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EXPLANATORY NOTES

Thia booklet shows the content of the two 1990 census questionnaire* being delivered by mail. The content of these forms was determined a-er review of the 1960 census experience, extensive consultation with many government and private users of census data, and a series of experimental cenauses and surveys ln which various alternatives were tested.

Two principal type* of data-collection forms - a 100-percent questionnaire (or "ahort form") and a sample questionnaire (or "king form") — are being used in the census. Each household receives one of the two questionnaire*.

Short form — This questionnaire contain* 7 population questions snd 7 housing questions, shown on page* 1 -3 of this booklet. On average, about 5 ln every 6 households will receive the short form. For the average household, this form will take an estimated tA minute* to complete.

Long form — This questionnaire has all of the short-form question* plus housing questionc H8 through H26, shown on pages A and 5, and population question* 8 through 33, shown on pages 6 and 7. The population questions are repeated for each member of the household but these pages were not reproduced in thi* booklet. A statistical aample of approximately t in every 6 households will receive the long form. For the average household, this form will take an estimated 43 minutes to complete.

An instruction guide accompanies sech questionnaire to help the respondents complete the form, and a preaddressad envelope is provided for returning the questionnaire.

For additional information about the 1990 U.S. Census, please write the Director. Bureau of the Census, Washington, DC 20233

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FOICENSUSUSE

Measuring America

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1990 Questionnaire

Page 6

QUESTIONS ASKED OF A SAMPLE OF HOUSEHOLDS

PLEASE ANSWER THESE QUESTIONS

PERSON 1

8. In what U.S. State or foreign country was this person bom? -7

(Name of Stale or foreign country; or PuertoRlcoT Guam, etc.)

9. Is this person a CITIZEN of the United States?

O Yes. bom In the United States— Skip to 11 asj

O Yes, bom in Puerto Rico, Guam, the TM

U.S. Virgin Islands, or Northern Marianas
O Yes, bom abroad of American parent or parents
O Yet, U.S. citizen by naturalization
O No, not a citizen of the United Slates

10. When did this person come to the United SUtes to stay?

O 1987 to 1990 TM 0 1970 to 1974

O 1985 or 1986 O 1965 to 1969

O 1982 to 1984 O I960 to 1964

O 1980 or 1981 O 1950 to 1959

O 1975 to 1979 O Before 1950

11. At any time since February 1, 1990, has this person attended regular school or college?

Include only nursery school, kindergarten, elementary school, and schooling which leads to a high school diploma or a college degree. O No, has not attended since February 1 O Yet, public school, public college M

O Yes, private school, private college"

12. How much school has this person COMPLETED? Fl ONE drda for the highest level COMPLETED or degree RECEIVED. tf currently enrolled, mark the level

of previous grade attended or highest degree received.

No school completed

Nursery school asa

Kindergarten TM

1st, 2nd, 3rd, or 4th grade

5th, 6th, 7th. or 8th grade

9th grade

10th grade

11th grade

12th end.. NO DIPLOMA

HIGH SCHOOL GRADUATE - high school

DIPLOMA or the equivalent (For example: GED)
Some college but no degree
Associate degree in college - Occupational program
Associate degree In college - Academic program
Bachelor,s degree (For example: BA, AB, BS)
Master,s degree (For example: MA, MS, MEng,

MEd, MSW. MBA)
Professional school degree (For example: MD,

DOS, DVM. LLB, JD) ■_
Doctorate degree

(For example: PhD, EdD)

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14a. Did true person five in this house or apartment S years ago (on April 1,1985)?

O Bom after April 1.1985 — Goto questions for

r- v/ M*.. ,£. the nexf person

O Yes — Skip to 15a

r 0 No

b. Where did this person live 5 years ago
(on April 1,1985)?
(1) Name of U.S. State or foreign country -

(If outside U.S., print answer above and skip to 15a.)

(2) NameofcounrylntheU.S.

(3) Name of city or town in the U.S.

(4) Did this person live inside the city
or town limits?

O Yes

O No, lived outside the ctty/town limits

15a. Does this person speak a language other than
English at home?
O Yes O Ho Stop to 16

b. What is this language?

(For example: Chinese, Italian, Spanish, Vietnamese) c. How well does this person speak English? O VeryweD O Not well

O Well

O Notatal

When was this person born?

O Bom before April 1, 1975— Go to 17a

O Bom April 1, 1975 or later - Go to questions

for the next person

17a. Has this person ever been on active-duty military service In the Armed Forces of the United States or ever been m the United States military Reserves or the National Guard? If service was in Reserves or National Guard only, see instruction guide.

O Yes, now on active duty

O Yes, on active duty in past, but not now ]

C Yes, service In Reserves or National
Guard only — Skip to 18

O No -Skip to 18

b. Was active-duty military service during —

Fill A cirde for each period in which this person served.

O September 1980 or liter

O May 1975 to August 1980

O Vietnam era (August 1964—April 1975)

O February 1955- Jury 1964

O Korean conflict (June 1950—January 1955)

O World War II (September 1940-July 1947)

O World War I (April 1917-November 1918)

O Any other time

c. In total, how many yeara of active-duty military service hae thla peraon had?

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tfonnaire-also contains population questions 8 to 33, shown hero on pages 6 and 7. These questions appear onpBirs ot facing page* of the BffilSav, ■■gang" 7,8 and S> etc.) far each parson in the fousaholqV Note thatquestions17a toSS^o not applytOparaonsunder15 years of age. -,;

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28. Industry or Employer

a. For whom did this person work?

If now on active duty In the Armed

Forces, fiU this circle

branch of the Armed Forces.

-»- O and print the

(Name of company, business, or other employer) b. What kind of business or toduetry was this?—j

Describe the activity at location where employed. /

[For example: hospital, newspaper publishing,
mall order house, auto engine manufacturing,
retail bakery)

c. Is thUi mainly — FlH ONt circle

O Manufacturing O Other (agriculture,

O Wholesale trade ccHistructton, service.

O Retail trade government, etc.)

29. Occupation

a. What kind of work was this person doing? —f

I r —i

(For example: registered nurse, personnel manager,

supervisor of order department, gasoline engine
assembler, cake leer)

b. What were this person,s most important activities

or duties?-?

i r 1

(For example: patient care, directing hiring policies,
supervising order clerks, assembling engines,
Idng cakes)

30. Waa this person - FBI ONE drde

O Employee of a PRIVATE FOR PROFIT company or

business or of an Individual, for wages, salary, or jj| commissions

O Employee of a PRIVATE NOT-FOR-PROFIT,

tax-exempt, or charitable organization
O Local GOVERNMENT employee (dty, county, etc.)
O Slave GOVERNMENT employe
O Federal GOVERNMENT employee
O SElJ-EMPLOYH3ln«vnNOTlNCORrX)rWTTiD

business, professional practice, or farm
O SELF-EMPLOYED In own INCORPORATED ■

business, professional practice, or farm
O Working WTTHOUT PAY In family business or farm

31a. Last year (1989), did this person work, even (or a
lew days, at a paid Job or In a business or Cum?
O Yes

O No -Skip to 32

b. How many weeks did this person work In 1969?

Count paid vacation, paid sick
leave, and military service.

I—1

M !Weeks

c. During tha weeks WORKED in 1989, how many hours did this person usually work each week?

Hours

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1990 Questionnaire

QUESTIONS ASKED OF ALt^OUSEHOfcDS

PERSON 7

NOW PLEASE ANSWER QUESTIONS Hla-H26 FOR YOUR HOUSEHOLD

Page 3

M a RELATIVE of Person 1:

O Husband/wife O

O Natural-born O

or adopted O

son/daughter O

O Stepson/

stepdaughter

Brother/sister Father/mother Grandchild Other relative

K NOT RELATED to Person 1:

O Roomer, boarder. O Unmarried or foster child partner

O Housemate, « O Other

roommate H nonrelarJve

O Mate

O Female

O White
O HackorNegro

O Indian (Amer.) (Print the name of the enrolled or principal tribe.]-?

O Eskimo O Aleut

Asian or Pacific Islander (API)

Chinese

Filipino |

Hawaiian
Korean
Vietnamese

Japanese Asian Indian Samoan Guamanian Other API

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O Other race (Print race)-/"

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Hli

, Did you leave anyone out of your list of persona for
Question 1* on page 1 became you were not sure II
the person should be listed — (or example, someone
temporarily away on a business trip or vacation, a
newborn baby still In the hospital, or a person who
stays here once in a while and has no other home?
O Yes. please print the name(s) O No

and reason (a).-y

b. Did you Include anyone In your list ol persons tor

Question la on page 1 even though you were not sure ■ that the person should be listed — (or example, a

visitor who Is staying here temporarily or a person who

usually Uves somewhere else?

O Yes, please print the name(s) O No

and reason (s). -y

O Now married
O Widowed
O Divorced

Separated
Never married

No (not Spanlsh/Hlspanlc)

Yes, Mexican, Mexican-Am., Chicano

Yes, Puerto Rlcan aaj

Yes, Cuban ***

Yes. other Spanish/Hispanic
(Print one group, for example: Argentinean
Colombian, Dominican, Nlcaraguan,
Sa..vadoran, Spaniard, and so on.; 3

Which best describes this building? Include all
apartments, flats, etc., even If vacant.

O A mobile home or trailer

O A one-family house detached from any other house

O A one-family house attached to one or more houses

O A building with 2 apartments

O A building with 3 or 4 apartments

O A building with 5 to 9 apartments

O A building with 10 to 19 apartments

O A building with 20 to 49 apartments

O A building with SO or more apartments

O Other

H3. How many rooms do you have in this house or apartment?

Do NOT count bathrooms, porches, balconies, foyers, haQs,
or half-rooms.

O 1 room
O 2 rooms
O 3 rooms

O 4 rooms
O 5 rooms
O 6 rooms

O 7 rooms
O 8 rooms

O 9 or more
rooms

H4. Is this house or apartment —

O Owned by you or someone in this household
with a mortgage or loan?

O Owned by you or nmtoiw In this houwhold free

and dear (without a mortgage)?
O Rented for cash rent?
O Occupied without payment of cash rent?

FOR CENSUS USE

A. Total
persons

B. Type of unit
Occupied

O First form
O Cont,n

Vacant

O Regular
O Usual home
elsewhere

CI. Vacancy status

O For rent O For seas/

O For sale only rec/occ

O Rented or O For migrant

sold, not workers

occuPied O Other vacant

C2. Is this unit boarded up?

O Yes O No

D. Months vacant

0 Less than 1 o 6 up to 12 O lupto2 O 12upto24 O 2 up to 6 o 24 or more

E. Complete after

O IH O TC O QA 1C1

O P/F O RE O l/T O

O MV O ED 0 EN —

O P0 O P3 O P6

O PI O P4 O IA JIC2

O PZ O P5 0 SM O

F. Cov.

O lb O la O 7 O HI

94

Measuring America

Page 4

QUESTIONS ASKED OF A SAMPLE OF HOUSEHOLDS

H8. When did the person listed in column 1 on page 2 move into this house or apartment?

1989 or 1990 198S to 1988 1980 to 1984 1970 to 1979 1960 to 1969 1959 or earlier

H9. How many bedrooms do you have: that is, how many bedrooms would you list if this house or apartment were on the market for sale or rent?

O No bedroom

O 1 bedroom

O 2 bedrooms

O 3 bedrooms

O 4 bedrooms

O 5 or more bedrooms

H10. Do you have COMPLETE plumbing facilities in this house or apartment; that is, 1) hot and cold piped water, 2) a flush toilet, and 3) a bathtub or shower?

0 Yes. have all three factttles
O No

Hll. Do you have COMPLETE kitchen facilities: that is. 1) a sink with piped water, 2) a range or cookstove, and 3) a refrigerator?

O Yes

Q No

H12. Do you have a telephone in this house or apartment?

O Yes

O No

H13. How many automobiles, vans, and trucks of one-ton capacity or less are kept at home for use by members of your household?

None 1

2 3 4 5 6 7 or more

PLEASE ALSO ANSWER THESE

HI*. Which FUEL U used MOST for heating this house or apartment?

O Gas: from underground pipes

serving the neighborhood

O Gas: bottled, tank, or LP

O Electricity

C Fuel oil. kerosene, etc.

C Coal or coke

O Wood

0 Solar energy

O Other hid

a_ O No fuel used

H15. Do you get water from —

O A public system such as a city water
department, or private company?

O An individual drilled well?

O An individual dug well?

O Some other source such as a spring,
creek, river, cistem, etc.?

H16. Is this building connected to a public sewer?

C Yes, connected to public sewer

O No, con nected to septic tank or cesspool

O No, use other means

H17. About when was this building first bulk?

1985 1980 1970 1960 1950 1940 1939 Dont

or 1990 to 1988 to 1984 to 1979 to 1969 to 1959 >tt> 1949 or earber know

H18. Is this house or apartment part of a
condominium?

O Yes
O No

It you live in an apartment building, skip Jo H20.

H19a, Is this house on less than 1 acre?

O Wea-SklptoHZ0
O No

b. In 1989, what were the actual sales of all agricultural
products from this property?

None
$1 to $999
$1,000 to $2,499
$2,500 to $4,999
$5,000 to $9,999
$10,000 or more

H20. What are the yearly costs of utilities and
fuels for this house or apartment?

H you have lived here less than 1 year,
estimate the yearly cost.

a. Electricity

I*. M

Yearly cort — Dollars

O Included In rent or In condominium fee
O No charge or electridty not used

i». -Ofi,

Yearly cost — Dollars

C included In rent or in condominium fee
C No charge or gas not used

. Water

IJL ■M

Yearly cost — Dollars

O Included in rent or In condominium fee
O No charge

d. OH, coal, kerosene, wood, etc.

IS. -°P-i

Yearly cost — Dollars

O Included In rent or in condominium fee
O No charge or these fuels not used

The sample questionnaire contains housing questions
H8 to H26 shown here on pages 4 and 5.

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