Census 2010 Enumeration Form: Questions and Instructions to Respondents

U.S. Department of Commerce
Economics and Statistics Administration
U.S. Census Bureau

This is the official form for all the people at this address. It is quick and easy, and your answers are protected by law.

Use a blue or black pen.

Start here

    The Census must count every person living in the United States on April 1, 2010. Before you answer Question 1, count the people living in this house, apartment, or mobile home using our guidelines.

  1. Count all people, including babies, who live and sleep here most of the time.
  2. The Census Bureau also conducts counts in institutions and other places, so:

  3. Do not count anyone living away either at colleges or in the Armed Forces.
  4. Do not count anyone in a nursing home, jail, prison, detention facility, etc. on April 1, 2010.
  5. Leave these people off your form, even if they will return to live here after they leave college, the nursing home, the military, jail, etc. Otherwise, they may be counted twice.
  6. The Census must also include people without a permanent place to stay, so:

  7. If someone who has no permanent place to stay is staying here on April 1, 2010, count that person. Otherwise, he or she may be missed in the census.

1. How many people were living or staying in this house, apartment, or mobile home on April 1, 2010?
Number of people = ____

2. Were there any additional people staying here April 1, 2010 that you did not include in Question 1? Mark [x] all that apply.
[] Children, such as newborn babies or foster children
[] Relatives, such as adult children, cousins, or in-laws
[] Nonrelatives, such as roommates or live-in baby sitters
[] People staying here temporarily
[] No additional people

3. Is this house, apartment, or mobile home: Mark [x] one box.
[] Owned by you or someone in this household with a mortgage or loan? Include home equity loans.
[] Owned by you or someone in this household free and clear (without a mortgage or loan)?
[] Rented?
[] Occupied without payment of rent?

4. What is your telephone number? We may call if we don't understand an answer.
Area Code + Number
[ ][ ][ ]-[ ][ ][ ]-[ ][ ][ ][ ]

5. Please provide information for each person living here. Start with a person living here who owns or rents this house, apartment, or mobile home. If the owner or renter lives somewhere else, start with any adult living here. This will be Person 1.
What is [this person's] name? Print name below.
Last Name [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
MI [ ]

6. What is [this person's] sex? Mark [x] one box.
[] Male
[] Female

7. What is [this person's] age and what is [this person's] date of birth?
Please report babies age as 0 when the child is less than 1 year old.
Print numbers in boxes.
Age on April 1, 2010 [ ][ ][ ]
Month [ ][ ] Day [ ][ ] Year of birth [ ][ ][ ][ ]

NOTE: Please answer BOTH Question 8 about Hispanic Origin and Question 9 about race. For this census, Hispanic origins are not races.

8. Is [this person] of Hispanic, Latino, or Spanish origin?
[] No, not of Hispanic, Latino, or Spanish origin
[] Yes, Mexican, Mexican Am., Chicano
[] Yes, Puerto Rican
[] Yes, Cuban
[] Yes, another Hispanic, Latino, or Spanish origin -- Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

9. What is [this person's] race? Mark [x] one or more boxes.
[] White
[] Black, African Am., or Negro
[] American Indian or Alaska Native -- Print name of enrolled or principal tribe. [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
[] Asian Indian
[] Chinese
[] Filipino
[] Japanese
[] Korean
[] Vietnamese
[] Other Asian -- Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
[] Native Hawaiian
[] Guamanian or Chamorro
[] Samoan
[] Other Pacific Islander -- Print race, for example, Fijian, Tongan, and so on. [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
[] Some other race -- Print race. [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

10. Does [this person] sometimes live or stay somewhere else?
[] No
[] Yes -- Mark [x] all that apply.
[] In college housing
[] In the military
[] At a seasonal or second residence
[] For child custody
[] In jail or prison
[] In a nursing home
[] For another reason

If more people were counted in Question 1, continue with Person 2.

Person 2

1. Print name of Person 2.
Last Name [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
MI [ ]

2. How is this person related to Person 1? Mark [x] one box.
[] Husband or wife
[] Biological son or daughter
[] Adopted son or daughter
[] Stepson or stepdaughter
[] Brother or sister
[] Father or mother
[] Grandchild
[] Parent-in-law
[] Son-in-law or daughter-in-law
[] Other relative
[] Roomer or boarder
[] Housemate or roommate
[] Unmarried partner
[] Other nonrelative

[Remainder of questions for Person 2 are omitted but are the same as Person 1 questions 6-10.]

[Questions for Persons 3- 6 are omitted.]

If more than six people were counted in Question 1 on the front page, turn the page and continue.

Use this section to complete information for the rest of the people you counted in Question 1 on the front page. We may call for additional information about them.

Person 7

Last Name [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
MI [ ]

Sex
[] Male
[] Female

Age on April 1, 2010
[ ][ ][ ]

Date of Birth
Month [ ][ ] Day [ ][ ] Year [ ][ ][ ][ ]

Related to Person 1?
[] Yes
[] No

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