Your SlideShare is downloading. ×
US Census 2000 Short Form
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

US Census 2000 Short Form

401
views

Published on

Published in: Business

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
401
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. PLEASE DO NOT FILL OUT THIS FORM. This is not an official census form. It is for informational purposes only. 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! Start Here Please use a black or blue pen. 4. What is Person 1’s telephone number? We may call this person if we don’t understand an answer. 1. How many people were living or staying in this Area Code + Number house, apartment, or mobile home on April 1, 2000? – – Number of people 5. What is Person 1’s sex? Mark # ONE box. INCLUDE in this number: Male Female • foster children, roomers, or housemates • people staying here on April 1, 2000 who have PY 6. What is Person 1’s age and what is Person 1’s date of birth? no other permanent place to stay Age on April 1, 2000 • people living here most of the time while working, CO even if they have another place to live DO NOT INCLUDE in this number: Print numbers in boxes. • college students living away while attending college L Month Day Year of birth • people in a correctional facility, nursing home, or mental hospital on April 1, 2000 A • Armed Forces personnel living somewhere else N • people who live or stay at another place most O of the time   NOTE: Please answer BOTH Questions 7 and 8. TI 2. Is this house, apartment, or mobile home — 7. Is Person 1 Spanish/Hispanic/Latino? Mark # the "No" A Mark # ONE box. box if not Spanish /Hispanic /Latino. RM No, not Spanish / Hispanic / Latino Yes, Puerto Rican Owned by you or someone in this household with a mortgage or loan? Yes, Mexican, Mexican Am., Chicano Yes, Cuban Owned by you or someone in this household free and Yes, other Spanish / Hispanic / Latino — Print group. FO clear (without a mortgage or loan)? Rented for cash rent? Occupied without payment of cash rent? IN 8. What is Person 1’s race? Mark # one or more races to indicate what this person considers himself/herself to be. 3. Please answer the following questions for each person living in this house, apartment, or mobile White home. Start with the name of one of the people Black, African Am., or Negro living here who owns, is buying, or rents this American Indian or Alaska Native — Print name of enrolled or principal tribe. house, apartment, or mobile home. If there is no such person, start with any adult living or staying here. We will refer to this person as Person 1. What is this person’s name? Print name below. Asian Indian Japanese Native Hawaiian Chinese Korean Guamanian or Chamorro Last Name Filipino Vietnamese Samoan Other Asian — Print race. Other Pacific Islander — Print race. First Name MI Some other race — Print race. OMB No. 0607-0856: Approval Expires 12/31/2000   If more people live here, continue with Person 2. Form D-61A
  • 2. Your answers are important! Census information helps your Every person in the Census counts. community get financial Person 2 Person 3 assistance for roads, hospitals, schools, and more. 1. What is Person 2’s name? Print name below. 1. What is Person 3’s name? Print name below. Last Name Last Name First Name MI First Name MI 2. How is this person related to Person 1? Mark # ONE box. 2. How is this person related to Person 1? Mark # ONE box. Husband/wife If NOT RELATED to Person 1: Husband/wife If NOT RELATED to Person 1: Natural-born son/daughter Roomer, boarder Natural-born son/daughter Roomer, boarder Adopted son/daughter Housemate, roommate Adopted son/daughter Housemate, roommate Stepson/stepdaughter Unmarried partner Stepson/stepdaughter Unmarried partner Brother/sister Foster child Brother/sister Foster child Father/mother Other nonrelative Father/mother Other nonrelative Grandchild Grandchild Parent-in-law Parent-in-law Son-in-law/daughter-in-law Son-in-law/daughter-in-law PY Other relative — Print Other relative — Print exact relationship. exact relationship. CO 3. What is this person’s sex? Mark # ONE box. 3. What is this person’s sex? Mark # ONE box. Male Female Male Female 4. What is this person’s age and what is this person’s date 4. What is this person’s age and what is this person’s date L of birth? Print numbers in boxes. of birth? Print numbers in boxes. A Age on April 1, 2000 Month Day Year of birth Age on April 1, 2000 Month Day Year of birth N O TI   NOTE: Please answer BOTH Questions 5 and 6.   NOTE: Please answer BOTH Questions 5 and 6.   A 5. Is this person Spanish /Hispanic /Latino? Mark # the 5. Is this person Spanish /Hispanic /Latino? Mark # the RM "No" box if not Spanish /Hispanic /Latino. "No" box if not Spanish /Hispanic /Latino. No, not Spanish / Hispanic / Latino Yes, Puerto Rican No, not Spanish / Hispanic / Latino Yes, Puerto Rican Yes, Mexican, Mexican Am., Chicano Yes, Cuban Yes, Mexican, Mexican Am., Chicano Yes, Cuban FO Yes, other Spanish / Hispanic / Latino — Print group. Yes, other Spanish / Hispanic / Latino — Print group. IN 6. What is this person’s race? Mark # one or more races to 6. What is this person’s race? Mark # one or more races to indicate what this person considers himself/herself to be. indicate what this person considers himself/herself to be. White White Black, African Am., or Negro Black, African Am., or Negro American Indian or Alaska Native — Print name of enrolled or principal tribe. American Indian or Alaska Native — Print name of enrolled or principal tribe. Asian Indian Japanese Native Hawaiian Asian Indian Japanese Native Hawaiian Chinese Korean Guamanian or Chamorro Chinese Korean Guamanian or Chamorro Filipino Vietnamese Samoan Filipino Vietnamese Samoan Other Asian — Print race. Other Pacific Islander — Print race. Other Asian — Print race. Other Pacific Islander — Print race. Some other race — Print race. Some other race — Print race.   If more people live here, continue with Person 3.   If more people live here, continue with Person 4.  
  • 3. Knowing about age, race, and Information about children helps sex helps your community your community plan for child Person 4 care, education, and recreation. Person 5 better meet the needs of everyone. 1. What is Person 4’s name? Print name below. 1. What is Person 5’s name? Print name below. Last Name Last Name First Name MI First Name MI 2. How is this person related to Person 1? Mark # ONE box. 2. How is this person related to Person 1? Mark # ONE box. Husband/wife If NOT RELATED to Person 1: Husband/wife If NOT RELATED to Person 1: Natural-born son/daughter Roomer, boarder Natural-born son/daughter Roomer, boarder Adopted son/daughter Housemate, roommate Adopted son/daughter Housemate, roommate Stepson/stepdaughter Unmarried partner Stepson/stepdaughter Unmarried partner Brother/sister Foster child Brother/sister Foster child Father/mother Other nonrelative Father/mother Other nonrelative Grandchild Grandchild Parent-in-law Parent-in-law PY Son-in-law/daughter-in-law Son-in-law/daughter-in-law Other relative — Print Other relative — Print exact relationship. exact relationship. CO 3. What is this person’s sex? Mark # ONE box. 3. What is this person’s sex? Mark # ONE box. Male Female Male Female 4. What is this person’s age and what is this person’s date 4. What is this person’s age and what is this person’s date L of birth? Print numbers in boxes. of birth? Print numbers in boxes. A Age on April 1, 2000 Month Day Year of birth Age on April 1, 2000 Month Day Year of birth N O TI   NOTE: Please answer BOTH Questions 5 and 6.   NOTE: Please answer BOTH Questions 5 and 6.   A 5. Is this person Spanish /Hispanic /Latino? Mark # the 5. Is this person Spanish /Hispanic /Latino? Mark # the RM "No" box if not Spanish /Hispanic /Latino. "No" box if not Spanish /Hispanic /Latino. No, not Spanish / Hispanic / Latino Yes, Puerto Rican No, not Spanish / Hispanic / Latino Yes, Puerto Rican Yes, Mexican, Mexican Am., Chicano Yes, Cuban Yes, Mexican, Mexican Am., Chicano Yes, Cuban FO Yes, other Spanish / Hispanic / Latino — Print group. Yes, other Spanish / Hispanic / Latino — Print group. IN 6. What is this person’s race? Mark # one or more races to 6. What is this person’s race? Mark # one or more races to indicate what this person considers himself/herself to be. indicate what this person considers himself/herself to be. White White Black, African Am., or Negro Black, African Am., or Negro American Indian or Alaska Native — Print name of enrolled or principal tribe. American Indian or Alaska Native — Print name of enrolled or principal tribe. Asian Indian Japanese Native Hawaiian Asian Indian Japanese Native Hawaiian Chinese Korean Guamanian or Chamorro Chinese Korean Guamanian or Chamorro Filipino Vietnamese Samoan Filipino Vietnamese Samoan Other Asian — Print race. Other Pacific Islander — Print race. Other Asian — Print race. Other Pacific Islander — Print race. * Some other race — Print race. Some other race — Print race.   If more people live here, continue with Person 5.   If more people live here, continue with Person 6.   1042
  • 4. Your answers help your community plan Person 6 for the future. 1. What is Person 6’s name? Print name below. Last Name First Name MI 2. How is this person related to Person 1? Mark # ONE box. Husband/wife If NOT RELATED to Person 1: Natural-born son/daughter Roomer, boarder Adopted son/daughter Housemate, roommate Stepson/stepdaughter Unmarried partner Brother/sister Foster child Father/mother Other nonrelative Grandchild Parent-in-law PY Son-in-law/daughter-in-law CO Other relative — Print exact relationship. 3. What is this person’s sex? Mark # ONE box. Please turn L A Male Female 4. What is this person’s age and what is this person’s date to go to last N of birth? Print numbers in boxes. O Age on April 1, 2000 Month Day Year of birth page. TI A RM   NOTE: Please answer BOTH Questions 5 and 6. FO 5. Is this person Spanish /Hispanic /Latino? Mark # the "No" box if not Spanish /Hispanic /Latino. IN No, not Spanish / Hispanic / Latino Yes, Puerto Rican Yes, Mexican, Mexican Am., Chicano Yes, Cuban Yes, other Spanish / Hispanic / Latino — Print group. 6. What is this person’s race? Mark # one or more races to indicate what this person considers himself/herself to be. White Black, African Am., or Negro American Indian or Alaska Native — Print name of enrolled or principal tribe. Asian Indian Japanese Native Hawaiian Chinese Korean Guamanian or Chamorro Filipino Vietnamese Samoan Other Asian — Print race. Other Pacific Islander — Print race. Some other race — Print race.   If more people live here, list their names on the back of this page in the spaces provided. Form D-61A
  • 5. Persons 7 – 12 The Census Bureau estimates that, for the If you didn’t have room to list everyone who average household, this form will take about lives in this house or apartment, please list the 10 minutes to complete, including the time for others below. You may be contacted by the reviewing the instructions and answers. Census Bureau for the same information about Comments about the estimate should be directed these people. to the Associate Director for Finance and Administration, Attn: Paperwork Reduction Project Person 7 — Last Name 0607-0856, Room 3104, Federal Building 3, Bureau of the Census, Washington, DC 20233. Respondents are not required to respond to any First Name MI information collection unless it displays a valid approval number from the Office of Management and Budget. Person 8 — Last Name PY First Name MI Thank you for CO completing your official Person 9 — Last Name L U.S. Census 2000 form. A N First Name MI O TI The "Informational Copy" shows the content of the United States A Census 2000 "short" form RM Person 10 — Last Name questionnaire. Each household will receive either a short form (100-percent questions) or a long FO First Name MI form (100-percent and sample questions). The short form IN questionnaire contains 6 population questions and 1 housing question. On average, about 5 in every Person 11 — Last Name 6 households will receive the short form. The content of the forms resulted from reviewing the 1990 First Name MI census data, consulting with federal and non-federal data users, and conducting tests. Person 12 — Last Name For additional information about Census 2000, visit our website at www.census.gov or write to the First Name MI Director, Bureau of the Census, Washington, DC 20233. FOR OFFICE USE ONLY A. JIC1 B. JIC2 C. JIC3 D. JIC4
  • 6. If you need help completing this form, call 1-800-XXX-XXXX 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 1-800-XXX-XXXX between 8:00 a.m. and 9:00 p.m., 7 days a week. The telephone call is free. ¿ NECESITA AYUDA? Si usted necesita ayuda para completar este cuestionario llame al 1-800-XXX-XXXX entre las 8:00 a.m. y las 9:00 p.m., 7 días a la semana. La llamada telefónica es gratis. ) 1041

×