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OMB No. XXXX-XXXX
Special Census Transitory Unit
Continuation Questionnaire
U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU
Enter the 12-digit Case ID number for this household. This number is found below the SC-Q-TL barcode label.
–
FOR NPC
USE ONLY
–
SCID
State
of
questionnaire(s)
T
Questionnaire
D
R
AF
Unit/Site Number
TL Name
TL Block
TL Tract
AA
Copy transitory unit
information and TL Name
from the Transitory Location
Listing Sheet (SC-693.2)➜
County
CONTINUATION QUESTIONNAIRE
FOR SPECIAL CENSUS
TRANSITORY UNITS
FORM
SC-CQ-TL
23083017
(10-07-2022) Notional Draft
§8)?:¤
1. What is the name of
Person
6.
?
Print name below and verify the spelling.
First Name
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J
MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Please read the RELATIONSHIP section on the Information
Sheet.
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
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
Japanese
Chamorro
T
2.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Asian Indian
AF
3.
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark I
K ONE box.
J
Male
Female
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
R
4. What was this person’s age on (Special Census Day)? What
is this person’s date of birth? If you don’t know the exact age,
please estimate. For babies less than 1 year old, do not report
the age in months. Report 0 as the age.
years
Print numbers in boxes.
Month
Day
Year of birth
D
Age on (Special Census Day)
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
5.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.
2
23083025
§8)?B¤
1. What is the name of
Person
6.
?
Print name below and verify the spelling.
First Name
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J
MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Please read the RELATIONSHIP section on the Information
Sheet.
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
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
Japanese
Chamorro
T
2.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Asian Indian
AF
3.
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark I
K ONE box.
J
Male
Female
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
R
4. What was this person’s age on (Special Census Day)? What
is this person’s date of birth? If you don’t know the exact age,
please estimate. For babies less than 1 year old, do not report
the age in months. Report 0 as the age.
years
Print numbers in boxes.
Month
Day
Year of birth
D
Age on (Special Census Day)
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
5.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.
3
23083033
§8)?J¤
1. What is the name of
Person
6.
?
Print name below and verify the spelling.
First Name
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J
MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Please read the RELATIONSHIP section on the Information
Sheet.
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
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
Japanese
Chamorro
T
2.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Asian Indian
AF
3.
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark I
K ONE box.
J
Male
Female
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
R
4. What was this person’s age on (Special Census Day)? What
is this person’s date of birth? If you don’t know the exact age,
please estimate. For babies less than 1 year old, do not report
the age in months. Report 0 as the age.
years
Print numbers in boxes.
Month
Day
Year of birth
D
Age on (Special Census Day)
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
5.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.
4
23083041
§8)?[¤
1. What is the name of
Person
6.
?
Print name below and verify the spelling.
First Name
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J
MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Please read the RELATIONSHIP section on the Information
Sheet.
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
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
Japanese
Chamorro
T
2.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Asian Indian
AF
3.
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark I
K ONE box.
J
Male
Female
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
R
4. What was this person’s age on (Special Census Day)? What
is this person’s date of birth? If you don’t know the exact age,
please estimate. For babies less than 1 year old, do not report
the age in months. Report 0 as the age.
years
Print numbers in boxes.
Month
Day
Year of birth
D
Age on (Special Census Day)
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
5.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.
5
23083058
§8)?c¤
1. What is the name of
Person
6.
?
Print name below and verify the spelling.
First Name
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J
MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Please read the RELATIONSHIP section on the Information
Sheet.
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
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
Japanese
Chamorro
T
2.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Asian Indian
AF
3.
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark I
K ONE box.
J
Male
Female
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
R
4. What was this person’s age on (Special Census Day)? What
is this person’s date of birth? If you don’t know the exact age,
please estimate. For babies less than 1 year old, do not report
the age in months. Report 0 as the age.
years
Print numbers in boxes.
Month
Day
Year of birth
D
Age on (Special Census Day)
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
5.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S4 on the
SC-Q-TL, continue with the next person on the next
page.
6
23083066
§8)?k¤
1. What is the name of
Person
6.
?
Print name below and verify the spelling.
First Name
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark I
K one or more boxes AND print origins.
J
MI
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
Please read the RELATIONSHIP section on the Information
Sheet.
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
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
Japanese
Chamorro
T
2.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Asian Indian
AF
3.
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
Is this person male or female? Mark I
K ONE box.
J
Male
Female
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
R
4. What was this person’s age on (Special Census Day)? What
is this person’s date of birth? If you don’t know the exact age,
please estimate. For babies less than 1 year old, do not report
the age in months. Report 0 as the age.
years
Print numbers in boxes.
Month
Day
Year of birth
D
Age on (Special Census Day)
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
5.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If needed, continue with the next person on another
Continuation Questionnaire (SC-CQ-TL) and update
the number of continuation questionnaires on page 8
of the SC-Q-TL and page 1 of the SC-CQ-TL
questionnaires.
7
23083074
AF
T
§8)?s¤
D
R
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23083082
OMB No. XXXX-XXXX
File Type | application/pdf |
Author | OneFormUser |
File Modified | 2022-10-07 |
File Created | 2022-08-25 |