Questionnaire Text

Questionnaire form view entire document:  text  image
How many people are living or staying at this address?
- Include everyone who is living or staying here for more than 2 months.
- Include yourself if you are living here for more than 2 months.
- Include anyone else staying here who does not have another place to stay, even if they are here for 2 months or less.
- Do not include anyone who is living somewhere else for more than 2 months, such as a college student living away or someone in the Armed Forces on deployment.
Number of people _ _
Fill out pages 2, 3, and 4 for everyone, including yourself, who is living or staying at this address for more than 2 months. Then complete the rest of the form.

2. How is this person related to person 1?

[x] Person 1

2. How is this person related to person 1?

[] Husband or wife
[] Biological son or daughter
[] Adopted son or daughter
[] Stepson or stepdaughter
[] Brother or sister
[] Father or mother
[] Grandchild
[] Parent-in-law
[] Son-in-law or daughter-in-law
[] Other relative
[] Roomer or boarder
[] Housemate or roommate
[] Unmarried partner
[] Foster child
[] Other nonrelative
Questionnaire instructions view entire document:  text  image
Answer person questions 1 through 6 for the first five people listed on pages 2,3, and 4 of the questionnaire.

2. If the person is related to Person 1 by birth, marriage, or adoption, but is not the ''husband or wife,'' ''biological son or daughter,'' ''adopted son or daughter,'' ''stepson or stepdaughter,'' ''brother or sister,'' ''father or mother,'' ''grandchild,'' ''parent-in-law,'' ''son-in-law or daughter-in-law,'' of person 1, mark the "other relative" box. Therefore, a niece or nephew of Person 1 would be categorized as "other relative."

If a person is not related to Person 1, mark the applicable box. A "roomer or boarder" is someone who occupies room(s) and makes cash or non-cash payment(s). A "housemate or roommate" is someone sharing the house/apartment (but who is not romantically involved) with Person 1. An "unmarried partner," also known as a domestic partner, is a person who shares a close personal relationship with Person 1. A "foster child" is someone under the age of 21 who is involved in the formal foster care system. For all other people who are not related to person 1, mark the "other nonrelative" box.