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The Diary Household Characteristics Questionnaire Back Section is used by the field representative to record contact information, including the respondent's preferred mode and time of contact, address and telephone numbers. This section is also used to record information on a non-interview. IMPORTANT: The Census Bureau does not release to the Bureau of Labor Statistics any confidential information such as names and addresses. This information is only used during the course of the interview.
Diary Survey
Visit Number:
Date is:
Earliest Placement Date:
Latest Placement Date:
* Instruct the respondent on how to complete the Week 1 Diary, and attempt to leave the Diary form with the respondent.
* Was the Week 1 Diary placed?
*The ideal date for picking up the Week 1 Diary is between [fill: 8 days after today's date] and [fill: 14 days after today's date].
* If you traveled LESS than 50 miles to place this Diary -- Will the respondent be available for pick up during this period?
* If you traveled 50 miles or MORE to place this Diary, answer NO, and attempt a Diary double placement.
* Was this a Week 1 and Week 2 double placement?
* Why were both diaries placed?
* Specify: [enter text] _____________
* What type of non-interview do you have?
Type A = No one home, refusal
Type B = Temporarily absent, Vacant, under construction, occupied by persons with URE
Type C = Demolished, house moved, merged, condemned, located on base, CU moved
* Enter TYPE A noninterview
* Specify other TYPE A [enter text] _____________
* Enter type of refusal
* Specify type of refusal [enter text] _____________
* Enter TYPE B noninterview
* Specify other TYPE B [enter text] _____________
* Enter TYPE C noninterview
* Specify other TYPE C [enter text] _____________
* Did you classify this unit by observation only?
* Enter contact person's name [enter text] _____________
* Enter contact person's title [enter text] _____________
* Enter contact person's phone number [enter value] _____________
* Enter contact person's phone number extension [enter value] _____________
* Enter contact person's street address [enter text] _____________
* Enter second line of address if necessary [enter text] _____________
* Enter city [enter text] _____________
* Enter state [enter text] _____________
* Enter zipcode [enter value] _____________
* Race of individual
Number of household members: [enter value] _____________
* Tenure code
* Instruct the respondent on how to complete the Week 2 Diary, and attempt to leave the Diary form with the respondent.
* Was the Week 2 Diary placed?
* What type of non-interview do you have?
Type A = No one home, refusal
Type B = Temporarily absent, Vacant, under construction, occupied by persons with URE
Type C = Demolished, house moved, merged, condemned, located on base, CU moved
* Enter TYPE A noninterview
* Specify other TYPE A [enter text] _____________
* Enter type of refusal
* Specify type of refusal [enter text] _____________
* Enter TYPE B noninterview
* Specify other TYPE B [enter text] _____________
* Enter TYPE C noninterview
* Specify other TYPE C [enter text] _____________
* Did you classify this unit by observation only?
* Enter contact person's name [enter text] _____________
* Enter contact person's title [enter text] _____________
* Enter contact person's phone number [enter value] _____________
* Enter contact person's phone number extension [enter value] _____________
* Enter contact person's street address [enter text] _____________
* Enter second line of address if necessary [enter text] _____________
* Enter city [enter text] _____________
* Enter state [enter text] _____________
* Enter zipcode [enter value] _____________
* Race of individual
Number of household members: [enter value] _____________
* Tenure code
Instruct respondent to begin filling out the diary [today/tomorrow].
Week 1 [or 2] Pick Up Date: [fill in date]/ Double Placement – Week 1 Pick up: [fill in date] Double Placement – Week 2 Pickup: [fill in date]
Thank you.
I will return on [fill in date] to pick up the Diary/both Diaries and complete/continue the interview.
Thank you.
*DO NOT place Diary. Roster section not complete
I'd like to schedule a DATE to conduct/complete the interview. May I return on
When is the best time to contact you?
* Enter specific best time to contact [enter value] _____________
Would a Sunday interview be acceptable?
End of Back Section
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Last Modified Date: January 2, 2013