SLIDE 95 95
SECTION 1: Household Members SECTION 2: Household Demographics SECTION 3: Spouse/Parent Relationships Person line #
A1
FIRST NAME
A2
MIDDLE NAME
A3
LAST NAME
B
Sex
C
Relationship to Person 1
D
Date of Birth MM/DD/YYYY
E
Age
F
Hispanic
G
Race Code(s)
H
(15+) Educ Code
I
(15+) Ever in Armed Forces?
J
(15+) Marital Status Code
K
Spouse lives here? Enter line #
L
Mother lives here? Enter line #
M
Father lives here? Enter line # Person line # 1 M F [Person 1] / / Y N Y N 1 2 M F / / Y N Y N 2 3 M F / / Y N Y N 3 4 M F / / Y N Y N 4 5 M F / / Y N Y N 5 6 M F / / Y N Y N 6 PERSON LINE # (HH ROSTER): First, I need to list all the people who live or stay at this address – that is, people who live and sleep here most of the time. Let’s begin with the name of the person or one of the persons who owns or rents this home.
- C. RELATIONSHIP: Please look at Flashcard A [RELATIONSHIPS] and tell me what is (your / …’s) relationship to [PERSON 1]?
(1) Husband/Wife (2) Unmarried Partner (3) Child (biological/step/adopted) (4) Grandchild (5) Mother/Father (6) Brother/Sister (7) Other Relative (uncle/cousin/mother -in-law/father-in-law/etc.) (8) Foster Child (9) Housemate/Roommate (10) Roomer/Boarder (11) Other Non-Relative
- F. HISPANIC: (Are you / Is …) Spanish, Hispanic, or Latino?
- G. RACE: Please choose one or more races from Flashcard B [RACE] that (you / …) consider(s) (your/him/her)self to be. [MARK 6 FOR “OTHER”]
(1) White (2) Black or African American (3) American Indian or Alaska Native (4) Asian (5) Native Hawaiia n or Other Pacific Islander
- H. EDUCATION: Please look at Flashcard C [EDUCATION]. What is the highest level of school (you have / … has) completed, or the highest degree (you have / he/she has) received?
- J. MARITAL STATUS: (Are you / Is …) currently (1) married, (2) widowed, (3) divorced, (4) separated, or (5) (have you / has …) never been married?
SECTION 4: Instructions
1) IF THERE ARE MORE THAN 12 PERSONS, WRITE DOWN THE NUMBER OF PERSONS WHO DID NOT GET LISTED. IF 12 OR FEWER PEOPLE, ENTER „0‟.__________ 2) CIRCLE THE PERSON LINE NUMBER IN THE FIRST COLUMN TO INDICATE RESPONDENT FOR THIS CONTROL CARD. 3) IN COLUMN E, CIRCLE THE AGES OF PERSONS AGE 15 AND OLDER. 4) COUNT TOTAL NUMBER OF PERSONS AGE 15 AND OLDER. RECORD HERE AND TEXT BOX AT TOP. ________ 5) COMPLETE AN EVENT HISTORY CALENDAR WITH EACH PERSON AGE 15 AND OLDER (IF AT ALL POSSIBLE), OR WITH A PROXY IF PERSON IS UNAVAILABLE. Control Number: Household Address: FR Code: __________________ FR Code: __________________ FR Code: __________________ Was a Debit Card Promised? Circle: Y N IF YES, Debit Card # _______________________________________ Household Contact Name: _____________________________ Household Contact Phone #_______________________ Total Number of HH Members age 15+: ______ OMB #: 0607-0725 Expiration Date: 08/31/2010 Form Name: SIPP-EHC2008CC NOTICE – Your report to the U.S. Census Bureau is confidential by law (Title 13, U.S. Code). It may be seen only by individuals who are sworn for life to protect the confidentiality of these data and may be used only for statistical purposes. RECORD EACH VISIT ON “CONTACT LOG” INTRODUCTION: Hello, I’m _________ from the U.S. Census Bureau. Here is my ID card. We are conducting a survey on the economic situation of people who live in the United States, and I have some questions to ask you. We sent a letter to your address describing our study and letting you know that I’d be visiting. Did you get that letter? SHOW LETTER IF NECESSARY, AND DESCRIBE STUDY AS NEEDED. CC RESPONDENT MUST BE A MEMBER OF THE HOUSEHOLD AT LEAST 15 YEARS OLD. BEGIN FILLING HH ROSTER. LIST OWNER / RENTER ON LINE 1.