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Yearly amount — Dollars

H23a. Do you have a mortgage, deed of trust, contract to purchase, or similar debt on THIS property?

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O Yes, contract to purchase O No-StoptoH24a

b. How much is your regular monthly mortgage payment on THIS property? Include payment only on frrst mortgage or contract to purchase.

i* m

Monthly amount — Dollars

H24a. Do you have a second or Junior

mortgage or a home equity loan on THIS property?

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b. How much is your regular monthly payment on all second or Junior mortgages and all home equity loans?

OR

OR

H22. What was the annual payment for fire, hazard, and flood Insurance on THIS property?

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Yearly amount — Dollars

OR

1$. M

Monthly amount — Dollars

OR

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O No regular payment required Stdp to H24a

c. Does your regular monthly mortgage payment Include payments for real estate taxes on THIS property?

O Yes, taxes included in payment

O No, taxes paid separately or taxes not required

d. Does your regular monthly mortgage payment Include payments for Are, hazard, or flood insurance on THIS property?

O Yes, Insurance Included In payment

O No, insurance paid separately or no Insurance

O None

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Census 2000 used two questionnaires-a long-form samPle of households throughout the United States and

(sample) and a short-form (100 percent) questionnaire. territories, contained 29 inquiries in addition to the 8

The short-form questionnaire consisted of 7 questions questions asked on the short-form questionnaire. These

that could be answered by up to 6 persons within a house- additional quesitons, as in the past, collected information

hold (see questions 1-6 and 33 on long-form questionnaire on the population, housing, economic, and social charac

reproduced here). Space was provided to identify 6 addi- teristics of the Nation's households,
tional members of the household. The U.S. Census Bureau
would collect data on persons 7-1 2 by telephone inter-
view.

Measuring America 97

2000 Questionnaire

^^United States

Census 2000

U.S. Department of Commerce Bureau of the Census

This is the official form for all the people at this address. It is quick and easy, and your answers are protected by law. Complete the Census and help your community get what it needs — today and in the future!

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The "Informational Copy" shows
the content of the United States
Census 2000 "long" form
questionnaire. Each household will
receive either a short form
(100-percent questions) or a long
form (100-percent and sample
questions). The long form
questionnaire includes the same
6 population questions and
1 housing question that are on the
Census 2000 short form, plus
26 additional population questions,
and 20 additional housing
questions. On average, about 1 in
every 6 households will receive the
long form. The content of the forms
resulted from reviewing the 1990
census data, consulting with
federal and non-federal data users,
and conducting tests.

For additional information about
Census 2000, visit our website at
www.census.gov or write to the
Director, Bureau of the Census,
Washington, DC 20233.

Start Here

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Please use a black or blue pen.

How many people were living or staying in this house, apartment, or mobile home on April 1, 2000?

Number of people Y'■

INCLUDE in this number:

• foster children, roomers, or housemates

• people staying here on April 1, 2000 who
have no other permanent place to stay

• people living here most of the time while
working, even if they have another place to live

DO NOT INCLUDE in this number:

• college students living away while
attending college

• people in a correctional facility, nursing home,
or mental hospital on April 1, 2000

.. > - • Armed Forces personnel living somewhere else

• people who live or stay at another place most

of the time

Please turn the page and print the names of all the people living or staying here on April 1, 2000.

J

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If you need help completing this form, call 1-800-XXX-XXXX between 8:00 a.m. and 9:00 p.m.. 7 days a week. The telephone call is free.

TDD - Telephone display device lor the hearing impaired. Call 1-800-XXX-XXXX between 8:00 a.m. and 9:00 p.m., 7 days a week. The telephone call is free.

iNECESITA AYUDA? Si usted necesita ayuda para completar este cuestionario llame al I 1-800-XXX-XXXX entre las 8:00 a.m. y las 9:00 p.m., 7 dlas a la semana. La llamada 1 telefOnica es gratis.

The Census Bureau estimates that for the average household, this form will take about
38 minutes to complete, including the time for reviewing the instructions and answers.
Comments about the estimate should be directed to the Associate Director for Finance and
Administration, Attn: Paperwork Reduction Project 0607-0856, Room 3104, Federal
Building 3, Bureau of the Census, Washington, DC 20233.

Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of Management and Budget.

OMB No. 0607-0856: Approval Expires 12/31/2000

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