Please fill one column for each person listed in Question 1a on page 1. |
PERSON 1 |
PERSON 2 |
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Last Name
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Last Name
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2. Do not ask for Person 1. How is ... related to (Person 1)? Fill ONE circle for each person.
If Other relative of person in column 1, fill circle and print exact relationship, such as mother-in-law, grandparent, son-in-law, niece, cousin, and so on. |
START in this column with the household member (or one of the members) in whose name the home is owned, being bought, or rented.
If there is no such person, start in this column with any adult household member. |
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3. Is ... male or female? Fill One circle for each person |
Male Female |
Male Female |
4. What is ... 's race? For example, White, Black, American Indian, Eskimo, Aleut or an Asian or Pacific Islander group such as Chinese, Filipino, Hawaiian, Korean, Vietnamese, Japanese, Asian Indian, Samoan, Guammanian, and so on. Fill ONE circle for the race that the person considers himself/herself to be. If response is "American Indian", ask What is the name of ....'s enrolled or principal tribe?
If response is an "Other API" group such as Cambodian, Tongan, Laotian, Hmong, Thai, Pakastani, and so on, fill the "Other API" circle and print the name of the group.
If response is "Other race", ask Which group does ... consider (himself/herself) to be? |
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5. AGE AND YEAR OF BIRTH
a. How old is ...? (Age should be as of April 1, 1990)
If unknown, say Please give me your best estimate. Print the age in the boxes, then fill matching circle under each box.
b. In what year was ... born? Print the year of birth in the boxes, then fill the matching circle below each box.
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6. Is ... now married, widowed, divorced, seperated, or has ... never been married? Fill ONE circle for each person.
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7. Is ... of Spanish/Hispanic origin? For example: Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Spaniard, or from the Spanish-speaking countries of Central or South America.
If "Yes", ask Which Spanish/Hispanic group is ...? Fill the appropriate circle and if "Other Spanish/Hispanic," print one group.
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| No (not Spanish/Hispanic) |
| Yes, Mexican, Mexican-Am., Chicano |
| Yes, Puerto Rican |
| Yes, Cuban |
| Yes, other Spanish/Hispanic (Print one group, for example: Argentinian, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on...) |
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| No (not Spanish/Hispanic) |
| Yes, Mexican, Mexican-Am., Chicano |
| Yes, Puerto Rican |
| Yes, Cuban |
| Yes, other Spanish/Hispanic (Print one group, for example: Argentinian, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on...) |
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