| OMB No. 0607-xxxx, Approval Expires xx/xx/xxxx | |
| Instructions for "GQ Name" tab (Required) | |
| The 2020 Post-Census Group Quarters Review (PCGQR) will accept only population count submissions for in-scope group quarters. Do not submit boundary or housing unit cases to the 2020 PCGQR. Supplemental demographic data (such as name, age, race, Hispanic origin) are OPTIONAL. Population counts and demographic data for GQ residents should be consistent with the 2020 Census Residence Criteria and Residence Situations and additional guidance provided by the Census Bureau due to the COVID-19 pandemic for GQ residents. | |
| 2020 Census CQR submission | Was this GQ submitted to 2020 Census CQR? If this GQ was submitted as part of 2020 Census Count Question Resolution operation case, please select YES. https://www.census.gov/programs-surveys/decennial-census/decade/2020/planning-management/evaluate/cqr.html |
| 2020 Census CQR case number | If the answer of the previous question is YES, please include the CQR case number. |
| GQ Name | The actual building name where residents, clients and/or staff live or stay. Include institution name for additional information if possible. |
| GQ Type Description | The group quarters type code and description. (See 2020 Group Quarters Code List Attached) |
| GQ Address Number | Address number of the actual physical location hosting the residents or clients. |
| GQ Street Name | Street name of the actual physical location hosting the residents or clients. |
| GQ City | City of the actual physical location hosting the residents or clients. |
| GQ State | State of the actual physical location hosting the residents or clients. |
| GQ ZIP Code | ZIP Code of the actual physical location hosting the residents or clients. |
| GQ Location Description | Location description (if there is no address) of the actual physical location hosting the residents or clients. If available, include latitude/longitude when Address Number and Street Name is not available. |
| GQ Population on Census Day | The number of persons that were living or staying in this building on Census Day (April 1, 2020). This should be consistent with the 2020 Census Residence Criteria and Residence Situations and additional guidance provided by the Census Bureau due to the COVID-19 pandemic. For example, include students who would have been living in this college/university student housing GQ on April 1, 2020. College students should be counted where they usually live, even if they were temporarily staying elsewhere while their school was closed because of COVID-19. [Note: Federal prisoners detained in state and local correctional facilities (GQ Type Codes 103, 104, 105, and 203),are counted by the particular federal agencies that have jurisdiction over those federal detainees. Therefore, any known federal detainees should not be reported for these GQ Type Codes.] |
| State FIPS code | State FIPS code. For example, the State FIPS Code for Arizona is 04 |
| County FIPS code | County FIPS code |
| Census tract code | Census Track code |
| Census block code | Census Block code |
| GQ POC | Point of Contact at the GQ, if applicable. If you obtained data from the GQ POC, please provide the name of the POC for the case. For example: Jane Doe, administrator GQ. |
| Data Source | What source did you use to provide the population count/demographic data? For example: Jane Doe, administrator GQ. |
| Submitter's Name and Title | Person that submitted the 2020 PCGQR case. For Example: John Doe, Mayor of Anywhere City. |
| Notes: | Include any additional notes you understand that would help the Census Bureau to conduct research related to this GQ. |
| Instructions for Optional "GQ Resident/Client Data" tab | |
| Population counts and demographic data should be submitted for GQ residents who lived at the GQ on Census Day (April 1, 2020). They should be consistent with the 2020 Census Residence Criteria and Residence Situations and additional guidance provided by the Census Bureau due to the COVID-19 pandemic . | |
| GQ Name | The actual building name where residents, clients and/or staff live or stay. |
| First Name | First name |
| Middle Initial | Middle initial |
| Last Name(s) | Last name(s) [Note: If person uses "Junior" or "Senior" in their name, enter the last name and the suffix (for example: Smith Jr) in the Last Name(s) field.] |
| Sex | What is this person's sex? (Male or Female) [Note: Please report the person's biological sex as Male or Female. If this information is not available, please leave the field blank.] |
| Date of Birth | What is this person's date of birth? If you know the date of birth, enter it. If you do not know the exact date of birth, enter as much as you know. |
| Month of Birth |
Provide month of birth in numeric format as two digits. |
| Day of Birth | Provide day of birth in numeric format as two digits. |
| Year of Birth |
Provide four-digit year of birth. |
| Age on April 1, 2020 | What was this person's age (in years) on Census Day (April 1, 2020)? [Note: Enter age, as of April 1, 2020. For babies less than 1 year old, do not enter the age in months. Enter 0 as the age. Do not round the age up if the person was close to having a birthday on April 1, 2020. If this information is not available, please leave the field blank.] |
| Hispanic, Latino, or Spanish Origin | Is the person of Hispanic, Latino, or Spanish origin? (Yes or No) [Note: Please answer BOTH Questions about Hispanic origin and race. For this census, Hispanic origins are not races.] |
| Hispanic, Latino, or Spanish Origin Details | If Yes, please provide details. For example, Mexican, Mexican Am, Chicano, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, or Another Hispanic, Latino, or Spanish origin. |
| Race | What is this person's race? You may report more than one group. (White, Black or African Am, American Indian or Alaska Native, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, Other Asian, Native Hawaiian, Samoan, Chamorro, Other Pacific Islander, or Some other race) |
| Race Details | Please provide details. See the examples below. White - For example, German, Irish, English, Italian, Lebanese, Egyptian, etc. Black or African American - For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. American Indian or Alaska Native - 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. Other Asian - For example, Pakistani, Cambodian, Hmong, etc. Other Pacific Islander - For example, Tongan, Fijian, Marshallese, etc. Some other race - Provide race or origin. |
| Lived or Stayed at GQ Most of Time | Did the person live or stay at this GQ most of the time? (Yes or No) Select "Yes" if this person lived (or would have lived) and slept at this GQ more often than any other place as of Census Day (April 1, 2020). |
| Alternate Address: Address Number | Address number of another place where person sometimes lived or stayed when not at this GQ. [Note: If person never stayed at any place other than this GQ, leave the Alternate Address blank. If person had more than one alternate address, enter the address of the place where they lived or stayed more often.] |
| Alternate Address: Street Name | Street name of another place where person sometimes lived or stayed when not at this GQ. |
| Alternate Address: Apt / Unit | Apartment or Unit (if applicable) of another place where person sometimes lived or stayed when not at this GQ. |
| Alternate Address: Rural Route Address | Rural Route address (if applicable, and no street address is available) of another place where person sometimes lived or stayed when not at this GQ. |
| Alternate Address: City | City of another place where person sometimes lived or stayed when not at this GQ. |
| Alternate Address: State | State of another place where person sometimes lived or stayed when not at this GQ. |
| Alternate Address: ZIP Code | ZIP Code of another place where person sometimes lived or stayed when not at this GQ. |
| Alternate Address: Location Description | Location description (if there is no address) of another place where person sometimes lived or stayed when not at this GQ. |
| Link to 2020 Census Residence Criteria and Residence Situations: https://www.census.gov/content/dam/Census/programs-surveys/decennial/2020-census/2020-Census-Residence-Criteria.pdf | |
| Example scenarios: | |
| A town representative reviews the population counts of group quarters for individual census blocks and believes the population count for the census block is lower than it should be because there is a large student housing facility in that block. The designated representative can provide evidence of the population on April 1, 2020. A town representative is informed by a nursing facility administrator that the GQ submitted a count for July 1, 2020 rather than a count as of April 1, 2020. The April 1 population was higher than the July count. A town representative discovers that a local jail inadvertently did not include inmates awaiting trial, who should have been included. The GQ administrator has records showing the count on April 1, 2020 was higher than published. |
|
| 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. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data. The Census Bureau estimates that completing this program will take 5.2 hours on average. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to dcmd.pcgqr@census.gov. This collection has been approved by the Office of Management and Budget (OMB). The eight digit OMB approval number that appears on this form confirms this approval. If this number were not displayed, the Census Bureau could not conduct this program. The 2020 Post-Census Group Quarters Review is provided under Title 13 U.S.C. Section 6. The purpose of the 2020 Post-Census Group Quarters Review is to provide a mechanism for governmental units to request a review of their official 2020 Census results, specifically those for the population in Group Quarters. Personally identifiable information collected includes name, address, date of birth or age, and race or ethnicity. Disclosure of the information provided to us is permitted under the Privacy Act of 1974 (5 U.S.C. § 552a) and may be shared with other Census Bureau staff for the work-related purposes. Disclosure of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice SORN CENSUS-5, Decennial Census Program. Furnishing this information is voluntary. Failure to do so will result in the Census Bureau’s inability to review population counts for group quarters in blocks where governmental units believe there was an undercount during the 2020 Census. The information will be shared with U.S. Census Bureau staff, contractors, and non-Census sponsors that are authorized and have a need to know. The information will be secured by staff (employees and contractors) that have received training on privacy and confidentiality policies and practices. |
|
| 2020 Census Group Quarters Definitions and Code List | |
| (For Data Collection Only) | |
| Group Quarters: | |
| A group quarters is a place where people live or stay, in a group living arrangement that is owned or managed by an entity or organization providing housing and/or services for the residents. These services may include custodial or medical care as well as other types of assistance, and residency is commonly restricted to those receiving these services. This is not a typical household-type living arrangement. People living in group quarters are usually not related to each other. Group quarters include such places as college residence halls, residential treatment centers, skilled-nursing facilities, group homes, military barracks, correctional facilities, and workers’ dormitories. |
|
| Institutional Group Quarters: | |
| Facilities that house those who are primarily ineligible, unable, or unlikely to participate in the labor force while residents. | |
| CORRECTIONAL FACILITIES FOR ADULTS | |
| Type Code: 101 | Federal Detention Centers: |
| Stand alone, generally multi-level, federally operated correctional facilities that provide “short-term” confinement or custody of adults pending adjudication or sentencing. These facilities may hold pretrial detainees, holdovers, sentenced offenders, and Immigration and Customs Enforcement (ICE) inmates, formerly called Immigration and Naturalization Service (INS) inmates. These facilities include: Metropolitan Correctional Centers (MCCs), Metropolitan Detention Centers (MDCs), Federal Detention Centers (FDCs), Bureau of Indian Affairs Detention Centers, ICE Service Processing Centers, and ICE contract detention facilities. |
|
| Type Code: 102 Federal Prisons Type Code: 103 State Prisons |
Federal and State Prisons: |
| Adult correctional facilities where people convicted of crimes serve their sentences. Common names include: prison, penitentiary, correctional institution, federal or state correctional facility, and conservation camp. The prisons are classified by two types of control: (1) “federal” (operated by or for the Bureau of Prisons of the Department of Justice) and (2) “state.” Residents who are forensic patients or criminally insane are classified on the basis of where they resided at the time of enumeration. Patients in hospitals (units, wings, or floors) operated by or for federal or state correctional authorities are counted in the prison population. Other forensic patients will be enumerated in psychiatric hospital units and floors for long-term non-acute patients. This category may include privately operated correctional facilities. | |
| Type Code: 104 | Local Jails and Other Municipal Confinement Facilities: |
| Correctional facilities operated by or for counties, cities, and American Indian and Alaska Native tribal governments. These facilities hold adults detained pending adjudication and/or people committed after adjudication. This category also includes work farms and camps used to hold people awaiting trial or serving time on relatively short sentences. Residents who are forensic patients or criminally insane are classified on the basis of where they resided at the time of enumeration. Patients in hospitals (units, wings, or floors) operated by or for local correctional authorities are counted in the jail population. Other forensic patients will be enumerated in psychiatric hospital units and floors for long-term non-acute patients. This category may include privately operated correctional facilities. |
|
| Type Code: 105 | Correctional Residential Facilities: |
| These are community-based facilities operated for correctional purposes. The facility residents may be allowed extensive contact with the community, such as for employment or attending school, but are obligated to occupy the premises at night. Examples are halfway houses, restitution centers, and prerelease, work release, and study centers. |
|
| Type Code: 106 | Military Disciplinary Barracks and Jails: |
| Correctional facilities managed by the military to hold those awaiting trial or convicted of crimes. |
|
| JUVENILE FACILITIES | |
| Type Code: 201 | Group Homes for Juveniles (non-correctional): |
| Includes community-based group living arrangements for youth in residential settings that are able to accommodate three or more clients of a service provider. The group home provides room and board and services, including behavioral, psychological, or social programs. Generally, clients are not related to the care giver or to each other. Examples are maternity homes for unwed mothers, orphanages, and homes for abused and neglected children in need of services. Group homes for juveniles do not include residential treatment centers for juveniles or group homes operated by or for correctional authorities. |
|
| Type Code: 202 | Residential Treatment Centers for Juveniles (non-correctional): |
| Includes facilities that primarily serve youth that provide services on-site in a highly structured live-in environment for the treatment of drug/alcohol abuse, mental illness, and emotional/behavioral disorders. These facilities are staffed 24-hours a day. The focus of a residential treatment center is on the treatment program. Residential treatment centers for juveniles do not include facilities operated by or for correctional authorities. |
|
| Type Code: 203 | Correctional Facilities Intended for Juveniles: |
| Includes specialized facilities that provide strict confinement for its residents and detain juveniles awaiting adjudication, commitment or placement, and/or those being held for diagnosis or classification. Also included are correctional facilities where residents are permitted contact with the community, for purposes such as attending school or holding a job. Examples are residential training schools and farms, reception and diagnostic centers, group homes operated by or for correctional authorities, detention centers, and boot camps for juvenile delinquents. |
|
| NURSING FACILITIES/SKILLED-NURSING FACILITIES | |
| Type Code: 301 | Nursing Facilities/Skilled-Nursing Facilities: |
| Includes facilities licensed to provide medical care with seven day, twenty-four hour coverage for people requiring long-term non-acute care. People in these facilities require nursing care, regardless of age. Either of these types of facilities may be referred to as nursing homes. | |
| OTHER INSTITUTIONAL FACILITIES | |
| Type Code: 401 | Mental (Psychiatric) Hospitals and Psychiatric Units in Other Hospitals: |
| Includes psychiatric hospitals, units and floors for long-term non-acute care patients. The primary function of the hospital, unit, or floor is to provide diagnostic and treatment services for long-term non-acute patients who have psychiatric-related illness. All patients are enumerated in this category. |
|
| Type Code: 402 | Hospitals with Patients Who Have No Usual Home Elsewhere: |
| Includes hospitals if they have any patients who have no exit or disposition plan, or who are known as "boarder patients" or "boarder babies." All hospitals are eligible for inclusion in this category except psychiatric hospitals, units, wings or floors operated by federal, state or local correctional authorities. Patients in hospitals operated by these correctional authorities will be counted in the prison or jail population. Psychiatric units and hospice units in hospitals are also excluded. Only patients with no usual home elsewhere are enumerated in this category. | |
| Type Code: 403 | In-Patient Hospice Facilities: |
| Includes in-patient hospice facilities (both free-standing and units in hospitals) that provide palliative, comfort, and supportive care for the terminally ill patient and their families. Only patients with no usual home elsewhere are tabulated in this category. |
|
| Type Code: 404 | Military Treatment Facilities with Assigned Patients: |
| These facilities include military hospitals and medical centers with active duty patients assigned to the facility. Only these patients are enumerated in this category. |
|
| Type Code: 405 | Residential Schools for People with Disabilities: |
| Includes schools that provide the teaching of skills for daily living, education programs, and care for students with disabilities in a live-in environment. Examples are residential schools for the physically or developmentally disabled. |
|
| Noninstitutional Group Quarters: | |
| Facilities that house those who are primarily eligible, able, or likely to participate in the labor force while residents. | |
| COLLEGE/UNIVERSITY STUDENT HOUSING | |
| Type Code: 501 | College/University Student Housing (owned/leased/managed by a college/university): |
| Includes residence halls, and other buildings, including apartment-style student housing, designed primarily to house college and university students in a group living arrangement either on or off campus. These facilities are owned, leased, or managed by a college, university, or seminary. Fraternity and sorority housing recognized by the college or university are included as college student housing. Students attending the U.S. Naval Academy, the U.S. Military Academy (West Point), the U.S. Coast Guard Academy, and the U.S. Air Force Academy are counted in military group quarters. |
|
| Type Code: 502 | College/University Student Housing (owned/leased/managed by a private company/agency): |
| Includes buildings designed primarily to house college and university students in a group living arrangement either on or off campus. These facilities are owned, leased, or managed by a private company or agency (i.e., not owned/leased/managed by a college/university). This category includes apartment-style student housing. Residents typically enter into “by the bed” leases (i.e., single-liability leases). | |
| MILITARY QUARTERS | |
| Type Code: 601 Military Quarters | Military Quarters: |
| These facilities include military personnel living in barracks (including “open” barrack transient quarters) and dormitories and military ships. Patients assigned to Military Treatment Facilities and people being held in military disciplinary barracks and jails are not enumerated in this category. Patients in Military Treatment Facilities with no usual home elsewhere are not enumerated in this category. | |
| Type Code: 602 Military Ships | |
| OTHER NONINSTITUTIONAL FACILITIES* | |
| Type Code: 701 | Emergency and Transitional Shelters (with Sleeping Facilities) for People Experiencing Homelessness: |
| Facilities where people experiencing homelessness stay overnight. These include: | |
| 1) shelters that operate on a first-come, first-serve basis where people must leave in the morning and have no guaranteed bed for the next night; | |
| 2) shelters where people know that they have a bed for a specified period of time (even if they leave the building every day); and | |
| 3) shelters that provide temporary shelter during extremely cold weather (such as churches). This category does not include shelters that operate only in the event of a natural disaster. Examples are emergency and transitional shelters; missions; hotels and motels used to shelter people experiencing homelessness; shelters for children who are runaways, neglected or experiencing homelessness; and similar places known to have people experiencing homelessness. |
|
| Type Code: 801 | Group Homes Intended for Adults: |
| Group homes are community-based group living arrangements in residential settings that are able to accommodate three or more clients of a service provider. The group home provides room and board and services, including behavioral, psychological, or social programs. Generally, clients are not related to the care giver or to each other. Group homes do not include residential treatment centers or facilities operated by or for correctional authorities. | |
| Type Code: 802 | Residential Treatment Centers for Adults: |
| Residential facilities that provide treatment on-site in a highly structured live-in environment for the treatment of drug/alcohol abuse, mental illness, and emotional/behavioral disorders. They are staffed 24-hours a day. The focus of a residential treatment center is on the treatment program. Residential treatment centers do not include facilities operated by or for correctional authorities. | |
| Type Code: 901 | Workers’ Group Living Quarters and Job Corps Centers: |
| Includes facilities such as dormitories, bunkhouses, and similar types of group living arrangements for agricultural and non-agricultural workers. This category also includes facilities that provide a full-time, year-round residential program offering a vocational training and employment program that helps young people 16-to-24 years old learn a trade, earn a high school diploma or GED and get help finding a job. Examples are group living quarters at migratory farmworker camps, construction workers’ camps, Job Corps centers and vocational training facilities. |
|
| Type Code: 903 | Living Quarters for Victims of Natural Disasters: These are temporary group living arrangements established as a result of natural disasters. |
| *Note: Out-of-scope Service Base locations are: Soup Kitchens (702), Regularly Scheduled Mobile Food Vans (704), and Targeted Non-Sheltered Outdoor Locations (706). Also out-of-scope are Religious Group Quarters and Domestic Violence Shelters (904) | |
| 2020 Census CQR submission? Was this GQ also submitted to 2020 Census CQR? YES/NO |
GQ Name | GQ Type Description | GQ Address Number | GQ Street Name | GQ City | GQ State | GQ ZIP Code | GQ Location Description | GQ Population on Census Day (April 1, 2020) |
State FIPS code | County FIPS code | Census tract code | Census block code | GQ POC (name of person, if applicable, that you contacted for information about this GQ) | Data Source (where did you obtain your information) | Submitter's Name and Title | Notes: |
| Please read the Instructions tab before completing the template. |
Include any additional notes you understand that would help the Census Bureau to conduct research related to this GQ. | ||||||||||||||||
| No | Freshman Hall, State University | 501-College/University Student Housing (College/University owned/leased/managed) | 123 | Terrapin Road | University Park | MD | 20742 | 15 | 24 | 149 | 000000 | Jane Doe, administrator | Jane Doe, administrator | John Doe, Mayor Anywhere City | |||
| GQ Name | First Name | Middle Initial | Last Name(s) | Sex | Date of Birth | Age on April 1, 2020 | Hispanic, Latino, or Spanish Origin | Hispanic, Latino, or Spanish Origin Details | Race | Race Details | Lived or Stayed at GQ Most of the Time | Alternate Address: Address Number | Alternate Address: Street Name | Alternate Address: Apt / Unit | Alternate Address: Rural Route Address | Alternate Address: City | Alternate Address: State | Alternate Address: ZIP Code | Alternate Address: Location Description | ||
| Month of Birth (MM) | Day of Birth (DD) | Year of Birth (YYYY) | |||||||||||||||||||
| Please read the Instructions tab before completing the template. | |||||||||||||||||||||
| Freshman Hall | Mary | Q | Jones | Female | 03 | 05 | 1999 | 21 | Yes | Dominican | Black or African Am | African American and Jamaican | No | 123 | Main Street | College Park | MD | 12345 | |||
| Freshman Hall | John | D | Kay | Male | 02 | 20 | 1997 | 23 | Yes | Mexican | Chinese, Filipino, and Samoan | No | 456 | Fruit Road | Apt A | Suitland | MD | 12345 | |||
| Freshman Hall | Omar | Barry Senior | Male | 10 | 15 | 2000 | 19 | No | White | German and Irish | Yes | 789 | Tree Avenue | Unit 212 | College Park | MD | 12345 | ||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |