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29 April
Count Me In
Census 2001
[United Kingdom]

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?

A whole house or bungalow that is:
[] Detached
[] Semi-detached
[] Terraced (including end-terrace)
A flat, maisonette, or apartment that is:
[] In a purpose-built block of flats or tenement
[] Part of a converted or shared house (includes bet-sits)
[] In a commercial building (for example, in an office building, or hotel, or over a shop)
Mobile or temporary structure:
[] A caravan or other mobile or temporary structure

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

This means that all the rooms, including the kitchen, bathroom and toilet are behind a door that only your household can use.

[] Yes, all the rooms are behind a door that only our household can use
[] No

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

Do not count bathrooms, toilets, halls or landings, or rooms that can only be used for storage such as cupboards.
Do not count all other rooms, for example kitchens, living rooms, bedrooms, utility rooms and studies.
If tow rooms have been converted into one, count them as one room.

Number of rooms _ _

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

[] Yes
[] No

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

[] Basement or semi-basement
[] Ground floor (street level)
[] First floor (floor above street level)
[] Second floor
[] Third or fourth floor
[] Fifth floor or higher

H6. Does your accommodation have central heating?

If you have central heating available, [check] 'Yes" whether or not you use it.
Central heating includes:
- gas, oil or solid fuel central heating
- night storage heaters
- warm air heating
- underfloor heating

[] Yes, in some or all rooms
[] No

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

Include any company car or van if available for private use.

[] None
[] One
[] Two
[] Three
[] Four or more, please write in number _ _

H8. Does your household own or rent the accommodation?

[Check] one box only.

[] Owns outright -- Go to H10
[] Owns with a mortgage or loan -- Go to H10
[] Pays part rent and part mortgage (shared ownership) -- Go to H10
[] Rents -- Go to H9
[] Lives rent free -- Go to H9

H9. Who is your landlord?

[Question H9 applies to rented and free-of-charge dwellings.]

[] Council (Local Authority)
[] Housing Association, Housing Co-operative, Charitable Trust, Registered Social Landlord
[] Private landlord or letting agency
[] Employer of a household member
[] Relative or friend of a household member
[] Other

[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?

[Question H10 is asked of households in Scotland who pay rents or lives rent-free, per question H8.]

[] Furnished
[] 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]

[] Husband or wife
[] Partner
[] Son or daughter
[] Step-child
[] Brother or sister
[] Mother or father
[] Step-mother or step-father
[] Grandchild
[] Grandparent
[] Other related
[] Unrelated

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)

First name and surname ________

2. What is your sex?

[] Male
[] Female

3. What is your date of birth?

Day _ _ Month _ _ Year _ _ _ _

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

[] Single (never married)
[] Married (first marriage)
[] Re-married
[] Separated (but sill legally married)
[] Divorced
[] Widowed

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

[] Yes -- Go to 6
[] No -- Go to 7

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

Only answer this question if you have answered 'Yes' to Question 5. [Question 6 was asked of full-time students or schoolchildren.]

[] Yes, I live at this address during the school/college/university term -- Go to 7
[] No, I live elsewhere during the school/college/university term -- Go to 36

7. What is your country of birth?

[] England
[] Wales
[] Scotland
[] Northern Ireland
[] Republic of Ireland
[] Elsewhere, please write in the present name of the country ________

8. What is your ethnic group?

Choose one section from A to E, then [check] the appropriate box to indicate your cultural background.

A White
[] British
[] Irish
[] Any other White background, please write in ________
B Mixed
[] White and Black Caribbean
[] White and Black African
[] White and Asian
[] Any other Mixed background, please write in ________
C Asian or Asian British
[] Indian
[] Pakistani
[] Bangladeshi
[] Any other Asian background, please write in ________
D Black or Black British
[] Caribbean
[] African
[] Any other Black background, please write in ________
E Chinese or other ethnic group
[] Chinese

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

10. What is your religion?

This question is voluntary.
[Check] one box only.

[] None
[] Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
[] Buddhist
[] Hindu
[] Jewish
[] Muslim
[] Sikh
[] Any other religion, please write in ________

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

[] Good?
[] Fairly good?
[] Not good?

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?

Do not count anything you do as part of your paid employment.
[Check] time spent in a typical week.

[] No
[] Yes, 1-19 hours a week
[] Yes, 10-49 hours a week
[] Yes, 50+ hours a week

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?

Include problems which are due to old age.

[] Yes
[] No

14. What was your usual address one year ago?

If you were a child at boarding school or a student one year ago, give the address at which you were living during the school/college/university term.
For a child born after 29 April 2000, [check] 'No usual address one year ago'.

[] The address shown on the front of the form
[] No usual address one year ago
[] Elsewhere, please write in below ________
Post code _ _ _ _ - _ _ _

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?

[Check] all the qualifications that apply or, if not specified, the nearest equivalent.

[] 1+ O levels/CSEs/GCSEs (any grades)
[] 5+ O levels, 5+ CSEs (grade 1), 5+ GCSEs (grades A-C), School Certificate
[] 1+ A levels/AS levels
[] 2+ A levels, 4+ AS levels, Higher School Certificate
[] First Degree (eg BA, BSc)
[] Higher Degree (eg MA, PhD, PGCE, post-graduate certificates/diplomas)
[] NVQ Level 1, Fountain GNVQ
[] NVQ Level 2, Intermediate GNVQ
[] NVQ Level 3, Advanced GNVQ
[] NVQ Levels 4-5, HNC, HND
[] Other Qualifications (eg City and Guilds, RSA/OCR, BTEC/Edexcel)
[] No Qualifications

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

[Check] all the boxes that apply.

[] No professional Qualifications
[] Qualifies Teacher Status (for schools)
[] Qualified Medical Doctor
[] Qualified Dentist
[] Qualified Nurse, Midwife, Health visitor
[] Other 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?

[Check] 'Yes' if away from work ill, on maternity leave, on holiday or temporarily laid off.
[Check] 'Yes' for any paid work, including casual or temporary work, even if only for one hour.
[Check] 'Yes' if you worked, paid or unpaid, in your own/family business.

[] Yes -- Go to 24
[] No -- Go to 19

[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?

[] Yes
[] No

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

[] Yes
[] No

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

[] Yes
[] No

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

[Check] all boxes that apply.

[] Retired
[] Student
[] Looking after home/family
[] Permanently sick/disabled
[] None of the above

23. Have you ever worked?

[] Yes, please write in the year you last worked _ _ _ _ -- Go to 24
[] No, have never worked -- Go to 36

[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?

[] Employee
[] Self-employed with employees
[] Self-employed/freelance without employees

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

If you are (were) self-employed, [check] to show how many people you employ (employed).

[] 1-9
[] 10-24
[] 25-499
[] 500 or more

Person [number] - continued

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

For example, Primary School Teacher, State Registered Nurse, Car Mechanic, Television Service Engineer, Benefits Assistant.
Civil Servants, Local Government Officers - give job title not grade or pay band.
________

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

________

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

A supervisor or foreman is responsible for overseen the work of other employees on a day-to-day basis.

[] Yes
[] No

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

For example, Making Shoes, Repairing Cars, Secondary Education, Food Wholesale, Clothing Retail, Doctor's Surgery.
If you are (were) self-employed/freelance or have (had) your own business, what is (was) the nature of your business?
Civil Servants, Local Government Officers - please specify your Department.

________

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?

If you have your own business, write in the name.

________
[] Self-employed/freelance
[] Work for a private individual
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?

[Check] one box only.
[Check] the box for the longest part, by distance, of your usual journey to work.

[] Work mainly at or from home
[] Underground, metro, light rail, tram
[] Train
[] Bus, minibus or coach
[] Motor cycle, scooter or moped
[] Driving a car or van
[] Passenger in a car or van
[] Taxi
[] Bicycle
[] On foot
[] Other

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.

Number of hours worked a week _ _

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?

[Question 16 was asked of persons in Scotland.]

[] Understand spoken Gaelic
[] Speak Gaelic
[] Read Gaelic
[] Write Gaelic
[] None of these

[From Wales enumeration form]

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

[Question 16 was asked of persons in Wales.]

Check all the boxes that apply.

[] Understand spoken Welsh
[] Speak Welsh
[] Read Welsh
[] Write Welsh
[] None of these

[From Northern Ireland enumeration form]

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

[Question 16 was asked of persons in Northern Ireland.]

Check all the boxes that apply.

[] Understand spoken Irish
[] Speak Irish
[] Read Irish
[] Write Irish
[] None of these