Questionnaire Text

2019 ACS 2014 ACS 2009 ACS 2004 ACS
2018 ACS 2013 ACS 2008 ACS 2003 ACS
2017 ACS 2012 ACS 2007 ACS 2002 ACS
2016 ACS 2011 ACS 2006 ACS 2001 ACS
2015 ACS 2010 ACS 2005 ACS 2000 5%
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2019 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No

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2018 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No

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2017 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No

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2016 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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Mark the "Yes" or "No" box for each type of income, and enter the amount received IN THE PAST 12 MONTHS for each "Yes" response.

If income from any source was received jointly by household members, 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.

When reporting income received jointly, DO NOT include the amount for a person not listed on pages 2, 3, or 4.

47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.


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2015 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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Mark the "Yes" or "No" box for each type of income, and enter the amount received IN THE PAST 12 MONTHS for each "Yes" response.

If income from any source was received jointly by household members, 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.

When reporting income received jointly, DO NOT include the amount for a person not listed on pages 2, 3, or 4.

47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.


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2014 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
Questionnaire instructions view entire document:  text  image

Mark the "Yes" or "No" box for each type of income, and enter the amount received IN THE PAST 12 MONTHS for each "Yes" response.

If income from any source was received jointly by household members, 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.

When reporting income received jointly, DO NOT include the amount for a person not listed on pages 2, 3, or 4.

47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.


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2013 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
Questionnaire instructions view entire document:  text  image

Mark the "Yes" or "No" box for each type of income, and enter the amount received IN THE PAST 12 MONTHS for each "Yes" response.

If income from any source was received jointly by household members, 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.

When reporting income received jointly, DO NOT include the amount for a person not listed on pages 2, 3, or 4.

47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.


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2012 ACS
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e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
Questionnaire instructions view entire document:  text  image

Mark the "Yes" or "No" box for each type of income, and enter the amount received IN THE PAST 12 MONTHS for each "Yes" response.

If income from any source was received jointly by household members, 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.

When reporting income received jointly, DO NOT include the amount for a person not listed on pages 2, 3, or 4.

47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.


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2011 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2010 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2009 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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47e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2008 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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46e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2007 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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41e.Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2006 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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41e.Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2005 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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41e.Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2004 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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41e.Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2003 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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41e.Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2002 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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40e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2001 ACS
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47. INCOME IN THE PAST 12 MONTHS.


Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the TOTAL AMOUNT during the PAST 12 MONTHS. (NOTE: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "No" box to show types of income NOT received.

If net income was a loss, mark the "Loss" box to the right of the dollar amount.

For income received jointly, report the appropriate share for each person -- or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.

e) Supplemental Security Income (SSI)
[ ] Yes -->$_____________________.00 (TOTAL AMOUNT for past 12 MONTHS)
[ ] No
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40e. Include Supplemental Security Income (SSI) received by elderly, blind, or disabled persons.

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2000 5%
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31. INCOME IN 1999 - Mark [X] 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 [X] the “No” box if the income source was not received. If net income was a loss, enter the amount and mark [X] 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.

e. Supplemental Security Income (SSI)

[] Yes
Annual amount - Dollars
$[ ][ ][ ],[ ][ ][ ].00
[] No