Count Me In
- 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.
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.
Registrar General for England and Wales
- 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.
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.
- 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]
- 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.
 Terraced (including end-terrace)
 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)
 Yes, all the rooms are behind a door that only our household can use
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 _ _
 Ground floor (street level)
 First floor (floor above street level)
 Second floor
 Third or fourth floor
 Fifth floor or higher
Central heating includes:
- gas, oil or solid fuel central heating
- night storage heaters
- warm air heating
- underfloor heating
 Yes, in some or all rooms
 Four or more, please write in number _ _
 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?
 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
[From Scotland enumeration form.]
- 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.
- 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).]
Relationship of Person [number] to Person -- [number]
 Son or daughter
 Brother or sister
 Mother or father
 Step-mother or step-father
 Other related
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.]
2. What is your sex?
 Married (first marriage)
 Separated (but sill legally married)
 No -- Go to 7
 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
 Northern Ireland
 Republic of Ireland
 Elsewhere, please write in the present name of the country ________
 Any other White background, please write in ________
 White and Black African
 White and Asian
 Any other Mixed background, please write in ________
 Any other Asian background, please write in ________
 Any other Black background, please write in ________
[Check] one box only.
 Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
 Any other religion, please write in ________
 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?
[Check] time spent in a typical week.
 Yes, 1-19 hours a week
 Yes, 10-49 hours a week
 Yes, 50+ hours a week
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
 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?
 No professional Qualifications
 Qualifies Teacher Status (for schools)
 Qualified Medical Doctor
 Qualified Dentist
 Qualified Nurse, Midwife, Health visitor
 Other Professional Qualifications
[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
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?
 Looking after home/family
 Permanently sick/disabled
 None of the above
 No, have never worked -- Go to 36
 Self-employed with employees
 Self-employed/freelance without employees
 500 or more
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?
30. What is (was) the business of the employer at the place where you work (worked)?
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.
32. What is the full name of the organization you work for in your main job?
 Work for a private individual
Post-code _ _ _ _ - _ _ _
 Mainly work at or from home
 Offshore installation
 No fixed place
[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
 Bus, minibus or coach
 Motor cycle, scooter or moped
 Driving a car or van
 Passenger in a car or van
 On foot
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.
 Understand spoken Gaelic
 Speak Gaelic
 Read Gaelic
 Write Gaelic
 None of these
Check all the boxes that apply.
 Understand spoken Welsh
 Speak Welsh
 Read Welsh
 Write Welsh
 None of these
Check all the boxes that apply.
 Understand spoken Irish
 Speak Irish
 Read Irish
 Write Irish
 None of these