1. Regional

Officecode

U.

S.

DEPARTMENT OF COMMERC

E

BUREAU OF THE CENSUS

2. CONTROL NUMBER

PSU code Segment

number

Segment number suffix

Sampledesignation

3a. HH No. 3b. CU No. 4. Interview No.

NOTE: Office staff should complete transcription items 1–4 below for interviewed CU’s only.

Q

23

45

U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

ACTING AS COLLECTING AGENT FOR

U.S. DEPARTMENT OF LABOR

BUREAU OF LABOR STATISTICS

QUESTIONNAIRE

QUARTERLY INTERVIEW SURVEY

CONSUMER EXPENDITURE SURVEYS

Serialnumber

Serialsuffix

Checkdigit

U.S. CENSUS BUREAU
Section 1 – GENERAL SURVEY INFORMATION

FORM CE-302(4-1-2001)

NOTICE – Youonly by sworn 

7. RECORD OF IN

Activity

InterviewingField RepresentatiOffice editOffice transcriptio

8. QUESTIONNA

a. Enter the li

code 99 for 

b. Enter the li

c. In answerin

expense bo

d. If any bills, 

cost inform

9. LAST SECTION 

1 01 25 3

0670

0660 Li

0690 0680 

Mark (X) on

AlwaysAlmost 

0760 1

2

0770 1 Bills

07800790

0850

 Part A – Field Representative Records

1.

Mark (X) all 

5. RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.

OFFICE USE ONLY

2. 3a. 3b. 4.

1234

5678

0020004000600080

0100012001400160

9

101112

0180020002200240

0250

Call Reason REASON FOR

TELEPHONE CONTACT

1 Telephone call

to collect data

2 Telephone call to

scheduleappointment

3 Other telephone 

call

Call Call Reason Reason

4 Personal visit to collect data5 Personal visit to schedule appointment6 Other personal visit

6. RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for REASON FOR VISIT

reason of visit from list of codes at right.

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 1

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

234

0270030003300360

0280031003400370

Trip Time Reason OFFICE USE

ONLY

BeganEnded

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a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

678

0390042004500480

0400043004600490

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 9

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

101112

0510054005700600

0520055005800610

RegionalOffice code

Control number

PSU code Segment No. Sample designation Serial No. Segment number suffix

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the respondethe last section 

(a) (b) (c) (a) (b) (c) (a) (b) (c)

(a) (b) (a) (b) (a) (b)

Check digit

Section 1
Section 1 – GENERAL SURVEY INFORMATION

FORM CE-302(4-1-2001)

NOTICE – Youonly by sworn 

7. RECORD OF IN

Activity

InterviewingField RepresentatiOffice editOffice transcriptio

8. QUESTIONNA

a. Enter the li

code 99 for 

b. Enter the li

c. In answerin

expense bo

d. If any bills, 

cost inform

9. LAST SECTION 

1 01 25 3

0670

0660 Li

0690 0680 

Mark (X) on

AlwaysAlmost 

0760 1

2

0770 1 Bills

07800790

0850

 Part A – Field Representative Records

1.

Mark (X) all 

5. RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.

OFFICE USE ONLY

2. 3a. 3b. 4.

1234

5678

0020004000600080

0100012001400160

9

101112

0180020002200240

0250

Call Reason REASON FOR

TELEPHONE CONTACT

1 Telephone call

to collect data

2 Telephone call to

scheduleappointment

3 Other telephone 

call

Call Call Reason Reason

4 Personal visit to collect data5 Personal visit to schedule appointment6 Other personal visit

6. RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for REASON FOR VISIT

reason of visit from list of codes at right.

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 1

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

234

0270030003300360

0280031003400370

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 5

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

678

0390042004500480

0400043004600490

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 9

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

101112

0510054005700600

0520055005800610

RegionalOffice code

Control number

PSU code Segment No. Sample designation Serial No. Segment number suffix

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the respondethe last section 

(a) (b) (c) (a) (b) (c) (a) (b) (c)

(a) (b) (a) (b) (a) (b)

Check digit
Section 1 – GENERAL SURVEY INFORMATION

FORM CE-302(4-1-2001)

NOTICE – Youonly by sworn 

7. RECORD OF IN

Activity

InterviewingField RepresentatiOffice editOffice transcriptio

8. QUESTIONNA

a. Enter the li

code 99 for 

b. Enter the li

c. In answerin

expense bo

d. If any bills, 

cost inform

9. LAST SECTION 

1 01 25 3

0670

0660 Li

0690 0680 

Mark (X) on

AlwaysAlmost 

0760 1

2

0770 1 Bills

07800790

0850

 Part A – Field Representative Records

1.

Mark (X) all 

5. RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.

OFFICE USE ONLY

2. 3a. 3b. 4.

1234

5678

0020004000600080

0100012001400160

9

101112

0180020002200240

0250

Call Reason REASON FOR

TELEPHONE CONTACT

1 Telephone call

to collect data

2 Telephone call to

scheduleappointment

3 Other telephone 

call

Call Call Reason Reason

4 Personal visit to collect data5 Personal visit to schedule appointment6 Other personal visit

6. RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for REASON FOR VISIT

reason of visit from list of codes at right.

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 1

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

234

0270030003300360

0280031003400370

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 5

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

678

0390042004500480

0400043004600490

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 9

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

101112

0510054005700600

0520055005800610

RegionalOffice code

Control number

PSU code Segment No. Sample designation Serial No. Segment number suffix

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the respondethe last section 

(a) (b) (c) (a) (b) (c) (a) (b) (c)

(a) (b) (a) (b) (a) (b)

Check digit
Section 1 – GENERAL SURVEY INFORMATION

FORM CE-302(4-1-2001)

NOTICE – Youonly by sworn 

7. RECORD OF IN

Activity

InterviewingField RepresentatiOffice editOffice transcriptio

8. QUESTIONNA

a. Enter the li

code 99 for 

b. Enter the li

c. In answerin

expense bo

d. If any bills, 

cost inform

9. LAST SECTION 

1 01 25 3

0670

0660 Li

0690 0680 

Mark (X) on

AlwaysAlmost 

0760 1

2

0770 1 Bills

07800790

0850

 Part A – Field Representative Records

1.

Mark (X) all 

5. RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.

OFFICE USE ONLY

2. 3a. 3b. 4.

1234

5678

0020004000600080

0100012001400160

9

101112

0180020002200240

0250

Call Reason REASON FOR

TELEPHONE CONTACT

1 Telephone call

to collect data

2 Telephone call to

scheduleappointment

3 Other telephone 

call

Call Call Reason Reason

4 Personal visit to collect data5 Personal visit to schedule appointment6 Other personal visit

6. RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for REASON FOR VISIT

reason of visit from list of codes at right.

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 1

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

234

0270030003300360

0280031003400370

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 5

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

678

0390042004500480

0400043004600490

Trip Time Reason OFFICE USE

ONLY

BeganEnded

a.m.p.m. 9

a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.a.m.p.m.

BeganEndedBeganEndedBeganEnded

101112

0510054005700600

0520055005800610

RegionalOffice code

Control number

PSU code Segment No. Sample designation Serial No. Segment number suffix

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the respondethe last section 

(a) (b) (c) (a) (b) (c) (a) (b) (c)

(a) (b) (a) (b) (a) (b)

Check digit
Section 1 – GENERAL SURVEY INFORMATION – Continued

Part A.1 – Consumer Unit and Reference Period Explanations

1. Consumer Unit

Page 2 FORM CE-302

Section 1 – Part A.1

During this interview, I will use the wordsconsumer unit or CU. A consumer unit is the(person/group of persons) in this household who(is/are) independent of all other persons in thishousehold for payment of their major expenses.

2.

Most questions that I will be asking refer to aspecific time period. During this interview, thetime period, unless I state otherwise, is for thepast three months, that is, from the first day of(Month, three months previous to this month) totoday.

FIELD REPRESENTATIVE NOTE: Read the following paragraphs (control card items 23f and 35b) ONLY if you have NOT read them already.

The person(s) I’m including in your CU (is/are):(READ NAMES OF ALL PERSONS LISTED IN CONTROLCARD ITEM 18 WITH THE SAME CU MARKED INCONTROL CARD ITEM 23g.)

Reference Period
Section 1 

– GENERAL SURVEY INFORMATION 

– Continued

Part B

– General Housing Characteristics

– For New Consumer Units Only (For Returning Consumer Units, Go to Secti

3.

Ask if not apparent byobservation.Which best describes thisbuilding?

b. How many half bathrooms are

there in this unit?

5. How many rooms are there in

this unit, including allfinished living areas andexcluding all bathrooms?

0100

0040 01 Single family detached (detached

structure with only one primaryresidence; however, the structure couldinclude a rental unit(s) in the basement,attic, etc.)Other – Specify and go to item 4

Page 3 FORM CE-302

Information Booklet,page 5

1102 Row or townhouse – inner unit (2, 3, or 4

story structure with 2 walls in commonwith other units and a private groundlevel entrance; it may have a rental unitas part of the structure)

03 End row or end townhouse (one common

wall)

04 Duplex (detached two unit structure with

one common wall between the units)

05 3-plex or 4-plex (3 or 4 unit structure with

all units occupying the same level orlevels) – Go to item 5

06 Garden (a multi-unit structure, usually

wider than it is high, having 2, 3, orpossibly 4 floors; characteristically theunits not only have common walls butare also stacked on top of one another) –Go to item 5

07 High-rise (a multi-unit structure which

has 4 or more floors) – Go to item 5

08 Apartment or flat (a unit not described

above; could be located in the basement,attic, second floor, or over the garage ofone of the units described above) –Go to item 5

09 Mobile home or trailer – Go to item 510 College dormitory – Go to section 1, part C

4. What is the approximate

size of the lot on whichthis unit is located?

Lot size (approximate acreage)

0050 01

0203040506

1 acre or less – 43,560 sq. ft.2 acres – 87,120 sq. ft.3 to 5 acres6 to 10 acresGreater than 10 acresNo lot

0060

0 None

01 Gas (underground piping)

Number

6. How many bedrooms are

there in this unit? 0070 Number

7a.

Count all rooms used MAINLYfor sleeping, even if also usedfor other purposes.

0 None

How many completebathrooms are there in thisunit?

0080 Number

A COMPLETE BATHROOM hasa toilet, a bathtub or shower,and a sink, all with runningwater.

0 None

0090 Number

A HALF BATHROOM has atleast a toilet OR bathtub orshower, but does not have allthe facilities of a completebathroom.

X

8. What fuel is used most for –

b. Heating water in this unit?

0110

c. Cooking?

FIELD REPRESENTATIVE – Complete part B for new 

Booklet with instructions 

0120

1a.

Ask if not apparent.Is this house in a publichousing project, that is, is it owned by a local housing authority or otherlocal public agency?

b. If NO – Are your housing

costs lower because theFederal, State, or localgovernment is paying partof the cost?

0010 1

2

Yes – Go to item 2No

0020 1

2

YesNo

2.

Ask if not apparent.Are these living quarterspresently used as studenthousing by a college oruniversity?

0030 1

2

YesNo

No fuel usedDon’t knowFuel oil

02 Electricity030504 Other – Specify01 Gas (underground piping)

X

No fuel usedDon’t knowFuel oil

02 Electricity030504 Other – Specify0102030405

X

Gas (underground piping)ElectricityFuel oilOther – SpecifyNo fuel usedDon’t know

a. Heating this unit?

X Don’t know
Section 1 – GENERAL SURVEY INFORMATION – Continued

Part C – Major Household Appliances – For New Consumer Units Only

Page 4 FORM CE-302

Section 1 – Part C

3 01 28 3

Electric cooking stove, 0010 range, or oven 1Information Booklet, page 6

a

Yes No

GO TO SECTION 2

PROCESSING USE ONLY

b c

Video tape recorder, videodisc player, or video cassetterecorder (VCR)Sound components,component system, orcompact disc sound systemGas cooking stove, range,or ovenMicrowave ovenOther cooking stove, range,or ovenRefrigeratorHome-freezerHome computerBuilt-in dishwasherPortable dishwasherGarbage disposalClothes washerClothes dryerColor televisionDoes your CU have any of thefollowing appliances?

If YES –Howmany?

Was this (Were any ofthese) –

1. Purchased for own use?2. Included with owned

home?

3. Received as a gift?4. Included with rental unit?5. Rented separately?FIELD REPRESENTATIVE –Mark (X) all that apply.

00200030004000500060007000800090010001100120013001400150

11111111111111

222222222222222

222222222222222

1 3 4 5

55555555555555

11111111111111

3 43 43 43 43 43 43 43 43 43 43 43 43 43 4
Section 2 – RENTED LIVING QUARTERS

Part A – CU Tenure, Rental Payments, Facilities, and Services for the Sample Unit 1 02 01 2

1. FIELD REPRESENTATIVE CHECK ITEM

b.

0010 1 Student housing –

Go to item 6

0020 1

2

Yes – Go to item 6No

2a.

0300 1

2

YesNo – Go to item 5a

FIELD REPRESENTATIVE – Complete part A, item 1, for all consumer units. For interviews 2 through 

Units only. Complete part A, items 4a through 6, for both rented Sample 

expenses for college or university regulated living quarters in section 16 

3.

Page 5 FORM CE-302

a. Mark (X) appropriate box based upon

section 1, part B, item 2 for first interviewor new consumer units. For subsequentinterviews, this item will be prefilled.

2 Not student housing

Are these living quarters owned orbeing bought by you (or any membersof your CU)?ASK IF NOT PREVIOUSLY ANSWERED –IF PREVIOUSLY ANSWERED MARK (X)APPROPRIATE BOX.

c. Do you (or any members of your CU)

pay rent for these living quarters?

0030 1

2

YesNo – Go to item 4a

.00

RENTAL OF THE SAMPLE UNITWhat is the rental charge to your CUfor this unit, including any extracharge for garage or parking facilities?Do not include direct payments bylocal, state, or federal agencies.

0040

X Don’t know

$

b. What period of time does this cover? 0050 4

9

MonthOther – Specify

c. Since the 1st of (month, 3 months ago),

how many payments have been made? 0060 Number

d. Were all the payments in the amount

of (rental charge reported in item 2a)? 0070 12 Yes – Go to item 2f No

Payment Number

$ 0080 .00

$ 0100 .00

0120 $ .00

$ 0140 .00 0150

013001100090

e. If NO – What was the amount of each

payment and how many paymentswere made at that amount?

f. Were any payments made during the

current month? 0200 1

2

YesNo – Go to item 3

g. If YES – How much? 0210

Does the rental payment include thecost of –

a.b.c.

Electricity? Gas? Piped-in water?

1111

Yes

2222

No

4a. Did you (or any members of your CU)

receive any reduced or free rent forthis unit as a form of pay since the1st of (month, 3 months ago)?

0320 4

9

MonthOther – Specify

1 Yes –

No –

b. What is the rental charge to another

tenant for a similar unit?

c. What period of time does this cover?

X Don’t know

5a. Is any portion of this unit used for

your own business? 0540 1

2

YesNo – Go to item 6

0620

What percent of the rental payment iscounted as a business expense?

b.

Enter to the nearest whole percent. Percent

Complete part Bfor other rentalproperty

Go to nextsection

6. Since the 1st of (month, 3 months ago),

have you (or any members of yourCU) rented any other houses,apartments, or temporary livingquarters not used for business orvacation? Do not include college oruniversity regulated housing.

05500310 .00 $

.00

2

.00 $

02600220023002400250

Section 2

Garage or parking facilities 0270

1 21 2

e.d. Heating? 

Trash/Garbage collection?

f.
Section 2 – RENTED LIVING QUARTERS – Continued

Part B – Rental Payments, Facilities, and Services for Other Than Sample Unit

1 02 02 0

1a.

FIELD REPRESENTATIVE – 

2.

Page 6 FORM CE-302

.00

RENTAL OF OTHER THANSAMPLE UNITWhat is the rental charge to your CUfor the other unit, including any extracharge for garage or parkingfacilities?

0010

X Don’t know

$

b. What period of time does this cover? 0020 4

9

MonthOther – Specify

c. Since the 1st of (month, 3 months ago),

how many payments have been made? 0030 Number

d. Were all the payments in the amount

of (rental charge reported in item 1a)? 0040 12 Yes – Go to item 1f No

Payment Number

$ 0050 .00

$ 0070 .00$ 0090 .00$ 0110 .00 0120

010000800060

e. If NO – What was the amount of each

payment and how many paymentswere made at that amount?

f. Were any payments made during the

current month? 0170 1

2

YesNo – Go to item 2

g. If YES – How much? 0180

Does the rental payment include thecost of –

a. Electricity? 1

Yes

2

No

1 Yes –2 No –

3a. Did you or any members of your CU

receive any free or reduced rent forthe unit as a form of pay since the1st of (month, 3 months ago)?

0250 1

2

YesNo – Go to item 4

0300

What is the rental charge to anothertenant for a similar unit?

b.

Complete part Bfor other rentalproperty

Go to nextsection

5. Since the 1st of (month, 3 months ago),

have you (or any members of yourCU) rented any other houses,apartments, or temporary livingquarters not used for business orvacation? Do not include college oruniversity regulated housing.

0260

4a. Is any portion of the unit used for

your own business? 0280 1

2

YesNo – Go to item 5

What percent of the rental payment iscounted as a business expense? Enterto the nearest whole percent.

b.

02900270 4

9

MonthOther – Specify

c. What period of time does this cover?

PROCESSING

USE ONLY

.00 Percent

.00 $

01900200021002200230

.00 $

Section 2

e. Trash/Garbage collection? 1 2f. Garage or parking facilities? 0240 1 2d. Heating? c. Piped-in water?b. Gas? 1

11 2

22

Section 2 – Part B
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE

Part A.1 – Screening Questions (If New Consumer Unit, Go to Part A.2)

8 03 00 7

1. Ask column g for each property listed, except if property has been disposed of previously ("YES" in column b). If mortgage

information (amount paid), column j is recorded for a property, ask column k. If column I is "YES," ask column n.

Page 7 FORM CE-302

0001

TYPE

After completing all screening items (Part A.1) fill the appropriate parts of section 3 for each property owned.For each property previously recorded and still owned ("Yes" in item 1, column g), complete part I. For each property previously recorded and disposed of within the last 3 months ("No" in item 1, column g), complete parts D aIf property was disposed of during a previous interview (column b = 1, YES) do not complete any other part of section 3.

••••

If this box is marked – Go to item 3a (no owned properties reported in previous interviews).

FIELD REPRESENTATIVE INSTRUCTIONS

PROCESSING USE ONLY

YES NO

Mortgage or lump sum home equity information

reported in previous interview

ab c d e f g h i j 

Property number

Property

disposed of

(part D

completed)

Property

description

(part B, item 1c)

Property type ENTER

PROPERTYCODE frompart B,item 1b.

Code 300

time

share

(part B,

item 13,

box 2)

1. Condo2. Co-op3. Something

else(part B,item 10)

Do youstill have(propertydescription)?If "No," goto column j.

Are (Were)any of theexpensesfor thispropertydeductedasbusiness,farm, orrentalexpenses?

If "Yes" incolumn h –

YES YES NO NO

What percentof theexpenses forthis propertyare (were)deducted?Enter to thenearest wholepercent.

No mortgage

or lump sum

home equity

loan

Y

.00 $

Mortgage

or loan

number

Go to

column l.

Mortgage

Home equity loan

Amount paid

from part F,

item 11 or

part G,

item 11

Hamo(luholoapa(ampachIf pma

1 2 1 2 1 2 Percent 1 2 1 

0021 

.00 1 2 1 2 1 2 Percent 1 2 $ 1 

0041 

.00 1 2 1 2 1 2 Percent 1 2 $ 1 

0061 

.00 1 2 1 2 1 2 Percent 1 2 $ 1 

0081 

.00 1 2 1 2 1 2 Percent 1 2 $ 1 

0101 

.00 1 2 1 2 1 2 Percent 1 2 $ 1 

0121 

.00 1 2 1 2 1 2 Percent 1 2 $ 1 

0141 

.00 1 2 1 2 1 2 Percent 1 2 $ 1 

PROPERTY INVENTORY CHART

If "No," goto column j.

Section 3

If a mortgage or lump sum home equity loan payment amount changed since a previous interview ("Yes" in item 1, column k), If a new or additional mortgage or home equity loan was obtained on a previously recorded property ("Yes" in item 2a), compFor each newly acquired property, complete parts B, E, and I. For each newly acquired property that was disposed of within the past 3 months, complete parts B, D, E, and I.

••••
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part A.1 – Screening Questions – Continued 1 03 01 0

2a. Since the 1st of (month, 3 months ago), have you obtained

any additional mortgages, including second mortgages orhome equity loans for any property you own?

b. If YES – For which property was this additional mortgage or

home equity loan obtained?

0010 1

2

YesNo – Go to item 3a

c.

Ask for each property.Was this a mortgage or a home equity loan?

0020 1 Mortgage –

f.

Ask or verify.Is this new loan a line of credit home equity loan?

Page 8 FORM CE-302

Enter the appropriate property number(s)and property code(s) in item 2g belowfrom the property inventory chart (items1a and 1e).2 Home Equity Loan –

Mark (X) "Yes" in mortgagecolumn in item 2g

Continue with item 2d

d. There are two basic types of home equity loans. I’ll

describe both types. Please tell me which type moreclosely describes your loan.

01 A loan where you (your CU) received the entire

lump-sum borrowed when you (your CU) tookout the loan; or

02 A line of credit loan where you (your CU) can

increase the amount borrowed by simply writing acheck or using a special credit card?

e. Is this new loan a lump sum home equity loan? 0030 1 Yes –

2 No – Continue with item 2f

Mark (X) "Yes" in lump sum homeequity loan column in item 2g

0040 1 Yes – Mark (X) "Yes" in line of credit home

equity loan column in item 2g

g. Complete the chart below for each additional mortgage/home equity loan.

Yes Yes YesYes Yes YesYes Yes YesYes Yes YesYes Yes Yes

Property number Property code Mortgage (Complete a part F) Lump sum home equity loan (Complete a part G) Line of credit home equity loan (Complete a part H)

3a. Since the 1st of (month, 3 months ago), have you (or any

members of your CU) purchased or otherwise acquired anyproperty or real estate?

0050 1

2

Yes – Ask items 3b and 3c

No – Go to next part or section

b. Please look at (page 7, Information Booklet). What kind of

property was it (were they)?ENTER PROPERTY CODE(S) FROM BELOW100 The home in which you (your CU) currently live(s)200 A home in which you (your CU) used to live600 Property for business or investment purposes only300 A second home, vacation home or recreational property400 Unimproved land with no buildings on it500 Other property – Specify

c. Do you still have this property?

Mark (X) the appropriate box in "still owned" column.

Property code Still owned

0070 1

2

YesNo

0090 1

2

YesNo

0110 1

2

YesNo

006000800100

4. FIELD REPRESENTATIVE INSTRUCTION – 

disposed of in the reference period and f

(NO

C

("

Section 3

Section 3 – Part A.1 (Continued)
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE

Part A.2 – Screening Questions – For New Consumer Units Only

1 03 02 8

1. Now I want to talk about owned living quarters

and other currently owned real estate. I’ll beasking separately about each of these types ofproperty. (Hand respondent Information Booklet,page 7.) Do you (any members of your CU) ownthe home in which you (your CU) currentlylive(s)? (Treat land contracts as ownership.)

3.

FIELD REPRESENTATIVE – Ask part A

8.

Page 9 FORM CE-302

2 Go to item 3

Do you (Does your CU) own any property onlyfor business or investment purposes?

b. If YES – How many different properties?

c. Please look at page 7 in the Information Booklet. What

kind of property(ies) was it (were they)?

Number

0120

FIELD REPRESENTATIVE INSTRUCTIONS – Refer to thechart to the right. Complete all appropriate parts foreach property disposed of in the reference period andfor each property currently owned before moving on tonext property.

PROPERTY STATUS

Property

code YES NO

If YES ask – How many

such properties do you(does your CU) own?

0010 1 20020 1 0030

Since the first of (month, 3 months ago), have you

(has anyone in your CU) lived in any other homethat you (any member of your CU) still own(s)?

2.

600200100300400500

0035 1 2 Go to item 4

2 Go to item 5 Number 0040 1 00502 Go to item 6 Number 0060 1 00702 Go to item 7a Number 0080 1 0090

0100 1 2 Go to item 8

Number 0110

READ IF "YES" IN ITEM 3 – In the followingquestions, please do not include any of theproperties you (your CU) own(s) only forbusiness or investment purposes.

4. Other than property you have already

mentioned, do you (does your CU) own a secondhome, vacation home, or recreational property?

5. Other than property you have already mentioned,

do you (does your CU) own any unimproved land,that is, land without buildings on it?

6. Do you (Does your CU) own any other real

estate? – Specify

7a. Since the first of (month, 3 months ago), did you (your CU)

own any real estate or land that you (your CU) no longerown(s)?

Enter property code(s) from below.100 – The home in which you (your CU) currently live(s)

200 – A home in which you (your CU) used to live

600 – Property for business or investment purposes only

300 – A second home, vacation home, or recreational property

400 – Unimproved land with no buildings on it

500 – Other property – Specify

Note – Do not fill any parts for property code 600.

Currently owned

("YES" in items 1–6)

Disposed of

("YES" in item 7a)

B, E, I B, D, E, I

0130 01400160 01700190 02000220 0230

015001800210

Yes
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part B – Detailed Property Description

1 03 03 6

FIELD REPRESENT

Page 10 

FORM CE-302

.00

FIELD REPRESENTATIVE CHECK ITEM

Now I’m going to ask you some questions about (property description).

0060

b. What percent of the expenses for this property are (were)

deducted?

0120 1

23

A purchase, a contract with a builder, or a trade-in?A gift or inheritance?Other – Specify

0100 1 Item 3a is after the 1st of the month 3 months

ago – Go to item 4

Ask if not apparent. Do not ask for unimproved land (code 400).

0240 1

2

Share ownership for entire yearTime-sharing arrangement

PROCESSING USE ONLY

a.

b.

c.

d.

1 03 0

10.

1.

New Consumer Units – Assign aproperty number to each property inconsecutive order starting with 1.Enter the property number in item 1a,the property code in item 1b, a briefdescription of the property (such as"own home") in item 1c, and appropriateownership status in item 1d.

0010 Number0130 .00 $

0020

1 Currently owned (from part A.1, item 3c or

part A.2, items 1–6)

0010 Number 

Code 0020 Code 

Description Description 

0030

PROPERTY NUMBERPROPERTY CODE from part A.1,item 3b or part A.2, items 1–7DESCRIPTIONCURRENT OWNERSHIPSTATUS from part A.1 orpart A.2

Are (Were) any of the expenses for this property deducted asbusiness, farm, or rental expenses?

2a.

In what month and year did you (your CU) close or settle on thisproperty? If land contract – In what month and year did the land

contract begin?

3a.

0040 1 Yes 2 No – Go to item 3

Percent – If 100%, delete this property.

b. FIELD REPRESENTATIVE CHECK ITEM

Mark (X) the appropriate box for each property and follow appropriateskip pattern.

0080 Month Year 0090 0080 Month 

0

0100 

4. How did you (your CU) acquire this property?

Mark (X) the FIRST answer that applies. Go to item 8

0060 .00 Percen0120 1

23

A purchase, a contraA gift or inheritanceOther – Specify 

Hand the respondent Information Booklet, page 8.Closing costs include these kinds of things. Not including closingcosts, what was the total price paid for the property?

5.6. What was the amount of the down payment? 0140 .00 $

0160 .00 $ 7. About how much were the closing costs?

About how much do you think this property would sell for ontoday’s market?

8.

What are your (your CU’s) annual property taxes for (propertydescription)?

9.

0190 .00 $0200 .00 $

Is this property a condominium, cooperative, or something else?

0210 1

2

A condominiumA cooperative

3 Something else

0230 1 Yes 2 No – Go to part D or E as appropriate

0040 1 Yes 0210 1

2

A condominiumA cooperative

If vacation property/second home (code 300), ask questions 11–13. Allother properties, go to part D or E as appropriate.

11. Where is (property description) located?

OFFICE USE ONLY

City or placeForeign country

State City or place

Foreign country

12. Do you (Does your CU) share ownership of this

property with anyone else outside your CU?

Go to part Dor E asappropriate



0220 0220 

13. Do you (Does your CU) share ownership for the entire year, or is this

a time-sharing arrangement where you have (your CU has) ownershipof the property only for a specified time period each year?

0240 1

2

Share ownership foTime-sharing arran

0230 1 Yes 2 No – Go 

2 Disposed of (from part A.1, item 3c or part A.2, item 7)

1 Currently owned (f

part A.2, items 1–6

0030

2 Disposed of (from pa

0130 

$

0140 

$

0160 

$

0190 

$

0200 

$

Item 3a is before the 1st of the month 3 months ago – Go to item 8

1

Item 3a is before the ago – Go to item 8

2 2 

Item 3a is after the 1ago – Go to item 4

Property numbers listed for interviews 2–5 begin with the next highest availablenumber form section 3A.1, column a.

Section 3 – Part B
Page 11 

FORM CE-302

NOTES

NOTE: As of April 1999, Section 3 Part C no longer exists.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part D – Disposed of Property

1 03 33 3

FIELD REPRESENT

Page 12 

FORM CE-302

FIELD REPRESENTATIVEITEMDid you (your CU) sell this property, give it to someone else (outside your CU), or dosomething else with it?

PROCESSING USE ONLY

a.

b.

c.

1. 1 03 34 1 

Complete at the 1stinterview in which theproperty is reported asbeing disposed of. Enterthe property number initem 1a, the propertycode in item 1b, and abrief description of theproperty in item 1c.

0010 Number0060 $

123

Sold the propertyGave it to someone elseSomething else – Specify

0020

Code

Description

0030

PROPERTY NUMBERPROPERTY CODEDESCRIPTION

2.

In what month and year did you (your CU) (sell/response to item 2) this property?

3.

0040

Month Year

0050

4. What was the selling price (trade-in value)?

Mark property traded-in as "sold."

Hand the respondent Information Booklet, page 9.Here is a list of some of the costs people may have when selling (trading) property. Looking at the list may help you remember what your (your CU’s) expenses were. What were the total expenses in selling (trading) this property?

5.6a.

What was the amount of the mortgage that you (your CU) financed?

b.

Did you (your CU) finance any part of the sale (trade) for the buyer?

If "sold" in item 2, go to item 4; otherwisego to part E.

0070 $0090 $

12

YesNo – Go to part E

0080

0010 Number

123

Sold the propertyGave it to someone elseSomething else – Specify

0020

Code

Description

00300040

Month Year

0050

Mark property traded-in as "sold."

If "sold" in item 2, go to item 4; otherwisego to part E.

12

YesNo – Go to part E

0080

0010 

123

0020

Description

00300040

Mon

If "sogo to 

12

Y

0080

NOTES

.00.00.00

0060 $0070 $0090 $

.00.00.00

0060 $0070 $0090 $

A property number listedmust match to a previouslyreported number fromsection 3A.1, column aand/or section 3B, item 1a.

Section 3 – Part D
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part E – Mortgage/Home Equity Loan Screening Questions

1. FIELD REPRESENTATIVE ITEM2.

12

Co-op property – Go to item 4a

Not co-op

FIELD REPRESEN

Page 13 

FORM CE-302

Enter the property number in item1a, the property code in item 1b,and a brief description of theproperty in item 1c.I want to ask next about any mortgages you(your CU) had in the last three months on (propertydescription).

b.

Number

Description

a.b.

c.

PROPERTY NUMBER

PROPERTY CODEDESCRIPTION

b.

Excluding home equity loans, do you (does your CU)presently have a mortgage on this property?

3a.

Have you (Has your CU) had a mortgage on this property since the 1st of (month, 3 months ago)?Since the lst of (month, 3 months ago), have you(has your CU) made any payments on a mortgagethat was obtained from an outside lender for your(your CU’s) shares in the cooperative?

4a. In addition to your (your CU’s) share of the

cooperative’s total costs, do you (does your CU)make payments on a mortgage that was obtainedfrom an outside lender for your (your CU’s) sharesin the cooperative?

5. Do you (Does your CU) have a home equity

loan or any other loan which gives the lenderclaim on this property in case the loan is notrepaid?

Code

FIELD REPRESENTATIVE CHECK ITEMMark (X) appropriate box based upon part B, item 10.

6. Now let’s talk about your (your CU’s) (loan

description). There are two basic types of homeequity loans. I’ll describe both types. Please tell

me which more closely describes your loan.• A loan where you (your CU) received the entire

lump-sum borrowed when you (your CU) tookout the loan; or

• A line of credit loan where you (your CU) can

increase the amount borrowed by simplywriting a check or using a special credit card. 

If YES ask –How many mortgages have you(has your CU) had on thisproperty since the 1st of(month, three months ago)?

YesNo – Go to item 3b Number

– Go to item 5

YesNo – Go to item 5 Number

– Go to item 5

YesNo – Go to item 4b Number

– Go to item 5

YesNo – Go to item 5 Number

– Go to item 5

If YES ask –How many loans like this haveyou (has your CU) had on thisproperty since the 1st of (month,three months ago)?

YesNo – Go to item 7 NumberYesNo – Go to item 6b NumberYesNo – Go to item 7 Number

Do you (Does your CU) have a line of credithome equity loan?Do you (Does your CU) have a lump sum homeequity loan?

b.

a.

7.

a.b.c.

FIELD REPRESENTATIVE INSTRUCTIO

Enter number of mortgages for this Enter number of lump sum home eq(from item 6a)Enter number of line of credit home (from item 6b)

• After completing the appropriate p• If no mortgages nor home equity 

A property number listed mustmatch to a previously reportednumber from section 3A.1, columna and/or section 3B, item 1a.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part E – Mortgage/Home Equity Loan Screening Questions – Continued

1. FIELD REPRESENTATIVE ITEM2.

12

Co-op property – Go to item 4a

Not co-op

FIELD REPRESEN

Page 14 

FORM CE-302

Enter the property number in item1a, the property code in item 1b,and a brief description of theproperty in item 1c.I want to ask next about any mortgages you (your CU) had in the last three months on (property description).

b.

Number

Description

a.b.

c.

PROPERTY NUMBER

PROPERTY CODEDESCRIPTION

b.

Excluding home equity loans, do you (does your CU) presently have a mortgage on this property?

3a.

Have you (Has your CU) had a mortgage on this property since the 1st of (month, 3 months ago)?Since the lst of (month, 3 months ago), have you(has your CU) made any payments on a mortgagethat was obtained from an outside lender for your(your CU’s) shares in the cooperative?

4a. In addition to your (your CU’s) share of the

cooperative’s total costs, do you (does your CU)make payments on a mortgage that was obtainedfrom an outside lender for your (your CU’s) sharesin the cooperative?

5. Do you (Does your CU) have a home equity

loan or any other loan which gives the lenderclaim on this property in case the loan is notrepaid?

Code

FIELD REPRESENTATIVE CHECK ITEMMark (X) appropriate box based upon part B, item 10.

6. Now let’s talk about your (your CU’s) (loan

description). There are two basic types of homeequity loans. I’ll describe both types. Please tell

me which more closely describes your loan.• A loan where you (your CU) received the entire

lump-sum borrowed when you (your CU) tookout the loan; or

• A line of credit loan where you (your CU) can

increase the amount borrowed by simplywriting a check or using a special credit card. 

If YES ask –How many mortgages have you(has your CU) had on thisproperty since the 1st of(month, three months ago)?

YesNo – Go to item 3b Number

– Go to item 5

YesNo – Go to item 5 Number

– Go to item 5

YesNo – Go to item 4b Number

– Go to item 5

YesNo – Go to item 5 Number

– Go to item 5

If YES ask –How many loans like this haveyou (has your CU) had on thisproperty since the 1st of (month,three months ago)?

YesNo – Go to item 7 NumberYesNo – Go to item 6b NumberYesNo – Go to item 7 Number

Do you (Does your CU) have a line of credithome equity loan?Do you (Does your CU) have a lump sum homeequity loan?

b.

a.

7.

a.b.c.

FIELD REPRESENTATIVE INSTRUCTIO

Enter number of mortgages for this Enter number of lump sum home eq(from item 6a)Enter number of line of credit home (from item 6b)

• After completing the appropriate p• If no mortgages nor home equity 

A property number listed mustmatch to a previously reportednumber from section 3A.1, columna and/or section 3B, item 1a.

Section 3 – Part E (Continued)
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part E – Mortgage/Home Equity Loan Screening Questions – Continued

1. FIELD REPRESENTATIVE ITEM2.

12

Co-op property – Go to item 4a

Not co-op

FIELD REPRESEN

Page 15 

FORM CE-302

Enter the property number in item1a, the property code in item 1b,and a brief description of theproperty in item 1c.I want to ask next about any mortgages you (your CU) had in the last three months on (property description).

b.

Number

Description

a.b.

c.

PROPERTY NUMBER

PROPERTY CODEDESCRIPTION

b.

Excluding home equity loans, do you (does your CU) presently have a mortgage on this property?

3a.

Have you (Has your CU) had a mortgage on this property since the 1st of (month, 3 months ago)?Since the lst of (month, 3 months ago), have you(has your CU) made any payments on a mortgagethat was obtained from an outside lender for your(your CU’s) shares in the cooperative?

4a. In addition to your (your CU’s) share of the

cooperative’s total costs, do you (does your CU)make payments on a mortgage that was obtainedfrom an outside lender for your (your CU’s) sharesin the cooperative?

5. Do you (Does your CU) have a home equity

loan or any other loan which gives the lenderclaim on this property in case the loan is notrepaid?

Code

FIELD REPRESENTATIVE CHECK ITEMMark (X) appropriate box based upon part B, item 10.

6. Now let’s talk about your (your CU’s) (loan

description). There are two basic types of homeequity loans. I’ll describe both types. Please tell

me which more closely describes your loan.• A loan where you (your CU) received the entire

lump-sum borrowed when you (your CU) tookout the loan; or

• A line of credit loan where you (your CU) can

increase the amount borrowed by simplywriting a check or using a special credit card. 

If YES ask –How many mortgages have you(has your CU) had on thisproperty since the 1st of(month, three months ago)?

YesNo – Go to item 3b Number

– Go to item 5

YesNo – Go to item 5 Number

– Go to item 5

YesNo – Go to item 4b Number

– Go to item 5

YesNo – Go to item 5 Number

– Go to item 5

If YES ask –How many loans like this haveyou (has your CU) had on thisproperty since the 1st of (month,three months ago)?

YesNo – Go to item 7 NumberYesNo – Go to item 6b NumberYesNo – Go to item 7 Number

Do you (Does your CU) have a line of credithome equity loan?Do you (Does your CU) have a lump sum homeequity loan?

b.

a.

7.

a.b.c.

FIELD REPRESENTATIVE INSTRUCTIO

Enter number of mortgages for this Enter number of lump sum home eq(from item 6a)Enter number of line of credit home (from item 6b)

• After completing the appropriate p• If no mortgages nor home equity 

A property number listed mustmatch to a previously reportedfrom section 3A.1, column a and/orsection 3B, item 1a.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part F – Mortgages

1 03 43 2

FIELD REPRESENT

Page 16 

FORM CE-302

FIELD REPRESENTATIVE ITEMI’d like to ask some additional questions aboutyour mortgage. In what month and year did you(your CU) make your (your CU’s) first paymenton this mortgage?

PROCESSINGUSE ONLY

a.

b.

c.

1. 1 03 44 0

Enter the property number in item1a, the property code in item 1b, abrief description of the property initem 1c. A property number listedmust match to a previously reportednumber from section 3A.1, column aand/or section 3B, item 1a.

0010 Number0055 1

2

30-year15-year

0020 Code

Description

0030

PROPERTY NUMBERPROPERTYCODEDESCRIPTION

2.

Is this a 30-year mortgage, a 15-yearmortgage, or something else?

3.

0035

Month Year

0045

What was the rate of interest at the time themortgage was obtained? Enter in two decimalplaces, such as 9.50% for 9 1/2%. (Include all FHAguarantee insurance if applicable.)

4.6a. Is this a fixed rate mortgage?

10.

There are many different kinds ofmortgages. Which one of these (handrespondent Information Booklet, page 10) comesclosest to yours (your CU’s)?

b.

On your (your CU’s) last regular payment,which of these things were included? (Handrespondent Information Booklet, page 11.) Mark (X) all that apply.

0075

12

0090 Fixed rate of interest

d. LOAN 

NUMBER

5. What is the current interest rate on your

(your CU’s) mortgage? (Convert fractions to

decimals.)

Have you (Has your CU) refinanced orrenegotiated this mortgage?

7.

What was the amount of the mortgage when you(your CU) obtained it, excluding any interest?

8.

How often are (were) mortgage paymentsdue?

9.

11.12.

On your (your CU’s) last regular payment,what was the total amount you (your CU)paid for those things?If any of codes 2–6 marked in item 10, ask –How much of that amount was for principaland interest?

3 Something else – Specify

0065 Number of years

. Percent

0080

. Percent

If same as item 4, go to item 6a. If different, go to item 6b.

0085 1 Yes – Go to item 7 2 No0235 .00 $0245 .00 $

Variable or adjustablerate of interestGraduated paymentRollover or renegotiable

34

56

Deferred interestOther – Specify

X Don’t know

0105 1 Yes – Read to respondent – The following question 

refers to this current mortgage. 2 No

12

WeeklyBiweeklyMonthlyQuarterly

0170

34

567

SemiannuallyAnnuallyOther – Specify

1 Principal and 

interest

3

5 Mortgage guarantee 

insurance

0175 0220

x Don’t know

0190 2 Property taxes Any other payments – Specify 0230 6

0010 Number0055 1

2

30-year15-year

0020 Code

Description

0030

0035

Month Year

0045

00750090

3 Some

0065 

. Percent

0080

. Percent

0085 1 Yes – Go to item 7 2 No0105 1 Yes – Read to respondent – The fo

refers mortga

2 No

12

WeeklyBiweeklyMonthlyQuarterly

0170

34

567

SemiaAnnuaOther 

Number Number 

1 1 

If same as 6a. If diffe

02000210

Property insurance

4 Life insurance

0235 .00 $0245 .00 $

1 Principal and 

interest

3

5 Mortg

insura

0175 0220

x 

0190 2 Property taxes Any o

Speci

0230 6

02000210

Property insurance

4 Life insurance

0130 .00 $ 0130 .00 $ 

12

Fixed rate of interestVariable or adjustablerate of interestGraduated paymentRollover or renegotiable

34

56

DeferrOther 

X Don’t 

Enter the 3-digit loan number in item 1d, beginning with 101 andassigning loan numbersconsecutively, regardless ofproperty number.

Section 3 – Part E (Continued)
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part G – Lump Sum Home Equity Loans

1 03 58 0

FIELD REPRESENT

Page 17 

FORM CE-302

FIELD REPRESENTATIVE ITEMI’d like to ask some additional questions aboutyour lump sum home equity loan. In whatmonth and year did you (your CU) make your(your CU’s) first payment on this loan?

PROCESSINGUSE ONLY

a.

b.

c.

1. 1 03 59 8

Enter the property number in item1a, the property code in item 1b, abrief description of the property initem 1c. A property number listedmust match to a previously reportednumber from section 3A.1, column aand/or section 3B, item 1a.

0010 Number0055 1

2

30-year15-year

0020 Code

Description

0030

PROPERTY NUMBERPROPERTYCODEDESCRIPTION

2.

Is this a 30-year home equity loan, a 15-yearhome equity loan, or something else?

3.

0035

Month Year

0045

What was the rate of interest at the time thehome equity loan was obtained? Enter in twodecimal places, such as 9.50% for 9 1/2%. (Includeall FHA guarantee insurance if applicable.)

4.6a. Is this a fixed rate home equity loan?

10.

There are many different kinds of lump sumhome equity loans. Which one of these (handrespondent Information Booklet, page 10) comesclosest to yours (your CU’s)?

b.

On your (your CU’s) last regular payment,which of these things were included? (Handrespondent Information Booklet, page 11.) Mark (X) all that apply.

0075

12

0090 Fixed rate of interest

d. LOAN 

NUMBER

5. What is the current interest rate on your

(your CU’s) home equity loan? (Convertfractions to decimals.)Have you (Has your CU) refinanced orrenegotiated this lump sum home equityloan?

7.

What was the amount of the lump sum homeequity loan when you (your CU) obtained it,excluding any interest?

8.9. How often are (were) loan payments due?

11.12.

On your (your CU’s) last regular payment,what was the total amount you (your CU)paid for those things?If any of codes 2–6 marked in item 10, ask –How much of that amount was for principaland interest?

3 Something else – Specify

0065 Number of years

. Percent

0080

. Percent

If same as item 4, go to item 6a. If different, go to item 6b.

0085 1 Yes – Go to item 7 2 No0235 .00 $0245 .00 $

Variable or adjustablerate of interestGraduated paymentRollover or renegotiable

34

56

Deferred interest

X Don’t know

0105 1 Yes – Read to respondent –

2 No

12

WeeklyBiweeklyMonthlyQuarterly

0170

34

567

SemiannuallyAnnuallyOther – Specify

1 Principal and 

interest

3

5 Mortgage guarantee 

insurance

0175 0220

x Don’t know

0190 2 Property taxes Any other payments – Specify 0230 6

0010 Number0055 1

2

30-year15-year

0020 Code

Description

00300035

Month Year

0045

00750090

3 Some

0065 

. Percent

0080

. Percent

0085 1 Yes – Go to item 7 2 No

12

WeeklyBiweeklyMonthlyQuarterly

0170

34

567

SemiaAnnuaOther 

Number Number 

2 2 

If same as 6a. If diffe

02000210

Property insurance

4 Life insurance

0235 .00 $0245 .00 $ x 

0130 .00 $ 0130 .00 $ 

The following questionrefers to this currentlump sum home equityloan.

0105 1 Yes – Read to respondent –

2 No

The forefers lump sloan.

1 Principal and 

interest

3

5 Mortg

insura

0175 02200190 2 Property taxes Any o

Speci

0230 6 0200

0210

Property insurance

4 Life insurance

Other – Specify

12

Fixed rate of interestVariable or adjustablerate of interestGraduated paymentRollover or renegotiable

34

56

Deferr

X Don’t 

Other 

Enter the 3-digit loan number initem 1d, beginning with 201 andassigning loan numbersconsecutively, regardless ofproperty number.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part H – Line of Credit Home Equity Loans

1. FIELD REPRESENTATIVE 

ITEM

2.

FIELD REPRESEN

Page 18 

FORM CE-302

Enter the property number initem 1a, the property code initem 1b, a brief description ofthe property in item 1c. Aproperty number listed mustmatch to a previouslyreported property number insection 3A.1, column a and/orsection 3B, item 1a.

Number

Description

a.b.

c.

PROPERTY NUMBER

PROPERTY CODEDESCRIPTION

I’d like to ask some additional questionsabout your (your CU’s) line of credit home

equity loan. Since the 1st of (last month),have you (has any member of your CU)made any payments for this loan?

3. If YES – What was the amount of the last

payment?

4.

Code

Yes

PROCESSING USE ONLY

d. LOAN 

NUMBER

No – Go to next loan or

part I

0010

0020

1 03 68 9

0030 Number

Prior to the last payment, what was thetotal amount owed?

12

004000500060

$ .00

$ .00

1 03 69 7 1 03 70 5

Number

Description

Code

YesNo – Go to next loan or

part I

0010

00200030 Number

12

0040

Number

Description

Code

YesNo – Go to next loan or

part I

0010

00200030 Number

12

0040

333

00500060

$ .00

$ .00

00500060

$ .00

$ .00

Enter the 3-digit loan numberin item 1d, beginning with 301and assigning loan numbersconsecutively, regardless ofproperty number.

Section 3 – Part H
Section 3 

– OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE 

– Continued

Part I 

– Ownership Costs

b. Since the 1st of (month, 3 months ago), what was

the total amount that you (your CU) paid extra?

3a.

FIELD REPRESENTATI

Page 19 

FORM CE-302

Now I want to ask about other payments on(property description) during the last threemonths. Since the 1st of (month, 3 months ago),have you (any members of your CU) paid morethan the amount required on any mortgage orlump sum home equity loan?

Number 0010

2. FIELD REPRESENTATIVE CHECK ITEM

1 03 77 0

0390 

$

0160 01 Repayment of 

cooperative

0380 1

2

YesNo – Go to item 

PROCESSINGUSE ONLY

0040 1

2

YesNo – Go to item 4a

0050

12

0030 Mortgage/lump sum

home equity loanNo mortgage/no lumpsum home equity loan –Go to item 4a

.00

$

1. FIELD REPRESENTATIVE ITEM

Enter the property number in item1a, the property code in item 1b,and a brief description of theproperty in item 1c.

a. PROPERTY

NUMBER

b. PROPERTY

CODE

c. DESCRIPTION

0020 Code

Description

Mark (X) the appropriate box.If there was a mortgage or lump sum home equityloan on the property within the past 3 months, markbox 1; if not, mark box 2.

c. How much of the (amount in item 3b) did you

(your CU) pay since the 1st of (current month)? 0060 .00

$

d. Were there any penalty charges as a result of

the extra payments? 0070 1

2

YesNo – Go to item 4a

e. Since the 1st of (month, 3 months ago), how

much were these penalty charges? 0080 .00

$

f. How much of the (amount in item 3e) did you

(your CU) pay since the 1st of (current month)? 0090 .00

$

4a. Since the 1st of (month, 3 months ago), have you

(has your CU) made any payments for ground orland rent for (property description)?

0100 1

2

YesNo – Go to item 5

b. If YES 

– What was the total amount paid?

0110 .00

$

c. How much of the (amount in item 4b) was paid

since the 1st of (current month)? 0120 .00

$

5. FIELD REPRESENTATIVE CHECK ITEM 0130 1 Condominium – Go to

item 7

2 Co-op – Go to item 83 Neither condo nor

co-op – Continue

with item 6

Mark (X) the appropriate box.If property is condo, mark box 1.If property is co-op, mark box 2.If property is neither, mark box 3.



Refer to part B,item 10 orpart A.1, item 1,column d

6. If property is not condo/co-op, ask 

–

Do you (Does your CU) make regular paymentsto a homeowner’s association?

0140 1

2

Yes – Go to item 9No – Go to item 11a

7. If property is condo, ask 

–

Are you (Is your CU) required to make regularpayments of condominium fees for generalmaintenance or management services?

0150 1

2

Yes – Go to item 9No – Go to item 11a

11 Other – Specif

0170 02 Property taxes

Repairs and mincluding lawn removal

018001900200

0210 06 Improvements

0220 07 Recreational, i

swimming, gofacilities

0230 08 Security, inclu

alarm systems

0240 09 Utilities: such 

electricity, wat

0250 10 Trash collectio0260

b.

If property is co-op, ask 

–

10a.

8.

Now I’d like to ask you aboutpayments you make (your CUmakes) directly to the cooperativefor your (your CU’s) share of itscosts. Since the 1st of (month, 3months ago), for which of the thingson this card (hand the respondentInformation Booklet, page 12) have you(has your CU) made any payments?Mark (X) all that apply.If any entry in boxes 1

–11, go to

item 10a.If no entries in boxes 1

–11, go to

item 11a.

9. If property is not co-op, ask 

–

Which of the services and privilegeslisted (hand the respondent InformationBooklet, page 13) are included in thosepayments?Mark (X) all that apply.

0270 21 Management

0280 22 Repairs and m

including lawn removal

0340035003600370

0330 27 Security, inclu

alarm systems

0290 23 Improvements0300 24 Utilities: such 

electricity, wat

0310 25 Parking0320 26 Recreational, i

swimming, gofacilities

31 Other – Specif28 Maid service

Are any of the costs included in your(your CU’s) mortgage payment?

0410 

$

0400 1

2

YesNo – Go to item 

0420 

$

If YES 

– How much per month?

c. In addition to those costs, since the

1st of (month, 3 months ago), have you(has your CU) made any other regularpayments for these services?

d. Since the 1st of (month, 3 months

ago), how much have you (has yourCU) paid for these services?

e. How much of the (amount in item 10d) was

paid since the 1st of (current month)?

2930

Medical servicTrash collectio

030405

Property insurManagement

A property number listed mustmatch to a previously reportednumber from section 3A.1, column aand/or section 3B, item 1a.
Section 3 

– OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE 

– Continued

Part I 

– Ownership Costs 

– Continued

b. Since the 1st of (month, 3 months ago), what was

the total amount that you (your CU) paid extra?

3a.

FIELD REPRESENTATI

Page 20 

FORM CE-302

Now I want to ask about other payments on(property description) during the last threemonths. Since the 1st of (month, 3 months ago),have you (any members of your CU) paid morethan the amount required on any mortgage orlump sum home equity loan?

Number 0010

2. FIELD REPRESENTATIVE CHECK ITEM

1 03 78 8

0390 

$

0160 01 Repayment of 

cooperative

0380 1

2

YesNo – Go to item 

PROCESSING USE ONLY

0040 1

2

YesNo – Go to item 4a

0050

12

0030 Mortgage/lump sum

home equity loanNo mortgage/no lumpsum home equity loan –Go to item 4a

.00

$

1. FIELD REPRESENTATIVE ITEM

Enter the property number initem 1a, the property code initem 1b, and a brief descriptionof the property in item 1c.

a. PROPERTY

NUMBER

b. PROPERTY

CODE

c. DESCRIPTION

0020 Code

Description

Mark (X) the appropriate box.If there was a mortgage or lump sum home equityloan on the property within the past 3 months, markbox 1; if not, mark box 2.

c. How much of the (amount in item 3b) did you

(your CU) pay since the 1st of (current month)? 0060 .00

$

d. Were there any penalty charges as a result of

the extra payments? 0070 1

2

YesNo – Go to item 4a

e. Since the 1st of (month, 3 months ago), how

much were these penalty charges? 0080 .00

$

f. How much of the (amount in item 3e) did you

(your CU) pay since the 1st of (current month)? 0090 .00

$

4a. Since the 1st of (month, 3 months ago), have you

(has your CU) made any payments for ground orland rent for (property description)?

0100 1

2

YesNo – Go to item 5

b. If YES 

– What was the total amount paid?

0110 .00

$

c. How much of the (amount in item 4b) was paid

since the 1st of (current month)? 0120 .00

$

5. FIELD REPRESENTATIVE CHECK ITEM 0130 1 Condominium – Go to

item 7

2 Co-op – Go to item 83 Neither condo nor

co-op – Continue

with item 6

Mark (X) the appropriate box.If property is condo, mark box 1.If property is co-op, mark box 2.If property is neither, mark box 3.



Refer to part B,item 10 orpart A.1, item 1,column d

6. If property is not condo/co-op, ask 

–

Do you (Does your CU) make regular paymentsto a homeowner’s association?

0140 1

2

Yes – Go to item 9No – Go to item 11a

7. If property is condo, ask 

–

Are you (Is your CU) required to make regularpayments of condominium fees for generalmaintenance or management services?

0150 1

2

Yes – Go to item 9No – Go to item 11a

11 Other – Specif

0170 02 Property taxes

Repairs and mincluding lawn removal

018001900200

0210 06 Improvements

0220 07 Recreational, i

swimming, gofacilities

0230 08 Security, inclu

alarm systems

0240 09 Utilities: such 

electricity, wat

0250 10 Trash collectio0260

b.

If property is co-op, ask 

–

10a.

8.

Now I’d like to ask you aboutpayments you make (your CUmakes) directly to the cooperativefor your (your CU’s) share of itscosts. Since the 1st of (month, 3months ago), for which of the thingson this card (hand the respondentInformation Booklet, page 12) have you(has your CU) made any payments?Mark (X) all that apply.If any entry in boxes 1

–11, go to

item 10a.If no entries in boxes 1

–11, go to

item 11a.

9. If property is not co-op, ask 

–

Which of the services and privilegeslisted (hand the respondent InformationBooklet, page 13) are included in thosepayments?Mark (X) all that apply.

0270 21 Management

0280 22 Repairs and m

including lawn removal

0340035003600370

0330 27 Security, inclu

alarm systems

0290 23 Improvements0300 24 Utilities: such 

electricity, wat

0310 25 Parking0320 26 Recreational, i

swimming, gofacilities

31 Other – Specif28 Maid service

Are any of the costs included in your(your CU’s) mortgage payment?

0410 

$

0400 1

2

YesNo – Go to item 

0420 

$

If YES 

– How much per month?

c. In addition to those costs, since the

1st of (month, 3 months ago), have you(has your CU) made any other regularpayments for these services?

d. Since the 1st of (month, 3 months

ago), how much have you (has yourCU) paid for these services?

e. How much of the (amount in item 10d) was

paid since the 1st of (current month)?

2930

Medical servicTrash collectio

030405

Property insurManagement 

A property number listed mustmatch to a previously reportednumber in section 3A.1, column aand/or section 3B, item 1a.

Section 3

– Part I (Continued)
Section 3 

– OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE 

– Continued

Part I 

– Ownership Costs 

– Continued

b. Since the 1st of (month, 3 months ago), what was

the total amount that you (your CU) paid extra?

3a.

FIELD REPRESENTATI

Page 21 

FORM CE-302

Now I want to ask about other payments on(property description) during the last threemonths. Since the 1st of (month, 3 months ago),have you (any members of your CU) paid morethan the amount required on any mortgage orlump sum home equity loan?

Number 0010

2. FIELD REPRESENTATIVE CHECK ITEM

1 03 79 6

0390 

$

0160 01 Repayment of 

cooperative

0380 1

2

YesNo – Go to item 

PROCESSING USE ONLY

0040 1

2

YesNo – Go to item 4a

0050

12

0030 Mortgage/lump sum

home equity loanNo mortgage/no lumpsum home equity loan –Go to item 4a

.00

$

1. FIELD REPRESENTATIVE ITEM

Enter the property number initem 1a, the property code initem 1b, and a brief descriptionof the property in item 1c.

a. PROPERTY

NUMBER

b. PROPERTY

CODE

c. DESCRIPTION

0020 Code

Description

Mark (X) the appropriate box.If there was a mortgage or lump sum home equityloan on the property within the past 3 months, markbox 1; if not, mark box 2.

c. How much of the (amount in item 3b) did you

(your CU) pay since the 1st of (current month)? 0060 .00

$

d. Were there any penalty charges as a result of

the extra payments? 0070 1

2

YesNo – Go to item 4a

e. Since the 1st of (month, 3 months ago), how

much were these penalty charges? 0080 .00

$

f. How much of the (amount in item 3e) did you

(your CU) pay since the 1st of (current month)? 0090 .00

$

4a. Since the 1st of (month, 3 months ago), have you

(has your CU) made any payments for ground orland rent for (property description)?

0100 1

2

YesNo – Go to item 5

b. If YES 

– What was the total amount paid?

0110 .00

$

c. How much of the (amount in item 4b) was paid

since the 1st of (current month)? 0120 .00

$

5. FIELD REPRESENTATIVE CHECK ITEM 0130 1 Condominium – Go to

item 7

2 Co-op – Go to item 83 Neither condo nor

co-op – Continue

with item 6

Mark (X) the appropriate box.If property is condo, mark box 1.If property is co-op, mark box 2.If property is neither, mark box 3.



Refer to part B,item 10 orpart A.1, item 1,column d

6. If property is not condo/co-op, ask 

–

Do you (Does your CU) make regular paymentsto a homeowner’s association?

0140 1

2

Yes – Go to item 9No – Go to item 11a

7. If property is condo, ask 

–

Are you (Is your CU) required to make regularpayments of condominium fees for generalmaintenance or management services?

0150 1

2

Yes – Go to item 9No – Go to item 11a

11 Other – Specif

0170 02 Property taxes

Repairs and mincluding lawn removal

018001900200

0210 06 Improvements

0220 07 Recreational, i

swimming, gofacilities

0230 08 Security, inclu

alarm systems

0240 09 Utilities: such 

electricity, wat

0250 10 Trash collectio0260

b.

If property is co-op, ask 

–

10a.

8.

Now I’d like to ask you aboutpayments you make (your CUmakes) directly to the cooperativefor your (your CU’s) share of itscosts. Since the 1st of (month, 3months ago), for which of the thingson this card (hand the respondentInformation Booklet, page 12) have you(has your CU) made any payments?Mark (X) all that apply.If any entry in boxes 1

–11, go to

item 10a.If no entries in boxes 1

–11, go to

item 11a.

9. If property is not co-op, ask 

–

Which of the services and privilegeslisted (hand the respondent InformationBooklet, page 13) are included in thosepayments?Mark (X) all that apply.

0270 21 Management

0280 22 Repairs and m

including lawn removal

0340035003600370

0330 27 Security, inclu

alarm systems

0290 23 Improvements0300 24 Utilities: such 

electricity, wat

0310 25 Parking0320 26 Recreational, i

swimming, gofacilities

31 Other – Specif28 Maid service

Are any of the costs included in your(your CU’s) mortgage payment?

0410 

$

0400 1

2

YesNo – Go to item 

0420 

$

If YES 

– How much per month?

c. In addition to those costs, since the

1st of (month, 3 months ago), have you(has your CU) made any other regularpayments for these services?

d. Since the 1st of (month, 3 months

ago), how much have you (has yourCU) paid for these services?

e. How much of the (amount in item 10d) was

paid since the 1st of (current month)?

2930

Medical servicTrash collectio

030405

Property insurManagement 

A property number listed mustmatch to a previously reportednumber from section 3A.1, columna and/or section 3B, item 1a.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part J – Change in Mortgage or Lump Sum Home Equity Loan Payment

3.

FIELD REPRESENTATIV

Page 22 

FORM CE-302

Is this a 30-year mortgage (lump sum home equity loan), a15-year mortgage (home equity loan), or something else?

Number 0010

What was the reason for the change in the amount of yourmortgage (lump sum home equity loan) payment for (propertydescription)?

2.

1 03 92 9 

PROCESSING USE ONLY

0045 1

23

30-year15-yearSomething else – Specify

12345678

0040 Go to item 8

Go to item 7Go to item 11Go to item 8

1. FIELD REPRESENTATIVE ITEM

Complete a separate page foreach change in the amount of themortgage or lump sum homeequity loan payment reported inpart A.1, item 1, column k.

a. PROPERTY NUMBER

b. PROPERTY CODE

c. DESCRIPTION

0020 Code

Description

4a. Is this a fixed rate mortgage (lump sum home equity loan)? 0055 1

2

Yes – Go to item 5No

b. There are many different kinds of mortgages (lump sum home

equity loans). Which one of these comes closest to yours (yourCU’s)?



6. How often are (were) mortgage (lump 

payments due?Enter in two decimal places, such as "9.5

d. MORTGAGE (LOAN) NUMBER

e. TYPE OF LOAN

Number 0030

0035 1

2

MortgageLump sum home equity loan

Enter the property number initem 1a, the property code initem 1b, the property descriptionin item 1c, and the mortgage(loan) number in item 1d. Mark(X) the appropriate type of loanin item 1e.1 –2 –3 –

Change in escrow account paymentChange in interest ratePaid off

4 – Change in amount of the graduated payment for a graduated

payment mortgage (loan)

5 – Mortgage (loan) renegotiated (rollover or renegotiable mortgage

(loan))

6 –7 –8 –X –

Refinanced mortgage (loan) (this includes changing the termof the mortgage (loan))Other reasonsMore than one of the aboveDon’t know

X

Go to item 3

Number of years 0050

Hand respondent Information Booklet, page 10. 0060 1

23456

Fixed rate of interestVariable or adjustable interest rateGraduated paymentRollover or renegotiableDeferred interestOther – Specify

5. What was the amount of the mortgage (lump sum home equity

loan) when you (your CU) obtained it, excluding any interest?

10.

7. What is the current interest rate for t

home equity loan)?(Include all FHA guarantee insurance if a

8.

Hand respondent Information Booklet, paOn your (your CU’s) last regular paymthings were included?

9. On your (your CU’s) last regular paym

amount you (your CU) paid for these If any of Codes 2–6 marked in item 8 ask How much of that amount was for pr

11. In what month did the amount of you

sum home equity loan) payment chan

Don’t know

0070 .00 $

X

A property number listed mustmatch to a previously reportedproperty number in section 3A.1,column a.

Section 3 – Part J
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part J – Change in Mortgage or Lump Sum Home Equity Loan Payment – Continued

3.

FIELD REPRESENTATIV

Page 23 

FORM CE-302

Is this a 30-year mortgage (lump sum home equity loan), a15-year mortgage (home equity loan), or something else?

Number 0010

What was the reason for the change in the amount of yourmortgage (lump sum home equity loan) payment for (propertydescription)?

2.

1 03 93 7 

PROCESSING USE ONLY

0045 1

23

30-year15-yearSomething else – Specify

12345678

0040 Go to item 8

Go to item 7Go to item 11Go to item 8

1. FIELD REPRESENTATIVE ITEM

a. PROPERTY NUMBER

b. PROPERTY CODE

c. DESCRIPTION

0020 Code

Description

4a. Is this a fixed rate mortgage (lump sum home equity loan)? 0055 1

2

Yes – Go to item 5No

b. There are many different kinds of mortgages (lump sum home

equity loans). Which one of these comes closest to yours (yourCU’s)?



6. How often are (were) mortgage (lump 

payments due?Enter in two decimal places, such as "9.5

d. MORTGAGE (LOAN) NUMBER

e. TYPE OF LOAN

Number 0030

0035 1

2

MortgageLump sum home equity loan

1 –2 –3 –

Change in escrow account paymentChange in interest ratePaid off

4 – Change in amount of the graduated payment for a graduated

payment mortgage (loan)

5 – Mortgage (loan) renegotiated (rollover or renegotiable mortgage

(loan))

6 –7 –8 –X –

Refinanced mortgage (loan) (this includes changing the termof the mortgage (loan))Other reasonsMore than one of the aboveDon’t know

X

Go to item 3

Number of years 0050

Hand respondent Information Booklet, page 10. 0060 1

23456

Fixed rate of interestVariable or adjustable interest rateGraduated paymentRollover or renegotiableDeferred interestOther – Specify

5. What was the amount of the mortgage (lump sum home equity

loan) when you (your CU) obtained it, excluding any interest?

10.

7. What is the current interest rate for t

home equity loan)?(Include all FHA guarantee insurance if a

8.

Hand respondent Information Booklet, paOn your (your CU’s) last regular paymthings were included?

9. On your (your CU’s) last regular paym

amount you (your CU) paid for these If any of Codes 2–6 marked in item 8 ask How much of that amount was for pr

11. In what month did the amount of you

sum home equity loan) payment chan

Don’t know

0070 .00 $

X

Complete a separate page foreach change in the amount of themortgage or lump sum homeequity loan payment reported inpart A.1, item 1, column k.Enter the property number initem 1a, the property code initem 1b, the property descriptionin item 1c, and the mortgage(loan) number in item 1d. Mark(X) the appropriate type of loanin item 1e.A property number listed mustmatch to a previously reportedproperty number in section 3A.1,column a.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part J – Change in Mortgage or Lump Sum Home Equity Loan Payment – Continued

3.

FIELD REPRESENTATIV

Page 24 

FORM CE-302

Is this a 30-year mortgage (lump sum home equity loan), a15-year mortgage (home equity loan), or something else?

Number 0010

What was the reason for the change in the amount of yourmortgage (lump sum home equity loan) payment for (propertydescription)?

2.

1 03 94 5 

PROCESSING USE ONLY

0045 1

23

30-year15-yearSomething else – Specify

12345678

0040 Go to item 8

Go to item 7Go to item 11Go to item 8

1. FIELD REPRESENTATIVE ITEM

a. PROPERTY NUMBER

b. PROPERTY CODE

c. DESCRIPTION

0020 Code

Description

4a. Is this a fixed rate mortgage (lump sum home equity loan)? 0055 1

2

Yes – Go to item 5No

b. There are many different kinds of mortgages (lump sum home

equity loans). Which one of these comes closest to yours (yourCU’s)?



6. How often are (were) mortgage (lump 

payments due?Enter in two decimal places, such as "9.5

d. MORTGAGE (LOAN) NUMBER

e. TYPE OF LOAN

Number 0030

0035 1

2

MortgageLump sum home equity loan

1 –2 –3 –

Change in escrow account paymentChange in interest ratePaid off

4 – Change in amount of the graduated payment for a graduated

payment mortgage (loan)

5 – Mortgage (loan) renegotiated (rollover or renegotiable mortgage

(loan))

6 –7 –8 –X –

Refinanced mortgage (loan) (this includes changing the termof the mortgage (loan))Other reasonsMore than one of the aboveDon’t know

X

Go to item 3

Number of years 0050

Hand respondent Information Booklet, page 10. 0060 1

23456

Fixed rate of interestVariable or adjustable interest rateGraduated paymentRollover or renegotiableDeferred interestOther – Specify

5. What was the amount of the mortgage (lump sum home equity

loan) when you (your CU) obtained it, excluding any interest?

10.

7. What is the current interest rate for t

home equity loan)?(Include all FHA guarantee insurance if a

8.

Hand respondent Information Booklet, paOn your (your CU’s) last regular paymthings were included?

9. On your (your CU’s) last regular paym

amount you (your CU) paid for these If any of Codes 2–6 marked in item 8 ask How much of that amount was for pr

11. In what month did the amount of you

sum home equity loan) payment chan

Don’t know

0070 .00 $

Section 4

X

Complete a separate page foreach change in the amount of themortgage or lump sum homeequity loan payment reported inpart A.1, item 1, column k.Enter the property number initem 1a, the property code initem 1b, the property descriptionin item 1c, and the mortgage(loan) number in item 1d. Mark(X) the appropriate type of loanin item 1e.A property number listed mustmatch to a previously reportedproperty number in section 3A.1,column a.

Section 3 – Part J (Continued)
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES

Part A – Telephone Expenses

Page 25 FORM CE-302

What is the name of the company whichprovides the telephone (or pager) services?

2.

PROCESSING USE ONLY 1 04 01 8

YesNo – Go to part B

1. Since the 1st of (month, 3 months ago), have

you (or any members of your CU) receivedany bills for telephone or pager services?Do not include bills for telephones orpagers used entirely for business purposes.

00100910 .00

(1) Basic (local) service charge

(2)

7a. Is any of the total charge to be deducted as a

business expense?

b.

8. Did you (or any members of your CU) receive

any other bills for telephones or pagers notused entirely for business purposes from anyother companies?If YES – What percentage will be deducted?

Number

Name of telephone company

Bill 2

0 None 0020

Month

0900 1 Yes0920 1 Yes – Complete a separate page for each telephone company

2 No – Go to item 8

Percent

2 No – Go to part B

Month

.00 $

Section 4

Residential serviceMobile/Cellular ServicePager/Beeper Service

004000500060

Bill 1

1

Yes No

0070 2

.00 $ 0140

Amount

123

How many telephone (or pager) bills werereceived from (company name) ?

3.4a. What was the total amount of bill (bill

number)? Exclude any unpaid bills from a

previous billing period.

b. In what month was the bill received?

5. What types of telephone (or pager) services

did the bill include? (Mark (X) all that apply)

6a. Which of the following telephone service items

were included in the bill? (Mark (X) all that apply.)Complete a separate column for each billreceived since the 1st of (month, 3 months ago.)Hand the respondent Information Booklet, Page 13a.

0080 1 2

(3) 0090 1 2

Domestic long distance chargeInternational long distance charge

(4) Telephone related services such as 

caller ID, call waiting, or voice mailboxes? (Do not include data services) 1 0100 2

(5) Installation or repair of telephone line(s) 1 0110 2

(6) Telephone or pager purchases or rentals 1 0120 2

.00 $ 0160.00 $ 0180.00 $ 0200

.00 $ 0210

b. (If unable to separate (7–10) above) What was

the total amount for these non-telephonerelated services?

(7) Internet access or data services 1 0130 2(8) Cable or satellite television services 1 0150 2(9) DSL or ISDN charges 1 0170 2

(10) Non-telephone related rentals or

purchases 1 0190 2

0 None 0230

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

025002600270

1

Yes No

0280 2

.00 $ 0350

Amount

123

0290 1 20300 1 2

1 0310 21 0320 21 0330 2

.00 $ 0370.00 $ 0390.00 $ 0410

1 0340 21 0360 21 0380 21 0400 2

0 

0440

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

046004700480

Bill 3

1

Yes No

0490 2

$ 0560

Amount

123

0500 1 20510 1 2

1 0520 21 0530 21 0540 2

$ 0580$ 0600$ 0620

1 0550 21 0570 21 0590 21 0610 2

0030 0240 0450 

If YES (7–10) Ask – How much?

0220 1 Bills

2 Estimate3 Checkbook

c. FIELD REPRESENTATIVE CHECK ITEM

Was a bill or checkbook used or was anestimate given?

.00 $ 0420

0430 1 Bills

2 Estimate3 Checkbook

.00 $ 0630

0640 1 Bills

2 Estimate3 Checkbook
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part A – Telephone Expenses – Continued

Page 26 FORM CE-302

Section 4 – Part A (Continued)

What is the name of the company whichprovides the telephone (or pager) services?

2.

PROCESSING USE ONLY 1 04 02 6

00100910 .00

(1) Basic (local) service charge

(2)

7a. Is any of the total charge to be deducted as a

business expense?

b.

8. Did you (or any members of your CU) receive

any other bills for telephones or pagers notused entirely for business purposes from anyother companies?If YES – What percentage will be deducted?

Number

Name of telephone company

Bill 2

0 None 0020

Month

0900 1 Yes0920 1 Yes – Complete a separate page for each telephone company

2 No – Go to item 8

Percent

2 No – Go to part B

Month

.00 $

Section 4

Residential serviceMobile/Cellular ServicePager/Beeper Service

004000500060

Bill 1

1

Yes No

0070 2

.00 $ 0140

Amount

123

How many telephone (or pager) bills werereceived from (company name) ?

3.4a. What was the total amount of bill (bill

number)? Exclude any unpaid bills from a

previous billing period.

b. In what month was the bill received?

5. What types of telephone (or pager) services

did the bill include? (Mark (X) all that apply)

6a. Which of the following telephone service items

were included in the bill? (Mark (X) all that apply.)Complete a separate column for each billreceived since the 1st of (month, 3 months ago.)Hand the respondent Information Booklet, Page 13a.

0080 1 2

(3) 0090 1 2

Domestic long distance chargeInternational long distance charge

(4) Telephone related services such as 

caller ID, call waiting, or voice mailboxes? (Do not include data services) 1 0100 2

(5) Installation or repair of telephone line(s) 1 0110 2

(6) Telephone or pager purchases or rentals 1 0120 2

.00 $ 0160.00 $ 0180.00 $ 0200

.00 $ 0210

b. (If unable to separate (7–10) above) What was

the total amount for these non-telephonerelated services?

(7) Internet access or data services 1 0130 2(8) Cable or satellite television services 1 0150 2(9) DSL or ISDN charges 1 0170 2

(10) Non-telephone related rentals or

purchases 1 0190 2

0 None 0230

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

025002600270

1

Yes No

0280 2

.00 $ 0350

Amount

123

0290 1 20300 1 2

1 0310 21 0320 21 0330 2

.00 $ 0370.00 $ 0390.00 $ 0410

1 0340 21 0360 21 0380 21 0400 2

0 

0440

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

046004700480

Bill 3

1

Yes No

0490 2

$ 0560

Amount

123

0500 1 20510 1 2

1 0520 21 0530 21 0540 2

$ 0580$ 0600$ 0620

1 0550 21 0570 21 0590 21 0610 2

0030 0240 0450 

If YES (7–10) Ask – How much?

0220 1 Bills

2 Estimate3 Checkbook

c. FIELD REPRESENTATIVE CHECK ITEM

Was a bill or checkbook used or was anestimate given?

.00 $ 0420

0430 1 Bills

2 Estimate3 Checkbook

.00 $ 0630

0640 1 Bills

2 Estimate3 Checkbook
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part A – Telephone Expenses – Continued

Page 27 FORM CE-302

What is the name of the company whichprovides the telephone (or pager) services?

2.

PROCESSING USE ONLY 1 04 03 4

00100910 .00

(1) Basic (local) service charge

(2)

7a. Is any of the total charge to be deducted as a

business expense?

b.

8. Did you (or any members of your CU) receive

any other bills for telephones or pagers notused entirely for business purposes from anyother companies?If YES – What percentage will be deducted?

Number

Name of telephone company

Bill 2

0 None 0020

Month

0900 1 Yes0920 1 Yes – Complete a separate page for each telephone company

2 No – Go to item 8

Percent

2 No – Go to part B

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

004000500060

Bill 1

1

Yes No

0070 2

.00 $ 0140

Amount

123

How many telephone (or pager) bills werereceived from (company name) ?

3.4a. What was the total amount of bill (bill

number)? Exclude any unpaid bills from a

previous billing period.

b. In what month was the bill received?

5. What types of telephone (or pager) services

did the bill include? (Mark (X) all that apply)

6a. Which of the following telephone service items

were included in the bill? (Mark (X) all that apply.)Complete a separate column for each billreceived since the 1st of (month, 3 months ago.)Hand the respondent Information Booklet, Page 13a.

0080 1 2

(3) 0090 1 2

Domestic long distance chargeInternational long distance charge

(4) Telephone related services such as 

caller ID, call waiting, or voice mailboxes? (Do not include data services) 1 0100 2

(5) Installation or repair of telephone line(s) 1 0110 2

(6) Telephone or pager purchases or rentals 1 0120 2

.00 $ 0160.00 $ 0180.00 $ 0200

.00 $ 0210

b. (If unable to separate (7–10) above) What was

the total amount for these non-telephonerelated services?

(7) Internet access or data services 1 0130 2(8) Cable or satellite television services 1 0150 2(9) DSL or ISDN charges 1 0170 2

(10) Non-telephone related rentals or

purchases 1 0190 2

0 None 0230

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

025002600270

1

Yes No

0280 2

.00 $ 0350

Amount

123

0290 1 20300 1 2

1 0310 21 0320 21 0330 2

.00 $ 0370.00 $ 0390.00 $ 0410

1 0340 21 0360 21 0380 21 0400 2

0 

0440

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

046004700480

Bill 3

1

Yes No

0490 2

$ 0560

Amount

123

0500 1 20510 1 2

1 0520 21 0530 21 0540 2

$ 0580$ 0600$ 0620

1 0550 21 0570 21 0590 21 0610 2

0030 0240 0450 

If YES (7–10) Ask – How much?

0220 1 Bills

2 Estimate3 Checkbook

c. FIELD REPRESENTATIVE CHECK ITEM

Was a bill or checkbook used or was anestimate given?

.00 $ 0420

0430 1 Bills

2 Estimate3 Checkbook

.00 $ 0630

0640 1 Bills

2 Estimate3 Checkbook
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part A – Telephone Expenses – Continued

Page 28 FORM CE-302

Section 4 – Part A (Continued)

What is the name of the company whichprovides the telephone (or pager) services?

2.

PROCESSING USE ONLY 1 04 04 2

00100910 .00

(1) Basic (local) service charge

(2)

7a. Is any of the total charge to be deducted as a

business expense?

b.

8. Did you (or any members of your CU) receive

any other bills for telephones or pagers notused entirely for business purposes from anyother companies?If YES – What percentage will be deducted?

Number

Name of telephone company

Bill 2

0 None 0020

Month

0900 1 Yes0920 1 Yes – Complete a separate page for each telephone company

2 No – Go to item 8

Percent

2 No – Go to part B

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

004000500060

Bill 1

1

Yes No

0070 2

.00 $ 0140

Amount

123

How many telephone (or pager) bills werereceived from (company name) ?

3.4a. What was the total amount of bill (bill

number)? Exclude any unpaid bills from a

previous billing period.

b. In what month was the bill received?

5. What types of telephone (or pager) services

did the bill include? (Mark (X) all that apply)

6a. Which of the following telephone service items

were included in the bill? (Mark (X) all that apply.)Complete a separate column for each billreceived since the 1st of (month, 3 months ago.)Hand the respondent Information Booklet, Page 13a.

0080 1 2

(3) 0090 1 2

Domestic long distance chargeInternational long distance charge

(4) Telephone related services such as 

caller ID, call waiting, or voice mailboxes? (Do not include data services) 1 0100 2

(5) Installation or repair of telephone line(s) 1 0110 2

(6) Telephone or pager purchases or rentals 1 0120 2

.00 $ 0160.00 $ 0180.00 $ 0200

.00 $ 0210

b. (If unable to separate (7–10) above) What was

the total amount for these non-telephonerelated services?

(7) Internet access or data services 1 0130 2(8) Cable or satellite television services 1 0150 2(9) DSL or ISDN charges 1 0170 2

(10) Non-telephone related rentals or

purchases 1 0190 2

0 None 0230

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

025002600270

1

Yes No

0280 2

.00 $ 0350

Amount

123

0290 1 20300 1 2

1 0310 21 0320 21 0330 2

.00 $ 0370.00 $ 0390.00 $ 0410

1 0340 21 0360 21 0380 21 0400 2

0 

0440

Month

.00 $

Residential serviceMobile/Cellular ServicePager/Beeper Service

046004700480

Bill 3

1

Yes No

0490 2

$ 0560

Amount

123

0500 1 20510 1 2

1 0520 21 0530 21 0540 2

$ 0580$ 0600$ 0620

1 0550 21 0570 21 0590 21 0610 2

0030 0240 0450 

If YES (7–10) Ask – How much?

0220 1 Bills

2 Estimate3 Checkbook

c. FIELD REPRESENTATIVE CHECK ITEM

Was a bill or checkbook used or was anestimate given?

.00 $ 0420

0430 1 Bills

2 Estimate3 Checkbook

.00 $ 0630

0640 1 Bills

2 Estimate3 Checkbook
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part B – Additional Telephone Expenses

Page 29 FORM CE-302

1 04 09 0

0020 .00 $

1a. Since the first of (month, 3 months ago),

have you (or any members of your CU)purchased any pre-paid phone cards?

b. What was the total amount paid?

2 No – Go to item 2a1 Yes

c. How much of the total amount was paid

this month?

0 None

0030 .00 $0050 .00 $

2a. Since the first of (month, 3 months ago), have you (or

any members of your CU) had any expenses for publicpay phone services not already reported? Do notinclude expenses for phone cards associated with yourregular phone bill or pre-paid phone cards.

b. What was the total amount paid?

2 No – Go to part C1 Yes

c. How much of the total was paid this

month?

0 None

0060 .00 $00100040
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part C – Screening Questions 1 04 25 7

1. Since the first of (month, 3 months ago), have you (or

any members of your CU) received any bills for anyof the following utilities, fuels, or services? Do notinclude bills for rented vacation properties orproperties used entirely for business.

0020

Yes

2a.

FIELD REPRESENTATIVE: Read eachitem in bold listed below.

b.

If YES –Since the 1st of (month, 3 months ago), have you (or any members of yourCU) received any bills for utilities or fuels for a rented vacation property,such as a cottage?

c.

d.

Page 30 FORM CE-302

Section 4 – Part C

Electricity

Combined expenses for items

Piped-in water 

Combined trash/garbage/

Ask item 2, then complete a column in part D for 

Combined trash/garbage/water 

UTILITY

CODE YES NO

110120130140150160170180190200210220230240250260270280290310100

No – Go to part D

Which utility or fuel was the charge for? Enter a utility code below for each bill

reported.In what month was the bill received? Enter month below for each bill reported.What was the total amount of the charges? Enter amount below for each bill

reported.

003000400050

PROCESSING

USE ONLY Utility code Month Utility Month code

PRE

$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00

TRANSCRIBE L

12

Property

number

from

part D,

item 2

Utility

code

from

part D,

item 1a

NOTES

Amount

Amount

Cable TV, satellite services, orcommunity antenna, if notalready reported 

each utility, fuel, or service reported in item 1.

Combined electric/water/sewerage

Internet connection and othercomputer data services notalready reported Natural or utility gas

Combined gas and electricity 

Fuel oil Kerosene Bottled or tank gas Wood Coal Other fuels 

130–180 

Trash/Garbage collection Sewerage maintenance 

water/sewerage Combined trash/garbage/sewerageCombined water/sewerage 

Water softening service Septic tank cleaning 

300
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part D – Detailed Questions

3.

Page 31 FORM CE-302

What is the name of the company or government agency whichprovides (utility or fuel description)?

0010

2. What property were the charges for?

PROCESSING USE ONLY 1 04 51 3

0045

979899

Rented sample unitOther rented unit

1. FIELD REPRESENTATIVE

TRANSCRIPTION ITEM Enter a utility code in item 1a anda description of utility or fuel initem 1b from part C, item 1.• Owned properties – Enter a description of the property and enter a 0020

property number for –

Property reported at this interview in section 3, part B, item 1a

• All other properties – Mark (X) appropriate box and enter a description

of the property.

Property previously reported in section 3, part A.1, item 1, col. a

4. How many bills were received for (utility or fuel) for (property

description)?

5.6.

What period of time was covered by the bill? If period coveredchanged for a utility or fuel during the reference period, complete aseparate column for each different period of time.Do you have any of these bills or other records showing these(utility or fuel) charges?In what month was the bill received?What was the unit-of-measure, such as kilowatt hours, gallons,cubic feet or therms?

b.

c.

d.

FIELD REPRESENTATIVE CHECK ITEM Ask items 7c–f for utility codes 100–130 only if bills, receipts, or otherrecords are available (code 1, item 6), otherwise go to item 7g.

7a. What was the amount of bill (bill number)?

e. Did the bill include any charges for merchandise, repairs, or other

services which were not part of the cost of (utility or fuel)?

What was the quantity consumed for bill (bill number)?

Description

Property number

Property not owned orrented by CU

Name

Number

Bill 1 Bill 2 Bill 3 Bill 4

.00 $

Month

12

0110

1

Estimate

01300070

.00 $

Month

12

018002000140

.00 $

Month

12

0250 Yes02700210

.00 $

Month

12

03200340

0280

Recordsused

Description

a. UTILITY CODE Codeb. DESCRIPTION OF UTILITY OR FUEL

Ask for utility codes 100–120, 200–260, and 290 only.

12

Month2 months

0055 3

4

QuarterOther – Specify

Complete a separate column for each bill received since the 1st of(month, 3 months ago).

0060 1 Yes 2 No

Unit-of-measure Unit-of-measure Unit-of-measure Unit-of-measure

OFFICE USE ONLY 0095 0165 0235 0305

0105 0175 0245 0315

Quantity Quantity Quantity Quantity

No – Goto item 7g

No – Goto item 7g

YesNo – Goto item 7g

YesNo – Goto item 7g

Yes

f. How much were these charges?

g.

0190 0260 0330

2

1 Records

used

2

1 Records

used

2

1

EstimateRecordsused

2

0080 0150 0220 0290

8. Was any part of the charge deducted as a business expense?9.

0420 1 Yes 2 No

Since the 1st of (month, 3 months ago), did you (or anymembers of your CU) receive any other utility or fuel bills? 0440 1 Yes – Complete a separate column for each property

.00 $

0120

.00 $ .00 $ .00 $

Estimate Estimate

2 No

Was a bill or other record used or was an estimate given?Checks or checkbooks are not considered records.
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part D – Detailed Questions – Continued

3.

Page 32 FORM CE-302

What is the name of the company or government agency whichprovides (utility or fuel description)?

0010

2. What property were the charges for?

PROCESSING USE ONLY 1 04 53 9

0045

979899

Rented sample unitOther rented unit

1. FIELD REPRESENTATIVE

TRANSCRIPTION ITEM Enter a utility code in item 1a anda description of utility or fuel initem 1b from part C, item 1.• Owned properties – Enter a description of the property and enter a 0020

property number for –

Property reported at this interview in section 3, part B, item 1a

• All other properties – Mark (X) appropriate box and enter a description

of the property.

Property previously reported in section 3, part A.1, item 1, col. a

4. How many bills were received for (utility or fuel) for (property

description)?

5.6.

What period of time was covered by the bill? If period coveredchanged for a utility or fuel during the reference period, complete aseparate column for each different period of time.Do you have any of these bills or other records showing these(utility or fuel) charges?In what month was the bill received?What was the unit-of-measure, such as kilowatt hours, gallons,cubic feet or therms?

b.

c.

d.

FIELD REPRESENTATIVE CHECK ITEM Ask items 7c–f for utility codes 100–130 only if bills, receipts, or otherrecords are available (code 1, item 6), otherwise go to item 7g.

7a. What was the amount of bill (bill number)?

e. Did the bill include any charges for merchandise, repairs, or other

services which were not part of the cost of (utility or fuel)?

What was the quantity consumed for bill (bill number)?

Description

Property number

Property not owned orrented by CU

Name

Number

Bill 1 Bill 2 Bill 3 Bill 4

.00 $

Month

12

0110

1

Estimate

01300070

.00 $

Month

12

018002000140

.00 $

Month

12

0250 Yes02700210

.00 $

Month

12

03200340

0280

Recordsused

Description

a. UTILITY CODE Codeb. DESCRIPTION OF UTILITY OR FUEL

Ask for utility codes 100–120, 200–260, and 290 only.

12

Month2 months

0055 3

4

QuarterOther – Specify

Complete a separate column for each bill received since the 1st of(month, 3 months ago).

0060 1 Yes 2 No

Unit-of-measure Unit-of-measure Unit-of-measure Unit-of-measure

OFFICE USE ONLY 0095 0165 0235 0305

0105 0175 0245 0315

Quantity Quantity Quantity Quantity

No – Goto item 7g

No – Goto item 7g

YesNo – Goto item 7g

YesNo – Goto item 7g

Yes

f. How much were these charges?

g.

0190 0260 0330

2

1 Records

used

2

1 Records

used

2

1

EstimateRecordsused

2

0080 0150 0220 0290

8. Was any part of the charge deducted as a business expense?9.

0420 1 Yes 2 No

Since the 1st of (month, 3 months ago), did you (or anymembers of your CU) receive any other utility or fuel bills? 0440 1 Yes – Complete a separate column for each property

.00 $

0120

.00 $ .00 $ .00 $

Estimate Estimate

2 No

Was a bill or other record used or was an estimate given?Checks or checkbooks are not considered records.

Section 4 – Part D (Continued)
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part D – Detailed Questions – Continued

3.

FORM CE-302

What is the name of the company or government agency whichprovides (utility or fuel description)?

0010

2. What property were the charges for?

PROCESSING USE ONLY 1 04 55 4

0045

979899

Rented sample unitOther rented unit

1. FIELD REPRESENTATIVE

TRANSCRIPTION ITEM Enter a utility code in item 1a anda description of utility or fuel initem 1b from part C, item 1.• Owned properties – Enter a description of the property and enter a 0020

property number for –

Property reported at this interview in section 3, part B, item 1a

• All other properties – Mark (X) appropriate box and enter a description

of the property.

Property previously reported in section 3, part A.1, item 1, col. a

4. How many bills were received for (utility or fuel) for (property

description)?

5.6.

What period of time was covered by the bill? If period coveredchanged for a utility or fuel during the reference period, complete aseparate column for each different period of time.Do you have any of these bills or other records showing these(utility or fuel) charges?In what month was the bill received?What was the unit-of-measure, such as kilowatt hours, gallons,cubic feet or therms?

b.

c.

d.

FIELD REPRESENTATIVE CHECK ITEM Ask items 7c–f for utility codes 100–130 only if bills, receipts, or otherrecords are available (code 1, item 6), otherwise go to item 7g.

7a. What was the amount of bill (bill number)?

e. Did the bill include any charges for merchandise, repairs, or other

services which were not part of the cost of (utility or fuel)?

What was the quantity consumed for bill (bill number)?

Description

Property number

Property not owned orrented by CU

Name

Number

Bill 1 Bill 2 Bill 3 Bill 4

.00 $

Month

12

0110

1

Estimate

01300070

.00 $

Month

12

018002000140

.00 $

Month

12

0250 Yes02700210

.00 $

Month

12

03200340

0280

Recordsused

Description

a. UTILITY CODE Codeb. DESCRIPTION OF UTILITY OR FUEL

Ask for utility codes 100–120, 200–260, and 290 only.

12

Month2 months

0055 3

4

QuarterOther – Specify

Complete a separate column for each bill received since the 1st of(month, 3 months ago).

0060 1 Yes 2 No

Unit-of-measure Unit-of-measure Unit-of-measure Unit-of-measure

OFFICE USE ONLY 0095 0165 0235 0305

0105 0175 0245 0315

Quantity Quantity Quantity Quantity

No – Goto item 7g

No – Goto item 7g

YesNo – Goto item 7g

YesNo – Goto item 7g

Yes

f. How much were these charges?

g.

0190 0260 0330

2

1 Records

used

2

1 Records

used

2

1

EstimateRecordsused

2

0080 0150 0220 0290

8. Was any part of the charge deducted as a business expense?9.

0420 1 Yes 2 No

Since the 1st of (month, 3 months ago), did you (or anymembers of your CU) receive any other utility or fuel bills? 0440 1 Yes – Complete a separate column for each property

.00 $

0120

.00 $ .00 $ .00 $

Estimate Estimate

2 No

Was a bill or other record used or was an estimate given?Checks or checkbooks are not considered records.

Page 33 

Section 5
Section 5 –

Part A – Screening Questions

1. Since the 1st of (month, 3 months ago), have

you (or any members of your CU) hadexpenses for –?

3a.

FIELD REPRESENTATIVE –

Page 34 

FORM CE-302

Section 5 – Part A

Have there been any expenses for propertyyou owned or rented since the 1st of(month, 3 months ago), for any of thefollowing jobs? (Renters should notinclude jobs that have been or will betotally reimbursed by anyone outside oftheir CU.)

b. Which of the following?

Job code

from

part B,

item 1

JOB

CODE

Dwellings under construction including a vacation orsecond home

2.

100

CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCEOF PROPERTY

In this section, all extotally reimbursed b

Information Booklet, page 14 YES NOInformation Booklet, page 14Information Booklet, page 14Have there been any expenses that dealwith the upkeep or improvement of thisunit or any other unit you owned or rentedsince the 1st of (month, 3 months ago)?(Renters should not include jobs that havebeen or will be totally reimbursed byanyone outside of their CU.)

Yes No – Go to item 4a

Building an addition to the house or a new structure,such as a porch, garage, or new wing 110

120130140150

Finishing a basement or an attic or enclosing a porch

Remodeling one or more rooms in the houseLandscaping the ground or planting new shrubs or treesBuilding outdoor patios, walks, fences, or otherenclosures, driveways, or permanent swimming pools

Repairing outdoor patios, walks, fences, driveways, orpermanent swimming pools

Inside painting or paperingOutside paintingPlastering or panelingPlumbing or water heating installations and repairsElectrical workHeating or air-conditioning jobsFlooring repair or replacement, including inlaid linoleumor vinyl tile

160170180190200210220230

Insulation 240

260270280290300310

Roofing, gutters, or downspouts

SidingInstallation, repair, or replacement of window panes,screens, storm doors, awnings, and the likeMasonry, brick, or stucco workOther improvements or repairsUse only if unable to itemize above – Combined expenses

12 

Property

description

from part B,

item 2a

Pr

des

c

from 

ite

8. FIELD REPRESENTATIVE INSTRUC

PROCESSING USE 

4a. Have there been any expenses 

(property that you do not own members of your CU)?

b. Which jobs were those expense

Enter job code(s) from items 1 throFIELD REPRESENTATIVE CHECK IT

5. Job codes items 1, 2, 3, and 4

b. If YES – What kind of job will th

used for?Enter a job code.

6a. Since the 1st of (month, 3 month

current month, have you (or anCU) purchased any materials oyet started?

c. What was the total cost of thes

supplies?

7a. Since the 1st of (month, 3 month

current month, have you (or anCU) purchased any materials ospecific job?

b. If YES – What was the total cost

Section 5
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued

Part B – Job Description

1 05 50 2

1.6.

Page 35 FORM CE-302

.00

FIELD REPRESENTATIVEITEMEnter the job code from part A. (For combinedjobs use code 310.)

0050 $

b. Enter a property number – For owned property

enter the property number from section 3. Mark(X) the appropriate box for all other properties.

0020

979899

Rented sample unitOther rented unit

c. Since the 1st of (month, 3 months ago), how

much have you paid for labor and anymaterials THEY PROVIDED?FIELD REPRESENTATIVE CHECK ITEM 0030 1

2345

AdditionAlterationReplacementMaintenance and repairNew construction

0120 1

2

YesNo – Go to item 8a

Did the charge(s) include the cost of anyappliances or equipment?

(month, 3 months ago)?

7. Which of these items did it include and what

was the cost of each?

b. What was the total cost for all items purchased for

this job in –What percent of the total cost was (will be)reimbursed or paid by someone outside of your CU?

0250 0140 

PROCESSING USE ONLYJOB NUMBER 1

0010 Code

Property not owned or rentedby CU

Property number

On which property was the (job description)done?

2a. Description

b. Job classification – Mark (X) one.

What work was done? Description should beadequate to classify as "alteration," "repair," etc.,and to identify in next interview.

3a. Description

0070 0 None .00 $00400110 .00

0 None – Go to item 8a

$

OFFICE USE ONLY – Enter detail job codes.

What was the total cost of the job? Includeall costs paid for by you (or any members ofyour CU) or by any non-CU member, such asinsurance companies, and so forth.

4.

Did you do all the work yourself or did youpay someone or contract with a builder to doall or part of the work?

5a. 0060 1

2

Self only – Go to item 8aPaid or contracted withsomeone else

b. What was the cost for all labor, materials,

appliances, or equipment THEY PROVIDED IN –

(month, 2 months ago)? 0080 0 None .00 $(last month)? 0090 0 None .00 $(the current month)? 0100 0 None .00 $

If codes 100–130, 200–220, or 300 in item 1, ask

items 6 and 7; for all other codes, go to item 8a.Information Booklet, page 15

8a.

0130

(month, 3 months ago)? 0260 

b.

(month, 2 months ago)? 0270 (last month)? 0280 (the current month)? 0290 

1

01500160 

2

Have you (or any members of your CU)PURCHASED any materials, supplies, tools, orequipment for doing this job?

0300 

9a. Have you (or any members of your CU) RENTED any

tools or equipment for doing this job?

b. What was the total cost for all items rented for this

job in –

(month, 3 months ago)? 0310 (month, 2 months ago)? 0320 (last month)? 0330 (the current month)? 0340 

03700350 

10a. Was (Will) any of the total cost of (read entry in

item 4) (be) reimbursed or paid by someoneoutside of your CU?

0380 

11a. Were (Will) any of these expenses for this job (be)

deducted as a business expense?

b. What percent was (will be) deducted? 0390 

An owned property number listed must match apreviously reported property number in section3A.1, column a and/or section 3B, item 1a.
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued

Part B – Job Description – Continued

1 05 51 0

1.6.

Page 36 FORM CE-302

.00

FIELD REPRESENTATIVEITEMEnter the job code from part A. (For combinedjobs use code 310.)

0050 $

b. Enter a property number – For owned property

enter the property number from section 3. Mark(X) the appropriate box for all other properties.

0020

979899

Rented sample unitOther rented unit

c. Since the 1st of (month, 3 months ago), how

much have you paid for labor and anymaterials THEY PROVIDED?FIELD REPRESENTATIVE CHECK ITEM 0030 1

2345

AdditionAlterationReplacementMaintenance and repairNew construction

0120 1

2

YesNo – Go to item 8a

Did the charge(s) include the cost of anyappliances or equipment?

(month, 3 months ago)?

7. Which of these items did it include and what

was the cost of each?

b. What was the total cost for all items purchased for

this job in –What percent of the total cost was (will be)reimbursed or paid by someone outside of your CU?

0250 0140 0370

PROCESSING USE ONLYJOB NUMBER 2

0010 Code

Property not owned or rentedby CU

Property number

On which property was the (job description)done?

2a. Description

b. Job classification – Mark (X) one.

What work was done? Description should beadequate to classify as "alteration," "repair," etc.,and to identify in next interview.

3a. Description

0070 0 None .00 $00400110 .00

0 None – Go to item 8a

$

OFFICE USE ONLY – Enter detail job codes.

What was the total cost of the job? Includeall costs paid for by you (or any members ofyour CU) or by any non-CU member, such asinsurance companies, and so forth.

4.

Did you do all the work yourself or did youpay someone or contract with a builder to doall or part of the work?

5a. 0060 1

2

Self only – Go to item 8aPaid or contracted withsomeone else

b. What was the cost for all labor, materials,

appliances, or equipment THEY PROVIDED IN –

(month, 2 months ago)? 0080 0 None .00 $(last month)? 0090 0 None .00 $(the current month)? 0100 0 None .00 $

If codes 100–130, 200–220, or 300 in item 1, ask

items 6 and 7; for all other codes, go to item 8a.Information Booklet, page 15

8a.

0130

(month, 3 months ago)? 0260 

b.

(month, 2 months ago)? 0270 (last month)? 0280 (the current month)? 0290 

1

01500160 

2

Have you (or any members of your CU)PURCHASED any materials, supplies, tools, orequipment for doing this job?

0300 

9a. Have you (or any members of your CU) RENTED any

tools or equipment for doing this job?

b. What was the total cost for all items rented for this

job in –

(month, 3 months ago)? 0310 (month, 2 months ago)? 0320 (last month)? 0330 (the current month)? 0340 

0350 

10a. Was (Will) any of the total cost of (read entry in

item 4) (be) reimbursed or paid by someoneoutside of your CU?

0380 

11a. Were (Will) any of these expenses for this job (be)

deducted as a business expense?

b. What percent was (will be) deducted? 0390 

Section 5 – Part B (Continued)

An owned property number listed must match apreviously reported property number in section3A.1, column a and/or section 3B, item 1a.
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued

Part B – Job Description – Continued

1 05 52 8

1.6.

Page 37 FORM CE-302

.00

FIELD REPRESENTATIVEITEMEnter the job code from part A. (For combinedjobs use code 310.)

0050 $

b. Enter a property number – For owned property

enter the property number from section 3. Mark(X) the appropriate box for all other properties.

0020

979899

Rented sample unitOther rented unit

c. Since the 1st of (month, 3 months ago), how

much have you paid for labor and anymaterials THEY PROVIDED?FIELD REPRESENTATIVE CHECK ITEM 0030 1

2345

AdditionAlterationReplacementMaintenance and repairNew construction

0120 1

2

YesNo – Go to item 8a

Did the charge(s) include the cost of anyappliances or equipment?

(month, 3 months ago)?

7. Which of these items did it include and what

was the cost of each?

b. What was the total cost for all items purchased for

this job in –What percent of the total cost was (will be)reimbursed or paid by someone outside of your CU?

0250 0140 0370

PROCESSING USE ONLYJOB NUMBER 3

0010 Code

Property not owned or rentedby CU

Property number

On which property was the (job description)done?

2a. Description

b. Job classification – Mark (X) one.

What work was done? Description should beadequate to classify as "alteration," "repair," etc.,and to identify in next interview.

3a. Description

0070 0 None .00 $00400110 .00

0 None – Go to item 8a

$

OFFICE USE ONLY – Enter detail job codes.

What was the total cost of the job? Includeall costs paid for by you (or any members ofyour CU) or by any non-CU member, such asinsurance companies, and so forth.

4.

Did you do all the work yourself or did youpay someone or contract with a builder to doall or part of the work?

5a. 0060 1

2

Self only – Go to item 8aPaid or contracted withsomeone else

b. What was the cost for all labor, materials,

appliances, or equipment THEY PROVIDED IN –

(month, 2 months ago)? 0080 0 None .00 $(last month)? 0090 0 None .00 $(the current month)? 0100 0 None .00 $

If codes 100–130, 200–220, or 300 in item 1, ask

items 6 and 7; for all other codes, go to item 8a.Information Booklet, page 15

8a.

0130

(month, 3 months ago)? 0260 

b.

(month, 2 months ago)? 0270 (last month)? 0280 (the current month)? 0290 

1

01500160 

2

Have you (or any members of your CU)PURCHASED any materials, supplies, tools, orequipment for doing this job?

0300 

9a. Have you (or any members of your CU) RENTED any

tools or equipment for doing this job?

b. What was the total cost for all items rented for this

job in –

(month, 3 months ago)? 0310 (month, 2 months ago)? 0320 (last month)? 0330 (the current month)? 0340 

0350 

10a. Was (Will) any of the total cost of (read entry in

item 4) (be) reimbursed or paid by someoneoutside of your CU?

0380 

11a. Were (Will) any of these expenses for this job (be)

deducted as a business expense?

b. What percent was (will be) deducted? 0390 

Section 6

An owned property number listed must match apreviously reported property number in section3A.1, column a and/or section 3B, item 1a.
Section 6 – APPLIANCES, HOUSEHOLD EQUIPMENT, 

AND OTHER SELECTED ITEMS

8 06 02 6

1. Since the 1st of (month, 3 months ago),

have you (or any members of your CU)purchased or rented any of thefollowing items for your CU, or forsomeone outside your CU?

Page 38 FORM CE-302

Section 6 – Part A

FIELD REPRESENTATIVE – Hand the respondent the 

proceed. Ask column a, qindividual items and com

a

Information Booklet, page 16

2. FIELD REPRESENTATIVE 1 06 01 3

CHECK ITEMMark (X) box if there areno entries recorded incolumns b–j.

0010 999 Go to

Part B

ITEM

CODE YES NO

What type did you purchaseor rent?

PROCESSING USE ONLY

b

00100020003000400050006000700080009001000110012001300140015001600170

c

ENTERITEMCODEfromcolumn a.

d

Was this –

33

e

Whendidyoupurchaseit?

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

f

What was thepurchasepriceafter anytrade-inallowance?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

YES NO

COOKING STOVE, RANGE, OR OVEN 

ElectricGasOther

REFRIGERATORHOME-FREEZERDISHWASHER

100110130140150160170180190220200210

Part A – Purchase of Household Appliances

Do not list any appliance previouslyreported in section 5B, item 7. If anappliance is reported in both section 5 andsection 6, probe to verify that they are notduplicated.

Built-inPortable

GARBAGE DISPOSALCLOTHES WASHERCLOTHES DRYERRANGE HOOD Combination of any of the above items

NOTES

Enter a brand name or a briefdescription of item.

3 – Purchased 

forsomeoneoutside your CU?

2 – Rented? 

Go tocolumn g.

1 – Purchased

for own use?

Mark (X) box

If code 2 incolumn d –

Did thisincludesales tax?

g h

Month 

333333333333333

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

1 1 2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

2

Section 6

What wasthe totalrentalexpensesince the1st of(month, 3months ago),excludingthe currentmonth?

MICROWAVE OVEN 120
FORM CE-302

Page 39 

Section 6 

– APPLIANCES, HOUSEHOLD EQUIPMENT,

AND OTHER SELECTED ITEMS 

– Continued

6 06 04 6

1. Since the 1st of (month, 3 months ago), have

you (or any members of your CU) purchasedor rented any of the following items for yourCU, or for someone outside your CU?

a

Information Booklet, pages 16–18

2. FIELD REPRESENTATIVE 1 06 03 9

CHECK ITEMMark (X) box if there areno entries recorded incolumns b

–i.

0010

0010 999 Go to

nextpage

ITEM

CODE YES NO

What type did youpurchase or rent?

PROCESSING USE ONLY

b

0200

c

ENTERITEMCODEfromcolumn a.

d

Was this –

YES 

SMALL HOUSEHOLDAPPLIANCESTELEPHONE ANDACCESSORIES

230

Small electricalkitchen appliances

Electric personal careappliances Smoke detectorsElectric floor cleaningequipment 

OTHER HOUSEHOLDAPPLIANCESSEWING MACHINES TELEPHONE ANSWERINGDEVICESTYPEWRITERS AND OTHEROFFICE MACHINES FORNON-BUSINESS USE CALCULATORSCOMPUTERS, COMPUTERSYSTEMS AND RELATEDHARDWARE FORNON-BUSINESS USE COMPUTER SOFTWARE ANDACCESSORIES FORNON-BUSINESS USE PHOTOGRAPHIC EQUIPMENT LAWNMOWING MACHINERYAND OTHER YARDEQUIPMENT TOOLS FOR HOME USE 

Power toolsNon-power tools

HEATING AND COOLINGEQUIPMENT

Window air conditionersPortable cooling and heatingequipment 

240250260270280590660610620640650300310320330340350

Use only if unable to itemize above 

– Combined expenses 800

Enter brand name ora brief description ofthe item.

002000300040005000600070008000900100011001200130014001500160017001800190

1 – Purchased for

own use?

2 – Rented?

Go to column g

3 – Purchased for

someone outside your CU?

Mark (X) box

e

When didyoupurchaseit?

Month

f

What did it cost?(Include deliverycharges, excludeinstallationcharges.)Go to column h.

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

g

If code 2 incolumn d –What was thetotal rentalexpense sincethe 1st of(month, 3months ago),excluding thecurrent month?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

h

Did tinclusalestax?

1 

FIELD REPRESENTATIVE 

– Hand the respondent 

proceed. Ask column items and complete a 

 Part B 

– Purchase of Household Appliances and Other Selected Items

12 312 312 312 312 312 312 312 312 312 312 312 312 312 312 312 312 312 312 312 3

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 
Section 6 

– APPLIANCES, HOUSEHOLD EQUIPMENT, 

AND OTHER SELECTED ITEMS 

– Continued

6 06 06 1

1. Since the 1st of (month, 3 months ago), have

you (or any members of your CU) purchasedor rented any of the following items for yourCU, or for someone outside your CU?

Page 40 FORM CE-302

Section 6 

– Part B (Continued)

FIELD REPRESENTATIVE 

– Hand the respondent the 

proceed. Ask column a, ritems and complete a sep

a

Information Booklet, page 18

2. FIELD REPRESENTATIVE 1 06 05 4

CHECK ITEMMark (X) box if there areno entries recorded incolumns b

–i.

0010 999 Go to

nextpage

ITEM

CODE YES NO

What type did youpurchase or rent?

PROCESSING USE ONLY

b

006000700080009001000110012001300140015001600170018001900200

c

ENTERITEMCODEfromcolumn a.

d

Was this –

33

e

Whendidyoupurchaseit?

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

f

What did it cost?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

g 

TELEVISIONS, RADIO, VIDEO,SOUND EQUIPMENT (DO NOTINCLUDE PURCHASESINSTALLED IN VEHICLES)

Color televisions (portable andtable models) 360

370380390400440420430

Part B 

– Purchase of Household Appliances and Other Selected Items 

– Continued

Enter a brand name or a brief description of the item.

3 – Purchased 

for someoneoutside yourCU?

2 – Rented? 

Go tocolumn g.

1 – Purchased

for own use?

Mark (X) box

If code 2 incolumn d 

–

Did tinclusales 

h

Month 

333333333333333

1 $ .00

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

Color televisions consoles andcombinations of TV; large screen color TV projection equipment; color monitors and other itemsBlack and white TV’s and combinations of TV’s with

other items

VCR, video camera, video discplayer, camcorderRadio, all typesOther sound and video equipment, including accessories (audio/video tapes,etc. should be recorded inSection 17) Use only if unable to itemizeabove – Combined expensesSound components, componentsystems, and compact discsound systems

MUSICAL INSTRUMENTS,SUPPLIES ANDACCESSORIES

Piano, organ, or keyboard

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

YES 

810450460

0040

2 3 $ .00 1 $ .00 0030 1 2 3 $ .00 1 $ .00 0020 1 2 3 $ .00 1 $ .00 0010 1 

0050

Go to column h.(Include deliverycharges, excludeinstallationcharges.)

What was thetotal rentalexpense sincethe 1st of (month,3 months ago),excluding thecurrent month?

Satellite dishesOther

670

Tape recorders and players
FORM CE-302

Page 41 

Section 6 – APPLIANCES, HOUSEHOLD EQUIPMENT,

AND OTHER SELECTED ITEMS – Continued

6 06 08 7

1. Since the 1st of (month, 3 months ago), have

you (or any members of your CU) purchasedor rented any of the following items for yourCU, or for someone outside your CU?

a

Information Booklet, page 19

2. FIELD REPRESENTATIVE 1 06 07 0

CHECK ITEMMark (X) box if there areno entries recorded incolumns b–i.

0010

0010 999 Go to

section7

ITEM

CODE YES NO

What type did youpurchase or rent?

PROCESSING USE ONLYb

0200

c

ENTERITEMCODEfromcolumn a.

d

Was this –

YES 

SPORTS, RECREATION, ANDEXERCISE EQUIPMENT 

General sports equipment(Include here athletic shoes forsports related use, such asfootball, baseball, soccer, orbowling) Health and exercise equipmentCamping equipmentHunting and fishing equipmentWinter sports equipmentWater sports equipmentOutboard motorsBicycles

470480490820500510520530540550560570

Use only if unable to itemize above – Combined expenses 

Enter brand name ora brief description ofthe item.

002000300040005000600070008000900100011001200130014001500160017001800190

1 – Purchased for

own use?

2 – Rented?

Go to column g

3 – Purchased for

someone outside your CU?

Mark (X) box

e

When didyoupurchaseit?

Month

f

What did it cost?(Include deliverycharges, excludeinstallationcharges.)Go to column h.

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

g

If code 2 incolumn d –What was thetotal rentalexpense since the1st of (month, 3months ago),excluding thecurrent month?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

h

Did tinclusalestax?

1 

FIELD REPRESENTATIVE – Hand the respondent th

proceed. Ask column a, items and complete a s

 Part B – Purchase of Household Appliances and Other Selected Items – Continued

123123123123123123123123123123123123123123123123123123123123

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 

Tricycles and battery poweredridersPlayground equipmentOther sports and recreationequipment

NOTES

Section 7
Section 7 – HOUSEHOLD EQUIPMENT REPAIRS, SERVICE CONTRACTS, 

AND FURNITURE REPAIR AND REUPHOLSTERING

1a. Since the 1st of (month, 3 months ago), did 

you (or any members of your CU) have any expenses for maintenance or repair of household equipment?

Page 42 FORM CE-302

NOTES

FIELD REPRESENTATIVE – Hand the responden

questions 1a and 1b 

Information Booklet, page 20

2. FIELD REPRESENTATIVE CHECK ITEM 1 07 01 1

Mark (X) box if there are no entries recorded incolumns a–f in part B. 0010 999 Go to next

section

ITEM

CODE

YES NO

PROCESSING

USE ONLY

0060007000800090010001100120013001400150016001700180019002000030

a

ENTERITEMCODEfrompart A.

In whatmonth was(repairdone/servicecontractpurchased)?

c

Wt

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

Did you (or any members of your CU) have any expenses for service contracts?Garbage disposal, range hood, or built-indishwasher 100

110120220130140150160170

Part A – Screening Questions

2 – Service 

contract

1 – Equipment

repair

Mark (X)

b d

Month

1 $ 

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 

Other household appliances, such as washer,refrigerator, or range/ovenTelevision, radio, video and sound equipment,except those installed in automobiles or othervehiclesComputers, computer systems, and relatedequipment for non-business useLawn and garden equipmentUse only if unable to itemize above –Combined expensesMusical instruments and accessories

190200210

00500040 1 2 $ 

1 2 $ 

0020 1 2 $ 0010 1 2 $ 

Yes – Go to column 

1a below

No

b.

Yes – Go to column 

1b below

No

YES NO

1a. Repair or

maintenance

1b. Service

contracts

Part B – Household Equipment Repairs and Service Contracts

Repair

or

contract

No.

What is/was (repaired/coveredby service contract)? Describe the item repaired or thetype of service or equipmentcovered by the service contract.Include all items covered.

123456789

1011121314151617181920

Section 7 – Part A and Part B

Section 7

Heating or air conditioning equipmentTermite or pest control treatmentSport and recreational equipmentPhotographic equipmentHand or power tools
NOTE: As of April 2001, Section 7, Parts C and D no longer exist.

Page 43 FORM CE-302

NOTES

Section 8
Section 8 – HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS

5 08 01 0

Since the 1st of (month, 3 months ago), have you (orany members of your CU) purchased for your CUor for someone outside your CU any of thefollowing?

Page 44 FORM CE-302

Section 8 – Part A

FIELD REPRESENTATIVE – Hand the respondent the Info

the headings (in bold print) in the group. Complete columns 

a

Information Booklet, pages 21 and 22

ITEM

CODE YES NO

What did you purchase?

PROCESSING USE ONLY

b

00100020003000400050006000700080009001000110012001300140015001600170

c

ENTERITEMCODEfromcolumna.

d

Was this purchasedfor your CUor for someoneoutsideyour CU?

e

In what monthdid youpurchaseit?

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

f

What was thepurchaseprice?$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

g

Did this includesalestax?

LIVING, FAMILY, OR RECREATION ROOM FURNITURE Sofas Living room chairsLiving room tablesModular wall units, shelves or cabinets

100101102103104105110122120106121

Part A – Purchases

Enter a brief description of the item purchased.

1 – For use by 

the CU.

Mark box

If "No,"go to nextitem incolumn a.Did youpurchaseanyother . . .?

h

Month YES NO

1 1 2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

2

2 – For

someoneoutside your CU.

YES NO

Ping-pong, pool tables and other similarrecreation room itemsOther living room, family or recreationroom furniture including desksLiving room furniture combinationsDINING ROOM AND KITCHENFURNITUREAll dining room and kitchen furnitureBEDROOM FURNITUREMattress and springsCombined bedroom furniture (codes 120and 121)Bedroom furniture other than mattressesand springs

130

INFANTS FURNITURE ANDEQUIPMENTInfants furnitureInfants equipment 131

140

OUTDOOR FURNITURE ANDEQUIPMENTPatio, porch or outdoor furnitureOutdoor equipment

170171

OFFICE FURNITURE FOR HOME USE All office furniture for home use. Excludeany furniture used exclusively forbusiness

173

Combined furniture expense. Use only ifunable to itemize separatelyHOUSEHOLD DECORATIVE ITEMS 

160150141

0180 1 2 $ .00 

1 2

Clocks Lamps, and other lighting fixturesOther household decorative items

Section 8
Section 8 – HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS – Continued

5 08 02 8

Have you (or any members of your CU) purchasedfor your CU or for someone outside your CU anyof the following?

Page 45 

a

Information Booklet, pages 23 and 24

ITEM

CODE YES NO

What did you purchase?

b

001000200030004000500060007000800090010001100120013001400150

c

ENTERITEMCODEfromcolumna.

d

Was this purchasedfor your CUor someoneoutsideyour CU?

e

In what monthdid youpurchaseit?

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 2

f

What was thepurchaseprice?$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

g

Did this includesalestax?

CLOSET STORAGE AND TRAVELITEMSStorage itemsTravel items

180181191192193195198202200196201

Part A – Purchases – Continued

Enter a brief description of the item purchased.

1 – For use by 

the CU.

Mark box

If "No,"go to nextitem incolumn a.Did youpurchaseanyother . . .?

h

Month YES NO

1 1 2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 2

2 – For

someoneoutsideyour CU.

YES NO

Plastic dinnerwareChina and other dinnerwareStainless, silver, and other flatwareGlasswareServing pieces other than silverNon-electric cookwareDISHES, DINNERWARE, FLATWARE,GLASSWARE, AND COOKWAREHOUSEHOLD LINENSSilver serving piecesBedroom linensBathroom linensKitchen and dining room linensOther linens 203FLOOR AND WINDOW COVERINGSOriginal wall-to-wall carpetReplacement wall-to-wall carpet

212

Use only if unable to itemize above –Combined kitchenware (Codes 190–196)

190197

Use only if unable to itemize above –Combined linens (Codes 200–203)

Slipcovers, decorative pillows andcushionsUse only if unable to itemize above –Combined expensesRoom size rugs and other nonpermanent floor coverings, includingcarpet squaresCurtains and drapesVenetian blinds, window shades, otherwindow coverings

NOTES

204205215220214210211

FORM CE-302
Section 8 – HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS – Continued

Page 46 FORM CE-302 

Part B – Rental, Leasing, or Repair of Furniture

1a. Since the 1st of (month, 3 months ago), have you (or any

members of your CU) rented or leased any furniture?

b. If YES – What was the total expense?

00100020

12

YesNo –Go to item 2a

$ .00

1 08 03 5

2a. Since the 1st of (month, 3 months ago), have you (or any

members of your CU) had any expenses for repairing,refinishing, or reupholstering furniture, including the costof fabric?

b. If YES – What was the total expense?

00400050

12

YesNo –Go to next section

$ .00

c. How much of the total amount was spent this month? 0030 $ .00

0060 $ .00 c. How much of the total amount was spent this month?

Section 8 – Part B
Section 9 – CLOTHING AND SEWING MATERIALS

6 09 02 4

1. Since the 1st of (month, 3 months ago),

have you (or any members of yourCU) purchased any of the followingitems, for persons age 2 and over,either for members of your CU or forsomeone outside your CU?

Page 47 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the In

column a and complete coluIdentical items are those of 

a

Information Booklet, page 25

2. FIELD REPRESENTATIVE 1 09 01 7

CHECK ITEMMark (X) box if there areno entries recorded incolumns b–i.

0010 999 Go to

nextpage

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumn a.

d

For whom was it purchased? IfCU member, enter name and linenumber from Control Card.

e

Howmanydid youpurchase?

f g 

Coats, jackets, andfurs

110120130140150160170

Part A – Clothing

Describe briefly the item purchased.

Name

How muchdid it cost?

Dis

Month 

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

0040

$ .00 0030 $ .00 0020 $ .00 0010 

0050

Sport coats andtailored jackets SuitsVests Sweaters and sweatersetsPants, slacks, andjeansShorts and short setsExclude all athletic shortsShirts, blouses, andtops

180

Dresses Skirts

100190

NOTES

If someone outside CU, enter nameand appropriate code as follows:90 – Male 16 and over91 – Female 16 and over92 – Male 2–1593 – Female 2–15

Line No.or code

Enter number of identicalitemspurchased.

In whatmonthdid youpurchaseit?

$ .00 

Section 9
Section 9 – CLOTHING AND SEWING MATERIALS – Continued

6 09 04 0

1. Have you (or any members of your

CU) purchased any of the followingitems, for persons age 2 and over,either for members of your CU or forsomeone outside your CU?

Page 48 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the Info

column a and complete columIdentical items are those of th

a

Information Booklet, page 26

2. FIELD REPRESENTATIVE 1 09 03 3

CHECK ITEMMark (X) box if there areno entries recorded incolumns b–i.

0010 999 Go to

nextpage

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumn a.

d

For whom was it purchased? IfCU member, enter name and linenumber from Control Card.

e

Howmanydid youpurchase?

f g 

Undergarments

210

Part A – Clothing – Continued

Describe briefly the item purchased.

Name

How muchdid it cost?

Diincsa

Month 

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

1 1 1 1 1 1 1 1 1 1 1 1 1 1

YE

0040

$ .00 0030 1 $ .00 0020 1 $ .00 0010 1 

0050

Hosiery

200

NOTES

If someone outside CU, enter nameand appropriate code as follows:90 – Male 16 and over91 – Female 16 and over92 – Male 2–15

93 – Female 2–15

Line No.or code

Enter number of identicalitemspurchased.

In whatmonthdid youpurchaseit?

$ .00 

1 

Section 9 – Part A (Continued)

Section 9
Section 9 – CLOTHING AND SEWING MATERIALS – Continued

6 09 06 5

1. Have you (or any members of your

CU) purchased any of the followingitems, for persons age 2 and over,either for members of your CU or forsomeone outside your CU?

Page 49 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the Info

column a and complete columIdentical items are those of th

a

Information Booklet, page 26

3. FIELD REPRESENTATIVE 1 09 05 8

CHECK ITEMMark (X) box if there areno entries recorded incolumns b–i.

0010 999 Go to

part B

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumn a.

d

For whom was it purchased? IfCU member, enter name and linenumber from Control Card.

e

Howmanydid youpurchase?

f g 

Nightwear andloungewear

230240250260270280

Part A – Clothing – Continued

Describe briefly the item purchased.

Name

How muchdid it cost?

Diincsa

Month 

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

1 1 1 1 1 1 1 1 1 1 1 1 1 1

YE

0040

$ .00 0030 1 $ .00 0020 1 $ .00 0010 1 

0050

AccessoriesActive sportswearUniforms, for whichthe cost is notreimbursedCostumesCombined clothing – Thisshould be used only if the respondent cannotitemize clothingpurchases. Specify (in the Notes) the types ofclothing combinedFootwear(Include here athleticshoes not specificallypurchased for sportsrelated use.) 

220

NOTES

If someone outside CU, enter nameand appropriate code as follows:90 – Male 16 and over91 – Female 16 and over92 – Male 2–15

93 – Female 2–15

Line No.or code

Enter number of identicalitemspurchased.

In whatmonthdid youpurchaseit?

$ .00 

1 

2. Have you (or any

members of your CU)purchased any otherclothing which youhave not previouslymentioned? Do notinclude infantsclothing. If YES – probe

and assign an item code.
Section 9 – CLOTHING AND SEWING MATERIALS – Continued

6 09 07 3

Page 50 FORM CE-302

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumna fromtheprecedingpages.

d

For whom was it purchased? 

e

Howmanydid youpurchase?

f g 

Part A – Clothing – Continued

Describe briefly the item purchased.

Name

How muchdid it cost?

Did thisincludesales tax?

h

Did you purchaseanyother . . .?

i

If "No," goto nextitem incolumn a.

Month YES NO

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21

YES NO

0040

$ .00 0030 1 2$ .00 0020 1 2$ .00 0010 1 2

0050

If someone outside CU, enter nameand appropriate code as follows:90 – Male 16 and over91 – Female 16 and over92 – Male 2–15

93 – Female 2–15

Line No.or code

Enternumber of identicalitemspurchased.

In whatmonthdid youpurchaseit?

$ .00 

1 2

If CU member, enter name and linenumber from Control Card.

NO

Section 9 – Part A (Continued)
Section 9 

– CLOTHING AND SEWING MATERIALS 

– Continued

6 09 12 3

1a. Have you (or any members of your

CU) purchased clothing for infantsunder 2 years of age either formembers of your CU or for someoneoutside your CU?

Page 51 FORM CE-302

FIELD REPRESENTATIVE 

– Hand the respondent the Info

column a and complete columIdentical items are those of th

a

Information Booklet, page 26 and 27

3. FIELD REPRESENTATIVE 1 09 11 6

CHECK ITEMMark (X) box if there areno entries recorded incolumns b–i.

0010 999 Go to

part C

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumn a.

d

Was this purchased for your CUor for someone outside of yourCU?

e

Howmanydid youpurchase?

f g 

Such as –

300310320330360

Part B 

– Infants Clothing, Watches, Jewelry, and Hairpieces

Describe briefly the item purchased.

CU member

How muchdid it cost?

Did incsale

Month 

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

1 1 1 1 1 1 1 1 1 1 1 1 1 1

YE

0040

$ .00 0030 1 $ .00 0020 1 $ .00 0010 1 

0050

290

Non-CU member

Enter number of identicalitemspurchased.

In whatmonthdid youpurchaseit?

$ .00 

1 

b. Have you (or any

members of your CU)purchased any otherinfants clothing whichyou have not previously mentioned?Coats, jackets, orsnowsuitsDresses and otherouterwearUnderwear and diapers,including disposableCombined clothing forinfants –This should beused only if therespondent cannotitemize clothingpurchases. Specify (inthe Notes) the types ofclothing combined.Sleeping garmentsLayettesAccessories 340If YES – probe and assign an item code.

2. Have you (or any

members of your CU)purchased any of thefollowing items,either for members of your CU or forsomeone outside your CU?Information Booklet,page 27Watches 370JewelryHairpieces, wigs, ortoupees

380390

111111111111111111

222222222222222222
Section 9 – CLOTHING AND SEWING MATERIALS – Continued

6 09 13 1

Page 52 FORM CE-302

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumna fromtheprecedingpage.

d

Was this purchased for your CUor for someone outside of yourCU?

e

Howmanydid youpurchase?

f g 

Part B – Infants Clothing, Watches, Jewelry, and Hairpieces – Continued

Describe briefly the item purchased.

CU member

How muchdid it cost?

Did thisincludesales tax?

h

Did you purchaseanyother . . .?

i

If "No," goto nextitem incolumn a.

Month YES NO

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21

YES NO

0040

$ .00 0030 1 2$ .00 0020 1 2$ .00 0010 1 2

0050

Non-CU member

Enter number of identicalitemspurchased.

In whatmonthdid youpurchaseit?

$ .00 

1 2

NO

111111111111111111

222222222222222222

Section 9 – Part B (Continued)
Section 9 – CLOTHING AND SEWING MATERIALS – Continued

5 09 22 4

1. Have you (or any members of your CU)

purchased any sewing materials, either formembers of your CU or for someone outsideyour CU?

Page 53 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the Info

column a and complete columIdentical items are those of th

a

Information Booklet, page 27

2. FIELD REPRESENTATIVE 1 09 21 5

CHECK ITEMMark (X) box if there are noentries recorded in columns b–h. 0010 999 Go to

part D

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumn a.

d

Was this purchased foryour CU or for someoneoutside of your CU?

e

How much did itcost?

f 

Were these –

410420430440

Part C – Sewing Materials

Describe briefly the item purchased.

CU member

Did incsal

Month 

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

YES 

0040

$ .00 0030 $ .00 0020 $ .00 0010 

0050

400

Non-CUmember

In whatmonthdid youpurchaseit?

$ .00 

Sewing materials for makingslipcovers, curtains, etc., andfor handwork in the homeincluding yarn?Sewing materials for makingclothes?Use only if unable to itemizeseparately – Combined sewingmaterials Sewing notions?Other sewing materials?If YES , read the list of individual itemsbelow. Complete columns b–h for eachitem purchased.

YES NO – Go to item 2

NOTES

111111111111111111

222222222222222222

111111111111111111
Section 9 – CLOTHING AND SEWING MATERIALS – Continued

5 09 32 3

1. Have you (or any members of your CU) had

expenses for any of the following, either formembers of your CU or for someone outsideyour CU?

Page 54 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the Info

column a and complete columIdentical items are those of th

a

Information Booklet, page 27

2. FIELD REPRESENTATIVE 1 09 31 4

CHECK ITEMMark (X) box if there are noentries in columns b–h. 0010 999 Go to section

10

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTERITEMCODEfromcolumn a.

d

Was this purchased foryour CU or for someoneoutside of your CU?

e

How much did itcost?

f 

460470480490

Part D – Clothing Services

Describe briefly the item purchased.

CU member

Did incsal

Month 

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

YES 

0040

$ .00 0030 $ .00 0020 $ .00 0010 

0050

450

Non-CUmember

In whatmonthdid youpurchaseit?

$ .00 

Repair, alteration, andtailoring for clothing andaccessoriesShoe repair and other shoeservicesWatch or jewelry repair

NOTES

111111111111111111

222222222222222222

111111111111111111

Section 10

Clothing storageClothing rental

Section 9 – Part D
Section 10 – RENTED AND LEASED VEHICLES

Part A.1 – Screening Questions (If New Consumer Unit, Go to Part A.2.)

1 10 01 5

1a.

Information Booklet, page 28

0030 1 Yes –

FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructio

a column for questions 2–5 for each vehicle rented. For like ventries into one column. Otherwise, complete a separate col

Page 55 FORM CE-302

Since the 1st of (month, 3 months ago),have you (or any members of yourCU) rented any vehicles which werenot used ENTIRELY for business? Donot include leased vehicles.

2 No

If YES – Read the list of individual itemsbelow and mark (X) the appropriate "Yes"or "No" box.

0080

b. If YES to an individual item ask – How

many?

0010 

Automobile

YES NO

Yes No – Go to item 6

HOW

MANY?

VEHICLE

CODE YES NO

Truck,includingvansMotorizedcamper-coachTrailer-typecamperOtherattachabletype camperMotorcycle,motor scooter,or moped(motorizedbicycle)Boat, with amotorBoat, withouta motorTrailer, otherthan campertype, such asfor a boat orcyclePrivate planeAny othervehicle

100110120130140150160170180190200

NOTES

2. FIELD REPRESENTATIVE ITEM

a. Describe briefly the type of vehicle rented, such as "auto"

or "boat."

0140 .00 Percent

Go to next rentedvehicle or item 6

0130 1 Yes

2 No – Go to next rented

vehicle or item 6

PROCESSING USE ONLYVEHICLE NUMBER

1 10 02 

12

Description Description 

b. Enter vehicle code from item 1b. 0010 Code

3. Was it rented solely for use on a vacation, overnight

trip, or a trip of 75 miles or more one way?

4. Since the 1st of (month, 3 months ago), excluding (the

current month) what has been your expense for rentingthis vehicle?

5a. Were (Will) any of the rental expenses (be) deducted

as business expenses, reimbursed, or paid bysomeone else?

b. If YES – What percent of the total expense will this

cover? Enter to nearest whole percent.If periodic payments were made, enter in the notes theamount of the payment and the number of paymentsincurred during the reference period. Compute the totalexpense and enter the amount in this item.

7 10 10 3

LEASED VEHICLES

If this box is marked, no vehicles were previously reported – Go to item 7a.

6. Ask column f for each vehicle listed, except if vehicle has been disposed of previously ("Yes" in column b below).

1

a

LEASED VEHICLE INVENTORY CHA

Vehicle identification

PROCESSING

USE ONLY

b

c d

YES NO

Vehicle

number

Vehicle

disposed of Vehicle identification from part B, item 2

Vehicle used

for business

from part B,

item 6a

e

YE

Enter vehiclecode frompart B, item 1b.

Do havIf Nbox item 

YEAR MAKE MODEL

1 

002000300040005000600070

234567

1 1 1 1 1 1 

0030 1 Yes –

2 No

00800140 .

Go ve

0130 1 Yes

2 No – Go 

veh

0010 

$ .00 $

Section 10
Section 10 – RENTED AND LEASED VEHICLES – Continued

Part A.1 – Screening Questions – Continued

7a. 1 10 11 4

0010 1

2

YesNo – Go to section 11

FIELD REPRESENTATIVE – 

Page 56 

FORM CE-302

Since the 1st of (month, 3 months ago), haveyou (or any members of your CU) begunleasing any automobile or truck not usedENTIRELY for business?Enter vehicle code

b. If YES – What kind of vehicle was it?

0020 00300040 00500060 00700080 00900100 0110

Automobile

VEHICLE

CODE

Truck, including vans

100110

FIELD REPRESENTATIVE INSTRUCTIONComplete part B for each newly leased vehicle.

Section 10 – Part A.1 (Continued)

Section 10
Section 10 – RENTED AND LEASED VEHICLES – Continued

Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY

1 10 12 2

1a.

Information Booklet, page 28

0030 1 Yes –

FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with i

complete a column for questions 2–5 for each vehicpurpose, combine entries into one column. Otherw

Page 57 FORM CE-302

Since the 1st of (month, 3 months ago),have you (or any members of yourCU) rented any vehicles which werenot used ENTIRELY for business? Donot include leased vehicles.

2 No

If YES – Read the list of individual itemsbelow and mark (X) the appropriate "Yes"or "No" box.

0080

b. If YES to an individual item ask – How

many?

Yes No – Go to item 6a

2. FIELD REPRESENTATIVE ITEM

a. Describe briefly the type of vehicle rented, such as "auto"

or "boat."

0140 .00 Percent

Go to next rentedvehicle or item 6

0130 1 Yes

2 No – Go to next rented

vehicle or item 6

PROCESSING USE ONLYVEHICLE NUMBER

1 10 13 

12

Description Description 

b. Enter vehicle code from item 1b. 0010 Code

3. Was it rented solely for use on a vacation, overnight

trip, or a trip of 75 miles or more one way?

4. Since the 1st of (month, 3 months ago), excluding (the

current month) what has been your expense for rentingthis vehicle?

5a. Were (Will) any of the rental expenses (be) deducted

as business expenses, reimbursed, or paid bysomeone else?

b. If YES – What percent of the total expense will this

cover? Enter to nearest whole percent.If periodic payments were made, enter in the notes theamount of the payment and the number of paymentsincurred during the reference period. Compute the totalexpense and enter the amount in this item.

LEASED VEHICLES

0030 1 Yes –

2 No

00800140 .

Go ve

0130 1 Yes

2 No – Go 

veh

0010 

1 10 20 5

6a.

0010 1

2

YesNo – Go to section 11

Since the 1st of (month, 3 months ago), haveyou (or any members of your CU) made anylease payments or begun leasing anyautomobile or truck not used ENTIRELY forbusiness?Enter vehicle code

b. If YES – What kind of vehicle was it? 0020 0030

0040 00500060 00700080 00900100 0110

Automobile

VEHICLE

CODE

Truck, including vans

100110

FIELD REPRESENTATIVE INSTRUCTIONComplete part B on next page for each leased vehicle.

0120 0130

$ .00 Automobile $

HOW

MANY?

VEHICLE

CODE YES NO

Truck,includingvansMotorizedcamper-coachTrailer-typecamperOtherattachabletype camperMotorcycle,motor scooter,or moped(motorizedbicycle)Boat, with amotorBoat, withouta motorTrailer, otherthan campertype, such asfor a boat orcyclePrivate planeAny othervehicle

100110120130140150160170180190200

NOTES
Section 10 – RENTED AND LEASED VEHICLES – Continued

Part B – Detailed Questions for Leased Vehicles

1 10 21 3

Page 58 FORM CE-302

1. FIELD REPRESENTATIVE ITEM 

a. New CU’s – Assign vehicle

numbers in consecutive orderbeginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1

or A.2.

3. How many cylinders does it have?

What is the year, make, and model?

5a. How many doors does it have?6a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is

counted as a business expense?

7.

0123 1

234

Station wagon?Convertible?Hatchback?Other?

How many miles are currently on the vehicle?

0020

Automatic transmission?

Power steering?

2.

2nd through 5th interviews –Assign the next available vehiclenumber from chart in part A.1,column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine

or electric)

4. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

(Ask for vehicle code 100)

0050

Doors 0122Percent 0140 If 100%, delete this vehicle and go to next vehicle.

Miles

(Enter to nearest whole mile)

01500130 1

2

Yes, used for businessPersonal use only – Go to item 7

8. Was it new or used when first leased? 0160 1 New 2 Used9. Was this vehicle leased from a – 0170 1

234

New or used vehicle dealer?Independent leasing company?Bank?Someplace else? – Specify

10a.

0010 Number 

What was the number of paymentscontracted for?

b. In what month and year was the first

payment made?

c. What is the amount of each payment?

d. What period is covered by each payment?

e. Does the payment include any charges other

than the lease amount such as autoinsurance or maintenance?

f. If YES – How much of the payment is for

these extra charges?

11. Is any of the (period reported in item 10d)

leasing cost paid by an employer?

12. Was a trade-in allowance received?13a. Was a cash down payment made? (A down

payment is a capitalized cost reduction.)

b. Was any portion of the cash down payment

paid by an employer?

14a. Do you still have this vehicle?

b. In what month was the lease terminated?c. Were any fees incurred at the termination of

the lease?

Year

Section 10 – Part B
Page 59 

FORM CE-302

Section 10 – RENTED AND LEASED VEHICLES – ContinuedPart B – Detailed Questions for Leased Vehicles – Continued

1 10 24 7

1. FIELD REPRESENTATIVE ITEM 

a. New CU’s – Assign vehicle

numbers in consecutive orderbeginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1

or A.2.

3. How many cylinders does it have?

What is the year, make, and model?

5a. How many doors does it have?6a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is

counted as a business expense?

7.

0123 1

234

Station wagon?Convertible?Hatchback?Other?

How many miles are currently on the vehicle?

0020

Automatic transmission?

Power steering?

2.

2nd through 5th interviews –Assign the next available vehiclenumber from chart in part A.1,column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine

or electric)

4. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

(Ask for vehicle code 100)

0050

Doors 0122Percent 0140 If 100%, delete this vehicle and go to next vehicle.

Miles

(Enter to nearest whole mile)

01500130 1

2

Yes, used for businessPersonal use only – Go to item 7

8. Was it new or used when first leased? 0160 1 New 2 Used9. Was this vehicle leased from a – 0170 1

234

New or used vehicle dealer?Independent leasing company?Bank?Someplace else? – Specify

10a.

0010 Number 

What was the number of paymentscontracted for?

b. In what month and year was the first

payment made?

c. What is the amount of each payment?

d. What period is covered by each payment?

e. Does the payment include any charges other

than the lease amount such as autoinsurance or maintenance?

f. If YES – How much of the payment is for

these extra charges?

11. Is any of the (period reported in item 10d)

leasing cost paid by an employer?

12. Was a trade-in allowance received?13a. Was a cash down payment made? (A down

payment is a capitalized cost reduction.)

b. Was any portion of the cash down payment

paid by an employer?

14a. Do you still have this vehicle?

b. In what month was the lease terminated?c. Were any fees incurred at the termination of

the lease?

Year
Section 10 – RENTED AND LEASED VEHICLES – Continued

Part B – Detailed Questions for Leased Vehicles – Continued

1 10 27 0

Page 60 FORM CE-302

1. FIELD REPRESENTATIVE ITEM 

a. New CU’s – Assign vehicle

numbers in consecutive orderbeginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1

or A.2.

3. How many cylinders does it have?

What is the year, make, and model?

5a. How many doors does it have?6a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is

counted as a business expense?

7.

0123 1

234

Station wagon?Convertible?Hatchback?Other?

How many miles are currently on the vehicle?

0020

Automatic transmission?

Power steering?

2.

2nd through 5th interviews –Assign the next available vehiclenumber from chart in part A.1,column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine

or electric)

4. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

(Ask for vehicle code 100)

0050

Doors 0122Percent 0140 If 100%, delete this vehicle and go to next vehicle.

Miles

(Enter to nearest whole mile)

01500130 1

2

Yes, used for businessPersonal use only – Go to item 7

8. Was it new or used when first leased? 0160 1 New 2 Used9. Was this vehicle leased from a – 0170 1

234

New or used vehicle dealer?Independent leasing company?Bank?Someplace else? – Specify

10a.

0010 Number 

What was the number of paymentscontracted for?

b. In what month and year was the first

payment made?

c. What is the amount of each payment?

d. What period is covered by each payment?

e. Does the payment include any charges other

than the lease amount such as autoinsurance or maintenance?

f. If YES – How much of the payment is for

these extra charges?

11. Is any of the (period reported in item 10d)

leasing cost paid by an employer?

12. Was a trade-in allowance received?13a. Was a cash down payment made? (A down

payment is a capitalized cost reduction.)

b. Was any portion of the cash down payment

paid by an employer?

14a. Do you still have this vehicle?

b. In what month was the lease terminated?c. Were any fees incurred at the termination of

the lease?

Year

Section 10 – Part B (Continued)
Section 11 – OWNED VEHICLES

Part A.1 – Screening Questions (If New Consumer Unit, Go to Part A.2)

FIELD REPRESENTATIVE – Ask par

vehicle

Page 61 

FORM CE-302

0010

YES NO

4 11 00 9 

If this box is marked, no vehicles were previously reported – Go to item 2a.

1. Ask column h for each vehicle listed, except if vehicle has been disposed of previously ("Yes" in column b).

10

a

OWNED VEHICLE INVENTORY CHART

Vehicle identification

PROCESSING USE ONLYb c d YES NO Vehicle number Vehicle disposed of (part C completed) Vehicle description from part B, item 2 Vehicle used for business from part B, item 7a e g h YES NO Enter vehicle code from part B, item 1b. YEAR MAKE MODEL i Do you still have (vehicle)? If NO – complete part C for all vehicles disposed of. Codes 100–120 and 150 only

1 2

For each vehicle code 100 through 120 and 150 listed which has not been disposed of, ask column i.

How many milesare currently onthe vehicle?Enter to nearestwhole mile.

1

Vehicle identification from part B, item 3

23456789

1112131415161718

00200030004000500060007000800090010001100120013001400150016001700180

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

Section 11

f

Enter

mileage

from

part B,

item 10b

or part A.1,

column i

Codes 100–120 and 150 only
Section 11 – OWNED VEHICLES – Continued

Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY

FIELD REPRESENTATIVE – Hand the respo

you proceed. Afor each vehicle 

Page 62 

FORM CE-302

AutomobileTruck, including vansMotorized camper-coachTrailer type camperOther attachable type camperMotorcycle, motor scooter, or moped (motorized bicycle)Boat, purchased with a motorBoat, purchased without a motorTrailer other than camper type, such as for a boat or cyclePrivate planeAny other vehicle

1.

Information Booklet, page 28

b. If YES – How many?

4. FIELD REPRESENTA

Do you (or any members of your CU) own any of thefollowing vehicles not used exclusively for business?

YES NO Complete part B for 

VEHICLE CODE

100110120130140150160170180190200

1

1 11 02 1

Number 0240

a. 2

2a.

b.

c.

d.

e.

f.

g.h.

i.j.

k.

If YES – How many?

00100030005000700090011001300150017001900210

1 21 21 21 21 21 21 21 21 21 2

00200040006000800100012001400160018002000220

12

Yes – Ask items 2b and 2cNo – Go to item 3a

02300250 0260 02700280 0290 03000310 0320 0330

Have you (or any members of your CU) purchased any suchvehicles since the 1st of the (month, 3 months ago) as a gift to

someone outside of your CU?

c. What kind of vehicle(s) did you purchase?

0360 0370 03800390 0400 04100450 0460 0470

Enter a separate code for each vehicle.

3a. 1

2

Yes – Ask items 3b and 3cNo – Go to item 4

Have you (or any members of your CU) disposed of any 0340 automobiles or other vehicles since the 1st of (month,3 months ago)?

b. If YES – How many?

Number 0350

c. What kind of vehicle(s) did you dispose of?

Enter a separate code for each vehicle.

Complete parts B an

0420 0430 0440

Section 11

Section 11 – Part A.2
Section 11 – OWNED VEHICLES – Continued

Part B – Detailed Questions

1 11 03 9

Page 63 FORM CE-302

1. FIELD REPRESENTATIVE ITEM

a. New CU’s – Assign vehicle numbers in

consecutive order beginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1 or A.2.

4. How many cylinders does it have?

What is the year, make, and model?

6a. How many doors does it have?7a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is counted as a

business expense?

0123 1

234

Station wagon?Convertible?Hatchback?Other?

0020

Automatic transmission?

Power steering?

3.

2nd through 5th interviews – Assign thenext available vehicle number from chart inpart A.1, column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine, or electric)

5. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

Ask for vehicle code 100.

0050

Doors 0122

0140 Percent If 100%, delete this vehicle and go to next vehicle.

Miles – If item 10a is code 3,stop and go to next vehicle

01800130 1

2

Yes, used for businessPersonal use only – Go to item 8

8. Was it new or used when acquired? 0150 1 New 2 Used9. Was this vehicle purchased from – 0160 1

23

Vehicle dealership?Private individual?Other? – Specify

11.

0010 Number

In what month and year was it 

b. If YES – On the 1st of (month, 3 

loans on (vehicle) paid off or wepayments to be made?

c. What was the amount paid for 

allowance and discount?

d. Did this price include sales tax

e. Was any of the amount or price 

f. If YES – How much?

13a. Was a trade-in allowance recei14. What was the amount of the ca15a. What was the source of credit?

Year

Complete items 3, 4, and 5 for autos and trucks only(vehicle codes 100 and 110).

2.

Do not ask for vehicle codes 100 or 110.Briefly describe the (vehicle).

Description

10a. Was this vehicle – 0170 1

2

Purchased for own use?Purchased as a gift to others? –Go to item 11

3 Received as gift?

Ask for item codes 100–120 and 150 only.

b. How many miles are currently on the vehicle?

12a. Was any portion of the purchas

b. If YES – How much?

Ask items 14 and 15 for credit paymenAsk if codes "2," "3," or "4" marked 

b. Was this a home equity loan?

c. How much was borrowed, excl

d. What was the number of paym

e. In what month and year was th

f. What is the amount of each pa

g. What period is covered by each h. Does the payment include any 

principal and interest such as alife insurance?If YES – How much of the paymcharges?

i.
Page 64 

FORM CE-302

Section 11 – OWNED VEHICLES – ContinuedPart B – Detailed Questions – Continued

1 11 04 7

1. FIELD REPRESENTATIVE ITEM

a. New CU’s – Assign vehicle numbers in

consecutive order beginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1 or A.2.

4. How many cylinders does it have?

What is the year, make, and model?

6a. How many doors does it have?7a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is counted as a

business expense?

0123 1

234

Station wagon?Convertible?Hatchback?Other?

0020

Automatic transmission?

Power steering?

3.

2nd through 5th interviews – Assign thenext available vehicle number from chart inpart A.1, column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine, or electric)

5. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

Ask for vehicle code 100.

0050

Doors 0122

0140 Percent If 100%, delete this vehicle and go to next vehicle.

Miles – If item 10a is code 3,stop and go to next vehicle

01800130 1

2

Yes, used for businessPersonal use only – Go to item 8

8. Was it new or used when acquired? 0150 1 New 2 Used9. Was this vehicle purchased from – 0160 1

23

Vehicle dealership?Private individual?Other? – Specify

11.

0010 Number

In what month and year was it 

b. If YES – On the 1st of (month, 3 

loans on (vehicle) paid off or wepayments to be made?

c. What was the amount paid for 

allowance and discount?

d. Did this price include sales tax

e. Was any of the amount or price 

f. If YES – How much?

13a. Was a trade-in allowance recei14. What was the amount of the ca15a. What was the source of credit?

Year

Complete items 3, 4, and 5 for autos and trucks only(vehicle codes 100 and 110).

2.

Do not ask for vehicle codes 100 or 110.Briefly describe the (vehicle).

Description

10a. Was this vehicle – 0170 1

2

Purchased for own use?Purchased as a gift to others? –Go to item 11

3 Received as gift?

Ask for item codes 100–120 and 150 only.

b. How many miles are currently on the vehicle?

12a. Was any portion of the purchas

b. If YES – How much?

Ask items 14 and 15 for credit paymenAsk if codes "2," "3," or "4" marked 

b. Was this a home equity loan?

c. How much was borrowed, excl

d. What was the number of paym

e. In what month and year was th

f. What is the amount of each pa

g. What period is covered by each h. Does the payment include any 

principal and interest such as alife insurance?If YES – How much of the paymcharges?

i.

Section 11 – Part B (Continued)
Section 11 – OWNED VEHICLES – Continued

Part B – Detailed Questions – Continued

1 11 05 4

Page 65 FORM CE-302

1. FIELD REPRESENTATIVE ITEM

a. New CU’s – Assign vehicle numbers in

consecutive order beginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1 or A.2.

4. How many cylinders does it have?

What is the year, make, and model?

6a. How many doors does it have?7a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is counted as a

business expense?

0123 1

234

Station wagon?Convertible?Hatchback?Other?

0020

Automatic transmission?

Power steering?

3.

2nd through 5th interviews – Assign thenext available vehicle number from chart inpart A.1, column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine, or electric)

5. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

Ask for vehicle code 100.

0050

Doors 0122

0140 Percent If 100%, delete this vehicle and go to next vehicle.

Miles – If item 10a is code 3,stop and go to next vehicle

01800130 1

2

Yes, used for businessPersonal use only – Go to item 8

8. Was it new or used when acquired? 0150 1 New 2 Used9. Was this vehicle purchased from – 0160 1

23

Vehicle dealership?Private individual?Other? – Specify

11.

0010 Number

In what month and year was it 

b. If YES – On the 1st of (month, 3 

loans on (vehicle) paid off or wepayments to be made?

c. What was the amount paid for 

allowance and discount?

d. Did this price include sales tax

e. Was any of the amount or price 

f. If YES – How much?

13a. Was a trade-in allowance recei14. What was the amount of the ca15a. What was the source of credit?

Year

Complete items 3, 4, and 5 for autos and trucks only(vehicle codes 100 and 110).

2.

Do not ask for vehicle codes 100 or 110.Briefly describe the (vehicle).

Description

10a. Was this vehicle – 0170 1

2

Purchased for own use?Purchased as a gift to others? –Go to item 11

3 Received as gift?

Ask for item codes 100–120 and 150 only.

b. How many miles are currently on the vehicle?

12a. Was any portion of the purchas

b. If YES – How much?

Ask items 14 and 15 for credit paymenAsk if codes "2," "3," or "4" marked 

b. Was this a home equity loan?

c. How much was borrowed, excl

d. What was the number of paym

e. In what month and year was th

f. What is the amount of each pa

g. What period is covered by each h. Does the payment include any 

principal and interest such as alife insurance?If YES – How much of the paymcharges?

i.
Page 66 

FORM CE-302

Section 11 – OWNED VEHICLES – ContinuedPart B – Detailed Questions – Continued

1 11 06 2

1. FIELD REPRESENTATIVE ITEM

a. New CU’s – Assign vehicle numbers in

consecutive order beginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1 or A.2.

4. How many cylinders does it have?

What is the year, make, and model?

6a. How many doors does it have?7a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is counted as a

business expense?

0123 1

234

Station wagon?Convertible?Hatchback?Other?

0020

Automatic transmission?

Power steering?

3.

2nd through 5th interviews – Assign thenext available vehicle number from chart inpart A.1, column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine, or electric)

5. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

Ask for vehicle code 100.

0050

Doors 0122

0140 Percent If 100%, delete this vehicle and go to next vehicle.

Miles – If item 10a is code 3,stop and go to next vehicle

01800130 1

2

Yes, used for businessPersonal use only – Go to item 8

8. Was it new or used when acquired? 0150 1 New 2 Used9. Was this vehicle purchased from – 0160 1

23

Vehicle dealership?Private individual?Other? – Specify

11.

0010 Number

In what month and year was it 

b. If YES – On the 1st of (month, 3 

loans on (vehicle) paid off or wepayments to be made?

c. What was the amount paid for 

allowance and discount?

d. Did this price include sales tax

e. Was any of the amount or price 

f. If YES – How much?

13a. Was a trade-in allowance recei14. What was the amount of the ca15a. What was the source of credit?

Year

Complete items 3, 4, and 5 for autos and trucks only(vehicle codes 100 and 110).

2.

Do not ask for vehicle codes 100 or 110.Briefly describe the (vehicle).

Description

10a. Was this vehicle – 0170 1

2

Purchased for own use?Purchased as a gift to others? –Go to item 11

3 Received as gift?

Ask for item codes 100–120 and 150 only.

b. How many miles are currently on the vehicle?

12a. Was any portion of the purchas

b. If YES – How much?

Ask items 14 and 15 for credit paymenAsk if codes "2," "3," or "4" marked 

b. Was this a home equity loan?

c. How much was borrowed, excl

d. What was the number of paym

e. In what month and year was th

f. What is the amount of each pa

g. What period is covered by each h. Does the payment include any 

principal and interest such as alife insurance?If YES – How much of the paymcharges?

i.

Section 11 – Part B (Continued)
Section 11 – OWNED VEHICLES – Continued

Part B – Detailed Questions – Continued

1 11 07 0

Page 67 FORM CE-302

1. FIELD REPRESENTATIVE ITEM

a. New CU’s – Assign vehicle numbers in

consecutive order beginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1 or A.2.

4. How many cylinders does it have?

What is the year, make, and model?

6a. How many doors does it have?7a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is counted as a

business expense?

0123 1

234

Station wagon?Convertible?Hatchback?Other?

0020

Automatic transmission?

Power steering?

3.

2nd through 5th interviews – Assign thenext available vehicle number from chart inpart A.1, column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine, or electric)

5. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

Ask for vehicle code 100.

0050

Doors 0122

0140 Percent If 100%, delete this vehicle and go to next vehicle.

Miles – If item 10a is code 3,stop and go to next vehicle

01800130 1

2

Yes, used for businessPersonal use only – Go to item 8

8. Was it new or used when acquired? 0150 1 New 2 Used9. Was this vehicle purchased from – 0160 1

23

Vehicle dealership?Private individual?Other? – Specify

11.

0010 Number

In what month and year was it 

b. If YES – On the 1st of (month, 3 

loans on (vehicle) paid off or wepayments to be made?

c. What was the amount paid for 

allowance and discount?

d. Did this price include sales tax

e. Was any of the amount or price 

f. If YES – How much?

13a. Was a trade-in allowance recei14. What was the amount of the ca15a. What was the source of credit?

Year

Complete items 3, 4, and 5 for autos and trucks only(vehicle codes 100 and 110).

2.

Do not ask for vehicle codes 100 or 110.Briefly describe the (vehicle).

Description

10a. Was this vehicle – 0170 1

2

Purchased for own use?Purchased as a gift to others? –Go to item 11

3 Received as gift?

Ask for item codes 100–120 and 150 only.

b. How many miles are currently on the vehicle?

12a. Was any portion of the purchas

b. If YES – How much?

Ask items 14 and 15 for credit paymenAsk if codes "2," "3," or "4" marked 

b. Was this a home equity loan?

c. How much was borrowed, excl

d. What was the number of paym

e. In what month and year was th

f. What is the amount of each pa

g. What period is covered by each h. Does the payment include any 

principal and interest such as alife insurance?If YES – How much of the paymcharges?

i.
Page 68 

FORM CE-302

Section 11 – OWNED VEHICLES – ContinuedPart B – Detailed Questions – Continued

1 11 08 8

1. FIELD REPRESENTATIVE ITEM

a. New CU’s – Assign vehicle numbers in

consecutive order beginning with 1.

PROCESSING USE ONLY

VEHICLE NUMBER

b. Enter a vehicle code from part A.1 or A.2.

4. How many cylinders does it have?

What is the year, make, and model?

6a. How many doors does it have?7a. Is it used for business?

b. Is it a . . .?b. If used for business – What percent of the mileage is counted as a

business expense?

0123 1

234

Station wagon?Convertible?Hatchback?Other?

0020

Automatic transmission?

Power steering?

3.

2nd through 5th interviews – Assign thenext available vehicle number from chart inpart A.1, column a.

a.b. VEHICLE CODE

Code

OFFICE USE ONLY

Enter auto code

0030

Make Model

004000600070008000900100011001200121

Cylinders

0 No cylinders (rotary, turbine, or electric)

5. Does it have –

a.b.

c.

d.

e.

f.

g.h.

Power brakes?Air conditioning?Sun roof?Turbo charged engine?Diesel engine?Four wheel drive?

11111111

22222222

Yes No

Ask for vehicle code 100.

0050

Doors 0122

0140 Percent If 100%, delete this vehicle and go to next vehicle.

Miles – If item 10a is code 3,stop and go to next vehicle

01800130 1

2

Yes, used for businessPersonal use only – Go to item 8

8. Was it new or used when acquired? 0150 1 New 2 Used9. Was this vehicle purchased from – 0160 1

23

Vehicle dealership?Private individual?Other? – Specify

11.

0010 Number

In what month and year was it 

b. If YES – On the 1st of (month, 3 

loans on (vehicle) paid off or wepayments to be made?

c. What was the amount paid for 

allowance and discount?

d. Did this price include sales tax

e. Was any of the amount or price 

f. If YES – How much?

13a. Was a trade-in allowance recei14. What was the amount of the ca15a. What was the source of credit?

Year

Complete items 3, 4, and 5 for autos and trucks only(vehicle codes 100 and 110).

2.

Do not ask for vehicle codes 100 or 110.Briefly describe the (vehicle).

Description

10a. Was this vehicle – 0170 1

2

Purchased for own use?Purchased as a gift to others? –Go to item 11

3 Received as gift?

Ask for item codes 100–120 and 150 only.

b. How many miles are currently on the vehicle?

12a. Was any portion of the purchas

b. If YES – How much?

Ask items 14 and 15 for credit paymenAsk if codes "2," "3," or "4" marked 

b. Was this a home equity loan?

c. How much was borrowed, excl

d. What was the number of paym

e. In what month and year was th

f. What is the amount of each pa

g. What period is covered by each h. Does the payment include any 

principal and interest such as alife insurance?If YES – How much of the paymcharges?

i.

Section 11 – Part B (Continued)
Section 11 – OWNED VEHICLES – Continued

Part C – Disposed of Vehicles

1 11 51 8

Page 69 FORM CE-302

1. FIELD REPRESENTATIVE

ITEMComplete a column in the1st interview in which thevehicle is disposed of. Entervehicle number and vehiclecode. Vehicle number andcode must match apreviously reported vehiclenumber and code fromsection 11A.1, columns aand g, or section 11B, items 1a and 1b.

PROCESSING USE ONLY

VEHICLE NUMBER

4a. Were you reimbursed for the value of

the vehicle?How much did you sell it for?

b. In what month was it (read answer from

item 2a)?

0020

3.

a.b. VEHICLE CODE Code

5a. Were there any outstanding loans on

the vehicle when it was disposed of?

0010 Number

12

Sold?Traded in?

0090

X Don’t know

.00 $

If sold (code 1, item 2a).

2a. How did you dispose of the vehicle?

Mark (X) one box.

0030

456

Damaged beyond repair?Stolen?Other – Specify

3 Given away to someone outside the

CU, including students away atschool?

Month – 0040 If code 3 in item 2a, go to item 5a

0050 .00 $ Go to item 5a

If damaged beyond repair (code 4, item 2a)or stolen (code 5, item 2a). 1

2

YesNo – Go to item 4c

00600110

b. Were any final payments made on the loan?

12X

YesNo – Go to item 5a

Don’t know

c. Do you expect to be reimbursed for the value 0080 of the vehicle?

d. How much will you receive for the vehicle?

12

YesNo – Go to next vehicle

0100

12

YesNo – Go to next vehicle

c. If YES – How much was the final payment?

0070 .00 $ Go to item 5a0120 .00 $

b. How much did you receive for the vehicle?

NOTES

1 11 52 6

0020 Code0010 Number

12

Sold?Traded in?

0090

X Don’t know

.00 $

0030

456

Damaged beyond repair?Stolen?Other – Specify

3 Given away to someone outside the

CU, including students away atschool?

Month – 0040 If code 3 in item 2a, go to item 5a

0050 .00 $ Go to item 5a

12

YesNo – Go to item 4c

00600110

12X

YesNo – Go to item 5a

Don’t know

0080

12

YesNo – Go to next vehicle

0100

12

YesNo – Go to next vehicle

0070 .00 $ Go to item 5a0120 .00 $

0020 0010 

12

STr

0090

X D

$

0030

456

DStO

3 G

Csc

0040 0050 

$ 

12

YeN

00600110

12X

YeN

D

0080

12

YeN

0100

12

YeN

0070 

$ 

0120 

$
Section 11 – OWNED VEHICLES – Continued

Part C – Disposed of Vehicles – Continued

1 11 55 9

FORM CE-302

1. FIELD REPRESENTATIVE

ITEM PROCESSING USE ONLY

VEHICLE NUMBER

4a. Were you reimbursed for the value of

the vehicle?How much did you sell it for?

b. In what month was it (read answer from

item 2a)?

0020

3.

a.b. VEHICLE CODE

5a. Were there any outstanding loans on

the vehicle when it was disposed of?

0010 Number

12

Sold?Traded in?

0090

X Don’t know

.00 $

If sold (code 1, item 2a).

2a. How did you dispose of the vehicle?

Mark (X) one box.

0030

456

Damaged beyond repair?Stolen?Other – Specify

3 Given away to someone outside the

CU, including students away atschool?

Month – 0040 If code 3 in item 2a, go to item 5a

0050 .00 $ Go to item 5a

If damaged beyond repair (code 4, item 2a)or stolen (code 5, item 2a). 1

2

YesNo – Go to item 4c

00600110

b. Were any final payments made on the loan?

12X

YesNo – Go to item 5a

Don’t know

c. Do you expect to be reimbursed for the value 0080 of the vehicle?

d. How much will you receive for the vehicle?

12

YesNo – Go to next vehicle

0100

12

YesNo – Go to next vehicle

c. If YES – How much was the final payment?

0070 .00 $ Go to item 5a0120 .00 $

b. How much did you receive for the vehicle?

NOTES

1 11 56 7

0020 Code0010 Number

12

Sold?Traded in?

0090

X Don’t know

.00 $

0030

456

Damaged beyond repair?Stolen?Other – Specify

3 Given away to someone outside the

CU, including students away atschool?

Month – 0040 If code 3 in item 2a, go to item 5a

0050 .00 $ Go to item 5a

12

YesNo – Go to item 4c

00600110

12X

YesNo – Go to item 5a

Don’t know

0080

12

YesNo – Go to next vehicle

0100

12

YesNo – Go to next vehicle

0070 .00 $ Go to item 5a0120 .00 $

0020 0010 

12

STr

0090

X D

$

0030

456

DStO

3 G

Csc

0040 0050 

$ 

12

YeN

00600110

12X

YeN

D

0080

12

YeN

0100

12

YeN

0070 

$ 

0120 

$

Complete a column in the1st interview in which thevehicle is disposed of. Entervehicle number and vehiclecode. Vehicle number andcode must match apreviously reported vehiclenumber and code fromsection 11A.1, columns aand g, or section 11B, items 1a and 1b.

Page 70 Section 11 – Part C (Continued)
Section 12 – VEHICLE OPERATING EXPENSES

8 12 02 4

1.

I will now ask about expenses forvehicle services, parts, andequipment. Please do not includeexpenses for vehicles used entirelyfor business.

Page 71 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the In

column a and complete colucolumn a. Complete a sepa

a

Information Booklet, pages 29 and 30

2. 1 12 01 1

Mark (X) box if there areno entries recorded incolumns b–k.

0010 999 Go to

nextpage

ITEM

CODE YES NO

What was the expense for?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150

c

ENTERITEMCODEfromcolumn a.

d

Did thisexpenseincludelabor?

e

Which vehicle was it for?

f g 

Oil change, lubrication,and oil filter 

110120130140150160170

Part A – Vehicle Maintenance and Repair, Parts, and Equipment

Enter a brief description.

h

Describe briefly and enter the vehicle codefrom the vehicle code list.

Description

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

2

1 21 21 21 21 21 21 21 21 21 21 21

NO Month

0040

$ .00 0030 1 2$ .00 0020 1 2$ .00 0010 1 2

0050

Motor tune-up 

180100190

Section 12

Vehicle

code

In what monthdid you have this expense?

YES

What was the total cost?

Did thisincludesales tax?

2

1 21 21 21 21 21 21 21 21 21 21 21

NO

1 21 21 2

YES

Since the 1st of (month, 3 months ago),have you (or any members of yourCU) had expenses for any of thefollowing?Brake work Battery purchasesand installation Tire purchasesand mountingTire repairFront end alignment,wheel balancing andwheel rotationSteering or front-endworkElectrical system work Engine repairor replacementAir conditioning workEngine coolingsystem work 210

200

FIELD REPRESENTATIVECHECK ITEM

NOTES
Section 12 – VEHICLE OPERATING EXPENSES – Continued

8 12 04 0

1.

Page 72 FORM CE-302

Section 12 – Part A (Continued)

FIELD REPRESENTATIVE – Hand the respondent the Info

column a and complete columcolumn a. Complete a separa

a

Information Booklet, pages 30 and 31

2. 1 12 03 7

Mark (X) box if there areno entries recorded incolumns b–k.

0010 999 Go to

Part B

ITEM

CODE YES NO

What was the expense for?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150

c

ENTERITEMCODEfromcolumn a.

d

Did thisexpenseincludelabor?

e

Which vehicle was it for?

f g 

Exhaust system work 

320330340350360370

Part A – Vehicle Maintenance and Repair, Parts, and Equipment – Continued

Enter a brief description.

h

Describe briefly and enter the vehicle codefrom the vehicle code list.

Description

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

2

1 21 21 21 21 21 21 21 21 21 21 21

NO Month

0040

$ .00 0030 1 2$ .00 0020 1 2$ .00 0010 1 2

0050

300

Vehicle

code

In what monthdid you have this expense?

YES

What was the total cost?

Did thisincludesales tax?

2

1 21 21 21 21 21 21 21 21 21 21 21

NO

1 21 21 2

YES

Since the 1st of (month, 3 months ago),have you (or any members of yourCU) had expenses for any of thefollowing?Clutch or transmissionworkShock absorberreplacementDrive shaft or rear-endworkAudio equipment andinstallationOther vehicle services,parts, and equipmentFIELD REPRESENTATIVECHECK ITEMBody work and paintingVehicle accessories andcustomizing

310

Use only if unable to itemize separately.Combined expenses(Codes 100–370) 500

Section 12
FORM CE-302

Page 73

Section 12 – VEHICLE OPERATING EXPENSES – Continued

1. Since the 1st of (month, 3 months

ago), have you (or any members ofyour CU) had expenses for –

a

2. FIELD REPRESENTATIVE 1 12 25 0

CHECK ITEMMark (X) box ifthere are noentries recordedin columns b–f.

0010

0010 999 Go to

part C

ITEM

CODE YES NO

PROCESSING USE ONLY

b c

ENTERITEMCODEfromcolumn a.

PRE

1 2

Description

from

column b

Month

from

column d

Driver’s license? 400

Vehicle inspection? 410

415

$ $ 

 Part B – Licensing, Registration, and Inspection of Vehicles

State vehicleregistration?

00200030004000500060007000800090010001100120013001400150016001700180

Enter the item description

from column a.

3 12 26 4

Month

d

In whatmonthdid youhave thisexpense?

e

What was thetotal amount ofthe expense?

f

Did youhave anyotherexpensesfor . . .?

YES NO

If "No,"go to nextitem incolumn a.

$ $ $ $ $ $ $ 

FIELD REPRESENTATIVE – A

g

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

0100

$ $ 

430

Use only if unable toitemize above –Combined expenses

NOTES

$ $ $ $ $ $ $ $ $ $ $ $ 

Local vehicleregistration? 425
Section 12 – VEHICLE OPERATING EXPENSES – Continued

Part C – Other Vehicle Operating Expenses 1 12 51 6

1a.

Page 74 FORM CE-302

.00

Since the 1st of (month, 3 months ago), what has been the CU’sAVERAGE MONTHLY expense for gasoline and other fuels (includinggasohol) to operate automobiles, trucks, motorcycles, or any othervehicles?

0010 $

b. Was any of this expense for the purchase of diesel fuel?

Since the 1st of (month, 3 months ago), have you (or any members ofyour CU) purchased any oil for operating vehicles, other than oilincluded with the purchase of an oil change? Do not includepurchases for vehicles used entirely for business.

2a.

Since the 1st of (month, 3 months ago), excluding (this month), have you

(or any members of your CU) purchased any antifreeze, brake fluid,transmission fluid, or additives, except if purchased with a tune-up?Do not include purchases for vehicles used entirely for business.

3a.

Since the 1st of (month, 3 months ahad expenses for –

4.

Since the 1st of (month, 3 months a(or any members of your CU) had apolicies? Do not include service pobusiness.

5a.

0 None – Go to item 2a

0020 1

2

YesNo – Go to item 1d

c. If YES – How much?

0030 .00 $

d. Was any of the average monthly cost counted as a business expense? 0040 1

2

YesNo – Go to item 2a

e. How much of the (dollar amount in item 1a) was counted as a business

expense? 0050 .00 $

0060 1

2

YesNo – Go to item 3a 

b. What was the total cost?

0070

12

YesNo – Go to item 3a

c. Was any of this purchased this month?

.00

0080

$

d. If YES – How much was purchased this month?

0100 1

2

YesNo – Go to item 4a

0090 .00 $

b. What was the total cost of these purchases?

0110 .00 $

c. Towing charges, excluding contra

b. If YES – How much was paid, exclu

month?

a. Parking, including garage rental, m

fees, except any expenses includenot include parking expenses that entirely for business.

d. If YES – How much was paid, exclu

current month?

e. Docking and landing fees for boat

f. If YES – How much was paid, exclu

current month?

b. If YES – How much?

Since the 1st of (month, 3 months a(or any members of your CU) had afor recreational vehicles, including 

6a. 

b. If YES – How much?

NOTES

c. Automobile service clubs, such as 

d. If YES – How much?

Section 12 – Part C
Section 13 – INSURANCE OTHER THAN HEALTH

Part A.1 – SCREENING QUESTIONS (For New Consumer Units, Go to Part A.2)

Page 75 FORM CE-302

0010

PROCESSING USE ONLY

a

FIELD REPRESENTATIVE – Hand the respondent the 

Ask items 1 through 3 in 

YES NO

1 2

7 13 00 8

1.

If this box is marked, no policies were previously reported – Go to item 2aComplete columns i through m for each previously reported policy. Do not ask for policies previously discontinued ("Yes" box checked in column e). Also do not ask for polwhich premiums are entirely paid by someone outside of the CU ("Yes" box checked in column f).

Policy number

00200030004000500060007000800090010001100120013001400150

123456789

101112131415

b

Insurance

description

from part B,

item 2a

c

INSURANCE

CODE

from

part B,

item 2b

d

Insurance company

name from part B,

item 3

e

Policy

discontinued

from part

B, item 1b

YES NO

f

Premiums

paid entirely

by someone

outside the

CU from

part B, item

6a, (codes 3

and 4)

Payroll

deduction from

part B,

item 6b

g

YES NO

h

Expenses reported in previous interview

from part B, items 7, 8a, and 8c

Payment

period Total paid Amount paid this month

$ .00 $ .00

$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00$ .00 $ .00

Do you still

have (policy

description) ?

YES NO

i

Since the 1st

of (month, 3

months ago),

have you had

any expense

for (policy)?

YES NO

j

1 2

1 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 21 2 1 2

If YES –

k

How much?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

NONHEALTH INSURANCE POLICY INVENTORY CHART

Section 13
FORM CE-302

Page 76 

Section 13 – INSURANCE OTHER THAN HEALTH – Continued

Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY 1 13 02 7

0020 Number 1

Hand the respondent the Ask items 1–3 in part A.2 

Information Booklet, page 32 

1. Do you (or any members of your CU) have any –

a. Life insurance or other policies which provide benefits in case

of death or disability? 

b. Automobile or other vehicle insurance? c. Insurance protecting your home, furniture, personal effects,

or other property against fire, theft, loss, or damages fromother means –(1) Homeowner’s insurance? (2) Tenant’s insurance? 

d. Other types of nonhealth insurance? 

2a. Since the 1st of (month, 3 months ago), have you (or any

members of your CU) made any payments for insurancepolicies, other than health insurance, which you nolonger have?

b. What kind of insurance policy(ies) was it (were they)?

Enter insurance code from items 1a–d for each policy reported.

c. How many?

3a. Have you (or any members of your CU) made any payments

for insurance policies, other than health, for persons not inyour CU?

b. What kind of insurance policy(ies) was it (were they)?

Enter insurance code from items 1a–d for each policy reported.

c. How many?

YES NO Insurance code If YES – How many policies or plans does your CU have?

2 100

200300400500

0010

0040 Number 0030 1 20060 Number 0050 1 20080 Number 0070 1 2

0090 0100 Number 1 2

4. FIELD REPRESENTATIVE INSTRUCTIONS

Complete a column in part B for each policy reported.Complete a column in part B for each discontinued policy. Be sure to mark the discontinued box, part B, item 1b.

0130 1

2

Yes – Ask items 2b and 2c

No – Go to item 3a

Insurance code

01400160018002000220

How many?

0150 Number0170 Number0190 Number0210 Number0230 Number

0300 1

2

Yes – Ask items 3b and 3c

No – Go to item 4

Insurance code

03100330035003700390

How many?

0320 Number0340 Number0360 Number0380 Number0400 Number

Section 13 – Part A.2

Section 13
Section 13 – INSURANCE OTHER THAN HEALTH – Continued

Part B – Detailed Questions

a.

2a.

Page 77 FORM CE-302

1. FIELD REPRESENTATIVE ITEM

New CU’s – Enter policynumbers in consecutive orderbeginning with 1.

FIELD REPRESENTATIVE – Combine payments if m

insurance (for example

1 13 03 5

b.

4.5a.

b.

6a.

b.

8a.

b.

2nd through 5th interviews –Enter the next available policynumber from chart in part A.1. b.

PROCESSING USE ONLY

POLICY NUMBERDISCONTINUED

What type of insurance is (was) it?Enter insurance code from part A.1 or part A.2.What is the name of the insurance company?Ask only for insurance code 200 from item 2b.Describe briefly what vehicles are covered.Ask only for insurance code 300 from item 2b.Describe briefly the property this policy covers.Enter property number from section 3, part A.1 or part B.Are the policy premiums paid . . .?Are any premiums paid through payrolldeductions?How often are premiums on this policy paid?Mark (X) the appropriate box.Since the 1st of (month, 3 months ago), what wasyour total expense for this insurance policy?Enter the actual amount the CU paid, do not includeany expenses paid for the CU by others.Were any payments made this month?If YES – How much was paid this month?

3.

Enter name of insurance company, not theinsurance agent.

7.

c.

1 13 04 3 

0010

1

Number

0020

Description

Code

Insurance company name

0030

DescriptionDescription

0160 0170 01800220 1

234

Entirely by CUPartially by CU and partially bysomeone outside the CUEntirely by an employer orunionEntirely by another group orpersons outside the CU

Go tonextpolicy



0230 1 Yes No 20240 Weekly

BiweeklyMonthly – directlyMonthly – in mortgage paymentQuarterlySemiannuallyAnnuallyPaid-up policy – Go to next policyOther – Specify

123456789

.00 0250 $

0 None – Go to next policy12

YesNo – Go to next policy

0260

$ 0270 .00

0010

1

Number

0020

Description

Code

Insurance company name

0030

Description

0160 0170 01800220 1

234

Entirely by CUPartially by CU and partially bysomeone outside the CUEntirely by an employer orunionEntirely by another group orpersons outside the CU

Go tonextpolicy



0230 1 Yes No 20240 Weekly

BiweeklyMonthly – directlyMonthly – in mortgage paymentQuarterlySemiannuallyAnnuallyPaid-up policy – Go to next policyOther – Specify

123456789

.00 0250 $

0 None – Go to next policy12

YesNo – Go to next policy

0260

$ 0270 .00

0010

1

0020

DescriptionInsurance c

0030

DescriptionDescription

0160 0220 1

234

0230 1 0240 

123456789

0250 $

0 12

0260

$ 0270 

Description
Section 13 – INSURANCE OTHER THAN HEALTH – Continued

Part B – Detailed Questions – Continued

a.

2a.

Page 78 FORM CE-302

Section 13 – Part B (Continued)

1. FIELD REPRESENTATIVE ITEM

New CU’s – Enter policynumbers in consecutive orderbeginning with 1.

FIELD REPRESENTATIVE – Combine payments if m

insurance (for example

1 13 07 6

b.

4.5a.

b.

6a.

b.

8a.

b.

2nd through 5th interviews –Enter the next available policynumber from chart in part A.1. b.

PROCESSING USE ONLY

POLICY NUMBERDISCONTINUED

What type of insurance is (was) it?Enter insurance code from part A.1 or part A.2.What is the name of the insurance company?Ask only for insurance code 200 from item 2b.Describe briefly what vehicles are covered.Ask only for insurance code 300 from item 2b.Describe briefly the property this policy covers.Enter property number from section 3, part A.1 or part B.Are the policy premiums paid . . .?Are any premiums paid through payrolldeductions?How often are premiums on this policy paid?Mark (X) the appropriate box.Since the 1st of (month, 3 months ago), what wasyour total expense for this insurance policy?Enter the actual amount the CU paid, do not includeany expenses paid for the CU by others.Were any payments made this month?If YES – How much was paid this month?

3.

Enter name of insurance company, not theinsurance agent.

7.

c.

1 13 08 4 

0010

1

Number

0020

Description

Code

Insurance company name

0030

DescriptionDescription

0160 0170 01800220 1

234

Entirely by CUPartially by CU and partially bysomeone outside the CUEntirely by an employer orunionEntirely by another group orpersons outside the CU

Go tonextpolicy



0230 1 Yes No 20240 Weekly

BiweeklyMonthly – directlyMonthly – in mortgage paymentQuarterlySemiannuallyAnnuallyPaid-up policy – Go to next policyOther – Specify

123456789

.00 0250 $

0 None – Go to next policy12

YesNo – Go to next policy

0260

$ 0270 .00

0010

1

Number

0020

Description

Code

Insurance company name

0030

DescriptionDescription

0160 0170 01800220 1

234

Entirely by CUPartially by CU and partially bysomeone outside the CUEntirely by an employer orunionEntirely by another group orpersons outside the CU

Go tonextpolicy



0230 1 Yes No 20240 Weekly

BiweeklyMonthly – directlyMonthly – in mortgage paymentQuarterlySemiannuallyAnnuallyPaid-up policy – Go to next policyOther – Specify

123456789

.00 0250 $

0 None – Go to next policy12

YesNo – Go to next policy

0260

$ 0270 .00

0010

1

0020

DescriptionInsurance c

0030

DescriptionDescription

0160 0220 1

234

0230 1 0240 

123456789

0250 $

0 12

0260

$ 0270 
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE

Part A.1 – Screening Questions (For New Consumer Units, Go to Part A.2)

Page 79 FORM CE-302

8 14 00 4

PROCESSING USE ONLY

1.2a.

b.

0010

FIELD REPRESENTATIVE – Complete questions 1

Complete part C for al

Complete columns i through m in the "Health Insurance Policy Inventory Chart" below for each policy previously reported, exceptpolicies that were discontinued ("YES" in column f).

If this box is marked, no policies were previously reported – Go to item 2a.

1 14 01 7

HEALTH INSURANCE POLICY INVENTORY CHART

a b c d e f g h

Policy number

12345

678

9

1011

12

00200030004000500060007000800090010001100120

Insurance

description

from part B, item 4a

Type

code

from

part B,

item 4a

Name of

insurance company

from part B, item 2

Payroll

deductions

from part B,

item 7.

Policy

discontinued

from part B,

item 1b

Premium

paid entirely

by someone

outside the

CU from

part B,

item 6

(code 

3 or 4)

YES NO

Since the 1st of (month, 3 months ago), have you (or any members of yourCU) purchased any (additional) health or hospitalization insurance?If YES – How many policies did you buy?Complete a column in part B for each new policy.Since the 1st of (month, 3 months ago), have you (or any members of your CU)made any payments for health insurance plans for persons outside of your CU?If YES – How many policies did you buy?Complete a column in part B for each policy.

Number

YesNo – Go to item 3a

3a.

b.

0010 1

2

0020

YesNo – Go to next part

0030 1

2

Number 0040

YES NO YES NO 

1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 

Section 14

FIELD REPRESENTATIVE INSTRUCTIONSComplete a column in part B for each new policy reported. If "No," to items 2 and 3 – Go to part C.

4.

Enter 

payment

from part B,

item 8a oritem 10 or

14A.1

column k

Enter time

period

covered 

from part B,

item 8b

NOTES

Expenses reported in

previous interview

Enter

payments

made this

month from

part B,

item 11b or

14A.1

column m

.00.00.00.00.00.00.00.00.00.00.00.00

$$$$$$$$$$$$

.00.00.00.00.00.00.00.00.00.00.00.00

$$$$$$$$$$$$
Page 80 

Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued

1 14 02 5

1a. Do you (or any members of your CU) have any hospitalization

or health insurance plans or belong to a plan that pays all orpart of your medical expenses? Please consider any specialpurpose plans you may have, such as those listed on page 32aof the Information Booklet.

0010

FIELD REPRESENTATIVE – Ask items 1, 2, and 3 

 Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY – Continued

b.If YES – How many policies do you have?

2a. Since the 1st of (month, 3 months ago), have you (or any

members of your CU) made payments for hospitalization orhealth insurance policies which you no longer have?

b.If YES – How many policies?

3a. Have you (or any members of your CU) made any payments for

health insurance plans for persons outside of your CU?

b.If YES – How many policies?

4. FIELD REPRESENTATIVE INSTRUCTIONS

Complete a column in part B for each policy reported.If the policy was reported in item 2, be sure to mark the discontinued box in part B, item 1b.If "No," to items 1, 2, and 3 – Go to part C.

12

YesNo – Go to item 2a

Number 0020

0030 1

2

YesNo – Go to item 3a

Number 0040

0050 1

2

YesNo – Go to item 4

Number 0060

Section 14

Section 14 – Part A.2
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued

Part B – Detailed Questions

Page 81 FORM CE-302

1.

0010

1 14 03 3

8a.9a.

b.c.

FIELD REPRESENTATIVE ITEMNew CU’s – Enter a policy number in consecutive

order beginning with 1.2nd thru 5th interviews – Enter policy number in

consecutive order using the next available number inpolicy chart in part A.1.

PROCESSING

USE ONLY

POLICYNUMBERDISCONTINUED

a.b.

Number

0020 1

2. What is the name of the insurance company?

Enter name of insurance company, not the insurance agent.

Insurance company name

3. How many CU members are covered by this policy? 0060 Number 0 None

Was the policy obtained on an individual or group basis?

1 – Individually obtained2 – Group through place of employment

3 – Group through other organization

5. 0070 1

Are premiums paid –1 – Entirely by CU members?2 – Partially by CU members?3 – Entirely by an employer or union?

4 – Entirely by another group or

person outside of the CU?

6. 0090 1

2

If code 3 or 4, go to next policy



7. Are any of the premiums paid through payroll deductions? 0100 1 Yes 2 No

$ What is your part of the regular health insurance payment, (including all payroll deductions)? 0110

b. What period of time is covered by the regular payment? 0120 1

234

Week2 weeksMonthQuarter

567

6 months YearOther –Specify

11a.

Since the 1st of (month, 3 months ago), were any paymentsmade on this policy?

0130 1 Yes 2 No – Go to

next policy

Was each payment in the amount of (regular payment amountreported in item 8a)?

0140 1 Yes 2 No – Go to

item 10

How many payments were made? 0150 Number

10. Ask only if item 9b is "NO." 0160 $

Were any payments made during the current month? 0170 1 Yes 2 No – Go to

next policy

b. If YES – How much was paid during the current month? 0180 $

1 14 04 1 1 14 05 8 

What was the total expense paid for this policy?

0010 Number 0010 Num

.00

1 Blue Cross/Blue Shield

2 3

If Blue Cross/Blue Shield, Mark (X) box.

34

Go to item 11a



.00

Information Booklet, page 32a 4a. What type of insurance plan is it?1 – Health Maintenance Organization2 – Fee for Service Plan

b. If, except in the case of an emergency, you go to a doctor other

than one in the group center or your primary care doctor, withouta referral, will the plan pay any of your expenses?Ask only if item 4a is "1".

c. Is this fee for service plan a –

1 – Traditional Fee for Service Plan?

d. Is this special purpose insurance plan–

Ask only if item 4a is "4."

2 – Preferred Provider Option Plan

1 Go to 4b 4 Go to 4d

Don’tknow –Go to 5

x

0061

23

Go to 4cGo to 5

4 – Other special purpose plan

Go to item 5

 12

0030006200630064

YesNo Go to item 5

 12

123

456 Specify

Ask only if item 4a is "2."1 – Dental insurance?

2 – Vision insurance?3 – Prescription drug insurance?

4 – Mental health insurance?5 – Dread disease policy?6 – Other type of special purpose health insurance?

0020 1

Insurance company name

0060 Number 0 None0070 10090 1

2

If code 3 or 4, go to next policy



0100 1 Yes 2 No0110 $0120 1

234

Week2 weeksMonthQuarter

567

6 months YearOther –Specify

0130 1 Yes 2 No – Go to

next policy

0140 1 Yes 2 No – Go to

item 10

0150 Number0160 $0170 1 Yes 2 No – Go to

next policy

0180 $

.00

1 Blue Cross/Blue Shield

2 334

Go to item 11a



.00.00

1 Go to 4b 4 Go to 4d

Don’tknow –Go to 5

x

0061

23

Go to 4cGo to 5

Go to item 5

 12

0030006200630064

YesNo Go to item 5

 12

123

456 Specify

0020 1

Insurance company na

0060 Numbe0070 10090 1

2

If cgo po



0100 1 Yes 2 0110 $0120 1

234

Week2 weeksMonthQuarter

567

0130 1 Yes 2 0140 1 Yes 2 0150 Num0160 $0170 1 Yes 2 0180 $

1 Blue Cross/

2 334

1 Go to 4b 

0061

23

Go to 4cGo to 5

Go to item 

 12

0030006200630064

YesNo Go to 

 12

123

456 S

.00

3 – Commercial Medicare Supplement
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued

Part B – Detailed Questions

FORM CE-302

Section 14 – Part B (Continued)

1.

0010

1 14 08 2

8a.9a.

b.c.

FIELD REPRESENTATIVE ITEMNew CU’s – Enter a policy number in consecutive

order beginning with 1.2nd thru 5th interviews – Enter policy number in

consecutive order using the next available number inpolicy chart in part A.1.

PROCESSING

USE ONLY

POLICYNUMBERDISCONTINUED

a.b.

Number

0020 1

2. What is the name of the insurance company?

Enter name of insurance company, not the insurance agent.

Insurance company name

3. How many CU members are covered by this policy? 0060 Number 0 None

Was the policy obtained on an individual or group basis?

1 – Individually obtained2 – Group through place of employment

3 – Group through other organization

5. 0070 1

Are premiums paid –1 – Entirely by CU members?2 – Partially by CU members?3 – Entirely by an employer or union?

4 – Entirely by another group or

person outside of the CU?

6. 0090 1

2

If code 3 or 4, go to next policy



7. Are any of the premiums paid through payroll deductions? 0100 1 Yes 2 No

$ What is your part of the regular health insurance payment, including all payroll deductions? 0110

b. What period of time is covered by the regular payment? 0120 1

234

Week2 weeksMonthQuarter

567

6 months YearOther –Specify

11a.

Since the 1st of (month, 3 months ago), were any paymentsmade on this policy?

0130 1 Yes 2 No – Go to

next policy

Was each payment in the amount of (regular payment amountreported in item 8a)?

0140 1 Yes 2 No – Go to

item 10

How many payments were made? 0150 Number

10. Ask only if item 9b is "NO." 0160 $

Were any payments made during the current month? 0170 1 Yes 2 No – Go to

next policy

b. If YES – How much was paid during the current month? 0180 $

1 14 09 0 1 14 10 8 

What was the total expense paid for this policy?

0010 Number 0010 Num

.00

1 Blue Cross/Blue Shield

2 3

If Blue Cross/Blue Shield, Mark (X) box.

34

Go to item 11a



.00

Information Booklet, page 32a 4a. What type of insurance plan is it?1 – Health Maintenance Organization2 – Fee for Service Plan

b. If, except in the case of an emergency, you go to a doctor other

than one in the group center or your primary care doctor, withouta referral, will the plan pay any of your expenses?Ask only if item 4a is "1".

c. Is this fee for service plan a –

1 – Traditional Fee for Service Plan?

d. Is this special purpose insurance plan–

Ask only if item 4a is "4."

2 – Preferred Provider Option Plan

1 Go to 4b 4 Go to 4d

Don’tknow –Go to 5

x

0061

23

Go to 4cGo to 5

4 – Other special purpose plan

Go to item 5

 12

0030006200630064

YesNo Go to item 5

 12

123

456 Specify

Ask only if item 4a is "2."1 – Dental insurance?

2 – Vision insurance?3 – Prescription drug insurance?

4 – Mental health insurance?5 – Dread disease policy?6 – Other type of special purpose health insurance?

0020 1

Insurance company name

0060 Number 0 None0070 10090 1

2

If code 3 or 4, go to next policy



0100 1 Yes 2 No0110 $0120 1

234

Week2 weeksMonthQuarter

567

6 months YearOther –Specify

0130 1 Yes 2 No – Go to

next policy

0140 1 Yes 2 No – Go to

item 10

0150 Number0160 $0170 1 Yes 2 No – Go to

next policy

0180 $

.00

1 Blue Cross/Blue Shield

2 334

Go to item 11a



.00.00

1 Go to 4b 4 Go to 4d

Don’tknow –Go to 5

x

0061

23

Go to 4cGo to 5

Go to item 5

 12

0030006200630064

YesNo Go to item 5

 12

123

456 Specify

0020 1

Insurance company na

0060 Numbe0070 10090 1

2

If cgo po



0100 1 Yes 2 0110 $0120 1

234

Week2 weeksMonthQuarter

567

0130 1 Yes 2 0140 1 Yes 2 0150 Num0160 $0170 1 Yes 2 0180 $

1 Blue Cross/

2 334

1 Go to 4b 

0061

23

Go to 4cGo to 5

Go to item 

 12

0030006200630064

YesNo Go to 

 12

123

456 S

.00

Page 82 

3 – Commercial Medicare Supplement
Page 83 

FORM CE-302

Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued

Part C – Medicare, Medicaid, and Other Health Insurance Plans Not Directly Paid For By The CU

1a.

0020

1 14 51 2

Number

0010 1

2

b.

Are you (or any members of your CU) presently enrolled inMedicare or have you (or any members of your CU) been enrolledsince the 1st of (month, 3 months ago)? Medicare is the FederalHealth Insurance Plan.If YES – How many members of your CU are covered by Medicare?

YesNo – Go to item 2a

2a.

0040 Number0030 1

2

b.

Is anyone in your CU enrolled in Medicaid or has anyone in yourCU been enrolled since the first of (month, 3 months ago)?If YES – How many members of your CU are covered by Medicaid?

YesNo – Go to item 3

FIELD REPRESEN

3. Are you (or any members of your CU) covered by any plan other

than Medicare or Medicaid which provides free health care suchas TRICARE, CHAMPUS or military health care?

0050 1

2

YesNo

Section 15
Section 15 – MEDICAL AND HEALTH EXPENDITURES

Part A – Screening Questions for

Payments

Page 84 FORM CE-302

Section 15 – Part A and Part B

1.

0010

PROCESSING USE ONLY

a b

4 15 02 6

1 15 01 4

ENTERITEMCODEfrompart A.

$ .00

0010 999 Go to

nextpage

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there areno entries recorded inpart B.

Part B – Payments For Medical Expenses

CU

member

YES NO

Hand respondent Information Booklet, pages 33 and 34.Now I am going to ask you some questionsabout medical payments and reimbursements.I will begin with your payments.By payments I mean any expenses paid by anymembers of your CU directly to a medicalprovider by cash, check, or credit card for amedical service or item. Include all payments,even those for persons who are not CUmembers.Since the 1st of (month, 3 months ago), haveyou (or any members of your CU) madeany payments for the following?Read all bold items below.EYE CARE, such as

Eye examinations,treatment, or surgery 

Purchase of eye glasses orcontact lenses Combined eye careservices

DENTAL CARE INPATIENT HOSPITALCARE, such as

Hospital room 

Hospital services Combined hospital roomand services 

SERVICES BY MEDICALPROFESSIONALS OTHERTHAN PHYSICIANS PHYSICIAN SERVICES 

Combined hospital careand physicians’ services 

ITEM

CODE YES NO

Payments

110120130200320410420430310

FIELD REPRESENTATIVE – Hand the respondent the Inform

question 1, followed by generaeach payment or set of identicaPERSON, in the SAME MONTH

Ask if not apparent –What was the (care/service or item)?Who received the (care/service or item)?Was the person a CU member?

Care/service or item Person’s name

Month

Always ask –

In whatmonthwas(were)thepayment(s)made?

What was theamount of thepayment?

Did youmakeanyotherpayment(s)for . . .?If "No,"go tonext itemin part A.

1 2

c d

YES NO

e

0020003000400050006000700080009001000110012001300140015001600170

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

330

Section 15
FORM CE-302

Page 85 

Section 15 – MEDICAL AND HEALTH EXPENDITURES – Continued

Part A – Screening Questions forPayments – Continued

1.

0010

PROCESSING USE ONLY

a b

4 15 05 9

1 15 04 8

ENTERITEMCODEfrompart A.

$ .00

0010 999 Go to

nextpage

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there areno entries recorded inpart B.

Part B – Payments For Medical Expenses – Continued

CU

member

YES NO

Hand respondent Information Booklet, pages 34 and 35.Since the 1st of (month, 3 months ago), haveyou (or any members of your CU) madeany payments for the following?Read all bold items below.OTHER MEDICAL CARESERVICES, such as

Lab tests or x-rays 

Other medical care Combined medicalcare services 

MEDICINE AND MEDICAL SUPPLIES, such as

Hearing aids 

Prescribed medicines orprescribed drugs Rental of supportive orconvalescent equipment Combined medicine andmedical supplies 

ITEM

CODE YES NO

Payments

510520530540620640650660610

FIELD REPRESENTATIVE – Hand the responden

heading and sub-capayments. Identical MONTH. For combin

Ask if not apparent –What was the (care/service or item)?Who received the (care/service or item)?Was the person a CU member?

Care/service or item Person’s name

Month

Always ask –

In whatmonthwas(were)thepayment(s)made?

What was theamount of thepayment?

Did youmakeanyotherpayment(for . . .?If "No,"go tonext itemin part A.

1 2

c d

YES NO

e

0020003000400050006000700080009001000110012001300140015001600170

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

630

Care in convalescent ornursing home 

670

Purchase of supportive orconvalescent equipment Rental of medical orsurgical equipment forgeneral use Purchase of medical orsurgical equipment forgeneral use 
Section 15 

– MEDICAL AND HEALTH EXPENDITURES 

– Continued

Part C 

– Screening Questions for

Reimbursements

Page 86 FORM CE-302

Section 15 

– Part C and Part D

1.

0010

PROCESSING USE ONLY

a

b

4 15 07 5

1 15 06 3

ENTERITEMCODEfrompart C.

$ .00

0010 999 Go to

nextpage

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there areno entries recorded inpart D.

Part D 

– Reimbursements For Medical Expenses

CU

member

YES NO

Hand respondent Information Booklet, pages 33 and 34.Now I am going to ask you some questionsabout your reimbursements.By reimbursements I mean money received forany members of your CU from an insurancecompany, medical care provider, or non CUmember, for medical expenses which youpreviously paid or will pay.Since the 1st of (month, 3 months ago), haveyou (or any members of your CU) receivedany reimbursements for the following?Read all bold items below.EYE CARE, such as

Eye examinations,treatment, or surgery 

Purchase of eye glasses orcontact lenses Combined eye careservices

DENTAL CARE INPATIENT HOSPITALCARE, such as

Hospital room 

Hospital services Combined hospital roomand services 

SERVICES BY MEDICALPROFESSIONALS OTHERTHAN PHYSICIANS PHYSICIAN SERVICES 

Combined hospital careand physicians’ services 

ITEM

CODE YES NO

Reimbursements

110120130200320410420430310

FIELD REPRESENTATIVE 

– Hand the respondent the Inform

part C, question 1, followed by part D for each reimbursement SERVICE for the SAME PERSON

Ask if not apparent –What was the (care/service or item)?Who received the (care/service or item)?Was the person a CU member?

Care/service or item Person’s name

Month

Always ask –

In whatmonthwas(were)thereimbursement(s) received?

What was theamount of thereimbursements?

Did youreceiveany otherreimbursement(s)for . . .?If "No,"go tonext itemin part C.

1 2

c

d

YES NO

e

0020003000400050006000700080009001000110012001300140015001600170

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

330
FORM CE-302

Page 87 

Section 15 – MEDICAL AND HEALTH EXPENDITURES – ContinuedPart C – Screening Questions for

Reimbursements – Continued

1.

0010

PROCESSING USE ONLY

a b

4 15 09 

1 15 08 9

ENTERITEMCODEfrompart C.

$ .00

0010 999 Go to

thenextsection

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there areno entries recorded inpart D.

Part D – Reimbursements for Medical Expenses – Continued

CU

member

YES NO

Hand respondent Information Booklet, pages 34 and 35.Since the 1st of (month, 3 months ago), haveyou (or any members of your CU) receivedany reimbursements for the following?Read all bold items below.OTHER MEDICAL CARESERVICES, such as

Lab tests or x-rays 

Other medical care Combined medicalcare services 

MEDICINE AND MEDICAL SUPPLIES, such as

Hearing aids 

Prescribed medicines orprescribed drugs Rental of supportive orconvalescent equipment Combined medicine andmedical supplies 

ITEM

CODE

YES NO

Reimbursements

510520530540620640650660610

FIELD REPRESENTATIVE – Hand the respondent the In

heading and sub-categoriesidentical reimbursements. the SAME MONTH. For com

Ask if not apparent –What was the (care/service or item)?Who received the (care/service or item)?Was the person a CU member?

Care/service or item Person’s name

Month

Always ask –

In whatmonthwas(were)thereimbursement(s)received?

What was theamount of thereimbursements?

Did youreceive anotherreimbursement(s)for . . .?If "No,"go tonext itemin part C.

1 2

c d

YES NO

e

0020003000400050006000700080009001000110012001300140015001600170

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

630

Care in convalescent ornursing home 

670

Purchase of supportive orconvalescent equipment Rental of medical orsurgical equipment forgeneral use Purchase of medical orsurgical equipment forgeneral use 
Section 16 – EDUCATIONAL EXPENSES

Page 88 FORM CE-302

Section 16

1.

0010

PROCESSING USE ONLY

a b

7 16 02 7

ENTERITEMCODEfromcolumn a.

$ .00

4.

YES NO

Information Booklet,page 36.

FIELD REPRESENTATIVE – Hand the respondent the Inform

column a questions 1, 2, and 3 aseparate line for each payment same month.

Month

1 2

c d e

What was the expense for?Describe briefly the expense.

Who was it for?If CU member,enter name andline number fromControl Card. Ifsomeone outsideCU, enter 99.

Name Line No. or

code

Since the 1st of (month,3 months ago), have you(or any members ofyour CU) paid for anyrecreational lessons orother instructions formembers of this CUor other persons? 

ITEM

CODE YES NO

100

2. Have you (or any

members of your CU)paid for nursery schoolor child day care centersfor members of this CUor other persons? 200

00200030004000500060007000800090010001100120013001400150

1 3

4

5

2

Complete without

asking if information

is known.

What kind ofschool was it?

1 – College or

university

2 – Elementary or

high school

3 – Child day

care center

4 – Nursery school

or preschool

5 – Other school

Mark (X) box

In whatmonthwas thepaymentmade?

f

How much waspaid?

g h

Has any ofthis amountbeen or willany of it bereimbursedby anemployer,agency, orotherperson?

If "No," go tocolumn j.

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

3a. Have you (or any

members of your CU)paid for any (other)school relatedexpenses formembers of this CUor other persons? If YES – Did youpay for –

b.

Tuition?Housing while attendingschool?Food or board whileattending school? Use only if unable toseparate – Combinedroom and board(Codes 310 and 320) 

300320330310

FIELDREPRESENTATIVECHECK ITEMMark (X) box ifthere are noentries recordedin columns b–j.

999 Go to

nextpage

0010

1 16 01 2

1 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 2

Secti
FORM CE-302

Section 16 – EDUCATIONAL EXPENSES – Continued

Page 89 

0010

PROCESSING USE ONLY

a b

7 16 04 3

ENTERITEMCODEfromcolumn a.

$ .00

4.

YES NO

Information Booklet, page 36.

Month

1 2

c d e

What was the expense for?Describe briefly the expense.

Who was it for?If CU member,enter name andline number fromControl Card. Ifsomeone outsideCU, enter 99.

Name Line No. or

code

ITEM

CODE YES NO

340

350

00200030004000500060007000800090010001100120013001400150

1 3

4

5

2

Complete without

asking if information

is known.

What kind ofschool was it?

1 – College or

university

2 – Elementary or

high school

3 – Child day

care center

4 – Nursery school

or preschool

5 – Other school

Mark (X) box

In whatmonthwas thepaymentmade?

f

How much waspaid?

g h

Has any ofthis amountbeen or willany of it bereimbursedby anemployer,agency, orotherperson?

If "No," go tocolumn j.

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

3b. Did you pay for – (Continued)

Other combined educationexpenses (Include anycombined educationalexpenses not previouslyreported.) (Codes 100,200, 300, 310, 320,340–360) 

360380370

FIELDREPRESENTATIVECHECK ITEMMark (X) box ifthere are noentries recordedin columns b–j.

999 Go to

nextsection

0010

1 16 03 8

1 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

21 3

4

5

2

1 21 21 21 21 21 21 21 21 21 21 21 21 21 2

Private school bus? Purchase of any schoolbooks, supplies, orequipment whichhas not already beenreported?Other school relatedexpenses not alreadyreported?Combined expenses forbooks and tuition (Codes300 and 350) Use only if the respondentis unable to separateexpenses.
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS,

AND ENTERTAINMENT EXPENSES

Part A – Subscriptions and Memberships

Page 90 FORM CE-302

Section 17 – Part A

1.

0010

PROCESSING USE ONLY

a b

4 17 02 2

ENTERITEMCODEfromcolumn a.

$ .00

2.

FIELD REPRESENTATIVE – Ask column a and complete col

c d e

Since the 1st of (month, 3 months ago),have you (or any members of your CU)purchased any of the following for yourCU or someone outside your CU?

ITEM

CODE YES NO

100

200

f 

900

FIELDREPRESENTATIVECHECK ITEMMark (X) box ifthere are noentries recordedin columns b–g.

999 Go to

nextpage

0010

1 17 01 0

FIELD REPRESENTATIVE –Read each item listedbelow.Newspaper delivery Books purchased from abook club Compact discs, tapes,videos, or recordspurchased from amail-order club Magazine or periodicalsubscriptionsTheater, concert, opera,or other musical series,season tickets Season tickets tosporting events Reference books NOTin sets Encyclopedias orother sets ofreference books 

300400500600700

0020003000400050006000700080009001000110012001300140015001600170018001900200

What is the name of the(subscription, club, or organizationreported in column a)?Enter name such as "Daily News,""Redbook," "Columbia Record Club,"and "Book of the Month Club."

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

What was thetotal costduring thisperiod?(Includeshipping andhandlingfees.)

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

How much of thisamount was paidthis month?

No

00000000000000000000

$ .00$ .00$$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

.00

Was this purchasefor your CU orsomeone outsideyour CU?

1 – For CU

CU Outside CU

2 – For someone

outside your CU
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS,

AND ENTERTAINMENT EXPENSES – Continued

Part A – Subscriptions and Memberships – Continued

Page 91 FORM CE-302

3.

0010

PROCESSING USE ONLY

a b

4 17 04 8

ENTERITEMCODEfromcolumn a.

$ .00

4.

FIELD REPRESENTATIVE – Ask column a and complet

c d e

Have you (or any members of your CU)had any membership costs or otherexpenses related to any of the following?Do not include contributions to ormembership in religious, professional,business, or other tax deductibleorganizations.

ITEM

CODE YES NO

800

810

f 

FIELDREPRESENTATIVECHECK ITEMMark (X) box ifthere are noentries recordedin columns b–g.

999 Go to

thenextsection

0010

1 17 03 6

FIELD REPRESENTATIVE –Read each item listedbelow.Country clubs, healthclubs, swimming pools,tennis clubs, social orother recreationalorganizationsCivic, service, orfraternalorganizationsCredit cardmembership fees Shopping clubmemberships such as Costco and Sam’s

820840

0020003000400050006000700080009001000110012001300140015001600170018001900200

What is the name of the(subscription, club, or organizationreported in column a)?Enter name such as "Jaycees," "KentSwim and Country Club," and "AmocoMotor Club."

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

What was thetotal costduring thisperiod?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

How much of thamount was paithis month?

$ .00$ .00$$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

.00

NOTES

Was this expensefor your CU orsomeone outsideyour CU?

1 – For CU

CU Outside CU

2 – For someone

outside your CU
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS, AND ENTERTAINMENT EXPENSES – Continued

Part B – Books and Entertainment Expenses

Page 92 FORM CE-302

Section 17 – Part B

1 17 26 7

3a.

b.

0010

.00 $

1a. Since the 1st of (month, 3 months

ago), have you (or any membersof your CU) paid any fees forparticipating in sports such astennis, golf, bowling,or swimming?What was the total expensefor them?How much of the total amountwas spent this month?Have you (or any members of yourCU) paid any single admissionsto spectator sporting events suchas football, baseball, hockey,or soccer?What was the total expensefor them?How much of the total amountwas spent this month?Have you (or any members ofyour CU) paid any singleadmissions to entertainmentactivities such as movies, plays,operas, or concerts?What was the total expensefor them?How much of the total amountwas spent this month?Have you (or any members ofyour CU) bought any (other)books, including paperbacks,not purchased through a bookclub? (Exclude reference books orschool books.)What was the total expensefor them?How much of the total amountwas spent this month?

b.b.c.

2a.

c.c.

4a.

b.

12

YesNo – Go to item 2a

0020

0

.00 $ 0030

None

0040 1

2

YesNo – Go to item 3a

.00 $ 0050

0

.00 $ 0060

None

0070 1

2

YesNo – Go to item 4a

.00 $ 0080

0

.00 $ 0090

None

0100 1

2

YesNo – Go to item 5a

c.

.00 $ 0110

0

.00 $ 0120

None

5a. Have any CU members bought

any magazines not included in asubscription?What was the total expensefor them?How much of the total amountwas spent this month?

b.c.

0130 1

2

YesNo – Go to item 6a

.00 $ 0140

0

.00 $ 0150

None

6a. Have any CU members

purchased single copies ofnewspapers (non-subscription)?What was the total expensefor them?How much of the total amountwas spent this month?

b.c.

0160 1

2

YesNo – Go to item 7a

.00 $ 0170

0

.00 $ 0180

None

7a. Have any CU members

purchased compact discs, audiotapes, needles, or records otherthan through a mail-order club?What was the total expensefor them?How much of the total amountwas spent this month?

b.c.

0190 1

2

YesNo – Go to item 8a

.00 $ 0200

0

.00 $ 0210

None

8a. Have any CU members purchased

any photographic film?What was the total amountspent?How much of the total amountwas spent this month?

b.c.

0220 1

2

YesNo – Go to item 9a

.00 $ 0230

0

.00 $ 0240

None

9a. Have any CU members paid for

film processing?What was the total amountspent?How much of the total amountwas spent this month?

b.c.

0250 1

2

YesNo – Go to item 10a

.00 $ 0260

0

.00 $ 0270

None

11
Section 18 

– TRIPS AND VACATIONS

Part A 

– Screening Questions

b. If YES – How many trips like this did you have?

3a.

FIELD REPRESENTATIVE 

–

Page 93 

FORM CE-302

(Other than the trips you already mentioned,) Since the1st of (month, 3 months ago), have you (or any membersof your CU) been away overnight or longer to visitrelatives or friends?

Trips 0020

FIELD REPRESENTATIVE – Ask if box is marked.

2.

1 18 00 0

0030 1

2

YesNo –

1a. Now I’m going to ask about trips and vacations. First I’d

like to ask about trips taken by you (or any members ofyour CU) which were paid for by someone else. Sincethe 1st of (month, 3 months ago), have you (or anymembers of your CU) taken any trips entirely paid for byanyone outside your CU, such as a business, employer,or relative?

Last interview you reported trip(s) which had not

yet ended. I’d like to ask about that trip (those trips)now.

0010 1

2

YesNo –

Ask part A items Identical trips arreimbursed to th

1 18 01 8

Go to item 2

Complete items 8e–8i

for each trip checkedin 8a.

b. If YES – How many trips were taken to visit relatives or

friends? Trips 0040

Ask items 8c–8i for

each trip reported

4a. (Other than the trips you already mentioned,) Since the

1st of (month, 3 months ago), have you (or any membersof your CU) been away overnight or longer for business? 0050 1

2

YesNo –

b. If YES – How many trips were taken for business? Trips 0060

Ask items 8c–8i for

each trip reported

5a. (Other than the trips you already mentioned,) Since the

1st of (month, 3 months ago), have you (or any membersof your CU) been away overnight or longer forrecreation such as sightseeing, sports events, club ororganizational meetings, or outdoor recreation?

0070 1

2

YesNo –

b. If YES – How many trips were taken for these reasons? Trips 0080

Ask items 8c–8i for

each trip reported

6a. (Other than the trips you already mentioned,) Since the

1st of (month, 3 months ago), have you (or any membersof your CU) been away overnight or longer on any otherkind of trip?

0090 1

2

YesNo –

b. If YES – How many trips were taken for these reasons? Trips 0100

Ask items 8c–8i for

each trip reported

7a. Now let’s talk about times when you (or any members of

your CU) did not stay away overnight, but wentsomewhere at least 75 miles away from home. Since the1st of (month, 3 months ago), have you (or any membersof your CU) taken any trips like that?

0110 1

2

YesNo –

b. If YES – How many such trips were taken? Trips 0120

Ask items 8c–8i for

each trip reported

Complete part B Complete part C

9. TRIP TALLY CHART

• For trips ENTIRELY paid for by someone outside the CU, complete one part D.• For trips paid for by CU or trips partially paid for by someone outside the CU, fill out the char

and complete the appropriate detailed part for each trip.

Trip

identification

No.

Trip

identification

No.

Trip paid for

entirely by CU

(from column h)

Trip paid for

entirely by CU

(from column h)

Trip partially

paid for by

non-CU members

(from column i)

no

(f

Complete part BComplete part BComplete part B

Complete part BComplete part BComplete part BComplete part B

Complete part CComplete part CComplete part C

1234

5678

8. Ask columns c–i for each trip reported in items 2–7b. Do not record any trip more than once. Tri

Go toitem 2

Go toitem 4aGo toitem 5aGo toitem 6aGo toitem 7aGo toitem 9

How ma

you (o

of you

to (de

(mon

(If one titem 8g(If more 

0 Not ended – trip, go 

Go to nexttrip

In what month

did this

trip end?

e

Month

Where did you (they)

go on this trip?

d

City or placeStateForeign countryCity or placeStateForeign countryCity or placeStateForeign countryCity or placeStateForeign country

123

3b (relatives or friends)4b (business)

c

Trip type

5b (sightseeing, sports, etc.)6b (any others)7b (day trips)3b (relatives or friends)4b (business)5b (sightseeing, sports, etc.)6b (any others)7b (day trips)3b (relatives or friends)4b (business)5b (sightseeing, sports, etc.)6b (any others)7b (day trips)3b (relatives or friends)4b (business)5b (sightseeing, sports, etc.)6b (any others)7b (day trips)

FROM ITEM –FROM ITEM –FROM ITEM –FROM ITEM –

a b

Line

No.

Trip

not

ended

1

24

(If one titem 8g(If more 

Not ended – trip, go Go to nexttrip

Month

(If one titem 8g(If more 

Not ended – trip, go Go to nexttrip

Month

(If one titem 8g(If more 

Not ended – trip, go Go to nexttrip

Month

3

45123451234512345

000
Section 18 – TRIPS AND VACATIONS – Continued

Part A – Screening Questions – Continued

Page 94 FORM CE-302

1

Month

1 18 01 8

NOTES 8. Ask columns c–i for each trip reported in items 2–7b. Do not record any trip more than once. Trips reported in item 1b will b

9. TRIP TALLY CHART – Continued

• For trips ENTIRELY paid for by someone outside the CU, complete one part D.• For trips paid for by CU or trips partially paid for by someone outside the CU, fill out the

chart below and complete the appropriate detailed part for each trip.

a bc d e f 

Trip

not

ended

Line

No.

5678

Trip type

FROM ITEM –

12345

3b (relatives or friends)4b (business)5b (sightseeing, sports, etc.)6b (any others)7b (day trips)

FROM ITEM –FROM ITEM –FROM ITEM –

City or placeStateForeign country

Where did you (they)

go on this trip?

0 Not ended –

Go to next trip

In what month did

this trip end?

MonthMonthMonth

Trips

(If more than one trip,go to item 8h)(If one trip, go to item 8g)

How many trips did you

(or members of your CU)

take to (destination) in

(month ended)?

Trips

(If more than one trip,go to item 8h)(If one trip, go to item 8g)

Trips

(If more than one trip,go to item 8h)(If one trip, go to item 8g)

Trips

(If more than one trip,go to item 8h)(If one trip, go to item 8g)

2

Ye

iteneNo itene

Did or 

em

ot

mem

the co

12

Ye

iteneNo itene

12

Ye

iteneNo itene

12

Ye

iteneNo itene

Trip

identification

No.

9

101112

Trip paid for

entirely by CU

(from column h)

Trip partially paid for

by non-CU members

(from column i)

Complete part B Complete part C

Trip

identification

No.

13141516

Complete part B

Complete part BComplete part B

Complete part CComplete part CComplete part C

Complete part B Complete parComplete part BComplete part BComplete part B

Complete parComplete parComplete par

Trip paid for

entirely by CU

(from column h)

Trip partially paid 

by non-CU mem

(from column 

12345

3b (relatives or friends)4b (business)5b (sightseeing, sports, etc.)6b (any others)7b (day trips)

12345

3b (relatives or friends)4b (business)5b (sightseeing, sports, etc.)6b (any others)7b (day trips)

12345

3b (relatives or friends)4b (business)5b (sightseeing, sports, etc.)6b (any others)7b (day trips)

0 Not ended –

Go to next trip

0 Not ended –

Go to next trip

0 Not ended –

Go to next trip

City or placeStateForeign countryCity or placeStateForeign countryCity or placeStateForeign country

Section 18 – Part A (Continued)
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU

1 18 34 9

FIELD REPRESENTATIVE –

Page 95 

FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set ofsimilar trips, I will ask about them as a group. Please give thetotal of all these trips for each of the following questions. 

PROCESSING USE ONLY

a.

b.

c.

1.

In item 1a, enter Trip I.D.number from Trip TallyChart in part A. Transcribetrip destination in item 1b,the number of (identical)trips in item 1c, and themonth the trip ended initem 1d.

0010 Identification number0110 .00 $

Food and beverages 1LodgingTransportationAnything else

00200050

TRIP IDENTIFICATION NUMBERDESTINATIONNUMBER OF (IDENTICAL) TRIPS

e.

Sometimes when people take a trip they have some sort ofpackage deal that covers some or all of the costs. Was all orpart of this trip covered by a package deal?

2a.

0040

12

YesNo – Go to item 3a

0060

d. MONTH ENDED

f.

g. Verify if already reported. Otherwise, ask – How many nights did

you (or any members of your CU) spend away from home onthis trip?Now I’d like to ask some additional questions about the trip(s)

you (your CU) took to (destination). If day trip, go to item 2a.

c.

If "Yes," ask for each item: Did the package deal include . . .How much did you (or any members of your CU) pay for thepackage deal?

OFFICE USE ONLY

Nights

b.

FIELD REPRESENTATIVE – Read each item listed.

0070008000900100

2 X

1 2 X

1 2 X1 2 X

0030 Number

Yes No DK

Starting at the beginning of this trip, all the kinds of transportation you (oof your CU) used from the time you (tto the time you (they) got back home

3a.

Hand respondent Information Booklet, paPROBE – Any other kinds of transporttrip?If no codes 1–12 marked, go to item 4.

COMMERCIAL

Local (taxi, etc.)

AirplaneTrainBusShip

0102030405

01200130014001500160

RENTED

Car, jeep

Truck, vanMotorcycle, mopedPrivate planeBoat, trailerCamperOther vehicles

06070809101112

0170018001900200021002200230

PRIVATE

Car owned by CUVehicle leased by CUOther vehicle owned by CUVehicle owned by someone elseOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marked in i

If any codes 6–17 marked, co

4.

NOTES

Specify
Section 18 

– TRIPS AND VACATIONS 

– Continued

Part B 

– Trips Paid Entirely by CU 

– Continued

Page 96 FORM CE-302

While on the trip did you (or any members of your 0410 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.5a.

0420

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees to play

sports or exercise (not counting what the package dealcovered)? (Hand respondent Information Booklet, page 39.)

0430

.00 $

How much did you (or any members of your CU)spend for that?

b.

12

YesNo – Go to item 5e

While on the trip, did you (or any members of yourCU) spend anything for tolls?

c.

If YES –

How much did you (or any members of your CU)spend for tolls?

d.

Did you (or any members of your CU) have anyparking fees?

e.

If YES –

f. How much were they?

0440 .00 $0460 .00 $0450 1

2

YesNo – Go to item 6a

Did you (or any members of your CU) spend anythingfor hotels, motels, cottages, trailer camps, or otherlodging (not counting what the package dealcovered)?

b.

If YES –What was the cost, including taxes and tips?

7a. Did you (or any members of your CU) spend anything

for meals, snacks, or drinks at restaurants, bars, orfast food places (not counting what the packagedeal covered)?

0480 .00 $0470 1

2

YesNo – Go to item 7a

0500 .00 $0490 1

2

YesNo – Go to item 8a

0520 .00 $0510 1

2

YesNo – Go to item 8a

b.

If YES –What was the cost, including taxes and tips?Was any of the (amount in item 7b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes and tips?

d.

0540 .00 $0560 .00 $0550 1

2

YesNo – Go to item 9a

b.

If YES –What were the expenses, including taxes?Was any of the (amount in item 8b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes?

d.

8a. Did you (or any members of your CU) spend anything

for food or beverages at grocery stores, conveniencestores, or liquor stores on this trip?

b.

If YES –How much did you (or any members of your CU) payto rent sports equipment?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Handrespondent Information Booklet, page 38.)

0530 1

2

YesNo – Go to item 9a

0580 .00 $0570 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

05900600

11a. Did you (or any members of your CU) spend anything on

this trip for entertainment or admissions (not countingwhat the package deal covered)? (Hand respondentInformation Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

06100620

12a. Did you (or any members of your CU) have any expenses

for this trip such as for souvenirs, passports, touristbooklets, and so on?

b.

If YES –How much were these expenses?

06300640

13a. You’ve told me about many expenses you (your CU) had

on this trip. Were any of the expenses you just reportedfor anyone outside your CU?

b. Did these expenses include anything for . . .? 

0650 

FIELD REPRESENTATIVE – Read each item listed.

c. How much of the total expenses for this trip were

for persons outside your CU?

14a. If the respondent is unable to break down food and beverages,

lodging, transportation, other expenses, or expenses for others,enter these expenses. Only those expenses a respondent is notable to break down should be combined and entered here.

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTER LAST TRIP, G

06600670068006900700 0710 07200730074007500760 

b.

Section 18

– Part B (Continued)
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU – Continued

1 18 36 4

FIELD REPRESENTATIVE –

Page 97 

FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set ofsimilar trips, I will ask about them as a group. Please give thetotal of all these trips for each of the following questions. 

PROCESSING USE ONLY

a.

b.

c.

1.

In item 1a, enter Trip I.D.number from Trip TallyChart in part A. Transcribetrip destination in item 1b,the number of (identical)trips in item 1c, and themonth the trip ended initem 1d.

0010 Identification number0110 .00 $

Food and beverages 1LodgingTransportationAnything else

00200050

TRIP IDENTIFICATION NUMBERDESTINATIONNUMBER OF (IDENTICAL) TRIPS

e.

Sometimes when people take a trip they have some sort ofpackage deal that covers some or all of the costs. Was all orpart of this trip covered by a package deal?

2a.

0040

12

YesNo – Go to item 3a

0060

d. MONTH ENDED

f.

g. Verify if already reported. Otherwise, ask – How many nights did

you (or any members of your CU) spend away from home onthis trip?Now I’d like to ask some additional questions about the trip(s)you (your CU) took to (destination). If day trip, go to item 2a.

c.

If "Yes," ask for each item: Did the package deal include . . .How much did you (or any members of your CU) pay for thepackage deal?

OFFICE USE ONLY

Nights

b.

FIELD REPRESENTATIVE – Read each item listed.

0070008000900100

2 X

1 2 X

1 2 X1 2 X

0030 Number

Yes No DK

Starting at the beginning of this trip, all the kinds of transportation you (oof your CU) used from the time you (tto the time you (they) got back home

3a.

Hand respondent Information Booklet, paPROBE – Any other kinds of transporttrip?If no codes 1–12 marked, go to item 4.

COMMERCIAL

Local (taxi, etc.)AirplaneTrainBusShip

0102030405

01200130014001500160

RENTED

Car, jeep

Truck, vanMotorcycle, mopedPrivate planeBoat, trailerCamperOther vehicles

06070809101112

0170018001900200021002200230

PRIVATE

Car owned by CUVehicle leased by CUOther vehicle owned by CUVehicle owned by someone elseOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marked in i

If any codes 6–17 marked, co

4.

NOTES

Specify
Section 18 

– TRIPS AND VACATIONS 

– Continued

Part B 

– Trips Paid Entirely by CU 

– Continued

Page 98 FORM CE-302

While on the trip did you (or any members of your 0410 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.5a.

0420

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees to play

sports or exercise (not counting what the package dealcovered)? (Hand respondent Information Booklet, page 39.)

0430

.00 $

How much did you (or any members of your CU)spend for that?

b.

12

YesNo – Go to item 5e

While on the trip, did you (or any members of yourCU) spend anything for tolls?

c.

If YES –

How much did you (or any members of your CU)spend for tolls?

d.

Did you (or any members of your CU) have anyparking fees?

e.

If YES –

f. How much were they?

0440 .00 $0460 .00 $0450 1

2

YesNo – Go to item 6a

Did you (or any members of your CU) spend anythingfor hotels, motels, cottages, trailer camps, or otherlodging (not counting what the package dealcovered)?

b.

If YES –What was the cost, including taxes and tips?

7a. Did you (or any members of your CU) spend anything

for meals, snacks, or drinks at restaurants, bars, orfast food places (not counting what the packagedeal covered)?

0480 .00 $0470 1

2

YesNo – Go to item 7a

0500 .00 $0490 1

2

YesNo – Go to item 8a

0520 .00 $0510 1

2

YesNo – Go to item 8a

b.

If YES –What was the cost, including taxes and tips?Was any of the (amount in item 7b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes and tips?

d.

0540 .00 $0560 .00 $0550 1

2

YesNo – Go to item 9a

b.

If YES –What were the expenses, including taxes?Was any of the (amount in item 8b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes?

d.

8a. Did you (or any members of your CU) spend anything

for food or beverages at grocery stores, conveniencestores, or liquor stores on this trip?

b.

If YES –How much did you (or any members of your CU) payto rent sports equipment?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Handrespondent Information Booklet, page 38.)

0530 1

2

YesNo – Go to item 9a

0580 .00 $0570 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

05900600

11a. Did you (or any members of your CU) spend anything on

this trip for entertainment or admissions (not countingwhat the package deal covered)? (Hand respondentInformation Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

06100620

12a. Did you (or any members of your CU) have any expenses

for this trip such as for souvenirs, passports, touristbooklets, and so on?

b.

If YES –How much were these expenses?

06300640

13a. You’ve told me about many expenses you (your CU) had

on this trip. Were any of the expenses you just reportedfor anyone outside your CU?

b. Did these expenses include anything for . . .? 

0650 

FIELD REPRESENTATIVE – Read each item listed.

c. How much of the total expenses for this trip were

for persons outside your CU?

14a. If the respondent is unable to break down food and beverages,

lodging, transportation, other expenses, or expenses for others,enter these expenses. Only those expenses a respondent is notable to break down should be combined and entered here.

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTER LAST TRIP, G

06600670068006900700 0710 07200730074007500760 

b.

Section 18

– Part B (Continued)
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU – Continued

1 18 38 0

FIELD REPRESENTATIVE –

Page 99 

FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set ofsimilar trips, I will ask about them as a group. Please give thetotal of all these trips for each of the following questions. 

PROCESSING USE ONLY

a.

b.

c.

1.

In item 1a, enter Trip I.D.number from Trip TallyChart in part A. Transcribetrip destination in item 1b,the number of (identical)trips in item 1c, and themonth the trip ended initem 1d.

0010 Identification number0110 .00 $

Food and beverages 1LodgingTransportationAnything else

00200050

TRIP IDENTIFICATION NUMBERDESTINATIONNUMBER OF (IDENTICAL) TRIPS

e.

Sometimes when people take a trip they have some sort ofpackage deal that covers some or all of the costs. Was all orpart of this trip covered by a package deal?

2a.

0040

12

YesNo – Go to item 3a

0060

d. MONTH ENDED

f.

g. Verify if already reported. Otherwise, ask – How many nights did

you (or any members of your CU) spend away from home onthis trip?Now I’d like to ask some additional questions about the trip(s)

you (your CU) took to (destination). If day trip, go to item 2a.

c.

If "Yes," ask for each item: Did the package deal include . . .How much did you (or any members of your CU) pay for thepackage deal?

OFFICE USE ONLY

Nights

b.

FIELD REPRESENTATIVE – Read each item listed.

0070008000900100

2 X

1 2 X

1 2 X1 2 X

0030 Number

Yes No DK

Starting at the beginning of this trip, all the kinds of transportation you (oof your CU) used from the time you (tto the time you (they) got back home

3a.

Hand respondent Information Booklet, paPROBE – Any other kinds of transporttrip?If no codes 1–12 marked, go to item 4.

COMMERCIAL

Local (taxi, etc.)

AirplaneTrainBusShip

0102030405

01200130014001500160

RENTED

Car, jeep

Truck, vanMotorcycle, mopedPrivate planeBoat, trailerCamperOther vehicles

06070809101112

0170018001900200021002200230

PRIVATE

Car owned by CUVehicle leased by CUOther vehicle owned by CUVehicle owned by someone elseOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marked in i

If any codes 6–17 marked, co

4.

NOTES

Specify
Section 18 

– TRIPS AND VACATIONS 

– Continued

Part B 

– Trips Paid Entirely by CU 

– Continued

Page 100 FORM CE-302

While on the trip did you (or any members of your 0410 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.5a.

0420

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees to play

sports or exercise (not counting what the package dealcovered)? (Hand respondent Information Booklet, page 39.)

0430

.00 $

How much did you (or any members of your CU)spend for that?

b.

12

YesNo – Go to item 5e

While on the trip, did you (or any members of yourCU) spend anything for tolls?

c.

If YES –

How much did you (or any members of your CU)spend for tolls?

d.

Did you (or any members of your CU) have anyparking fees?

e.

If YES –

f. How much were they?

0440 .00 $0460 .00 $0450 1

2

YesNo – Go to item 6a

Did you (or any members of your CU) spend anythingfor hotels, motels, cottages, trailer camps, or otherlodging (not counting what the package dealcovered)?

b.

If YES –What was the cost, including taxes and tips?

7a. Did you (or any members of your CU) spend anything

for meals, snacks, or drinks at restaurants, bars, orfast food places (not counting what the packagedeal covered)?

0480 .00 $0470 1

2

YesNo – Go to item 7a

0500 .00 $0490 1

2

YesNo – Go to item 8a

0520 .00 $0510 1

2

YesNo – Go to item 8a

b.

If YES –What was the cost, including taxes and tips?Was any of the (amount in item 7b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes and tips?

d.

0540 .00 $0560 .00 $0550 1

2

YesNo – Go to item 9a

b.

If YES –What were the expenses, including taxes?Was any of the (amount in item 8b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes?

d.

8a. Did you (or any members of your CU) spend anything

for food or beverages at grocery stores, conveniencestores, or liquor stores on this trip?

b.

If YES –How much did you (or any members of your CU) payto rent sports equipment?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Handrespondent Information Booklet, page 38.)

0530 1

2

YesNo – Go to item 9a

0580 .00 $0570 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

05900600

11a. Did you (or any members of your CU) spend anything on

this trip for entertainment or admissions (not countingwhat the package deal covered)? (Hand respondentInformation Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

06100620

12a. Did you (or any members of your CU) have any expenses

for this trip such as for souvenirs, passports, touristbooklets, and so on?

b.

If YES –How much were these expenses?

06300640

13a. You’ve told me about many expenses you (your CU) had

on this trip. Were any of the expenses you just reportedfor anyone outside your CU?

b. Did these expenses include anything for . . .? 

0650 

FIELD REPRESENTATIVE – Read each item listed.

c. How much of the total expenses for this trip were

for persons outside your CU?

14a. If the respondent is unable to break down food and beverages,

lodging, transportation, other expenses, or expenses for others,enter these expenses. Only those expenses a respondent is notable to break down should be combined and entered here.

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTER LAST TRIP, G

06600670068006900700 0710 07200730074007500760 

b.

Section 18

– Part B (Continued)
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU – Continued

1 18 40 6

FIELD REPRESENTATIVE –

Page 101 

FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set ofsimilar trips, I will ask about them as a group. Please give thetotal of all these trips for each of the following questions. 

PROCESSING USE ONLY

a.

b.

c.

1.

In item 1a, enter Trip I.D.number from Trip TallyChart in part A. Transcribetrip destination in item 1b,the number of (identical)trips in item 1c, and themonth the trip ended initem 1d.

0010 Identification number0110 .00 $

Food and beverages 1LodgingTransportationAnything else

00200050

TRIP IDENTIFICATION NUMBERDESTINATIONNUMBER OF (IDENTICAL) TRIPS

e.

Sometimes when people take a trip they have some sort ofpackage deal that covers some or all of the costs. Was all orpart of this trip covered by a package deal?

2a.

0040

12

YesNo – Go to item 3a

0060

d. MONTH ENDED

f.

g. Verify if already reported. Otherwise, ask – How many nights did

you (or any members of your CU) spend away from home onthis trip?Now I’d like to ask some additional questions about the trip(s)

you (your CU) took to (destination). If day trip, go to item 2a.

c.

If "Yes," ask for each item: Did the package deal include . . .How much did you (or any members of your CU) pay for thepackage deal?

OFFICE USE ONLY

Nights

b.

FIELD REPRESENTATIVE – Read each item listed.

0070008000900100

2 X

1 2 X

1 2 X1 2 X

0030 Number

Yes No DK

Starting at the beginning of this trip, all the kinds of transportation you (oof your CU) used from the time you (tto the time you (they) got back home

3a.

Hand respondent Information Booklet, paPROBE – Any other kinds of transporttrip?If no codes 1–12 marked, go to item 4.

COMMERCIAL

Local (taxi, etc.)

AirplaneTrainBusShip

0102030405

01200130014001500160

RENTED

Car, jeep

Truck, vanMotorcycle, mopedPrivate planeBoat, trailerCamperOther vehicles

06070809101112

0170018001900200021002200230

PRIVATE

Car owned by CUVehicle leased by CUOther vehicle owned by CUVehicle owned by someone elseOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marked in i

If any codes 6–17 marked, co

4.

NOTES

Specify
Section 18 

– TRIPS AND VACATIONS 

– Continued

Part B 

– Trips Paid Entirely by CU 

– Continued

Page 102 FORM CE-302

While on the trip did you (or any members of your 0410 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.5a.

0420

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees to play

sports or exercise (not counting what the package dealcovered)? (Hand respondent Information Booklet, page 39.)

0430

.00 $

How much did you (or any members of your CU)spend for that?

b.

12

YesNo – Go to item 5e

While on the trip, did you (or any members of yourCU) spend anything for tolls?

c.

If YES –

How much did you (or any members of your CU)spend for tolls?

d.

Did you (or any members of your CU) have anyparking fees?

e.

If YES –

f. How much were they?

0440 .00 $0460 .00 $0450 1

2

YesNo – Go to item 6a

Did you (or any members of your CU) spend anythingfor hotels, motels, cottages, trailer camps, or otherlodging (not counting what the package dealcovered)?

b.

If YES –What was the cost, including taxes and tips?

7a. Did you (or any members of your CU) spend anything

for meals, snacks, or drinks at restaurants, bars, orfast food places (not counting what the packagedeal covered)?

0480 .00 $0470 1

2

YesNo – Go to item 7a

0500 .00 $0490 1

2

YesNo – Go to item 8a

0520 .00 $0510 1

2

YesNo – Go to item 8a

b.

If YES –What was the cost, including taxes and tips?Was any of the (amount in item 7b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes and tips?

d.

0540 .00 $0560 .00 $0550 1

2

YesNo – Go to item 9a

b.

If YES –What were the expenses, including taxes?Was any of the (amount in item 8b) for alcoholic

beverages?

c.

If YES –What was the cost for alcoholic beverages, includingtaxes?

d.

8a. Did you (or any members of your CU) spend anything

for food or beverages at grocery stores, conveniencestores, or liquor stores on this trip?

b.

If YES –How much did you (or any members of your CU) payto rent sports equipment?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Handrespondent Information Booklet, page 38.)

0530 1

2

YesNo – Go to item 9a

0580 .00 $0570 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

05900600

11a. Did you (or any members of your CU) spend anything on

this trip for entertainment or admissions (not countingwhat the package deal covered)? (Hand respondentInformation Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

06100620

12a. Did you (or any members of your CU) have any expenses

for this trip such as for souvenirs, passports, touristbooklets, and so on?

b.

If YES –How much were these expenses?

06300640

13a. You’ve told me about many expenses you (your CU) had

on this trip. Were any of the expenses you just reportedfor anyone outside your CU?

b. Did these expenses include anything for . . .? 

0650 

FIELD REPRESENTATIVE – Read each item listed.

c. How much of the total expenses for this trip were

for persons outside your CU?

14a. If the respondent is unable to break down food and beverages,

lodging, transportation, other expenses, or expenses for others,enter these expenses. Only those expenses a respondent is notable to break down should be combined and entered here.

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTER LAST TRIP, G

06600670068006900700 0710 07200730074007500760 

b.

Section 18

– Part B (Continued)
Section 18 – TRIPS AND VACATIONS – Continued

Part C – Partially Reimbursed Trips

1 77 01 4

FIELD REPRESENTATIVE –

Page 103 

FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set ofsimilar trips, I will ask about them as a group. Please give thetotal of all these trips for each of the following questions. 

PROCESSING USE ONLY

Ask part C for partiaidentical trips befor

a.

b.

c.

1.

In item 1a, enter Trip I.D.number from Trip TallyChart in part A. Transcribetrip destination in item 1b,the number of (identical)trips in item 1c, and themonth the trip ended initem 1d.

0010 Identification number0110 .00 $

Food and beverages 1LodgingTransportationAnything else

00200050

TRIP IDENTIFICATION NUMBERDESTINATIONNUMBER OF (IDENTICAL) TRIPS

e.

Sometimes when people take a trip they have some sort ofpackage deal that covers some or all of the costs. Was all orpart of this trip covered by a package deal?

2a.

0040

12

YesNo – Go to item 3a

0060

d. MONTH ENDED

f.

g. Verify if already reported. Otherwise, ask – How many nights did

you (or any members of your CU) spend away from home onthis trip?You told me that someone outside your CU paid for part of thetrip(s) you (your CU) took to (trip destination). In the nextquestions I’m interested only in the costs you (your CU) had topay, not those paid or to be paid by a business or employer. Ifday trip, go to item 2a.

c.

If "Yes," ask for each item: Did the package deal include . . .How much did you (or any members of your CU) pay for thepackage deal?

OFFICE USE ONLY

Nights

b.

FIELD REPRESENTATIVE – Read each item listed.

0070008000900100

2 X

1 2 X

1 2 X1 2 X

0030 Number

Yes No DK

Starting at the beginning of this trip, all the kinds of transportation you (oof your CU) used from the time you (tto the time you (they) got back home

3a.

Hand respondent Information Booklet, paPROBE – Any other kinds of transporttrip?If no codes 1–12 marked, go to item 4.

COMMERCIAL

Local (taxi, etc.)

AirplaneTrainBusShip

0102030405

01200130014001500160

RENTED

Car, jeep

Truck, vanMotorcycle, mopedPrivate planeBoat, trailerCamperOther vehicles

06070809101112

0170018001900200021002200230

PRIVATE

Car owned by CUVehicle leased by CUOther vehicle owned by CUVehicle owned by someone elseOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marked in i

If any codes 6–17 marked, co

4.

NOTES

Specify
Section 18 

– TRIPS AND VACATIONS 

– Continued

Part C 

– Partially Reimbursed Trips 

– Continued

Page 104 FORM CE-302

While on the trip did you (or any members of your 0410 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.5a.

0420

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees to pl

sports or exercise (not counting what the package dealcovered)? (Hand respondent Information Booklet, page 39.)

0430

.00 $

What costs for gasoline or other fuels won’t bereimbursed?

b.

12

YesNo – Go to item 5e

While on the trip, did you (or any members of yourCU) spend anything for tolls?

c.

If YES –

d. What costs for tolls won’t be reimbursed?

Did you (or any members of your CU) have anyparking fees?

e.

If YES –

f. What costs for parking fees won’t be reimbursed?

0440 .00 $0460 .00 $0450 1

2

YesNo – Go to item 6a

Did you (or any members of your CU) spend anythingfor hotels, motels, cottages, trailer camps, or otherlodging (not counting what the package dealcovered)?

b.

If YES –What costs for lodging, including taxes and tips,won’t be reimbursed?

7a. Did you (or any members of your CU) spend anything

for meals, snacks, or drinks at restaurants, bars, orfast food places (not counting what the packagedeal covered)?

0480 .00 $0470 1

2

YesNo – Go to item 7a

0500 .00 $0490 1

2

YesNo – Go to item 8a

0520 .00 $0510 1

2

YesNo – Go to item 8a

b.

If YES –What costs for these things won’t be reimbursed?

Was any of the (amount in item 7b) for alcoholicbeverages?

c.

If YES –What costs for alcoholic beverages, including taxesand tips, won’t be reimbursed?

d.

0540 .00 $0560 .00 $0550 1

2

YesNo – Go to item 9a

b.

If YES –What costs, including taxes, won’t be reimbursed?Was any of the (amount in item 8b) for alcoholic

beverages?

c.

If YES –What cost for alcoholic beverages, including taxes,won’t be reimbursed?

d.

8a. Did you (or any members of your CU) spend anything

for food or beverages at grocery stores, conveniencestores, or liquor stores on this trip?

b.

If YES –What costs for renting sports equipment won’t be

reimbursed?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Handrespondent Information Booklet, page 38.)

0530 1

2

YesNo – Go to item 9a

0580 .00 $0570 1

2

YesNo – Go to item 10a

b.

If YES –What costs for playing sports won’t be reimbursed?

11a. Did you (or any members of your CU) spend anything o

this trip for entertainment or admissions (not countingwhat the package deal covered)? (Hand respondentInformation Booklet, page 40.)

b.

If YES –What costs for entertainment and admissions won’t be

reimbursed?

12a. Did you (or any members of your CU) have any expense

for this trip such as for souvenirs, passports, touristbooklets, and so on?

b.

If YES –What costs for these things won’t be reimbursed?

13a. You’ve told me about many non-reimbursed expenses y

(your CU) had on this trip. Were any of these expensesyou just reported for anyone outside your CU?

b. Did these expenses include anything for . . .? 

FIELD REPRESENTATIVE – Read each item listed.

c. How much of the total non-reimbursed expenses for

this trip were for persons outside your CU?

14a. If the respondent is unable to break down food and beverage

lodging, transportation, other expenses, or expenses for otheenter the expenses that won’t be reimbursed. Only thosenon-reimbursed expenses a respondent is not able to breakdown should be combined and entered here

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTER LAS

0 None

0 None0 None0 None0 None0 None0 None0 None0 None

b.

Section 18

– Part C (Continued)
Section 18 – TRIPS AND VACATIONS – Continued

Part C – Partially Reimbursed Trips – Continued

1 77 03 0

FIELD REPRESENTATIVE –

Page 105 

FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set ofsimilar trips, I will ask about them as a group. Please give thetotal of all these trips for each of the following questions. 

PROCESSING USE ONLY

Ask part C for partiaidentical trips befor

a.

b.

c.

1.

In item 1a, enter Trip I.D.number from Trip TallyChart in part A. Transcribetrip destination in item 1b,the number of (identical)trips in item 1c, and themonth the trip ended initem 1d.

0010 Identification number0110 .00 $

Food and beverages 1LodgingTransportationAnything else

00200050

TRIP IDENTIFICATION NUMBERDESTINATIONNUMBER OF (IDENTICAL) TRIPS

e.

Sometimes when people take a trip they have some sort ofpackage deal that covers some or all of the costs. Was all orpart of this trip covered by a package deal?

2a.

0040

12

YesNo – Go to item 3a

0060

d. MONTH ENDED

f.

g. Verify if already reported. Otherwise, ask – How many nights did

you (or any members of your CU) spend away from home onthis trip?You told me that someone outside your CU paid for part of thetrip(s) you (your CU) took to (trip destination). In the nextquestions I’m interested only in the costs you (your CU) had topay, not those paid or to be paid by a business or employer. Ifday trip, go to item 2a.

c.

If "Yes," ask for each item: Did the package deal include . . .How much did you (or any members of your CU) pay for thepackage deal?

OFFICE USE ONLY

Nights

b.

FIELD REPRESENTATIVE – Read each item listed.

0070008000900100

2 X

1 2 X

1 2 X1 2 X

0030 Number

Yes No DK

Starting at the beginning of this trip, all the kinds of transportation you (oof your CU) used from the time you (tto the time you (they) got back home

3a.

Hand respondent Information Booklet, paPROBE – Any other kinds of transporttrip?If no codes 1–12 marked, go to item 4.

COMMERCIAL

Local (taxi, etc.)

AirplaneTrainBusShip

0102030405

01200130014001500160

RENTED

Car, jeep

Truck, vanMotorcycle, mopedPrivate planeBoat, trailerCamperOther vehicles

06070809101112

0170018001900200021002200230

PRIVATE

Car owned by CUVehicle leased by CUOther vehicle owned by CUVehicle owned by someone elseOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marked in i

If any codes 6–17 marked, co

4.

NOTES

Specify
Section 18 

– TRIPS AND VACATIONS 

– Continued

Part C 

– Partially Reimbursed Trips 

– Continued

Page 106 FORM CE-302

While on the trip did you (or any members of your 0410 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.5a.

0420

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees to pl

sports or exercise (not counting what the package dealcovered)? (Hand respondent Information Booklet, page 39.)

0430

.00 $

What costs for gasoline or other fuels won’t bereimbursed?

b.

12

YesNo – Go to item 5e

While on the trip, did you (or any members of yourCU) spend anything for tolls?

c.

If YES –

d. What costs for tolls won’t be reimbursed?

Did you (or any members of your CU) have anyparking fees?

e.

If YES –

f. What costs for parking fees won’t be reimbursed?

0440 .00 $0460 .00 $0450 1

2

YesNo – Go to item 6a

Did you (or any members of your CU) spend anythingfor hotels, motels, cottages, trailer camps, or otherlodging (not counting what the package dealcovered)?

b.

If YES –What costs for lodging, including taxes and tips,won’t be reimbursed?

7a. Did you (or any members of your CU) spend anything

for meals, snacks, or drinks at restaurants, bars, orfast food places (not counting what the packagedeal covered)?

0480 .00 $0470 1

2

YesNo – Go to item 7a

0500 .00 $0490 1

2

YesNo – Go to item 8a

0520 .00 $0510 1

2

YesNo – Go to item 8a

b.

If YES –What costs for these things won’t be reimbursed?

Was any of the (amount in item 7b) for alcoholicbeverages?

c.

If YES –What costs for alcoholic beverages, including taxesand tips, won’t be reimbursed?

d.

0540 .00 $0560 .00 $0550 1

2

YesNo – Go to item 9a

b.

If YES –What costs, including taxes, won’t be reimbursed?Was any of the (amount in item 8b) for alcoholic

beverages?

c.

If YES –What cost for alcoholic beverages, including taxes,won’t be reimbursed?

d.

8a. Did you (or any members of your CU) spend anything

for food or beverages at grocery stores, conveniencestores, or liquor stores on this trip?

b.

If YES –What costs for renting sports equipment won’t be

reimbursed?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Handrespondent Information Booklet, page 38.)

0530 1

2

YesNo – Go to item 9a

0580 .00 $0570 1

2

YesNo – Go to item 10a

b.

If YES –What costs for playing sports won’t be reimbursed?

11a. Did you (or any members of your CU) spend anything o

this trip for entertainment or admissions (not countingwhat the package deal covered)? (Hand respondentInformation Booklet, page 40.)

b.

If YES –What costs for entertainment and admissions won’t be

reimbursed?

12a. Did you (or any members of your CU) have any expense

for this trip such as for souvenirs, passports, touristbooklets, and so on?

b.

If YES –What costs for these things won’t be reimbursed?

13a. You’ve told me about many non-reimbursed expenses y

(your CU) had on this trip. Were any of these expensesyou just reported for anyone outside your CU?

b. Did these expenses include anything for . . .? 

FIELD REPRESENTATIVE – Read each item listed.

c. How much of the total non-reimbursed expenses for

this trip were for persons outside your CU?

14a. If the respondent is unable to break down food and beverage

lodging, transportation, other expenses, or expenses for otheenter the expenses that won’t be reimbursed. Only thosenon-reimbursed expenses a respondent is not able to breakdown should be combined and entered here

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTER LAS

0 None

0 None0 None0 None0 None0 None0 None0 None0 None

b.

Section 18

– Part C (Continued)
Section 18 – TRIPS AND VACATIONS – Continued

Part D – 100% Reimbursed Trips 1 77 67 5

1. FIELD REPRESENTATIVE CHECK ITEM

Enter number of trips ENTIRELY paid for byNON-CU member from part A, item 1a or 1b.

b.

0010 Trips

2a. You told me that you (your CU) had

(number from item 1) trip(s) entirely paid forby non-CU members. Even on trips entirelypaid for by non-CU members there aresometimes miscellaneous expenses whichare not paid for. Did you (your CU) haveany expenses on this trip (these trips) thatwill not be covered by a business,employer, or other non-CU member?

0020 1

2

YesNo – Go to part E

0040

1111

Page 107 FORM CE-302

FIELD REPRESENTATIVE – Comp

Did these expenses include anything for – ?FIELD REPRESENTATIVE – Read each item listed. 0030

c. What was the total amount for these

expenses?

YES NO DK

GO TO PART E

007000500060

Food and beverages ...Lodging .............Transportation .......Anything else – Specify

2222

XXXX

.00 $

0 None – Go to part E
FORM CE-302

Page 108

Section 18 – TRIPS AND VACATIONS – Continued

Part E – Trip Expenses for Non-CU Members 1 77 68 3

c.

Trips

1a. Sometimes people in a CU don’t take a trip

themselves, but pay for part or all of a tripthat someone else takes. Since the 1st of(month, three months ago), have you (has yourCU) paid for part or all of such a trip for anynon-CU members?

0010 1

2

YesNo – Go to part F

0040

1111

FIELD REPRESENTATIVE – Ask p

Did these expenses include anything for – ?FIELD REPRESENTATIVE – Read each item listed. 0030

d. What was the total amount that you (your

CU) paid for that trip (those trips)?

YES NO DK

GO TO PART F

007000500060

Food and beverages ...Lodging .............Transportation .......Anything else – Specify

2222

XXXX

.00 $

b. How many trips was that?

If Yes –

0020

Section 18 – Part E
Section 18 – TRIPS AND VACATIONS – Continued

Part F – Local Overnight Stays 1 77 69 1

1. We’ve talked about many different kinds of trips.

Sometimes people don’t take a trip, but they stayovernight in a local hotel or motel such as forholidays or family getaways. Since the 1st of(month, 3 months ago), have you (or any members ofyour CU) stayed overnight in a local hotel or motel?

b.

0020 Nights0010 1

2

YesNo – Go to next section

0050

1111

Page 109 FORM CE-302

FIELD REPRESENTATIVE – Ask part F for all CU’s. 

(Ask all questions in this part fo

Ask for each item – Did the package deal include

anything for . . .?FIELD REPRESENTATIVE – Read each item listed.

0040

YES NO DK

008000600070

2222

XXXX

$

2. VERIFY IF ALREADY REPORTED, OTHERWISE ASK –

How many nights did you (or any members of yourCU) spend away from home on this stay?

3a. Sometimes when people stay away from home

overnight they have some sort of package dealthat covers some or all of the costs. Was all orpart of this stay covered by anything like that?

0030 1

2

YesNo – Go to item 4a

c. How much did you (or any members of your CU)

pay for the package deal?

b. What was the cost, including taxes and tips?

4a. Did you (or any members of your CU) spend

anything for hotels, motels, cottages, trailercamps, or other lodging (not counting what thepackage deal covered)?

c. Was any of the (amount in item 5b) for alcoholic

beverages?

d. What was the cost for alcoholic beverages,

including taxes and tips?

0140 $0090 1

2

YesNo – Go to item 5a

0100 .00 $

b. What was the cost, including taxes and tips?

5a. Did you (or any members of your CU) spend

anything for meals, snacks, or drinks atrestaurants, bars, or fast food places (notcounting what the package deal covered)?

0110 1

2

YesNo – Go to item 6a

0120 $0130 1

2

YesNo – Go to item 6a

c. Was any of the (amount in item 6b) for 

beverages?

d. What was the cost for alcoholic beve

including taxes?

b. What were the expenses, including ta

6a. Did you (or any members of your CU) 

anything for food or beverages at groconvenience stores, or liquor stores? 

b. How much did you (or any members o

7a. (Hand respondent Information Booklet, pa8. If the respondent is unable to break down 

beverages, lodging, entertainment, or oththese expenses. Only those expenses a reable to break down should be combined aDid the (amount) include anything for FIELD REPRESENTATIVE – Read each item 

9. Did you (or any members of your CU) 

stays at local hotels or motels? Did you (or any members of your CU) on this stay for entertainment or admcounting what the package deal cove

Food and beverages ...........Lodging .....................Entertainment ................Anything else – Specify

.00.00.00
FORM CE-302

Page 110 

Section 18 – TRIPS AND VACATIONS – Continued

Part F – Local Overnight Stays – Continued 1 77 70 9

1. We’ve talked about many different kinds of trips.

Sometimes people don’t take a trip, but they stayovernight in a local hotel or motel such as forholidays or family getaways. Since the 1st of(month, 3 months ago), have you (or any members ofyour CU) stayed overnight in a local hotel or motel?

b.

0020 Nights0010 1

2

YesNo – Go to next section

0050

1111

FIELD REPRESENTATIVE – Ask part F for all CU’s. 

(Ask all questions in this part fo

Ask for each item – Did the package deal include

anything for . . .?FIELD REPRESENTATIVE – Read each item listed.

0040

YES NO DK

008000600070

2222

XXXX

.00 $

2. VERIFY IF ALREADY REPORTED, OTHERWISE ASK –

How many nights did you (or any members of yourCU) spend away from home on this stay?

3a. Sometimes when people stay away from home

overnight they have some sort of package dealthat covers some or all of the costs. Was all orpart of this stay covered by anything like that?

0030 1

2

YesNo – Go to item 4a

c. How much did you (or any members of your CU)

pay for the package deal?

b. What was the cost, including taxes and tips?

4a. Did you (or any members of your CU) spend

anything for hotels, motels, cottages, trailercamps, or other lodging (not counting what thepackage deal covered)?

c. Was any of the (amount in item 5b) for alcoholic

beverages?

d. What was the cost for alcoholic beverages,

including taxes and tips?

0140 $0090 1

2

YesNo – Go to item 5a

0100 $

b. What was the cost, including taxes and tips?

5a. Did you (or any members of your CU) spend

anything for meals, snacks, or drinks atrestaurants, bars, or fast food places (notcounting what the package deal covered)?

0110 1

2

YesNo – Go to item 6a

0120 $0130 1

2

YesNo – Go to item 6a

c. Was any of the (amount in item 6b) for 

beverages?

d. What was the cost for alcoholic beve

including taxes?

b. What were the expenses, including ta

6a. Did you (or any members of your CU) 

anything for food or beverages at groconvenience stores, or liquor stores? 

b. How much did you (or any members o

7a. (Hand respondent Information Booklet, pa8. If the respondent is unable to break down 

beverages, lodging, entertainment, or oththese expenses. Only those expenses a reable to break down should be combined aDid the (amount) include anything for FIELD REPRESENTATIVE – Read each item 

9. Did you (or any members of your CU) 

stays at local hotels or motels? Did you (or any members of your CU) on this stay for entertainment or admcounting what the package deal cove

Food and beverages ...........Lodging .....................Entertainment ................Anything else – Specify

.00.00.00

Section 18 – Part F (Continued)
Section 19 – MISCELLANEOUS EXPENSES

4 19 02 8

1. Since the 1st of (month, 3 months ago),

have you (or any members of your CU)had expenses for any of the following,either for your CU or for someoneoutside your CU?

Page 111 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the Information Booklet w

complete columns b through g for each "YES" rmark the box in column d and enter the total ex

a

Information Booklet, pages 41 and 42

2. FIELD 1 19 01 6

REPRESENTATIVECHECK ITEMMark (X) box if thereare no entries recorded in columns b – g.

0010

0010 999 Go to

nextpage

ITEM

CODE YES NO

What was the expense for?Describe briefly.

PROCESSING USE ONLYb

002000300040005000600070008000900100011001200130014001500160017001800190020002100220

c

ENTERITEMCODEfromcolumn a.

d

In what month didyou have thisexpense?If it is a continuousexpense throughoutthe reference period,mark box.

Month Continuous expense

1 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 3

e

Was this expensefor your CU orsomeone outsideof your CU?1 – For CU

CU Outside CU

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

f

What was the totalamount of theexpense?

For continuingexpenses, do notinclude expenses forthe current month.

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

g

YES NO

Did youhave anyotherexpensesfor . . .?

FUNERALS, BURIALS,OR CREMATION PURCHASE OR UPKEEP OF CEMETERY LOTS ORVAULTS COMBINATIONS OF THEABOVECATERED AFFAIRS FRESH FLOWERS ORPOTTED PLANTS LEGAL FEES Do not include legal feesrelated to real estateclosing costs which werereported in section 3.ACCOUNTING FEES HOME SERVICESGardening or lawn careservices Housekeeping servicesBabysitting or other childcare in your own homeBabysitting or other childcare in someone else’s

home 

Care for invalids,convalescents, handicappedor elderly persons in thehome Other home services andsmall repair jobs aroundthe house, not previouslyreported 

100110120130140150160170180190220200210

Use only if cannot itemizethe above 

2 – For someone

outside your CU

Part A – Miscellaneous Expenses

OCCUPATIONALEXPENSES 380
FORM CE-302

Page 112 

Section 19 – MISCELLANEOUS EXPENSES – Continued

4 19 04 4

3. Since the 1st of (month, 3 months

ago), have you (or any members ofyour CU) had expenses for any ofthe following, either for your CU orfor someone outside your CU?

a 

Information Booklet, page 42

4. FIELD 1 19 03 2

REPRESENTATIVECHECK ITEMMark (X) box ifthere are noentries recordedin columns b–g.

0010

0010 999 Go to

Part B

ITEM

CODE YES NO

What was the expense for?Describe briefly.

PROCESSING USE ONLYb

002000300040005000600070008000900100011001200130014001500160017001800190020002100220

c

ENTERITEMCODEfromcolumn a.

d

In what month didyou have thisexpense?If it is a continuousexpense throughoutthe reference period,mark box.

Month Continuous expense

1 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 3

e

Was this expensefor your CU orsomeone outsideof your CU?1 – For CU2 – For someone

outside your CU

CU Outside CU

1 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 2

f

What was thetotal amount ofthe expense?For continuingexpenses, do notinclude expensesfor the currentmonth.$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

g

YES NO

Did youhave anyotherexpensesfor . . .?

TV COMPUTERGAMES ANDCOMPUTER GAMESOFTWAREHAND HELDCOMPUTERGAMES ANDCOMPUTER BOARDGAMESTOYS ANDGAMESHOBBIESMOVING, STORAGE,AND FREIGHTEXPRESSPURCHASE OFPETS, PETSUPPLIES, ANDMEDICINEFOR PETS PET SERVICES VETERINARIANEXPENSESFOR PETS 

290300330340230240250260

ADULT DAY CARE CENTERS 350PROFESSIONALPHOTOGRAPHY FEESHOME SECURITYSYSTEM SERVICEFEES

360370

Part A – Miscellaneous Expenses – Continued

LOTTERIES ANDGAMES OF CHANCE 390

Section 19 – Part A (Continued)
FORM CE-302

Page 113

Section 19

– MISCELLANEOUS EXPENSES

– Continued

4 19 06 6

1. Since the 1st of (month, 3 months

ago), have you (or any members ofyour CU) paid any of the followingto help support someone outsideof your CU?

a 

4. FIELD 1 19 04 8

REPRESENTATIVECHECK ITEMMark (X) box ifthere are noentries recordedin columns b–f.

0010

0010 999 Go to

nextpage

ITEM

CODE YES NO

What was the (payment/contribution) for?

PROCESSING USE ONLY

b

002000300040005000600070008000900100011001200130014001500160017001800190020002100220

c

ENTERITEMCODEfromcolumn a.

d

In what month didyou make the (payment/contribution)?If it is a continuouspayment/contributionthroughout the referenceperiod, mark box.

Month Continuous expense

1 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 31 3

e f

What was the totalamount of the(payment/contribution)?For continuingpayments/contributions,do not includepayments/contributionsfor the currentmonth.$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

YES NO

Did you makeany other(payments/contributions)for . . .?

College studentsliving away fromhome 100Child support 110

Part B

– Contributions

FIELD REPRESENTATIVE

– Hand the respondent the Information Booklet w

complete columns b through f for each "YES" support, mark the box in column d and enter t

Alimony 120

2. Since the 1st of

(month, 3 months ago),have you (or anymembers of your CU)given any money bycash, checks, moneyorders, or creditcards to benefit –Educationalinstitutions 130Politicalorganizations 140Religiousorganizations,including churches,temples, andmosques, but notincluding parochialschools 150Charities and all otherorganizations 160Any and all otherpersons not in yourCU, such as friends,co-workers, orhomeless persons 170

3. Have you (or any

members of your CU)given any stocks,bonds, or mutualfunds to persons ororganizationsoutside your CU? 180

Describe briefly the payment/contribution.

Information Booklet, page 42a
Section 20 – EXPENSE PATTERNS FOR FOOD, BEVERAGES, AND OTHER SELECTED ITEMS

Part A – Food and Beverages 1 20 01 4

Since the 1st of (month, 3 months ago), what has been yourusual WEEKLY expense at the grocery store or supermarket?

b.

Page 114 FORM CE-302

Section 20 – Part A

About how much of this amount was for nonfood items, suchas paper products, detergents, home cleaning supplies, petfoods, and alcoholic beverages?

0040 $

2a. Have you (or any members of your CU) purchased any food or

nonalcoholic beverages from places other than grocery stores,such as convenience stores, specialty stores, bakeries, homedelivery, vegetable stands, or farmers’ markets? Include anylarge purchases made for freezing or canning.

.00 $

0030 1

2

YesNo – Go to item 3a

0 None – Go to item 2a

0010

1a.

$

0 None

0020

b. What was your usual WEEKLY expense at these places?

3a. Have you (or any members of your CU) purchased any beer,

wine, or other alcoholic beverages to be served at home? 0050 1

2

YesNo – Go to item 4a

b. What was your usual MONTHLY expense for beer and wine?

$

0 None

0060

c. What was your usual MONTHLY expense for other alcoholic

beverages? $

0 None

0070

4a. Have you (or any members of your CU) purchased any beer,

wine or other alcoholic beverages in restaurants, taverns,cocktail lounges, or clubs?

0080 1

2

YesNo – Go to item 5a

b. What was the usual MONTHLY expense?

$ 0090

5a. Have you (or any members of your CU) purchased meals,

snacks, or fast food from restaurants, cafeterias, carry-outs,street vendors, or other such places?

0100 1

2

YesNo – Go to item 6a

b. What was the usual MONTHLY expense for these purchases?

$ 0110

6a. Have you (or any members of your CU) paid for board outside

of a boarding house? 0120 1

2

YesNo – Go to item 7a

b. What was the usual MONTHLY expense?

b. If YES – What are the names of all CU members who purc

meals at school?Enter the name of each CU member purchasing meals at schocolumn a, then ask columns b through d for each name entere

7.

Have you (or any members of your CU) received any free beverages, or meals through public or private welfareagencies, including religious organizations? Do not includmeals in school or preschool programs.Ask only if preschool or school age students; otherwise mark 

9a. 

Since the 1st of (month, 3 months ago), not including (this month), have you (or members of your CU) purchased anmeals at school for preschool through high school agechildren?

8a. Have you (or any members of your CU) received any free 

at work as part of your pay? 

b. About what was the WEEKLY dollar value of such mealsc. Since the 1st of (month, 3 months ago), how many weeks 

members of your CU receive such meals?

3 20 02 8

001000200030004000500060007000800090

PROCESSING USE ONLYa Name 

Enter line numbfrom ContCard. 

.00.00.00.00.00.00

0130 $ .00
FORM CE-302

Page 115 

Section 20 – EXPENSE PATTERNS FOR FOOD, BEVERAGES, AND OTHER SELECTED ITEMS – Continued

Part B – Selected Services and Goods 1 20 03 0

1a. Since the 1st of (month, 3 months ago) excluding (this month)

have you (or any members of your CU) had any expenses forcoin-operated laundry or dry cleaning machines?

0010 1

2

0020 .00 $

YesNo – Go to item 2a

b. What was the total cost?c. Was any of this amount for items other than clothes such as

linens or drapes? 0030 12 Yes No – Go to item 2a

d. How much?

0040 $

X Don’t know

2a. Have you (or any members of your CU) had any expenses for

dry cleaning or laundry services?

0050 1

2

0060 $

YesNo – Go to item 3a

b. What was the total cost for dry cleaning or laundry services?c. Was any of this amount for items other than clothes such as

linens or drapes? 0070 12 Yes No – Go to item 3a

d. How much?

0080 $

X Don’t know

3. Have you (or any members of your CU) purchased tobacco

products, such as – 0090 1

2

0100 $

Yes

a. Cigarettes? No – Go to item 3cb. If YES – What is the usual WEEKLY expense for cigarettes?

0110 1

2

YesNo – Go to item 4

c. Cigars, pipe tobacco, or other tobaccos, including chewing

tobacco?

0130 $

0 None

d. If YES – What is the usual WEEKLY expense for cigars, pipe

tobacco, or other tobaccos? 0120 $

4. Since the 1st of (month, 3 months ago), excluding (this month),

what has been the expense for haircuts, styling, and otherrelated services for all members of your CU?

5a. Have you (or any members of your CU) had any expenses for

the rental of a safe deposit box located in a bank or similarfinancial institution?

0140 1

2

0150 $

YesNo – Go to item 6a

0 None

b. What was the total rental expense for the safe deposit box

since the 1st of (month, 3 months ago), excluding this month?

6a. Have you (or any members of your C

checking accounts or other banking fees?

b. What is the usual MONTHLY charge

7a. Since the 1st of (month, 3 months ag

month) have you (or any members of expenses for taxis or limousine servexpenses entirely reimbursed for buexpenses incurred on a trip.

b. If YES – What was the total expense?

8a. Do you (or any members of your CU

services such as a bus, subway, mincommuter bus and train service?

b. What is the usual MONTHLY cost to 

to go to –

(1) Work? (2) School? (3) Other places? 

.00.00.00.00.00

.00

.00
Section 21 – CREDIT LIABILITY

Part A.1 – Credit Balances – Second Quarter Only

Page 116 FORM CE-302

Section 21 – Part A

1.

0010

PROCESSING USE ONLY

a bc d

1 21 02 0

On the 1st of (the current month), did you (or anymembers of your CU) owe any money to any ofthe following? Do not include mortgage, home equityloans, automobile loans, or business related loans.Read each item listed below. Complete a separate linefor each individual store, credit card, etc.

ITEM

CODE YES NO

00200030004000500060007000800090010001100120013001400150

1 21 01 2

CREDIT SOURCERevolving credit accountsincluding store, gasoline, andgeneral purpose credit cards,such as Sears, Amoco, Visa,MasterCard, etc. ...............Stores for installment creditaccounts .....................Banks and savings and loancompanies ....................Credit unions .................Finance companies ............Insurance companies (Do notinclude insurancepremium payments) .............Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance ..................Other credit sources ...........

100

200300400500600700800

ENTERITEMCODEfromcolumn a

What is the name of the (credit source)to which you owe money?Enter name of store, credit card, financecompany, bank, credit union, insurancecompany, etc.

FIELD REPRESENTATIVE – Complete columns b th

How much was owed to(credit source)?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

e

Don’tknow YES N

Did any membyour CU owe amoney to any (credit source)?If "No," go to necredit source incolumn a.

X

0010 999 Go to

nextsection

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are no entriesrecorded in columns b–e.

XXXXXXXXXXXXXX
Section 21 – CREDIT LIABILITY – Continued

Part A.1 – Credit Balances – Continued – Second Quarter Only

Page 117 FORM CE-302

0010

PROCESSING USE ONLY

a bc d

1 21 03 8

ITEM

CODE

00200030004000500060007000800090010001100120013001400150

CREDIT SOURCERevolving credit accountsincluding store, gasoline, andgeneral purpose credit cards,such as Sears, Amoco, Visa,MasterCard, etc. ...............Stores for installment creditaccounts .....................Banks and savings and loancompanies ....................Credit unions .................

Finance companies ............Insurance companies (Do notinclude insurancepremium payments) .............Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance ..................Other credit sources ...........

100

200300400500600700800

ENTERITEMCODEfromcolumn a

What is the name of the (credit source)to which you owe money?Enter name of store, credit card, financecompany, bank, credit union, insurancecompany, etc.

FIELD REPRESENTATIVE – Complete columns b th

How much was owed to(credit source)?

$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

e

Don’tknow YES N

Did any membyour CU owe amoney to any (credit source)?If "No," go to necredit source incolumn a.

XXXXXXXXXXXXXXX

Skip to Section 22A

$
Section 21 – CREDIT LIABILITY

Part A.2 – Credit Balances – Fifth Quarter Only

Page 118 FORM CE-302

Section 21 – Part A.2

1.

0010

PROCESSING USE ONLY

a bc d

1 21 11 1

On the 1st of (the current month), did you (or anymembers of your CU) owe any money to any ofthe following? Do not include mortgage, home equityloans, automobile loans, or business related loans.Read each item listed below. Complete a separate linefor each individual store, credit card, etc.

ITEM

CODE YES NO

00200030004000500060007000800090010001100120013001400150

1 21 10 3

CREDIT SOURCERevolving credit accountsincluding store, gasoline, andgeneral purpose credit cards,such as Sears, Amoco, Visa,MasterCard, etc. ............Stores for installment creditaccounts ...................Banks and savings and loancompanies .................Credit unions ...............Finance companies ..........Insurance companies (Do notinclude insurancepremium payments) ...........Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance ...............Other credit sources .........

100

200300400500600700800

ENTERITEMCODEfromcolumn a

What is the name of the (credit source)to which you owed money?Enter name of store, credit card, financecompany, bank, credit union, insurancecompany, etc.

FIELD REPRESENTATIVE – Complete columns b th

Ask if "Yes" in item 1.$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

Don’t

know 

X

0010 999 Go to

part B

3. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are noentries recorded in columns b–f.

XXXXXXXXXXXXXX

What was on the 1st year ago)?

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 

2a. On the 1st day of (current month, one year ago), did

you (or any members of your CU) owe money toany creditor that you did not owe money to on the1st day of (the current month, the current year)?

YES NO

b. What was the source of Item code(s) the credit? ..........

Complete columns b, c, e,and f for each credit sourcereported.

How much was owed to(credit source)?
Section 21 – CREDIT LIABILITY – Continued

Part A.2 – Credit Balances – Continued – Fifth Quarter Only

Page 119 FORM CE-302

0010

PROCESSING USE ONLY

a bc d

1 21 12 9

ITEM

CODE

00200030004000500060007000800090010001100120013001400150

CREDIT SOURCERevolving credit accountsincluding store, gasoline, andgeneral purpose credit cards,such as Sears, Amoco, Visa,MasterCard, etc. ..............Stores for installment creditaccounts ...................

Banks and savings and loancompanies ..................Credit unions ................Finance companies ...........Insurance companies (Do notinclude insurancepremium payments) ............Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance .................Other credit sources ..........

100

200300400500600700800

ENTERITEMCODEfromcolumn a

What is the name of the (credit source)to which you owed money?Enter name of store, credit card, financecompany, bank, credit union, insurancecompany, etc.

FIELD REPRESENTATIVE – Complete columns b th

Ask if "Yes" in item 1.$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

Don’t

know 

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ What was on the 1st year ago)?

XXXXXXXXXXXXXXX

How much was owed to(credit source)?
Section 21 – CREDIT LIABILITY – Continued

Part B – Finance Charges – Fifth Quarter Only

Page 120 FORM CE-302

Section 21 – Part B

FIELD REPRESENTATIVE –

During the past 12 months, have you (or anymembers of your CU) paid any finance charges,interest charges or late fees to any of the followingexcept for mortgage, home equity loans, orautomobile loans?

0010

.00 $

12

YesNo

X Don’t know

a.

1 21 20 2

Ask items a through h and recomonths for each item.

Revolving credit accounts including store, gasolineand general purpose credit cards, such as Sears,Amoco, Visa, MasterCard, etc.?

0020

Do not include yearly fees.If YES – How much was paid for finance, interest

and late charges?

0030 1

2

YesNo

b. Stores for installment credit accounts?

.00 $

X Don’t know

If YES – How much was paid for finance, interest 0040

and late charges?

0050 1

2

YesNo

c. Banks and Savings and Loans?

.00 $

X Don’t know

If YES – How much was paid for finance, interest 0060

and late charges?

0070 1

2

YesNo

d. Credit unions?

.00 $

X Don’t know

If YES – How much was paid for finance, interest 0080

and late charges?

0090 1

2

YesNo

e. Finance companies?

.00 $

X Don’t know

If YES – How much was paid for finance, interest 0100

and late charges?

0110 1

2

YesNo

f. Insurance companies?

.00 $

X Don’t know

If YES – How much was paid for finance, interest 0120

and late charges?

0130 1

2

YesNo

g. Doctors, dentists, hospitals, or other medical

practitioners for expenses not covered byinsurance?

.00 $

X Don’t know

If YES – How much was paid for finance, interest 0140

and late charges?

0150 1

2

YesNo

h. Other credit sources?

.00 $

X Don’t know

If YES – How much was paid for finance, interest 0160

and late charges?

N
Section 22 

– WORK EXPERIENCE AND INCOME

Part A 

– Second Quarter, Fifth Quarter or New Consumer Units Only

1. 1 22 01 0 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 121 FORM CE-302

FIELD REPRESENTATIVE 

– Ask a separate page of part A f

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . work per week? 0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

During the last 12 months, did . . . receive any money in wagesor salary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.During the last 12 months, howmuch did . . . receive in wages andsalaries for ALL JOBS before anydeductions?

b.

c.

Could you tell me which range onCARD A best reflects . . .’s total

wages and salaries for all jobsduring the last 12 months?What period of time did this cover?

12

Yes – Go to item 6a 

No – Go to item 7

0120

.00 $

6e. Was the

. . .’s lasIf YES – 

SocMe

Rai

(1)(2)

Gov

(3) Priv(4)(5)(6)

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

6.

a.

0100 $0–$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

d.

What was the amount of . . .’s lastpay before deductions?Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

If "Don’t know" or "Refuse" – Go to item 6b.

1234567

1 week2 weeksMonthQuarterYearOther – Specify

___________________Twice a month

FedSta

f. Are Soc

NORMA

g. Does th

Securitportion 

7. During 

have anown noor profe

h. Other t

employpension the last 

a. What w

loss aft

b. Could y

CARD A loss frobusinespractice 

0110

Go to item 6c

–

Ask only item 7a. 
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued

Page 122 FORM CE-302

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10



Section 22 – Part A (Coninued)
Section 22

– WORK EXPERIENCE AND INCOME

– Continued

Part A

– Second Quarter, Fifth Quarter or New Consumer Units Only

– Continued

1. 1 22 06 9 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 123 FORM CE-302

FIELD REPRESENTATIVE 

– Ask a separate page of part A f

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . work per week? 0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

During the last 12 months, did . . . receive any money in wagesor salary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.During the last 12 months, howmuch did . . . receive in wages andsalaries for ALL JOBS before anydeductions?

b.

c.

Could you tell me which range onCARD A best reflects . . .’s total

wages and salaries for all jobsduring the last 12 months?What period of time did this cover?

12

Yes – Go to item 6a 

No – Go to item 7

0120

.00 $

6e. Was the

. . .’s lasIf YES – 

SocMe

Rai

(1)(2)

Gov

(3) Priv(4)(5)(6)

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

6.

a.

0100 $0–$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

d.

What was the amount of . . .’s lastpay before deductions?Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

If "Don’t know" or "Refuse" – Go to item 6b.

1234567

1 week2 weeksMonthQuarterYearOther – Specify

___________________Twice a month

FedSta

f. Are Soc

NORMA

g. Does th

Securitportion 

7. During 

have anown noor profe

h. Other t

employpension the last 

a. What w

loss aft

b. Could y

CARD A loss frobusinespractice 

0110

Go to item 6c

–

Ask only item 7a. 
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued

Page 124 FORM CE-302

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10



Section 22 – Part A (Continued)
Section 22

– WORK EXPERIENCE AND INCOME

– Continued

Part A

– Second Quarter, Fifth Quarter or New Consumer Units Only

– Continued

1. 1 22 11 9 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 125 FORM CE-302

FIELD REPRESENTATIVE 

– Ask a separate page of part A f

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . work per week? 0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

During the last 12 months, did . . . receive any money in wagesor salary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.During the last 12 months, howmuch did . . . receive in wages andsalaries for ALL JOBS before anydeductions?

b.

c.

Could you tell me which range onCARD A best reflects . . .’s total

wages and salaries for all jobsduring the last 12 months?What period of time did this cover?

12

Yes – Go to item 6a 

No – Go to item 7

0120

.00 $

6e. Was the

. . .’s lasIf YES – 

SocMe

Rai

(1)(2)

Gov

(3) Priv(4)(5)(6)

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

6.

a.

0100 $0–$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

d.

What was the amount of . . .’s lastpay before deductions?Ask only if "Don’t know" or "Refuse" item6a. Information Booklet, page 44.

If "Don’t know" or "Refuse" – Go to item 6b.

1234567

1 week2 weeksMonthQuarterYearOther – Specify

___________________Twice a month

FedSta

f. Are Soc

NORMA

g. Does th

Securitportion 

7. During 

have anown noor profe

h. Other t

employpension the last 

a. What w

loss aft

b. Could y

CARD A loss frobusinespractice 

0110

Go to item 6c

–

Ask only item 7a. 
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued

Page 126 FORM CE-302

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10



Section 22 – Part A (Continued)
Section 22 

– WORK EXPERIENCE AND INCOME

Part A

– Second Quarter, Fifth Quarter or New Consumer Units Only

– Continued

1. 1 22 16 8 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 127 FORM CE-302

FIELD REPRESENTATIVE 

– Ask a separate page of part A f

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . work per week? 0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

During the last 12 months, did . . . receive any money in wagesor salary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.During the last 12 months, howmuch did . . . receive in wages andsalaries for ALL JOBS before anydeductions?

b.

c.

Could you tell me which range onCARD A best reflects . . .’s total

wages and salaries for all jobsduring the last 12 months?What period of time did this cover?

12

Yes – Go to item 6a 

No – Go to item 7

0120

.00 $

6e. Was the

. . .’s lasIf YES – 

SocMe

Rai

(1)(2)

Gov

(3) Priv(4)(5)(6)

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

6.

a.

0100 $0–$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

d.

What was the amount of . . .’s lastpay before deductions?Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

If "Don’t know" or "Refuse" – Go to item 6b.

1234567

1 week2 weeksMonthQuarterYearOther – Specify

___________________Twice a month

FedSta

f. Are Soc

NORMA

g. Does th

Securitportion 

7. During 

have anown noor profe

h. Other t

employpension the last 

a. What w

loss aft

b. Could y

CARD A loss frobusinespractice 

0110

Go to item 6c

–

Ask only item 7a. 
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued

Page 128 FORM CE-302

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10



Section 22 – Part A (Continued)
Section 22

– WORK EXPERIENCE AND INCOME

– Continued

Part A

– Second Quarter, Fifth Quarter or New Consumer Units Only

– Continued

1. 1 22 21 8 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 129 FORM CE-302

FIELD REPRESENTATIVE 

– Ask a separate page of part A f

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . work per week? 0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

During the last 12 months, did . . . receive any money in wagesor salary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.During the last 12 months, howmuch did . . . receive in wages andsalaries for ALL JOBS before anydeductions?

b.

c.

Could you tell me which range onCARD A best reflects . . .’s total

wages and salaries for all jobsduring the last 12 months?What period of time did this cover?

12

Yes – Go to item 6a 

No – Go to item 7

0120

.00 $

6e. Was the

. . .’s lasIf YES – 

SocMe

Rai

(1)(2)

Gov

(3) Priv(4)(5)(6)

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

6.

a.

0100 $0–$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

d.

What was the amount of . . .’s lastpay before deductions?Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

If "Don’t know" or "Refuse" – Go to item 6b.

1234567

1 week2 weeksMonthQuarterYearOther – Specify

___________________Twice a month

FedSta

f. Are Soc

NORMA

g. Does th

Securitportion 

7. During 

have anown noor profe

h. Other t

employpension the last 

a. What w

loss aft

b. Could y

CARD A loss frobusinespractice 

0110

Go to item 6c

–

Ask only item 7a. 
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued

Page 130 FORM CE-302

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10



Section 22 – Part A (Continued)
Section 22

– WORK EXPERIENCE AND INCOME

– Continued

Part A

– Second Quarter, Fifth Quarter or New Consumer Units Only

– Continued

1. 1 22 26 7 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 131 FORM CE-302

FIELD REPRESENTATIVE 

– Ask a separate page of part A f

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . work per week? 0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

During the last 12 months, did . . . receive any money in wagesor salary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.During the last 12 months, howmuch did . . . receive in wages andsalaries for ALL JOBS before anydeductions?

b.

c.

Could you tell me which range onCARD A best reflects . . .’s total

wages and salaries for all jobsduring the last 12 months?What period of time did this cover?

12

Yes – Go to item 6a 

No – Go to item 7

0120

.00 $

6e. Was the

. . .’s lasIf YES – 

SocMe

Rai

(1)(2)

Gov

(3) Priv(4)(5)(6)

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

6.

a.

0100 $0–$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

d.

What was the amount of . . .’s lastpay before deductions?Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

If "Don’t know" or "Refuse" – Go to item 6b.

1234567

1 week2 weeksMonthQuarterYearOther – Specify

___________________Twice a month

FedSta

f. Are Soc

NORMA

g. Does th

Securitportion 

7. During 

have anown noor profe

h. Other t

employpension the last 

a. What w

loss aft

b. Could y

CARD A loss frobusinespractice 

0110

Go to item 6c

–

Ask only item 7a. 
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued

Page 132 FORM CE-302

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10



Section 22 – Part A (Continued)
Section 22 

– WORK EXPERIENCE AND INCOME 

– Continued

Part B

– Second Quarter, Fifth Quarter or New Consumer Units ONLY

– Ask for entire CU as a group.

Page 133 FORM CE-302

0010

1. During the last 12 months, did you

(or any members of your CU) receiveincome from any of the following –Interest on bank accounts, moneymarket funds, CD’s, or bonds?

What was the total amount receivedby all CU members?

a.b.c.

12

Yes – Go to item 1b

No – Go to item 2

.00 $ 0020

Could you tell me which range onCARD C best reflects the totalamount of interest received by allCU members during the last 12months?

a. REGULAR income from dividends,

trusts, estates, or royalties?

.00 $ 0050 b. What was the total amount received by all CU members?

Ask only if "Don’t know" or "Refuse" to

item 1b. Information Booklet, page 46. $0 –$999 $1,000–$1,999

$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0030

12

2. During the last 12 months, did you (or

any members of your CU) receive any –

0040 1

2

Yes – Go to item 2b

No – Go to item 3

If "Don’t know" or "Refuse" – Go to item 2c.If "Don’t know" or "Refuse" – Go to item 1c.

c. Could you tell me which range on

CARD C best reflects the totalamount of income from dividends,trusts, estates, or royalties duringthe last 12 months?

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0060

12

0070

3. During the last 12 months, did you (or any

members of your CU) receive any income from –What was the total amount received by allCU members?

a.b.c.

12

Yes – Go to item 3b

No – Go to item 4

.00 0080 $

Could you tell me which range on CARD Cbest reflects the total amount of incomefrom retirement pensions and annuitiesduring the last 12 months?

a. Unemployment compensation or

supplemental unemployment compensation?

.00 $ 0110 b. What was the total amount received by all CU members?

Ask only if "Don’t know" or "Refuse" to

item 3b. Information Booklet, page 46.

$0 –$999

$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0090

12

4. During the last 12 months, did you (or any

members of your CU) receive any incomefrom –

0100 1

2

Yes – Go to item 4b

No – Go to item 5

If "Don’t know" or "Refuse" – Go to item 4c.

If "Don’t know" or "Refuse" – Go to item 3c.

c.

$0 –$999

$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0120

12

0130

5. During the last 12 months, did you (or any

members of your CU) receive any income from –Worker’s compensation or veteran’s benefits

including the GI Bill but not including militaryretirement?

What was the total amount received by allCU members?

a.b.

12

Yes – Go to item 5b

No – Go to item 6

.00 $ 0140

If "Don’t know" or "Refuse" – Go to item 5c.

Could you tell me which range on CARD Cbest reflects the total amount received inunemployment compensation during thelast 12 months?Retirement, disability and survivor pensions orannuities from private companies, military,government, IRA or Keogh?

Up until this point, we havediscussed earnings for individualmembers. Now, I would like to talk toyou about your CU as a whole.Ask only if "Don’t know" or "Refuse" to

item 2b. Information Booklet, page 46.

Go to item 4

Go to item 5Go to item 6

––

–

Go to item 3

–

Go to item 2

–

FIELD REPRESENTATIVE

– Ask these items for entire 

interview in a new consu

Ask only if "Don’t know" or "Refuse" to

item 4b. Information Booklet, page 46.

1 22 97 8 PROCESSING USE ONLY
FORM CE-302

Page 134 

Section 22 

– WORK EXPERIENCE AND INCOME 

– Continued

Part B

– Second Quarter, Fifth Quarter or New Consumer Units ONLY

– Continued

7d. Could you tell me which range on

CARD C best reflects the totalvalue of food stamps or electronicbenefits received in the last 12months?

.00 $ 0240 a. How much net income or loss was received from roomers or boarders?

Ask only if "Don’t know" or "Refuse"to item 7c. Information Booklet, page46.

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0220

12

8. During the last 12 months, did you (or

any members of your CU) have any netincome or loss from any type of rentalof rooms or living units?

0230 1

2

Yes – Go to item 8a

No – Go to item 9

b. Could you tell me which range on

CARD C best reflects your netincome or loss from roomers orboarders?

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0260

12

Could you tell me which range onCARD C best reflects the netincome or loss received fromother rental units during the last12 months?

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0290

12

Ask only if "Don’t know" or "Refuse"to item 8a. Information Booklet, page46.

Go to item 8c

0 Loss

.00 $ 0270

c. How much net income or loss was

received from other rental units?

Go to item 9

d.

Ask only if "Don’t know" or "Refuse" to

item 8c. Information Booklet, page 46.

0 Loss1 Loss

If "Don’t know" or "Refuse" – Go to item 8b.

1 Loss

If "Don’t know" or "Refuse" – Go to item 8d.

02500280

9. During the last 12 months, did you

(or any members of your CU)receive any income from –

0300 1

2

Yes – Go to item 

a. Child support? No – Go to item 

If YES –

b. Did you receive a one time lump

sum payment for child support?

0310 1

2

YesNo – Go to item 

If YES –What was the total amount of lumpsum payments received by ALL CUmembers in the last 12 months?

$ 0320

If "Don’t know" or"Refuse" – Go to item 

Ask only if "Don’t know" or "Refuse"to item 9b. Information Booklet,page 46.

c. Could you tell me which range on

CARD C best reflects the totalamount received in lump sumpayments for child support by ALLCU members during the last 12months?

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and ove

123456789

1011

0330

12

0340 1

2

YesNo – Go to item 

If YES –What was the total amount of nonlump sum payments received by ALLCU members in the last 12 months?

$ 0350

If "Don’t know" or"Refuse" – Go to ite

Did you receive any child supportpayments in other than a lump sumamount?

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and ove

123456789

1011

0360

12

Could you tell me which range onCard C best reflects the totalamount received in child supportpayments, other than lump sumamounts, by ALL CU membersduring the last 12 months?Ask only if "Don’t know" or "Refuse"to item 9d. Information Booklet,page 46.

d.e.

0 None0 None



Section 22

– Part B (Continued)
Page 135 

FORM CE-302

Section 22 – WORK EXPERIENCE AND INCOME – ContinuedPart B – Second Quarter, Fifth Quarter or New Consumer Units ONLY – Continued

0510 

$ 0500 1

2

YesNo

13. During the last 12 months, did you (or any

members of your CU) receive any REFUNDSfrom any of the following?

a.

If YES – What was the total amount received

by ALL CU members?Federal income tax?

0530 

$ 0520 1

2

Yes

b. State and local income tax? No

0550 

$ 0540 1

2

Yes

c. Overpayment on Social Security? No

0570 

$ 0560 1

2

Yes

d. Insurance policies? No

0590 

$ 0580 1

2

Yes

e. Property taxes? No

0610 

$ 0600 1

2

YesNo

f. Other sources, including any other taxes – Specify

0630 

$ 0620 1

2

YesNo

14. During the last 12 months, did you (or any

members of your CU) pay any of thefollowing –

a.

If YES – What was the total amount PAID byALL CU members?Federal income tax in addition to thatwithheld from earnings?

0650 

$ 0640 1

2

YesNo

b. State and local income tax in addition to that

withheld from earnings?

0670 

$ 0660 1

2

Yes

c. Personal property taxes for vehicles? No

0690 

$ 0680 1

2

YesNo

d. Personal property taxes and other taxes not

reported elsewhere? Do not include SocialSecurity tax for the self-employed – Specify

a. Money from the sale of household

furnishings, equipment, clothing,jewelry, pets, or other belongings,not including the sale of vehiclesor real estate?

.00 $ 0450 b. What was the total amount received by ALL CU members?

11. During the last 12 months, did

you (or any members of your CU)receive any –

0440 1

2

Yes – Go to item 11bNo – Go to item 12

c. Could you tell me which range on

CARD C best reflects the totalamount of other money incomereceived during the last 12 months?

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0490

12

0470

12. During the last 12 months, did

you (or any members of your CU)receive any –Other money income, includingmoney received from cashscholarships and fellowships,stipends not based on working, orfrom the care of foster children?

a. 1

2

Yes – Go to item 12bNo – Go to item 13

.00 $ 0480

Go to item 12Go to item 13

–

What was the total amountreceived by ALL CU members?

b.

–

Ask only if "Don’t know" or "Refuse"to item 12b. Information Booklet, page46.

c. Could you tell me which range on

CARD C best reflects the totalamount received from these salesduring the last 12 months?

$0 –$999$1,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000 and over

123456789

1011

0460

12

Ask only if "Don’t know" or "Refuse"to item 11b. Information Booklet, page46.

If "Don’t know" or"Refuse" – Go to item 11c.If "Don’t know" or"Refuse" – Go to item 12c.
FORM CE-302

Page 136 

NOTES

NOTE: As of January, 1996, Section 22 Part C no longer exists.
Page 137 

FORM CE-302

Section 22 – WORK EXPERIENCE AND INCOME – ContinuedPart D – Third and Fourth Quarter – CU Members 14 Years Old and Over who previously did not work

1 23 13 3

0010

1. OFFICE TRANSCRIPTION ITEMS

CU members who previouslyreported not working.

PROCESSING USE ONLY

NAMELINE NUMBER

a.b.

2. Since the 1st of (month, 3 months ago), did. . . earn any

income from wages, or salary from a business,partnership, professional practice, or farm?FIELD REPRESENTATIVE ITEMEnter the name and line numberof all new CU members recordedon the control card for the firsttime in this interview who are 14years old or older.• Complete a page in part E for each "Yes" response in item 2 and for each new CU member listed in item 3.

YesNo

0020 1

2

3.

NAMELINE NUMBER

a.b. 0030

1 23 14 1

0010

YesNo

0020 1

2

0030

1 23 15 8

0010

YesNo

0020 1

2

0030

1 

00100020 1

2

0030

1 23 19 0

0010

OFFICE TRANSCRIPTION ITEMSCU members who previouslyreported not working.

PROCESSING USE ONLY

NAMELINE NUMBER

a.b.

2. Since the 1st of (month, 3 months ago), did. . . earn any

income from wages, or salary from a business,partnership, professional practice, or farm?FIELD REPRESENTATIVE ITEMEnter the name and line numberof all new CU members recordedon the control card for the firsttime in this interview who are 14years old or older.• Complete a page in part E for each "Yes" response in item 2 and for each new CU member listed in item 3.

YesNo

0020 1

2

3.

NAMELINE NUMBER

a.b. 0030

1 23 20 8

0010

YesNo

0020 1

2

0030

1 23 21 6

0010

YesNo

0020 1

2

0030

1 

00100020 1

2

0030

NOTES

1.
Section 22 

– WORK EXPERIENCE AND INCOME 

– Continued

Part E 

– Third and Fourth Quarter

1. 1 23 25 7 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 138 FORM CE-302

FIELD REPRESENTATIVE 

–

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . usually work perweek?

0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080 1

2

Yes – Go to item 6a

No – Go to item 7

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

6. During the past 12 months, did . . .

receive any money in wages orsalary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.

a.

What was the amount of . . .’s lastpay before deductions?

d. What period of time did this cover?

c.

0110 .00 $0120 1

23456

1 week2 weeksMonthQuarterYearOther – Specify 

6e. Was the

. . .’s la

(1) Fed

StaSocMedRail

7.

GovPriv

During tany inco

nonfarm profess

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

Complete a separate pagmember who turned 14 reported income in prev

During the last 12 months, howmuch did . . . receive in wages andsalaries for All JOBS before anydeductions?

b. Could y

CARD A loss frobusineprofess12 monAsk onl

item 7a

7

(2) (3)(4)(5)(6)

f. Are Soc

NORMADoes thSecurity portion 

g.

Other temploypension during t

h.a. What w

after ex

b. Could you tell me which range on

CARD A best reflects . . . totalwages and salaries for all jobsduring the last 12 months?

0100 $0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

Twice a month

If "Don’t know" or "Refuse" – Go to item 6b.

Go to item 6c

–

Section 22

– Part E
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part E – Third and Fourth Quarter – Continued

Page 139 FORM CE-302

FIELD REPRESENTATIVE – Complete a separate pag

member who turned 14 reported income in prev

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10


Section 22 

– WORK EXPERIENCE AND INCOME 

– Continued

Part E 

– Third and Fourth Quarter

1. 1 23 30 7 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 140 FORM CE-302

FIELD REPRESENTATIVE 

–

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . usually work perweek?

0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080 1

2

Yes – Go to item 6a

No – Go to item 7

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

6. During the past 12 months, did . . .

receive any money in wages orsalary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.

a.

What was the amount of . . .’s lastpay before deductions?

d. What period of time did this cover?

c.

0110 .00 $0120 1

23456

1 week2 weeksMonthQuarterYearOther – Specify 

6e. Was the

. . .’s la

(1) Fed

StaSocMedRail

7.

GovPriv

During tany inco

nonfarm profess

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

Complete a separate pagmember who turned 14 reported income in prev

During the last 12 months, howmuch did . . . receive in wages andsalaries for All JOBS before anydeductions?

b. Could y

CARD A loss frobusineprofess12 monAsk onl

item 7a

7

(2) (3)(4)(5)(6)

f. Are Soc

NORMADoes thSecurity portion 

g.

Other temploypension during t

h.a. What w

after ex

b. Could you tell me which range on

CARD A best reflects . . . totalwages and salaries for all jobsduring the last 12 months?

0100 $0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

Twice a month

If "Don’t know" or "Refuse" – Go to item 6b.

Go to item 6c

–

Section 22

– Part E (Continued)
Section 22 

– WORK EXPERIENCE AND INCOME 

– Continued

Part E

– Third and Fourth Quarter

– Continued

Page 141 FORM CE-302

FIELD REPRESENTATIVE 

– Complete a separate pag

member who turned 14 reported income in prev

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10



Section 22

– Part E (Continued)
Section 22 

– WORK EXPERIENCE AND INCOME 

– Continued

Part E 

– Third and Fourth Quarter

1. 1 23 35 6 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 142 FORM CE-302

FIELD REPRESENTATIVE 

–

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . usually work perweek?

0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080 1

2

Yes – Go to item 6a

No – Go to item 7

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

6. During the past 12 months, did . . .

receive any money in wages orsalary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.

a.

What was the amount of . . .’s lastpay before deductions?

d. What period of time did this cover?

c.

0110 .00 $0120 1

23456

1 week2 weeksMonthQuarterYearOther – Specify 

6e. Was the

. . .’s la

(1) Fed

StaSocMedRail

7.

GovPriv

During tany inco

nonfarm profess

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

Complete a separate pagmember who turned 14 reported income in prev

During the last 12 months, howmuch did . . . receive in wages andsalaries for All JOBS before anydeductions?

b. Could y

CARD A loss frobusineprofess12 monAsk onl

item 7a

7

(2) (3)(4)(5)(6)

f. Are Soc

NORMADoes thSecurity portion 

g.

Other temploypension during t

h.a. What w

after ex

b. Could you tell me which range on

CARD A best reflects . . . totalwages and salaries for all jobsduring the last 12 months?

0100 $0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

Twice a month

If "Don’t know" or "Refuse" – Go to item 6b.

Go to item 6c

–

Section 22

– Part E (Continued)
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part E – Third and Fourth Quarter – Continued

Page 143 FORM CE-302

FIELD REPRESENTATIVE – Complete a separate pag

member who turned 14 reported income in prev

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10


Section 22 

– WORK EXPERIENCE AND INCOME 

– Continued

Part E 

– Third and Fourth Quarter

1. 1 23 40 6 FIELD REPRESENTATIVE

ITEMEnter the first nameand line number ofeach CU member 14years old and over.

0020 Weeks0010

0 Did not work –

Go to item 5

Page 144 FORM CE-302

FIELD REPRESENTATIVE 

–

0040

2. In the last 12 months, how many 

weeks did . . . work either full time orpart time, not counting work aroundthe house? Include paid vacation andpaid sick leave.

3. In the weeks that . . . worked, how

many hours did . . . usually work perweek?

0030

4a.

Information Booklet, page 43

00500060

b. Was . . .

12

YesNo

0090 .00 $0080 1

2

Yes – Go to item 6a

No – Go to item 7

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager

02 – Teacher03 – Professional

CODE1 –2 – A Federal government employee?3 – A State government employee?

4 – A local government employee?5 –6 –

CodeCode

Ask if code 5 and not a farm – Is the business 

incorporated?

Administrative support, technical, salesOperator, assembler, laborerPrecision production, craft, repairFarming, forestry, fishingArmed forces

5.

Ask if item 2 marked "Did not work" –CODE1 – Retired?2 – Taking care of home/family?3 – Going to school?4 – Ill, disabled, unable to work?5 – Unable to find work?6 – Doing something else? – SpecifyWhat was the main reason . . . didnot work during the past 12 months?Was . . .

0070 Code

6. During the past 12 months, did . . .

receive any money in wages orsalary? Include all wages, salaries,commissions, tips, allowances,Armed Forces pay, severance pay,teaching fellowships, and the like.

a.

What was the amount of . . .’s lastpay before deductions?

d. What period of time did this cover?

c.

0110 .00 $0120 1

23456

1 week2 weeksMonthQuarterYearOther – Specify 

6e. Was the

. . .’s la

(1) Fed

StaSocMedRail

7.

GovPriv

During tany inco

nonfarm profess

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail

06 – Sales, business goods and services

07 – Technician

Administrative support, including clerical

Service08 – Protective service

09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming

17 – Forestry, fishing, groundskeeping

18 – Armed forces

An employee of a PRIVATEcompany, business, or individualworking for wages or salary?

Self-employed in OWN business,professional practice, or farm?Working WITHOUT PAY in familybusiness or farm?

Complete a separate pagmember who turned 14 reported income in prev

During the last 12 months, howmuch did . . . receive in wages andsalaries for All JOBS before anydeductions?

b. Could y

CARD A loss frobusineprofess12 monAsk onl

item 7a

7

(2) (3)(4)(5)(6)

f. Are Soc

NORMADoes thSecurity portion 

g.

Other temploypension during t

h.a. What w

after ex

b. Could you tell me which range on

CARD A best reflects . . . totalwages and salaries for all jobsduring the last 12 months?

0100 $0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" to

item 6a. Information Booklet, page 44.

Twice a month

If "Don’t know" or "Refuse" – Go to item 6b.

Go to item 6c

–

Section 22

– Part 3 (Continued)
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part E – Third and Fourth Quarter – Continued

Page 145 FORM CE-302

FIELD REPRESENTATIVE – Complete a separate pag

member who turned 14 reported income in prev

7c.

1 Loss

0320 .00 $

During the last 12 months, did . . . haveany income from . . .’s own farm?

e. Could you tell me which range on

CARD A best reflects . . .’s income

or loss from . . .’s own farm duringthe last 12 months?

0340

$0 –$4,999

$5,000–$9,999$10,000–$14,999$15,000–$19,999$20,000–$29,999$30,000–$39,999$40,000–$49,999$50,000–$69,999$70,000–$89,999$90,000–$119,999$120,000 and over

123456789

1011

Ask only if "Don’t know" or "Refuse" toitem 7d. Information Booklet, page 44.

0310 1

2

Yes – Go to item 7dNo – Go to item 8

d. What was the amount of income or loss

after expenses? Go to item 8

If "Don’t know" or "Refuse" – Go to item 7e

8. During the last 12 months, did . . . place

any money in a retirement plan such asan Individual Retirement Account (IRA)or Keogh? Do not include rollovers.

0350 1

2

Yes No

0360 .00 If YES – How much? $

9. During the last 12 months, did . . .

receive from the U.S. Government anymoney from –

a. Social Security checks?

0420 1

2

Yes No

b. Railroad Retirement checks?

0380 1

2

Yes No

c. FIELD REPRESENTATIVE CHECK ITEM –

Is "Yes" marked in items 9a and/or 9b?

0390 1

2

Yes – Go to item 9dNo – Go to item 10

d. What was the amount of the last

Social Security or RailroadRetirement payment received?

0400 .00 $ Go to item 9f

If "Don’t know" or "Refuse" – Go to item 9e

0410

0 Loss

e. Could you tell me which range on

CARD B best reflects the amount of. . .

’s last Social Security or Railroad

Retirement payment received?Ask only if "Don’t know" or "Refuse" toitem 9d. Information Booklet, page 45.

9f. Is this amount AFTER the deduction

for a Medicare premium?

0370 1

2

Yes No

g. During the past 12 months, how many

Social Security or Railroad Retirementpayments did . . . receive?

Num

10. During the last 12 months, did . . .

receive any –

a. Supplemental Security Income (SSI)

payments from the U.S. Government?

0440 1

2

Yes No

b. Supplemental Security Income (SSI)

payments from the STATE or LOCALgovernment?

0450 1

2

Yes No

c. During the last 12 months, how

much did . . . receive inSupplemental Security Incomechecks form ALL governmentsources?If "Yes" in items 10a and/or10b –

0460 

$ 

If "Don’t know" or 

0470 $0 –$999

$5,000–$1,999$2,000–$2,999$3,000–$3,999$4,000–$4,999$5,000–$9,999$10,000–$14,9$15,000–$19,9$20,000–$29,9$30,000–$39,9$40,000–$49,0$50,000 and o

123456789

101112

d.

Ask only if "Don’t know" or "Refuse" to

item 10c. Information Booklet, page 46.

11. FIELD REPRESENTATIVE CHECK ITEM 0480 1

2

Records 

Mark (X) the appropriate box based No records usupon the respondent’s use of records inproviding responses to items 6–10

Could you tell me which range onCARD C best reflects the amount . . .received in Supplemental SecurityIncome from all government sourcesduring the last 12 months?

0330

0430

Less than $300$300–$399$400–$499$500–$599$600–$699$700–$799$800–$899$900–$999$1,000–$1,499

$1,500 and over

123456789

10


NOTE – As of April 2001 Section 22, Part F no longer exists

Page 146 FORM CE-302

Section 22 – Part F

NOTES
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part G – Changes In Assets – Fifth Quarter Only

Page 147 FORM CE-302

a.

1 22 99 4

Savings accounts in banks, savings and loans,credit unions and similar accounts?

.00 $

0 None

0020

1. On the last day of (last month), what was the total 

amount your CU had in –

b. Checking accounts, brokerage accounts and other

similar accounts?

.00 0050 $

b. Checking accounts?

3a. Did you (or any members of your CU) own any

securities, such as stocks, mutual funds, privatebonds, government bonds or Treasury notes onthe last day of (last month)?

0100 1

2

YesNo – Go to item 4

b. If YES – What was the estimated value of all such

securities on the last day of (last month)? .00 0110 $

.00 $

0 None

0010

.00 $

0 None

0030

c. U.S. Savings bonds?

2. How does the amount your CU had at the end of

the last day of (last month) compare with theamount your CU had on the last day of (last month,one year ago) in –

123

Same – Go to item 2b

MoreLess

If more or less – How much more (less)?

a. Savings accounts?

0040

.00 0070 $

123

Same – Go to item 2c

MoreLess

0060

c. U.S. Savings bonds?

.00 0090 $

123

Same – Go to item 3a

MoreLess

0080

c. How does this compare with the value of such

securities your CU held on the last day of (lastmonth, one year ago)?

.00 0130 $

123

Same – Go to item 4

MoreLess

0120

If more or less – How much more (less)?

4. During the past 12 months, did you (or any

members of your CU) purchase any stocks,mutual funds or bonds?

0140 1

2

YesNo – Go to item 5

.00 If YES – What was the total purchase price 0150 $

including broker fees?

If YES – What was the net amount received from

sales after subtracting broker fees?

1 Yes

No 

5. During the past 12 months, did you (or any

members of your CU) sell any stocks, mutualfunds or bonds?

b. What was the value of these goods or services?

$

0160

2

0260 $

123

SamMoLes

0250

11.

8a.

If YES – How much did you invest?

1 Yes

No 

6. During the past 12 months, did you (or any

members of your CU) make any investments toyour own business or farm?

$

0180

2

01700190

If YES – What was the value of such assets?

1 Yes

No 

7. During the past 12 months, did you (or any

members of your CU) withdraw any assets fromyour own business or farm?

$

0200

2

0210

1 Yes

No 

During the past 12 months, were any goods orservices from your own business or farmwithdrawn for personal use?

0220

2

0230 $

b. How does the amount owed to your CU on the

last day of (last month) compare with the amountowed to your CU by persons outside your CU onthe last day of (last month, one year ago)?

9a. 1 Yes

No 

On the last day of (last month), did anyone outsideof your CU owe money to you or any member ofyour CU?

0240

2

If more or less – How much more (less)?

10. 1 Yes

No 

Did anyone outside of your CU owe money to youor any member of your CU on the last day of (lastmonth, one year ago)?

0270

2

If YES – How much was owed? 

0280 $

1 Yes

No

During the past 12 months, did you (or anymembers of your CU) receive settlement onsurrender of any insurance policies (life orannuity)?

0290

2

If YES – How much did you receive?

0300 $

FIELD REPRESENTATIVE – Ask thes
FORM CE-302

Page 148

Section 24 – TOTAL CU INCOME – For New Consumer Units Only

1.

TOTAL CU INCOME 1 24 01 6

0010

101112131415

LossUnder $3,000$3,000–$5,999$6,000–$7,499$7,500–$9,999$10,000–$12,999$13,000–$14,999$15,000–$19,999$20,000–$24,999$25,000–$29,999$30,000–$34,999$35,000–$49,999$50,000–$74,999$75,000+RefusedDon’t know

NOTES

FIELD REPRESENTATIVE – Hand the responden

proceed. Ask the qu

Section 24

123456789

X

Information Booklet, page 47

Which category representsthe total combined income ofthis CU during the past 12months? This includes moneyfrom jobs, net income frombusiness, farm or rent,pensions, dividends, interest,social security payments, andany other money incomereceived by all CU members14 years of age or older.
Section 24 Section 21 Section 22 Section 16 Section 17 Section 18 Section 19 Section 20 Section 11 Section 12 Section 13 Section 14 Section 15 Section 10 Section 7 Section 8 Section 9 

HOUSEHOLD EQUIPMENT REPAIRS, SERVICE CONTRACTS, AND FURNITURE REPAIR AND REUPHOLSTERING

HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS

CLOTHING AND SEWING MATERIALS

RENTED AND LEASED VEHICLES

OWNED VEHICLES

VEHICLE OPERATING EXPENSES

INSURANCE OTHER THAN HEALTH

HOSPITALIZATION AND HEALTH INSURANCE

MEDICAL AND HEALTH EXPENDITURES

EDUCATIONAL EXPENSES

SUBSCRIPTIONS, MEMBERSHIPS, BOOKS, AND ENTERTAINMENT EXPENSES

TRIPS AND VACATIONS

MISCELLANEOUS EXPENSES

EXPENSE PATTERNS FOR FOOD, BEVERAGES, AND OTHER SELECTED ITEMS

CREDIT LIABILITY

WORK EXPERIENCE AND INCOME

TOTAL CU INCOME