The American Community Survey 2020 Questionnaire
13190012DCThe American Community SurveyStart HereCOPYThis booklet shows thecontent of theAmerican Community Surveyquestionnaire. ONLast NameFirst NameMIATIComplete this form and mail itback as soon as possible.ARespond online today at:https://respond.census.gov/acsORPlease print the name and telephone number of theperson who is filling out this form. We will onlycontact you if needed for official Census Bureau business.LYou have two ways to respond:RMArea Code NumberYour response is required by law.— How many people are living or staying at this address? INCLUDE everyone who is living or staying here for morethan 2 months.INFOThe American Community Survey isconducted by the U.S. Census Bureau.This survey is one of only a fewsurveys for which all recipients arerequired by law to respond. TheU.S. Census Bureau is required bylaw to protect your information. INCLUDE yourself if you are living here for more than 2months. INCLUDE anyone else staying here who does not haveanother place to stay, even if they are here for 2 months orless.If you need help or havequestions about completingthis form, please call1-800-354-7271. DO NOT INCLUDE anyone who is living somewhere else formore than 2 months, such as a college student living away orsomeone in the Armed Forces on deployment.Number of peopleTelephone Device for the Deaf (TDD):Call 1–800–582–8330.¿NECESITA AYUDA? Llame sin cargoalguno al 1-877-833-5625.For more information about the AmericanCommunity Survey, visit our website at:https://www.census.gov/acs Fill out pages 2 – 7 for everyone, including yourself,who is living or staying at this address for morethan 2 months. Then complete the rest of the form.ACS-1(INFO)(2020)FORM(07-13-2019)§.4!- OMB No. 0607-0810OMB No. 0607-0936
13190020Person 1 NOTE: Please answer BOTH Question 5 about(Person 1 is the person living or staying here in whosename this house or apartment is owned, being bought,or rented. If there is no such person, start with the nameof any adult living or staying here.) Hispanic origin and Question 6 about race. For thissurvey, Hispanic origins are not races.5Is Person 1 of Hispanic, Latino, or Spanish origin?Please print today’s date.No, not of Hispanic, Latino, or Spanish originMonthYes, Mexican, Mexican Am., ChicanoDayYearYes, Puerto RicanYes, Cuban1Yes, another Hispanic, Latino, or Spanish origin – Print,for example, Salvadoran, Dominican, Colombian,Guatemalan, Spaniard, Ecuadorian, etc. CWhat is Person 1’s name?Last Name (Please print)First NameMI6What is Person 1’s race?Mark (X) one or more boxes AND print origins.How is this person related to Person 1?What is Person 1’s age and what is Person 1’sdate of birth? For babies less than 1 year old, do notwrite the age in months. Write 0 as the age.Print numbers in boxes.MonthDayYear of birthAmerican Indian or Alaska Native – Print name of enrolledor principal tribe(s), for example, Navajo Nation, BlackfeetTribe, Mayan, Aztec, Native Village of Barrow InupiatTraditional Government, Nome Eskimo Community, etc. CFORMAAge (in years)ALFemaleNMaleChineseVietnameseNative HawaiianFilipinoKoreanSamoanAsian IndianJapaneseChamorroOther Asian –Print, for example,Pakistani,Cambodian,Hmong, etc. CIN4Black or African Am. – Print, for example,African American, Jamaican, Haitian, Nigerian, Ethiopian,Somali, etc. CWhat is Person 1’s sex? Mark (X) ONE box.O3Person 1COXTI2PYWhite – Print, for example, German, Irish, English,Italian, Lebanese, Egyptian, etc. CSome other race – Print race or origin. C§.4!5 2Other PacificIslander – Print,for example,Tongan, Fijian,Marshallese, etc. C
13190038Person 2 NOTE: Please answer BOTH Question 5 aboutHispanic origin and Question 6 about race. For thissurvey, Hispanic origins are not races.15What is Person 2’s name?Is Person 2 of Hispanic, Latino, or Spanish origin?Last Name (Please print)No, not of Hispanic, Latino, or Spanish originYes, Mexican, Mexican Am., ChicanoFirst NameYes, Puerto RicanMIYes, Cuban2Yes, another Hispanic, Latino, or Spanish origin – Print,for example, Salvadoran, Dominican, Colombian,Guatemalan, Spaniard, Ecuadorian, etc. CHow is this person related to Person 1?Mark (X) ONE box.Opposite-sex husband/wife/spouseOpposite-sex unmarried partner6Same-sex husband/wife/spouseWhat is Person 2’s race?Mark (X) one or more boxes AND print origins.White – Print, for example, German, Irish, English,Italian, Lebanese, Egyptian, etc. CPYSame-sex unmarried partnerCOBiological son or daughterAdopted son or daughterBlack or African Am. – Print, for example,African American, Jamaican, Haitian, Nigerian, Ethiopian,Somali, etc. CStepson or stepdaughterALBrother or sisterNFather or motherOGrandchildTIParent-in-lawSon-in-law or daughter-in-lawAOther relativeRMRoommate or housemateWhat is Person 2’s sex? Mark (X) ONE box.Male4ChineseVietnameseNative HawaiianFilipinoKoreanSamoanAsian IndianJapaneseChamorroOther Asian –Print, for example,Pakistani,Cambodian,Hmong, etc. CIN3FOFoster childOther nonrelativeAmerican Indian or Alaska Native – Print name of enrolledor principal tribe(s), for example, Navajo Nation, BlackfeetTribe, Mayan, Aztec, Native Village of Barrow InupiatTraditional Government, Nome Eskimo Community, etc. CFemaleWhat is Person 2’s age and what is Person 2’sdate of birth? For babies less than 1 year old, do notwrite the age in months. Write 0 as the age.Print numbers in boxes.Age (in years)MonthDayYear of birthSome other race – Print race or origin. C§.4!G 3Other PacificIslander – Print,for example,Tongan, Fijian,Marshallese, etc. C
13190046Person 3 NOTE: Please answer BOTH Question 5 aboutHispanic origin and Question 6 about race. For thissurvey, Hispanic origins are not races.15What is Person 3’s name?Is Person 3 of Hispanic, Latino, or Spanish origin?Last Name (Please print)No, not of Hispanic, Latino, or Spanish originYes, Mexican, Mexican Am., ChicanoFirst NameYes, Puerto RicanMIYes, Cuban2Yes, another Hispanic, Latino, or Spanish origin – Print,for example, Salvadoran, Dominican, Colombian,Guatemalan, Spaniard, Ecuadorian, etc. CHow is this person related to Person 1?Mark (X) ONE box.Opposite-sex husband/wife/spouseOpposite-sex unmarried partner6Same-sex husband/wife/spouseWhat is Person 3’s race?Mark (X) one or more boxes AND print origins.White – Print, for example, German, Irish, English,Italian, Lebanese, Egyptian, etc. CPYSame-sex unmarried partnerCOBiological son or daughterAdopted son or daughterBlack or African Am. – Print, for example,African American, Jamaican, Haitian, Nigerian, Ethiopian,Somali, etc. CStepson or stepdaughterALBrother or sisterNFather or motherOGrandchildTIParent-in-lawSon-in-law or daughter-in-lawAOther relativeRMRoommate or housemateWhat is Person 3’s sex? Mark (X) ONE box.Male4ChineseVietnameseNative HawaiianFilipinoKoreanSamoanAsian IndianJapaneseChamorroOther Asian –Print, for example,Pakistani,Cambodian,Hmong, etc. CIN3FOFoster childOther nonrelativeAmerican Indian or Alaska Native – Print name of enrolledor principal tribe(s), for example, Navajo Nation, BlackfeetTribe, Mayan, Aztec, Native Village of Barrow InupiatTraditional Government, Nome Eskimo Community, etc. CFemaleWhat is Person 3’s age and what is Person 3’sdate of birth? For babies less than 1 year old, do notwrite the age in months. Write 0 as the age.Print numbers in boxes.Age (in years)MonthDayYear of birthSome other race – Print race or origin. C§.4!O 4Other PacificIslander – Print,for example,Tongan, Fijian,Marshallese, etc. C
13190053Person 4 NOTE: Please answer BOTH Question 5 aboutHispanic origin and Question 6 about race. For thissurvey, Hispanic origins are not races.15What is Person 4’s name?Is Person 4 of Hispanic, Latino, or Spanish origin?Last Name (Please print)No, not of Hispanic, Latino, or Spanish originYes, Mexican, Mexican Am., ChicanoFirst NameYes, Puerto RicanMIYes, Cuban2Yes, another Hispanic, Latino, or Spanish origin – Print,for example, Salvadoran, Dominican, Colombian,Guatemalan, Spaniard, Ecuadorian, etc. CHow is this person related to Person 1?Mark (X) ONE box.Opposite-sex husband/wife/spouseOpposite-sex unmarried partner6Same-sex husband/wife/spouseWhat is Person 4’s race?Mark (X) one or more boxes AND print origins.White – Print, for example, German, Irish, English,Italian, Lebanese, Egyptian, etc. CPYSame-sex unmarried partnerCOBiological son or daughterAdopted son or daughterBlack or African Am. – Print, for example,African American, Jamaican, Haitian, Nigerian, Ethiopian,Somali, etc. CStepson or stepdaughterALBrother or sisterNFather or motherOGrandchildTIParent-in-lawSon-in-law or daughter-in-lawAOther relativeRMRoommate or housemateWhat is Person 4’s sex? Mark (X) ONE box.Male4ChineseVietnameseNative HawaiianFilipinoKoreanSamoanAsian IndianJapaneseChamorroOther Asian –Print, for example,Pakistani,Cambodian,Hmong, etc. CIN3FOFoster childOther nonrelativeAmerican Indian or Alaska Native – Print name of enrolledor principal tribe(s), for example, Navajo Nation, BlackfeetTribe, Mayan, Aztec, Native Village of Barrow InupiatTraditional Government, Nome Eskimo Community, etc. CFemaleWhat is Person 4’s age and what is Person 4’sdate of birth? For babies less than 1 year old, do notwrite the age in months. Write 0 as the age.Print numbers in boxes.Age (in years)MonthDayYear of birthSome other race – Print race or origin. C§.4!V 5Other PacificIslander – Print,for example,Tongan, Fijian,Marshallese, etc. C
13190061Person 5 NOTE: Please answer BOTH Question 5 aboutHispanic origin and Question 6 about race. For thissurvey, Hispanic origins are not races.15What is Person 5’s name?Is Person 5 of Hispanic, Latino, or Spanish origin?Last Name (Please print)No, not of Hispanic, Latino, or Spanish originYes, Mexican, Mexican Am., ChicanoFirst NameYes, Puerto RicanMIYes, Cuban2Yes, another Hispanic, Latino, or Spanish origin – Print,for example, Salvadoran, Dominican, Colombian,Guatemalan, Spaniard, Ecuadorian, etc. CHow is this person related to Person 1?Mark (X) ONE box.Opposite-sex husband/wife/spouseOpposite-sex unmarried partner6Same-sex husband/wife/spouseWhat is Person 5’s race?Mark (X) one or more boxes AND print origins.White – Print, for example, German, Irish, English,Italian, Lebanese, Egyptian, etc. CPYSame-sex unmarried partnerCOBiological son or daughterAdopted son or daughterBlack or African Am. – Print, for example,African American, Jamaican, Haitian, Nigerian, Ethiopian,Somali, etc. CStepson or stepdaughterALBrother or sisterNFather or motherOGrandchildTIParent-in-lawSon-in-law or daughter-in-lawAOther relativeRMRoommate or housemateWhat is Person 5’s sex? Mark (X) ONE box.Male4ChineseVietnameseNative HawaiianFilipinoKoreanSamoanAsian IndianJapaneseChamorroOther Asian –Print, for example,Pakistani,Cambodian,Hmong, etc. CIN3FOFoster childOther nonrelativeAmerican Indian or Alaska Native – Print name of enrolledor principal tribe(s), for example, Navajo Nation, BlackfeetTribe, Mayan, Aztec, Native Village of Barrow InupiatTraditional Government, Nome Eskimo Community, etc. CFemaleWhat is Person 5’s age and what is Person 5’sdate of birth? For babies less than 1 year old, do notwrite the age in months. Write 0 as the age.Print numbers in boxes.Age (in years)MonthDayYear of birthSome other race – Print race or origin. C§.4! 6Other PacificIslander – Print,for example,Tongan, Fijian,Marshallese, etc. C
13190079If there are more than five people living or staying here, print their names in the spaces for Person 6through Person 12. We may call you for more information about them. CPerson 6Last Name (Please print)SexMaleFirst NameMIFirst NameMIFirst NameMIAge (in years)FemalePerson 7Last Name (Please print)SexMaleAge (in years)FemaleMaleAge (in years)FemaleLSexCOLast Name (Please print)PYPerson 8APerson 9First NameMIMaleAge (in years)FemaleASexTIONLast Name (Please print)RMPerson 10First NameMIFirst NameMIFirst NameMIFOLast Name (Please print)SexMalePerson 11IN FemaleAge (in years)Last Name (Please print)SexMaleFemaleAge (in years)Person 12Last Name (Please print)SexMaleFemale§.4!p Age (in years)7
13190087Housing Please answer the following questions aboutthe house, apartment, or mobile home at theaddress on the mailing label.1Which best describes this building?Include all apartments, flats, etc., even if vacant.AAnswer questions 4 – 5 if this is a HOUSE OR AMOBILE HOME; otherwise, SKIP to question 6a.4How many acres is this house or mobile home on?A mobile homeLess than 1 acre SKIP to question 6aA one-family house detached from anyother house1 to 9.9 acresA one-family house attached to one ormore houses10 or more acres5A building with 3 or 4 apartmentsIN THE PAST 12 MONTHS, what were the actualsales of all agricultural products from thisproperty?A building with 5 to 9 apartmentsNoneA building with 10 to 19 apartmentsCO 1 to 999A building with 20 to 49 apartments 1,000 to 2,499A building with 50 or more apartmentsL 2,500 to 4,999ABoat, RV, van, etc.About when was this building first built?O2000 or later – Specify yearN2ATI61980 to 1989b. How many of these rooms are bedrooms?Count as bedrooms those rooms you would list if thishouse, apartment, or mobile home were for sale orrent. If this is an efficiency/studio apartment, print "0".1939 or earlier3Number of bedroomsWhen did PERSON 1 (listed on page 2) move intothis house, apartment, or mobile home?Montha. How many separate rooms are in this house,apartment, or mobile home? Rooms must beseparated by built-in archways or walls that extendout at least 6 inches and go from floor to ceiling.Number of roomsIN1960 to 19691940 to 1949 10,000 or moreFO1970 to 1979 5,000 to 9,999 INCLUDE bedrooms, kitchens, etc. EXCLUDE bathrooms, porches, balconies, foyers,halls, or unfinished basements.RM1990 to 19991950 to 1959PYA building with 2 apartmentsYear§.4!x 8
13190095Housing (continued)711 Do you or any member of this household haveDoes this house, apartment, or mobile homehave –Yesaccess to the Internet using a –Noa. cellular data plan for asmartphone or other mobiledevice?a. hot and cold running water?b. a bathtub or shower?Nob. broadband (high speed)Internet service such as cable,fiber optic, or DSL serviceinstalled in this household?c. satellite Internet serviceinstalled in this household?d. dial-up Internet serviceinstalled in this household?e. some other service?Specify service Cc. a sink with a faucet?d. a stove or range?e. a refrigerator?8YesCan you or any member of this householdboth make and receive phone calls when atthis house, apartment, or mobile home?Include calls using cell phones, land lines, orother phone devices.YesNoPYone-ton capacity or less are kept at home foruse by members of this household?At this house, apartment, or mobile home –do you or any member of this household ownor use any of the following types of computers?YesCO912 How many automobiles, vans, and trucks ofNone1No2ALa. Desktop or laptopNb. SmartphoneOc. Tablet or other portablewireless computer456 or more13 Which FUEL is used MOST for heating thishouse, apartment, or mobile home?RMATId. Some other type of computerSpecify C310 At this house, apartment, or mobile home –Gas: from underground pipes serving theneighborhooddo you or any member of this household haveaccess to the Internet?FOGas: bottled, tank, or LPYes, by paying a cell phone company orInternet service providerElectricityINYes, without paying a cell phone company orInternet service provider SKIP to question 12Fuel oil, kerosene, etc.Coal or cokeNo access to the Internet at this house, apartment,or mobile home SKIP to question 12WoodSolar energyOther fuelNo fuel used§.4! 9
13190103Housing (continued)14 a. LAST MONTH, what was the cost of electricity 16 Is this house, apartment, or mobile home part offor this house, apartment, or mobile home?a condominium?Last month’s cost – Dollars Yes What is the monthly condominiumfee? For renters, answer only if you paythe condominium fee in addition to yourrent; otherwise, mark the "None" box.00,ORMonthly amount – DollarsIncluded in rent or condominium fee No charge or electricity not used.00,ORb. LAST MONTH, what was the cost of gas forthis house, apartment, or mobile home?NoneNoLast month’s cost – Dollars 17 Is this house, apartment, or mobile home –.00,Mark (X) ONE box.OROwned by you or someone in this householdwith a mortgage or loan? Include home equity loans.PYIncluded in rent or condominium feeOwned by you or someone in this household freeand clear (without a mortgage or loan)?No charge or gas not usedRented?COIncluded in electricity payment entered aboveOccupied without payment of rent? SKIP toon the next pageALc. IN THE PAST 12 MONTHS, what was the costof water and sewer for this house, apartment,or mobile home? If you have lived here less than12 months, estimate the cost.BO.00,OR18 a. What is the monthly rent for this house,apartment, or mobile home?AIncluded in rent or condominium feeTI Answer questions 18a and b if this house,apartment, or mobile home is RENTED.Otherwise, SKIP to question 19.NPast 12 months’ cost – DollarsMonthly amount – DollarsRMNo charged. IN THE PAST 12 MONTHS, what was the costof oil, coal, kerosene, wood, etc., for thishouse, apartment, or mobile home? If you havelived here less than 12 months, estimate the cost.FO ,b. Does the monthly rent include any meals?Past 12 months’ cost – DollarsYesIN .00,NoORIncluded in rent or condominium feeNo charge or these fuels not used15 IN THE PAST 12 MONTHS, did you or anymember of this household receive benefitsfrom the Food Stamp Program or SNAP (theSupplemental Nutrition Assistance Program)?Do NOT include WIC, the School Lunch Program, orassistance from food banks.YesNo§.4" .0010C
13190111Housing (continued)Cc. Does the regular monthly mortgage paymentinclude payments for real estate taxes on THISproperty?Answer questions 19 – 23 if you or any memberof this household OWNS or IS BUYING thishouse, apartment, or mobile home.Otherwise, SKIP to E .Yes, taxes included in mortgage paymentNo, taxes paid separately or taxes not required19 About how much do you think this house and lot,d. Does the regular monthly mortgage paymentinclude payments for fire, hazard, or floodinsurance on THIS property?apartment, or mobile home (and lot, if owned)would sell for if it were for sale?Amount – DollarsYes, insurance included in mortgage payment ,.00,No, insurance paid separately or no insurance20 What are the annual real estate taxes on THIS23 a. Do you or any member of this household haveproperty?a second mortgage or a home equity loan onTHIS property?Annual amount – DollarsYes, home equity loanPY .00,Yes, second mortgageORCOYes, second mortgage and home equity loanNoneNo SKIP to21 What is the annual payment for fire, hazard, andLb. How much is the regular monthly payment onall second or junior mortgages and all homeequity loans on THIS property?Aflood insurance on THIS property?NAnnual amount – Dollars .00O,D ORANoneNo regular payment required22 a. Do you or any member of this household haveRM.00,TIORMonthly amount – Dollarsa mortgage, deed of trust, contract topurchase, or similar debt on THIS property?DFOYes, mortgage, deed of trust, or similar debtAnswer question 24 if this is a MOBILE HOME.Otherwise, SKIP to E .Yes, contract to purchaseINNo SKIP to question 23a24 What are the total annual costs for personalproperty taxes, site rent, registration fees, andlicense fees on THIS mobile home and its site?Exclude real estate taxes.b. How much is the regular monthly mortgagepayment on THIS property? Include paymentonly on FIRST mortgage or contract to purchase.Annual costs – DollarsMonthly amount – Dollars , .00,.00ORNo regular payment required SKIP toquestion 23a§.4", E11Answer questions about PERSON 1 on the nextpage. If no one is listed as PERSON 1 on page 2,SKIP to page 48 for mailing instructions.
13190129Person 1 Please copy the name of Person 1 from page 2,then continue answering questions below.10 a. At any time IN THE LAST 3 MONTHS, has thisperson attended school or college? Include onlynursery or preschool, kindergarten, elementaryschool, home school, and schooling which leadsto a high school diploma or a college degree.Last NameNo, has not attended in the last 3months SKIP to question 11MIFirst NameYes, public school, public collegeYes, private school, private college, home school7b. What grade or level was this person attending?Mark (X) ONE box.Where was this person born?In the United States – Print name of state.Nursery school, preschoolKindergartenGrade 1 through 12 – Specifygrade 1 – 12PYOutside the United States – Print name offoreign country, or Puerto Rico, Guam, etc.8COCollege undergraduate years (freshman to senior)Graduate or professional school beyond abachelor’s degree (for example: MA or PhDprogram, or medical or law school)Is this person a citizen of the United States?LYes, born in the United States SKIP toquestion 10a11 What is the highest degree or level of school thisYes, born in Puerto Rico, Guam, theU.S. Virgin Islands, or Northern MarianasATIYes, U.S. citizen by naturalization – Print yearof naturalization COYes, born abroad of U.S. citizen parent or parentsNAperson has COMPLETED? Mark (X) ONE box.If currently enrolled, mark the previous grade orhighest degree received.FOWhen did this person come to live in theUnited States? If this person came to live in theUnited States more than once, print latest year.YearNursery schoolGrade 1 through 11 – Specifygrade 1 – 11IN9No schooling completedNURSERY OR PRESCHOOL THROUGH GRADE 12KindergartenRMNo, not a U.S. citizenNO SCHOOLING COMPLETED12th grade – NO DIPLOMAHIGH SCHOOL GRADUATERegular high school diplomaGED or alternative credentialCOLLEGE OR SOME COLLEGESome college credit, but less than 1 year ofcollege credit1 or more years of college credit, no degreeAssociate’s degree (for example: AA, AS)Bachelor’s degree (for example: BA, BS)AFTER BACHELOR’S DEGREEMaster’s degree (for example: MA, MS, MEng,MEd, MSW, MBA)Professional degree beyond a bachelor’sdegree (for example: MD, DDS, DVM, LLB, JD)Doctorate degree (for example: PhD, EdD)§.4" 12
13190137Person 1 (continued)15 a. Did this person live in this house or apartmentF1 year ago?Answer question 12 if this person has a bachelor’sdegree or higher. Otherwise, SKIP to question 13.Person is under 1 year old SKIP to question 16Yes, this house SKIP to question 16No, outside the United States and Puerto Rico –Print name of foreign country, orU.S. Virgin Islands, Guam, etc., below; then SKIPto question 1612 This question focuses on this person’sBACHELOR’S DEGREE. Please print below thespecific major(s) of any BACHELOR’S DEGREESthis person has received. (For example: chemicalengineering, elementary teacher education,organizational psychology)No, different house in the United States orPuerto Ricob. Where did this person live 1 year ago?PYAddress (Number and street name)13 What is this person’s ancestry or ethnic origin?COName of city, town, or post office(For example: Italian, Jamaican, African Am.,Cambodian, Cape Verdean, Norwegian, Dominican,French Canadian, Haitian, Korean, Lebanese, Polish,Nigerian, Mexican, Taiwanese, Ukrainian, and so on.)14 a. Does this person speak a language otherfollowing types of health insurance or healthcoverage plans? Mark "Yes" or "No" for EACH typeof coverage in items a – h.FOa. Insurance through a current orformer employer or union (of thisperson or another family member)For example: Korean, Italian, Spanish, VietnameseINb. Insurance purchased directly froman insurance company (by thisperson or another family member)c. How well does this person speak English?Very wellZIP Code16 Is this person CURRENTLY covered by any of theRMNo SKIP to question 15aAYesb. What is this language?Name of U.S. state orPuerto RicoTIthan English at home?ONALName of U.S. county or municipio in Puerto Ricoc. Medicare, for people 65 and older,or people with certain disabilitiesWelld. Medicaid, Medical Assistance, orany kind of government-assistanceplan for those with low incomesor a disabilityNot wellNot at alle. TRICARE or other military health caref. VA (enrolled for VA health care)g. Indian Health Serviceh. Any other type of health insuranceor health coverage plan – Specify C§.4"F 13YesNo
13190145Person 1 (continued)IGAnswer question 20 if this person is 15 years oldor over. Otherwise, SKIP to the questions forPerson 2 on page 19.Answer question 17a if this person is covered byhealth insurance. Otherwise, SKIP to question 18a.20 Because of a physical, mental, or emotional17 a. Is there a premium for this plan? A premiumcondition, does this person have difficulty doingerrands alone such as visiting a doctor’s officeor shopping?is a fixed amount of money paid on a regularbasis for health coverage. It does not includecopays, deductibles, or other expenses suchas prescription costs.YesYesNoNo SKIP to question 18a21 What is this person’s marital status?b. Does this person or another family memberreceive a tax credit or subsidy based onfamily income to help pay the premium?Now marriedDivorcedNoCOSeparatedPYWidowedYes18 a. Is this person deaf or does he/she haveNever married SKIP toserious difficulty hearing?J on the next pageYesL22 In the PAST 12 MONTHS did this person get –RMb. Widowed?c. Divorced?23 How many times has this person been married?Answer question 19a – c if this person is 5 yearsold or over. Otherwise, SKIP to the questions forPerson 2 on page 19.OnceTwo timesFOHANoNoNTIYesYesa. Married?Ob. Is this person blind or does he/she haveserious difficulty seeing even when wearingglasses?ANoThree or more timesIN19 a. Because of a physical, mental, or emotionalcondition, does this person have seriousdifficulty concentrating, remembering, ormaking decisions?24 In what year did this person last get married?YearYesNob. Does this person have serious difficultywalking or climbing stairs?YesNoc. Does this person have difficulty dressing orbathing?YesNo§.4"N 14
13190152Person 1 (continued)27 Has this person ever served on active duty in theJU.S. Armed Forces, Reserves, or National Guard?Mark (X) ONE box.Answer question 25 if this person is female and15 – 50 years old. Otherwise, SKIP to question 26a.Never served in the military SKIP to question 30aOnly on active duty for training in the Reservesor National Guard SKIP to question 29a25 In the PAST 12 MONTHS, has this person givenbirth to any children?Now on active dutyYesOn active duty in the past, but not nowNo28 When did this person serve on active duty in theU.S. Armed Forces? Mark (X) a box for EACH periodin which this person served, even if just for part of theperiod.26 a. Does this person have any of his/her owngrandchildren under the age of 18 living inthis house or apartment?September 2001 or laterYesAugust 1990 to August 2001 (includingPersian Gulf War)PYNo SKIP to question 27May 1975 to July 1990b. Is this grandparent currently responsible formost of the basic needs of any grandchildrenunder the age of 18 who live in this house orapartment?COVietnam era (August 1964 to April 1975)February 1955 to July 1964YesLKorean War (July 1950 to January 1955)No SKIP to question 27AJanuary 1947 to June 1950World War II (December 1941 to December 1946)ATIONc. How long has this grandparent been responsiblefor these grandchildren? If the grandparent isNovember 1941 or earlierfinancially responsible for more than one grandchild,answer the question for the grandchild for whomthe grandparent has been responsible for the29 a. Does this person have a VA service-connecteddisability rating?longest period of time.6 to 11 monthsb. What is this person’s service-connecteddisability rating?0 percentIN5 or more yearsNo SKIP to question 30aFO1 or 2 years3 or 4 yearsYes (such as 0%, 10%, 20%, . , 100%)RMLess than 6 months10 or 20 percent30 or 40 percent50 or 60 percent70 percent or higher§.4"U 15
13190160Person 1 (continued)K30 a. LAST WEEK, did this person work for pay at ajob (or business)?Yes SKIP to question 31Answer question 33 if you marked "Car, truck,or van" in question 32. Otherwise, SKIP toquestion 34.No – Did not work (or retired)33 How many people, including this person,usually rode to work in the car, truck, or vanLAST WEEK?b. LAST WEEK, did this person do ANY work forpay, even for as little as one hour?Person(s)YesNo SKIP to question 36a31 At what location did this person work LAST34 LAST WEEK, what time did this person’s trip toWEEK? If this person worked at more than onelocation, print where he or she worked most lastweek.work usually begin?HourMinutea. Address (Number and street name):a.m.PYp.m.If the exact address is not known, give a descriptionof the location such as the building name or thenearest street or intersection.35 How many minutes did it usually take thisCOperson to get from home to work LAST WEEK?MinutesTIYesANo, outside the city/town limits36 a. LAST WEEK, was this person on layoff froma job?RMd. Name of countyYes SKIP to question 36cNoFOe. Name of U.S. state or foreign countryb. LAST WEEK, was this person TEMPORARILYabsent from a job or business?INf. ZIP CodeAnswer questions 36 – 39 if this persondid NOT work last week. Otherwise, SKIP toquestion 40a.NLOc. Is the work location inside the limits of thatcity or town?ALb. Name of city, town, or post officeYes, on vacation, temporary illness,maternity leave, other family/personalreasons, bad weather, etc. SKIP toquestion 39No SKIP to question 3732 How did this person usually get to work LASTWEEK? Mark (X) ONE box for the method oftransportation used for most of the distance.Car, truck, or vanTaxicabBusMotorcycleSubway or elevated railBicycleLong-distance train orcommuter railWalkedLight rail, streetcar,or trolleyWorked fromhome SKIPto question 40aFerryboatOther method§.4"] c. Has this person been informed that he or shewill be recalled to work within the next 6months OR been given a date to return to work?Yes SKIP to question 38No16
13190178Person 1 (continue
The American Community Survey . This booklet shows the content of the American Community Survey questionnaire. Start Here . You have two ways to respond: Respond online today at: https://respond.census.gov/acs OR . Complete this form and mail it back as soon as possible. Your response is required by law. The American Community Survey is
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .
On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions
Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.
