美国2000年普查问卷长表（组图）
本文全文首发地址：
http://www.qixianglu.cn/627382.html
短表：
http://www.census.gov/dmd/www/pdf/d61a.pdf
长表：
http://www.census.gov/dmd/www/pdf/d-61b.pdf
图片版下载地址：
http://picasaweb.google.com/woodphone/2000
U.S. Department of Commerce
Bureau of the Census DC
This is the official form for all the people at this address.
It is quick and easy, and your answers are protected by
law. Complete the Census and help your community get
what it needs ?today and in the future!
OMB No. 0607-0856: Approval Expires 12/31/2000
Start Here Please use a black or
blue pen.
How many people were living or staying in this house,
apartment, or mobile home on April 1, 2000?
Number of people
1
Please turn the page and print the names of all the
people living or staying here on April 1, 2000.
INCLUDE in this number:
?foster children, roomers, or housemates
?people staying here on April 1, 2000 who
have no other permanent place to stay
?people living here most of the time while
working, even if they have another place to live
DO NOT INCLUDE in this number:
?college students living away while
attending college
?people in a correctional facility, nursing home,
or mental hospital on April 1, 2000
?Armed Forces personnel living somewhere else
?people who live or stay at another place most
of the time
The Census Bureau estimates that, for the average household, this form will take about
38 minutes to complete, including the time for reviewing the instructions and answers.
Comments about the estimate should be directed to the Associate Director for Finance and
Administration, Attn: Paperwork Reduction Project 0607-0856, Room 3104, Federal
Building 3, Bureau of the Census, Washington, DC 20233.
Respondents are not required to respond to any information collection unless it displays a
valid approval number from the Office of Management and Budget.
Form D-61B
?
If you need help completing this form, call 1?00朮XX朮XXX between 8:00 a.m. and
9:00 p.m., 7 days a week. The telephone call is free.
TDD ?Telephone display device for the hearing impaired. Call 1?00朮XX朮XXX between
8:00 a.m. and 9:00 p.m., 7 days a week. The telephone call is free.
縉ECESITA AYUDA? Si usted necesita ayuda para completar este cuestionario llame al
1?00朮XX朮XXX entre las 8:00 a.m. y las 9:00 p.m., 7 d韆s a la semana. La llamada
telef髇ica es gratis.
The "Informational Copy" shows
the content of the United States
Census 2000 "long" form
questionnaire. Each household will
receive either a short form
(100-percent questions) or a long
form (100-percent and sample
questions). The long form
questionnaire includes the same
6 population questions and
1 housing question that are on the
Census 2000 short form, plus
26 additional population questions,
and 20 additional housing
questions. On average, about 1 in
every 6 households will receive the
long form. The content of the forms
resulted from reviewing the 1990
census data, consulting with
federal and non-federal data users,
and conducting tests.
INFORMATIONAL COPY
For additional information about
Census 2000, visit our website at
www.census.gov or write to the
Director, Bureau of the Census,
Washington, DC 20233.
PLEASE DO NOT FILL OUT THIS FORM.
This is not an official census form. It is for informational purposes only.
Person 8 ?Last Name
Example ?Last Name
First Name MI
?
2 Please print the names of all the people who you
indicated in question 1 were living or staying here
on April 1, 2000.
Start with the person, or one of the people living
here who owns, is buying, or rents this house,
apartment, or mobile home. If there is no such
person, start with any adult living or staying here.
Person 1 ?Last Name
First Name
Person 2 ?Last Name
First Name
Person 3 ?Last Name
First Name
Person 4 ?Last Name
First Name
J
R
J
Person 9 ?Last Name
First Name
First Name
Person 11 ?Last Name
First Name
Person 12 ?Last Name
First Name
Person 5 ?Last Name
Person 6 ?Last Name
Person 7 ?Last Name O H N S O
O B I N
N
MI
MI
MI
MI
Person 10 ?Last Name
MI
MI
MI
MI
First Name
First Name
First Name
First Name
MI
MI
MI
MI
Next, answer questions about Person 1.
Form D-61B
2
List of Persons
?Please be sure you answered question 1 on the front
page before continuing.
FOR OFFICE USE ONLY
A. JIC1 B. JIC2 C. JIC3 D. JIC4
INFORMATIONAL COPY
What is this person抯 race? Mark one or
more races to indicate what this person considers
himself/herself to be.
1 What is this person抯 name? Print the name of
Person 1 from page 2.
6
Person 1 Your answers
are important!
Every person in the
Census counts.
Male
Last Name
First Name MI
What is this person抯 telephone number? We may
contact this person if we don抰 understand an answer.
2
Area Code + Number
- -
3 What is this person抯 sex? Mark ONE box.
Female
What is this person抯 age and what is this person抯
date of birth?
4
Age on April 1, 2000
Month
?NOTE: Please answer BOTH Questions 5 and 6.
No, not Spanish/Hispanic /Latino
Is this person Spanish/Hispanic/Latino? Mark
the "No" box if not Spanish/Hispanic / Latino.
5
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic /Latino ?Print group.
Day Year of birth
White
Black, African Am., or Negro
American Indian or Alaska Native ?Print name
of enrolled or principal tribe.
Native Hawaiian
Guamanian or
Chamorro
Samoan
Other Pacific
Islander ?
Print race.
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian ?Print race.
Some other race ?Print race.
7 What is this person抯 marital status?
Now married
Widowed
Divorced
Separated
Never married
a. At any time since February 1, 2000, has this
person attended regular school or college?
Include only nursery school or preschool,
kindergarten, elementary school, and schooling which
leads to a high school diploma or a college degree.
8
No, has not attended since February 1 ?Skip to 9
Yes, public school, public college
Yes, private school, private college
3
Form D-61B
Print numbers in boxes.
2043 ?L?
7
7
7
INFORMATIONAL COPY
Z
Question is asked of all persons on
the short (100-percent) and long
(sample) forms.
Z
Z
Z
Z
Z
No, outside the United States ?Print name of
foreign country, or Puerto Rico, Guam, etc., below;
then skip to 16.
8
Year
Form D-61B
4
11
Nursery school, preschool
b. What grade or level was this person attending?
Mark ONE box.
Kindergarten
Grade 1 to grade 4
Grade 5 to grade 8
Grade 9 to grade 12
College undergraduate years (freshman to senior)
Graduate or professional school (for example: medical,
dental, or law school)
9 What is the highest degree or level of school
this person has COMPLETED? Mark ONE box.
If currently enrolled, mark the previous grade or highest
degree received.
No schooling completed
Nursery school to 4th grade
5th grade or 6th grade
7th grade or 8th grade
9th grade
10th grade
11th grade
Some college credit, but less than 1 year
12th grade, NO DIPLOMA
HIGH SCHOOL GRADUATE ?high school DIPLOMA
or the equivalent (for example: GED)
1 or more years of college, no degree
Associate degree (for example: AA, AS)
Bachelor抯 degree (for example: BA, AB, BS)
Master抯 degree (for example: MA, MS, MEng, MEd,
MSW, MBA)
Professional degree (for example: MD, DDS, DVM,
LLB, JD)
Doctorate degree (for example: PhD, EdD)
10 What is this person抯 ancestry or ethnic origin?
(For example: Italian, Jamaican, African Am., Cambodian,
Cape Verdean, Norwegian, Dominican, French Canadian,
Haitian, Korean, Lebanese, Polish, Nigerian, Mexican,
Taiwanese, Ukrainian, and so on.)
a. Does this person speak a language other than
English at home?
Yes
No ?Skip to 12
b. What is this language?
(For example: Korean, Italian, Spanish, Vietnamese)
c. How well does this person speak English?
Very well
Well
Not well
Not at all
12 Where was this person born?
In the United States ?Print name of state.
Outside the United States ?Print name of foreign
country, or Puerto Rico, Guam, etc.
13 Is this person a CITIZEN of the United States?
Yes, born in the United States ?Skip to 15a
Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands,
or Northern Marianas
Yes, born abroad of American parent or parents
Yes, a U.S. citizen by naturalization
No, not a citizen of the United States
When did this person come to live in the
United States? Print numbers in boxes.
14
15
Person is under 5 years old ?Skip to 33
Yes, this house ?Skip to 16
No, different house in the United States
a. Did this person live in this house or apartment
5 years ago (on April 1, 1995)?
Person 1 (continued)
7
7
INFORMATIONAL COPY
15 b. Where did this person live 5 years ago? 19 a. Does this person have any of his/her own
grandchildren under the age of 18 living in this
house or apartment?
Yes
Name of city, town, or post office
5
Did this person live inside the limits of the
city or town?
No, outside the city/town limits
Name of county
Name of state
ZIP Code
16 Does this person have any of the following
long-lasting conditions:
a. Blindness, deafness, or a severe
vision or hearing impairment?
b. A condition that substantially limits
one or more basic physical activities
such as walking, climbing stairs,
reaching, lifting, or carrying?
Yes No
17 Because of a physical, mental, or emotional
condition lasting 6 months or more, does
this person have any difficulty in doing any of
the following activities:
a. Learning, remembering, or
concentrating?
Yes No
b. Dressing, bathing, or getting around
inside the home?
c. (Answer if this person is 16 YEARS OLD
OR OVER.) Going outside the home
alone to shop or visit a doctor抯 office?
d. (Answer if this person is 16 YEARS OLD
OR OVER.) Working at a job or business?
18 Was this person under 15 years of age on
April 1, 2000?
Yes ?Skip to 33
No
Yes
No ?Skip to 20a
b. Is this grandparent currently responsible for
most of the basic needs of any grandchild(ren)
under the age of 18 who live(s) in this house
or apartment?
Yes
No ?Skip to 20a
c. How long has this grandparent been responsible
for the(se) grandchild(ren)? If the grandparent is
financially responsible for more than one grandchild, answer
the question for the grandchild for whom the grandparent
has been responsible for the longest period of time.
Less than 6 months
6 to 11 months
1 or 2 years
3 or 4 years
5 years or more
20 a. Has this person ever served on active duty in
the U.S. Armed Forces, military Reserves, or
National Guard? Active duty does not include training
for the Reserves or National Guard, but DOES include
activation, for example, for the Persian Gulf War.
Yes, now on active duty
Yes, on active duty in past, but not now
No, training for Reserves or National
Guard only ?Skip to 21
No, never served in the military ?Skip to 21
b. When did this person serve on active duty
in the U.S. Armed Forces? Mark a box for
EACH period in which this person served.
April 1995 or later
Some other time
World War II (September 1940桱uly 1947)
Korean conflict (June 1950桱anuary 1955)
February 1955 to July 1964
Vietnam era (August 1964桝pril 1975)
May 1975 to August 1980
September 1980 to July 1990
August 1990 to March 1995 (including Persian Gulf War)
c. In total, how many years of active-duty military
service has this person had?
Less than 2 years
2 years or more
Person 1 (continued)
2045 Form D-61B ?N?
7
INFORMATIONAL COPY
LAST WEEK, did this person do ANY work for
either pay or profit? Mark the "Yes" box even if the
person worked only 1 hour, or helped without pay in a
family business or farm for 15 hours or more, or was on
active duty in the Armed Forces.
Form D-61B
6
21
Yes
Yes ?Skip to 25c
No
Drove alone
At what location did this person work LAST
WEEK? If this person worked at more than one location,
print where he or she worked most last week.
Car, truck, or van
Motorcycle
Worked at home ?Skip to 27
Other method
b. How many people, including this person,
usually rode to work in the car, truck, or van
LAST WEEK?
4 people
a. What time did this person usually leave home
to go to work LAST WEEK?
a. How did this person usually get to work LAST
WEEK? If this person usually used more than one method
of transportation during the trip, mark the box of the
one used for most of the distance.
No ?Skip to 25a
22
a. Address (Number and street name)
(If the exact address is not known, give a description
of the location such as the building name or the nearest
street or intersection.)
b. Name of city, town, or post office
c. Is the work location inside the limits of that
city or town?
Yes
No, outside the city/town limits
d. Name of county
e. Name of U.S. state or foreign country
f. ZIP Code
23
Walked
Bicycle
Taxicab
Ferryboat
Railroad
Subway or elevated
Streetcar or trolley car
Bus or trolley bus
23
?If "Car, truck, or van" is marked in 23a, go to 23b.
Otherwise, skip to 24a.
7 or more people
5 or 6 people
3 people
2 people
24
..
a.m. p.m.
b. How many minutes did it usually take this
person to get from home to work LAST WEEK?
?Answer questions 25?6 for persons who did not
work for pay or profit last week. Others skip to 27.
a. LAST WEEK, was this person on layoff from
a job?
25
Minutes
Yes, on vacation, temporary illness, labor
dispute, etc. ?Skip to 26
No ?Skip to 25d
b. LAST WEEK, was this person TEMPORARILY
absent from a job or business?
Yes ?Skip to 25e
No
c. Has this person been informed that he or she
will be recalled to work within the next 6 months
OR been given a date to return to work?
Yes
No ?Skip to 26
d. Has this person been looking for work during
the last 4 weeks?
Yes, could have gone to work
e. LAST WEEK, could this person have started a
job if offered one, or returned to work if recalled?
No, because of own temporary illness
No, because of all other reasons (in school, etc.)
1995 to 2000
1994 or earlier, or never worked ?Skip to 31
When did this person last work, even for a
few days?
26
Person 1 (continued)
7
7
INFORMATIONAL COPY
27 29
c. Is this mainly ?Mark ONE box.
a. For whom did this person work? If now on
active duty in the Armed Forces, mark this box ?
and print the branch of the Armed Forces.
Industry or Employer ?Describe clearly this person抯
chief job activity or business last week. If this person had
more than one job, describe the one at which this person
worked the most hours. If this person had no job or
business last week, give the information for his/her last job
or business since 1995.
Was this person ?Mark ONE box.
Manufacturing?
7
Annual amount ?Dollars
Weeks
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 repair shop, bank)
Wholesale trade?
Retail trade?
Other (agriculture, construction, service,
government, etc.)?
28 Occupation
a. What kind of work was this person doing?
(For example: registered nurse, personnel manager,
supervisor of order department, auto mechanic, accountant)
b. What were this person抯 most important
activities or duties? (For example: patient care,
directing hiring policies, supervising order clerks, repairing
automobiles, reconciling financial records)
Employee of a PRIVATE-FOR-PROFIT company or
business or of an individual, for wages, salary, or
commissions
Employee of a PRIVATE NOT-FOR-PROFIT,
tax-exempt, or charitable organization
Local GOVERNMENT employee (city, county, etc.)
State GOVERNMENT employee
Federal GOVERNMENT employee
SELF-EMPLOYED in own NOT INCORPORATED
business, professional practice, or farm
SELF-EMPLOYED in own INCORPORATED business,
professional practice, or farm
Working WITHOUT PAY in family business or farm
30 a. LAST YEAR, 1999, did this person work at a
job or business at any time?
Yes
No ?Skip to 31
b. How many weeks did this person work in 1999?
Count paid vacation, paid sick leave, and military service.
Usual hours worked each WEEK
c. During the weeks WORKED in 1999, how many
hours did this person usually work each WEEK?
31 INCOME IN 1999 ?Mark the "Yes" box for each
income source received during 1999 and enter the total
amount received during 1999 to a maximum of $999,999.
Mark the "No" box if the income source was not
received. If net income was a loss, enter the amount and
mark the "Loss" box next to the dollar amount.
For income received jointly, report, if possible, the
appropriate share for each person; otherwise, report
the whole amount for only one person and mark
the "No" box for the other person. If exact amount is
not known, please give best estimate.
a. Wages, salary, commissions, bonuses, or tips
from all jobs ?Report amount before deductions for
taxes, bonds, dues, or other items.
Yes
$ , .00
No
Person 1 (continued)
Name of company, business, or other employer
Annual amount ?Dollars
b. Self-employment income from own nonfarm
businesses or farm businesses, including
proprietorships and partnerships ?Report NET
income after business expenses.
Yes
$ , .00 Loss
No
2047 Form D-61B ?P?
7
7
7
7
7
7
7
INFORMATIONAL COPY
Form D-61B
8
31
33
Now, please answer questions 33?3 about
your household.
Owned by you or someone in this household with a
mortgage or loan?
c. Interest, dividends, net rental income, royalty
income, or income from estates and trusts ?Report
even small amounts credited to an account.
Yes Annual amount ?Dollars
$ , .00 Loss
No
d. Social Security or Railroad Retirement
Yes Annual amount ?Dollars
No
e. Supplemental Security Income (SSI)
Yes Annual amount ?Dollars
No
f. Any public assistance or welfare payments
from the state or local welfare office
Yes Annual amount ?Dollars
No
g. Retirement, survivor, or disability pensions ?
Do NOT include Social Security.
Yes Annual amount ?Dollars
$ , .00
No
h. Any other sources of income received regularly
such as Veterans?(VA) payments, unemployment
compensation, child support, or alimony ?Do NOT
include lump-sum payments such as money from an
inheritance or sale of a home.
Yes Annual amount ?Dollars
$ , .00
No
32 What was this person抯 total income in 1999? Add
entries in questions 31a?1h; subtract any losses. If net
income was a loss, enter the amount and mark the
"Loss" box next to the dollar amount.
Annual amount ?Dollars
None OR $ , .00 Loss
Owned by you or someone in this household free and
clear (without a mortgage or loan)?
Rented for cash rent?
Occupied without payment of cash rent?
Is this house, apartment, or mobile home ?
?
34
A mobile home
Which best describes this building? Include all
apartments, flats, etc., even if vacant.
A one-family house detached from any other house
A one-family house attached to one or more houses
A building with 2 apartments
A building with 3 or 4 apartments
A building with 5 to 9 apartments
A building with 10 to 19 apartments
A building with 20 to 49 apartments
A building with 50 or more apartments
Boat, RV, van, etc.
35 About when was this building first built?
1999 or 2000
1990 to 1994
1980 to 1989
1970 to 1979
1960 to 1969
1950 to 1959
1940 to 1949
1939 or earlier
When did this person move into this house,
apartment, or mobile home?
36
1999 or 2000
1995 to 1998
1990 to 1994
1980 to 1989
1970 to 1979
1969 or earlier
How many rooms do you have in this house,
apartment, or mobile home? Do NOT count bathrooms,
porches, balconies, foyers, halls, or half-rooms.
37
1 room
2 rooms
3 rooms
6 rooms
7 rooms
8 rooms
4 rooms
5 rooms
9 or more rooms
Person 1 (continued)
1995 to 1998
$ , .00
$ , .00
$ , .00
7
HOUSING QUESTIONS
INFORMATIONAL COPY
Question is asked of all households on
the short (100-percent) and long
(sample) forms.
Z
Z
38 How many bedrooms do you have; that is, how
many bedrooms would you list if this house,
apartment, or mobile home were on the market
for sale or rent?
44 Answer ONLY if this is a ONE-FAMILY HOUSE
OR MOBILE HOME ?All others skip to 45.
No bedroom
9
1 bedroom
2 bedrooms
3 bedrooms
4 bedrooms
5 or more bedrooms
39 Do you have COMPLETE plumbing facilities in this
house, apartment, or mobile home; that is, 1) hot
and cold piped water, 2) a flush toilet, and 3) a
bathtub or shower?
Yes, have all three facilities
No
40 Do you have COMPLETE kitchen facilities in this
house, apartment, or mobile home; that is,
1) a sink with piped water, 2) a range or stove,
and 3) a refrigerator?
Yes, have all three facilities
No
41 Is there telephone service available in this house,
apartment, or mobile home from which you can
both make and receive calls?
Yes
No
42 Which FUEL is used MOST for heating this house,
apartment, or mobile home?
Gas: from underground pipes serving
the neighborhood
Gas: bottled, tank, or LP
43 How many automobiles, vans, and trucks of
one-ton capacity or less are kept at home for use
by members of your household?
None
1
Electricity
Fuel oil, kerosene, etc.
Coal or coke
Wood
Solar energy
Other fuel
No fuel used
2
3
4
5
6 or more
a. Is there a business (such as a store or barber
shop) or a medical office on this property?
Yes
No
b. How many acres is this house or mobile
home on?
Less than 1 acre ?Skip to 45
1 to 9.9 acres
10 or more acres
c. In 1999, what were the actual sales of all
agricultural products from this property?
None
$1 to $999
$1,000 to $2,499
$2,500 to $4,999
$5,000 to $9,999
$10,000 or more
45 What are the annual costs of utilities and fuels for
this house, apartment, or mobile home? If you have
lived here less than 1 year, estimate the annual cost.
a. Electricity
Annual cost ?Dollars
$ , .00
OR
Included in rent or in condominium fee
No charge or electricity not used
b. Gas
Annual cost ?Dollars
Included in rent or in condominium fee
No charge or gas not used
c. Water and sewer
Annual cost ?Dollars
Included in rent or in condominium fee
No charge
d. Oil, coal, kerosene, wood, etc.
Annual cost ?Dollars
Included in rent or in condominium fee
No charge or these fuels not used
, .00
, .00
, .00
OR
OR
OR
Person 1 (continued)
2049 Form D-61B ?R?
$
$
$
INFORMATIONAL COPY
a. Do you have a second mortgage or a home
equity loan on THIS property? Mark all boxes
that apply.
?
Form D-61B
10
Yes
Answer ONLY if you PAY RENT for this house,
apartment, or mobile home ?All others skip to 47.
Are there more people living here? If yes,
continue with Person 2.
Yes
No
No
46
,
Monthly amount ?Dollars
a. What is the monthly rent?
$ .00
b. Does the monthly rent include any meals?
Answer questions 47a?3 if you or someone
in this household owns or is buying this house,
apartment, or mobile home; otherwise, skip to
questions for Person 2.
47
a. Do you have a mortgage, deed of trust, contract
to purchase, or similar debt on THIS property?
Yes, mortgage, deed of trust, or similar debt
Yes, contract to purchase
No ?Skip to 48a
b. How much is your regular monthly mortgage
payment on THIS property? Include payment only on
first mortgage or contract to purchase.
,
Monthly amount ?Dollars
$ .00
OR
No regular payment required ?Skip to 48a
c. Does your regular monthly mortgage payment
include payments for real estate taxes on THIS
property?
Yes, taxes included in mortgage payment
No, taxes paid separately or taxes not required
d. Does your regular monthly mortgage payment
include payments for fire, hazard, or flood
insurance on THIS property?
Yes, insurance included in mortgage payment
No, insurance paid separately or no insurance
48
Yes, a second mortgage
Yes, a home equity loan
No ?Skip to 49
b. How much is your regular monthly payment on
all second or junior mortgages and all home equity
loans on THIS property?
,
Monthly amount ?Dollars
$ .00
OR
No regular payment required
What were the real estate taxes on THIS property
last year?
49
,
Yearly amount ?Dollars
$ .00
OR
None
What was the annual payment for fire, hazard,
and flood insurance on THIS property?
50
,
Annual amount ?Dollars
$ .00
OR
None
What is the value of this property; that is,
how much do you think this house and lot,
apartment, or mobile home and lot would sell
for if it were for sale?
51
Less than $10,000
$10,000 to $14,999
$15,000 to $19,999
$20,000 to $24,999
$25,000 to $29,999
$30,000 to $34,999
$35,000 to $39,999
$40,000 to $49,999
$50,000 to $59,999
$60,000 to $69,999
$70,000 to $79,999
$80,000 to $89,999
$90,000 to $99,999
$100,000 to $124,999
$125,000 to $149,999
$150,000 to $174,999
$175,000 to $199,999
$200,000 to $249,999
$250,000 to $299,999
$300,000 to $399,999
$400,000 to $499,999
$500,000 to $749,999
$750,000 to $999,999
$1,000,000 or more
52 Answer ONLY if this is a CONDOMINIUM ?
What is the monthly condominium fee?
,
Monthly amount ?Dollars
$ .00
53 Answer ONLY if this is a MOBILE HOME ?
a. Do you have an installment loan or contract
on THIS mobile home?
b. What was the total cost for installment loan
payments, personal property taxes, site rent,
registration fees, and license fees on THIS mobile
home and its site last year? Exclude real estate taxes.
,
Yearly amount ?Dollars
$ .00
Person 1 (continued)
7
INFORMATIONAL COPY
1 What is this person抯 name? Print the name of
Person 2 from page 2.
Person
Last Name
First Name MI
11
Census information
helps your community
get financial assistance
for roads, hospitals,
schools and more. 2
Husband/wife
Natural-born son/daughter
Adopted son/daughter
Stepson/stepdaughter
Brother/ sister
Father/mother
Grandchild
Parent-in-law
Son-in-law/daughter-in-law
Roomer, boarder
Housemate, roommate
Unmarried partner
Foster child
Other nonrelative
If NOT RELATED to Person 1:
Other relative ?Print exact relationship.
2 How is this person related to Person 1?
Mark ONE box.
2051 Form D-61B ?T?
7
For Person 2, repeat
questions 3-32 of
Person 1.
INFORMATIONAL COPY
Question is asked of Persons 2?
on the short (100-percent) and
long (sample) forms.
Z
Z
12
Form D-61B
For Persons 3?. repeat questions 1-32 of
Person 2.
Information about
children helps your
community plan for
child care, education,
and recreation.
Person 3
NOTE ?The content for Question 2 varies
between Person 1 and Persons 2?.
Thank you for completing your official
U.S. Census form. If there are more than
six people at this address, the Census
Bureau may contact you for the same
information about these people.
--
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