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U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU Census Office County BCU Map Spot CONTINUATION QUESTIONNAIRE Within Map Spot ID FOR NPC USE ONLY §,¥!3¤ 11980018 FORM D-CQ-VI (07-26-2019) 2020 Census of the U.S. Virgin Islands Enter ID Number from Barcode Label on the D-Q-VI for this household. U.S. Virgin Islands ® OMB No. 0607-1006: Approval Expires 11/30/2021 1. What is the name of Person ? 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. 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 Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner ➜ If more people were counted in question 1 on the D-Q-VI, continue with the next person on the next page. Otherwise, skip to page 7 of the D-Q-VI. 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 NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ 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 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. 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 3. 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. Last Name(s) MI First Name 2 §,¥!;¤ 11980026 1. What is the name of Person ? NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ 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. 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 Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner ➜ If more people were counted in question 1 on the D-Q-VI, continue with the next person on the next page. Otherwise, skip to page 7 of the D-Q-VI. 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. 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 3. 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. Last Name(s) MI First Name §,¥!C¤ 11980034 3 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 1. What is the name of Person ? NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ 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. 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 Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner ➜ If more people were counted in question 1 on the D-Q-VI, continue with the next person on the next page. Otherwise, skip to page 7 of the D-Q-VI. 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. 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 3. 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. Last Name(s) MI First Name 4 §,¥!K¤ 11980042 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 1. What is the name of Person ? NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ 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. 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 Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner ➜ If more people were counted in question 1 on the D-Q-VI, continue with the next person on the next page. Otherwise, skip to page 7 of the D-Q-VI. 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. 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 3. 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. Last Name(s) MI First Name §,¥!\¤ 11980059 5 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 1. What is the name of Person ? ➜ 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. NOTE: Please answer BOTH the question about Hispanic origin and the question about race. For this census, Hispanic origin is not a race. ➜ 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. 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 Other nonrelative Father or mother Grandchild Opposite-sex husband/wife/spouse Opposite-sex unmarried partner 2. I J Does this person usually live or stay somewhere else? For example – Mark K all that apply. 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 3. 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. Last Name(s) MI First Name 6 §,¥!d¤ 11980067 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 Person — 7 §,¥!l¤ 11980075 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. 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. B 12th grade – NO DIPLOMA Last Name(s) MI First Name Please copy the name of the Person listed on page 2, then continue answering questions below. 9. Where was this person born? 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) 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 Ask question 10 if this person was born outside the U.S. Virgin Islands. Otherwise, SKIP to question 11a. A 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 8 Person — (continued) h. Any other type of health insurance or health coverage plan – Specify C §,¥!t¤ 11980083 9 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. Ask questions 22a – c if this person is 5 years old or over. Otherwise, SKIP to the questions for the next person on page 13. Yes No c. Does this person have difficulty dressing or bathing? Yes No Ask question 23 if this person is 15 years old or over. Otherwise, SKIP to the questions for the next person on page 13. 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 Person — (continued) §,¥!|¤ 11980091 E C D Never married ➜ SKIP to E Person — (continued) 10 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 §,¥"*¤ 11980109 F Person — (continued) 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 11 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) §,¥"2¤ 11980117 H 2015 to 2018 ➜ SKIP to H No ➜ SKIP to H G 12 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) Person — (continued) 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.)? §,¥":¤ 11980125 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. ➜ Continue with the questions for the next person on the next page. If this is the last person, SKIP to page 44 of the D-Q-VI. Person — §,¥"B¤ 11980133 13 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. 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. B 12th grade – NO DIPLOMA Last Name(s) MI First Name Please copy the name of the Person listed on page 3, then continue answering questions below. 9. Where was this person born? 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. A 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 Person — (continued) h. Any other type of health insurance or health coverage plan – Specify C §,¥"J¤ 11980141 14 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. Ask questions 22a – c if this person is 5 years old or over. Otherwise, SKIP to the questions for the next person on page 19. Yes No c. Does this person have difficulty dressing or bathing? Yes No Ask question 23 if this person is 15 years old or over. Otherwise, SKIP to the questions for the next person on page 19. 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 Person — (continued) §,¥"[¤ 11980158 15 E C D Never married ➜ SKIP to E Person — (continued) 16 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 §,¥"c¤ 11980166 F Person — (continued) 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 17 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) §,¥"k¤ 11980174 H 2015 to 2018 ➜ SKIP to H No ➜ SKIP to H G 18 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) Person — (continued) 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.)? §,¥"s¤ 11980182 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. ➜ Continue with the questions for the next person on the next page. If this is the last person, SKIP to page 44 of the D-Q-VI. Person — §,¥"{¤ 11980190 19 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. 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. B 12th grade – NO DIPLOMA Last Name(s) MI First Name Please copy the name of the Person listed on page 4, then continue answering questions below. 9. Where was this person born? 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. A 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 Person — (continued) h. Any other type of health insurance or health coverage plan – Specify C §,¥#)¤ 11980208 20 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. Ask questions 22a – c if this person is 5 years old or over. Otherwise, SKIP to the questions for the next person on page 25. Yes No c. Does this person have difficulty dressing or bathing? Yes No Ask question 23 if this person is 15 years old or over. Otherwise, SKIP to the questions for the next person on page 25. 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 Person — (continued) §,¥#1¤ 11980216 21 E C D Never married ➜ SKIP to E Person — (continued) 22 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 §,¥#9¤ 11980224 F Person — (continued) 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 23 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) §,¥#A¤ 11980232 H 2015 to 2018 ➜ SKIP to H No ➜ SKIP to H G 24 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) Person — (continued) 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.)? §,¥#I¤ 11980240 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. ➜ Continue with the questions for the next person on the next page. If this is the last person, SKIP to page 44 of the D-Q-VI. Person — §,¥#Z¤ 11980257 25 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. 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. B 12th grade – NO DIPLOMA Last Name(s) MI First Name Please copy the name of the Person listed on page 5, then continue answering questions below. 9. Where was this person born? 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. A 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 Person — (continued) h. Any other type of health insurance or health coverage plan – Specify C §,¥#b¤ 11980265 26 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. Ask questions 22a – c if this person is 5 years old or over. Otherwise, SKIP to the questions for the next person on page 31. Yes No c. Does this person have difficulty dressing or bathing? Yes No Ask question 23 if this person is 15 years old or over. Otherwise, SKIP to the questions for the next person on page 31. 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 Person — (continued) §,¥#j¤ 11980273 27 E C D Never married ➜ SKIP to E Person — (continued) 28 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 §,¥#r¤ 11980281 F Person — (continued) 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 29 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) §,¥#ƒ¤ 11980299 H 2015 to 2018 ➜ SKIP to H No ➜ SKIP to H G 30 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) Person — (continued) 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.)? §,¥$(¤ 11980307 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. ➜ Continue with the questions for the next person on the next page. If this is the last person, SKIP to page 44 of the D-Q-VI. Person — §,¥$0¤ 11980315 31 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. 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. B 12th grade – NO DIPLOMA Last Name(s) MI First Name Please copy the name of the Person listed on page 6, then continue answering questions below. 9. Where was this person born? 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. A 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 Person — (continued) h. Any other type of health insurance or health coverage plan – Specify C §,¥$8¤ 11980323 32 Ask questions 22a – c if this person is 5 years old or over. Otherwise, skip to the questions for the next person on page 7 of an additional D-CQ-VI. If this is the last person, SKIP to page 44 of the D-Q-VI. Ask question 23 if this person is 15 years old or over. Otherwise, skip to the questions for the next person on page 7 of an additional D-CQ-VI. If this is the last person, SKIP to page 44 of the D-Q-VI. 22. a. Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions? Yes No b. Does this person have serious difficulty walking or climbing stairs? Yes No c. Does this person have difficulty dressing or bathing? Yes No 23. Because of a physical, mental, or emotional condition, does this person have difficulty doing errands alone such as visiting a doctor’s office or shopping? Yes No 24. What is this person’s marital status? Now married Widowed Divorced Separated 25. In the PAST 12 MONTHS did this person get – a. Married? b. Widowed? c. Divorced? Yes No Person — (continued) §,¥$@¤ 11980331 33 Year Ask question 28 if this person is female and 15 years old or over. Otherwise, SKIP to question 29a. 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 E C D Never married ➜ SKIP to E Person — (continued) 34 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 §,¥$R¤ 11980349 F Person — (continued) 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 35 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) §,¥$Y¤ 11980356 H 2015 to 2018 ➜ SKIP to H No ➜ SKIP to H G 36 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) Person — (continued) 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. §,¥$a¤ 11980364 ➜ Continue with the questions for the next person on page 7 of an additional D-CQ-VI. If this is the last person, SKIP to page 44 of the D-Q-VI.