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U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU Census Office County BCU Map Spot A. PN B. Answered By: Respondent Group Quarters Administrator Observation (TNSOLs only) Other C. QC: Rework FOR OFFICIAL USE ONLY Group Quarters ID D. JIC1 JIC2 UHE BCU UHE Map Spot Within Map Spot ID UHE Within Map Spot ID §,g!+¤ 11700010 2020 Census of the U.S. Virgin Islands Individual Census Questionnaire FORM DI-Q-GE-VI (07-27-2019) This is your Individual Census Questionnaire for the 2020 Census of the U.S. Virgin Islands. It is important that everyone be counted, regardless of where they may be living at the time of the census. This Individual Census Questionnaire is to be used to count people who were living, staying or receiving services in group quarters on April 1, 2020. Some examples of group quarters include college or university residence halls, nursing homes, group homes, residential treatment centers, workers’ group living quarters and correctional facilities. Please answer ALL of the questions on this questionnaire. Then follow the instructions you were given when you received this questionnaire in order to return it to the appropriate person. You are required by law to respond to the census (Title 13, U.S. Code, Sections 141, 193, 221 and 223). Please turn to page 2 to begin. FOR NPC USE ONLY OMB No. 0607-1006: Approval Expires 11/30/2021 The Census Bureau estimates that completing the questionnaire will take 25 minutes on average. Send comments regarding this burden estimate or any other aspect of this burden to: Paperwork Reduction Project 0607-1006, 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 0607-1006” 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 the census. U.S. Virgin Islands ® INFORMATIONAL COPY 2 1. What is your name? Print name below. Last Name(s) MI First Name I J Are you male or female? Mark K ONE box. Male Female 4. What is your age on April 1, 2020, and what is your date of birth? If you don’t know the exact age, please estimate. For babies less than 1 year old, do not write the age in months. Write 0 as the age. Age on April 1, 2020 Month Day Year of birth years Do you live or stay here most of the time? 2. Yes No Address Number (For example: 5007) Street Name (For example: N Maple Ave) Apt/Unit (For example: Apt A or Lot 3) Village/Municipality/Estate ZIP Code Physical Description (if applicable) Besides here, what is the full address of a place where you sometimes live or stay? 3. I never stay at any other place. I only live here. 5. Print numbers in boxes. White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C 7. I J What is your race? Mark K one or more boxes AND print origins. Black or African Am. – Print, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C 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 Some other race – Print race or origin. C NOTE: Please answer BOTH Question 6 about Hispanic origin and Question 7 about race. For this census, Hispanic origin is not a race. ➜ No, not of Hispanic, Latino, or Spanish origin 6. Are you of Hispanic, Latino, or Spanish origin? Yes, Mexican, Mexican Am., Chicano Yes, Puerto Rican Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print, for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc. C Chinese Vietnamese Native Hawaiian Other Asian – Print, for example, Pakistani, Cambodian, Hmong, etc. C Filipino Korean Samoan Asian Indian Japanese Chamorro Other Pacific Islander – Print, for example, Tongan, Fijian, Marshallese, etc. C Use a blue or black pen. Start here §,g!=¤ 11700028 INFORMATIONAL COPY 3 §,g!E¤ 11700036 11. I J What is the highest degree or level of school you have COMPLETED? Mark K ONE box. If currently enrolled, mark the previous grade or highest degree received. No schooling completed Regular high school diploma Some college credit, but less than 1 year of college credit Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA) Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD) Doctorate degree (for example: PhD, EdD) 12th grade – NO DIPLOMA 1 or more years of college credit, no degree Associate’s degree (for example: AA, AS) Bachelor’s degree (for example: BA, BS) NURSERY OR PRESCHOOL THROUGH GRADE 12 Nursery school, preschool, or pre-kindergarten Kindergarten Grade 1 through 11 – Specify grade 1 – 11 C HIGH SCHOOL GRADUATE GED or alternative credential COLLEGE OR SOME COLLEGE AFTER BACHELOR’S DEGREE NO SCHOOLING COMPLETED 12. 13. Have you completed requirements for a vocational training program at a trade school, hospital, or some other kind of school for occupational training or place of work? Do not include academic college courses. Yes No Answer question 12 if you have a bachelor’s degree or higher. Otherwise, SKIP to question 13. B This question focuses on your BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES you have received? (For example: chemical engineering, elementary teacher education, organizational psychology) 8. Where were you born? 9. When did you come to live in the U.S. Virgin Islands? If you came to live in the U.S. Virgin Islands more than once, print latest year. Year 10. a. At any time since February 1, 2020, have you attended school or college? Include only nursery or preschool, pre-kindergarten, kindergarten, elementary school, home school, and schooling which leads to a high school diploma or a college degree. Yes No ➜ SKIP to question 11 b. Was that a public school or college, a private school or college, or home school? Public school or public college Private school or private college or home school I J c. What grade or level were you attending? Mark K ONE box. Nursery school, preschool, or pre-kindergarten Kindergarten Grade 1 through 12 – Specify grade 1 – 12 C College undergraduate years (freshman to senior) Graduate or professional school beyond a bachelor’s degree (for example: MA or PhD program, or medical or law school) U.S. Virgin Islands Outside the U.S. Virgin Islands – Print name of U.S. state, U.S. territory, or foreign country below. C Answer question 9 if you were born outside the U.S. Virgin Islands. Otherwise, SKIP to question 10a. A INFORMATIONAL COPY 4 19. In 2019, did you receive benefits from the Food Stamp Program, SNAP (the Supplemental Nutrition Assistance Program), or NAP (Nutrition Assistance Program)? Do NOT include WIC, the School Lunch Program, or assistance from food banks. 15. U.S. Virgin Islands Outside the U.S. Virgin Islands – Print name of U.S. state, U.S. territory, or foreign country below. C Yes No a. Where was your mother born? b. Where was your father born? U.S. Virgin Islands Outside the U.S. Virgin Islands – Print name of U.S. state, U.S. territory, or foreign country below. C 16. Yes No ➜ SKIP to question 17 a. Do you speak a language other than English at home? b. What is this language? For example: Korean, Italian, Spanish, Vietnamese. Very well Well c. How well do you speak English? Not well Not at all 17. Did you live at this address 5 years ago (on April 1, 2015)? Person is under 5 years old ➜ SKIP to question 19 Yes, this address ➜ SKIP to question 19 No, different address in the U.S. Virgin Islands No, outside the U.S. Virgin Islands – Print name of U.S. state, U.S. territory, or foreign country below. C 20. Are you CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark "Yes" or "No" for EACH type of coverage in items a – h. a. Insurance through a current or former employer or union (of yours or another family member) b. Insurance purchased directly from an insurance company (by you or another family member) c. Medicare, for people 65 and older, or people with certain disabilities d. Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability f. VA (enrolled for VA health care) e. TRICARE or other military health care g. Indian Health Service h. Any other type of health insurance or health coverage plan – Specify C Yes No 21. Yes No a. Are you deaf or do you have serious difficulty hearing? b. Are you blind or do you have serious difficulty seeing even when wearing glasses? Yes No 14. What is your ancestry or ethnic origin? (For example: Italian, Jamaican, African Am., Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian, and so on.) §,g!M¤ 11700044 18. I J What was your main reason for moving? Mark K ONE box. Employment Military Family-related To attend school Natural disaster Housing Other reason INFORMATIONAL COPY 5 §,g!T¤ 11700051 28. How many babies have you ever had, not counting stillbirths? Do not count stepchildren or children you have adopted. Year 22. a. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? Yes No b. Do you have serious difficulty walking or climbing stairs? Answer question 28 if you are female and 15 years old or over. Otherwise, SKIP to question 29a. E Answer questions 22a – c if you are 5 years old or over. Otherwise, the questionnaire is complete. C Yes No c. Do you have difficulty dressing or bathing? Yes No Answer question 23 if you are 15 years old or over. Otherwise, the questionnaire is complete. D 23. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping? Yes No 24. What is your marital status? Now married Widowed Divorced Separated Never married ➜ SKIP to E 25. In the PAST 12 MONTHS did you get – a. Married? b. Widowed? c. Divorced? Yes No 26. How many times have you been married? Once Two times Three or more times 27. In what year did you last get married? Number of children 29. a. Do you have any of your own grandchildren under the age of 18 living in this place? Yes No ➜ SKIP to question 30 b. Are you currently responsible for most of the basic needs of any grandchildren under the age of 18 who live in this place? Yes No ➜ SKIP to question 30 c. How long have you been responsible for these grandchildren? If you are financially responsible for more than one grandchild, answer the question for the grandchild for whom you have been responsible for the longest period of time. Less than 6 months 6 to 11 months 1 or 2 years 3 or 4 years 5 or more years None or INFORMATIONAL COPY 6 §,g!f¤ 11700069 34. At what location did you work LAST WEEK? U.S. Virgin Islands – Print name of village below. C Outside the U.S. Virgin Islands – Print name of U.S. state, U.S. territory, or foreign country below. C Answer question 36 if you marked "Car, truck, or private van/bus" in question 35. Otherwise, SKIP to question 37. F 30. I J Have you ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard? Mark K ONE box. Never served in the military ➜ SKIP to question 33a Only on active duty for training in the Reserves or National Guard ➜ SKIP to question 32a Now on active duty On active duty in the past, but not now a.m. p.m. 31. I J When did you serve on active duty in the U.S. Armed Forces? Mark K a box for EACH period in which you served, even if just for part of the period. September 2001 or later August 1990 to August 2001 (including Persian Gulf War) May 1975 to July 1990 Vietnam Era (August 1964 to April 1975) February 1955 to July 1964 Korean War (July 1950 to January 1955) January 1947 to June 1950 World War II (December 1941 to December 1946) November 1941 or earlier 32. Yes (such as 0%, 10%, 20%, ..., 100%) No ➜ SKIP to question 33a a. Do you have a VA service-connected disability rating? b. What is your service-connected disability rating? 0 percent 10 or 20 percent 30 or 40 percent 50 or 60 percent 70 percent or higher 33. Yes ➜ SKIP to question 34 No – Did not work (or retired) a. LAST WEEK, did you work for pay at a job (or business)? b. LAST WEEK, did you do ANY work for pay, even for as little as one hour? Yes No ➜ SKIP to question 39a 35. I J How did you usually get to work LAST WEEK? Mark K ONE box for the method of transportation used for most of the distance. Car, truck, or private van/bus Public van/bus Taxicab Motorcycle Bicycle Walked Plane or seaplane Boat, ferry, or water taxi Worked from home ➜ SKIP to question 43a Other method 36. How many people, including you, usually rode to work in the car, truck, or private van/bus LAST WEEK? Person(s) 37. LAST WEEK, what time did your trip to work usually begin? Hour Minute : 38. How many minutes did it usually take you to get from home to work LAST WEEK? Minutes INFORMATIONAL COPY 7 §,g!n¤ 11700077 39. a. LAST WEEK, were you on layoff from a job? Yes ➜ SKIP to question 39c No b. LAST WEEK, were you TEMPORARILY absent from a job or business? Answer questions 45a – f if you worked in the past 5 years (since 2015). Otherwise, SKIP to question 46. H Answer questions 39 – 42a if you did NOT work last week. Otherwise, SKIP to question 42b. G Yes, on vacation, temporary illness, maternity leave, other family/personal reasons, bad weather, etc. ➜ SKIP to question 42a No ➜ SKIP to question 40 c. Have you been informed that you will be recalled to work within the next 6 months OR been given a date to return to work? Yes ➜ SKIP to question 41 No 40. During the LAST 4 WEEKS, have you been ACTIVELY looking for work? Yes No ➜ SKIP to question 42a 41. LAST WEEK, could you have started a job if offered one, or returned to work if recalled? Yes, could have gone to work No, because of own temporary illness No, because of all other reasons (in school, etc.) 42. a. When did you last work, even for a few days? Usual hours worked each WEEK I J a. Which one of the following best describes your employment last week or the most recent employment in the past 5 years (since 2015)? Mark K ONE box. 2020 2019 ➜ SKIP to question 43a 2015 to 2018 ➜ SKIP to H 43. a. During 2019 (all 52 weeks), did you work EVERY week? Count paid vacation, paid sick leave, and military service as work. Yes ➜ SKIP to question 44 No b. During 2019 (all 52 weeks), how many WEEKS did you work? Include paid time off and include weeks when you only worked for a few hours. Weeks 44. During 2019, in the WEEKS WORKED, how many hours did you usually work each WEEK? 45. DESCRIPTION OF EMPLOYMENT The next series of questions is about the type of employment you had last week. If you had more than one job, describe the one at which the most hours were worked. If you did not work last week, describe the most recent employment in the past five years (since 2015). For-profit company or organization Local or territorial government (for example: public elementary school) Owner of non-incorporated business, professional practice, or farm Owner of incorporated business, professional practice, or farm Worked without pay in a for-profit family business or farm for 15 hours or more per week Active duty U.S. Armed Forces or Commissioned Corps Federal government civilian employee PRIVATE SECTOR EMPLOYEE Non-profit organization (including tax-exempt and charitable organizations) GOVERNMENT EMPLOYEE SELF-EMPLOYED OR OTHER 2014 or earlier, or never worked ➜ SKIP to question 46 b. LAST YEAR, 2019, did you work at a job or business at any time? Yes No ➜ SKIP to H I J d. Was this mainly – Mark K ONE box. manufacturing? wholesale trade? retail trade? other (agriculture, construction, service, government, etc.)? b. What was the name of your employer, business, agency, or branch of the Armed Forces? c. What kind of business or industry was this? Include the main activity, product, or service provided at the location where employed. (For example: elementary school, residential construction) INFORMATIONAL COPY 8 e. What was your main occupation? (For example: 4th grade teacher, entry-level plumber) f. Describe your most important activities or duties. (For example: instruct and evaluate students and create lesson plans, assemble and install pipe sections and review building plans for work details) 46. INCOME IN 2019 I J I J Mark K the "Yes" box for each type of income you received, and give your best estimate of the TOTAL AMOUNT during 2019. Mark K the "No" box to show types of income NOT received. If your net income was a loss, mark the "Loss" box to the right of the dollar amount. For income received jointly, report only your share of the amount received or earned. a. Did you receive any wages, salary, commissions, bonuses, or tips in 2019? b. Did you have any self-employment income from own nonfarm businesses or farm businesses, including proprietorships and partnerships, in 2019? c. Did you receive any interest, dividends, net rental income, royalty income, or income from estates and trusts in 2019? Report even small amounts credited to an account. e. Did you receive any Supplemental Security Income (SSI) in 2019? I J What was your total income for 2019? Add entries in questions 46a to 46h; subtract any losses. If net income was a loss, enter the amount and mark K the “Loss” box next to the dollar amount. 47. f. Did you receive any public assistance or welfare payments from the state or local welfare office in 2019? d. Did you receive any Social Security or Railroad Retirement income in 2019? Yes ➜ What was the amount from all jobs before deductions for taxes, bonds, dues, or other items? No None TOTAL AMOUNT – Dollars Loss Loss TOTAL AMOUNT for 2019 $ .00 TOTAL AMOUNT – Dollars $ .00 $ .00 $ .00 TOTAL AMOUNT – Dollars Yes ➜ What was the net income after business expenses? No TOTAL AMOUNT – Dollars $ .00 Loss Yes ➜ What was the amount? No TOTAL AMOUNT – Dollars $ .00 Yes ➜ What was the amount? No $ .00 TOTAL AMOUNT – Dollars Yes ➜ What was the amount? No $ .00 TOTAL AMOUNT – Dollars Yes ➜ What was the amount? No Yes ➜ What was the amount? No TOTAL AMOUNT – Dollars $ .00 Yes ➜ What was the amount? No OR g. Did you receive any retirement income, pensions, survivor or disability income in 2019? Include income from a previous employer or union, or any regular withdrawals or distributions from IRA, Roth IRA, 401(k), 403(b) or other accounts specifically designed for retirement. Do not include Social Security. h. Did you have any other sources of income received regularly such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support, or alimony in 2019? Do NOT include lump sum payments such as money from an inheritance or sale of a home. §,g!v¤ 11700085 INFORMATIONAL COPY