Want to get a look at what's on the form before you have to fill it out? Below you will find every question on the Census questionnaire. Your answers will help to decide how more than $400 billion will be given out to communities all over the country.
These are the questions that will be mailed to you in 2010. NOTE: THE FORM CANNOT BE FILLED OUT ONLINE. THIS IS JUST A PREVIEW OF THE QUESTIONS.
Question 1: How many people were living or staying in this house, apartment, or mobile home on April 1, 2010? Number of people= _____
Question 2: Were there any additional people staying here April 1, 2010 that you did not include in Question 1? Mark X on all that apply. ___Children, such as newborn babies or foster children ___Relatives, such as adult children, cousins, or in-laws ___Nonrelatives, such as roommates or live-in baby sitters ___People staying here temporarily ___No additional people
Question 3: Is this house, apartment, or mobile home - Mark X ONE. ___Owned by you or someone in this household with a mortgage or loan? Include home equity loans ___Owned by your or someone in this household free and clear (without a mortgage or loan)? ___Rented? ___Occupied without payment of rent?
Question 4: What is your telephone number? We may call if we don't understand an answer. Area Code + Number ____-____-__________
Question 5: Please provide information for each person living here. Start with a person living here who owns or rents this house, apartment, or mobile home. If the owner or renter lives somewhere else, start with any adult living here. This will be Person 1. Print name below. Last Name ___________ First Name ___________ Middle Initial _________
Question 6: What is Person 1's sex? Mark X ONE. ___Male ___Female
Question 7: What is Person 1's age and what is Person 1's date of birth? Please report babies as age 0 when the child is less than 1 year old. Print numbers. Age on April 1, 2010 ______ Month _________ Day _________ Year _________
Question 8: Is Person 1 of Hispanic, Latino, or Spanish origin? ___No, not of Hispanic, Latino, or Spanish origin ___Yes, Mexican, Mexican Am., Chicano ___Yes, Puerto Rican ___Yes, cuban ___Yes, another Hispanic, Latino or Spanish origin - Print origin, for example, Argentinean. __________________________
Question 9: What is Person 1's race? Mark X one or more. ___White ___Black, African Am., or Negro ___American Indian or Alaska Native - Print name of enrolled or principal tribe _________________________ ___Asian Indian ___Japanese ___Native Hawaiian ___Chinese ___Korean ___Guamanian or Chamorro ___Filipino ___Vietnamese ___Samoan ___Other Asian - Print for example, Loatian _______________________ ___Other Pacific Islander - Print for example, Fijian _________________ ___Some other race - Print _____________________________________ Question 10: Does Person 1 sometimes live or stay somewhere else? ___No ___Yes - Mark X all that apply ___In college housing ___For child custody ___In the military ___In jail or prison ___At a seasonal second residence ___In a nursing home ___For another reasonIf more people were counted in Question 1, continue with Person 2.