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.

23

45

U.S. DEPARTMENT OF COMMERCE

BUREAU OF THE CENSUS

ACTING AS COLLECTING AGENT FOR

U.S. DEPARTMENT OF LABOR

BUREAU OF LABOR STATISTICS

QUESTIONNAIRE

QUARTERLY INTERVIEW SURVEY

CONSUMER EXPENDITURE SURVEYS

Serialnumber

Serialsuffix

Checkdigit

REG_OFF A REA CODE SEGMENTI SEG_SUFF S A M P _ D E S S E R I A L

A L P H A S U F

C H E C K

HH_NUM CU_NUM
Section 1 – GENERAL SURVEY INFORMATION

FORM CE-302(4-1-99)

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. Segment number suffixSample designation Serial No.

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the responde

the last section 

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

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

Check digit

REG_0 FF

A REA CODE

SEGMENTII SEG_SUFF SA MP_DES SERIA L

S

A LPHA _SUF

CHECK HH_NUM CU_NUM

PH_CA L

VISIT TM_TRV
Section 1 – GENERAL SURVEY INFORMATION

FORM CE-302(4-1-99)

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. Segment number suffix Sample designation Serial No.

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the responde

the 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(4-1-99)

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. Segment number suffix Sample designation Serial No.

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the responde

the 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(4-1-99)

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. Segment number suffix Sample designation Serial No.

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the responde

the 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(4-1-99)

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. Segment number suffix Sample designation Serial No.

HH No. CU No. Interview 

No.

Q

Serial suffix

NOTES

23

45

Checkbor stubCancel

23

If the responde

the 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) to

today.

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 CONTROL

CARD ITEM 18 WITH THE SAME CU MARKED IN

CONTROL 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 by

observation.

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 MAINLY

for sleeping, even if also used

for other purposes.

0 None

How many completebathrooms are there in thisunit?

0080 Number

A COMPLETE BATHROOM has

a flush toilet, a bathtub or

shower, and a wash basin with

piped water.

0 None

0090 Number

A HALF BATHROOM has at

least a flush toilet OR bathtub

or shower, but does not have

all the facilities of a complete

bathroom.

X

8. What fuel is used most for –

b. Heating water in this unit?

0110

c. Cooking?

FIELD 

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

PUBLHOUS

GOVTCOST

ST_HOUS

BUILDING

LOT_SIZ E

ROOMSQ

BEDROOMQ

BA THRMQ

HLFBA THQ

HEA TFUEL

WA TERHT

COOKING
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-freezerComputer, not solely forgamesBuilt-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 own house?3. Received as a gift?4. Included with rental unit?5. Rented separately?

FIELD REPRESENTATIVE –

Mark (X) first box that applies.

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

MA JA PPLQ A PPLSTA T
Page 5 

FORM CE-302

NOTES
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 

3.

Page 6 FORM CE-302

Section 2 – Part A

a. Mark (X) appropriate box based upon

section 1, part B, item 2 for first interview

or new consumer units. For subsequent

interviews, 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 B

for other rental

property

Go to next

section

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

X Don’t know

$

.00

2

.00 $

02600220023002400250

Garage or parking facilities 0270

1 2

21

e.d. Heating? 

Trash/Garbage collection?

f.

O W N ED

REN T ED

RT REGX

RN T L PRD

RT PM T Q

RT PM T RG

RT I REGX RT I REGQ

RT CREX P

RT CREX X

RT EL ECT

RT GA S

RT W A T ER

RT H EA T

RT T RA SH

RT PA RK

RT A SPA Y

RT CO M PX

RT BSN S

RT BSN SZ

RTCMPPD
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 7 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 – G

o

t

o

i

t

e

m

1

f

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 B

for other rental

property

Go to next

section

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

X Don’t know

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? Enter

to 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 $

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

11 2

22

RT REGX

RN T L PRD

RT PM T Q

RT PM T RG

RT I REGX RT I REGQ

RT CREX P

RT CREX X

RT EL ECT

RT GA S

RT W A T ER

RT H EA T

RT T RA SH

RT PA RK

RT A SPA Y

RT CO M PX

RT BSN S

RT BSN SZ

RTCMPPD
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 8 FORM CE-302

Section 3 – Part A.1

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 

•••••••

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

PROPERTY

CODE from

part 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(property

description)?

If "No," go

to column j.

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

If "Yes" in

column h –

YES YES NO NO

What percentof theexpenses forthis propertyare (were)deducted?

Enter to the

nearest whole

percent.

No mortgage

or lump sum

home equity

loan

.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

Hm(hlp

(

p

cI

m

1 2 1 2 1 2 Percent 1 2 

0021 

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

0041 

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

0061 

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

0081 

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

0101 

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

0121 

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

0141 

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

PROPERTY INVENTORY CHART

If "No," go

to column j.

PRO P_N O A

PRO PD I SP

O W N Y A

ST I L O W N

BSN SEX PA

O BSN SZ BA

PROP_NO2

/ OWNY2
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 9 FORM CE-302

Enter the appropriate property number(s)

and property code(s) in item 2g below

from the property inventory chart (items

1a and 1e).

2 Home Equity Loan –

Mark (X) "Yes" in mortgage

column 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 home

equity 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 3cNo – 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 

(N
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) own

the home in which you (your CU) currentlylive(s)? (Treat land contracts as ownership.)

3.

FIELD REPRESENTATIVE – Ask part 

8.

Page 10 FORM CE-302

Section 3 – Part A.2

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 the

chart to the right. Complete all appropriate parts for

each property disposed of in the reference period and

for each property currently owned before moving on to

next 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 following

questions, 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 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 – SpecifyNote – 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 11 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 a

property number to each property in

consecutive order starting with 1.

Enter the property number in item

1a, the property code in item 1b, a

brief description of the property

(such as "own home") in item 1c,

and appropriate ownership 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 appropriate

skip 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 (property

description)?

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. All

other 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 D

or E as

appropriate



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

PRO P_N O B

O W N Y B

BSN SEX P

O BSN SZ B

A CQ U IRM O A Q U I RY R

A CQ M ET H

O W N _PU RX

O W N D PM T X

CL O SECST

PRO PV A L X

A N PRO PT X

PRO PT Y PE

V PRO PL O C

V SH A RED

V T I M ESH R
Page 12 

FORM CE-302

Section 3 – Part C

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 13 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 1st

interview in which the

property is reported as

being disposed of. Enter

the property number in

item 1a, the property

code in item 1b, and a

brief description of the

property 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; otherwise

go 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; otherwise

go to part E.

12

YesNo – Go to part E

0080

0010 

123

0020

Description

00300040

Mon

If "so

go to 

12

Y

0080

NOTES

.00.00.00

0060

$

0070

$

0090

$

.00.00.00

0060

$

0070

$

0090

$

PRO P_N O D

T X

O W N Y D

D I SPM T H D

D I SPM O D I SPY R

D I SPX

D ISPEX PX

M O RT H O L D

T RU ST X
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part E – Mortgage/Home Equity Loan Screening Questions

1. FIELD REPRESENTATIVE 

ITEM

2.

12

Co-op property – Go to item 4aNot co-op

FIELD REPRESEN

Page 14 FORM CE-302

Section 3 – Part E

Enter the property 

number in item 1a, the 

property code in item 1b, 

and a brief description of

the property 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 amortgage that was obtained from an outsidelender for your (your CU’s) shares in thecooperative?

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

cooperative’s total costs, do you (does yourCU) make payments on a mortgage that wasobtained from an outside lender for your(your CU’s) shares in 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 home

equity loans. I’ll describe both types. Please tellme 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 
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

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

1. FIELD REPRESENTATIVE 

ITEM

2.

12

Co-op property – Go to item 4aNot co-op

FIELD REPRESEN

Page 14a FORM CE-302

Enter the property 

number in item 1a, the 

property code in item 1b, 

and a brief description of

the property 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 amortgage that was obtained from an outsidelender for your (your CU’s) shares in thecooperative?

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

cooperative’s total costs, do you (does yourCU) make payments on a mortgage that wasobtained from an outside lender for your(your CU’s) shares in 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 home

equity loans. I’ll describe both types. Please tellme 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 
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

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

1. FIELD REPRESENTATIVE 

ITEM

2.

12

Co-op property – Go to item 4aNot co-op

FIELD REPRESEN

Page 14b FORM CE-302

Section 3 – Part E (Continued)

Enter the property 

number in item 1a, the 

property code in item 1b, 

and a brief description of

the property 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 amortgage that was obtained from an outsidelender for your (your CU’s) shares in thecooperative?

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

cooperative’s total costs, do you (does yourCU) make payments on a mortgage that wasobtained from an outside lender for your(your CU’s) shares in 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 home

equity loans. I’ll describe both types. Please tellme 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 
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued

Part F – Mortgages

1 03 43 2

FIELD REPRESENT

Page 15 FORM CE-302

FIELD REPRESENTATIVEITEMI’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?

PROCESSING USE ONLY

a.

b.

c.

1. 1 03 44 0

Enter the property

number in item 1a, the

property code in item 1b,

a brief description of the

property in item 1c.

Enter the 3-digit loan

number in item 1d,

beginning with 101 and

assigning loan numbers

consecutively, regardless

of property number.

0010 Number0055 1

2

30-year15-year

0020 Code

Description

0030

PROPERTY NUMBERPROPERTY CODEDESCRIPTION

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 decimal

places, such as 9.50% for 9 1/2%. (Include all FHA

guarantee insurance if applicable.)

4.6a. Is this a fixed rate mortgage?

10.

There are many different kinds ofmortgages. Which one of these (hand

respondent Information Booklet, page 10) comes

closest to yours (your CU’s)?

b.

On your (your CU’s) last regular payment,which of these things were included? (Hand

respondent 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 . Percent0085 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 

PRO P_N O F

O W N Y F

L O A N _N O F

FRST PY M O FRST PY Y R

M T ERM

M O RT T ERM

O L D M RRT

N EW M RRT

FI X ED RT E

PA Y T Y PE

REFIN ED

O RGM RT X

M RT PM PD

M RT PM T X

PRIN IN T X

P A Y P R I N I

P A Y P R O I N

P A Y P R O T X

P A Y L I F I N

P A Y M O R I N

P A Y O T H E R
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 16 FORM CE-302

FIELD REPRESENTATIVEITEMI’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?

PROCESSING USE ONLY

a.

b.

c.

1. 1 03 59 8

Enter the property

number in item 1a, the

property code in item 1b,

a brief description of the

property in item 1c.

Enter the 3-digit loan

number in item 1d,

beginning with 201 and

assigning loan numbers

consecutively, regardless

of property number.

0010 Number0055 1

2

30-year15-year

0020 Code

Description

0030

PROPERTY NUMBERPROPERTY CODEDESCRIPTION

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 two

decimal places, such as 9.50% for 9 1/2%. (Include

all 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 (hand

respondent Information Booklet, page 10) comes

closest to yours (your CU’s)?

b.

On your (your CU’s) last regular payment,which of these things were included? (Hand

respondent 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? (Convert

fractions 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 . Percent0085 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

Section 3 – Part G

Other – 

S

p

e

c

i

f

y

12

Fixed rate of interestVariable or adjustablerate of interestGraduated paymentRollover or renegotiable

34

56

Deferr

X Don’t 

Other 

PRO P_N O F

O W N Y F

L O A N _N O F

FRST PY M O FRST PY Y R

M T ERM

M O RT T ERM

O L D M RRT

N EW M RRT

FI X ED RT E

PA Y T Y PE

REFIN ED

O RGM RT X

M RT PM PD

M RT PM T X

PRIN IN T X

P A Y P R I N I

P A Y P R O I N

P A Y P R O T X

P A Y L I F I N

P A Y M O R I N

P A Y O T H E R
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 17 FORM CE-302

Enter the property

number in item 1a, the

property code in item 1b,

a brief description of the

property in item 1c.

Enter the 3-digit loan

number in item 1d,

beginning with 301 and

assigning loan numbers

consecutively, regardless

of property number.

Number

Description

a.b.

c.

PROPERTY NUMBER

PROPERTY CODEDESCRIPTION

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

00100020

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

001000200030 Number

12

0040

Number

Description

Code

YesNo – Go to next loan or

part I

001000200030 Number

12

0040

333

00500060

$ .00

$ .00

00500060

$ .00

$ .00

PRO P_N O H

O W N Y H

L O A N

_

N O H

PA ID L O A N

PA I D A M T X

PRI N A M T X
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 18 FORM CE-302

Section 3 – Part I

Now I want to ask about other payments on(property description) during the last three

months. 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 

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

ITEMEnter the property

number in item 1a, the

property code in item 1b,

and a brief description of

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 equity

loan on the property within the past 3 months, mark

box 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 or

part 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 – Specify

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, 3

months ago), for which of the things

on this card (hand the respondent

Information 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 Information

Booklet, page 13) are included in those

payments?

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 – Specify28 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 your

CU) 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

PRO P_N O I

O W N Y I

W A SM O RT

M O RT SPEC

SPECI A L X

SPECL X CM

SPPEN CH G

SPPEN CH X

SPPCH CM X

GRN D RN T X

GRN D RT CX

GRN D REN T

T Y PEPRO P

PA Y H O A SS

PA Y CO N D O

CO O PRG#

H O CO RG#

M GM O RT X

M GO T H ER

M GO T H RC
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 18a FORM CE-302

Now I want to ask about other payments on(property description) during the last three

months. 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

ITEMEnter the property

number in item 1a, the

property code in item 1b,

and a brief description of

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 equity

loan on the property within the past 3 months, mark

box 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 or

part 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 – Specify

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, 3

months ago), for which of the things

on this card (hand the respondent

Information 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 Information

Booklet, page 13) are included in those

payments?

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 – Specify28 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 your

CU) 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 
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 18b FORM CE-302

Section 3 – Part I (Continued)

Now I want to ask about other payments on(property description) during the last three

months. 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

ITEMEnter the property

number in item 1a, the

property code in item 1b,

and a brief description of

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 equity

loan on the property within the past 3 months, mark

box 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 or

part 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 – Specify

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, 3

months ago), for which of the things

on this card (hand the respondent

Information 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 Information

Booklet, page 13) are included in those

payments?

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 – Specify28 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 your

CU) 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 
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 19 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 (property

description)?

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 7

Go to item 11

Go to item 8

1. FIELD REPRESENTATIVE ITEM

Complete a separate page for

each change in the amount of the

mortgage or lump sum home

equity loan payment reported in

part 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 in

item 1a, the property code in

item 1b, the property description

in item 1c, and the mortgage

(loan) number in item 1d. Mark

(X) the appropriate type of loan

in 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

PRO P_N O J

O W N Y J

L O A N _N O J

L O A N T Y PJ

M O RT CH N G

O RW H A T

M RT T ERM J

FIX ED RT J

PA T T Y PJ

O RGM RT JX
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 19a 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 (property

description)?

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 7

Go to item 11

Go to item 8

1. FIELD REPRESENTATIVE ITEM

Complete a separate page for

each change in the amount of the

mortgage or lump sum home

equity loan payment reported in

part 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 in

item 1a, the property code in

item 1b, the property description

in item 1c, and the mortgage

(loan) number in item 1d. Mark

(X) the appropriate type of loan

in 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

$

Section 3 – Part J (Continued)

X
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 19b 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 (property

description)?

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 7

Go to item 11

Go to item 8

1. FIELD REPRESENTATIVE ITEM

Complete a separate page for

each change in the amount of the

mortgage or lump sum home

equity loan payment reported in

part 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 in

item 1a, the property code in

item 1b, the property description

in item 1c, and the mortgage

(loan) number in item 1d. Mark

(X) the appropriate type of loan

in 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
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES

Part A – Telephone Expenses

3.

Page 20 FORM CE-302

Section 4 – Part A

What is the name of the company whichprovides telephone services for (property

description)?

What property(ies) was (were) thetelephone bills for?

2.

PROCESSING USE ONLY 1 04 01 8

0030

YesNo – Go to part B

0040

96979899

Mobile (car) phoneRented sample unitOther rented unit

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

you (or any members of your CU) receivedany bills for telephone services? Do notinclude bills for telephones used entirelyfor business purposes.

00200430 .00

12

YesNo

• Owned properties – Enter a description of the

property and enter a 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, column a

4. How many telephone bills were received

for (property description) from (company

name)?

5a.

Complete a separate column for each bill

received since the 1st of (month, 3 months

ago).

b. In what month was the bill received?

6.

What was the total amount of bill (bill

number)? Exclude any unpaid bills from a

previous billing period.

a.

Does the total amount of the bill include –A basic service charge?Long distance call charges?Equipment purchases such as thepurchase of a telephone?

b.c.d. FIELD REPRESENTATIVE CHECK ITEM

Was a bill or checkbook used or was an

estimate given?

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 telephone bills fortelephones that are not used entirely forbusiness purposes?If YES – What percentage will be deducted?

Description

Property number

Property not owned orrented by CU

OFFICE USE ONLY Name of telephone company

Number

Bill 1 Bill 2 Bill 3 Bill 4

.00

$

0060 0 None

Month

0080

12

YesNo

0090

12

YesNo

0095

123

BillsEstimate

01100420 1 Yes

1 Yes – Complete a separate column for each property and each 

telephone 

company

0440

2 No – Go to item 8

Percent

2 No – Go to part B

0070

12

YesNo

.00

$

0120 0 None

Month

0140

12

YesNo

0150

12

YesNo

0155

123

01700130

12

YesNo

.00

$

0180 0 None

Month

0200

12

YesNo

0210

12

YesNo

0215

123

02300190

12

YesNo

.00

$

0240 0 None

Month

0260

12

YesNo

0270

12

YesNo

0275

123

02900250

00300040

96979899

Mobile (car) phoneRented sample unitOther rented unit

00200430 .00

12

YesNo

Property numb

Property not owned orrented by CU

OFFICE USE ONLY 

Number

Bill 1 Bill 2 

.00

$

0060 0 None

Month

0080

12

YesNo

0090

12

YesNo

0095

123

01100420 1 Yes

1 Yes – Complete a separate 

telephone 

company

0440

2 No – 

Percent

2 No – Go to part B

0070

12

YesNo

.0

$

0120 0 Non

Month

0140

12

YesNo

0150

12

YesNo

0155

123

01700130

Checkbook

BillsEstimate

BillsEstimate

BillsEstimateCheckbook

BillsEstimate

BillsEstim

PROCESSING USE ONLY 

Checkbook Check- book Check- book Chec

book 

U T L PRO PI

T EL _CO M P

T EL CH GX

T EL M O

T EL BA SI C

T EL N GD I S

T EL EQ PU R

REC_EST

T EL BSN S

T EL BSN Z
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – ContinuedPart A – Telephone Expenses – Continued

3.

Page 21 FORM CE-302

What is the name of the company whichprovides telephone services for (property

description)?

What property(ies) was (were) thetelephone bills for?

2.

PROCESSING USE ONLY 1 04 03 4

00300040

96979899

Mobile (car) phoneRented sample unitOther rented unit

00200430 .00

12

YesNo

• Owned properties – Enter a description of the

property and enter a 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, column a

4. How many telephone bills were received

for (property description) from (company

name)?

5a.

Complete a separate column for each bill

received since the 1st of (month, 3 months

ago).

b. In what month was the bill received?

6.

What was the total amount of bill (bill

number)? Exclude any unpaid bills from a

previous billing period.

a.

Does the total amount of the bill include –A basic service charge?Long distance call charges?Equipment purchases such as thepurchase of a telephone?

b.c.d. FIELD REPRESENTATIVE CHECK ITEM

Was a bill or checkbook used or was an

estimate given?

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 telephone bills fortelephones that are not used entirely forbusiness purposes?If YES – What percentage will be deducted?

Description

Property number

Property not owned orrented by CU

OFFICE USE ONLY Name of telephone company

Number

Bill 1 Bill 2 Bill 3 Bill 4

.00

$

0060 0 None

Month

0080

12

YesNo

0090

12

YesNo

0095

123

BillsEstimate

01100420 1 Yes

1 Yes – Complete a separate column for each property and each 

 telephone company

0440

2 No – Go to item 8

Percent

2 No – Go to part B

0070

12

YesNo

.00

$

0120 0 None

Month

0140

12

YesNo

0150

12

YesNo

0155

123

01700130

12

YesNo

.00

$

0180 0 None

Month

0200

12

YesNo

0210

12

YesNo

0215

123

02300190

12

YesNo

.00

$

0240 0 None

Month

0260

12

YesNo

0270

12

YesNo

0275

123

02900250

00300040

96979899

Mobile (car) phoneRented sample unitOther rented unit

00200430 .00

12

YesNo

Property numb

Property not owned orrented by CU

OFFICE USE ONLY

Number

Bill 1 Bill 2 

.00

$

0060 0 None

Month

0080

12

YesNo

0090

12

YesNo

0095

123

01100420 1 Yes

1 Yes – Complete a separate 

 telephone company

0440

2 No – 

Percent

2 No – Go to part B

0070

12

YesNo

.0

$

0120 0 Non

Month

0140

12

YesNo

0150

12

YesNo

0155

123

01700130

Checkbook

BillsEstimate

BillsEstimate

BillsEstimateCheckbook

BillsEstimate

BillsEstim

PROCESSING USE ONLY 

Checkbook Check- book Check- book Chec

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

Part B – 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 each item in bold listed below.

b.

If YES –Since the 1st of (month, 3 months ago), have you (or any members of your

CU) received any bills for utilities or fuels for a rented vacation property,such as a cottage?

c.

d.

Page 22 FORM CE-302

Section 4 – Part B

ElectricityNatural or utility gas

Combined gas and electricity 

Fuel oil Kerosene Bottled or tank gas Wood Coal Other fuels 

Combined expenses for items

130–180 

Piped-in water Trash/Garbage collection Sewerage maintenance 

Combined trash/garbage/

water/sewerage 

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

Combined trash/garbage/water 

Combined trash/garbage/sewerage

Combined water/sewerage 

Water softening service Septic tank cleaning 

UTILITY

CODE YES NO

110120130140150160170180190200210220230240250260270280290310100

No – Go to part C

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 C,

item 2

Utility

code

from

part C,

item 1a

NOTES

Amount

Amount

Cable TV, satellite services, orcommunity antenna 

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

Combined electric/water/sewerage

V A CU T L Y

V A CU T M O

V A CU T L X
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part C – Detailed Questions

3.

Page 23 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

00300045

979899

Rented sample unitOther rented unit

1. FIELD REPRESENTATIVE

TRANSCRIPTION ITEM Enter a utility code in item 1a and

a description of utility or fuel in

item 1b from part B, 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 covered

changed for a utility or fuel during the reference period, complete a

separate 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

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.

OFFICE USE 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 – Go

to item 7g

No – Go

to item 7g

YesNo – Go

to item 7g

YesNo – Go

to 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 any

members 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.

U T I L Y

W H A T PRO P

CO M PN A M E

BL PERIO D

U T L

CH GX

BI L L M O

U T L U N I T

U T I L CO N

I N CL SV C

I N CSV CX

BI L U SED

U T I L BU SN
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part C – Detailed Questions

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 53 9

00300045

979899

Rented sample unitOther rented unit

1. FIELD REPRESENTATIVE

TRANSCRIPTION ITEM Enter a utility code in item 1a and

a description of utility or fuel in

item 1b from part B, 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 covered

changed for a utility or fuel during the reference period, complete a

separate 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 other

records 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.

OFFICE USE 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 – Go

to item 7g

No – Go

to item 7g

YesNo – Go

to item 7g

YesNo – Go

to 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 any

members 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 24
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued

Part C – Detailed Questions

3.

Page 25 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

00300045

979899

Rented sample unitOther rented unit

1. FIELD REPRESENTATIVE

TRANSCRIPTION ITEM Enter a utility code in item 1a and

a description of utility or fuel in

item 1b from part B, 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 covered

changed for a utility or fuel during the reference period, complete a

separate 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 other

records 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.

OFFICE USE 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 – Go

to item 7g

No – Go

to item 7g

YesNo – Go

to item 7g

YesNo – Go

to 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 any

members 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 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 26 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 the

following 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, 

Information Booklet, page 14 YES NOInformation Booklet, page 14

Information Booklet, page 14

Have 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

de

fro

8. FIELD REPRESENTATIVE INSTRU

PROCESSING USE 

4a. Have there been any expense

(property that you do not owmembers of your CU)?

b. Which jobs were those expen

Enter job code(s) from items 1 thFIELD REPRESENTATIVE CHECK 

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

b. If YES – What kind of job will 

used for?

Enter a job code.

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

current month, have you (or aCU) purchased any materials yet started?

c. What was the total cost of th

supplies?

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

current month, have you (or aCU) purchased any materials specific job?

b. If YES – What was the total co
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued

Part B – Job Description

1 05 50 2

1.6.

Page 27 FORM CE-302

.00

FIELD REPRESENTATIVEITEM

Enter the job code from part A. (For combined

jobs 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?

025014

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 be

adequate 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.

013

(month, 3 months ago)? 026

b.

(month, 2 months ago)? 027(last month)? 028(the current month)? 029

1

015016

2

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

030

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)? 031(month, 2 months ago)? 032(last month)? 033(the current month)? 034

037035

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

item 4) (be) reimbursed or paid by someone

outside of your CU?

038

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

deducted as a business expense?

b. What percent was (will be) deducted? 039

CRM CO D EB

CRM PRO PI

CRM T Y PE

CRM CO D E

T O T JBCST

CO N T RA CT

CN T RCT X 3

CN T RCT X 2

CN T RCT X 1

CN T RCT X 0

CO N T RCT X

M A J_A PPL
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued

Part B – Job Description – Continued

1 05 51 0

1.6.

Page 28 FORM CE-302

.00

FIELD REPRESENTATIVEITEM

Enter the job code from part A. (For combined

jobs 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?

025014037

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 be

adequate 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.

013

(month, 3 months ago)? 026

b.

(month, 2 months ago)? 027(last month)? 028(the current month)? 029

1

015016

2

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

030

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)? 031(month, 2 months ago)? 032(last month)? 033(the current month)? 034

035

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

item 4) (be) reimbursed or paid by someone

outside of your CU?

038

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

deducted as a business expense?

b. What percent was (will be) deducted? 039

Section 5 – Part B (Continued)
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued

Part B – Job Description – Continued

1 05 52 8

1.6.

Page 29 FORM CE-302

.00

FIELD REPRESENTATIVEITEM

Enter the job code from part A. (For combined

jobs 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?

025014037

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 be

adequate 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.

013

(month, 3 months ago)? 026

b.

(month, 2 months ago)? 027(last month)? 028(the current month)? 029

1

015016

2

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

030

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)? 031(month, 2 months ago)? 032(last month)? 033(the current month)? 034

035

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

item 4) (be) reimbursed or paid by someone

outside of your CU?

038

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

deducted as a business expense?

b. What percent was (will be) deducted? 039
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 as a giftto someone outside your CU?

Page 30 FORM CE-302

Section 6 – Part A

FIELD REPRESENTATIVE

a

Information Booklet, page 16

2. FIELD REPRESENTATIVE 1 06 01 3

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–j.

0010 999 Go to

Part B

ITEM

CODE YES NO

What type did you purchaseor rent?

PROCESSING USE ONLY

b

00100020003000400050006000700080009001000110012001300140015001600170

c

ENTER

ITEM

CODE

from

column 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 

ElectricGasMicrowaveOther

REFRIGERATORHOME-FREEZERDISHWASHER

100110120130140150160170180190220200210

Part A – Purchase of Household Appliances

Do not list any appliance previously

reported in section 5B, item 7. If an

appliance is reported in both section 5 and

section 6, probe to verify that they are not

duplicated.

Built-inPortable

GARBAGE DISPOSALCLOTHES WASHERCLOTHES DRYERRANGE HOOD Combination of any of 

the above items

NOTES

Enter a brand name or a brief

description of item.

3 – Purchased 

as gift to others?

2 – Rented? 

Go to

column g.

1 – Purchased

for own use?

Mark (X) box

If code 2 in

column 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

What wasthe totalrentalexpensesince the1st of(month, 3

months ago),

excludingthe currentmonth?

M AJAPPLY

GFTC_M AJ

M AJ_M O

M AJPURX

M AJRENTX

M AJTAX
FORM CE-302

Page 31 

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 as a gift to someone outside your CU?

a

Information Booklet, pages 16–18

2. FIELD REPRESENTATIVE 1 06 03 9

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–i.

0010

0010 999 Go to

next

page

ITEM

CODE YES NO

What type did youpurchase or rent?

PROCESSING USE ONLY

b

0200

c

ENTER

ITEM

CODE

from

column 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 or

a brief description of

the item.

002000300040005000600070008000900100011001200130014001500160017001800190

1 – Purchased for

own use?

2 – Rented?

Go to column g

3 – Purchased

as gift toothers?

Mark (X) box

e

When didyoupurchaseit?

Month

f

What did it cost?(Include delivery

charges, exclude

installation

charges.)

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 in

column d –

What was thetotal rentalexpense sincethe 1st of(month, 3

months 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 t

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 

M INAPPLY

GFTCM IN

M IN_M OM I N PU RX

M INRENTX
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 as a gift to someone outside your CU?

Page 32 FORM CE-302

Section 6 – Part B (Continued)

FIELD REPRESENTATIVE – Hand the respondent the 

proceed. Ask column a, r

items and complete a sep

a

Information Booklet, page 18

2. FIELD REPRESENTATIVE 1 06 05 4

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–i.

0010 999 Go to

next

page

ITEM

CODE YES NO

What type did youpurchase or rent?

PROCESSING USE ONLY

b

006000700080009001000110012001300140015001600170018001900200

c

ENTER

ITEM

CODE

from

column 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 

as gift to others?

2 – Rented? 

Go to

column g.

1 – Purchased

for own use?

Mark (X) box

If code 2 in

column 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 withother itemsVCR, video camera, video discplayer, camcorderRadio, all typesOther sound and video equipment, including accessories (audio/video tapes,

etc. should be recorded in

Section 17) 

Use only if unable to itemize

above – Combined expenses

Sound 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 delivery

charges, exclude

installation

charges.)

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 33 

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 as a gift to someone outside your CU?

a

Information Booklet, page 19

2. FIELD REPRESENTATIVE 1 06 07 0

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–i.

0010

0010 999 Go to

section

7

ITEM

CODE YES NO

What type did youpurchase or rent?

PROCESSING USE ONLYb

0200

c

ENTER

ITEM

CODE

from

column a.

d

Was this –

YES 

SPORTS, RECREATION, ANDEXERCISE EQUIPMENT 

General sports equipment(Include here athletic shoes for

sports related use, such as

football, baseball, soccer, or

bowling) 

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 or

a brief description of

the item.

002000300040005000600070008000900100011001200130014001500160017001800190

1 – Purchased for

own use?

2 – Rented?

Go to column g

3 – Purchased

as gift toothers?

Mark (X) box

e

When didyoupurchaseit?

Month

f

What did it cost?(Include delivery

charges, exclude

installation

charges.)

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 in

column d –

What was thetotal rentalexpense since the1st of (month, 3

months ago),

excluding thecurrent month?

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

Did incsaltax

1 

FIELD REPRESENTATIVE – Hand the respondent t

proceed. Ask column 

items and complete a 

© 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 – 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 34 FORM CE-302

NOTES

FIELD REPRESENTATIVE – Hand the responde

questions 1a and 1

Information Booklet, page 20

2. FIELD REPRESENTATIVE CHECK ITEM 1 07 01 1

Mark (X) box if there are no entries recorded in

columns a–f in part B. 0010 999 Go to part C

ITEM

CODE

YES NO

PROCESSING

USE ONLY

0060007000800090010001100120013001400150016001700180019002000030

a

ENTER

ITEM

CODE

from

part A.

In whatmonth was(repairdone/servicecontractpurchased)?

c

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 expenses

Musical 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 the

type of service or equipment

covered by the service contract.

Include all items covered.

123456789

1011121314151617181920

Section 7 – Part A and Part B

Heating or air conditioning equipmentTermite or pest control treatmentSport and recreational equipmentPhotographic equipmentHand or power tools

RPAIRTYP

APPRPRYB

SRVCM O B

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

FURNITURE REPAIR AND REUPHOLSTERING – Continued

Part C – Screening Question

FIELD REPRESEN

Page 35 FORM CE-302

Did you (or any members of your CU) haveany expenses for repairing, refinishing orreupholstering furniture, including the costsfor fabric?

Yes – Go to part DNo – Go to next section

0010 $ .00

Part D – Furniture Repair or Reupholstering 4 07 04 9

a b

c

d

e

What item of furniture was repaired or reupholstered?

Describe type of furniture. ItemNo.

PROCESSING USE 

ONLY

OFFICE

USE

ONLY

In whatmonth didyou have itrepaired orreupholstered?

How muchdid it cost?

Did thisincludesales tax?

Month YES NO

002000300040005000600070008000900100

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

220220220220220220220220220220

1 21 21 21 21 21 21 21 21 21 2

123456789

10

PRE

1 23

Description from

column a

Month

from

column c

Cost from

column d

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

FU RN REPY

SRV CM O D

FU RN REPX

FRN REPT X
Section 8 – HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS

5 08 01 0

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

any members of your CU) purchased for your CUor as a gift to someone outside of your CU any ofthe following?

Page 36 FORM CE-302

Section 8 – Part A

FIELD REPRESENTATIVE – Hand the respondent the Inf

a

Information Booklet, pages 21 and 22

ITEM

CODE YES NO

What did you purchase?

PROCESSING USE ONLY

b

00100020003000400050006000700080009001000110012001300140015001600170

c

ENTER

ITEM

CODE

from

column

a.

d

Was this purchased foryour CU or as a gift to someoneoutsidethe 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 next

item in

column 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 – As a gift to

someoneoutsideCU.

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 120

and 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 if

unable to itemize separately

HOUSEHOLD DECORATIVE ITEMS 

160150141

0180 1 2 $ .00 

1 2

Clocks Lamps, and other lighting fixturesOther household decorative items

FU RN PU RY

FU RN M O FU RN GFT C

FU RN PU RX

FU RN PU RT X
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 as a gift to someone outside ofyour CU any of the following?

Page 37 FORM CE-302 

FIELD REPRESENTATIVE – Hand the respondent the Inf

a

Information Booklet, pages 23 and 24

ITEM

CODE YES NO

What did you purchase?

PROCESSING USE ONLY

b

001000200030004000500060007000800090010001100120013001400150

c

ENTER

ITEM

CODE

from

column

a.

d

Was this purchased for your CU or as a gift to someoneoutsidethe 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 next

item in

column 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 – As a gift to

someoneoutsideCU.

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 carpetRepacement 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 expenses

Room size rugs and other nonpermanent floor coverings, includingcarpet squaresCurtains and drapesVenetian blinds, window shades, otherwindow coverings1a. Since the 1st of (month, 3 months ago), have you

(or any members of your CU) rented or leasedany furniture?

If YES – What was the total expense for renting

or leasing furniture, excluding any expenses forthe current month?

b.

00100020

12

YesNo –Go to next section

$ .00

Part B – Rental or Leasing of Furniture 1 08 03 5 

204205215220214210211

FU RN RN T L

FU RN RN T X
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 38 FORM CE-302

Section 9 – Part A

FIELD REPRESENTATIVE – Hand the respondent the Inf

a

Information Booklet, page 25

2. FIELD REPRESENTATIVE 1 09 01 7

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–i.

0010 999 Go to

next

page

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTER

ITEM

CODE

from

column a.

d

For whom was it purchased? If

CU member, enter name and line

number 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 name

and 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 

identical

items

purchased.

In whatmonthdid youpurchaseit?

$ .00 

CL O T H Y APERSO N Y

CL O T H Q A

CL O T H M O A

CL O T H X A
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 39 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the Inf

column a and complete colu

Identical items are those of 

a

Information Booklet, page 26

2. FIELD REPRESENTATIVE 1 09 03 3

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–i.

0010 999 Go to

next

page

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTER

ITEM

CODE

from

column a.

d

For whom was it purchased? If

CU member, enter name and line

number from Control Card.

e

Howmanydid youpurchase?

f g 

Undergarments

210

Part A – Clothing – Continued

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

Hosiery

200

NOTES

If someone outside CU, enter name

and 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 

identical

items

purchased.

In whatmonthdid youpurchaseit?

$ .00
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 40 FORM CE-302

Section 9 – Part A (Continued)

FIELD REPRESENTATIVE – Hand the respondent the Inf

column a and complete colu

Identical items are those of 

a

Information Booklet, page 26

3. FIELD REPRESENTATIVE 1 09 05 8

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–i.

0010 999 Go to

part B

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTER

ITEM

CODE

from

column a.

d

For whom was it purchased? If

CU member, enter name and line

number 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?

Dis

Month 

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

0040

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

0050

AccessoriesActive sportswearUniforms, for whichthe cost is notreimbursedCostumesCombined clothing – This

should be used only if 

the respondent cannot

itemize clothing

purchases. Specify (in 

the Notes) the types of

clothing combined

Footwear(Include here athletic

shoes not specifically

purchased for sports

related use.) 

220

NOTES

If someone outside CU, enter name

and 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 

identical

items

purchased.

In whatmonthdid youpurchaseit?

$ .00

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 41 FORM CE-302

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTER

ITEM

CODE

from

column

a from

the

preceding

pages.

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," go

to next

item in

column 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 name

and 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 

identical

items

purchased.

In whatmonthdid youpurchaseit?

$ .00

1 2

If CU member, enter name and line

number from Control Card.

N
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 42 FORM CE-302

Section 9 – Part B

FIELD REPRESENTATIVE – Hand the respondent the Inf

a

Information Booklet, page 26 and 27

3. FIELD REPRESENTATIVE 1 09 11 6

CHECK ITEMMark (X) box if there are

no entries recorded in

columns b–i.

0010 999 Go to

part C

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTER

ITEM

CODE

from

column 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?

Dinsa

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

Y

0040

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

0050

290

Non-CU member

Enter 

number of 

identical

items

purchased.

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 be

used only if the

respondent cannot

itemize clothing

purchases. Specify (in

the Notes) the types of

clothing 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 27

Watches 370JewelryHairpieces, wigs, ortoupees

380390

111111111111111111

222222222222222222

CL O T H Y B

CL O GFT B

CL O T H Q B

CL O T H M O B

CL O T H X B
Section 9 – CLOTHING AND SEWING MATERIALS – Continued

6 09 13 1

Page 43 FORM CE-302

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTER

ITEM

CODE

from

column

a from

the

preceding

page.

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," go

to next

item in

column 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 

identical

items

purchased.

In whatmonthdid youpurchaseit?

$ .00

1 2

N

111111111111111111

222222222222222222
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 44 FORM CE-302

Section 9 – Part C

FIELD REPRESENTATIVE – Hand the respondent the Inf

a

Information Booklet, page 27

2. FIELD REPRESENTATIVE 1 09 21 5

CHECK ITEMMark (X) box if there are no

entries 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

ENTER

ITEM

CODE

from

column 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

Dinsa

Month 

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

Y

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 itemize

separately – Combined sewing

materials 

Sewing notions?Other sewing materials?If YES , read the list of individual items

below. Complete columns b–h for each

item purchased.

YES NO – Go to item 2

NOTES

111111111111111111

222222222222222222

111111111111111111

SEW IN GY SEW GFT C SEW I N GM O

SEW IN GX
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 45 FORM CE-302

FIELD REPRESENTATIVE – Hand the respondent the Inf

a

Information Booklet, page 27

2. FIELD REPRESENTATIVE 1 09 31 4

CHECK ITEMMark (X) box if there are no

entries in columns b–h. 0010 999 Go to section

10

ITEM

CODE YES NO

What did you buy?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150016001700180

c

ENTER

ITEM

CODE

from

column 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

Dinsa

Month 

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

Y

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

Clothing storageClothing rental

CL O T H Y D CL SV GFT C

CL O T H M O D

CL SRV CX
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 instructions 

Page 46 FORM CE-302

Section 10 – Part A.1

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 items

below 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 rented

vehicle or item 6

0130 1 Yes

2 No – Go to next rented

vehicle or item 6

PROCESSING USE ONLYVEHICLE NUMBER

1 10 02 3 

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 renting

this 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 the

amount of the payment and the number of payments

incurred during the reference period. Compute the total

expense and enter the amount in this item.

7 10 10 3

LEASED VEHICLES

If this box is marked, no vehicles were previously reported

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 CHART

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

YES 

Enter vehicle

code from

part B, item 1b.

Do yohave If NO

box a

item 6

YEAR MAKE MODEL

1 

002000300040005000600070

234567

1 1 1 1 1 1 

0030 1 Yes –

2 No

00800140 .00 

Go to 

vehic

0130 1 Yes

2 No – Go to 

vehic

0010 Co

$ .00 $

REN T CO D E

A N Y V A CA T

REN T EX PX

A N Y BSN RM

BSN SPCT Z

L V I N U M L V I CO D E

L V I 
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 47 FORM CE-302

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

you (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 – 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 wit

Page 48 FORM CE-302

Section 10 – Part A.2

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 items

below 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 rented

vehicle 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 renting

this 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 the

amount of the payment and the number of payments

incurred during the reference period. Compute the total

expense and enter the amount in this item.

LEASED VEHICLES

0030 1 Yes –

2 No

00800140 

G

v

0130 1 Yes

2 No – G

v

0010 

1 10 20 5

6a.

0010 1

2

YesNo – Go to section 11

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

you (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

REN T CO D E

A N Y V A CA T

REN T EX PX

A N Y BSN RM

BSN SPCT Z
Section 10 – RENTED AND LEASED VEHICLES – Continued

Part B – Detailed Questions for Leased Vehicles

1 10 21 3

Page 49 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.

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 vehicle

number 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

L SD N U M

L SD CO D E

M O D EL Y R M O D EL

N U M CY L

A N Y A U T O

A N Y ST EER

A N Y BRA K E

A N Y A C

A N Y RO O F

A N Y T U RBO

A N Y D I ESL

A N Y W H EEL

D O O RS

T Y PEV EH

A N Y BU SI N

PRCBSN SZ

M I L ESV EH

N EW U SED

L SD SO U RC
Page 50 

FORM CE-302

Section 10 – Part B (Continued)

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 order

beginning 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 vehicle

number 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 51 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.

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 vehicle

number 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 11 – OWNED VEHICLES

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

FIELD REPRESENTATIVE –

Page 52 FORM CE-302

Section 11 – Part A.1

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 mileare currently onthe vehicle?Enter to nearest

whole 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

f

Enter

mileage

from

part B,

item 10b

or part A.1,

column i

Codes 100–

120 and 

150 only

O V A N U M O V A CO D E

O V A H A V E

O V A M I L E
Section 11 – OWNED VEHICLES – Continued

Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY

FIELD REPRESENTATIVE – Hand the resp

you proceed. 

for each vehic

Page 53 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 REPRESENT

Do you (or any members of your CU) own any of thefollowing vehicles not used exclusively for business?

YES NO Complete part B fo

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 a

0420 0430 0440
Section 11 – OWNED VEHICLES – Continued

Part B – Detailed Questions

1 11 03 9

Page 54 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 the

next available vehicle number 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)

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, 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 

b. If YES – On the 1st of (month, 

loans on (vehicle) paid off or w

payments to be made?

c. What was the amount paid fo

allowance and discount?

d. Did this price include sales ta

e. Was any of the amount or pri

f. If YES – How much?

13a. Was a trade-in allowance rec14. What was the amount of the 15a. What was the source of cred

Year

Section 11 – Part B

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 purch

b. If YES – How much?

Ask items 14 and 15 for credit paymAsk if codes "2," "3," or "4" mark

b. Was this a home equity loan?

c. How much was borrowed, ex

d. What was the number of pay

e. In what month and year was 

f. What is the amount of each p

g. What period is covered by eah. Does the payment include an

principal and interest such as life insurance?If YES – How much of the pay

charges?

i.

MK MDLY

VEHICIB

VEHICYB

VEHICYR

CYLQ

A UTOTRA N

PWRSTEER

PWRBRA K E

A IRCA R

SUNROOF

TURBOCHG

DIESEL

NUMDOOR

A UTOTYPE

VEHBSNS

VEHBSNZ

VEHNEWU

VEHGFTC

VEHMILE

FRWHLDRV

VPURSRCE
Page 55 

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 the

next available vehicle number 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)

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, 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 

b. If YES – On the 1st of (month, 

loans on (vehicle) paid off or w

payments to be made?

c. What was the amount paid fo

allowance and discount?

d. Did this price include sales ta

e. Was any of the amount or pri

f. If YES – How much?

13a. Was a trade-in allowance rec14. What was the amount of the 15a. What was the source of cred

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 purch

b. If YES – How much?

Ask items 14 and 15 for credit paymAsk if codes "2," "3," or "4" mark

b. Was this a home equity loan?

c. How much was borrowed, ex

d. What was the number of pay

e. In what month and year was 

f. What is the amount of each p

g. What period is covered by eah. Does the payment include an

principal and interest such as life insurance?If YES – How much of the pay

charges?

i.
Section 11 – OWNED VEHICLES – Continued

Part B – Detailed Questions – Continued

1 11 05 4

Page 56 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 the

next available vehicle number 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)

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, 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 

b. If YES – On the 1st of (month, 

loans on (vehicle) paid off or w

payments to be made?

c. What was the amount paid fo

allowance and discount?

d. Did this price include sales ta

e. Was any of the amount or pri

f. If YES – How much?

13a. Was a trade-in allowance rec14. What was the amount of the 15a. What was the source of cred

Year

Section 11 – Part B (Continued)

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 purch

b. If YES – How much?

Ask items 14 and 15 for credit paymAsk if codes "2," "3," or "4" mark

b. Was this a home equity loan?

c. How much was borrowed, ex

d. What was the number of pay

e. In what month and year was 

f. What is the amount of each p

g. What period is covered by eah. Does the payment include an

principal and interest such as life insurance?If YES – How much of the pay

charges?

i.
Page 57 

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 the

next available vehicle number 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)

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, 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 

b. If YES – On the 1st of (month, 

loans on (vehicle) paid off or w

payments to be made?

c. What was the amount paid fo

allowance and discount?

d. Did this price include sales ta

e. Was any of the amount or pri

f. If YES – How much?

13a. Was a trade-in allowance rec14. What was the amount of the 15a. What was the source of cred

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 purch

b. If YES – How much?

Ask items 14 and 15 for credit paymAsk if codes "2," "3," or "4" mark

b. Was this a home equity loan?

c. How much was borrowed, ex

d. What was the number of pay

e. In what month and year was 

f. What is the amount of each p

g. What period is covered by eah. Does the payment include an

principal and interest such as life insurance?If YES – How much of the pay

charges?

i.
Section 11 – OWNED VEHICLES – Continued

Part B – Detailed Questions – Continued

1 11 07 0

Page 58 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 the

next available vehicle number 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)

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, 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 

b. If YES – On the 1st of (month, 

loans on (vehicle) paid off or w

payments to be made?

c. What was the amount paid fo

allowance and discount?

d. Did this price include sales ta

e. Was any of the amount or pri

f. If YES – How much?

13a. Was a trade-in allowance rec14. What was the amount of the 15a. What was the source of cred

Year

Section 11 – Part B (Continued)

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 purch

b. If YES – How much?

Ask items 14 and 15 for credit paymAsk if codes "2," "3," or "4" mark

b. Was this a home equity loan?

c. How much was borrowed, ex

d. What was the number of pay

e. In what month and year was 

f. What is the amount of each p

g. What period is covered by eah. Does the payment include an

principal and interest such as life insurance?If YES – How much of the pay

charges?

i.
Page 59 

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 the

next available vehicle number 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)

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, 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 

b. If YES – On the 1st of (month, 

loans on (vehicle) paid off or w

payments to be made?

c. What was the amount paid fo

allowance and discount?

d. Did this price include sales ta

e. Was any of the amount or pri

f. If YES – How much?

13a. Was a trade-in allowance rec14. What was the amount of the 15a. What was the source of cred

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 purch

b. If YES – How much?

Ask items 14 and 15 for credit paymAsk if codes "2," "3," or "4" mark

b. Was this a home equity loan?

c. How much was borrowed, ex

d. What was the number of pay

e. In what month and year was 

f. What is the amount of each p

g. What period is covered by eah. Does the payment include an

principal and interest such as life insurance?If YES – How much of the pay

charges?

i.
Section 11 – OWNED VEHICLES – Continued

Part C – Disposed of Vehicles

1 11 51 8

Page 60 FORM CE-302

1. FIELD REPRESENTATIVE

ITEMComplete a column in the

1st interview in which the

vehicle is disposed of.

Enter vehicle number and

vehicle code.

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 $

Section 11 – Part C (Continued)

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 5aDon’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 5aDon’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

0090

X 

$

0030

4563 

0040 0050 

$ 

12

00600110

12X

0080

12

0100

12

0070 

$ 

0120 

$

VEHICIC

VEHICYC

VDISPMO

SA LEX

REIMBURS

REIMBURX

EX REIMB

EX REIMBX

LOA NSTA T

FINPA YMT

FINPA YMX

VEHDISP
Section 11 – OWNED VEHICLES – Continued

Part C – Disposed of Vehicles – Continued

1 11 55 9

Page 61 FORM CE-302

1. FIELD REPRESENTATIVE

ITEMComplete a column in the

1st interview in which the

vehicle is disposed of.

Enter vehicle number and

vehicle code.

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 5aDon’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 5aDon’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

0090

X 

$

0030

4563 

0040 0050 

$ 

12

00600110

12X

0080

12

0100

12

0070 

$ 

0120 

$
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 62 FORM CE-302

Section 12 – Part A

FIELD REPRESENTATIVE – Hand the respondent the Inf

a

Information Booklet, pages 29 and 30

2. 1 12 01 1

Mark (X) box if there are

no entries recorded in

columns b–k.

0010 999 Go to

next

page

ITEM

CODE YES NO

What was the expense for?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150

c

ENTER

ITEM

CODE

from

column 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 code

from 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

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

VOPSERVY

VOPLA BOR

VOPMOA VOPEX PX

VOPTA X 

VOPVENYA
Section 12 – VEHICLE OPERATING EXPENSES – Continued

8 12 04 0

1.

Page 63 FORM CE-302 Section 12 – Part A

FIELD REPRESENTATIVE – Hand the respondent the Inf

column a and complete colu

column a. Complete a sepa

a

Information Booklet, pages 30 and 31

2. 1 12 03 7

Mark (X) box if there are

no entries recorded in

columns b–k.

0010 999 Go to

Part B

ITEM

CODE YES NO

What was the expense for?

PROCESSING USE ONLY

b

0060007000800090010001100120013001400150

c

ENTER

ITEM

CODE

from

column 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

Enter a brief 

description.

h

Describe briefly and 

enter the vehicle code

from 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
FORM CE-302

Page 64

Section 12 – VEHICLE OPERATING EXPENSES – Continued

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

ago), have you (or any members of

your CU) had expenses for –

a

2. FIELD REPRESENTATIVE 1 12 25 0

CHECK ITEMMark (X) box if

there are no

entries recorded

in columns b–f.

0010

0010 999 Go to

part C

ITEM

CODE YES NO

PROCESSING USE ONLY

b c

ENTER

ITEM

CODE

from

column a.

PRE

1 2

Description

from

column b

Month

from

column d

Driver’s license? 400

Vehicle inspection? 410

420

$ $ 

© Part B – Licensing, Registration, and Inspection of Vehicles

Vehicle registration?

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 next

item in

column a.

$ $ $ $ $ $ $ 

FIELD REPRESENTATIVE – 

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

0100

$ $ 

430

Use only if unable to

itemize above –

Combined expenses

Section 12 – Part B

NOTES

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

VOPREGY

VOPMO_C

VOPREGX
Section 12 – VEHICLE OPERATING EXPENSES – Continued

Part C – Other Vehicle Operating Expenses 1 12 51 6

1a.

Page 65 FORM CE-302

.00

Since the 1st of (month, 3 months ago), what has been the CU’s

AVERAGE 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 of

your 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 

had expenses for –

4.

Since the 1st of (month, 3 months 

(or any members of your CU) had policies? Do not include service business.

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 contr

b. If YES – How much was paid, exc

month?

a. Parking, including garage rental, 

fees, except any expenses includnot include parking expenses thaentirely for business.

d. If YES – How much was paid, exc

current month?

e. Docking and landing fees for boa

f. If YES – How much was paid, exc

current month?

b. If YES – How much?

Since the 1st of (month, 3 months 

(or any members of your CU) had for recreational vehicles, includi

6a. 

b. If YES – How much?

NOTES

VOPGA SX

VOPDIES

VOPDIESX

VOPBSNS

VOPBSNSX

VOPOIL

VOPOILX

VOPOILNT

VOPOILNX

VOPFLUID

VOPFLUDX
FORM CE-302

Page 67 

Section 13 – INSURANCE OTHER THAN HEALTH – ContinuedPart A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY 1 13 02 7

0020 Number 1

Hand the respondent th

Ask items 1–3 in part A.

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 2cNo – Go to item 3a

Insurance code

01400160018002000220

How many?

0150 Number0170 Number0190 Number0210 Number0230 Number

0300 1

2

Yes – Ask items 3b and 3cNo – Go to item 4

Insurance code

03100330035003700390

How many?

0320 Number0340 Number0360 Number0380 Number0400 Number
Section 13 – INSURANCE OTHER THAN HEALTH – Continued

Part B – Detailed Questions

a.

2a.

Page 68 FORM CE-302

Section 13 – Part B

1. FIELD REPRESENTATIVE ITEM

New CU’s – Enter policy

numbers in consecutive order

beginning with 1.

FIELD REPRESENTATIVE – Combine payments if 

insurance (for examp

1 13 03 5

b.

4.5a.

b.

6a.

b.

8a.

b.

2nd through 5th interviews –Enter the next available policy

number 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 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 was

your total expense for this insurance policy?

Enter the actual amount the CU paid, do not include

any 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 the

insurance 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 to

next

policy



0230 1 Yes 2 No0240 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 to

next

policy



0230 1 Yes 2 No0240 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

DescriptiInsuranc

0030

DescriptiDescripti

0160 0220 1

234

0230 1 0240 

123456789

0250

$

0 12

0260

$ 0270 

Description

PO L I CY I B

PL CY ST A B

PO L I CY Y B

I N SPRPY

PREM PA I D

PA Y D ED PR

PREM PERD

I N SEX PBX

I N SEX PB

I N SN EX X B
Section 13 – INSURANCE OTHER THAN HEALTH – Continued

Part B – Detailed Questions – Continued

a.

2a.

Page 69 FORM CE-302 Section 13 – Part B

1. FIELD REPRESENTATIVE ITEM

New CU’s – Enter policy

numbers in consecutive order

beginning with 1.

FIELD REPRESENTATIVE – Combine payments if 

insurance (for examp

1 13 07 6

b.

4.5a.

b.

6a.

b.

8a.

b.

2nd through 5th interviews –Enter the next available policy

number 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 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 was

your total expense for this insurance policy?

Enter the actual amount the CU paid, do not include

any 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 the

insurance 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 to

next

policy



0230 1 Yes 2 No0240 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 to

next

policy



0230 1 Yes 2 No0240 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

DescriptiInsuranc

0030

DescriptiDescripti

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 70 FORM CE-302

Section 14 – Part A.1

8 14 00 4

PROCESSING USE ONLY

1.2a.

b.

0010

FIELD REPRESENTATIVE – Complete questions 

Complete part C for 

Complete columns i through m in the "Health Insurance Policy Inventory Chart" below for each policy previously reported, except

policies 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 your

CU) 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 

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

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

H H I PD L I A

H H I CO D EA

H H I PRO U T
FORM CE-302

Page 71 

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 a

© 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 – HOSPITALIZATION AND HEALTH INSURANCE – Continued

Part B – Detailed Questions

Page 72 FORM CE-302

Section 14 – Part B

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 in

policy 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 payments

made on this policy?

0130 1 Yes 2 No – Go to

next policy

Was each payment in the amount of (regular payment amount

reported 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 0

What was the total expense paid for this policy?

0010 Number 0010 

.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 4c

Go to 5

4 – Other special purpose plan

Go to item 5 



12

0030006200630064

YesNo Go to item 5 



12123

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 –G

o

t

o

5

x

0061

23

Go to 4c

Go to 5

Go to item 5 



12

0030006200630064

YesNo Go to item 5 



12123

456 Specify

0020 1

Insurance compan

0060 Nu0070 10090 1

2

0100 1 Yes 0110

$

0120 1

234

Week2 weeksMonthQuarter

0130 1 Yes 0140 1 Yes 0150 0160

$

0170 1 Yes 0180

$

1 Blue C

2 34

1 Go to 4

0061

23

Go to 4

Go to 5

Go t



12

0030006200630064

YesNo 



12123

56 

.00

3 – Commercial Medicare Supplement

H H I PD L I B

H H I ST A T B

H H I BCBS

H H I CO V Q

H H I CO D E

H H I PO S

H H I FEET

H H I SPECT

H H I GRO U P

H H I PRM PD

H H I PRD ED

H H I RPM X B

H H I CPM T B

H H I RPM PD

H H I RPM T B

H H I Q PM T B

H H I I RGX B

H H I CM EX B

H H I CM X X B
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued

Part B – Detailed Questions

FORM CE-302 Section 14 – Part B

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 in

policy 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 payments

made on this policy?

0130 1 Yes 2 No – Go to

next policy

Was each payment in the amount of (regular payment amount

reported 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 1

What was the total expense paid for this policy?

0010 Number 0010 

.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 4c

Go to 5

4 – Other special purpose plan

Go to item 5 



12

0030006200630064

YesNo Go to item 5 



12123

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 4c

Go to 5

Go to item 5 



12

0030006200630064

YesNo Go to item 5 



12123

456 Specify

0020 1

Insurance compan

0060 Nu0070 10090 1

2

0100 1 Yes 0110

$

0120 1

234

Week2 weeksMonthQuarter

0130 1 Yes 0140 1 Yes 0150 0160

$

0170 1 Yes 0180

$

1 Blue C

2 34

1 Go to 4

0061

23

Go to 4

Go to 5

Go t



12

0030006200630064

YesNo 



12123

56 

.00

Page 73 

3 – Commercial Medicare Supplement
Page 74 

FORM CE-302

Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – ContinuedPart 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 Federal

Health 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 REPRES

3. Are you (or any members of your CU) covered by any plan other

than Medicare or Medicaid which provides free health care suchas CHAMPUS or military health care?

0050 1

2

YesNo

H H M CREN R

H H M CRCO V

M D CD EN R

M D CD CO V

O T H PL A N
FORM CE-302

Page 75 

NOTES
Section 15 – MEDICAL AND HEALTH EXPENDITURES

Part A – Screening Questions forPayments

Page 76 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

ENTER

ITEM

CODE

from

part A.

$ .00

0010 999 Go to

next

page

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are

no entries recorded in

part 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), have

you (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 care

services

DENTAL CARE INPATIENT HOSPITALCARE, such as

Hospital room 

Hospital services Combined hospital room

and services 

SERVICES BY MEDICALPROFESSIONALS OTHERTHAN PHYSICIANS PHYSICIAN SERVICES 

Combined hospital care

and physicians’ services 

ITEM

CODE YES NO

Payments

110120130200320410420430310

FIELD REPRESENTATIVE – Hand the respondent the In

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(sfor . . .?

If "No,"

go to

next item

in 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

M ED PCA RY

M ED PGFT C

M ED PM T M O

M ED PM T X
FORM CE-302

Page 77 

Section 15 – MEDICAL AND HEALTH EXPENDITURES – ContinuedPart A – Screening Questions forPayments – Continued

1.

0010

PROCESSING USE ONLY

a b

4 15 05 9

1 15 04 8

ENTER

ITEM

CODE

from

part A.

$ .00

0010 999 Go to

next

page

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are

no entries recorded in

part 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), have

you (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 medical

care services 

MEDICINE AND MEDICAL SUPPLIES, such as

Hearing aids 

Prescribed medicines orprescribed drugs Rental of supportive orconvalescent equipment Combined medicine and

medical supplies 

ITEM

CODE YES NO

Payments

510520530540620640650660610

FIELD REPRESENTATIVE – Hand the responden

heading and sub-cat

payments. Identical i

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(sfor . . .?

If "No,"

go to

next item

in 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 forReimbursements

Page 78 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

ENTER

ITEM

CODE

from

p

a

r

t

C

.

$ .00

0010 999 Go to

next

page

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are

no entries recorded in

part 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), have

you (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 care

services

DENTAL CARE INPATIENT HOSPITALCARE, such as

Hospital room 

Hospital services Combined hospital room

and services 

SERVICES BY MEDICALPROFESSIONALS OTHERTHAN PHYSICIANS PHYSICIAN SERVICES 

Combined hospital care

and physicians’ services 

ITEM

CODE YES NO

Reimbursements

110120130200320410420430310

FIELD REPRESENTATIVE – Hand the respondent the In

part C, question 1, followed 

part D for each reimbursem

SERVICE for the SAME PER

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 to

next item

in 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

M ED RCA RY

M ED RGFT C

M ED RM BM O

M ED RM BX
FORM CE-302

Page 79 

Section 15 – MEDICAL AND HEALTH EXPENDITURES – ContinuedPart C – Screening Questions forReimbursements – Continued

1.

0010

PROCESSING USE ONLY

a b

4 15 09 

1 15 08 9

ENTER

ITEM

CODE

from

part C.

$ .00

0010 999 Go to

next

page

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are

no entries recorded in

part 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), have

you (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 medical

care services 

MEDICINE AND MEDICAL SUPPLIES, such as

Hearing aids 

Prescribed medicines orprescribed drugs Rental of supportive orconvalescent equipment Combined medicine and

medical supplies 

ITEM

CODE

YES NO

Reimbursements

510520530540620640650660610

FIELD REPRESENTATIVE – Hand the respondent the In

heading and sub-categorie

identical 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 to

next item

in 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 80 FORM CE-302

Section 16

1.

0010

PROCESSING USE ONLY

a b

7 16 02 7

ENTER

ITEM

CODE

from

column a.

$ .00

4.

YES 

Information Booklet,

page 36.

FIELD REPRESENTATIVE – Hand the respondent the In

Month

1 

c d e

What was the expense for?Describe briefly the expense.

Who was it for?If CU member,

enter name and

line number from

Control Card. If

someone outside

CU, 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 this ambeen or any of reimbuby anemployagencyotherperson

If "No," 

column 

$ .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 you

pay for – 

b.

Tuition?Housing while attendingschool?Food or board whileattending school? Use only if unable to

separate – Combined

room and board

(Codes 310 and 320) 

300320330310

FIELDREPRESENTATIVECHECK ITEM

Mark (X) box if

there are no

entries recorded

in columns b–j.

999 Go to

next

page

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

EDUC_A Y EDUCGFTC

EDSCHL_A

EDMONTHA

EDEX OX AEDRE
FORM CE-302

Section 16 – EDUCATIONAL EXPENSES – Continued

Page 81 

0010

PROCESSING USE ONLY

a b

7 16 04 3

ENTER

ITEM

CODE

from

column a.

$ .00

4.

YES 

Information Booklet, page 36.

Month

1 

c d e

What was the expense for?Describe briefly the expense.

Who was it for?If CU member,

enter name and

line number from

Control Card. If

someone outside

CU, 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 this ambeen or any of reimbuby anemployagencyotherperson

If "No," 

column 

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

3b. Did you pay for – (Continued)

Other combined education

expenses (Include any

combined educational

expenses not previously

reported.) (Codes 100,

200, 300, 310, 320,

340–360) 

360380370

FIELDREPRESENTATIVECHECK ITEM

Mark (X) box if

there are no

entries recorded

in columns b–j.

999 Go to

next

section

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

Private school bus? Purchase of any schoolbooks, supplies, orequipment whichhas not already beenreported?Other school relatedexpenses not alreadyreported?Combined expenses for

books and tuition (Codes

300 and 350) 

Use only if the respondent

is unable to separate

expenses.
Page 82 

FORM CE-302

NOTES
FORM CE-302

Page 83 

NOTES
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS,

AND ENTERTAINMENT EXPENSES

Part A – Subscriptions and Memberships

Page 84 FORM CE-302

Section 17 – Part A

1.

0010

PROCESSING USE ONLY

a b

4 17 02 2

ENTER

ITEM

CODE

from

column a.

$ .00

3.

YES NO

FIELD REPRESENTATIVE – Ask column a and complet

Description f

column c

c d e

1

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

have you (or any members of your CU)purchased any of the following for yourown use?

ITEM

CODE YES NO

100

200

f g

2a.

b.

900

FIELDREPRESENTATIVECHECK ITEMMark (X) box if

there are no

entries recorded

in columns b–g.

999 Go to

next

page

0010

1 17 01 0

FIELD REPRESENTATIVE –

Read each item listed

below.

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

Have you (or any members of your CU)purchased any of these as a gift tosomeone outside the CU?If YES –

Complete a separate line for each

gift purchased.

Whatwaspurchased?

YES NO – Go to item 3

Item code(s)

0020003000400050006000700080009001000110012001300140015001600170018001900200

What is the name of the

(subscription, club, or

organization reported

in column a)?

Enter name such as "Daily

News," "Redbook," "Columbia

Record Club," and "Book of the

Month Club."

Mark (X)

the

appropriate

box.

OWN

USE GIFT

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?

None

00000000000000000000

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

.00

Did youpurchaseanyother. . .?If "No," go

to next item

in column a.

S1 7 CODEA

S1 7 GFTCA

S1 7 PURX A

S1 7 CMEX X
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS,

AND ENTERTAINMENT EXPENSES – Continued

Part A – Subscriptions and Memberships – Continued

Page 85 FORM CE-302

4.

0010

PROCESSING USE ONLY

a b

4 17 04 8

ENTER

ITEM

CODE

from

column a.

$ .00

6.

YES NO

FIELD REPRESENTATIVE – Ask column a and complet

Description f

column c

c d e

1

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 or

membership in religious, professional,

business, or other tax deductible

organizations.

ITEM

CODE YES NO

800

810

f g

5a.

b.

FIELDREPRESENTATIVECHECK ITEMMark (X) box if

there are no

entries recorded

in columns b–g.

999 Go to

the

next

section

0010

1 17 03 6

FIELD REPRESENTATIVE –

Read each item listed

below.

Country clubs, healthclubs, swimming pools,tennis clubs, social orother recreationalorganizationsCivic, service, orfraternalorganizationsCredit cardmembershipsAutomobile serviceclubs

820830

Have you (or any members of your CU)purchased any memberships as a gift tosomeone outside the CU?If YES –

Complete a separate line for each

gift membership.

Whatmembershipswerepurchased?

YES NO – Go to item 6

Item code(s)

0020003000400050006000700080009001000110012001300140015001600170018001900200

What is the name of the

(subscription, club, or

organization reported

in column a)?

Enter name such as "Jaycees,"

"Kent Swim and Country

Club," and "Amoco Motor

Club."

Mark (X)

the

appropriate

box.

OWN

USE GIFT

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 thisamount was paidthis month?

None

00000000000000000000

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

.00

Did youpurchaseanyother. . .?If "No," go

to next item

in column a.

NOTES
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS, AND ENTERTAINMENT EXPENSES – Continued

Part B – Books and Entertainment Expenses

Page 86 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 members

of 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 or

school 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 – 

G

o

t

o

i

t

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

SPORTFEE

SPORTFEEX

SPFEECMX

SPORTA DM

SPORTA DX

SPRTA DX C

RECA DMIT

RECA DMX

RECA DMX C

OTHBOOK S

OTHBOOK X

OTHBK X CM

I

MA GA Z X

MA GA Z INE

MA GA Z X CM

NEWSPA PR

NEWSPPRX

NEWSPPX C

RECORDYN

RECORDX

RECORDX M

FILM

FILMX

FILMX CM

FILMPRCS

FLMPRCSX

FLMPRX CM
FORM CE-302

Page 87 

NOTES
Section 18 – TRIPS AND VACATIONS

Part A – Screening Questions

b. If YES – How many trips like this did you have?

3a.

FIELD REPRESENTATIVE –

Page 88 FORM CE-302

Section 18 – Part A

(Other than the trips you already mentioned,) Since the1st of (month, 3 months ago), have you (or any members

of 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 any

members 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 

Identical tri

reimbursed 

1 18 01 8

Go to item 2

Complete items 8e–8i

for each trip checked

in 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 members

of 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 members

of 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 members

of 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 members

of 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 

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)

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 on

Go to

item 2

Go to

item 4a

Go to

item 5a

Go to

item 6a

Go to

item 7a

Go to

item 9

Ho

y

o

t

(If 

ite

(If 

0 Not ended – tr

Go to next

trip

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 –

ba

Line

No.

Trip

not

ended

1

24

(If 

ite

(If 

Not ended – trGo to next

trip

Month

(If 

ite

(If 

Not ended – trGo to next

trip

Month

(If 

ite

(If 

Not ended – trGo to next

trip

Month

3

45123451234512345

000

A NYOUTSD

NUMOUTSD

A NYRELS

NUMRELS

A NYBSNS

NUMBSNS

A NYREC

NUMREC

A NYOTHER

NUMOTHER

A NYTRP7 5

NUMTRP7 5

TRIPLINE TYPETRIP ENDTRPMO 
Section 18 – TRIPS AND VACATIONS – Continued

Part A – Screening Questions – Continued

Page 89 FORM CE-302

1

Month

1 18 02 6

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 

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

D

th

121212

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 BComplete part BComplete part B

Complete part CComplete part CComplete part C

Complete part B CompletComplete part BComplete part BComplete part B

CompletCompletComplet

Trip paid for

entirely by CU

(from column h)

Trip partially 

by non-CU 

(from col

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 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU

1 18 34 9

FIELD REPRESENTAT

Page 90 FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read

Since you (your CU) took a set of

similar 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 Tally

Chart in part A. Enter trip

destination in item 1b, the

number of (identical) trips

in item 1c, and the month

the trip ended in item 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. How much did you (or any members of your CU) pay for the

package deal?

OFFICE USE ONLY

Nights

b. I

f

"

Y

e

s

,

"

a

s

k

f

o

r

e

a

c

h

Did the package deal include . . .

F

I

E

L

D

R

E

P

R

E

S

E

N

T

A

T

0070008000900100

2 X

1 2 X

1 2 X1 2 X

0030 Number

Yes No DK

Starting at the beginning of this all the kinds of transportation yoof your CU) used from the time yto the time you (they) got back h

3a.

Hand respondent Information Book

PROBE – Any other kinds of trans

trip?

If no codes 1–12 marked, go to item 

COMMERCIA

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 eOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marke

If any codes 6–17 mark

4.

Section 18 – Part B

NOTES

Specify

TRIPIDBC

TRIPDEST

NUMSA ME

NUMNIGHT

PK GTRIP

FOODDEA L

LODGDEA L

TRA NDEA L

ELSEDEA L

PK GTRIPX

CMPLA 

CMTRA 

CMBUSY

CMLO

CMBUS

CMSHIP

RTCA RY

RTTRUCK Y

RTM

RTPLA 

RTBOA T

RTCA MP

RTOTHE

PVC

PV

PVTRA 

EOTRIPMO
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely by CU – Continued

Page 91 FORM CE-302

While on the trip did you (or any members of your 0010 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.

1 18 35 6

5a.

0020

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.)

0030

.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?

0040 .00

$

0060 .00

$

0050 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)?

0080 .00

$

0070 1

2

YesNo – Go to item 7a

0100 .00

$

0090 1

2

YesNo – Go to item 8a

0120 .00

$

0110 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.

0140 .00

$

0160 .00

$

0150 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)? (Hand

respondent Information Booklet, page 38.)

0130 1

2

YesNo – Go to item 9a

0180 .00

$

0170 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

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 respondent

Information Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

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?

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 . . .? 

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 not

able 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 TR

b.

A NYGA S

GA SOILX

A NYTOLL

TRPTOLLX

A NYPA RK

PA RK INGX

LODGING

LDGCOSTX

TRPFOOD

TRPA LCHX

TRPFOODX

TRPA LCIN

A NYGROC

TRPGROCX

A NYA LC

TRPA LCGX

A NYSPEQP

TRSPRTX

FOODOUTS

LODGOUTS

TRA NOUTS

ELSEOUTS

FOODCOMB

LODGCOMB

TRA NCOMB

ELSECOMB

OTHRCOMB
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU – Continued

1 18 36 4

FIELD REPRESENTAT

Page 91a FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set of

similar 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 Tally

Chart in part A. Enter trip

destination in item 1b, the

number of (identical) trips

in item 1c, and the month

the trip ended in item 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 all the kinds of transportation yoof your CU) used from the time yto the time you (they) got back h

3a.

Hand respondent Information Book

PROBE – Any other kinds of trans

trip?

If no codes 1–12 marked, go to item 

COMMERCIA

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 eOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marke

If any codes 6–17 mark

4.

Section 18 – Part B (Continued)

NOTES

Specify
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely by CU – Continued

Page 91b FORM CE-302

While on the trip did you (or any members of your 0010 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.

1 18 37 2

5a.

0020

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.)

0030

.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?

0040 .00

$

0060 .00

$

0050 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)?

0080 .00

$

0070 1

2

YesNo – Go to item 7a

0100 .00

$

0090 1

2

YesNo – Go to item 8a

0120 .00

$

0110 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.

0140 .00

$

0160 .00

$

0150 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)? (Hand

respondent Information Booklet, page 38.)

0130 1

2

YesNo – Go to item 9a

0180 .00

$

0170 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

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 respondent

Information Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

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?

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 . . .? 

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 not

able 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 TR

b.
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU – Continued

1 18 38 0

FIELD REPRESENTAT

Page 91c FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set of

similar 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 Tally

Chart in part A. Enter trip

destination in item 1b, the

number of (identical) trips

in item 1c, and the month

the trip ended in item 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 all the kinds of transportation yoof your CU) used from the time yto the time you (they) got back h

3a.

Hand respondent Information Book

PROBE – Any other kinds of trans

trip?

If no codes 1–12 marked, go to item 

COMMERCIA

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 eOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marke

If any codes 6–17 mark

4.

Section 18 – Part B (Continued)

NOTES

Specify
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely by CU – Continued

Page 91d FORM CE-302

While on the trip did you (or any members of your 0010 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.

1 18 39 8

5a.

0020

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.)

0030

.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?

0040 .00

$

0060 .00

$

0050 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)?

0080 .00

$

0070 1

2

YesNo – Go to item 7a

0100 .00

$

0090 1

2

YesNo – Go to item 8a

0120 .00

$

0110 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.

0140 .00

$

0160 .00

$

0150 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)? (Hand

respondent Information Booklet, page 38.)

0130 1

2

YesNo – Go to item 9a

0180 .00

$

0170 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

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 respondent

Information Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

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?

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 . . .? 

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 not

able 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 TR

b.
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely By CU – Continued

1 18 40 6

FIELD REPRESENTAT

Page 91e FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set of

similar 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 Tally

Chart in part A. Enter trip

destination in item 1b, the

number of (identical) trips

in item 1c, and the month

the trip ended in item 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 all the kinds of transportation yoof your CU) used from the time yto the time you (they) got back h

3a.

Hand respondent Information Book

PROBE – Any other kinds of trans

trip?

If no codes 1–12 marked, go to item 

COMMERCIA

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 eOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marke

If any codes 6–17 mark

4.

Section 18 – Part B (Continued)

NOTES

Specify
Section 18 – TRIPS AND VACATIONS – Continued

Part B – Trips Paid Entirely by CU – Continued

Page 91f FORM CE-302

While on the trip did you (or any members of your 0010 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.

1 18 41 4

5a.

0020

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.)

0030

.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?

0040 .00

$

0060 .00

$

0050 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)?

0080 .00

$

0070 1

2

YesNo – Go to item 7a

0100 .00

$

0090 1

2

YesNo – Go to item 8a

0120 .00

$

0110 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.

0140 .00

$

0160 .00

$

0150 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)? (Hand

respondent Information Booklet, page 38.)

0130 1

2

YesNo – Go to item 9a

0180 .00

$

0170 1

2

YesNo – Go to item 10a

b.

If YES –How much did you (or any members of your CU) pay?

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 respondent

Information Booklet, page 40.)

b.

If YES –How much did you (or any members of your CU) spend?

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?

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 . . .? 

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 not

able 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 TR

b.
Section 18 – TRIPS AND VACATIONS – Continued

Part C – Partially Reimbursed Trips

1 77 01 4

FIELD REPRESENTATIVE –

Page 92 FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read

Since you (your CU) took a set of

similar 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 p

identical trips b

a.

b.

c.

1.

In item 1a, enter Trip I.D.

number from Trip Tally

Chart in part A. Enter trip

destination in item 1b, the

number of (identical) trips

in item 1c, and the month

the trip ended in item 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 next

questions I’m interested only in the costs you (your CU) had topay, not those paid or to be paid by a business or employer. 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 all the kinds of transportation yoof your CU) used from the time yto the time you (they) got back h

3a.

Hand respondent Information Book

PROBE – Any other kinds of trans

trip?

If no codes 1–12 marked, go to item 

COMMERCIA

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 eOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marke

If any codes 6–17 mark

4.

Section 18 – Part C

NOTES

Specify

TRIPIDBC

TRIPDEST

NUMSA ME

NUMNIGHT

PK GTRIP

FOODDEA L

LODGDEA L

TRA NDEA L

ELSEDEA L

PK GTRIPX

CMPLA 

CMTRA 

CMLO

CMBUS

CMSHIP

RTCA RY

RTTRUCK Y

RTM

RTPLA 

RTBOA T

RTCA MP

RTOTH

PV

PV

PVTRA 

EOTRIPMO
Section 18 – TRIPS AND VACATIONS – Continued

Part C – Partially Reimbursed Trips – Continued

Page 93 FORM CE-302

While on the trip did you (or any members of your 0010 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.

1 77 02 2

5a.

0020

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees 

sports or exercise (not counting what the package covered)? (Hand respondent Information Booklet, page 

0030

.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?

0040 .00

$

0060 .00

$

0050 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)?

0080 .00

$

0070 1

2

YesNo – Go to item 7a

0100 .00

$

0090 1

2

YesNo – Go to item 8a

0120 .00

$

0110 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 alcoholic

beverages?

c.

If YES –What costs for alcoholic beverages, including taxesand tips, won’t be reimbursed?

d.

0140 .00

$

0160 .00

$

0150 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 bereimbursed?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Hand

respondent Information Booklet, page 38.)

0130 1

2

YesNo – Go to item 9a

0180 .00

$

0170 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 anythi

this trip for entertainment or admissions (not counwhat the package deal covered)? (Hand respondent

Information Booklet, page 40.)

b.

If YES –What costs for entertainment and admissions wonreimbursed?

12a. Did you (or any members of your CU) have any exp

for this trip such as for souvenirs, passports, touribooklets, and so on?

b.

If YES –What costs for these things won’t be reimbursed?

13a. You’ve told me about many non-reimbursed expen

(your CU) had on this trip. Were any of these expenyou 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 fo

this trip were for persons outside your CU?

14a. If the respondent is unable to break down food and beve

lodging, transportation, other expenses, or expenses for 

enter the expenses that won’t be reimbursed. Only thos

non-reimbursed expenses a respondent is not able to br

down should be combined and entered here

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTE

0 None0 None0 None0 None0 None0 None0 None0 None0 None

b.

A NYGA S

GA SOILX

A NYTOLL

TRPTOLLX

A NYPA RK

PA RK INGX

LODGING

LDGCOSTX

TRPFOOD

TRPA LCHX

TRPFOODX

TRPA LCIN

A NYGROC

TRPGROCX

A NYA LC

TRPA LCGX

A NYSPEQP

TRSPRTX

TRA N

LODG

FOO

ELS

OTHR

ELSE

TRA 

LODG

FOOD
Section 18 – TRIPS AND VACATIONS – Continued

Part C – Partially Reimbursed Trips – Continued

1 77 03 0

FIELD REPRESENTATIVE –

Page 93a FORM CE-302

FIELD REPRESENTATIVEITEMIf set of identical trips read – Since you (your CU) took a set of

similar 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 p

identical trips b

a.

b.

c.

1.

In item 1a, enter Trip I.D.

number from Trip Tally

Chart in part A. Enter trip

destination in item 1b, the

number of (identical) trips

in item 1c, and the month

the trip ended in item 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 next

questions I’m interested only in the costs you (your CU) had topay, not those paid or to be paid by a business or employer. 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 all the kinds of transportation yoof your CU) used from the time yto the time you (they) got back h

3a.

Hand respondent Information Book

PROBE – Any other kinds of trans

trip?

If no codes 1–12 marked, go to item 

COMMERCIA

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 eOther transport

1314151617

02400250026002700280

Codes 6–17: If no codes 6–17 marke

If any codes 6–17 mark

4.

Section 18 – Part C (Continued)

NOTES

Specify
Section 18 – TRIPS AND VACATIONS – Continued

Part C – Partially Reimbursed Trips – Continued

Page 93b FORM CE-302

While on the trip did you (or any members of your 0010 CU) stop to buy any gasoline, oil, diesel fuel, or anyother fuels?

6a.

1 77 04 8

5a.

0020

12

YesNo – Go to item 5c

10a. Did you (or any members of your CU) pay any fees 

sports or exercise (not counting what the package covered)? (Hand respondent Information Booklet, page 

0030

.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?

0040 .00

$

0060 .00

$

0050 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)?

0080 .00

$

0070 1

2

YesNo – Go to item 7a

0100 .00

$

0090 1

2

YesNo – Go to item 8a

0120 .00

$

0110 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 alcoholic

beverages?

c.

If YES –What costs for alcoholic beverages, including taxesand tips, won’t be reimbursed?

d.

0140 .00

$

0160 .00

$

0150 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 bereimbursed?

9a. Did you (or any members of your CU) have any

expenses for rental of sports equipment (notcounting what the package deal covered)? (Hand

respondent Information Booklet, page 38.)

0130 1

2

YesNo – Go to item 9a

0180 .00

$

0170 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 anythi

this trip for entertainment or admissions (not counwhat the package deal covered)? (Hand respondent

Information Booklet, page 40.)

b.

If YES –What costs for entertainment and admissions wonreimbursed?

12a. Did you (or any members of your CU) have any exp

for this trip such as for souvenirs, passports, touribooklets, and so on?

b.

If YES –What costs for these things won’t be reimbursed?

13a. You’ve told me about many non-reimbursed expen

(your CU) had on this trip. Were any of these expenyou 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 fo

this trip were for persons outside your CU?

14a. If the respondent is unable to break down food and beve

lodging, transportation, other expenses, or expenses for 

enter the expenses that won’t be reimbursed. Only thos

non-reimbursed expenses a respondent is not able to br

down should be combined and entered here

Does this (amount) include anything for . . .? FIELD REPRESENTATIVE – Read each item listed.

GO TO NEXT TRIP; AFTE

0 None0 None0 None0 None0 None0 None0 None0 None0 None

b.
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 by

NON-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 for

by 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 94 FORM CE-302

Section 18 – Part D

FIELD REPRESENTATIVE – C

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

NUMYUPD

A NYYUPD

FOODYUPD

LODGYUPD

TRA NYUPD

ELSEYUPD

TOTYUPDX
FORM CE-302

Page 95

Section 18 – TRIPS AND VACATIONS – ContinuedPart 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 your

CU) 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 – A

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

A NYNONCU

NUMNONCU

FOODNOCU

LODGNOCU

TRA NNOCU

ELSENOCU

TRNONCUX
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 of

your CU) stayed overnight in a local hotel or motel?

b.

0020 Nights0010 1

2

YesNo – Go to next section

0050

1111

Page 96 FORM CE-302

Section 18 – Part F

FIELD REPRESENTATIVE – Ask part F for all CU’s. 

(Ask all questions in this pa

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

beverages?

d. What was the cost for alcoholic 

including taxes?

b. What were the expenses, includi

6a. Did you (or any members of your 

anything for food or beverages aconvenience stores, or liquor sto

b. How much did you (or any memb

7a. (Hand respondent Information Book8. If the respondent is unable to break 

beverages, lodging, entertainment, o

these expenses. Only those expense

able to break down should be comb

Did the (amount) include anything FIELD REPRESENTATIVE – Read eac

9. Did you (or any members of your 

stays at local hotels or motels? Did you (or any members of your on this stay for entertainment or counting what the package deal 

Food and beverages ...........Lodging .....................Entertainment ................Anything else – Specify

.00.00.00

A NYLOC

NUMLOC

A NYLOCDL

FOODLCDL

ENTRLCDL

ELSELCDL

LOCDEA LX

A NYLODGE

LOCMEA LX

A NYMEA L

A NYA LCML

A LCMEA LX

LODGLCDL

LOCLODGX
FORM CE-302

Page 97 

Section 18 – TRIPS AND VACATIONS – ContinuedPart 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 of

your 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 pa

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

beverages?

d. What was the cost for alcoholic 

including taxes?

b. What were the expenses, includi

6a. Did you (or any members of your 

anything for food or beverages aconvenience stores, or liquor sto

b. How much did you (or any memb

7a. (Hand respondent Information Book8. If the respondent is unable to break 

beverages, lodging, entertainment, o

these expenses. Only those expense

able to break down should be comb

Did the (amount) include anything FIELD REPRESENTATIVE – Read eac

9. Did you (or any members of your 

stays at local hotels or motels? Did you (or any members of your on this stay for entertainment or counting what the package deal 

Food and beverages ...........Lodging .....................Entertainment ................Anything else – Specify

.00.00.00
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 98 FORM CE-302

Section 19

FIELD REPRESENTATIVE – Hand the respondent the 

you proceed. Ask column 

continuing expenses such 

enter the total expense fo

a

Information Booklet, pages 41 and 42

2. FIELD 1 19 01 6

REPRESENTATIVECHECK ITEMMark (X) box if there

are no entries recorded 

in columns b

–

g.

0010

0010 999 Go to

next

page

ITEM

CODE YES NO

What was the expense for?Describe briefly.

PROCESSING USE ONLY

b

002000300040005000600070008000900100011001200130014001500160017001800190020002100220

c

ENTER

ITEM

CODE

from

column a.

d

In what month didyou have thisexpense?If it is a continuous

expense throughout

the 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 continuing

expenses, do not

include expenses for

the 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 fees

related to real estate

closing costs which were

reported 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’shome Care for invalids,convalescents, handicappedor elderly persons in thehome Other home services andsmall repair jobs aroundthe house, not previouslyreported 

100110120130140150160170180190220200210

Use only if cannot itemize

the above 

ADULT DAY CARE CENTERS 350

2 – For someone

outside your CU

PROFESSIONALPHOTOGRAPHY FEESHOME SECURITYSYSTEM SERVICE FEES

360370

MISCCODE

MISCMO

MISCGFTC

MISCEX PX
FORM CE-302

Page 99 

Section 19 – MISCELLANEOUS EXPENSES – Continued

4 19 04 4

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

ago), have you (or any members of

your 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 if

there are no

entries recorded

in columns b–g.

0010

0010 999 Go to

section

20

ITEM

CODE YES NO

What was the expense for?Describe briefly.

PROCESSING USE ONLYb

002000300040005000600070008000900100011001200130014001500160017001800190020002100220

c

ENTER

ITEM

CODE

from

column a.

d

In what month didyou have thisexpense?If it is a continuous

expense throughout

the 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 continuing

expenses, do not

include expenses

for the 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 . . .?

TV COMPUTERGAMES ANDCOMPUTER GAMESOFTWAREHAND HELDCOMPUTERGAMES ANDCOMPUTER BOARDGAMESTOYS ANDGAMESHOBBIESMOVING, STORAGE,AND FREIGHTEXPRESSPURCHASE OFPETS, PETSUPPLIES, ANDMEDICINEFOR PETS PET SERVICES VETERINARIANEXPENSESFOR PETS ALIMONYCHILDSUPPORTMONEY GIVEN TONON-CU MEMBERS,CHARITIES, ANDOTHERORGANIZATIONS

290300330340230240250260310320270

COMPUTERINFORMATIONSERVICES 280
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 your

usual WEEKLY expense at the grocery store or supermarket?

b.

Page 100 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 home delivery, specialty stores, bakeries, conveniencestores, dairy stores, vegetable stands, or farmers’ markets?Include any large purchases made for freezing or canning.

.00

$

0030 1

2

YesNo – Go to item 3a

0150 1

234

1 month2 months3 months4 months

0 None – Go to item 2a

0010

1a.

$

0 None

0020

b. What was your usual WEEKLY expense at these places?

3a. Do you (or any members of your CU) ever buy 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

alcoholic beverages in restaurants, taverns, or cocktaillounges?

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 dinners,

other meals or snacks in restaurants, cafeterias, cafes,drive-ins, 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 not

received in a boarding house? 0120 1

2

YesNo – Go to item 7a

b. What was the usual MONTHLY expense?

$ 0130

7a. Have you (or any members of your CU) received any food

stamps? 0140 1

2

YesNo – Go to item 8

b. For how many months since the 1st of (month, 3 months ago),

were food stamps received?

$ 0160

c. What was the value of all food stamps received?

b. If YES – What are the names of all CU members who 

meals at school?

Enter the name of each CU member purchasing meals at 

column a, then ask columns b through d for each name e

8.

Have you (or any members of your CU) received any beverages, or meals through public or private welfaagencies, including religious organizations? Do not 

meals in school or preschool programs.

Ask only if preschool or school age students; otherwise m

10a. 

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

have you (or members of your CU) purchased any mschool or in a preschool program for preschool or schildren?

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

at work as part of your pay? 

b. About what was the WEEKLY dollar value of such mc. Since the 1st of (month, 3 months ago), how many we

members of your CU receive such meals?

3 20 02 8

001000200030004000500060007000800090

PROCESSING USE ONLY

a

Name

.00.00.00.00.00.00.00.00

GROCWEK X

OTHSTUFX

OTHSTOR

OSTORWK X

A LCOHOL

BRWINMOX

OTHA LMOX

A LC_OUT

A LC_OUTX

DINEOUT

DINE_MOX

BOA RD

BOA RDX

FD_STA MP

FD_STPRD

FD_STMPX
FORM CE-302

Page 101 

Section 20 – EXPENSE PATTERNS FOR FOOD, BEVERAGES, AND OTHER SELECTED ITEMS – ContinuedPart 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) used public pay phoneservice?

0010 1

2

0020 $

YesNo – Go to item 2a

0 None

b. What was the total expense?

2a. Have you (or any members of your CU) used coin-operated

laundry or dry cleaning machines?

0030 1

2

0040 .00 $

YesNo – Go to item 3a

b. What was the total cost for these machines?c. Was any of this amount for items other than clothes? 0050 1

2

YesNo – Go to item 3a

d. How much?

0060 $

X Don’t know

3a. Have you (or any members of your CU) sent clothes or other

items to the dry cleaners or laundry?

0070 1

2

0080 $

YesNo – Go to item 4a

b. What was the total cost for dry cleaning or laundry services?c. Was any of this amount for items other than clothes? 0090 1

2

YesNo – Go to item 4a

d. How much?

0100 $

X Don’t know

4. Do any members of your CU use tobacco products, such as – 0110 1

2

0120 $

YesNo – Go to item 4c

a. Cigarettes?b. If YES – What is the usual WEEKLY expense for cigarettes?

0130 1

2

YesNo – Go to item 5

c. Cigars, pipe tobacco, or other tobaccos, including chewing

tobacco?

0150 $

0 None

d. If YES – What is the usual WEEKLY expense for cigars, pipe

tobacco, or other tobaccos? 0140 $

5. What is the usual MONTHLY expense for haircutting, styling,

and other related services for all members of your CU?

6a. Do you (or any members of you

located in a bank or a similar fi

b. What was the total rental expe

since the 1st of (month, 3 month

7a. Do you (or any members of you

checking accounts or other ban

b. What is the usual MONTHLY ch

8a. Since the 1st of (month, 3 month

members of your CU) used taxinonbusiness purposes, except 

b. If YES – What was the total expe

9a. Do you (or any members of you

services such as a bus, subwaycommuter bus and train servic

b. What is the usual MONTHLY co

to go to –

(1) Work? (2) School? (3) Other places? 

.00.00.00.00.00.00.00

PA YPHONE

PA YPHONX

LNDROMA T

LNDRYX

OTHLNDRY

OTHLNDRX

DRYCLEA N

DRYCLNX

OTHDRCLN

OTHDCLNX

CIGA RETX

OTHTOBA C

OTHTBA CX

CIGA RETT

HA IRMOX
Section 21 – CREDIT LIABILITY

Part A.1 – Credit Balances – Second Quarter Only

Page 102 FORM CE-302

Section 21 – Part A

1.

0010

PROCESSING USE ONLY

a b c d

1 21 02 0

On the 1st of (the current month), did you (or any

members of your CU) owe any money to any ofthe following? Do not include mortgage, home equity

loans, automobile loans, or business related loans.

Read each item listed below. Complete a separate line

for 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 not

include insurance

premium payments) .............

Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance ..................Other credit sources ............

100

200300400500600700800

ENTER

ITEM

CODE

from

column a

What is the name of the (credit source)to which you owe money?Enter name of store, credit card, finance

company, bank, credit union, insurance

company, etc.

FIELD REPRESENTATIVE – Complete columns 

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 

Did any myour CU omoney to 

(credit souIf "No," go 

credit sour

column a.

X

0010 999 Go to

next

section

2. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are no entries

recorded in columns b–e.

XXXXXXXXXXXXXX

CREDITR1

CREDITX 1
Section 21 – CREDIT LIABILITY – Continued

Part A.1 – Credit Balances – Continued – Second Quarter Only

Page 103 FORM CE-302

0010

PROCESSING USE ONLY

a b c 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 not

include insurance

premium payments) .............

Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance ..................Other credit sources ............

100

200300400500600700800

ENTER

ITEM

CODE

from

column a

What is the name of the (credit source)to which you owe money?Enter name of store, credit card, finance

company, bank, credit union, insurance

company, etc.

FIELD REPRESENTATIVE – Complete columns 

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 

Did any myour CU omoney to 

(credit souIf "No," go 

credit sour

column a.

XXXXXXXXXXXXXXX

Skip to Section 22A

$
Section 21 – CREDIT LIABILITY

Part A.2 – Credit Balances – Fifth Quarter Only

Page 104 FORM CE-302

Section 21 – Part A

1.

0010

PROCESSING USE ONLY

a b c d

1 21 11 1

On the 1st of (the current month), did you (or any

members of your CU) owe any money to any ofthe following? Do not include mortgage, home equity

loans, automobile loans, or business related loans.

Read each item listed below. Complete a separate line

for 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 not

include insurance

premium payments) ...........

Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance ...............Other credit sources .........

100

200300400500600700800

ENTER

ITEM

CODE

from

column a

What is the name of the (credit source)to which you owed money?Enter name of store, credit card, finance

company, bank, credit union, insurance

company, etc.

FIELD REPRESENTATIVE – Complete columns 

Ask if "Yes" in item 1.$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

Don’tknow 

X

0010 999 Go to

part B

3. FIELD REPRESENTATIVE

CHECK ITEMMark (X) box if there are no

entries recorded in columns b–f.

XXXXXXXXXXXXXX

What on th

year a

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

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 source

reported.

How much was owed to(credit source)? CREDITX 5

CREDITR5
Section 21 – CREDIT LIABILITY – Continued

Part A.2 – Credit Balances – Continued – Fifth Quarter Only

Page 105 FORM CE-302

0010

PROCESSING USE ONLY

a b c d

1 21 12 9

ITEM

CODE

002000300040005000600070008000900100011001200130-1400150

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 not

include insurance

premium payments) .............

Doctors, dentists, hospitals, orother medical practitioners forexpenses not coveredby insurance ..................Other credit sources ............

100

200300400500600700800

ENTER

ITEM

CODE

from

column a

What is the name of the (credit source)to which you owed money?Enter name of store, credit card, finance

company, bank, credit union, insurance

company, etc.

FIELD REPRESENTATIVE – Complete columns 

Ask if "Yes" in item 1.$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00$ .00

Don’tknow 

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ What on the 

year a

XXXXXXXXXXXXXXX

How much was owed to(credit source)?
Section 21 – CREDIT LIABILITY – Continued

Part B – Finance Charges – Fifth Quarter Only

Page 106 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 

months 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?

CREDCA RD

CRDCA RDX

INSTA LL

INSTA LLX

BA NK

BA NK X

CRDUNION

CDUNIONX

FINA NCE

FININT

INSURE

INSUREX

MEDICA L

MEDICA LX

OTHER

PDOTHERX
Page 107 

FORM CE-302

NOTES
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 name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 108 FORM CE-302

Section 22 – Part A

FIELD REPRESENTATIVE – Ask a separate page of part 

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00

$

0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

During the past 12 months, did . . .receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

0230 .00

$

12

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00

$

0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00

$

0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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.

0220

a.

M EM BN O

I N CW EEK Q

O CCU CO D E

I N C_H RSQ

I N CO M EY

I N CO RP

I N CN O N W K

SA L A RY ST

SA L A RY X

N O N FA RM

N O N FA RM X

N FRM L O SS

FA RM I N C

FA RM IN CX

FA RM L O SS

SO CSECI N

RRRET IRX

I N CM ED CR

SS_RRQ

RRRET I N C
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 name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 109 FORM CE-302

FIELD REPRESENTATIVE – Ask a separate page of part 

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

During the past 12 months, did . . .receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

0230 .00 $

12

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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.

0220

a.
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 name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 110 FORM CE-302

Section 22 – Part A (Continued)

FIELD REPRESENTATIVE – Ask a separate page of part 

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

During the past 12 months, did . . .receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

0230 .00 $

12

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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.

0220

a.
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued

1. 1 22 16 8 FIELD REPRESENTATIVE

ITEMEnter the first name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 111 FORM CE-302

FIELD REPRESENTATIVE – Ask a separate page of part 

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

During the past 12 months, did . . .receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

0230 .00 $

12

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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.

0220

a.
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 name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 112 FORM CE-302

Section 22 – Part A (Continued)

FIELD REPRESENTATIVE – Ask a separate page of part 

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

During the past 12 months, did . . .receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

0230 .00 $

12

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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.

0220

a.
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 name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 113 FORM CE-302

FIELD REPRESENTATIVE – Ask a separate page of part 

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

During the past 12 months, did . . .receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

0230 .00 $

12

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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.

0220

a.
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part B – Second Quarter, Fifth Quarter or New Consumer Units – Ask for entire CU as a group.

Page 114 FORM CE-302

Section 22 – Part B

1 22 97 8

0005

.00 $

1. During the past 12 months, did you

(or any members of your CU) receiveincome from any of the following –Income from unemploymentcompensation?If YES – What was the total amount

received by ALL CU members?Income from worker’s compensationor veteran’s benefits includingeducation benefits, but excludingmilitary retirement?

a.b.c.

12

YesNo – Go to item 1b

0020

FIELD 

PROCESSING USE

ONLY

0025

.00 $

12

YesNo – Go to item 1c

0030 If YES – What was the total amount received by ALL CU members?

Income from public assistance orwelfare including money receivedfrom job training grants such asJob Corps?

0035

.00 $

12

YesNo – Go to item 1d

0040 If YES – What was the total amount received by ALL CU members?

d. Income from interest on savings

accounts or bonds? 0050

.00 $

12

YesNo – Go to item 1e

0060 If YES – What was the total amount received by ALL CU members?

e. Regular income from dividends,

royalities, estates, or trusts? 0070

.00 $

12

YesNo – Go to item 1f

0080 If YES – What was the total amount received by ALL CU members?

f. Income from pensions or annuities

from private companies, military,Government, IRA, or Keogh? 0090

.00 $

12

YesNo – Go to item 1g

0100 If YES – What was the total amount received by ALL CU members?

g. Net income or loss from any type

of rental of rooms or living units? 0110 12 Yes No – Go to item 1hIf YES –(1) How much net income or loss

was received from roomers orboarders?

.00 $ 0120

0130 0

1

NoneLoss

(2) How much net income or loss

was received from paymentsfrom other rental units?

.00 $ 0140

0150 0

1

NoneLoss

1h. Income from child support? 0155

.00 $

12

YesNo – Go to item 1i

0165

If YES –

(1) Did you receive a one time lump

sum payment for child support?

0160 1

2

YesNo – Go to item 1h(2)

If YES –

What was the total amountreceived by ALL CU members inlast 12 months?

(2) Did you receive any child support

payments in other than a lumpsum amount?

0170 1

2

YesNo – Go to item 1i

.00 $ 0175

If YES –What was the total amountreceived by ALL CU members inlast 12 months?

i. Income from regular contributions

from –(1) Alimony?(2) Other sources such as from

persons outside the CU?

If YES – for item i(1) or i(2) –Altogether what was the totalamount received by ALL CUmembers?

0180 1

2

YesNo

0185 1

2

YesNo

.00 $ 0188

2. During the past 12 months, did

you (or any members of your CU)receive any –Lump sum payments from estates,trusts, royalties, alimony, prizes orgames of chance, or from personsoutside of the CU?If YES – What was the total amount

received by ALL CU members?Money from the sale of householdfurnishings, equipment, clothing,jewelry, pets, or other belongings,excluding the sale of vehicles orproperty?Other money income, includingmoney received from cashscholarships and fellowships,stipends not based on working, orfrom the care of foster children?

a.b.c.

If YES – What was the total amount

received by ALL CU members?

If YES – What was the total amount

received by ALL CU members?

0190 1

2

YesNo – Go to item 2b

.00 $ 0200

0210 1

2

YesNo – Go to item 2c

.00 $ 0220

0230 1

2

YesNo – Go to item 3

.00 $ 0240

3

abcdefabcd

4

NOTES

UNEMPCM

UNEMPLX

P

COMPENSN

COMPENSX

WELFA RE

WELFA REX

INTEA RN

INTEA RNX

FIN A N IN G

FIN I N CX

PEN SI O N S

PEN SI O N X

I N C_L O SS

I N C L O SSA

I N C L O SSN

I N C L O SSB

I N CL O SBN

CH D SU P

CH D L M P

CH D L M PX

CH D SPO T H

CH D O T H X

A L I M SU P

O T H CO N T

A L IO T H X

L U M PSU M

L U M PSU M X

SA L EI N C

SA L EIN CX

O T H ERI N C

O T H RI N CX
FORM CE-302

Page 115 

NOTES

NOTE: As of January, 1996, Section 22 Part C no longer exists.
Page 116 

FORM CE-302

Section 22 – Part D

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 ITEM

Enter the name and line number

of all new CU members recorded

on the control card for the first

time in this interview who are 14

years 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

00100020 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 ITEM

Enter the name and line number

of all new CU members recorded

on the control card for the first

time in this interview who are 14

years 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

00100020 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 name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 117 FORM CE-302

FIELD REPRESENTATIVE –

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

6. During the past 12 months, did . . .

receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

a.

0230 .00 $0220 1

2

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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 

member who turned 

reported income in p

M EM BN O

I N CW EEK Q

I N C H RSQ

O CCU CO D E

I N CO M EY

I N CO RP

I N CN O N W K

SA L A RY X

N O N FA RM

N O N FA RM X

N FRM L O SS

FA RM I N C

FA RM IN CX

FA RM L O SS

SO CSECI N

RRRET I N C

I N CM ED CR

SS RRQ

SA LA RYST

RRRETIRX
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part E – Third and Fourth Quarter – Continued

1. 1 23 30 7 FIELD REPRESENTATIVE

ITEMEnter the first name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 118 FORM CE-302

FIELD REPRESENTATIVE –

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

6. During the past 12 months, did . . .

receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

a.

0230 .00 $0220 1

2

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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 

member who turned 

reported income in p

Section 22 – Part E (Continued)
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part E – Third and Fourth Quarter – Continued

1. 1 23 35 6 FIELD REPRESENTATIVE

ITEMEnter the first name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 119 FORM CE-302

FIELD REPRESENTATIVE –

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

6. During the past 12 months, did . . .

receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

a.

0230 .00 $0220 1

2

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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 

member who turned 

reported income in p
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part E – Third and Fourth Quarter – Continued

1. 1 23 40 6 FIELD REPRESENTATIVE

ITEMEnter the first name

and line number of

each CU member 14

years old and over.

0020 Weeks0010

0 Did not work – 

Go to item 5

Page 120 FORM CE-302

FIELD REPRESENTATIVE –

0070

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 44

00800090

b. Was . . .

0240

12

YesNo

0210 .00 $0200 1

2

YesNo – Go to item 6b

PROCESSING USE

ONLY

NAMELINE NUMBER

a.

b.

Hours per week

01 – Administrator, manager02 – Teacher03 – ProfessionalCODE1 –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 . . .

0100 Code

6. During the past 12 months, did . . .

receive any money in – Wages or salary? Include commissions,

tips, Armed Forces pay and allowances. 

What was the amount of incomereceived before any deductions?

a.

0230 .00 $0220 1

2

YesNo – Go to item 6c

Income or loss from . . .’s ownnonfarm business, partnership, orprofessional practice?What was the amount of income orloss after expenses?

b.

3 Loss

c. Income or loss from . . .’s own farm?

What was the amount of income orloss after expenses?

02700260 .00 $0250 1

2

YesNo – Go to item 7

3 Loss

0280 1

2

YesNo

7. During the past 12 months, did . . .

receive from the U.S. Governmentany money – 

a. From Social Security checks?

From Railroad Retirement checks?FIELD REPRESENTATIVE CHECK ITEMWhat was the amount of the lastSocial Security or RailroadRetirement payment received?During the past 12 months, howmany Social Security or RailroadRetirement payments did . . . receive?Is this amount AFTER the deductionfor a Medicare premium?

e.

d.

c.

b.

f.

0290 1

2

YesNo

0300 1

2

Yes – Go to item 7d No – Go to item 8a

0310 .00 $0320 1

2

YesNo

0330 Number

8. Dur

. . . Any che

a.

Any cheGov

b.

If YEHow Supche

9.

Ask 

(cod

Whalast this 

10. Was 

. . .’If YE

Fed

StatSocMedIf NO 

payyou

Rail

a.

b.

11.

Ask 

12. Oth

empfor conplan 

13a. Dur

placsuch (IRA 

14. FIEL

GovPriv

c.

d.

e.

f.

g.

b. If YE

Mar

the r

resp

DoeSecport

Is "Yes" marked in items 7a and/or 7b?

The job in which . . . received the mostearnings during the past 12 months fits best in the following category:04 –Manager, professional05 – Sales, retail06 – Sales, business goods and services07 – Technician

Administrative support, including clerical

Service08 – Protective service09 – Private household service10 – Other service11 –12 – Transportation operator13 – Handler, helper, laborer

Machine operator, assembler, inspector

14 –15 – Construction, mining

Mechanic, repairer, precision production

16 – Farming17 – Forestry, fishing, groundskeeping18 – 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 

member who turned 

reported income in p

Section 22 – Part E (Continued)
FORM CE-302

Page 121 

NOTES
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part F – Occupational Expenses and Contributions – Fifth Quarter Only

Page 122 FORM CE-302

Section 22 – Part F

FIELD REPRESENTATIVE –

0010

.00 $

12

YesNo – Go to item 2a

a.

1 22 98 6

Ask 

0020 If YES – What was the total amount of these occupational expenses?

If YES – How much?

.00 $

X Don’t know

0041

1. During the past 12 months, did you (or any 

members of your CU) have any occupationalexpenses such as union dues, tools, uniforms,business or professional association dues, licenses,or permits?

2. During the past 12 months, did you (or any

members of your CU) make any –

Cash contributions for support of persons not inthe CU, including alimony, child support, orstudents living away at college?

0030

.00 $

12

YesNo – Go to item 2b

0040

(1) How much of this amount was for

alimony?

.00 $

X Don’t know

0042 (2) How much of this amount was for child

support?

.00 $

X Don’t know

0060 (3) How much of this amount was for the expenses of college or university students

while attending school away from home?

b.

If YES – How much?Gifts of cash, bonds, or stocks to persons not inthe CU? 0070

.00 $

12

YesNo – Go to item 2c

0080

c.

If YES – How much?Contributions to charities, such as United Way,Red Cross, etc.? 0090

.00 $

12

YesNo – Go to item 2d

0100

d.

If YES – How much?Contributions to church and other religiousorganizations, excluding parochial schoolexpenses?

0110

.00 $

12

YesNo – Go to item 2e

0120

e.

If YES – How much?Contributions to educational organizations? 0130

.00 $

12

YesNo – Go to item 2f

0140

f.

If YES – How much?Political contributions? 0150

.00 $

12

YesNo – Go to item 2g

0160

g.

If YES – How much?Other contributions? – Specify in "Notes" 0170

.00 $

12

YesNo – Go to next part

0180

O CCEX PN

O CCEX PN X

CSH CN T RB

CSH CN T BX

A L I M O X

CH L D SU PX

CO L L EX PX

CBSGI FT

CBSGFT X

CN T RCH A R

CN T RCH RX

CN T REL G

CN T REL GX

CN T RED O R

CN T ED O RX

CN T RPO L

CN T RPO L X

M I SCCN T R

M I SCCN T RX
Section 22 – WORK EXPERIENCE AND INCOME – Continued

Part G – Changes In Assets – Fifth Quarter Only

Page 123 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 the

amount your CU had on the last day of (last month,

one year ago) in –

123

Same – Go to item 2bMoreLess

If more or less – How much more (less)?

a. Savings accounts?

0040

.00 0070 $

123

Same – Go to item 2cMoreLess

0060

c. U.S. Savings bonds?

.00 0090 $

123

Same – Go to item 3aMoreLess

0080

c. How does this compare with the value of such

securities your CU held on the last day of (last

month, one year ago)?

.00 0130 $

123

Same – G

o

t

o

i

t

e

m

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 

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

0250

11a.

8a.

If YES – How much did you invest?

1 

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 

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 

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 amount

owed to your CU by persons outside your CU onthe last day of (last month, one year ago)?

9a. 1 

On the last day of (last month), did anyone outside

of your CU owe money to you or any member ofyour CU?

0240

2

If more or less – How much more (less)?

10. 1 

Did anyone outside of your CU owe money to youor any member of your CU on the last day of (last

month, one year ago)?

0270

2

If YES – How much was owed? 

0280 $

1 

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 

SA V A CCT X

CK BK A CT X

U SBN D X

CO M PSA V

CO M PSA V X

CO M PCK G

CO M PCK GX

CO M PBN D

CO M PBN D X

SECO W N D

CO M PSEC

CO M PSECX

PU RSSEC

PU RSSECX

S

B

W 

W 

M 

CO 

M O 

S

SECESTX
FORM CE-302

Page 124

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

NO

FIELD REPRESENTATIVE – Hand the respon

proceed. Ask the 

Section 24

123456789

X

Information Booklet, page 43

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.

CUINCOME
Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Section 9 Section 10 Section 11 Section 12 Section 13 Section 14 Section 15 Section 16 Section 17 Section 18 Section 19 Section 20 Section 21 Section 22 Section 24

GENERAL SURVEY INFORMATION

RENTED LIVING QUARTERS

OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE

UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES

CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY

APPLIANCES, HOUSEHOLD EQUIPMENT, AND OTHER SELECTED ITEMS

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