Small Populations, Large Effects Improving the Measurement of the Group Quarters Population in the American Community Survey (2012) / Chapter Skim
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Appendix B: 2011 American Community Survey: Housing Unit Questionnaire
Appendix B: 2011 American Community Survey: Housing Unit Questionnaire
Pages 101-116
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From page 101... ...
Appendix B 2011 American Community Survey: Housing Unit Questionnaire 101
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From page 102... ...
¿NECESITA AYUDA? Si usted habla español y ● DO NOT INCLUDE anyone who is living somewhere else for more than necesita ayuda para completar su cuestionario, 2 months, such as a college student living away or someone in the llame sin cargo alguno al 1-877-833-5625.
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From page 103... ...
Asian Indian Japanese Asian Indian Japanese Native Hawaiian Native Hawaiian Chinese Korean Chinese Korean Guamanian or Chamorro Guamanian or Chamorro Filipino Vietnamese Filipino Vietnamese Samoan Samoan Other Asian – Print race, Other Pacific Islander – Other Asian – Print race, Other Pacific Islander – for example, Hmong, Print race, for example, for example, Hmong, Print race, for example, Laotian, Thai, Pakistani, Fijian, Tongan, and Laotian, Thai, Pakistani, Fijian, Tongan, and Cambodian, and so on.
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From page 104... ...
Asian Indian Japanese Asian Indian Japanese Native Hawaiian Native Hawaiian Chinese Korean Chinese Korean Guamanian or Chamorro Guamanian or Chamorro Filipino Vietnamese Filipino Vietnamese Samoan Samoan Other Asian – Print race, Other Pacific Islander – Other Asian – Print race, Other Pacific Islander – for example, Hmong, Print race, for example, for example, Hmong, Print race, for example, Laotian, Thai, Pakistani, Fijian, Tongan, and Laotian, Thai, Pakistani, Fijian, Tongan, and Cambodian, and so on.
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From page 105... ...
Person 11 Last Name (Please print) First Name MI Asian Indian Japanese Native Hawaiian Chinese Korean Guamanian or Chamorro Filipino Vietnamese Samoan Sex Male Female Age (in years)
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From page 106... ...
Coal or coke 3 Wood Number of rooms When did PERSON 1 (listed on page 2) move into this house, apartment, or Solar energy mobile home?
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From page 107... ...
11 a. LAST MONTH, what was the cost 12 IN THE PAST 12 MONTHS, did anyone in C Answer questions 16 – 20 if you or of electricity for this house, this household receive Food Stamps or someone else in this household OWNS apartment, or mobile home?
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From page 108... ...
Does the regular monthly mortgage payment include payments for real estate taxes on THIS property? D Answer question 21 if this is a MOBILE HOME.
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From page 109... ...
12th grade – NO DIPLOMA Outside the United States – Print name of HIGH SCHOOL GRADUATE foreign country, or Puerto Rico, Guam, etc. Regular high school diploma For example: Korean, Italian, Spanish, Vietnamese GED or alternative credential c.
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From page 110... ...
Medicaid, Medical Assistance, or Guard? Active duty does not include training for the any kind of government-assistance Widowed Reserves or National Guard, but DOES include plan for those with low incomes activation, for example, for the Persian Gulf War.
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From page 111... ...
f. ZIP Code Yes, on vacation, temporary illness, 40 During the PAST 12 MONTHS, in the WEEKS maternity leave, other family/personal WORKED, how many hours did this person reasons, bad weather, etc.
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From page 112... ...
$ .00 Yes ➔ a Federal GOVERNMENT employee? , For income received jointly, report the appropriate No SELF-EMPLOYED in own NOT INCORPORATED TOTAL AMOUNT for past share for each person – or, if that's not possible, business, professional practice, or farm?
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From page 113... ...
113 APPENDIX B PREPUBLICATION COPY, UNCORRECTED PROOFS 13191127 Person 2 The balance of the questionnaire has questions for Person 2, Person 3, Person 4, and Person 5. The questions are the same as the questions for Person 1.
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From page 115... ...
Please DO NOT RETURN your questionnaire to this address. Use the enclosed EDIT CLERK TELEPHONE CLERK JIC3 JIC4 preaddressed envelope to return your completed questionnaire.
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