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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:
* Was the Week 1 Diary placed?
* Will the respondent be available for pick up during this period?
* 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
* Specify other TYPE A [enter text] _____________
* Specify type of refusal [enter text] _____________
* Specify other TYPE B [enter text] _____________
* 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] _____________
Number of household members: [enter value] _____________
* 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
* Specify other TYPE A [enter text] _____________
* Specify type of refusal [enter text] _____________
* Specify other TYPE B [enter text] _____________
* 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] _____________
Number of household members: [enter value] _____________
Instruct respondent to begin filling out the diary [today/tomorrow].
Week 1 [or 2] Pick Up Date is [fill in date]/ Double Placement Pick up Date is [fill in date]
Thank you.
I will return on [give date] to pick up the Week 1 [and/or 2] diary and complete/continue with the interview.
*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?
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Last Modified Date: April 18, 2008