Questionnaire Text

Questionnaire form view entire document:  text  image
Person 1
(Person 1 is the person living or staying here in whose name this house or apartment is owned, being bought, or rented. If there is no such person, start with the name of any adult living or staying here.)

2. How is this person related to Person 1?

[X] Person 1

[Repeat for persons X = 2 - 5.]

2. How is this person related to Person 1?

Mark (X) one box.

[] Opposite-sex husband/wife/spouse
[] Opposite-sex unmarried partner
[] Same-sex husband/wife/spouse
[] Same-sex unmarried partner
[] 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
[] Roommate or housemate
[] Foster child
[] Other nonrelative

[Repeat for Persons Y = 6 - 12.]

Questionnaire instructions view entire document:  text  image
Person questions 1-6

Answer questions 1-6 for the first five people 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.

P2. If the person is in an intimate relationship with Person 1, such as a boyfriend or girlfriend, mark the ''opposite-sex unmarried partner'' or ''same-sex unmarried partner'' box.

An ''other relative'' is someone related to Person 1 by birth, marriage, or adoption, but "not" one of the options listed -- for example, a niece or nephew. If a foster child is related to Person 1, include in the appropriate relative category, such as ''grandchild,'' or include in the ''other relative'' category.

A ''foster child'' is someone under the age of 21 who is involved in the formal foster care system.

If the person is not related to Person 1 and is not one of the options listed, mark the "other nonrelative" box.