OMB No. 0607-0999: Approval Expires 09/30/2020 2018 Census Test U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU FOR OFFICIAL USE ONLY A OR go online at survey.census.gov to complete the 2018 Census Test. Use a blue or black pen. O F M R 2. Before you answer Question 1, count the people living in this house, apartment, or mobile home using our guidelines. Were there any additional people staying here on April 1, 2018 that you did not include in Question 1? J Mark I K all that apply. Children, related or unrelated, such as newborn babies, grandchildren, or foster children • Count all people, including babies, who live and sleep here most of the time. • If no one lives and sleeps at this address most of the time, go online at survey.census.gov or call the number on page 8. IN Relatives, such as adult children, cousins, or in-laws Nonrelatives, such as roommates or live-in babysitters People staying here temporarily The census must also include people without a permanent place to live, so: 11528015 • If someone who does not have a permanent place to live is staying here on April 1, 2018, count that person. No additional people 3. Is this house, apartment, or mobile home — Mark K J ONE box. I Owned by you or someone in this household with a mortgage or loan? Include home equity loans. The Census Bureau also conducts counts in institutions and other places, so: Owned by you or someone in this household free and clear (without a mortgage or loan)? • Do not count anyone living away from here, either at college or in the Armed Forces. • Do not count anyone in a nursing home, jail, prison, detention facility, etc., on April 1, 2018. • Leave these people off your questionnaire, even if they will return to live here after they leave college, the nursing home, the military, jail, etc. Otherwise, they may be counted twice. Rented? Occupied without payment of rent? 4. What is your telephone number? We will only contact you if needed for official Census Bureau business. Telephone Number 1. How many people were living or staying in this house, apartment, or mobile home on April 1, 2018? – Number of people = FORM DH-61 (12-27-2017) – §,Uq0¤ Start here I T N O L A Person 1 5. Please provide information for each person living here. If there is someone living here who pays the rent or owns this residence, start by listing him or her as Person 1. If the owner or the person who pays the rent does not live here, start by listing any adult living here as Person 1. ➜ NOTE: Please answer BOTH Question 8 about Hispanic origin and Question 9 about race. For this census, Hispanic origins are not races. 8. What is Person 1’s name? Print name below. First Name Is Person 1 of Hispanic, Latino, or Spanish origin? Mark K J one or more boxes AND print origins. I No, not of Hispanic, Latino, or Spanish origin MI Yes, Mexican, Mexican Am., Chicano Yes, Puerto Rican Last Name(s) Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. C What is Person 1’s sex? Mark K J ONE box. I Male 7. Female 9. What is Person 1’s race? Mark K J one or more boxes AND print origins. I What is Person 1’s age and what is Person 1’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age. Age on April 1, 2018 Print numbers in boxes. Month Day L A White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C Year of birth I T N O Black or African Am. – Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C years American Indian or Alaska Native – Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. C Chinese Vietnamese Native Hawaiian Filipino Korean Samoan Asian Indian Japanese Chamorro Other Asian – Print, for example, Pakistani, Cambodian, Hmong, etc. C §,Uq8¤ IN O F M R A Other Pacific Islander – Print, for example, Tongan, Fijian, Marshallese, etc. C Some other race – Print race or origin. C ➜ If more people were counted in Question 1 on the front page, continue with Person 2 on the next page. 2 11528023 6. 1. Person 2 Print name of First Name ➜ NOTE: Please answer BOTH Question 6 about Hispanic origin and Question 7 about race. For this census, Hispanic origins are not races. MI 6. Last Name(s) Is this person of Hispanic, Latino, or Spanish origin? Mark K J one or more boxes AND print origins. I No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano 2. Yes, Puerto Rican Does this person usually live or stay somewhere else? Mark K J all that apply. I Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. C No 3. Yes, for college Yes, with a parent or other relative Yes, for a military assignment Yes, at a seasonal or second residence Yes, for a job or business Yes, in a jail or prison Yes, in a nursing home Yes, for another reason 7. What is this person’s race? Mark K J one or more boxes AND print origins. I White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C How is this person related to Person 1? Mark K J ONE box. I Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Black or African Am. – Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law IN Son-in-law or daughter-in-law Other relative N O L A O F M R A I T American Indian or Alaska Native – Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. C Chinese Vietnamese Native Hawaiian Filipino Korean Samoan Asian Indian Japanese Chamorro Other Asian – Print, for example, Pakistani, Cambodian, Hmong, etc. C Roommate or housemate Other Pacific Islander – Print, for example, Tongan, Fijian, Marshallese, etc. C 11528031 Other nonrelative 4. What is this person’s sex? Mark K J ONE box. I Male 5. Some other race – Print race or origin. C Female What is this person’s age and what is this person’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age. Age on April 1, 2018 Print numbers in boxes. Month Day Year of birth years ➜ If more people were counted in Question 1 on the front page, continue with Person 3 on the next page. 3 §,Uq@¤ Foster child 1. Person 3 Print name of First Name ➜ NOTE: Please answer BOTH Question 6 about Hispanic origin and Question 7 about race. For this census, Hispanic origins are not races. MI 6. Last Name(s) Is this person of Hispanic, Latino, or Spanish origin? Mark K J one or more boxes AND print origins. I No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano 2. Yes, Puerto Rican Does this person usually live or stay somewhere else? Mark K J all that apply. I Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. C No 3. Yes, for college Yes, with a parent or other relative Yes, for a military assignment Yes, at a seasonal or second residence Yes, for a job or business Yes, in a jail or prison Yes, in a nursing home Yes, for another reason 7. What is this person’s race? Mark K J one or more boxes AND print origins. I White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C How is this person related to Person 1? Mark K J ONE box. I Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Black or African Am. – Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law IN Son-in-law or daughter-in-law Other relative N O L A O F M R A I T American Indian or Alaska Native – Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. C Chinese Vietnamese Native Hawaiian Filipino Korean Samoan Asian Indian Japanese Chamorro Other Asian – Print, for example, Pakistani, Cambodian, Hmong, etc. C Roommate or housemate Other Pacific Islander – Print, for example, Tongan, Fijian, Marshallese, etc. C Other nonrelative 4. What is this person’s sex? Mark K J ONE box. I Male 5. Some other race – Print race or origin. C 11528049 §,UqR¤ Foster child Female What is this person’s age and what is this person’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age. Age on April 1, 2018 Print numbers in boxes. Month Day Year of birth years ➜ If more people were counted in Question 1 on the front page, continue with Person 4 on the next page. 4 1. Person 4 Print name of First Name ➜ NOTE: Please answer BOTH Question 6 about Hispanic origin and Question 7 about race. For this census, Hispanic origins are not races. MI 6. Last Name(s) Is this person of Hispanic, Latino, or Spanish origin? Mark K J one or more boxes AND print origins. I No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano 2. Yes, Puerto Rican Does this person usually live or stay somewhere else? Mark K J all that apply. I Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. C No 3. Yes, for college Yes, with a parent or other relative Yes, for a military assignment Yes, at a seasonal or second residence Yes, for a job or business Yes, in a jail or prison Yes, in a nursing home Yes, for another reason 7. What is this person’s race? Mark K J one or more boxes AND print origins. I White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C How is this person related to Person 1? Mark K J ONE box. I Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Black or African Am. – Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law IN Son-in-law or daughter-in-law Other relative N O L A O F M R A I T American Indian or Alaska Native – Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. C Chinese Vietnamese Native Hawaiian Filipino Korean Samoan Asian Indian Japanese Chamorro Other Asian – Print, for example, Pakistani, Cambodian, Hmong, etc. C Roommate or housemate Other Pacific Islander – Print, for example, Tongan, Fijian, Marshallese, etc. C 11528056 Other nonrelative 4. What is this person’s sex? Mark K J ONE box. I Male 5. Some other race – Print race or origin. C Female What is this person’s age and what is this person’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age. Age on April 1, 2018 Print numbers in boxes. Month Day Year of birth years ➜ If more people were counted in Question 1 on the front page, continue with Person 5 on the next page. 5 §,UqY¤ Foster child 1. Person 5 Print name of First Name ➜ NOTE: Please answer BOTH Question 6 about Hispanic origin and Question 7 about race. For this census, Hispanic origins are not races. MI 6. Last Name(s) Is this person of Hispanic, Latino, or Spanish origin? Mark K J one or more boxes AND print origins. I No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano 2. Yes, Puerto Rican Does this person usually live or stay somewhere else? Mark K J all that apply. I Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. C No 3. Yes, for college Yes, with a parent or other relative Yes, for a military assignment Yes, at a seasonal or second residence Yes, for a job or business Yes, in a jail or prison Yes, in a nursing home Yes, for another reason 7. What is this person’s race? Mark K J one or more boxes AND print origins. I White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C How is this person related to Person 1? Mark K J ONE box. I Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Black or African Am. – Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law IN Son-in-law or daughter-in-law Other relative N O L A O F M R A I T American Indian or Alaska Native – Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. C Chinese Vietnamese Native Hawaiian Filipino Korean Samoan Asian Indian Japanese Chamorro Other Asian – Print, for example, Pakistani, Cambodian, Hmong, etc. C Roommate or housemate Other Pacific Islander – Print, for example, Tongan, Fijian, Marshallese, etc. C Other nonrelative 4. What is this person’s sex? Mark K J ONE box. I Male 5. Some other race – Print race or origin. C 11528064 §,Uqa¤ Foster child Female What is this person’s age and what is this person’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age. Age on April 1, 2018 Print numbers in boxes. Month Day Year of birth years ➜ If more people were counted in Question 1 on the front page, continue with Person 6 on the next page. 6 1. Person 6 Print name of First Name ➜ NOTE: Please answer BOTH Question 6 about Hispanic origin and Question 7 about race. For this census, Hispanic origins are not races. MI 6. Last Name(s) Is this person of Hispanic, Latino, or Spanish origin? Mark K J one or more boxes AND print origins. I No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano 2. Yes, Puerto Rican Does this person usually live or stay somewhere else? Mark K J all that apply. I Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. C No 3. Yes, for college Yes, with a parent or other relative Yes, for a military assignment Yes, at a seasonal or second residence Yes, for a job or business Yes, in a jail or prison Yes, in a nursing home Yes, for another reason 7. What is this person’s race? Mark K J one or more boxes AND print origins. I White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C How is this person related to Person 1? Mark K J ONE box. I Opposite-sex husband/wife/spouse Opposite-sex unmarried partner Black or African Am. – Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C Same-sex husband/wife/spouse Same-sex unmarried partner Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister Father or mother Grandchild Parent-in-law IN Son-in-law or daughter-in-law Other relative N O L A O F M R A I T American Indian or Alaska Native – Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. C Chinese Vietnamese Native Hawaiian Filipino Korean Samoan Asian Indian Japanese Chamorro Other Asian – Print, for example, Pakistani, Cambodian, Hmong, etc. C Roommate or housemate Other Pacific Islander – Print, for example, Tongan, Fijian, Marshallese, etc. C 11528072 Other nonrelative 4. What is this person’s sex? Mark K J ONE box. I Male 5. Some other race – Print race or origin. C Female What is this person’s age and what is this person’s date of birth? For babies less than 1 year old, do not write the age in months. Write 0 as the age. Age on April 1, 2018 Print numbers in boxes. Month Day Year of birth years ➜ If more people were counted in Question 1 on the front page, continue with Person 7 on the next page. 7 §,Uqi¤ Foster child OMB No. 0607-0999: Approval Expires 09/30/2020 Use this section to complete information for the rest of the people you counted in Question 1 on the front page. We may call for additional information about them. Person 7 First Name MI Last Name(s) Date of Birth Sex Age on April 1, 2018 Male Female Month Day Related to Person 1? Year of birth Yes years No Person 8 First Name MI Last Name(s) Date of Birth Sex Age on April 1, 2018 Male Female Month Day Year of birth years Yes Person 9 First Name MI Last Name(s) Date of Birth Sex Age on April 1, 2018 Male Female years Person 10 First Name Sex IN O F Age on April 1, 2018 Male Female L A Related to Person 1? Month M R MI A Day I T N O Year of birth No Related to Person 1? Yes No Last Name(s) Date of Birth Month Day Year of birth years Related to Person 1? Yes No Thank you for completing the 2018 Census Test. If your enclosed postage-paid envelope is missing, please mail your completed questionnaire to: JIC1 JIC2 U.S. Census Bureau National Processing Center 1201 East 10th Street Jeffersonville, IN 47132 If you need help completing this questionnaire, call 1-844-330-2020, Sunday through Saturday from 7:00 a.m. to 9:00 p.m. ET. The telephone call is free. TDD — Telephone display device for the hearing impaired. Call 1-844-467-2020, Sunday through Saturday from 7:00 a.m. to 9:00 p.m. ET. The telephone call is free. The U.S. Census Bureau estimates that completing the questionnaire will take 10 minutes on average. Send comments regarding this burden estimate or any other aspect of this burden to: Paperwork Reduction Project 0607-0999, U.S. Census Bureau, DCMD-2H174, 4600 Silver Hill Road, Washington, DC 20233. You may email comments to <2020.census.paperwork@census.gov>; use “Paperwork Reduction Project 0607-0999” as the subject. This collection of information has been approved by the Office of Management and Budget (OMB). The eight-digit approval number that appears at the upper right of the questionnaire confirms this approval. If this number were not displayed, we could not conduct this survey. 8 11528080 §,Uqq¤ FOR OFFICIAL USE ONLY