Back Section
The Diary Household Characteristics Questionnaire Back Section is used by the field representative to record
contact information, including the respondent's preferred mode and time of contact, address and telephone numbers.
This section is also used to record information on a non-interview. IMPORTANT: The Census Bureau does not release to
the Bureau of Labor Statistics any confidential information such as names and
addresses. This information is only used during the course of the interview.
Choose one of the following:
- Enter 1 if attempting to place week 1 diary
- Enter 2 if attempting to place week 2 diary
Diary Survey
Visit Number:
Date is:
Earliest Placement Date:
Latest Placement Date:
- Enter 1 to Continue
* Instruct the respondent on how to complete the Week 1 Diary, and
attempt to leave the Diary form with the respondent.
* Was the Week 1 Diary placed?
- Yes
- No
*The ideal date for picking up the Week 1 Diary is between
[fill: 8 days after today's date] and [fill: 14 days after today's date].
* If you traveled LESS than 50 miles to place this Diary --
Will the respondent be available for pick up during this period?
* If you traveled 50 miles or MORE to place this Diary, answer NO,
and attempt a Diary double placement.
- Yes
- No
* The respondent WILL NOT be available for pick up during the normal pick up period for
the Week 1 Diary or you traveled 50 miles or MORE to place this Diary.
* Inquire about double placement.
* Was this a Week 1 and Week 2 double placement?
- Yes
- No
* Why were both diaries placed?
- No one available for a Week 1 pickup.
- CU requests no Week 1 pickup.
- FR does not work on Sunday
- Traveled 50 miles or more to place diary
- Other
* Specify:
[enter text] _____________
* What type of non-interview do you have?
Type A = No one home, refusal
Type B = Temporarily absent, Vacant, under construction, occupied by persons with URE
Type C = Demolished, house moved, merged, condemned, located on base, CU
moved
- TYPE A
- TYPE B
- TYPE C
* Enter TYPE A noninterview
- No one home (NOH)
- Refused (REF)
- Other Type A - specify
* Specify other TYPE A
[enter text] _____________
* Enter type of refusal
- Hostile Respondent
- Time Related Excuses
- Language Problems
- Other Refusal - specify
* Specify type of refusal
[enter text] _____________
* Enter TYPE B noninterview
- Vacant (for rent)
- Vacant (for sale)
- Vacant (other)
- Occupied by persons with URE
- Under construction, not ready
- All persons under 16
- Unfit, to be demolished
- Unoccupied tent site or trailer site
- Permit granted, construction not started
- Temporarily Absent (TA)
- Other Type B- specify
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* Specify other TYPE B
[enter text] _____________
* Enter TYPE C noninterview
- Spawned in error
- Demolished
- House or Mobile Home moved
- Converted to permanent nonresidential use
- Merged with units in the same structure
- Condemned
- Located on military base (post)
- Unused serial # on listing sheet
- CU moved
- CU merged with another CE CU within same address
- Other type C- specify
* Specify other TYPE C
[enter text] _____________
* Did you classify this unit by observation only?
- Yes
- No
* Enter contact person's name
[enter text] _____________
* Enter contact person's title
[enter text] _____________
* Enter contact person's phone number
[enter value] _____________
* Enter contact person's phone number extension
[enter value] _____________
* Enter contact person's street address
[enter text] _____________
* Enter second line of address if necessary
[enter text] _____________
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* Enter city
[enter text] _____________
* Enter state
[enter text] _____________
* Enter zipcode
[enter value] _____________
* Race of individual
- White
- Black or African American
- American Indian or Alaska native
- Asian
- Hawaiian or other Pacific Islander
Number of household members:
[enter value] _____________
* Tenure code
- Owned
- Rented
* Instruct the respondent on how to complete the Week 2 Diary, and
attempt to leave the Diary form with the respondent.
* Was the Week 2 Diary placed?
- Yes
- No
* What type of non-interview do you have?
Type A = No one home, refusal
Type B = Temporarily absent, Vacant, under construction, occupied by persons with URE
Type C = Demolished, house moved, merged, condemned, located on base, CU
moved
- TYPE A
- TYPE B
- TYPE C
* Enter TYPE A noninterview
- No one home (NOH)
- Refused (REF)
- Other Type A - specify
* Specify other TYPE A
[enter text] _____________
* Enter type of refusal
- Hostile Respondent
- Time Related Excuses
- Language Problems
- Other Refusal - specify
* Specify type of refusal
[enter text] _____________
* Enter TYPE B noninterview
- Vacant (for rent)
- Vacant (for sale)
- Vacant (other)
- Occupied by persons with URE
- Under construction, not ready
- All persons under 16
- Unfit, to be demolished
- Unoccupied tent site or trailer site
- Permit granted, construction not started
- Temporarily Absent (TA)
- Other Type B- specify
Back to top
* Specify other TYPE B
[enter text] _____________
* Enter TYPE C noninterview
- Spawned in error
- Demolished
- House or Mobile Home moved
- Converted to permanent nonresidential use
- Merged with units in the same structure
- Condemned
- Located on military base (post)
- Unused serial # on listing sheet
- CU moved
- CU merged with another CE CU within same address
- Other type C- specify
* Specify other TYPE C
[enter text] _____________
* Did you classify this unit by observation only?
- Yes
-
No
* Enter contact person's name
[enter text] _____________
* Enter contact person's title
[enter text] _____________
* Enter contact person's phone number
[enter value] _____________
* Enter contact person's phone number extension
[enter value] _____________
* Enter contact person's street address
[enter text] _____________
* Enter second line of address if necessary
[enter text] _____________
Back to top
* Enter city
[enter text] _____________
* Enter state
[enter text] _____________
* Enter zipcode
[enter value] _____________
* Race of individual
- White
- Black or African American
- American Indian or Alaska native
- Asian
- Hawaiian or other Pacific Islander
Number of household members:
[enter value] _____________
* Tenure code
- Owned
- Rented
Instruct respondent to begin filling out the diary [today/tomorrow].
Week 1 [or 2] Pick Up Date is [fill in date]/ Double Placement Pick up Date is [fill in date]
Thank you.
I will return on [give date] to pick up the Week 1 [and/or 2] diary and
complete/continue with the interview.
- Enter 1 to Continue
- Select another date
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Thank you.
- Enter 1 to Continue
*DO NOT place Diary. Roster section not complete
I'd like to schedule a DATE to conduct/complete the interview. May I return on
- Battery problem
- Select a [date]
When is the best time to contact you?
- BATTERY problem
- Morning (9am-12 noon)
- Noon/lunchtime (11am-1pm)
-
Afternoon (12 noon-4pm)
- Suppertime/early evening/dinnertime(4pm-7pm)
- Evening (6pm-9pm)
- Anytime (9am-9pm)
- Late evening/night (7pm-9pm)
- Daytime (9am-4pm)
- After 5pm
* Enter specific best time to contact
[enter value] _____________
Would a Sunday interview be acceptable?
- Battery problem
- Yes
- No
End of Back Section
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Last Modified Date: January 15, 2009