1
American Community Survey
Population: Question on Relationship
1 What is Person 2’s name?
Last Name (Please print)
13199021
Person 2
First Person 2Name
13199021
MI
1 ere in whose name this house ented. If there is no such ving or staying here.)
ere in whose name this house ented. If there is no such ving or staying here.)
MI
Question as it appears in the questionnaire. 1 What is Person 2’s name? First Mark How is this person related to Person 1? Name (X) ONE box. 2 Last Name (Please print)
Husband or wife Biological son or daughter Adopted son or daughter Husband or wife Stepson or stepdaughter Biological son or daughter Brother or sister Adopted son or daughter Father or mother Stepson or stepdaughter Grandchild Brother or sister Parent-in-law Father or mother Grandchild Male Parent-in-law
MI
Son-in-law or daughter-in-law Other relative Roomer or boarder Son-in-law or daughter-in-law Housemate or roommate Other relative Unmarried partner Roomer or boarder Foster child Housemate or roommate Other nonrelative Unmarried partner Foster child Other nonrelative
2 How is this person related to Person 1? Mark (X) ONE box.
st Name
1?
st Name
MI
ox. 1?
Source: ACS-1(2009)KFI 3 What is Person
2’s sex? Mark (X) ONE box.
Female
rson 1’s date of birth? 4 What is Person 2’s sex?andFEDERAL NEEDS of birth? MEETING what is Person ox. 3 What is Person 2’s age Mark (X) ONE box. 2’s date ild is less than 1 year old. Please report babies as age 0 when the child is less than 1 year old. Male Female boxes. The census subject about relationship Print numbersforboxes. is essential in classifying the population into families
Age (in years) Month Day Year of birth
rson 1’s date of and other groups. Information about changes in is Person 2’s date of the American family, birth? 4 What is Person 2’s age and what the composition of birth? ild is less than 1 year old. number Please report babies as age 0the number of children living old. only one parent, from the of people living alone to when the child is less than 1 year with boxes. Print number of federal programs. In federally funded is essential for planning and carrying out anumbers in boxes.
ear of birth
ear of birth Age (in programs, how the money Month Questionspent hinges, at originpartially, on nutrition and educationyears) 5 about Hispanic origin and 5 about Hispanic least and � NOTE: Please answer BOTH Day isYear of birth , Hispanic origins are not races. Questiondata about relationship. 6 about race. For this survey, Hispanic origins are not races. decennial census program
nish origin?
, Hispanic origins are not races.
5 about Hispanic origin and rigin
5 Is Person 2 of Hispanic, Latino, or Spanish origin? � NOTE: not of Hispanic, Latino, or Question 5 about Hispanic origin and No, Please answer BOTH Spanish origin 5 Is Person 2 of Hispanic, Latino, or Spanish origin?
Yes, Mexican, Mexican Am., Chicano
Question 6 about race. For this survey, Hispanic origins are not races.
Yes, Puerto Rican No, not of Hispanic, Latino, or Spanish origin Yes, Cuban Yes, Mexican, Mexican Am., Chicano Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example, Yes, Puerto Rican Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. Education Yes, Cuban
nish origin?
rigin
origin – Print origin, for example, araguan, Salvadoran, Spaniard,
COMMUNITY BENEFITS
Government
or more boxes.
Federal Data about relationship are used to Yes, another Hispanic, Latino, or Spanish origin – Print origin, for example, origin – Print origin, for example, agencies use data about relaArgentinean, Colombian, Nicaraguan, Salvadoran, Spaniard, araguan, Salvadoran, Spaniard, tionship for a variety of programmaticDominican,allocate funds to states and counties and so on.
Black, African Am., or Negro
to purposes. 6 What is Person 2’s race? Mark (X) one or more boxes. improve the education of children in lowincome families. White
or more boxes.
Housing 6 What is Person 2’s race? Mark (X) one or more boxes. t name of enrolled or principal tribe. American Indian or Alaska Native — Print name of enrolled or principal tribe. Social Services White Data about families in poverty are used to distribute funds for housing toor Negro Local health agencies plan and administer Black, African Am., local governments. programs promoting the well-being of t name of enrolled or principal tribe. American Indian or Alaska Native — Print name of enrolled or principal tribe. Japanese Asian Indian Native Hawaiian Native Hawaiian families and children using information on relationship. Korean Chinese Guamanian or Chamorro Guamanian or Chamorro
Samoan Native Hawaiian Other Pacific Islander – Guamanian orexample, Print race, for Chamorro Fijian, Tongan, and Samoan so on. Other Pacific Islander – Print race, for example, Fijian, Tongan, and so on. Filipino Asian Indian Other Asian – Print race, Chinese for example, Hmong, Laotian, Thai, Pakistani, Filipino Cambodian, and so on. Other Asian – Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on. Some other race – Print race. Vietnamese Japanese Korean Vietnamese Samoan www.census.gov Native Hawaiian Other Pacific Islander – Guamanian orexample, Print race, for Chamorro Fijian, Tongan, and Samoan so on. Other Pacific Islander – Print race, for example, Fijian, Tongan, and so on.
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Some other race – Print race.