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Page 6

ANSWER THESE QUESTIONS FOR Name of 16. When was this person born?

22a. Did this person work at any time last week? Person 1

O Born before April 1965

Yes - Fill this circle if this O No Fill this circle on pago 2:

Please go on with questions 17-33

person worked full

if this person Lost nema acceFires nomo Midda inklai O Born April 1965 or later

time or part time.

did not work, Turn to next page for next person

(Count part-time work

or did only own 11. In what State or foreign country was this person born?

such as delivering papers,
17. In April 1975 (five years ago) was this person –
Print the State where this person's mother was living

housework,

or helping without pay in school work, when this person was born. Do not give the location of a. On active duty in the Armed Forces?

a family business or farm. or volunteer the hospital unless the mother's home and the hospital

O Yes
O NO

Also count active duty

work,
were in the same State.

in the Armed Forces)
b. Attending college?
o Yes
No

Skip to 25

b. How many hours did this person work last week Name or State or forelon country; or Puerto Rico, Guam, etc. c. Working at a job or business?

(at all jobs)? 12. If this person was born in a foreign country

o Yes, full time O No

Subtract any time off; add overtime or extra hours worked. a. Is this person a naturalized citizen of the

o Yes, part time
United States?
0 Yes, a naturalized citizen
18a. Is this person a veteran of active-duty military

Hours
service in the Armed Forces of the United States?
No, not a citizen
O Born abroad of American parents
If service wes in National Guard or Reserves only

23. At what location did this person work last week?
see instruction guide.

If this person worked at more than one location, print b. When did this person come to the United States

o Yes

where he or she worked most last week.

No - Skip to 19
to stay?

If one location cannot be specified, she instruction guide.
b. Was active-duty military service during -
O 1975 to 1980 O 1965 to 1969 o 1950 to 1959

FII a circle for each period in which this person served.

O May 1975 or later o 1970 to 1974 O 1960 to 1964 O Before 1950

a. Address (Number and street)

------
o Vietnam era (August 1964-April 1975)
13a. Does this person speak a language other than

O February 1955- July 1964
English at home?

o Korean conflict (June 1950-January 1955)

if street address is not known, enter the bullding name, O World War II (September 1940-July 1947)

shopping center, or other physical location description. O Yes O No, only speaks English – Skip to 14

O World War I (April 1917-November 1918)

b. Name of city, town, village, borough, etc.

0 Any other time
b. What is this language?

19. Does this person have a physical, mental, or other
health condition which has lasted for 6 or more

c. Is the place of work inside the incorporated (legal)
months and which ...
- For example - Chinese, Irollon, Spanish, etc.)

limits of that city, town, village, borough, etc.? a. Umits the kind or amount

Yes No c. How well does this person speak English?

O of work this person can do at a job? .....

o Yes
o

O No, in unincorporated area
O Very well
O Not well

b. Provents this person from working at a job? o o
o Well
O Not at all
c. Limits or provants this pornon

d. County ------------------

from using public transportation? .......
14. What is this person's ancestry? If uncertain about
how to report ancostry, see Instrucdon guide,
20. If this person is a female - None 1 2 3 4 5 6 e State

f. ZIP Code
How many babies has she ever OOOOOOO
had, not counting stillbirths?

24. Last week, how long did it usually take this person

Do not count her stepchildren 7 8 9 10 11 12 of to get from home to work (one way)?
(For example: Afro-Amer., English, French, German, Honduran) or children she has adopted. оооооо
Hungarian, Irish, Italian, Jamaican, Korean, Lebanese, Mexicon,

Minutes
Nigerlon, Polish, Ukrainian, Venezuelon, etc.)

21. If this person has ever been married -
a. Has this porson been married more than once?

b. How did this person usually get to work last week? 15a. Did this person live in this house five years ago

o Once O More than once

If this person used more than one method, give the one (April 1, 1975)?

usually used for most of the distance. If in college or Armed Forces in April 1975, report ploce b. Month and year

Month and year

O Car

Taxicab
of residence there.

of marriage?
of first marriage?

O Truck

O Motorcycle
Born April 1975 or later - Turn to next page for

o Van

Bicycle
next person
TMonth) - 77eor

Bus or streetcar
Yes, this house - Skip to 16

o Walked only
(Month) (Year)

O Railroad

O Worked at home
F O No, ditterent house
c. If married more than once - Did the first marriage

O Subway or elevated 0 Other - Specify
end because of the death of the husband (or wife)?

If cor, truck, or von in 246, go to 24c.
b. Where did this person live five years ago

o Yes
No

Otherwise, skip to 28.
(April 1, 1975)?

FOR CENSUS USE ONLY
(1) State, foreign country,
Puerto Rico

13b.
14.
156.
23.

OVL 24a.
Guam, etc.:

OOO OOO OOO
I II I II

III III III III III

Ĉ a 2 2 2 2 2 2 2 2 2 2 2 2 (2) County:

3 3 3 3 3 3 3 (3) City, town,

4.4.4 village, etc.:

SSS

SSS

GGG GGG GGG GGG GGG (4) Inside the incorporated (legal) limits

? ? ?

? ? ?

??? ? ? ? ??? ??? ? of that city, town, village, etc.?

888

883
1898

888 8 3 & | 8 8 8 8 8 8 8 8 8
Yes O No, in unincorporated area
999

999999 | ១ ១ ១ ១ ១ ១១ ១ ១

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Measuring America

O 1975 to 1980 O 1965 to 1969 1950 to 1959 o 1970 to 1974 O 1960 to 1964 o Before 1950

Mon Mon |

Page 6

ANSWER THESE QUESTIONS FOR Name of 16. When was this person born?

22a. Did this person work at any time last week? Parton 1

o Born before April 1965

Yes Fill this circle If this O No - Fill this circle on pago 2:

Please go on with questions 17-33

person worked full

If this person
First namo Middle Inhlal
Born April 1965 or later -

time or part time.

did not work, Turn to next page for next person 11. In what State or foreign country was this person born?

(Count part-time work

or did only own

such as delivering papers, Print the State where this person's mother was living 17. In April 1975 (five years ago) was this person –

housework,

or helping without pay in school work, when this person was born. Do nor give the location of a. On active duty in the Armed Forces?

a family business or farm. or volunteer the hospital unless the mother's home and the hospital o Yes O No

Also count active duty

work.
were in the same Store,
b. Attending college?

In the Armed Forces)
0 Yes
O No

Skip to 25
Name of State or forelan country; or Puerto Rico, Guan, etc.

6. How many hours did this person work last week c. Working at a job or business?

(at all jobs)? 12. If this person was born in a foreign country

Yes, full time O No

Subtract any time off; add overtime or extre hours worked. a. Is this porson a naturalized citizen of the

O Yes, part time
United States?
O Yes, a naturalized citizen
18a. Is this person a veteran of active-duty military

Hours
O No, not a citizen

service in the Armed Forces of the United States?
O Born abroad of American parents
If service was in National Guard or Reserves only,

23. At what location did this person work last week?
see Instruction guide,

If this person worked ot more than one location, print b. When did this person come to the United States

Yes

where he or she worked most last week

O No - Skip to 19 to stay?

If one location cannot be specified, see Instruction guide.
b. Was active-duty military service during -
Fill a circle for coch period in which this person served.

a. Address (Number and street)
O May 1975 or later

O Vietnam era (August 1964-April 1975) 13a. Does this person speak a language other than

O February 1955- July 1964 English at home?

o Korean conflict (June 1950-January 1955)

If street address is not known, enter the building name,

shopping center, or other physical location description. F o Yes

o World War II (September 1940-July 1947)
O No, only speaks English – Skip to 14
o World War I (April 1917-November 1918)

b. Name of city, town, village, borough, atc.

O Any other time b. What is this language!

19. Does this person have a physical, mental, or other
health condition which has lasted for 6 or more

c. Is the place of work inside the incorporated (legal)
months and which ...
- For example - Chinese, Italien, Spanish, etc.) ---
1. Limits the kind or amount

limits of that city, town, village, borough, etc.?

Yes No c. How well does this person speak English?

of work this person can do at a job?.....

o Yes O No, in unincorporated area

0 0
O Very well
O Not well

b. Prevents this person from working at a job? 0 0
O Well
O Not at all
c. Limits or prevents this person

d. County

from using public transportation? .......
14. What is this person's ancestry? If uncertain about
how to report ancestry, see Instruction guide.
20.1f this person is a female - None 1 2 3 4 5 6 e. State

1. ZIP Code
How many babies has she over OOOOOOO
had, not counting stillbirths?

24a. Last week, how long did it usually take this person
Do not count her stepchildren 7 8 9 10 u 12

to get from home to work (one way)? (For example: Afro-Amer., English, French, German, Honduren or children she has adopted,

000000 Hungarian, Irish, Italian, Jamaican, Korean, Lebanese, Mexican,

Minutes
Nigerlon, Polish, Ukrainlan, Venezuelan, etc.)

21. If this person has ever been married -
a. Has this person been married more than once?

b. How did this person usually get to work last week? 15a. Did this person live in this house five years ago

o Once More than once

If this person used more than one method, give the one (April 1, 1975)?

usually used for most of the distance, If in college or Armed Forces in April 1975, report place b. Month and year

Month and year

o Car

O Taxicab
of residence there.

of marriage?
of first marriage?

O Truck

O Motorcycle
O Born April 1975 or later Turn to next page for

O Van

O Bicycle
next person
Months 7 Year]

O

Month) ----Year)
Yes, this house - Skip to 16

Bus or streetcar

o Walked only
o Railroad

Worked at home
No, different house
c. If married more than once - Did the first marriage

O Subway or elevated O Other - Specify
end because of the death of the husband (or wite)?
b. Where did this person live five years ago

| if car, truck, or von In 240, 90 to 246.
o Yes
O No

Otherwise, skip to 28.
(April 1, 1975)?

FOR CENSUS USE ONLY
(1) State, foreign country.
Puerto Rico,

Per. 11
13b.
14.
15b.

23.
Guam, etc.:

III

I II III |IIIIIIIIIIIIIIIIII 2 2 2

2 2 2 2 a 2 le aa 2 2 2 2 2 2 2 2 2 2 2 2 (2) County:

3 3 3

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 (3) City, town,

44. 444 4 4 4 4 village, etc.:

S5S

553 5

666 GGGGGG (4) Inside the incorporated (legal) limits

? ? ?

? ??

??? ??? ??? ??? of that city, town, village, etc.?

888 888 8 38 Yes O No, in unincorporated area

1999 ១ ១ ១ 999999999

Oon MV

11.

OV 240

V

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PERSON 1 ON PAGE 2

c. When going to work last woek, did this person usually o Drive alone - Skip to 28 o Drive others only Share driving

Ride as passenger only
d. How many people, including this person, usually rode
to work in the car, truck, or van last week?
O2 - 04

O 6
O 3
O 5

7 or more
After answering 240, skip to 28.
25. Was this person temporarily absent or on layott from a job
or business last week?

o Yes, on layoff
o Yes, on vacation, temporary illness, labor dispute, etc.
O No

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b. How many weeks did this person work in 1979?

Count pald vocation, paid sick leave, ond military service

Weeks

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c. During the weeks worked in 1979, how many hours did

this person usually work each weok?

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Hours

26a. Has this person been looking for work during the last 4 weeks! o Yes

No - Skip to 27
b. Could this person have taken a job last week?

O No, already has a job
O No, temporarily ill
O No, other reasons (in school, etc.)
o Yes, could have taken a job

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d. Of the weeks not worked in 1979 (if any), how many weeks 32a. ! 32b. was this person looking for work or on layott trom a job? DOBO Too

Weeks

IIIII!

¿a é a a a 32. Income in 1979

3333 3 3 3 Fill circles and print dollar amounts.

9.4 % Il net Income was a loss, write "Loss" above the dollar amount

5555

5 5 3 Il exact amount is not known, give best estimate For Income GGGG GGG received Jointly by household mernbers, see Instruction gulde. ????

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28. Industry a. For whom did this person work? If now on active duty in the

Armed Forces, print "AF" and skip to question 31.

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None of company, business, organization, or other employer] b. What kind of business or industry was this?

Describe the activity at location where employed.

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

auto engine manufacturing, breakfast cereal manufacturing) c. Is this mainly - (Fil om circie)

O 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?

During 1979 did this person receive any income from the 99 99
following sources?
If "Yes" to any of the sources below – How much did this

320.

1320. person receive for the entire year? a. Wages, salary, commissions, bonuses, or tips from all jobs... Report amount before deductions for taxes, bonds,

2 2 2 dues, or other Iterns.

3 3 3 o Yes - S

.00

qqq
O No

S53
Annual amount - Dollers)

GGGG

666 b. Own nonfarm business, partnership, or professional

? ? ?
practice ... Report nor income after business expenses.
0 Yes S

.00

999) 1999 Ο Νο

O AOIO AO

(Annual amount - Dollars) c. Own farm...

326. Report net Income after operating expenses. Include earnings as o tenent farmer or sharecropper.

II o Yes S

.00 O No

(Annual amount - Dollars) d. Interest, dividends, royalties, or net rental income ... Report even small amounos credited to an account. o Yes S

.00 O NO TAnnual amount - Dollars) e. Social Security or Railroad Retirement ...

32g.

33.
o Yes
O NO TAnnual amount - Dollars)

OOOO

III | IIII f. Supplemental Security (SSI). Aid to Families with

2 2 2 2 Ĉ a a a
Dependent Children (AFDC), or other public assistance

3 3 3 3
or public wellaro payments ...
o Yes S

S 55
O NO

666

(Annud amount - Dollars) 4. Unemployment compansation, veterans' payments.

pensions, alimony or child support, or any other sources
of income received regularly ...

Ао
Exclude lump sum paymenos such as money from on Inheritance
or the sale of a home,
o Yes S

.00
Ο Νο

3 3 3 Annual amount - Dollars

q qq 33. What was this person's total income in 1979? Add entries In questions 320

.00 through g; subtract any losses. TAnnud emount - Dollars)

888 If total amount was a loss, write "Loss" above amount. OR O None

១ ១ ១ Please turn to the next page and answer the questions for Person 2 on page 2

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(For example: Registered nurse, personnel manager, supervisor

order department, gasoline engine assembler, grinder operator) b. What were this person's most important activities or duties?

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TFor example: Patient care, direcúng hiring policies, supervising

order clerks, assembling engines, operating grinding mill) 30. Was this person - (Full one circle)

Employee of private company, business, or

individual, for wages, salary, or commissions ..... O Federal government employee ........ State government employee ......... Local government employee (city, county, etc.). ..... O Self-employed in own business, professional practice, or farm

Own business not incorporated..

Own business incorporated .....
Working without pay in family business or farm .....

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