Census
Field
Supervisor

Yes

I certify that I have reviewed the binder and all accompanying documents and that the work
has been completed satisfactorily.
Signature

Tally

Total

1. Failure to enter an action code and date on a line in
the Address List Page for HU
2. Failure to make corrections as necessary to the
Address List Page
3. Added map spot with no corresponding line for a HU
or completed a line with no corresponding map spot
on the Add Page for HUs
4. Listed living quarter on the Add Page with a street
name that does not appear on the block map
5. Listed living quarter on Add Page without a house
number/street name or road name/physical description
6. Duplicate map spot number within a Block
7. Deleted map spot number (or change in parentheses
number) without a corresponding action code

Special Instructions for when UHE or MOV is Marked in Item E

Ready to send to the ACO?

Total

2nd Review

Date

8. Enumerator did not canvass the entire Block or did
not return all maps for the Block
Number of Lines filled in Binder
Pass

Total number of Critical Errors
Check in to Field OCS

Repair

Clerk’s initials
Remarks

Fail

Draft 5 (10-26-2018)

FORM

D-ARLP-UE

Page

(9-25-2018)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

ADDRESS LIST PAGE
OPERATION: UPDATE ENUMERATE
2020 Census
State:

County:

Tract:

RCC:

ACO:

Block:

Line
No.

Case ID

Action
Code

Date
Listed

Address Address
Status
Type

Map
Spot
No.

Remarks

Location Address or Physical Location Description
Complete Street Name
Address
No.

Physical Location Description
GQ or TL Name / Facility Name

(1)

(2)

(3)

(4)

(5)

(6)

U.S. CENSUS BUREAU

(7)

Apt/Unit
No.

Mailing Address
(RR and Box Number or
HCR and Box Number)

Occupant Name

Mailing Zip Code

Telephone No.

(9)

(10)

Pop. Count

Zip Code

(8)

(11)

{

❤

Action Codes:

V – Verified
U – Uninhabitable, Demolished,
Burned Out
N – Nonresidential
C – Correction
E – Empty Mobile Home/Trailer Site
D2 – Duplicate
DCL – Unable to Locate

Address Status Codes:
HU – Housing Unit
GQ – Group Quarters
TL – Transitory Location

Address Type Codes:
S – Single Unit
M – Multiunit
T – Trailer/Mobile Home
O – Other

NOTE: A Pop Count of "0" indicates an address is vacant. A "GQ" or "TL" in the
Address Status column indicates a Group Quarters or Transitory Location. Do not
enumerate and do not make changes to listing.

Page Totals
Group
Quarters

Transitory
Locations

HU
Population

Vacant
HUs

Occupied
HUs

Total Housing
(Vacant + Occupied)

Draft 5 (10-26-2018)

FORM

D-ARAP-UE

Page

(10-26-2018)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

ADD PAGE FOR UPDATE ENUMERATE
2020 Census
State:

County:

Tract:

RCC:

ACO:

Block:

Line
No.

(1)

Date
Listed

Address
Type

(3)

(5)

Address
Status

Map
Spot No.

(4)

(6)

Questionnaire ID Label

(2)

PLACE PROCESSING
ID LABEL HERE

Address Status Codes:
TL – Transitory Location
HU – Housing Unit
GQ – Group Quarters
NOTE: A Pop Count of "0" indicates an address is vacant. List new GQs or TLs
but do not enumerate. Report any added GQs or TLs to your supervisor.

U.S. CENSUS BUREAU

Remarks

Location Address or Physical Location Description
Complete Street Name

Address
No.

Apt/Unit No.

Physical Location Description

Mailing Address
(RR and Box Number or
HCR and Box Number)

Occupant Name
(For GQ or TL
Contact Name)

Mailing
Zip Code

Telephone No.

(8)

(9)

Zip Code

GQ or TL Name/Facility Name
(7)

Address Type Codes:
S – Single Unit

M – Multiunit

T – Trailer/Mobile Home

O – Other

Pop. Count
(For TL – No.
of Units)

(10)

Page Totals
Group
Quarters

Transitory
Locations

HU Population

Vacant HUs

Occupied HUs

Total Housing
(Vacant + Occupied)

File Type	application/pdf
Author	OneFormUser
File Modified	2019-09-09
File Created	2018-12-19