Person Data (5 persons, max of 12):
Name
Telephone numbers
# of persons
Sex
Age and DOB
Hispanic/Latin/Spanish origin?
Race
Citizen? How obtained?
When came to U.S.?
Attend school or college last 3 months?
-What grade level?
Highest education level completed?
Major(s) of Bachelors Degree(s)?
Ancestry or ethnic origin?
Speak languages other than English?
How well speak English?
Live in house 1 year?
-No – where lived?
Health insurance coverage? Type?
Deaf or difficulty hearing?
Blind or difficulty seeing?
Difficulty concentrating, remembering, making decisions?
Difficulty working or climbing stairs?
Difficulty dressing or bathing?
Difficulty doing errands, appointments, shopping?
Marital status?
-Change in last 12 months?
# times married?
Years last married?
Given birth in last 12 months?
# grandchildren <18 living this house?
Grandparent responsible for basic needs?
-How long?
Served on active duty in Armed Forces?
-When?
VA service-connected disability?
-Rating?
Work for pay at a job last week?
Any work for pay last week?
Location of work?
Mode of transportation to work?
-How many others in same mode?
Time leaving home?
Length of time for commute?
On lay off from job last week?
Temporarily absent from job last week?
To be recalled to work within next 6 months?
Actively looking for work last 4 weeks?
Could have started job last week?
When last worked?
Work 50 or more weeks in last 12 months?
-How many weeks worked?
-How many hours worked/week?
Type of employment?
-For whom?
-Type of business or industry?
-Manufacturing/wholesale/retail?
Kind of work?
Most important activities or duties?
Income past 12 months? Wage, salary, tips, etc from all jobs?
Self-employment income – non-farm?
Interest, dividends, rents/royalties income?
Social Security/ Railroad retirement income amount?
Supplemental Security Income amount?
Public assistance/welfare payments amount?
Retirement, survivor, disability pensions amount?
Other income amount? VA, unemployment, child support.
Total income last 12 months?
Housing Data (for surveyed address):
Type of building?
Decade built?
Month/year moved in?
# acres?
Actual sales of agricultural products?
Business on property?
# separate rooms?
# bedrooms?
Hot & cold running water?
Flush toilet?
Bathtub or shower?
Sink w/faucet?
Stove or range?
Use a computer?
Use a hand-held computer or smart phone?
Use other type of computer?
Access to internet?
-Type of internet service?
# of vehicles?
Type of heating fuel?
Last month electricity cost?
Last month gas cost?
12-month cost of water/sewer?
12-month cost of oil, coal, kerosene, wood?
Receive Food Stamps or SNAP?
Is address part of a condominium?
Address owned or rented?
Monthly rent?
-Include meals?
Estimated resale value?
Annual real estate (RE) taxes amount?
Annual fire/hazard/flood (FHF) insurance amount?
Mortgage on property?
-Monthly payment?
-Include RE taxes?
-Include FHF insurance?
Second mortgage?
-Monthly payment/HELOC loan payment?
Annual cost for personal property tax & fees?
* law.cornell.edu has Title 13 Census. Section 141 concerns decennial census as does 193.
The United States Constitution (the Law) requires an enumeration of the population every 10 years for the purpose of apportioning the House of Representatives.
The Title 18 reference is not specific but would increase Title 13 penalties.
The 4th Amendment to the Law gives the people the right “to be secure in their persons, houses, papers, and effects against unreasonable searches and seizures.”
