American Community Survey Questionnaire, Revealed
Jul 10th, 2007 by Alex
Here is a rough copy of the American Community Survey questionnaire. I wasn’t able to locate a scanner, but I’m a quick typist. The only thing you’d gain from a scan is the design of the survey, which honestly isn’t too difficult to follow. I can confirm that there are no choices for you to indicate that you don’t wish to answer a particular question. I’ll try to locate a scanner for the letters and reminder cards that were sent to me.
You can decide for yourself whether it’s too personal or not.
Start Here
The person filling out the form must first identify themself by first and last name. They must provide a phone number, the date, and how many people are living or staying at the address.
List of Residents
For each resident, the following is requested.
- First and last name, gender, age and date of birth.
- Relationship to Person 1, defined as one of various family members, roommates, SOs, etc.
- Marital status
- Whether you’re are Spanish/Hispanic/Latino.
- What your race is.
I find it curious that they break out the Spanish/Hispanic/Latino and ask about them specifically. Perhaps an attempt to find about how illegal immigrants are migrating?
Housing
- A description of the building structure. For example a mobile home, one-family detached house, a building with two apartments, etc.
- When the building was first built.
- When did Person 1 move in?
- How many acres?
- In the past 12 months what were the actual sales of all agricultural products from the property?
- Is there is business on the premises?
- How many rooms are in the house?
- How many bedrooms?
- Does it have complete plumbing facilities?
- Does it have complete kitchen facilities?
- Is there telephone service?
- How many automobiles are kept and used by members of the household?
- Which fuel is used most for heating?
- What was the electric bill last month?
- What was the gas bill for last month?
- In the past 12 months, what was the cost of water and sewer?
- In the past 12 months, what was the cost of oil, coal, kerosene, wood, etc?
- At any time during the past 12 months did anyone receive food stamps? If yes, what was the value?
- Is it part of a condo? If so, what is the monthly condo fee?
- Is the house owned by a resident with a mortgage or a loan? free and clear? rented for cash? occupied without payment of cash?
- What is the monthly rent? does it include meals?
- What is the value of the property? i.e. how much would if sell for if it were for sale?
- What are the annual real estate taxes on the property?
- What is the annual payment for fire, hazard, and flood insurance on the property?
- Do you or any member have a mortage, deed of trust, contract to purchase, or similar debt on the property?
- How much is the regular monthly mortgage payment on this property?
- Does the payment include payments for real estate taxes?
- Does the payment include payments for insurance (as listed above)?
- Does a member have a second mortgage on the place? how much is the monthly payment?
- If a mobile home, what are the annual costs for taxes, site rent, registration fees, etc.
- Do you stay here year round?
- How many months to the members stay here?
- What is the primary reason the members are staying here?
Personal Questions
The following questions are asked of each person whose information was filled out in the 2nd section. There’s 3-4 pages for each person to fill out there own portion. Most questions start with “Is this person…”
- born in either in the U.S. (with a fill-in for state) or outside the U.S. (will fill-in for country)
- a citizen of the U.S. (with choices for natural born, born abroad, naturalized, not, etc).
- if not born in the U.S., what year did you come?
- at any time in the last 3 months did you attend regular school or college? (choices for No, Yes-public and Yes-private)
- What grade or level was this person attending? (range of educational levels)
- What is the highest degree or level of school completed? (ditto)
- What is the person’s ancestry or ethnic origin?
- Does this person speak a language other than English at home? if yes, what is it?
- How well does the person speak English?
- Did the person live here 1 year ago?
- Where did the person live 1 year ago? (fill in city, town, or PO)
- have any of the following long-lasting conditions: blindness, deafness, or a severe vision or hearing impairment? a condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifitng, or carrying?
- Because of physical, mental, or emotional condition lasting 6 months or more, does this personal have any difficulty in doing any of the following activities: learning, remembering, or concentrating? dressing, bathing, or getting around inside the home?
- 15 years or older only; because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulties going outside the home alone to shop or visit a doctor’s office? working at a job or business?
- females 15-50 only; given birth in the past 12 months?
- have any grandchildren under the age of 18 living in this house?
- is this grandparent currently responsible for most of the basic needs of them?
- how long have the grandparent been responsible for them?
- ever served on active duty? (variety of options, active now, active in the past year, on training, etc)
- when did you serve? (list of all major conflicts, check as many as you need)
- how many years of active duty service (less than 2, or 2 or more)?
- did you do ANY work for pay or profit last week?
- at what location did you work? fill in complete address of location
- how did you get to work (checkboxes for all sorts of transportation types)
- if an automobile, how many people rode in the car?
- what time did you usually leave for work last week?
- how many minutes did it take to get to work?
- if you didn’t work, were you laid off?
- if you didn’t work, were you temporarily off? on vacation? illness? labor dispute?
- if you didn’t work, have you been informed that you’ll be recalled within the next 6 months?
- if you didn’t work, have you been looking for work in the last 4 weeks?
- if you didn’t work, LAST WEEK could you have started a job if offered one?
- when did you last work? within 12 months? 1-5 years ago? over 5 years ago?
- during the past 12 months, how many week did you work?
- during the past 12 months, in the weeks worked, how many hours did you work each week?
- were you an employee of (private for profit, non profit, government, state, self-employed, etc)
- for whom did you work, fill in name
- what kind of business is this, fill in
- what kind of work are you doing, fill in
- what were this person’s most important activities or duties, fill-in
- income section; wages, salary, commissions, bonuses, or tips from all jobs for last 12 months (fill in)
- self-employment incoming from own businesse, including proprieteorships and partnerships last 12 months (fill in)
- interest, dividends, net rental incomes, royalty income, or income from estates and trusts, last 12 months (fill in)
- Social security or Railroad, last 12 months (fill in)
- SSI (ditto)
- public assistance or welfare payments or from the state or local office (ditto)
- retirement, survivor, or disability (ditto)
- any other sources of income; VA, unemployment, child support, etc (ditto)
- what was the total income during the past 12 months? (ditto)
I pay my taxes on all of my income. It sucks, but I do. These questions — despite numerous claims that this information will not be shared — could easily be used to pick people to be audited. The fact is that the IRS isn’t allowed to share the details of your tax return with the Census Bureau… so then why are survey recipients forced to provide that information to them under threat of penalty?
Bah, I’m not going to get started again today.
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This seems like extraordinarily standard demographic information. I still have a big problem with you being required to have your name on the form, and with you not having the opportunity to opt out of questions, but overall this looks like pretty standard stuff.
I’d much rather they collect this information than Giant collect information on my toothbrush purchasing habits via my Bonus Card.
Re: the Hispanic/Latino box being separate, as of the 2000 Census, the government decided to stop listing Hispanic (officially created as a racial category in the 70s by Nixon)/Latino/Chicano as a race. They consider it an ethnicity, so in their records you can be White/Hispanic, Black/Hispanic and so forth.
Beveragewench: That makes sense, but then makes the later write-in portion about ethnicity and origins somewhat redundant. Maybe its just the survey design.
I just got one of these ACS March 2008, druing the deepest economic turndown since the Great Depression, in a lame duck presidential election year, in the last year of an Administration that erased its own e-mail and hard drives to avoid Congressional scrutiny, and says warrantless surveilance and wire-tepping, reading everyone else’s communications, library records, and authorizes torture is okey dokey. Why should I care about this painfully obtrusive non-anonymous assault on personal privacy by a Federal Government agency that has had serious data breaches in the last few years ? It’s a walk in the park to complete a survey that makes one’s 1040 return look like a mere restaurant menu.
I think this is the paperwork for US Holocaust light, the purging of anyone who is not a right wing nut that will be compliant to ultra-conservative obedience and coroporate domination, who will be happy to work long hours as free trade zone wage slaves in the global economy. I truely believe that when I complete this survey, a year or 2 from now I will be interred or worse just like the Japanese Americans during WWII. (govrernment used Census records then for the “resettlement program.”).
Moreover, as part of the “baby boomer” demographic, I believe that the rulers will be culling the herd from our age/health group to make way for the young and healthy as a form of user-friendly Eugenics to euthanize the “unproductive.” Social Security and Healthcare crises solved !
Where is the ACLU on this? That’s what annoys me about them, they selectively choose their causes. There is nothing about this one their website. They should be leading the charge against this nonsense. Right-wing nuts are also outraged by this.