1. Regional

Officecode

0010

2. Control number

0020

PSUcode

Segmentnumber

Segmentnumbersuffix

Sampledesignation

Serialnumber

Serialnumbersuffix

0030 0040 0050 0060 0070

3a. HH

No.

0080

3b.CU

No.

0090

Q

4. Segment type

0100 1

234

UnitPermitAreaGroupQuarters

5a. Interview

No.

5b. Status of

unit

0110 1

2345

0120013001400150

01600170018001900200

5c. L

s

Yes YesYesYesYes

8a. Address (Sheet Line )

What is your (the) exact address?

House No., Street, Apt. No., or other identificationPlace State ZIP Code

Route No., P.O. Box, or other identificationPlace State ZIP Code

8b. Is this also your (the) mailing address? Yes No – Specify below

AREA SEGMENT ONLY

9. YEAR BUILT

Do NOT ask

Ask first visit

When was thestructureoriginally built?

Before4-1-90 –

Continue 

interview.

After4-1-90 –Complete item

10c when

required; end

interview.

10. COVERAGE QUESTIONS

Do NOT ask

Ask items that are marked

a.b.c.

Are there anyoccupied orvacant livingquarters besidesyour own in thisbuilding?Are there anyoccupied orvacant livingquarters besidesyour own on thisfloor?Is there any otherbuilding on thisproperty forpeople to live in –either occupiedor vacant?

Fill

Table X

Y – NFill

Table X

Y – NFill

Table X

Y – N

Interview 11a. Fi

number

12345

8c. Group Quarters name 8d. Type code 8e. Sample number

0250

14. CLASSIFICATION OF LIVING QUARTERS – 

Mark by observation.

14a. FIELD REPRESENTATIVE CHECK ITEM

Unit is –

In a Group Quarters – Refer to Group 

Quarters Tables of manual and mark 

appropriate box in either item 

14c or 14d.

NOT in a Group Quarters

12

14b. Access

Direct – Go to item 14c

Through another unit – Not a separateHU; combine with unit through whichaccess is gained. Apply merged unit

procedures if appropriate.

12

00400050

1 01 02 2

12. OFFICE USE

ONLY

0010

13. LAND USE – Follow instructions for box that is marked.13a. Urban – Go to item 14

RURAL

12

13b. During the past 12 months did sales of crops,

livestock, and other farm products from thisplace amount to $1,000 or more?

YesNo

12

0020 – Regular units and Group Quarters units coded 92–N or 93–N in

item 8d – Go to item 13b.

– Group Quarters units not coded 92–N or 93–N in item 8d – Mark "No"

in item 13b without asking, then go to item 14.

0030

14c. HOUSING

unit 

007

14d. Group Quarters

unit

36. OFFICE USE

ONLY

0090

37. DATE OF FINAL CONTACT

Interview No. Month Day Year

12345

01000140018002200260

01100150019002300270

01200160020002400280

Code

01300170021002500290

38. FINAL INTERVIEW STATUS

If codes 05, 11, or 19 – Specify

CODES FOR FINAL INTERV

Type A02 – No one home 

(unable to contact)

Type 

03 – Temporarily 

absent

04 – Refused05 – Other

06 – V07 – V08 – V09 – O

U

10 – U

n

11 – O

39. TYPE A NONINTERVIEW REQUIRED ENTRIES

Fill items 39a–39c for all Type A noninterviews, interview status codes 02–05.

39a. Race

code

Interview

number

1 03002345

39b. Number of

householdmembers

39c. Tenure

code

0330036003900420

03100340037004000430

03200350038004100440

RACE CODES

1 – White2 – Black3 – American

Indian,Eskimo, orAleut

4 – Asian or 

PacificIslander

TENURE

CODES

1 – Owned2 – Rented

40. NEXT QUARTER APPOINTMENT – Fill after the interview is complete.

Interview

number

2345

a.m.p.m.

Enter line number of respondent for current interview.

Mark "No appointment" box or enter appointment date and time.

Line number Appointment date and time

of respondent Month

No

appointment Day Day of week Time

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

41. REPORTIN42. CONTROL 

ITEMS TO FILLED FONONINTER

43. STATUS

OF UNITCODESFORITEM 5b

Checkdigit

0075
0010

1 01 04 8

0010

2 01 03 8 HOUSEHOLD RECORD – FILL ITEMS 17–22b FOR ALL PERSONS LIVING OR STAYING HERE. 

PROCESSING USE ONLY

PERSON LINE NUMBER

01

00200030004000500060007000800090010001100120013001400150016001700180

0203040506070809101112131415161718

16. 17. STATUS

Enter code.1 – Deleted2 – Reinstated

HOUSEHOLD ROSTER

(last name first)

18.

What are the names of all personsliving or staying here? Start withthe name of the person or one ofthe persons who owns or rentsthis home.List all persons who usually live here

and all persons who are temporarily

absent. Be sure to include infants under

1 year of age.

RELATIONSHIPTO REFERENCEPERSON

19.

Ask if not apparent.What is . . . ’srelationship to(reference person)?Example: Referenceperson, husband,wife, son,daughter-in-law,partner, lodger,lodger’s wife, etc.

HH

GO TO ITEM 20a.

code

CU

code

GO TO ITEM 23a.

21. SEX

Ask if not

apparent.

Is . . . maleor female?

Ask if not

apparent.

AWAY ATCOLLEGE

22a.

Are any ofthese personsliving away atcollege?If "YES" is

marked below

for a person,

mark "NO" in

22b without

asking.

HOUSEHOLDMEMBER

22b.

Does . . .usually livehere?If "NO,"

probe for

URE.

Male Female YES NO YES NO

1 2 1 2 1 2

CONSUMER UNIT NUMBER

Read item 23f.

23g. 24. BIRTH DATE/AGE

What is . . .’s date of birth?Verify age using information b

Example: 01-20-1963

12-01-1924

Month Day Year Age Ag

20a. I have listed . . . (Read names from item 18.) Have I missed – 

FIRST INTERVIEW

– any babies or small children? .................– anyone who usually lives here but is away now –

traveling, at school, or in a hospital? .............

– any lodgers, boarders, or persons you employ

who live here? ..........................

– anyone else staying here? ...................

YES NO

If "YES," ask

name and

record in

roster above

(item 18).

Go to item

21 above.



I have listed . . . (Read names from item 18.)Are all of these persons still living or staying here? .........

20b.

2nd–5th INTERVIEW

If NO, ask: Who no longer lives here?

For each person who has left the household, enter a code "1" in item 17.

20c.

Is anyone else living or staying here, including newborn babies? ..............................

20d.

2345

N

If YES, ask name and record in roster above (item 18). Go to

item 21 above.

N N N

Y Y Y YN N N NY Y Y Y

23a. FIELD REPRESENTATIVE CHECK ITEM

HOUSING UNIT COVERAGEUnit is – In a Group Quarters – Go to item 23d

NOT in a Group Quarters – Go to item 23b

Yes

23b. Do all the persons in this household live OR eat together? Ask if not apparent.

No – Neither live nor eat together – Fill Table X for

the person or group of persons not living or

eating with the reference person.

Yes – Redefine the unit to include space occupied by all

persons who live or eat together (apply merged unit

procedures if appropriate).

Does any other household on the property live OR eatwith this household?

23c. Ask if not apparent.

No – Go to item 23d

FIELD REPRESENTATIVE ITEM FOR ASSIGNING C

23d.

Include anyone who is a member at the time of in

12

Household contains only thperson or others related to person by blood, marriageother legal arrangements. – 

item 23g above for all hous

members. Go to item 23f.

Household contains only opersons not related to the rperson by blood, marriageor other legal arrangementGo to item 23e below.

FORM CE-300 (11-1-95)

1 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 21 2 1 2 1 2
0010

PROCESSING USE ONLY 1 01 05 5

23e.

12

FINANCIAL RESPONSIBILITYAsk first for reference person and all others

related to reference person by blood,

marriage, adoption, or other legal

arrangement. Then ask for each other

person or group of related persons.

1 01 06 3 1 01 07 1 

0010

Line No.(s)

0040

00200050

00300060

0070 Yes

No

(1) Do(es) . . . pay for all . . . housing

expenses with . . . own money?

12

0080 Yes

No

(2) Do(es) . . . pay for all . . . food

expenses with . . . own money?

12

0090 Yes

No

(3) Do(es) . . . pay for all . . . other 

living expenses such as clothing,transportation, etc., with . . . ownmoney?

FIELD REPRESENTATIVE CHECK ITEMAre two or more "Yes" boxes marked initems 23e(1)–(3)?

0100 1 Yes – Assign CU number 1

in item 23g

2 No – Ask item 23e(4)

(4) Does all or part of the money to 

pay for . . . (Specify expenses with 

"No" marked in items 23e(1)–(3).) 

come from someone in thishousehold?

0110 1 Yes – Ask item 23e(5)

No – Assign CU number 1

in item 23g

2

(5) Who is (are) that (these) person(s)?

0120

Line No.(s)

0150

01300160

01400170

0010

Line No.(s)

0040

00200050

00300060

0120

Line No.(s)

0150

01300160

01400170

0010

Line No.(s)

0040

00200050

0120

Line No.(s)

0150

01300160

12

0070 Yes

No

12

0080 Yes

No

12

0090 Yes

No

12

0070 Yes

No

12

0080 Yes

No

12

0090 Yes

No

0100 1 Yes – Assign next available CU

number in item 23g

2 No – Ask item 23e(4)

0110 1 Yes – Ask item 23e(5)

No – Assign next available CU

number in item 23g

2

0100 1 Yes – Assign next avai

number in item 2

2 No – Ask item 23e(4)

0110 1 Yes – Ask item 23e(5)

No – Assign next availa

number in item 23

2

1 Yes

23f. FIELD REPRESENTATIVE INSTRUCTION – Consumer Unit

Read to respondent.During this interview, I will use the words consumer unit orCU. A consumer unit is the (person/group of related persons) inthis household who (is/are) independent of all other persons inthis household for payment of their major expenses.The person(s) I’m including in your CU (is/are) –Read names of all persons listed in item 18 with the same

CU marked in item 23g.

Go to item 24 above.

1 01 24 6

30. Is there a business or commercial establishment on

the property?

2 No

0020 1 Yes

31. Is at least half or more of the structure(s) on this property

used or intended for use as housing units?

2 No

0030 1 Yes

32a. Does the owner live on this property?

2 No – Go to item 33

0040 1 Yes

32b. Are there 5 or more units on the property?

2 No – Go to item 34

0050 1 Yes – Go to item 34

32c. Does the owner live in the sample unit?

2 No

33a. What is the name, address, and telephone number of the

owner or agent of this property?

0060 1 Yes

33b. Is the owner or agent’s name, street address, city and State

entered in item 33a?

2 No

NameTelephone number – Include area code.Address – Street name, house number and unit designation, if anyCityState ZIP Code

34a. What is your telephone nu

Area code Num

123

0070 Telephone number ent

No telephone – Go to iRefused

34b. What is the best time to c

Refused

35. FIELD REPRESENTATIVE INS35a. Most questions that I will 

period. During this interviotherwise is for the past m(last month) to today.2nd–5th QUARTER

35b. Most questions that I will 

period. During this interviotherwise is for the past tday of (the month three moRead to respondent – RefereFIRST QUARTER

FORM CE-300 (11-1-95)

PROCESSING USE ONLY
Table X — Determing if an Additional Living Quarters Qualifies as 

START HERE

FORM CE-300 (11-1-95)

UNIT SEGMENTS 

(1) (2) (3) (4) (5) (6

Check the listing sheet.Is the address of theadditional living quarteralready listed?

Yes – Stop Table X.No – Go to column (2),

(4), (5) or (6)

depending on

segment type.

AREA SEGMENTS PERMIT SEGMENTS

Single Unit Multi

Are the additional livingquarters within the areasegment boundaries?

Are the additional livingquarters in a groupquarters?

Are the additional livingquarters within the samestructure and within thesame space (See Footnote 1)

occupied by the originalsample unit?

Are the additional livingquarters within the basicaddress (house numberand street name) of theoriginal sample unit?

Are the additiquarters withispace (See Foo

occupied by thsample unit?

an

Are the additiquarters the resplit apartmen

Yes – Go to column (3).No – Stop Table X; do

not interview.

Yes – Stop Table X; do 

not interview.

No – Go to column (7).

Yes – Go to column (7).No – Stop Table X; do

not interview.

Yes – Go to column (7).No – Stop Table X; do

not interview.

Yes to both Go to columNo to eitheStop Table 

interview.

FOOTNOTES:

1 – Occupation of the "same space" occurs if a housing unit has been split into two or more separate housing units.2 – If you determine that you have found an EXTRA unit at a single unit address in a UNIT segment (yes in column 5), you must prepares in INTER-COMM and fill ou

NOTES