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28. lndustry

a. For whom did this person work? lf now on active duty ln me Armed Forces, print "AF" end skip to question 31.

(Neme'ofccvnpeny'business, organtiation, or otmTr empioyer)

b. What kind of business or industry was this? Describe the activity at location where employed.

(For example: Hospital, newspaper publishing, mail order house, |

auto engine manufacturing, breakfast cereal manufacturing)

. ls this mainly — (Fill one circle)

a Manufacturing | O Retail trade O Wholesale trade O Other - (agriculture, construction, service, government, etc.)

29. Occupation

a. What kind of work was this person doing?

(For example: Registered nurse, personnel manager, supervisor of order department, gasoline engine assembler, grinder operator)

b. What were this person's most important activitles or dutles?

Jfor example: Patlent care, dlrecttnghirTng policies, supervising
order clerks, assembling engines, operating grinding mill)

30. Was this person — (Fill one circle)

Employee of private company, business, or eaj

individual, for wages, salary, or commissions O •*■

Federal government employee O

Stake government employee O

local government employee (city, county, etc.) O

Self-employed in own business,

professional practice, or farm —

Own business not incorporated o

Own business incorporated O

Working without pay ln family business or farm O

CENSUS
USE

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b. How many weeks did this person work in 19797 Count paid vacation, paid sick leave, and military service.

c. During the weeks worked in 1979, how many hours did this person usually work each week?

d. Of the weeks not worked in 1979 (if any), how many weeks was this person looking for work or on layoff from a job?

Weeks

32. lncome in 1979

Fill circles and print dollar amounts.

lf net lncome was a loss, write "Loss" above the dollar amount lfexact amount ls not known, five best estimate. For lncome received Jointly by household members, see lnstruction guide.

During 1979 did this person receive any income from the following sources?

lf "Yes" to any of the sources below - How much did this person receive for the entire year? a. Wages, salary, commissions, bonuses, or tips from

all jobs .. . Report amount before deductions for taxes, bonds, dues, or other ltems.

O Yes— | .no ° j*° (Annuel aTMunt~-Potion)

b. Own nonfarm business, partnership, or professional practice . . . Report net lncoma after business expenses.

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(Annual amount

~boiian)

c. Own farm...

Report net lncome after operating expenses. lnclude earnings as a tenant farmer or sharecropper.

O Yes ,*- , .no

O No

(Annuel amount - Dollars)

d. lnterest, dividends, royaltles, or net rental income ... Report even small amounts credited to an account.

O Yes -*- | no

° No (Annualamount'-Dollars)

e. Social Security or Railroad Retirement . . .

egg, O Yes-*- $ oo

(Annual amount - Doiiors)

O No

f. Supplemental Security (SSl), Aid to Familles with Dependent Children (AFDC), or other public assistance or public welfare payments ...

O Yes s- s .oo

O No

(Annual amount - Dollars)

. Unemployment compensation, veterans, payments, pensions, elimony or child support, or any other sources of income received regularly ...

Exclude lump-sum payments such as money from an lnheritance or the sale of a home.

tam O Yes -a- $ 00

° N° {Annie! emou~nt~-bcJhss)

33. What was this person's total income ln 1979?

Add entrles ln questions 32a
through g; subtree t any losses.

lf total amount was a loss,
write "Loss"above amount.

% .00

(Annuel amount - Hollers)
OR O None

CENSUS USE ONLY

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•*> Please turn to the next page and answer the questions for Person 2 on page 2

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88

Measuring America

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H19. When did the person listed ln column 1 move lnto this house (or apartment)? O 1979 or 1980 O 1950 to 1959

O 1975 to 1978 O 1949 or earller

U 1970101974 O Always lived here

O 1960 to 1969

H20. How are your living quarters healed?
Fill one circle for the kind of heot mod matt,
O Steam or hot water system
O Central warm-air furnace with ducts to the individual rooms

(Do not count electric hoot pumps hero)
O Elect/ic heat pump

O Other built-in electric units (permanently lnstalled ln wall, celllne,
or baseboard)

u

O Floor, wall, or pipeless furnace

O Room heaters with flue or vent burning gas, oil, or kerosene

O Room heaters without flue or vent, burning gas, oil, or kerosene (not portable)

O Fireplaces, stoves, or portable room heaters of any kind

O No heating equipment

H21a. Which fuel is used most tor house heating?

O Gas: from underground pipes serving the neighborhood O Gas: boltled, tank, or LP 0 Electricity o Fuel oil. kerosene, etc. |

O Coal or coke

O Wood

O Other fuel

O No fuel used

b. Which fuel is used most for water heating?

O Gas: from underground pipes

serving the neighborhood O Gas: boltled, tank, or LP O Electricity O Fuel oil, kerosene, etc.

O Coal or coke

O Wood

O Other fuel

O No fuel used

c. Which fuel it used most for cooking? O Gas: from underground pipes serving the neighborhood O Gas: bottled, tank, or LP O Electricity O Fuel oil. kerosene, etc I

o Coal or coke

O Wood

O Other fuel

U No fuel used

H22. What are the costs of utilitles and fuels for your living quarters? a. Electricity

$ 00 OR lncluded in rent or no charge

:.-. . O Electricity not used

Average monthly cost

b. Gas

$ .00 OR

Average monthly cost

o lncluded in rent or no charge O Gas not used

c. Water $

00 OR c-, lncluded in rent or no charge

Yaartycost

d. Oil, coal, kerosene, wood, etc.

$ 00 OR ° lnc,uded in rent or no charge

a--. O These fuels not used

Yaartycost

H23. Do you have complete kitchen facilitles? Complete kitchen focllitits

ere 0 sink wlrh piped water, a range or cookstove, and a refrigerator.
O Yes ■ O No

H24. How many bedrooms do you have?

Count rooms used mainly for sleeping oven lf used also for other purposes.
O No bedroom o 2 bedrooms O 4 bedrooms
O 1 bedroom O 3 bedrooms O 5 or more bedrooms

H25. How many bathrooms do you have?

A compters bathroom a a room with Hush toilet, bathtub or shower, a wash basin with piped water.

A half bathroom hot at least a flush toilet or bathtub or shower, but 6 not hare alt the facilitles for a complete bathroom.

O No bathroom, or only a half bathroom

O 1 complete bathroom

CENSUS USE

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O 1 complete bathroom, plus half bath(s)

O 2 or more complete bathrooms

H26. Do you have a telephone in your living quarters?

O Yes ■ O No

H27- Do you have air conditioning?

O Yes, a central air-conditioning system
O Yes, 1 individual room unit
O Yes, 2 or more individual room units
O No

H28. How many automobiles are kept at home for use by members
of your household?

O None ■ O 2 automobiles

o l automobile O 3 or more automobiles

H29. How many vans or trucks of one-ton capacity or less are kept at home for use by members of your household?

O None O 2 vans or trucks

O 1 van or truck O 3 or more vans or trucks

i i i i

2 8 8 8

3 3 3 3 14-1-13 3 3 3 G G G G

7 7 77

8 8 8 8

9 9 9 9

0 o a o

1 I l l 8 c 8 8 3 3 3 3

* + * 4>

S 3 3 3

G G G G

7 7 7 7

3 8 8 8

9999

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EXPLANATORY NOTES

This booklet shows the content of the two 1990 census questionnaires being
delivered by mall. The content of these forms was determined after revlew oTths
1980 census experience, extensive consultation with many Government end
private users of ceneus dots, end a serles of experiment.el censuses and surveys in
which various eitsmetrve* ware tasted ,

Two principal types of date-collection forms — a 10O-percent Queeitonrvjire lor
"snort form") and a sample quest tonne lre 1or "long form") — an being ueed in
the census. Each household receives ons of ths two queetlonneiree.

■hart team — Thla guastkmnaira contains 7 population Questions and 7 housing questions, shown on pegea 1 - 3 of this booklet On average, about S ln every 6 households will receive the short form. For tha average household, thla form wW take an eatlmetad 14 minutes to complete.

Lamsj foam — This questionnaire has all of ths short-form questions plus housing Questions H8 through H28, shown on psgss 4 and 6. and populetion questions 8 through 33, shown on psgss 6 snd 7. The population questions srs repeated for each member of the houeahold but these pages were not reproduced ln this booklet. A statistical semple of epproxlmsisly 1 m every 8 households will receive the long form. For the svsrsgs household, thkt form wM take en estimated 43 minutes to complete

An mstruciton guide accompanies each questionnaire to help the respondents
complete the form, and a preeddresssd envelope is provided for returning the
quswHonnasrs.

For additional lnformation about Ths 1990 U.S. Ceneus. peases writs the Director,
Bureau of ths Census, Washington. DC 20233

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