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Statistics Canada
2001 Census

[p. 1]

Ce questionnaire est disponible en français 1 800 591-2001

2B [Long form]

OFFICE USE ONLY

Prov. ____
FED ____
EA ____
VN ____
CCD ____
VR Line No. _ _ _
Map Block No. _ _

Form type
No. of persons ____
Questionnaire No.____ of ____
TD ____
UD _
NH/S _
FR _
TR _
Forms 3____
Coll.____
Count yourself in! May 15, 2001
For over 300 years, the census has painted a picture of our people and the places in which we live. This census, on May 15, 2001, will continue the tradition by providing information needed by community groups, businesses and governments to develop plans for education and training, seniors' housing, day care, fire protection, public transport, and many other programs that are important to all of us.
As Canada's national statistics agency, Statistics Canada uses census data for producing statistical tables, analytical reports and for selecting samples or following up respondents for some of our surveys. These uses are strictly for statistical purposes and no one outside of the agency can have access to your identifiable information.
By law, Statistics Canada must take a census every five years, and every household must fill in a census form. Also, by law, Statistics Canada must protect the confidentiality of the personal information you provide. Our employees, including census takers, are personally liable to fines or imprisonment should they break the confidentiality of your information.
Please complete your census form and mail it back on May 15, 2001.
Thank you for your cooperation.
Ivan P. Fellegi
Chief Statistician of Canada

This information is collected under the authority of the Statistics Act, R.S.C. 1985, c. S-19, and must be provided by law.
Confidential when completed

STEP A: Begin here by printing your address
No. and street or lot and concession ____Apt. No. ____
City, town, village, Indian reserve ____
Province/territory ____
Postal code ___ ___
Area code ___
Telephone number ___ - ____

For information and instructions see the Guide.
Call us free of charge: 1 800 591-2001
TTY/ TDD users call: 1 877 881-8301
[p. 2]

Whom to include in step B
Everyone who usually lives here, at this address: including newborn babies and room-mates;
Students: students who return to live with their parents during the year should be included at their parents' address, even if they live elsewhere while attending school or working at a summer job;
Children in joint custody: children in joint custody who live here most of the time. Children who spend equal time with each parent should be included in the home of the parent where they are staying on May 15, 2001;
Absent spouses: spouses or common-law partners who live elsewhere while working or studying but who return here periodically;
Landed immigrants: landed immigrants who usually live at this address;
Refugees: persons claiming refugee status and family members living here with them;
Persons from another country with a work, student or minister's permit: persons from another country who have an employment authorization, a student authorization or a Minister's permit, and family members living here with them;
Persons in institutions: persons who usually live here but are now in an institution (such
as a home for the aged, a hospital or a prison), if they have been there less than six months;
Persons with no other home: persons staying here on May 15, 2001, who have no
usual home elsewhere.

Do not include in step B
Persons who have their usual home at another address in Canada and who are staying here temporarily (for example, persons visiting or persons who have their secondary residence here, at this address);
Residents of another country visiting Canada (for example, on a business trip or on vacation);
Government representatives of another country or members of the Armed Forces of another country and family members.
If all persons staying at this address on May 15, 2001, have their usual home elsewhere in Canada or are visitors, government or military representatives of another country, mark this circle ... 01 [ ] Do not complete this questionnaire. Mail it in the enclosed postage-paid envelope.
[p. 3]

STEP B: List below all persons who usually live here, at this address, as of May 15, 2001, even if they are temporarily away. Don't forget to include yourself!
Begin the list with an adult followed, if applicable, by that person's spouse or common-law partner and by their children who usually live here. Continue with all other persons who usually live here. Children should be listed immediately after their parent(s).
Family name

____ Person 1
____ Person 2
____ Person 3
____ Person 4
____ Person 5
____ Person 6
____ Person 7
____ Person 8
____ Person 9
____ Person 10

Given name

____ Person 1
____ Person 2
____ Person 3
____ Person 4
____ Person 5
____ Person 6
____ Person 7
____ Person 8
____ Person 9
____ Person 10

Initial

____ Person 1
____ Person 2
____ Person 3
____ Person 4
____ Person 5
____ Person 6
____ Person 7
____ Person 8
____ Person 9
____ Person 10

If you need more space, use the "Comments" section on page 32.

STEP C: Did you leave anyone out of Step B because you were not sure the person should be listed?
For example: a person living at this address who has another home; a person temporarily away.

[] No
[] Yes
Specify the name, the relationship and the reason.
Name ____
Relationship ____
Reason ____
If you need more space, use the "Comments" section on page 32.

STEP D: Is anyone listed in Step B a farm operator?

A farm operator makes the day-to-day management decisions for a farm. Farms produce any of the following agricultural products intended for sale: crops, livestock, poultry, other agricultural products (greenhouse or nursery products, Christmas trees, sod, honey, maple syrup products, furs, eggs, milk, etc.)
[] No
[] Yes

STEP E: Copy the names from Step B to Question 1, on the top of the next page.

If more than six persons live here and you do not have a second questionnaire to include them, note this in the "Comments" section on page 32. A Statistics Canada representative will contact you.
[p. 4]
[Note: the following questions are asked with enough space provided for up to six householders to answer the questions.]

1. Name

In the space provided, copy the names in the same order as in Step B. Then answer the following questions for each person.
Family name ____
Given name ____
Initial ____

2. Sex

[] Male
[] Female

3. Date of birth

If exact date is not known, enter best estimate.
Day _ _
Month _ _
Year _ _ _ _

4. Marital status

Mark "x" one circle only.
[] Never
[] Legally married (and not separated)
[] Separated, but still legally married
[] Divorced
[] Widowed

5. Is this person living with a common-law partner?

Common-law refers to two people of the opposite sex or of the same sex who live together as a couple but who are not legally married to each other.
[] Yes
[] No

6. Relationship to person 1

For each person usually living here, describe his/her relationship to Person 1.
Mark "x" or specify one response only.
Stepchildren, adopted children and children of a common-law partner should be considered sons and daughters.
If none of the choices apply, use the "other" box to indicate this person's relationship to Person 1. Examples of "other" relationships to Person 1: grandparent, cousin, niece or nephew, lodger's husband or wife, room-mate's daughter or son, employee.
[] Person 1
[] Husband or wife of Person 1
[] Common-law partner (opposite-sex) of Person 1
[] Common-law partner (same-sex) of Person 1
[] Son or daughter or Person 1
[] Son-in-law or daughter-in-law of Person 1
[] Grandchild of Person 1
[] Father or mother of Person 1
[] Father-in-law or mother-in-law of Person 1
[] Brother or sister of Person 1
[] Brother-in-law or sister-in-law of Person 1
[] Lodger or boarder
[] Room-mate
[] Other, specify ____

[p. 5]
[Space to fill out answers from questions on page 4 for household members 3 through 6.]
[p. 6]

Activities of daily living

7. Does this person have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?

[] Yes, sometimes
[] Yes, often
[] No

8. Does a physical condition or mental condition or health problem reduce the amount or the kind of activity this person can do:

(a) At home?
[] Yes, sometimes
[] Yes, often
[] No
(b) At work or at school?
[] Yes, sometimes
[] Yes, often
[] No
[] Not applicable
(c) In other activities, for example, transportation or leisure?
[] Yes, sometimes
[] Yes, often
[] No

Socio-cultural information
9. Where was this person born?

Specify one response only, according to present boundaries.
[] Born in Canada, specify province or territory ____
[] Born outside Canada, specify country ____

10. Of what country is this person a citizen?

Indicate more than one citizenship, if applicable.
"Canada, by naturalization" refers to the process by which an immigrant is granted citizenship of Canada, under the Citizenship Act.
[] Canada, by birth
[] Canada, by naturalization
[] Other country, specify ____

11. Is this person now, or has this person ever been, a landed immigrant?

A "landed immigrant" is a person who has been granted the right to live in Canada permanently by immigration authorities.
[] No - Go to question 13
[] Yes

12. In what year did this person first become a landed immigrant?

[Question 12 was asked of persons who have ever been a landed immigrant, per question 11.]
If exact year is not known, enter best estimate.
Year _ _ _ _

[p. 7]
[Space to fill out answers from questions on page 6 for household members 3 through 6.]
[p. 8]
13. Can this person speak English or French well enough to conduct a conversation?

Mark "x" one circle only.
[] English only
[] French only
[] Both English and French
[] Neither English nor French

14. What language(s), other than English or French, can this person speak well enough to conduct a conversation?

[] None
Or specify other language(s) [below]
________

15(a). What language does this person speak most often at home?

[] English
[] French
[] Other, specify ____

15(b). Does this person speak any other languages on a regular basis at home?

[] No
[] Yes, English
[] Yes, French
[] Yes, other -- specify ____

16. What is the language that this person first learned at home in childhood and still understands?

If this person no longer understands the first language learned, indicate the second language learned.
[] English
[] French
[] Other, specify ____

While most people in Canada view themselves as Canadians, information on their ancestral origins has been collected since the 1901 Census to capture the changing composition of Canada's diverse population. Therefore, this question refers to the origins of the person's ancestors.17. To which ethnic or cultural group(s) did this person's ancestors belong?

For example, Canadian, French, English, Chinese, Italian, German, Scottish, Irish, Cree, Micmac, Métis, Inuit (Eskimo), East Indian, Ukrainian, Dutch, Polish, Portuguese, Filipino, Jewish, Greek, Jamaican, Vietnamese, Lebanese, Chilean, Somali, etc.
Specify as many groups as applicable [below]
________

[p. 9]
[Space to fill out answers from questions on page 8 for household members 3 through 6.]
[p. 10]
18. Is this person an Aboriginal person, that is, North American Indian, Métis or Inuit (Eskimo)?

If "Yes," mark "x" the circle(s) that best describe(s) this person now.
[] No - continue with the next question
[] Yes, North American Indian - go to question 20
[] Yes, Métis - go to question 20
[] Yes, Inuit (Eskimo) - go to question 20

19. Is this person:

[Question 19 is asked of persons who are not aboriginal person, per question 18.]
Mark "x" more than one or specify, if applicable.
This information is collected to support programs that promote equal opportunity for everyone to share in the social, cultural and economic life of Canada.
[] White
[] Chinese
[] South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
[] Black
[] Filipino
[] Latin American
[] Southeast Asian (e.g., Cambodian, Indonesian, Laotian, Vietnamese, etc.)
[] Arab
[] West Asian (e.g., Afghan, Iranian, etc.)
[] Japanese
[] 15 Korean
[] 16 Other, specify ____

20. Is this person a member of an Indian Band/First Nation?

[] No
[] Yes, member of an Indian Band/First Nation - go to next line
[] Specify Indian Band/First Nation (for example, Musqueam) ____

21. Is this person a Treaty Indian or a Registered Indian as defined by the Indian Act of Canada?

[] No
[] Yes, Treaty Indian or Registered Indian

22. What is this person's religion?

Indicate a specific denomination or religion even if this person is not currently a practising member of that group.
For example, Roman Catholic, Ukrainian Catholic, United Church, Anglican, Lutheran, Baptist, Greek Orthodox, Jewish, Islam, Buddhist, Hindu, Sikh, etc.
[] Specify one denomination or religion only ____
[] No religion

[p. 11]
[Space to fill out answers from questions on page 10 for household members 3 through 6.]
[p. 12]
23. Answer questions 24 to 51 for each person aged 15 and over.
Continue only for each person aged 15 and over.

Mobility
24. Where did this person live 1 year ago, that is, on May 15, 2000?

Mark "x" one circle only.
Note: For those who mark circle 03: Please give the name of the city or town rather than the metropolitan area of which it is a part. For example: Saanich rather than Victoria (metropolitan area); St. Albert rather than Edmonton (metropolitan area); Laval rather than Montreal (metropolitan area).
[] Lived at the same address as now
[] Lived at a different address in the same city, town, village, township, municipality or Indian reserve
[] Lived in a different city, town, village, township, municipality or Indian reserve in Canada. [Fill out 04, 05, and 06 below.] Specify name of:
City, town, village, township, municipality or Indian reserve ____
Province/territory ____
Postal code _ _ _ _ _ _
[] Lived outside Canada [Fill out next line]
Specify name of country ____

25. Where did this person live 5 years ago, that is, on May 15, 1996?

Mark "x" one circle only.
Note: For those who mark circle 11: Please give the name of the city or town rather than the metropolitan area of which it is a part. For example: Saanich rather than Victoria (metropolitan area); St. Albert rather than Edmonton (metropolitan area); Laval rather than Montreal (metropolitan area).
[] Lived at the same address as now
[] Lived at a different address in the same city, town, village, township, municipality or Indian reserve
[] Lived in a different city, town, village, township, municipality or Indian reserve in Canada. [Fill out 04, 05, and 06 below.] Specify name of:
City, town, village, township, municipality or Indian reserve ____
Province/territory ____
[] Lived outside Canada [Fill out next line]
Specify name of country ____

[p. 13]
[Space to fill out answers from questions on page 12 for household members 3 through 6.]
[p. 14]
Remember, these questions are only for persons aged 15 and over.

Education
26. What is the highest grade of secondary (high school) or elementary school attended by this person (completed or not)?

Enter highest grade (1 to 13) for elementary and secondary school only, excluding kindergarten.
In the case where the person has attended secondary school in the province of Quebec, include the total number of years of elementary and secondary schooling.
Number (1 to 13) of grades of secondary or elementary school _ _
Or
[] Never attended school or attended kindergarten only

27. How many years of education has this person completed at university?

[] None
[] Less than 1 year (of completed courses)
[] Number of completed years at university _ _

28. How many years of schooling has this person ever completed at an institution other than a university, a secondary (high) school or an elementary school?

Include years of schooling at community colleges, technical institutes, CEGEPs (general and professional), private trade schools or private business colleges, diploma schools of nursing, etc.
[] None
[] Less than 1 year (of completed courses)
[] Number of completed years at community colleges, trade schools, CEGEPs, etc. _ _

29. In the past nine months (that is, since last September), was this person attending a school, college or university?

Include attendance at elementary or secondary schools, business or trade schools, community colleges, technical institutes, CEGEPs, etc., for courses that can be used as credits towards a certificate, diploma or degree.
Mark "x" one circle only.
[] No, did not attend in the past nine months
[] Yes, full time
[] Yes, part time, day or evening

[p. 15]
[Space to fill out answers from questions on page 14 for household members 3 through 6.]
[p. 16]
Remember, these questions are only for persons aged 15 and over.
30. What certificates, diplomas or degrees has this person ever obtained?

Include all qualifications obtained from secondary (high) schools, or trade schools and other postsecondary educational institutions.
Mark "x" as many circles as applicable.
[] None - go to question 32
[] Secondary (high) school graduation certificate or equivalent
[] Trades certificate or diploma
[] Other non-university certificate or diploma (obtained at community college, CEGEP, technical institute, etc.)
[] University certificate or diploma below bachelor level
[] Bachelor's degree(s) (e.g., B.A., B.Sc., LL.B.)
[] University certificate or diploma above bachelor level
[] Master's degree(s) (e.g., M.A., M.Sc., M.Ed.)
[] Degree in medicine, dentistry, veterinary medicine or optometry (M.D., D.D.S., D.M.D., D.V.M., O.D.)
[] Earned doctorate (e.g., Ph.D., D.Sc., D.Ed.)

31. What was the major field of study or training of this person's highest degree, certificate or diploma (excluding secondary or high school graduation certificates)?

For example, accounting, carpentry, civil engineering, history, legal secretary, welding, etc.
[Question 31 was asked of persons 15+ who have ever obtained certificates, diplomas or degrees, per question 30.]
Major field of study or training ________
Or
[] This person's highest qualification is a secondary (high) school graduation certificate

[p. 17]
[Space to fill out answers from questions on page 16 for household members 3 through 6.]
[p. 18]
Remember, these questions are only for persons aged 15 and over.

Place of birth of parents
32. Where was each of this person's parents born?

Mark "x" or specify country according to present boundaries.
(a) Father
[] Born in Canada
[] Born outside Canada, specify country ____
(b) Mother
[] Born in Canada
[] Born outside Canada, specify country ____

Household activitiesNote: Last week refers to Sunday, May 6 to Saturday, May 12, 2001.
In Question 33, report all time spent on each activity, even if two or more activities took place at the same time. See the Guide for examples.
33. Last week, how many hours did this person spend doing the following activities:

(a) Doing unpaid housework, yard work or home maintenance for members of this household, or others?
Some examples include: preparing meals, washing the car, doing laundry, cutting the grass, shopping, household planning, etc.
[] None
[] Less than 5 hours
[] 5 to 14 hours
[] 15 to 29 hours
[] 30 to 59 hours
[] 60 hours or more
(b) Looking after one or more of this person's own children, or the children of others, without pay?
Some examples include: bathing or playing with young children, driving children to sports activities or helping them with homework, talking with teens about their problems, etc.
[] None
[] Less than 5 hours
[] 5 to 14 hours
[] 15 to 29 hours
[] 30 to 59 hours
[] 60 hours or more
(c) providing unpaid care or assistance to one or more seniors?
Some examples include: providing personal care to a senior family member, visiting seniors, talking with them on the telephone, helping them with shopping, banking or with taking medicine, etc.
[] None
[] Less than 5 hours
[] 5 to 9 hours
[] 10 to 19 hours
[] 20 hours or more

[p. 19]
[Space to fill out answers from questions on page 18 for household members 3 through 6.]
[p. 20]
Remember, these questions are only for persons aged 15 and over.

Labor market activities
34. Last week, how many hours did this person spend working for pay or in self-employment?

Include: working for wages, salary, tips or commission; working in his/her own business, farm or professional practice, alone or in partnership; working directly towards the operation of a family farm or business without formal pay arrangements (e.g., assisting in seeding, doing accounts).
Number of hours (to the nearest hour) - go to Question 40 ____
[] None - continue with the next question

[Questions 35-39 were asked of persons who had not worked last week, per question 34.]
35. Last week, was this person on temporary lay-off or absent from his/her job or business?

Mark "x" one circle only.
[] No
[] Yes, on temporary lay-off from a job to which this person expects to return
[] Yes, on vacation, ill, on strike or locked out, or absent for other reasons

36. Last week, did this person have definite arrangements to start a new job within the next four weeks?

[] No
[] Yes

37. Did this person look for paid work during the past four weeks?

For example, did this person contact an employment centre, check with employers, place or answer newspaper ads, etc.?
Mark "x" one circle only.
[] No
[] Yes, looked for full-time work
[] Yes, looked for part-time work (less than 30 hours per week)

38. Could this person have started a job last week had one been available?

Mark "x" one circle only.
[] Yes, could have started a job
[] No, already had a job
[] No, because of temporary illness or disability
[] No, because of personal or family responsibilities
[] No, going to school
[] No, other reasons

39. When did this person last work for pay or in self-employment, even for a few days?

Mark "x" one circle only.
[] In 2001 - continue with the next question
[] In 2000 - continue with the next question
[] Before 2000 - go to Question 51
[] Never - go to Question 51

[p. 21]
[Space to fill out answers from questions on page 20 for household members 3 through 6.]
[p. 22]
Remember, these questions are only for persons aged 15 and over.Note: Questions 40 to 48 refer to this person's job or business last week. If this person held no job last week, answer for the job of longest duration since January 1, 2000. If this person held more than one job last week, answer for the job at which he/she worked the most hours.
[Questions 40-50 were asked of persons who have worked for pay after 2000, per question 39.]
40. For whom did this person work?

For self-employed persons, enter the name of their business. If the business does not have a name, enter the person's name.
Name of firm, government agency, etc. ________
Section, plant, department, etc. (if applicable) ________

41. What kind of business, industry or service was this?

Please be specific. For example: road maintenance, secondary school, municipal police, wheat farm, retail shoe store, temporary help agency, full-service garage, trapping.
Kind of business, industry or service ________
_ _ _ _

42. What was this person's work or occupation?

Please be specific. For example: legal secretary, plumber, fishing guide, wood furniture assembler, restaurant manager, secondary school teacher. (If in the Armed Forces, give rank.)
Occupation ________

43. In this work, what were this person's main activities?

Please give details. For example: prepared legal documents, installed residential plumbing, guided fishing parties, made wood furniture products, managed operations of a restaurant, taught mathematics.
Main activities ________
_ _ _ _

[p. 23]
[Space to fill out answers from questions on page 22 for household members 3 through 6.]
[p. 24]
Remember, these questions are only for persons aged 15 and over.
44. In this job or business, was this person mainly:

Mark "x" one circle only.
[] Working for wages, salary, tips or commission? - go to Question 46
[] Working without pay for his/her spouse or another relative in a family farm or business? - go to Question 46
[] Self-employed without paid help (alone or in partnership)?
[] Self-employed with paid help (alone or in partnership)?

45. If self-employed, was this person's farm or business incorporated?

[Question 45 was asked of persons 15+ who have worked for pay after 2000 and are mainly self-employed, per question 44.]
[] No
[] Yes

46. At what address did this person usually work most of the time?

Example: 365 (Number) Laurier (Name) Ave. (Type) West. If direction (e.g. North, South, East or West) is a part of the street address, please include it. If street address is unknown, specify the building or nearest street intersection.
Please give the name of the city or town rather than the metropolitan area of which it is a part. For example: Saanich rather than Victoria (metropolitan area); St. Albert rather than Edmonton (metropolitan area); Laval rather than Montréal (metropolitan area).
If the address of work is different than the address of the employer, please provide the address where this person actually works (e.g., school teachers should provide the address of their school, not the address of the school board).
[] Worked at home (including farms) - go to Question 48
[] Worked outside Canada - go to Question 48
[] No fixed workplace address - go to Question 47
[] Worked at the address specified below: Specify complete address
Street address (see example) ________
City, town, village, township, municipality or Indian reserve ____
Province/territory ____
Postal code _ _ _ _ _ _

[p. 25]
[Space to fill out answers from questions on page 24 for household members 3 through 6.]
[p. 26]
Remember, these questions are only for persons aged 15 and over.
47. How did this person usually get to work?

If this person used more than one method of transportation, mark the one used for most of the travel distance.
[] Car, truck or van - as driver
[] Car, truck or van - as passenger
[] Public transit (e.g., bus, streetcar, subway, light-rail transit, commuter train, ferry)
[] Walked to work
[] Bicycle
[] Motorcycle
[] Taxicab
[] Other method

48(a). In this job, what language did this person use most often?

[] English
[] French
[] Other, specify ____

48(b). Did this person use any other languages on a regular basis in this job?

[] No
[] Yes, English
[] Yes, French
[] Yes, other - specify ____

49. In how many weeks did this person work in 2000?

Include those weeks in which this person: was on vacation or sick leave with pay; worked full time or part time; worked for wages, salary, tips or commission; was self-employed; worked directly towards the operation of a family farm or business without formal pay arrangements.
[] None - go to Question 51
Or
[] Number of weeks ____

50. During most of those weeks, did this person work full time or part time?

[Question 50 was asked of persons 15+ who worked in 2000, per question 49.]
Mark "x" one circle only.
[] Full time (30 hours or more per week)
[] Part time (less than 30 hours per week)

[p. 27]
[Space to fill out answers from questions on page 26 for household members 3 through 6.]
[p. 28]
Income in 200051. During the year ending December 31, 2000, did this person receive any income from the sources listed below?

Answer "yes" or "no" for all sources.
If "yes," also enter the amount; in case of a loss, also mark "loss."
Do not include child tax benefits.
Paid employment:
(a) Total wages and salaries, including commissions, bonuses, tips, etc., before any deductions
[] Yes
Dollars ____ Cents _ _
[] No
Self-employment:
(b) Net farm income (gross receipts minus expenses), including grants and subsidies under farm-support programs, marketing board payments, gross insurance proceeds
[] Yes
Dollars ____ Cents _ _
[] Loss
[] No
(c) Net non-farm income from unincorporated business, professional practice, etc. (gross receipts minus expenses)
[] Yes
Dollars ____ Cents _ _
[] Loss
[] No
Income from government:
(d) Old Age Security Pension, Guaranteed Income Supplement and Spouse's Allowance from federal government only (provincial income supplements should be reported in (g))
[] Yes
Dollars ____ Cents _ _
[] No
(e) Benefits from Canada or Quebec Pension Plan
[] Yes
Dollars ____ Cents _ _
[] No
(f) Benefits from Employment Insurance (total benefits before tax deductions)
[] Yes
Dollars ____ Cents _ _
[] No
(g) Other income from government sources, such as provincial income supplements and grants, the GST/HST credit, provincial tax credits, workers' compensation, veterans' pensions, welfare payments. (Do not include child tax benefits.)
[] Yes
Dollars ____ Cents _ _
[] No
Other income:
(h) Dividends, interest on bonds, deposits and savings certificates, and other investment income, such as net rents from real estate, interest from mortgages
[] Yes
Dollars ____ Cents _ _
[] Loss
[] No
(i) Retirement pensions, superannuation and annuities, including those from RRSPs and RRIFs
[] Yes
Dollars ____ Cents _ _
[] No
(j) Other money income, such as alimony, child support, scholarships
[] Yes
Dollars ____ Cents _ _
[] No
Total income from all of the above sources:
[] Yes
Dollars ____ Cents _ _
[] Loss
[] No

[p. 29]
[Space to fill out answers from questions on page 28 for household members 3 through 6.]
[p. 30]

STEP F: Answer Questions H1 to H8 about this dwelling.
A dwelling is a separate set of living quarters with a private entrance from the outside or from a common hallway or stairway inside the building. This entrance should not be through someone else's living quarters.
H1. Who pays the rent or mortgage, taxes, electricity, etc., for this dwelling?

If more than one person contributes to such payments, mark "x" as many circles as apply.
[] Person 1
[] Person 2
[] Person 3
[] Person 4
[] Person 5
[] Person 6
[] A person who is listed on another questionnaire for this dwelling
[] A person who does not live here

H2. Is this dwelling:

Mark "x" one circle only.
[] Owned by you or a member of this household (even if it is still being paid for)?
[] Rented (even if no cash rent is paid)?

H3(a). How many rooms are there in this dwelling?

Include kitchen, bedrooms, finished rooms in the attic or basement, etc.
Do not count bathrooms, halls, vestibules and rooms used solely for business purposes.
Number of rooms ____

H3(b). How many of these rooms are bedrooms?

Number of bedrooms ____

H4. When was this dwelling originally built?

Mark the period in which the building was completed, not the time of any later remodelling, additions or conversions. If year is not known, give best estimate.
[] 1920 or before
[] 1921-1945
[] 1946-1960
[] 1961-1970
[] 1971-1980
[] 1981-1985
[] 1986-1990
[] 1991-1995
[] 1996-2001

H5. Is this dwelling in need of any repairs?

Do not include desirable remodelling or additions.
[] No, only regular maintenance is needed (painting, furnace cleaning, etc.)
[] Yes, minor repairs are needed (missing or loose floor tiles, bricks or shingles, defective steps, railing or siding, etc.)
[] Yes, major repairs are needed (defective plumbing or electrical wiring, structural repairs to walls, floors or ceilings, etc.)

[p. 31]

Answer Questions H6 to H8 for only the dwelling that you now occupy, even if you own or rent more than one dwelling. If the exact amount is not known, please give best estimate.
Note: If you are a farm operator living on the farm you operate, mark "x" here [] and go to Step G on next page.

H6. For this dwelling, what are the yearly payments (last 12 months) for:

(a) Electricity?
[] None
[] Included in rent or other payments
Or
[] Dollars ____ Cents __ per year
(b) Oil, gas, coal, wood, or other fuels?
[] None
[] Included in rent or other payments
Or
[] Dollars ____ Cents __ per year
(c) Water and other municipal services?
[] None
[] Included in rent or other payments
Or
[] Dollars ____ Cents __ per year

H7. For renters only:

What is the monthly rent paid for this dwelling?
[] Rented without payment of cash rent
Or
[] Dollars ____ Cents _ _

H8. For owners only, answer parts (a) through (f):

(a) What are the total regular monthly mortgage or loan payments for this dwelling?
[] None, go to part (c)
Or
[] Dollars ____ Cents _ _ per month
(b) Are the property taxes (municipal and school) included in the amount shown in part (a)?
[] Yes, go to part (d)
[] No
(c) What are the estimated yearly property taxes (municipal and school) for this dwelling?
[] None
Or
[] Dollars ____ Cents _ _ per month
(d) If you were to sell this dwelling now, for how much would you expect to sell it?
Dollars ____
(e) Is this dwelling part of a registered condominium?
[] Yes, continue to part (f)
[] No, go to Step G on next page
(f) What are the monthly condominium fees?
[] None
Or
[] Dollars ____ Cents _ _ Cents per month

[p. 32]

STEP G: You have now completed your questionnaire. Please mail it today. Thank you for your cooperation.

Comments ________

The law protects what you tell us

The confidentiality of your census questionnaire is protected by law. All Statistics Canada employees have taken an oath of secrecy. Your personal census information
cannot be given to anyone outside Statistics Canada -- not the police, not another government department, not another person. This is your right.
Your census questionnaire will be retained in accordance with legislative requirements
and will be stored securely. You can ask to see the information you gave about yourself on your 2001 Census questionnaire after November 2001. To do this, write to the Privacy Coordinator, Statistics Canada, 25th Floor, R.H. Coats Building, Ottawa, Ontario K1A 0T6.