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Start here Use a blue or black pen. U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU APPLY LABEL HERE ➤ ➤ Census Office County BCU Map Spot No ➜ Skip to S3. Yes S1. Did you or anyone in this household live or stay here on April 1, 2020? Vacation or seasonal home or held for occasional use – Skip to page 7. Usually lives here – Skip to question 1. S2. Does someone usually live at this [house/apartment/mobile home], or is this a vacation or seasonal home where no one usually lives? S3. On April 1, 2020, was this unit Occupied by a different household? – Using a knowledgeable respondent, complete this questionnaire for the people occupying the household on April 1, 2020. Vacant? – Skip to page 7. Not a housing unit – Skip to “Respondent Information” on page 44. Address Number (For example: 5007) Street or Road Name (For example: N Maple Ave) Apt/Unit (For example: Apt A or Lot 3) Physical Description (if applicable) Village/Municipality/Estate ZIP Code 1. We need to count people where they live and sleep most of the time. Please read the WHO TO COUNT section on the Flashcard. Based on these instructions, how many people were living or staying in this [house/apartment/mobile home] on April 1, 2020? Number of people = I J Were there any additional people staying here on April 1, 2020 that you did not include in the count in the previous question? For example: Mark K all that apply. Include any additional people on the person pages. 2. Children, related or unrelated, such as newborn babies, grandchildren, or foster children Relatives, such as adult children, cousins, or in-laws Nonrelatives, such as roommates or live-in babysitters People staying here temporarily No additional people Within Map Spot ID FOR NPC USE ONLY §,¢!,¤ 11950011 Yes ➜Number of continuation questionnaires = No Are there any continuation questionnaires for this address? FORM DI-Q-VI (07-25-2019) 2020 Census of the U.S. Virgin Islands U.S. Virgin Islands ® OMB No. 0607-1006: Approval Expires 11/30/2021 INFORMATIONAL COPY 2 I J Is Person 1 male or female? Mark K ONE box. Male Female 4. Person 1 3. Now I am going to ask you questions about each person staying here. If there is someone staying here who pays the rent or owns this residence, I would like to start by listing him or her as Person 1. If the owner or the person who pays the rent is not staying here, I can start by listing any adult staying here as Person 1. What is Person 1’s name? Print name below and verify the spelling. Last Name(s) MI First Name 7. 6. Please read the HISPANIC ORIGIN section on the Flashcard. Is Person 1 of Hispanic, Latino, or Spanish origin? 5. Age on April 1, 2020 Month Day Year of birth Print numbers in boxes. years I J Please read the RACE section on the Flashcard. What is Person 1’s race? You may choose one or more races. Mark K one or more boxes AND print origins. NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ What is Person 1’s age on April 1, 2020? What is Person 1’s date of birth? If you don’t know the exact age, please estimate. For babies less than 1 year old, do not report the age in months. Report 0 as the age. ➜ If more people were counted in question 1 on the front page, continue with Person 2 on the next page. Otherwise, skip to page 7. §,¢!>¤ 11950029 White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C 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 No, not 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 INFORMATIONAL COPY Person 2 3 1. What is the name of ? Last Name(s) MI First Name Male Female 4. What is this person’s age on April 1, 2020? What is this person’s date of birth? If you don’t know the exact age, please estimate. For babies less than 1 year old, do not report the age in months. Report 0 as the age. 5. Print numbers in boxes. Age on April 1, 2020 Month Day Year of birth years I J Is this person male or female? Mark K ONE box. 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. Same-sex husband/wife/spouse Biological son or daughter Adopted son or daughter Stepson or stepdaughter Parent-in-law Son-in-law or daughter-in-law Other relative Roommate or housemate Foster child Brother or sister Same-sex unmarried partner 3. Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner I J Please read the RELATIONSHIP section on the Flashcard. How is this person related to Person 1? Mark K ONE box. NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ ➜ If more people were counted in question 1 on the front page, continue with Person 3 on the next page. Otherwise, skip to page 7. Print name below and verify the spelling. No With a parent or other relative For college In a jail or prison For a military assignment For another reason At a seasonal or second residence In a nursing home For a job or business §,¢!F¤ 11950037 White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C 7. I J Please read the RACE section on the Flashcard. What is this person’s race? You may choose one or more races. 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 No, not of Hispanic, Latino, or Spanish origin 6. Please read the HISPANIC ORIGIN section on the Flashcard. Is this person 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 INFORMATIONAL COPY Person 3 1. 4 ➜ What is the name of ? NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ If more people were counted in question 1 on the front page, continue with Person 4 on the next page. Otherwise, skip to page 7. Last Name(s) MI First Name Male Female 4. What is this person’s age on April 1, 2020? What is this person’s date of birth? If you don’t know the exact age, please estimate. For babies less than 1 year old, do not report the age in months. Report 0 as the age. 5. Print numbers in boxes. Age on April 1, 2020 Month Day Year of birth years I J Is this person male or female? Mark K ONE box. 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. Same-sex husband/wife/spouse Biological son or daughter Adopted son or daughter Stepson or stepdaughter Parent-in-law Son-in-law or daughter-in-law Other relative Roommate or housemate Foster child Brother or sister Same-sex unmarried partner 3. Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner I J Please read the RELATIONSHIP section on the Flashcard. How is this person related to Person 1? Mark K ONE box. Print name below and verify the spelling. No With a parent or other relative For college In a jail or prison For a military assignment For another reason At a seasonal or second residence In a nursing home For a job or business §,¢!N¤ 11950045 White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C 7. I J Please read the RACE section on the Flashcard. What is this person’s race? You may choose one or more races. 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 No, not of Hispanic, Latino, or Spanish origin 6. Please read the HISPANIC ORIGIN section on the Flashcard. Is this person 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 INFORMATIONAL COPY Person 4 5 1. ➜ What is the name of ? NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ If more people were counted in question 1 on the front page, continue with Person 5 on the next page. Otherwise, skip to page 7. Last Name(s) MI First Name Male Female 4. What is this person’s age on April 1, 2020? What is this person’s date of birth? If you don’t know the exact age, please estimate. For babies less than 1 year old, do not report the age in months. Report 0 as the age. 5. Print numbers in boxes. Age on April 1, 2020 Month Day Year of birth years I J Is this person male or female? Mark K ONE box. 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. Same-sex husband/wife/spouse Biological son or daughter Adopted son or daughter Stepson or stepdaughter Parent-in-law Son-in-law or daughter-in-law Other relative Roommate or housemate Foster child Brother or sister Same-sex unmarried partner 3. Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner I J Please read the RELATIONSHIP section on the Flashcard. How is this person related to Person 1? Mark K ONE box. Print name below and verify the spelling. No With a parent or other relative For college In a jail or prison For a military assignment For another reason At a seasonal or second residence In a nursing home For a job or business §,¢!U¤ 11950052 White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C 7. I J Please read the RACE section on the Flashcard. What is this person’s race? You may choose one or more races. 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 No, not of Hispanic, Latino, or Spanish origin 6. Please read the HISPANIC ORIGIN section on the Flashcard. Is this person 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 INFORMATIONAL COPY Person 5 1. 6 ➜ If more people were counted in question 1 on the front page of the D-Q-VI, continue with the next person on an additional continuation questionnaire (D-CQ-VI) and update the number of continuation questionnaires on page 1 of the D-Q-VI. ➜ What is the name of ? NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. Last Name(s) MI First Name Male Female 4. What is this person’s age on April 1, 2020? What is this person’s date of birth? If you don’t know the exact age, please estimate. For babies less than 1 year old, do not report the age in months. Report 0 as the age. 5. Print numbers in boxes. Age on April 1, 2020 Month Day Year of birth years I J Is this person male or female? Mark K ONE box. 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. Same-sex husband/wife/spouse Biological son or daughter Adopted son or daughter Stepson or stepdaughter Parent-in-law Son-in-law or daughter-in-law Other relative Roommate or housemate Foster child Brother or sister Same-sex unmarried partner 3. Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner I J Please read the RELATIONSHIP section on the Flashcard. How is this person related to Person 1? Mark K ONE box. Print name below and verify the spelling. No With a parent or other relative For college In a jail or prison For a military assignment For another reason At a seasonal or second residence In a nursing home For a job or business §,¢!]¤ 11950060 White – Print, for example, German, Irish, English, Italian, Lebanese, Egyptian, etc. C 7. I J Please read the RACE section on the Flashcard. What is this person’s race? You may choose one or more races. 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 No, not of Hispanic, Latino, or Spanish origin 6. Please read the HISPANIC ORIGIN section on the Flashcard. Is this person 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 INFORMATIONAL COPY Housing 4. How many acres is this house or mobile home on? Less than 1 acre ➜ SKIP to question 6a 1 to 9.9 acres Ask questions 4 – 5 if this is a HOUSE OR A MOBILE HOME; otherwise, SKIP to question 6a. A Please answer the following questions about this house, apartment, or mobile home. 1. Please read the BUILDING TYPE section on the Flashcard. Which best describes this building? Include all apartments, flats, etc., even if vacant. A mobile home A one-family house detached from any other house A one-family house attached to one or more houses A building with 2 apartments A building with 3 or 4 apartments 6. A building with 5 to 9 apartments A building with 10 to 19 apartments A building with 20 to 49 apartments A building with 50 or more apartments Boat, RV, van, etc. 2. About when was this building first built? 2000 or later – Specify year C 1990 to 1999 1980 to 1989 1970 to 1979 1960 to 1969 1950 to 1959 1940 to 1949 1939 or earlier 3. When did PERSON 1 (listed on page 2) move into this house, apartment, or mobile home? Month Year 10 or more acres 5. What were the actual sales of all agricultural products from this property in 2019? None $1 to $999 $1,000 to $2,499 $2,500 to $4,999 $5,000 to $9,999 $10,000 or more • INCLUDE bedrooms, kitchens, etc. • EXCLUDE bathrooms, porches, balconies, foyers, halls, or unfinished basements. Number of rooms Number of bedrooms 7. Does this house, apartment, or mobile home have – a. Running water? b. A bathtub or shower? d. A sink with a faucet? e. A stove or range? f. A refrigerator? Yes No 8. Can you or any member of this household both make and receive phone calls when at this house, apartment, or mobile home? Include calls using cell phones, land lines, or other phone devices. Yes No Two houses (American Samoa only) Three or more houses (American Samoa only) c. A flush toilet? 7 a. How many separate rooms are in this house, apartment, or mobile home? Rooms must be separated by built-in archways or walls that extend out at least 6 inches and go from floor to ceiling. b. How many of these rooms are bedrooms? Count as bedrooms those rooms you would list if this house, apartment, or mobile home were for sale or rent. If this is an efficiency/studio apartment, print "0". §,¢!o¤ 11950078 INFORMATIONAL COPY Housing (continued) 9. Please read the COMPUTER USE section on the Flashcard. At this house, apartment, or mobile home – do you or any member of this household own or use any of the following types of computers? a. Desktop or laptop b. Smartphone c. Tablet or other portable wireless computer d. Some other type of computer – Specify C Yes No 11. Please read the INTERNET section on the Flashcard. Do you or any member of this household have access to the Internet using a – a. Cellular data plan for a smartphone or other mobile device? b. Broadband (high speed) Internet service such as cable, fiber optic, or DSL service installed in this household? c. Satellite Internet service installed in this household? d. Dial-up Internet service installed in this household? e. Some other service? – Specify service C Yes No 10. a. At this house, apartment, or mobile home – do you or any member of this household have access to the Internet? Yes No ➜ SKIP to question 12 12. How many automobiles, vans, and trucks of one-ton capacity or less are kept at home for use by members of this household? None 1 2 3 4 5 6 or more 13. I J Please read the SOURCE OF WATER section on the Flashcard. In 2019, did this house, apartment, or mobile home get water from – Mark K all that apply. 15. Included in rent or condominium fee No charge or electricity not used a. What is the average monthly cost of electricity for this house, apartment, or mobile home? A public system? A cistern, catchment, tanks, or drums? A delivery vendor or water truck? A supermarket or grocery store? Some other source (a standpipe, spring, individual well, etc.)? Average monthly cost – Dollars Included in rent or condominium fee Included in electricity payment entered above b. What is the average monthly cost of gas for this house, apartment, or mobile home? Average monthly cost – Dollars No charge or gas not used Included in rent or condominium fee No charge c. What is the average monthly cost of water and sewer for this house, apartment, or mobile home? Average monthly cost – Dollars Included in rent or condominium fee No charge or these fuels not used d. What is the average monthly cost of oil, coal, kerosene, wood, etc., for this house, apartment, or mobile home? Average monthly cost – Dollars b. Do you or any member of this household pay a cell phone company or Internet service provider to access the Internet? Yes No ➜ SKIP to question 12 14. I J Please read the SEWAGE DISPOSAL section on the Flashcard. What is the MAIN means of sewage disposal for this house, apartment, or mobile home? Mark K ONE box. Public sewer Septic tank or cesspool Other OR OR OR OR .00 $ .00 $ .00 $ .00 $ 8 §,¢!w¤ 11950086 INFORMATIONAL COPY Ask questions 19a and 19b if this house, apartment, or mobile home is RENTED. Otherwise, SKIP to question 20. B Housing (continued) 16. In 2019, did you or any member of this household 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. 18. I J Is this house, apartment, or mobile home – Mark K ONE box. Owned by you or someone in this household with a mortgage or loan? Include home equity loans. Owned by you or someone in this household free and clear (without a mortgage or loan)? Rented? Ask questions 20 – 24 if this person or any member of this household OWNS or IS BUYING this house, apartment, or mobile home. Otherwise, SKIP to E on the next page. C Yes No Occupied without payment of rent? ➜ SKIP to C None Monthly amount – Dollars OR 17. Is this house, apartment, or mobile home part of a condominium? Yes ➜ What is the monthly condominium fee? For renters, answer only if you pay the condominium fee in addition to your rent. Otherwise, mark the "None" box. No 19. a. What is the monthly rent for this house, apartment, or mobile home? Monthly amount – Dollars b. Does the monthly rent include any meals? Yes No About how much do you think this house and lot, apartment, or mobile home (and lot, if owned) would sell for if it were for sale? 20. Amount – Dollars What were the annual real estate taxes on THIS property in 2019? 21. Annual amount – Dollars OR None What was the annual payment for fire, hazard, typhoon or hurricane, and flood insurance on THIS property in 2019? 22. Annual amount – Dollars None OR 23. a. Do you or any member of this household have a mortgage, deed of trust, contract to purchase, or similar debt on THIS property? Yes, mortgage, deed of trust, or similar debt Yes, contract to purchase No ➜ SKIP to question 24a b. How much is the regular monthly mortgage payment on THIS property? Include payment only on FIRST mortgage or contract to purchase. Monthly amount – Dollars OR No regular payment required ➜ SKIP to question 24a c. Does the regular monthly mortgage payment include payments for real estate taxes on THIS property? Yes, taxes included in mortgage payment No, taxes paid separately or taxes not required d. Does the regular monthly mortgage payment include payments for fire, hazard, typhoon or hurricane, or flood insurance on THIS property? Yes, insurance included in mortgage payment No, insurance paid separately or no insurance .00 $ .00 $ $ .00 $ .00 $ .00 $ .00 9 §,¢!¡¤ 11950094 INFORMATIONAL COPY Ask question 25 if this is a MOBILE HOME or a BOAT. Otherwise, SKIP to E. D Housing (continued) 25. What were the total annual costs for installment loan payments, personal property taxes, site rent, marina fee, registration fees, and license fees on THIS mobile home or boat and its site/slip fee in 2019? Exclude real estate taxes. 24. a. Do you or any member of this household have a second mortgage or a home equity loan on THIS property? Yes, home equity loan Yes, second mortgage Yes, second mortgage and home equity loan No ➜ SKIP to D No regular payment required b. How much is the regular monthly payment on all second or junior mortgages and all home equity loans on THIS property? Monthly amount – Dollars OR Annual costs – Dollars Ask questions about PERSON 1 on the next page if you listed at least one person on page 2. Otherwise, SKIP to page 44 for further instructions. E $ .00 $ .00 10 §,¢"#¤ 11950102 INFORMATIONAL COPY Person 1 11 §,¢"+¤ 11950110 12. I J Please read the HIGHEST DEGREE or LEVEL OF SCHOOL section on the Flashcard. What is the highest degree or level of school this person has COMPLETED? Mark K ONE box. If currently enrolled, mark the previous grade or highest degree received. Last Name(s) MI First Name Please copy the name of Person 1 from page 2, then continue answering questions below. 9. Where was this person born? 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) 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 13. This question focuses on this person’s BACHELOR’S DEGREE. What was the specific major or majors of any BACHELOR’S DEGREES this person has received? (For example: chemical engineering, elementary teacher education, organizational psychology.) 14. Has this person 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 Ask question 13 if this person has a bachelor’s degree or higher. Otherwise, SKIP to question 14. G 12th grade – NO DIPLOMA 8. U.S. Virgin Islands Outside the U.S. Virgin Islands – Print name of U.S. state, U.S. territory, or foreign country below. C 10. When did this person come to live in the U.S. Virgin Islands? If this person came to live in the U.S. Virgin Islands more than once, print latest year. Year 11. a. At any time since February 1, 2020 has this person 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 12 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 was this person 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) Ask question 10 if this person was born outside the U.S. Virgin Islands. Otherwise, SKIP to question 11a. F INFORMATIONAL COPY Person 1 (continued) 12 §,¢"=¤ 11950128 16. U.S. Virgin Islands Outside the U.S. Virgin Islands – Print name of U.S. state, U.S. territory, or foreign country below. C a. Where was this person’s mother born? b. Where was this person’s 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 17. Yes No ➜ SKIP to question 18 a. Does this person 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 does this person speak English? Not well Not at all 18. Did this person live in this house or apartment 5 years ago (on April 1, 2015)? Person is under 5 years old ➜ SKIP to question 20 Yes, this house ➜ SKIP to question 20 No, different house 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 19. I J What was this person’s main reason for moving? Mark K ONE box. a. Insurance through a current or former employer or union (of this person or another family member) b. Insurance purchased directly from an insurance company (by this person 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 Yes No 21. Yes No a. Is this person deaf or does he/she have serious difficulty hearing? b. Is this person blind or does he/she have serious difficulty seeing even when wearing glasses? Yes No 15. What is this person’s 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.) 20. Please read the HEALTH INSURANCE section on the Flashcard. Is this person 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. Employment Military Family-related To attend school Natural disaster Housing Other reason h. Any other type of health insurance or health coverage plan – Specify C INFORMATIONAL COPY Ask questions 22a – c if this person is 5 years old or over. Otherwise, SKIP to the questions for Person 2 on page 17. Ask question 23 if this person is 15 years old or over. Otherwise, SKIP to the questions for Person 2 on page 17. Person 1 (continued) 13 §,¢"E¤ 11950136 Year 22. a. Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions? Yes No b. Does this person have serious difficulty walking or climbing stairs? Ask question 28 if this person is female and 15 years old or over. Otherwise, SKIP to question 29a. Yes No c. Does this person have difficulty dressing or bathing? Yes No 23. Because of a physical, mental, or emotional condition, does this person have difficulty doing errands alone such as visiting a doctor’s office or shopping? Yes No 24. What is this person’s marital status? Now married Widowed Divorced Separated 25. In the PAST 12 MONTHS did this person get – a. Married? b. Widowed? c. Divorced? Yes No How many times has this person been married? Once Two times Three or more times 27. In what year did this person last get married? 29. a. Does this person have any of his/her own grandchildren under the age of 18 living in this house or apartment? Yes No ➜ SKIP to question 30 b. Is this grandparent currently responsible for most of the basic needs of any grandchildren under the age of 18 who live in this house or apartment? Yes No ➜ SKIP to question 30 c. How long has this grandparent been responsible for these grandchildren? If the grandparent is financially responsible for more than one grandchild, answer the question for the grandchild for whom the grandparent has 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 26. 28. How many babies has this person ever had, not counting stillbirths? Do not count stepchildren or children she has adopted. Number of children None or H I J Never married ➜ SKIP to J INFORMATIONAL COPY Person 1 (continued) 14 §,¢"M¤ 11950144 34. At what location did this person 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 Ask question 36 if you marked "Car, truck, or private van/bus" in question 35. Otherwise, SKIP to question 37. 30. I J Has this person 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 Please read the PERIOD OF SERVICE section on the Flashcard. When did this person serve on active duty in the U.S. Armed Forces? Mark K a box for EACH period in which this person 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. Does this person have a VA service-connected disability rating? b. What is this person’s 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 this person work for pay at a job (or business)? b. LAST WEEK, did this person do ANY work for pay, even for as little as one hour? Yes No ➜ SKIP to question 39a 35. I J Please read the TRANSPORTATION TO WORK section on the Flashcard. How did this person 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 this person, usually rode to work in the car, truck, or private van/bus LAST WEEK? Person(s) 37. LAST WEEK, what time did this person’s trip to work usually begin? Hour Minute : 38. How many minutes did it usually take this person to get from home to work LAST WEEK? Minutes K INFORMATIONAL COPY Person 1 (continued) 15 §,¢"T¤ 11950151 39. a. LAST WEEK, was this person on layoff from a job? Yes ➜ SKIP to question 39c No b. LAST WEEK, was this person TEMPORARILY absent from a job or business? Ask questions 45a – f if this person worked in the past 5 years (since 2015). Otherwise, SKIP to question 46. Ask questions 39 – 42a if this person did NOT work last week. Otherwise, SKIP to question 42b. Yes, on vacation, temporary illness, maternity leave, other family/personal reasons, bad weather, etc. ➜ SKIP to question 42a No ➜ SKIP to question 40 c. Has this person been informed that he or she 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, has this person been ACTIVELY looking for work? Yes No ➜ SKIP to question 42a 41. LAST WEEK, could this person 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 this person last work, even for a few days? Usual hours worked each WEEK I J a. Please read the TYPE OF WORKER section on the Flashcard. Which one of the following best describes this person’s 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 44. During 2019, in the WEEKS WORKED, how many hours did this person usually work each WEEK? 45. DESCRIPTION OF EMPLOYMENT The next series of questions is about the type of employment this person had last week. If this person had more than one job, describe the one at which the most hours were worked. If this person 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 this person work at a job or business at any time? Yes b. What was the name of this person’s employer, business, agency, or branch of the Armed Forces? 43. a. During 2019 (all 52 weeks), did this person 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 this person work? Include paid time off and include weeks when the person only worked for a few hours. Weeks 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) M 2015 to 2018 ➜ SKIP to M No ➜ SKIP to M L INFORMATIONAL COPY Person 1 (continued) 16 ➜ Continue with the questions for Person 2 on the next page. If no one is listed as Person 2 on page 3, SKIP to page 44 for further instructions. §,¢"f¤ 11950169 e. What was this person’s main occupation? (For example: 4th grade teacher, entry-level plumber) f. Describe this person’s 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 d. Was this mainly – Mark K ONE box. manufacturing? wholesale trade? retail trade? other (agriculture, construction, service, government, etc.)? a. Did this person receive any wages, salary, commissions, bonuses, or tips in 2019? b. Did this person have any self-employment income from own nonfarm businesses or farm businesses, including proprietorships and partnerships, in 2019? c. Did this person 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. Yes ➜ What was the amount from all jobs before deductions for taxes, bonds, dues, or other items? No TOTAL AMOUNT – Dollars Loss $ .00 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 e. Did this person receive any Supplemental Security Income (SSI) payments in 2019? f. Did this person receive any public assistance or public welfare payments from the state or local welfare office in 2019? d. Did this person receive any Social Security or Railroad Retirement benefits in 2019? $ .00 TOTAL AMOUNT – Dollars 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 What was this person’s total income for 2019? 47. None Loss TOTAL AMOUNT for 2019 $ .00 OR h. Did this person receive income on a regular basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support or alimony in 2019? TOTAL AMOUNT – Dollars $ .00 Yes ➜ What was the amount? No TOTAL AMOUNT – Dollars $ .00 Yes ➜ What was the amount? No g. Did this person 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. I J The next series of questions is about income received during 2019. If the exact amount is not known, please give your best estimate. If net income was a loss, please give the dollar amount of the loss. For income received jointly, report the appropriate share for each person - or, if that’s not possible, report the whole amount for only one person. Mark K the "No" box for the other person. INFORMATIONAL COPY