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PERSON 7

Middle Intel

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QUESTIONS ASKED OF ALL HOUSEHOLDS

Page 3
NOW PLEASE ANSWER QUESTIONS Hla-H26 FOR YOUR HOUSEHOLD
Hla, Did you leave anyone out of your list ol person for

If this is a ONE-FAMILY HOUSE -
Qucation la on page 1 because you were not sure i H5a. Is this house on ten or more acres?
the person should be listed - for example, someone
temporarily away on a business trip or vacation, a

Yes

No newborn baby still in the hospital, or a person who

6. le there a business (such as a store or barber shop) stays here once in a while and has no other home?

or a medical office on this property? Yes, please print the name(s)

O No and reason(s). 7

O Yes

O No
Answer only if you or someone in this household OWNS
OR IS BUYING this house ar apartment -

What is the value of this property; that be, how much
b. Did you include anyone in your list of persons for

do you think this house and lot or condominium unit
Question la on page 1 even though you were not sure

would sell for if it were for sale?
that the person should be listed – for aample, a
visitor who is staying here temporarily or a person who

Less than $10,000

$70,000 to $74.999
usually lives somewhere else?

O $10,000 to $14.999 $75,000 to 579,999
O Yes, please print the name(s)

O No

O $15,000 to $19,999 O $80,000 to $89,999
and reason(s). 7

O $20,000 to $24,999 O $90,000 to $99,999
O $25,000 to $29,999 O $100.000 10 5124,999
0 $30,000 to $34,999 O $125,000 to $149,999

O $35,000 to $39,999 O $150,000 to $174.999
H2. Which best describes this building? Include all

0 $40,000 to $44,999 O $175,000 to $199.999
apartments, flats, etc., even # vacant.

O $45.000 to $49,999 O $200,000 to $249,999

O $50,000 to $54,999 O $250,000 to $299,999
O A mobile home or traller

O $55,000 to $59,999 O $300,000 to $399,999
O A one-family house detached from any other house

() $60,000 to $64,999 o $400.000 10 5499,999
O A one-family house attached to one or more houses

O $65,000 to $69,999 O $500.000 or more
O A building with 2 apartments
O A building with 3 or 4 apartments
0 A building with 5 to 9 apartments
O A building with 10 to 19 apartments

Answer only if you PAY RENT for this house or Apartment -
O A building with 20 to 49 apartments

H7a. What is the monthly rent?
O A building with 50 or more apartments

O Less than $80

O $375 to $399 o Other

O $80 to $99

O S400 to $424
How many rooms do you have In this house or apartment? O $100 to $124

S425 to 449
Do NOT count bathrooms, porches, balconies, toyers, halls,

o $125 to $149

$450 to 5474 or half-rooms.

o $150 to $174

O $475 to $499
0 $175 to $199

$500 to $524
O 1 room
O 4 rooms
o 7 rooms
O $200 to $224

$525 to $549
O 2 rooms
O 5 rooms O 8 rooms

O $225 to $249

O $550 10 $599
o 3 rooms
O 6 rooms

o 9 or more
rooms
O $250 to $274

$600 to $649
Is this house or apartment -

O $275 to $299

O $650 to $699 o $300 to $324

5700 to $749 O Owned by you or someone in this household

0 $325 to $349

O $750 to $999 with a mortgage or loan?

O $350 to $374

$1,000 or more
O Owned by you or someone In this household free
and dear (without a mortgage) ?

b. Does the monthly rent include any meals?
O Rented for cash rent?
o Occupled without payment of cash rent?

Yes

No

FOR CENSUS USE
A. Total B. Type of unit

D. Months vacant

G. DO
persons
Occupied Vacant

o Less than 1 o 6 up to 12

o O Fest form o Regular

1 up to 2 0 12 up to 24

O 2 up to 6
O Cont'n O Usual home

0 24 or more i
elsewhere E. Complete after
Cl. Vacancy status

O LR O TCO QA JC 1 1 1 1 1 1 1
O For rent

O P/F O RE O
For seas/
I/ 0 2 2 2 ¿ ¿ ¿ ¿ ¿

a

¿ ĉ o For sale only

OMV OED O EN 3 3 3 3 3 3 3 3 3
rec/occ

3
o Rented or o For migrant
sold, not
O PO O P3 O P6

5 5 5 5

5 5 5 workers

5 5 occupied o Other vacant

oP1 oP4 oIA 6 6 6 6 6 6 GGGGG

O P2OP5 O SM ? ? ? ? ? ? ? ? ? ? ?
C2. Is this unit boarded up? F. Cov.

9 9 9 9 9 9 9 9 9 2
o Yes O No olo o lo 0 7 O HI

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Page 4

QUESTIONS ASKED OF A SAMPLE OF HOUSEHOLDS

PLEASE ALSO ANS WER THESE

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H20. What arc the yearly costs of utilities and
Mela for this house or apartment?
If you have kved here less than 1 year,
estimate the yearly cost.

s. Electricity

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O lncluded ln rent or ln condominium let O No charge or electricity not used

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OR

O lncluded ln rent or ln condominium n O No charge or gas not used

c. Water

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H14. Which FUEL ls used MOST for headng this house or apartment?

O Gas: from underground pipes

serving the neighborhood

O Gss: bottled, tank, or LP

O Electricity

C Fuel oil. kerosene, etc.

O Coslorcoke

O Wood

O Solar energy

O Otherfud

_. O No fuel used

H15. Do you get water from

O y public system such as a ciry water
department, or private company?

O yn individual drilled walP

O An lndividual dug wet?

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

H16. Uthlsbulktrng connected to a public sewer?

O Yes, connected to pubec sewer

O No. connected lo septic tank or cesspool

O No, use other means

H17. About when was this building Brst built?

1989
198S
1980
1970
1960
1950
1940
1939
Don't

or 1990
to 1988
to 1984
10 1979

K>1969
to 1959
to 1949

or earlier
know

H18. ls thss house or apartment part of s
condominium?

O Yes
O No

a*you fVe ln an apsrtmenf buifcOng, slop to H20.

HI9a. b this house on less than 1 acre?

O Yes-SVuproH20
O No

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

O None

O Sl to $999

O $1,000 to $2,499

O $2,500 to $4,999

O $5,000 to $9,999

O $10,000 or mors

Yearly cost — Dollars

0 lncluded in rent or ki condominium let O Nochargs

d. OU, coal, kerosene, wood, etc.

L» --OPJ

Yearly cost - Dosars

lncluded ln rent or in condominium fee 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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QUESTIONS FOR YOUR HOUSEHOLD

QUESTIONS ASKED OF A SAMPLE OF HOUSEHOLDS

PagcS

lNSTRUCTlON:

Answer questions H21 TO H26. lf than a one-lamily house, a condominium, or a mobile home that someone ln this household OWNS OR IS BUYlNG; otherwise, go to page 6.

H21. What wen the real estate taxes on THIS property laat year?

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9

Monthly

OR

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O No regular payment required — Stdp to H24a

c. Dose your regular monthly Include payments for real estate property?

sTHIS

O Yes, taxes lncluded si payment

O No. taxes paid separately or taxes not required

d. Does your regular monthly mortgage payment lnclude payments for Bre, hazard, or flood I on THIS property?

O Yes, lnsurance lncluded ln payment

O No, lnsurance paid separately or no lnsurance

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r- ->TMr. J. .- , ir sample of households throughout the United States and

Census 2000 used two questionnaires—a long-form K 3

(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 7-12 by telephone inter-
view.

Measuring America 97

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