2 How is this per
Husband or w
American Community Survey
1
What is Person 1’s name?
Last Name (Please print)
Biological so First Name MI
Adopted son
Population: Question on Sex
Stepson or s
Brother or si Grandchild
2 How is this person related to Person 1? Question as it1 appears in the questionnaire. X Person 3
What is Person 1’s sex? Mark (X) ONE box.
Male
Source: ACS-1(2009)KFI 4 What is Person
Father or mo
Parent-in-law
3 What is Person
Male
Female
1’s age and what is Person 1’s date of birth? Please report babies as age 0 when the child is less than 1 year old. Print numbers in boxes.
Age (in years) Month Year MEETING FEDERAL Day NEEDS of birth
4 What is Person
Age (in years)
Please report bab
Census data about sex are critical because so many federal programs must differentiate between males and females. NOTE: Please answer BOTH Question 5 about Hispanic origin and � The U.S. Departments of Education and Health and Human � NOTE: Please Question these race. For this implement, and evaluate various Question 6 abo Services are required by statute to use6 aboutdata to fund, survey, Hispanic origins are not races. social and welfare programs, such as 1 of Special Supplemental Food Program for Women, 5 Is Person the Hispanic, Latino, or Spanish origin? 5 Is Person 2 of H Infants, and Children (WIC) or the Low-Income Home Energy Assistance Program (LIHEAP). Laws No, not of H No, not of Hispanic, Latino, or Spanish origin to promote equal employment opportunity for women also require census data on sex. The Yes, Mexican Yes, Mexican, Mexican Am., Chicano U.S. Department of Veterans Affairs must use census data to develop its state projections of Yes, Puerto R veterans’ facilities and benefits. 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. Yes, Cuban
Yes, another Argentinean, and so on.
COMMUNITY BENEFITS
Planning
6
What is Person 1’s race? Mark (X) one or more boxes.
White
Education
6 What is Person
White
Data State and local planners analyze social Am., or Negro about sex are used to allocate Black, African funds to institutions of higher learning and economic characteristics of males American Indian or Alaska Native — Print name of enrolled or principal tribe. that increase participation, particularly and females to predict future needs for of minority women, in scientific and housing, education, childcare, health care, transportation, and employment. engineering programs under the Higher Education Act. Asian Indian Japanese Native Hawaiian Employment
Chinese Filipino Korean Guamanian or Chamorro Samoan
Black, African
American Ind
Asian Indian Chinese Filipino
Data about sex are used to evaluate Other Asian – Print race, Other Pacific Islander – employment practices under for example, Hmong, At the state and county levels, data about the Civil Print race, for example, Laotian, Thai, Pakistani, Fijian, Tongan, and Rights Act. sex are used to allocate funds for food, Cambodian, and so on. so on. health care services, and classes in meal The Equal Employment Opportunity planning to low-income women with Commission, using data about sex, children. establishes and evaluates guidelines dealing with equal employment opportunity.
Some other race – Print race.
Social Vietnamese Services
Other Asian for example, Laotian, Thai Cambodian,
Some other r
Housing Data about sex are used to evaluate Civil Rights Act.
2
§.4{6¤ policies and practices under the housing
www.census.gov
ACS-1(2009)KFI, Page 2, Base (Black)
ACS-1(2009)KFI, Page 2, G