England Household Form

Census Helpline 0845 301 2001
Text Phone for the Deaf 0845 303 2001
Website www.statistics.gov.uk

Name ________
Address ________
Post-code _ _ _ _ - _ _ _
CD _ _ _ _ _ _
ED _ _ _ _
Form Number _ _ _ _

• Form 1 of _
• Multi-form households only

To the Householder, Joint Householders or members of the household aged 16 or over
The Census is a count every ten years of all people and households in the country. Census information is used by central and local government, health authorities and many other organisations to allocate resources and plan services for everyone. The Office for National Statistics conducts the Census in England and Wales.
Completing your form
Completion of the Census form is compulsory under the Census Act 1920. If you refuse to complete it, or give false information, you may be liable to a fine. This liability does not apply to question 10 on religion. The requirement for you to return a completed form will not be satisfied until such a form has been received. If you need help please contact the Census Helpline.
Confidentiality
The information you provide is protected by law and treated in strict confidence. The information is only used for statistical purposes, and anyone using or disclosing Census information improperly will be liable to prosecution. Census forms will be held securely. Under the current terms of the Public Records Act 1958, the data will be treated as confidential for a period of 100 years.
Thank you for counting yourself in.
[Signed]
Len Cook
Registrar General for England and Wales

What you have to do

• Your household should complete this form in black or blue ink. A household is:

• one person living alone, or
• a group of people (not necessarily related) living at the same address with common housekeeping - sharing either a living room or sitting room, or at least one meal a day.

• This form covers five people. If there are more than five people in your household you will need an extra form.
• Identify household members in Table 1 (page 2). It will help you to complete the form if you use Table 2 to identify visitors.
• Answer the questions about your accommodation (page 3).
• Complete the relationship question (pages 4 and 5).
• Answer the remaining questions for every member of your household.
• Sign the Declaration and post the form back in the enveloped supplied.

For help or extra forms, call the Census helpline on 0845 301 2001 (local rate number).

Declaration
To be signed after completing this form. Please check that you have not missed any pages or questions.
This form is completed to the best of my knowledge and belief.
Signature/s ________
Date ____

Table 1 Household Members

• List all members of your household who usually live at this address, including yourself.

• Start wit the Householder or Joint Householders.
• Include anyone who is temporarily away from home on the night of 29 April 2001 who usually lives at this address.
• Include schoolchildren and students if they live at this address during the school, college or university term.
• Also include schoolchildren and students who are away from home during the school, college or university term and for whom only basic information is required.
• Include any baby born before 30 April 2001, even if still in hospital.
• Include people with more than one address if they live at this address for the majority of the time
• Include anyone who is staying with you who has no other usual address
• Remember to include a spouse or partner who works away from home, or is a member of the armed forces, and usually lives at this address.

• If any member of your household aged 16 or over requires a separate form for privacy reasons, please contact the Census Helpline and [check] the relevant box in the column marked 'Individual Form'.

[Below is a table with three columns labeled "Person No.," "First name and surname," and "Individual Form." The rows in the first column have the labels "Person 1" through "Person 10", with the phrase "If you have more than 5 people in your household, you will need an extra form" following "Person 5." The rows in the second column have space for the name and last name of the household members. The rows in the third column have boxes to be checked in case any individual requires and Individual Form]

Table 2 Visitors

• To help you complete the form you may use Table 2 to list any visitors at this address, on the night of 29 April 2001, who usually live elsewhere.
• If there are only visitors at this address, please complete questions H1 to H5 on page 3. No further questions need to be answered.

[Below is a table with two columns labeled "First name and surname" and "Usual address" followed by 5 rows for names to be filled.]

How to complete the remaining questions
Remember to use black or blue ink.
Put a tick in the appropriate box, like this [example]. If you mark the wrong box, fill in the box and put a tick in the right one, like this [example].
When you are required to write in an answer please use capital letters and leave one space between each word. Start a new line if a word will not fit.

[Example omitted]

Household Accommodation

H1. What type of accommodation does your household occupy?

H2. Is your household's accommodations self-contained?

H3. How many rooms do you have for use only by your household?

H4. Do you have a bath/shower and toilet for use only by your household?

H5. What is the lowest floor level of your household's living accommodation?

H6. Does your accommodation have central heating?

H7. How many cars or vans are owned, or available for use, by one or more members of your household?

H8. Does your household own or rent the accommodation?

H9. Who is your landlord?

[Question H10 applies to totally or partially owned dwellings]
H10. Please turn page [continue with person questionnaire]

[From Scotland enumeration form.]

H10. Is the accommodation provided furnished or unfurnished?

Household members and their relationships within the household

• The example below shows how to provide the relationship information for John Smith, his wife (Mary) and their three children (Alison, Steven and James).
• In this example, Steven's (Person 4) relationship to Person 1 is son, to Person 2 is son and to Person 2 is brother.

[example omitted]

• Use the same order and person numbers as in Table 1 (page 2), starting with Person 1.
• Print the name of each household member in the space at the top of each column.
• [Check] a box to show the relationship of each person to each of the other members of your household.
• Include relationship information for household members who require and Individual Form for privacy reasons. Questions on the following pages should be left blank for these people.

[Below there is a table with five columns labeled "Name of Person 1" through "Name of Person 5." The first column has space provided for the person's name, but no space for relationship. Columns 2 to 5 have a list of options for relationship - listed below - with respect to the preceding persons (e.g., person 3 is to indicate it's relationship to persons 1 and 2).]

Name of Person [number]
____ First name
____ Surname

Relationship of Person [number] to Person -- [number]

Remaining questions should be answered by each member of your household in the same order as Table 1 (page 2 of this Form). Where a household member is completing an Individual Form for privacy reasons, the remaining questions for this person should be left blank.

[The following 15 pages contain the person questions for five persons. We reproduce only one for convenience.]

Person [number]

[Questions 1 - 5 were asked of all persons.]

1. What is your name? (Person [number] in Table 1)

2. What is your sex?

[] Male
[] Female

3. What is your date of birth?

4. What is your marital status (on 29 April 2001)?

5. Are you a schoolchild or student in full-time education?

6. Do you live at the address shown on the front of this form during the school, college or university term?

7. What is your country of birth?

8. What is your ethnic group?

9 This question is not applicable in England. -- Go to 10

10. What is your religion?

11. Over the last twelve months would you say your health has on the whole been:

12. Do you look after, or give any help or support to family members, friends, neighbors or other because of:
- long- term physical or mental ill-health or disability, or
- problems related to old age?

Person [number] - continued

13. Do you have any long-term illness, health problem or disability which limits your daily activities or the work you can do?

14. What was your usual address one year ago?

15. If you are aged 16 to 74 -- Go to 16
If you are aged 15 and under, or 75 and over -- Go to 36

[Questions 16 - 35 were asked of people age 16 to 74.]

16. Which of these qualifications do you have?

17. Do you have any of the following professional qualifications?

18. Last week, were you doing any work:
- as an employee, or on a Government sponsored training scheme,
- as self-employed/freelance, or in your own/family business?

[Questions 19 - 23 were asked of persons who were not doing any work last week.]

19. Were you actively looking for any kind of paid work during the last 4 weeks?

20. If a job had been available last week, could you have started it within 2 weeks?


21. Last week, were you waiting to start a job already obtained?

22. Last week, were you any of the following?

23. Have you ever worked?

[Questions 24 - 35 were asked of persons who are currently working or have ever worked.]

24. Answer the remaining questions for the main job you were doing last week, or if not working last week, your last main job.
Your main job is the job in which you usually work the most hours.

25. Do (did) you work as an employee or are (were) you self-employed?

26. How many people work (worked) for your employer at the place where you wok (worked)?

Person [number] - continued

27. What is (was) the full title of your main job?

28. Describe what you do (did) in your main job.


29. Do (did) you supervise any other employees?


30. What is (was) the business of the employer at the place where you work (worked)?

31. If you were working last week -- Go to 32
If you were not working last week -- Go to 36

[Questions 32 - 35 were asked of persons who were working last week.]

32. What is the full name of the organization you work for in your main job?

33. What is the address of the place where you work in your main job?

If you report to a depot, write in the depot address.

________
Post-code _ _ _ _ - _ _ _
[] Mainly work at or from home
[] Offshore installation
[] No fixed place

34. How do you usually travel to work?

35. How many hours a week do you usually work in your main job?
Answer to nearest whole hour.
Give average for last four weeks.

36. There are no more questions for Person [number]

Go to questions for Person [next number].

If there are no more people in your household you do not need to answer any more questions. Please leave the following pages blank.

Remember to sign the Declaration on page 1.

[From Scotland enumeration form.]

16. Can you understand, speak, read, or write Scottish Gaelic?

[From Wales enumeration form]

9. Can you understand, speak, read, or write Welsh?

[From Northern Ireland enumeration form]

9. Can you understand, speak, read, or write Irish?