Q 9,919, GE -'809 jºoba.
& innº f Ol Ho-M
Jijū yº) (SUDOCG
- —º- ſ Wi.j\; sº OMB NO. 1220-0050
1. Regional 2. Control number sº ' ' || 3a. HH 3b. CU |4. Segment type *Stºus giunit 5b. Letter sent 7a. Extra Original unit Original unit FORM CE-802
Office § | 'd No. No. i g"; ".… . . A unit serial number serial suffix (9–17–2002)
code *::::' ' & #—1: ". . . , H
PSU Segment Segment Sample Serial Serial . Check 010 1 [ ] Unit it sedal no. . :* Yes 2 D No —- ots otá TMENT OF COMMERCE
code number number designation number number digit 2 [ ] Permit assigned .. º: DEPAR M. ti ..º. ation
Suffix suffix 3 [ ] Area [ ] by Was 6. Earliest placement date 7b. Sheet Line No. *"...# *śj r
2 Serial No. I
001 002 toos | 004 Loos roos ooz Tooys [oos 009 4 [ ] Group assigned oi2. Month Date 7c. jº 075 ^jº"
Unit NO. tº ºf e
D Quarters by R.O. | * 1 [ ] 2 || 3 || BUREAU OF LABOR STATISTICS
9. ADDRESS (Sheet Line ) AREA SEGMENTS ONLY 12. LAND USE – Follow instructions for box that is marked
9a. What is your (the) exact address? 10. YEAR BUILT 11. COVERAGE OUESTIONS 12a. H O U S E H O LD
H No., , Apt. No., ther identificati g - &
ouse No., Street, Apt. No., or other identification Last mºst visit L.Askitems that are marked in Eurban-Go to item 13 CHARACTERISTICS
Ask first visit D DO NOT ask 2[ ] Rural
[...] DO NOT ask aS
*-wº-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º: g — Regular units and Group Ouarters units OU ES IONNAIRE
When was this a. [] *::::::: #:. Y 2 N coded 92–N or 93–N item 9d – Go to item 12b
Place State ZIP Code :..., built? besides your own in this | Fill – Group Ouarters units not coded 92–N or 93–N in
buildin Table X iterm 9d – Mark "No" in item 12b without asking,
[T] 9 then go to item 13. CONSUMER EXPENDITURE
* , - - - e Before 4-1-90
9b. Is this also your (the) mailing address? | ||Yes | | No-Specify below Aſ Continue b. [] *::::::: #:. Y Z N | 12b. During the past 12 months did sales of crops, SU RVEYS
Route No., PO Box, or other identification interview besides your own on this Fill livestock, and other farm products from this
floor? Table X place amount to $1,000 or more?
Place State ZIP Code [] After 4-1-90 DIARY SURVEY
Complete item c. [] is there any other Y N 1[ ] Yes
116 when building on this property AZ 2[ ] No e s º
required; end for people to live in - Fill NOTICE – Your report to the Census Bureau is confidential by law
9c. Group Quarters name 9d. Type code 9e. Sample number interView either occupied or Table X (title 13, U.S. Code). It may be seen only by sworn Census employees
0.17 vacant? and may be used only for statistical purposes.
13. CLASSIFICATION OF LIVING OUARTERS – Mark by observation 14. UNITS IN STRUCTURE PROCESSING
- USE ONLY
13a. FIELD REPRESENTATIVE CHECK ITEM | 1.3b. ACCESS 13c. HOUSING unit 13d. Group Ouarters unit Ask if not apparent.
H h tº- its, both ied and vacant,
Unit i • * * w e 8| ] Ouarters not HU in rooming or ºn ...; otn occupied and vac
nit is — 021 1|| Direct – Go to item 13c 023 1[ ] House, apartment, flat 5| Mobile home or trailer with NO boarding house
ozo [] 2[ ] Through another unit- 2[ ] HU, in nontransient hotel, motel, etc. permanent room added 9| | Student quarters in college 024 1|| Only Group Quarters units 6 || 3–4 025
1 | | In a Group Ouarters – Refer to the Not a separate HU: 6|| Mobile home or trailer with one or ºnt q Q 2ſ Mobile home or trailer 7 [ ] 5 – 9
CE-350. 1 and mark the appropriate ...; unit' 3D HU, permanent in transient hotel, more permanent rooms added dormitory OOII e In Orſle O
box in either itern 13c or item 13c. through which access is motel, etc. | p * - 8 * - nº 10|| Group Ouarters unit not specified 3| || One, detached 8 || 10 – 19
2[ ] NOT in a Group Ouarters gained. (Apply merged 4[ ] HU, in rooming house 7 ºpecified above – Describe in above – Describe in "NOTES." 4L One, attached 9 [ ] 20–49
unit procedures if e [º] 2 10 || 50
appropriate.) 5 - Or more
Go to section 1, page 2
e I
15. WEEK 1 PLACEMENT | Earliest date Latest date 19. DIARY START DATES 20. FINAL INTERVIEW STATUS — Enter the appropriate code (01–19) for both placement and pickup for each week. 21. TENURE CODES
| |
PERIOD | | - 1 – Owned 2 – Rented
WEEK 1 Code WEEK 1 WEEK 2
16. RECORD OF TELEPHONE CONTACT AND REASON FOR CONTACT 01 – Diary placed or completed 22. Items on cover page to be
Enter code for reason of telephone contact from list. —- 1 Telephone call to collect data From ry p !º DIARY PLACEMENT DIARY PLACEMENT filled for noninterviews
2 Telephone calf to schedule appointment Month Date Year NONINTERVIEW O 17 TYPE A
3 Other telephone call | | Type A - — Code e Code Item 5a º
| | 02 - No one home (unable to contact) lf code is 01-05, enter month and date. If code is 01–05, enter month and date. Item 10 (lf applicable)
| | m - If code is 02–05, mark race and enter if code is 02–05, mark race and enter item 11 (if applicable)
Call Reason Field Representative Name Field Representative SUPERVISOR'S USE | | 03 - Temporarily absent during ENTRE number of household members and number of household members and Item 12
(Enter code) p COCIe R – Reint. O – Obs. | | reference week tenure code from item 21. tenure code from item 21. |tem 13
(a) (b) (c) (d) (e) Through 04 – Refused I I I I Item 14
& 010 | I Month/date of 0 18 | | Month/date of
1 || 001 002 Month Date Year 05 – Other – Specify | I placement | l placement . *::
2 OO3 004 e -
3 OO5 O06 Type B 1 [...] White 1 [ ] White ".
| | 06 – Vacant (for rent) 2 [...] Black 2 [ ] Black Race
4 007 008 | | 07 - Vacant (for sale) 3 [ ] American Indian, Eskimo, or Aleut 3 || American Indian, Eskimo, or Aleut HH-members
5 | OO9 O 10 week 2 I ;: §: º ith URE 4 [ ] Asian or Pacific Islander 4 [...] Asian or Pacific Islander Tenure
6 || 0 1 1 012 -uccupied by persons Wit TYPE B
7 || 013 0.14 From 10 – Under construction, not ready HH members 020 HH members Item 5a
Month. Date Year | 1 1 — Other – Specify Tenure 021 Tenure Item 10 (If applicable)
8 || 0 15 O16 f | p . º .." ºperto
! | DIARY PICKUP DIARY PICKUP tems
9 || 0 1 7 O 18 I I Type C Items 16b-d
10 || 019 O20 007 12 – Demolished 014 Code 022 Code items 17–18
| l 13 — House or mobile home moved lf code is 01-05, enter month and date. lf code is 01–05, enter month and date. Item 20, code
11 021 022 14 – C d idential I I I I
Through – Converted to permanent nonresidential use | | I | TYPE C
12 O23 024 Month I Dat I Y 15 – Merged I I Month/date t | Month/date . ; (If licable)
Onth Date 1 Year || 16 - Condemned Mark (X) appropriate box Mark (X) appropriate box tenn applicable
17. RECORD OF TR - - - -
AVEL TIME (See page 20) 17 - Located on military base (post) 1 [ ] Completed by respondent 1 [ ] Completed by respondent ºppºse
18 - CU moved m o
2 [ ] Partial recall 2 [ ] Partial recall ſt 17–18
18. RECORD OF INTERVIEW AND OFFICE ACTIVITY TIME (See page 20 | f m º e €rnS
(See page 20) 008 | 19 – Other – Specify 3 T Total recall 3 || || Total recall Item 20, code

Page 2

D Section 1 – HouseHold CHARACTERISTICS
FILL ITEMS 8g – 14 ONLY FOR MEMBERS OF THIS CU
Fill Table X (page 15) for the person
or group of persons not living or
eating with the reference person.
Ask if not apparent.
8c. Does any other household on
the property live OR eat with
this household?
[T] Yes – Redefine the unit to include
space occupied by all persons who
live or eat together (apply merged
unit procedures if appropriate).
D No – Go to item 8d —
2 Household contains one
or more persons not
related to the reference
arrangements — Enter "1"
in itern 8
person by blood,
marriage, adoption, or
other legal
arran
Itern
above for all
household members.
Go to item 8f on page 3.
ements – Go to
e on page 3
5 – Native Hawaiian
or other Pacific
Islander
6 – Other
40 - Some college but no degree
HOUSEHOLD RECORD — FILL TEMS 2—7b FOR ALL PERSONS LIVING OR STAYING HERE.
1. 3. HOUSEHOLD ROSTER 4. RELATIONSHIP TO 6. SEX 7a. AWAY AT || 7b. HOUSE- 8g. 9. BIRTH DATE/AGE HISPANIC ORIGIN 11. RACE 12. MARITAL EDUCATION – Fill for all 14. ARMED
(last name first) REFERENCE PERSON A. g., | . .991 FGF ºral | # whati..... as: 1 Oa. 1Ob. #%at STATUS CU members 14 and over. FORCES
SK J1 ITO tº ſeal tº IS - - - "$ 0 tºll (B g * IITTOrr'r?aIIOn ſº 13a. ATTAINMENT | 13b. ATTENDING MEMBER
a- Ask if not º $ - - - Show information Ask if not tº dº
2. *:::: &lrº ºº:: of Ask if not apparent. apparent apparent. Does = of birth? Hispanic, booklet, page 2. ;|g apparent Show information COLLEGE Ask if
-> Cº. º: 7 S 9 ith g iiv E | Verify age using Lating, or is . . . booklet page 4. Ask if code 39–46. 16–65
O || LL staying here? Start wi What is . . .’s relationship Are any of usually E | . s ſº Spanish? | 1 – Mexican Please ls . . . now — sº in item 13a. years old.
DO the name of the person to (reference person)? is . . . these persons | live here? 5 | information booklet. e tº gº choose 1 – Married, What is the is . . . currently | Is . .
§ > or one of the persons. - male or | living away at É le: If 4. § 2 – Mexican-American ONE Of 2 - Widowed, highest level of enrolled in a now in
5 || 2 who owns or rents this Example: Reference person, female? | college? If NO, s] = Example: º; §§ go 3–Chicano. more races 3 - Divorced, school . . .has college or the
g | | | home. husband, wife, son, lf) rves smartedlč"" |& # fººt,” || 4 - Puerto Rican jäärts)|4-separated. ..." |university #:,
# = List all persons who usually daughter-in-law, partner, ; below for a ; 3 Af : , 3. Ameri . . . to be. OR jº . . . has either-,
$2 z live here and all persons lodger, lodger's wife, etc. E person, mark F| Read If no is - Lell Otº TN-AA Tºrº Tº 5 – Never received? 1 - Full-time 1 - Yes
* | * who are temporarily O NO, in item 7b S item marked 7–Central or . Enter one or] married 2 – Part-time 2 - No
* | ? absent. Be sure to include H- without asking. F| #on §§§ South American º É: Ent d Enter code OR Enter
tº TU infants under 1 year of age. ...]3 3|next • | 8 – Other rCry? Deſ OVV. I tºter COO!e from below 3 – Not at all code
fl. l n ~ • code|code|S2'ſ Male Female YES NO YES | NO page | Mo. Date | Year Age | Yes | No Enter one code Enter code
201 || O1 1|| || 2 || 1 || 2[ ] 1[ ] | 2D | | | | | 1|| || 2 | | |
202 || O2 1D | 2D | 1ſ] 2[ ] 1|| || 2D | | | | | 1|| || 2 || |
203 || O3 1[ ] 2[ ] 1[ ] 2[ ] 1[ ] 2[ ] | | | | | 1 2[ ] | |
O4 1|| || 2D | | 1 | 2[ ] 1[ ] 2D | | | | | 1[ ] | 2D | |
O5 1|| 2[ ] 1[ ] 2|| 1|| 2[ ] | | | | 1[] 2| | | |
O6 1| | | 2 || 1ſ 2|| 1[ ] | 2 || | | | | | 1[ ] 2D |
O7 1[ ] | 2D | 1ſº 2[ ] 1[ ] | 2 | | | | | | 1[ ] 2D | |
08 1[ ] 2D 1[ ] 2[ ] 1[ ] 2[ ] | | | | 1[T] 2[ ] | |
209 || 09 1[ ] | 2D | 1 | 2[] 1|| || 2 | | | | | 1[ ] | 2D | |
2 1 0 || 1 O 1|| || 2D 1 2[ ] 1[ ] | 2 || l i | | | 1|| || 2 || |
211 || 11 1ſ 2ſ | 1 || 2L 1|| || 2D | | | | | 1[ ] 2ſ | |
12 1|| || 2 || || 1ſ 2[ ] 1D | 2D | | | | | 1[ ] | 2ſ | |
13 1[ ] | 2DT | 1 || 2[ ] 1|| || 2 | | | | | 1[] | 2D | |
14 1[ ] | 2ſ.) | 1|| 2[ ] 1[ ] | 2D | i | | | 1ſ] | 2D |
215 15 Nº. 1|| 2[T] 1[T] 2[ ] 1[ ] 2[ ] Nº. | | | | | 1[ ] 2D |
T WEEK 1 PLACEMENT. HOUSING UNIT COVERAGE CODES FOR ITEMS 11 AND 13
aska g FéiºšENTATVääEck ITEM |* {{#3; ######|NING
5. I have listed . . . (Read names from item 3.) 8a. Unit is - CU NUMBERS RACE EDUCATION
Have I missed — YES NO <- *
tº- [...] In a Group Quarters – Go to item 8d Include an vone who is a
— any babies or small children? tº g g g ge. . . . . . . . . . . . . . . . [...] [T] If "YES", ask D NOT in a Group Ouarters jºr at 1 – White 00 – Never attended, preschool, kindergarten
– anyone who usually lives here but is away now – - name and — Go to item 8b 2 – African American 01–11 – 1st grade through 11th grade
traveling, at school, or in a hospital? . . . . . . . . . . . . . . . [T] [T] record ſ Ask if not apparent. 231 || 1 || ºl. contains only or Black 38 - 12th de NO DIPLOMA
- roster above gº s the reference OerSOn Or s tº - 12th grade
sy.º.ºgarders, or persons you employ H B | #;"|*Hººl-hºº” §§§. 3 – American Indian ſº
U- Go to item [ ] reference person by or Alaska Native 39 – HIGH SCHOOL GRADUATE – high school DIPLOMA, or the
— anyone else staying here? . . . . . . . . . . . . . . . . . . . . . . . [I] [I] b Yes blood, marriage, e- equivalent (for example: GED)
6 above [ ] No – Neither live nor eat together — adoption, or other legal 4 – Asian
41 – Associate degree in college – Occupational/vocational program
42 - Associate degree in college – Academic program
43 – Bachelor's degree (For example: BA, AB, BS)
44 – Master's degree (For example: MA, MS, MEng, MEd, MSW, MBA)
45 – Professional School Degree (For example: MD, DDS, DVM, LLB, JD)
46 – Doctorate degree (For example: PhD, EdD)
FORM CE-802 (9–17–2002)

Section 1 – HOUSEHOLD CHARACTERISTICS – Continued
8e. FINANCIAL RESPONSIBILITY 311 O1 311 O2 31 1 O3 3.11 O4 31 1 O5
Ask first for reference person and all others related to Line No.(s) Line No.(s) Line No.(s) Line No.(s) Line No.(s)
reference person by blood, marriage, adoption or other legal .
#################"|E|| | | | | | | | ||E|| | | | | | | | ||E|| | | | | | | | ||E|| | | | | | | | ||E|| | | | | | | | |
related persons.
I | | | I I I l I l | I I | |
(1) Doſes) . . . pay for all . . . housing expenses with . . . [37] 1 [] Yes 1 [ ] Yes 1 [ ] Yes 1 DJ Yes 1 [ ] Yes
own money? 2 […] No 2 [...] No 2 [...] No 2 […] No 2 [ ] No
(2) 5...anº" for all . . . food expenses with . . . 1 [ ] Yes 1 [º] Yes 1 […] Yes 1 [ ] Yes 1 [ ] Yes
2 [ ] No 2 [ ] No 2 […] No 2 | | No 2 D No
(3) Doſes) . . . pay for all . . . other living expenses 319 Y Y
such as clothing, transportation, etc., with . . . 1 E Yes 1 E. 1 H €S 1 E. 1 E €S
own money? 2 | | No 2 | | No 2 | | No 2 | | No 2 | | No
FIELD REPRESENTATIVE CHECK ITEM 1 [ ] Yes – Assign CU No. 1 1 [...] Yes – Assign next available 1 [ ] Yes – Assign next available 1 [...] Yes – Assign next available 1 || Yes – Assign next available
Are two or more "YES" boxes marked in items 8e, 1–3? II] item 8g CU No. in item 8g CU No. in item 8g CU No. in item 8g C No. in item 8g
- 2 [ ] No – Ask item 8e (4) 2 [ ] No – Ask item 8e (4) 2 [...] No – Ask item 8e (4) 2 [ ] No – Ask item 8e (4) 2 [ ] No – Ask item 8e (4)
Be. (4) . *º *%amºś 1 [] Yes – Ask item 8e (5) 1 || Yes – Ask item 8e (5) 1 [ ] Yes – Ask item 8e (5) 1 [ ] Yes – Ask item 8e (5) 1 || Yes – Ask item 8e (5)
º in this household? * 2 [ ] No – Assign CU No. 1 2 [ ] No – Assign next available 2 [...] No – Assign next available 2 [ ] No – Assign next available 2 Ll No – Assign next available
in item 8g CU No. in item 8g CU No. in item 8g CU No. in item 8g CU No. in item 89
(5) Who is (are) that (these) person(s)? Line No.(s) Line No.(s) Line No.(s) Line No.(s) line No.(s)
Assign to same CU in item 8g. Assign to same CU in item 8g. Assign to same CU in item 8g. Assign to same CU in item 8g. Assign to same CU in item 8g.
NOTE - If more than 4 CU’s, stop interview. List the CU's on an INTER-COMM and call your office.
8f. FIELD REPRESENTATIVE INSTRUCTION – Consumer Unit NOTES
Read to respondent. During this interview, I will use the words consumer unit or CU. A consumer unit is the (person/group of related persons) in this
household who (is/are) independent of all other persons in this household for payment of their major expenses.
The person(s) I'm including in your CU (isſare) – Read names of all persons listed in item 3 with the same CU marked in item 8g. Go to item 9 on previous page.
FIELD REPRESENTATIVE CHECK ITEM b. Does one person usually make the purchases?
Does this household contain more than one CU7 1 || Yes
1 DJ Yes – Go to item 15a [T] g
2D No – Go to item 16a 2 | | No – Go to item 16a
If "YES" – Who? Enter line number
15a. Does more than one person in this household regularly contribute to the -
expense of items such as food, cleaning supplies, or paper products? T
1 [ ] Yes – Go to item 15b NOTE – If "YES", ask the person who usually makes the
2 [...] No – Go to item 16a purchases to record the expenses for the shared items.
16a. Are these living quarters used partly for business or rented to others? b. What percent of the expenses is counted as a business
expense?
1 [ ] No – Go to section 2 -
2 [ ] Part business
3 || | Rented to others 334|_ Percent
4 [...] Both business and rented to others
ASK AT WEEK 1 AND WEEK 2 PICK-UP WEEK 1 WEEK 2
17a. Were any CU members away overnight for one day or more
last week (during the diary reference period)? . . . . . . . . . . . . . . E . . E .
If "YES" – Which persons? x [ ] All x [ ] All
Enter line numbers Bºlſ - Bºlſ Gºlſº lºſſ Gaſ Gālſº
b. ; i. else, such as visitors, stay º º: l I | H | |
or one day or more last week (during the diary reference
period)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E . . H .
If "YES" – How many such persons? >y y
Enter the number of persons. 344 Persons _^ 354 Persons _^
FORM CE-802 (9-17-2002) Page 3
Page 4

Section 2 – CONSUMER UNIT CHARACTERISTICS (FIELD REPRESENTATIVE – Ask items 1–7 at Week 1 placement.)
Ask if not apparent from observation.
Ask only if preschool or school age children; otherwise mark "No".
5a. During the previous 30 days, have you (or members of your CU) purchased any
414 || 1 || Yes
2 [ ] No – Go to item 6
1a. Are these living quarters presently used as student housing 1 DJ Yes – Go to item 3a
by a college or university? 2 [ ] No meals at school or in a preschool program for preschool or school age children?
b. If "Yes" —What are the names of all CU members who purchased meals at school? Enter the name of each CU member
purchasing meals at school in column a, line number in column b, then ask columns c through d for each name entered.
b. Are your living quarters owned or being bought by you (or any 402 Yes – Go to it 1
members of your CU)? 1 H €S O o, eſſ) || C à b g d
2 | | No – Go to item 1d > Enter What is the How many
# line usual weekly weeks
* , tº tº - number expense for did . . .
C. *:::::::::::::” owned by regular ownership or as a condominium 1 [ ] Regular ownership Go to item 2 i. from ; meals . . . purchase
2 [...] Condominium Oſ) section 1, purchased at meals?
Probe: 3 [ ] Cooperative - Read probe and =) item 1 school?
then skip to item 2 O Name
In this survey, we consider a cooperative to be property which is 2
owned by a corporation. Each shareholder is entitled to occupy an %
individual unit. Is this what you mean? (FIELD REPRESENTATIVE: If the ill Enter number
respondent answers "No" to the probe, try to determine whether the O of weeks
ownership is "regular" or "condominium" and mark the appropriate box.) 2
Gl.
d. Are your living quarters rented for cash rent or occupied without 404 || 1 || Rented for cash 426
payment of cash rent? 2 || Occupied without Go to item 3a .00
payment of cash rent 427
.00
Ask if "Yes" in item 7 b. 1 [ ] Yes 428 OO
2. Do you have a mortgage on this property? 2 [ ] No e
429
3a. Since the 1st of (Month, 3 months ago), what was your usual weekly .00
expense at the grocery store or supermarket? 406 $
- 430 .00
O L | None – Go to item 3c Area code Number
b. About how much of this amount was for nonfood items, such as paper 6. What is your telephone number? | | | | | |
products, detergents, home cleaning supplies, pet foods and alcoholic 407 $ mºme
beverages? - 3. Th.
oD None 7. What is the best time of day to call or visit? p.m.
c. Have you (or any member of your CU) purchased any food or FIELD REPRESENTATIVE – Explain to the respondent how to complete the diary, then leave diary for week 1.
nonalcoholic beverages from places other than grocery stores, such 1 [...] Yes
as home delivery, specialty stores, bakeries, convenience stores, dairy T - NOTES
stores, vegetable stands, or farmers markets? Include any large 2 | | NO – Go to item 4a
purchases made for freezing or canning.
d. What was your usual weekly expense at these places?
ă loo xy
4a. Do you own an automobile, truck, or other vehicle? 1 [ ] Yes
Do not include any vehicle which is used entirely for business purposes. 2 [ ] No – Go to item 5a
b. How many?
41 1 — Number
c. is this (are any of these) vehicle(s) used partially for business? 1 [º] Yes
|.
2 || No – Go to item 5a
Ask if "Yes" in item 4c.
What percent of your total vehicle expense is counted as a business
expense? Enter to nearest whole percent.
413 - Percent
FORM CE-802 (9–17–2002)

> Section 3 – DIARY CHECK
(FIELD REPRESENTATIVE – Complete this section unless the entire CE-801 diary was completed by total recall for that week. In this case, go to
Field Representative instruction at the bottom of page 9 for week 1 or week 2 pickup.)
WEEK 1. PICKUP
WEEK 2 PICKUP
Part 1 – FOOD AWAY FROM HOME:
Part 1 - FOOD AWAY FROM HOME
Now I am going to quickly go through a list of items to help you remember purchases you (or members of
your CU) may have forgotten to enter in your Diary.
Did you (or members of your CU) have any expenses, which you did not enter in your Diary, for meals, snacks,
nonalcoholic or alcoholic drinks purchased from fast food, delivery, concession stands, buffets, or cafeterias?
Now I am going to quickly go through a list of items to help you remember purchases you (or members of
your CU) may have forgotten to enter in your Diary.
Did you (or members of your CU) have any expenses, which you did not enter in your Diary, for meals, snacks,
nonalcoholic or alcoholic drinks purchased from fast food, delivery, concession stands, buffets, or cafeterias?
1 DJ Yes 2 [º] No 3 [ ] Don't know 1 [...] Yes 2 [...] No 3 [ ] Don't know
à b - G d (Đ & b C d . G.
*. *...ºf ded Were º ded
g Total cost beverages include If \A.- ... iſ tº Total cost beverages include ſº V.Z.º. -- ºf
Line pnotiºs |NIG tºº 'nº. in total cost? #o: inueh? Line Phoºsing tºº nºx in total cost? ãº, uch?
No. and tip Mark (X) one No. and tip Mark (X) one
Dollars' Cents Yes | No Dollars Cents Dollars Cents Yes | No Dollars Cents
1 O1 | 1 2 | 1 O1 | 1 2 |
| | 2 | | | 2 |
1 O2 | 1 | | 1 O2 | 1 | |
| 1 | 2 | | 1 | 2 |
1 O3 | | | 1 O3 | | l
1 O4 | 1 | 2 | 1 O4 | 1 2 |
1 O5 - 1 2 1 O5 1 2
| 1 | 2 | | 1 | 2 |
1 OG | | | 1 O6 | | |
1 O7 | 1 | 2 | 1 O7 | 1 | 2 |
1 O8 ſ 1 2 | 1 O8 i 1 2 |
109 1 1 O9 1 2
| 1 | 2 | | 1 | 2 |
1 1 O | | | 1 1 O | | |
Purchased from full service restaurants where you (or members of your CU) paid for your meal after eating it?
Purchased from full service restaurants where you (or members of your CU) paid for your meal after eating it?
1 [º] Yes 2 [º] No 3 [ ] Don't know 1 || || Yes 2 [ ] No 3 [ ] Don't know
à b (G d (8) 8. b G d (e
. º d were alcoholic
g PROCE Total cost beverages included tº ſº Total cost beverages included gº Jº
Line oising List all meals, snacks, and Include tax in total cost? #sºuen, Line phoºsing List all meals, snacks, and Include tax in total cost? Écºuen,
No. beverages purchased and tip Mark (X) one No. beverages purchased and tip Mark (X) one
Dollars Cents Yes | No Dollars Cents Dollars' Cents Yes | No Dollars TCents
1 11 | 1 | 2 | 1 11 | 1 | 2 |
I | | I I |
1 12 | 1 2 | 1 12 | 1 2 |
| | | | 1 | 2 |
113 | 1 2 | 1 13 I | |
1 14 | 1 | 2 | 114. | 1 | 2 |
1 15 | 1 | 2 | 115 1 | 2 |
| | | | 1 | 2 |
1 16 | T | 1 16 | | |
117 1 2 1 17 1 2
1 18 | 1 2 | 1 18 | 1 | 2 |
I | | } I |
119 | 1 2 | 1 19 | 1 2 |
FORM CE-802 (9-17–2002)
Page 5
Page 6

Section 3 – DIARY CHECK (Continued)
WEEK 1. PICKUP
WEEK 2 PICKUP
Part 1 - FOOD AWAY FROM HOME
Part 1 - FOOD AWAY FROM HOME
Did you (or members of your CU) have any expenses, which you did not enter in your Diary, for meals,
snacks, nonalcoholic or alcoholic drinks purchased from vending machines or mobile vendors?
Did you (or members of your CU) have any expenses, which you did not enter in your Diary, for meals,
snacks, nonalcoholic or alcoholic drinks purchased from vending machines or mobile vendors?
1 [ ] Yes 2 [ ] No 3 [ ] Don't know 1 DJ Yes 2 [ ] No 3 [ ] Don't know
8. b (C d (e tºl b (C d ©
Were alcoholic Were alcoholic
Total cost º Total cost
e dº beverages included | If "Yes," tº PROCESSING m beverages included If "Yes,"
H. proºf; ING Li all meals, . and ºft- in total cost? How much? º o; Li all meals, . and 'nº.'ſ* in total cost? How much?
O. everages purchase Mark (X) one O. everages purchase Mark (X) one
Dollars Cents Yes | No Dollars Cents Dollars Cents Yes | No Dollars Cents
12O | 1 | 2 120 | 1 2 |
121 1 121 1 2
| 1 | 2 | | 1 | 2 |
122 | l | 122 | | |
123 | 1 2 | 123 | 1 | 2 |
Purchased from employer or school cafeterias?
Purchased from employer or school cafeterias?
1 [ ] Yes 2 [...] No 3 [ ] Don't know 1 [ ] Yes 2 D No 3 [ ] Don't know
8. b C à b C
Total cost Total cost
Line PROCESSING List all meals, snacks, and Include tax Line PROCESSING List all meals, snacks, and Include tax
No. USE beverages purchased and tip No. USE beverages purchased and tip
Dollars Cents Dollars Cents
128 128
129 129
130 o 130
131 | 131
For board or meal plan? For board or meal plan?
1 DYes 2 [ ] No 3 [...] Don't know 1 || Yes 2 [...] No 3 [ ] Don't know
&l b C 8. b (C
Total cost Total cost
Line PROCESSING List all meals, snacks, and Include tax Line PROCESSING List all meals, snacks, and Include tax
No. USE beverages purchased and tip No. USE beverages purchased and tip
Dollars Cents Dollars Cents
132 132 |
133 133
Did you (or members of your CU) have any expenses, which you did not enter in your Diary, for catered affairs?
Did you (or members of your CU) have any expenses, which you did not enter in your Diary, for catered affairs?
1 || Yes 2 [ ] No – Go to part 2 3 [ ] Don't know – Go to part 2 1 [ ] Yes 2 [ ] No – Go to part 2 3 [ ] Don't know – Go to part 2
al b C d © *:) b C d ©
Were alcoholic Were alcoholic
Total cost Total cost * :
e PROCESSING * beverages included | If "Yes," te PROCESSING & - beverages included | If "Yes,"
º USE lº ałł meals, . and "ºx in total cost? How much? º USE Li all meals, . and ºft;" in total cost? How much?
O. everages purchase Mark (X) one O. everages purchase Mark (X) one
Dollars Cents Yes | No Dollars Cents Dollars' Cents Yes | No Dollars Cents
134 | 1 | 2 | 134 | 1 | 2 |
| I | | | |
\ 135 | 1 2 | 135 | 1 2 |
FORNA CE-802 (9–17–2002)

D Section 3 – DIARY CHECK (Continued)
WEEK 1. PICKUP
WEEK 2 PICKUP
Part 2 – FOOD FOR HOME CONSUMPTION
Part 2 – FOOD FOR HOME CONSUMPTION
Did you (or members of your CU) have any expenses which you did not enter in your Diary for food,
nonalcoholic or alcoholic beverages, such as grocery items, purchased to be eaten at home?
Did you (or members of your CU) have any expenses which you did not enter in your Diary for food,
nonalcoholic or alcoholic beverages, such as grocery items, purchased to be eaten at home?
1 || || Yes 2 [ ] No – Go to part 3 3 [...] Don't know – Go to part 3 1 [ ] Yes 2 [ ] No – Go to part 3 3 | | Don't know – Go to part 3
3. b C d tº b G d
ls this item — Total cost - ls this item — Total cost
Line Paoºsing D me ºn nº Mark (X) one s f; !'; Line pnotiºns tº tº Mark (X) one g ; º
No. escribe item purchased WITCHUOIG Sa IeS No. Describe item purchased IITC/UCIe SafeS
Bottled tax Bottled tax
Fresh Frozenſ or | Other Fresh Frozen or | Other
canned Dollars Cents canned Dollars | Cents
2O1 1 2 3 4 | 2O1 1 2 3 4. |
2O2 1 2 3 4. 2O2 1 2 3 4.
2O3 T 2 3 4 2O3 1 2 3 4.
2O4. 1 2 3 4. | 204 1 2 3 4. |
2O5 1 2 3 4. | 2O5 1 2 3 4.
206 1 2 3 4 2O6 1 2 3 4
2O7 1 2 3 4. 2O7 1 2 3 4
208 1 2 3 4 | 208 1 2 3 4. |
209 1 2 3 4. 209 1 2 3 4.
21 O 1 2 3 4 21 O 1 2 3 4
21 1 1 2 3 4 | 211 1 2 3 4.
212 1 2 3 4 212 1 2 3 4.
213 1 2 3 4. 213 1 2 3 4.
214 T 2 3 4 214 1 2 3 4.
215 1 2 3 4 | 215 1 2 3 4 |
216 1 || 2 || 3 || 4 216 1 || 2 || 3 || 4
21 7 1 2 3 4 21 7 1 2 3 4.
218 1 2 3 4 218 1 2 3 4
219 1 2 3 4. | 219 1 2 3 4. |
220 1 2 3 4. 220 1 2 3 4.
221 1 2 3 4. 221 1 2 3 4.
222 1 2 3 4. | 222 T 2 3 4 |
223 1 2 3 4. 223 1 2 3 4
224 1 2 3 4 224 1 2 3 4.
225 1 2 3 4. 225 1 2 3 4.
226 1 2 3 4 | 226 1 2 3 4. |
227 1 2 3 4 227 1 2 3 4
228 1 || 2 || 3 || 4 228 1 || 2 || 3 || 4
229 1 2 3 4 | 229 1 2 3 4 |
230 1 2 3 4 23O 1 2 3 4
FORM CE-802 (9.17-2002)
Page 8

Section 3 – DIARY CHECK (Continued)
WEEK 1 PICKUP
WEEK 2 PICKUP
Part 3 – FOOD AND BEVERAGES PURCHASED AS GIFTS
Part 3 - FOOD AND BEVERAGES PURCHASED AS GIFTS
Did you (or members of your CU) have any expenses which you did not enter in your Diary for food,
nonalcoholic or alcoholic beverages for someone outside your CU7
Did you (or members of your CU) have any expenses which you did not enter in your Diary for food,
nonalcoholic or alcoholic beverages for someone outside your CU7
1 [ ] Yes 2 [ ] No - Go to part 4 3 [ ] Don't know – Go to part 4 1 [ ] Yes 2 Ll No – Go to part 4 3 || Don't know – Go to part 4
8. b (E d & b C d
|s this item — Total cost ls this item — Total cost
e |PROCESSING Mark (X) one Do not Li PROCESSING Mark (X) one . Do not
Line USE Describe item purchased include sales N. USE Describe item purchased include sales
No. - tax O. tax
Bottled Bottled
Fresh |Frozen or | Other Fresh |Frozenſ or | Other
canned Dollars Cents canned Dollars Cents
301 1 2 3 4. 3O1 1 2 3 4.
3O2 1 2 3 4. 3O2 1 2 3 4.
303 1 2 3 4 303 1 2 3 4
3O4 1 2 3 4 3O4. 1 2 3 4.
305 1 2 3 4. 3O5 1 2 3 4.
3O6 1 2 3 4. 3O6 1 2 3 4.
WEEK 1 PICKUP WEEK 2 PICKUP
Part 4 – CLOTHING, SHOES, AND JEWELRY Part 4 – CLOTHING, SHOES, AND JEWELRY
Did you (or members of your CU) have any expenses which you did not enter in your Diary for clothing, Did you (or members of your CU) have any expenses which you did not enter in your Diary for clothing,
shoes, or jewelry? shoes, or jewelry?
1 [ ] Yes 2 [ ] No – Go to part 5 3 T. Don't know – Go to part 5 1 || Yes 2 [ ] No – Go to part 5 3 D Don't know – Go to part 5
al b C d © 8|| b C d (e
Was this bought | For whom was this Was this bought | For whom was this
Total cost for someone item purchased? Total cost for someone item purchased?
e PROCESSING Do not outside your . * |! :º. e PROCESSING Do not outside your . 7 ||3:Mºy.
º USE Describe item purchased include sales Consumer unit # - §§ º USE Describe item purchased include sales consumer unit #: §§§
e tax Mark (X) one 4 - Female 2 through 15 tax Mark (X) one 4 – Female 2 through 15
5 - Under 2 years 5 – Under 2 years
Dollars Cents Yes NO Enter code Dollars Cents Yes No Enter code
4O1 | 1 2 4O1 | 1 2
402 | 1 2 402 1 2
403 | 1 2 403 | 1 2
ſ ſ
404 | 1 2 404 | 1 2
I |
405 | 1 2 405 | 1 2
| |
4O6 | 1 2 406 | 1 2
| |
4O7 | 1 2 4O7 | 1 2
408 1 2 408 1 2
4.09 1 2 4.09 1 2
| | 2
41o \ | 1 2 4.1. O | 1
FORNA CE-802 (9-17-2002)

D Section 3 – DIARY CHECK (Continued)
WEEK 1 PICKUP
WEEK 2 PICKUP
Part 5 – ALL OTHER PURCHASES AND EXPENSES
Part 5 – ALL OTHER PURCHASES AND EXPENSES
Did you (or members of your CU) have any expenses which you did not enter in your Diary for tobacco, gasoline,
or postage stamps?
Did you (or members of your CU) have any expenses which you did not enter in your Diary for tobacco, gasoline,
or postage stamps?
1 [ ] Yes 2 [ ] No 3 | | Don't know 1 [...] Yes 2 […] No 3 [ ] Don't know
El b (C d *: b C d
!. this bought !. this bought
Of $OTTIGO ſhº Of $On NGO TIB
+- PROCESSING Dºñas outside your it? e PROCESSING Dºña, outside your it?
Line USE Describe item purchased sales tax COLTSUITTO' U Lºn. º USE Describe item purchased sales tax COLTSU Tºlº ſ' U Lºn.
No. Mark (X) one O. Mark (X) one
Dollars Cents Yes No Dollars Cents Yes NO
5O1 | 1 2 5O1 | 1 2
502 T 2 502 1 2
503 | 1 2 503 | 1 2
I f
504 | 1 2 504 | 1 2
} I
505 | 1 2 505 | 1 2
I |
506 | 1 2 506 | 1 2
| |
5O7 | 1 2 507 | 1 2
508 1 2 508 1 2
509 1 2 509 1 2
Did you (or members of your CU) have any expenses for any other items which you may have forgotten to enter
in your Diary?
1 […] Yes 2 [...] No – Go to Field Representative
3 [ ] Don't know – Go to Field Representative
instructions at bottom of page &
instructions at bottom of page
Did you (or members of your CU) have any expenses for any other items which you may have forgotten to enter
in your Diary?
1 [ ] Yes 3 [ ] Don't know – Go to Field Representative
instructions at bottom of page
2 [ ] No – Go to Field Representative
instructions at bottom of page
8. b (C d &: b C d
Was this bought Was this bought
for someone for someone
e PROCESSING Total cost outside your . tº- PROCESSING Total cost outside your .
Line USE Describe item purchased Do % include consumer unit? Line USE Describe item purchased - Do not include consumer unit?
No. Sales tax Mark (X) one No. sales tax Mark (X) one
Dollars Cents Yes No Dollars Cents Yes No
5 1 O | 1 2 51 O l 1 2
511 1 2 511 1 2
5 12 1 2 5 12 1 2
513 1 2 513 1 2
514 1 2 514 1 2
515 1 2 515 1 2
5 16 1 2 516 1 2
517 1 2 517 1 2
518 1 2 518 1 2
FIELD REPRESENTATIVE – GO TO SECTION 1, ITEMS 17a-b ON PAGE 3, AND LEAVE DIARY FOR WEEK 2. FIELD REPRESENTATIVE – GO TO SECTION 1, ITEMS 17a-b ON PAGE 3, AND THEN CONTINUE WITH SECTION 4.
FORM CE-802 (9-17-2002)
Page 9
Page 10

> Section 4 – WORK EXPERIENCE AND INCOME
FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask a separate page in Part A for each CU member 14 years old or over.
Retirement payments did . . . receive?
Mark (X) the appropriate box based upon
the respondent's use of records in providing
responses to items 6–13.
2 || No records used
Part A
1. FIELD REPRESENTATIVE ITEM Pºgg; NS 601 1 Ask if item 2 marked "Did not work" — 8. During the past 12 months, did ...
Enter the first name and line 5. What was the main reason . . . did | rºCº VE - a 624 || 1 || Yes
number of each CU member not work during the past 12 months? a. Any Supplemental Security income 2 [ ] No
14 years old and over. 8. NAME Was . . . checks from the U.S. Government?
ſoo?] CODE b. Any Supplemental Security income
b. LINE NUMBER 99% 1 – Retired? Code checks ºhe State or local 625] 1 || || Yes
2. In the last 12 months, how many weeks 2 - Taking care of home/family? Government 2 [ ] No
tº- º -Fi -*i - Weeks 3 - Going to school? Ask if items 8a and/or 8b are marked
did . . . work either full-time or part-time, tºº Jº
not counting work around the house? 0 [] Did not work – 4 – III, disabled, unable to work? Yes" – .
Include paid vacation and paid sick leave. Go to item 5 5 – unable to find work? gº How much did . . . receive in
6-Doing something else? – Specifyz Supplemental Security Income 626
3. In the weeks that . . . worked, how many 604 Hours per checks altogether? $
hours did . . . usually work per week? week
s g Ask items 9–12 only if item 6a is marked
show Information Booklet, page 6 6. During the past 12 months, did . . . "YES". 627; $
4a. The job in which . . . received the most receive any money in — ----------------------
earnings during the past 12 months 1 [ ] Yes If 6a is marked "No," go to item 13a. 628. 1 [ ] Week 5 [ ] Year
fits best in the following category: a. Wages or salary? Include commissions, - 2 [ ] 2 Weeks 6 [ ] Other – Specif
g 2 [ ] No – Go to item 6b pecryp
Inter One Code. What was the amount of income last pay º what period of time did 4 [ ] Ouarter
this cover -
Manager, professional 605 Code received before any deductions? $ T 7 || Twice a month
O1 - Administrator, manager 10. Was there any money deducted from Yes | No Amount
Q2 - Teacher b. Income or loss from ....'s own 1 [ ] Yes . . .’s last pay for — |
os-Professional gº nonfarm business, partnership, or 2 [...] No – Go to item 6c If YES – How much was deducted? |
Administrative support, technical, sales professional practice? a. Federal income tax? 629] 1 [I] 2 T $
O4 – Administrative support, including gº ſº | ---
clerical What was the amount of income or |
O5 – Sales, retail loss after expenses? $ b. State and local income tax? 631 || 1 || || 2 || || $ —
06 – Sales, business goods and services 1 || Loss f Z
07 – Technician | %
Service & C. Social Security including Medicare? 633| 1 || || 2 || %
Q3 - Protective service º C. income or loss from . . .'s own farm? 1 || Yes |
º * , gºod Sº FVLC8 2 || No – Go to item 7 d. Railroad Retirement? 634] 1 T. 2 || $ loo
What was the amount of income or |
Operator, assembler, laborer 616
11 — Machine operator, assembler, loss after expenses? *= L e. Government Retirement? 1 || *H ||637 S
inspector 617 1 OSS
12 – Transportation operator m & 638 |
13 — Handler, helper, laborer 7 - Private pension fund? 1 [ ] 2 [ ] $ —
Precision rod ction, ft, re ai - During the past 12 months, did º, ºn tº I Z
*:::::::::::::::::::::ision ºn hºus covernment * Assºm, normany % %
production dºm [ ] Y 640 || 1 || || 2 ||
15 - Construction, mining 1 €S deducted from your paycheck? | 2%
e- tº a s a. From Social Security checks? 2 [ ] No
º Tº:ºw. fishing y Ask if item 10c or 10g is marked "Yes" —
- e - tº-f s b. From Railroad Retirement checks? 11. Does the money deducted for Social 641| 1 || Yes
17 — Forestry, fishing, groundskeeping 1 || Yes Security cover only the Medicare 2 [ ] No
Armed forces 2 [ ] No portion of Social Security?
18 – Armed forces 12
C. FIELD REPRESENTATIVE CHECK ITEM e . Other than Social Security, did any
b. Was Hºwzº" ºn ºf tº gº 1 DJ Yes – Go to item 7d employer or union that . . . worked 642|| 1 || Yes
º tº ls "YES" marked in items 7a and/or 7b2 2 [ ] No – Go to item 8a for during the last 12 months | | N
CODE contribute to a pension or retirement 2 O
1 — 3.’....: *::::Hindual 607 Code d. What was the amount of the last plan that . . . was enrolled inf
gº jº g Social Security or Railroad 621 gº * .
working for wages or salary? Ask if code 5 and not a Retirement º: received? $ 13a. During the past 12 months, did . . ;
2 - A FEDERAL qovernment empi 7 t- place any money in a retirement plan [T]
9 t ployee farm – Is the business tº & tº a 643| 1 || || Yes
3 — A STATE government employee? incorporated? e. Is this annount AFTER the deduction 1 [ ] Yes such as individual Retirement Account 2 [...] No
: sº § ºº: s for a Medicare premium? 2 || No (IRA & Keogh)? Exclude rollovers.
– Seir-employed in UISIness, gº º Aº º M \,A 2. ~ iſ
professional practice, or farm? 608. 1 [ ] Yes b. §: if item º is narked "Yes" — 644] $
6 – working witHouT PAY in family 2 [ ] No f. During the past 12 months, how ow much -
business or farm? many Social Security or Railroad 623 Number 14. FIELD REPRESENTATIVE CHECK ITEM 645 1 [ ] Records
FORM CE-802 (9-17-2002)

Section 4 – WORK EXPERIENCE AND INCOME – Continued
Retirement payments did . . . receive?
Mark (X) the appropriate box based upon
the respondent's use of records in providing
responses to items 6–13.
2 [ ] No records used
Part A FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask a separate page in Part A for each CU member 14 years old or over.
1. FIELD REPRESENTATIVE ITEM Fºgg; NS 601 2 Ask if item 2 marked "Did not work" — 8. During the past 12 months, did . . .
ſº º receive —
Enter the first name and line 5. Wº: j he º ºz' #h 7 a. Any Supplemental Security Income 624 || 1 || Yes
number of each CU member 3. NAME W. work during the pas ITOTTIns fº ..º.º. the U.S. Government? 2 [ ] No
14 years old and over. àS - - - ºn vºz -
CODE b. Any Supplemental Security Income
b. LINE NUMBER 18% s checks from the State or local 625] 1 [...] Yes
1. – Retired? º Code Government?
2. In the last 12 months, how many weeks 603 Week 2 - Taking care of home/family? k if i ked 2 [] No
did . . . work either full-time or part-time, €6 KS 3 – Going to school? Ask if items 8a and/or 8b are marke
not counting work around the house? 0 || Did not work — 4 – III, disabled, unable to work? Yes" — º tº tº
Include paid vacation and paid sick leave. Go to item 5 # º º 3:...º Specify §. i. j's tº . ... IT
gº * AZ upplemental Security income
3. In the weeks that . . . worked, how many 604 Hours per checks altogether? *] $ –
hours did . . . usually work per week? week :
Show Information Booklet, page 6 6 During the past 12 months, did #gº ms 9–12 only if item 6a is marked 627
4a. The job in which ... received the most j. º in — g tº E = ſº $
earnings during the past 12 months tº tº 1 [ ] Yes lf 6a is marked "No," go to item 13a. 628| 1 || Week 5 [...] Year
ITS DeSt Iſ the TOLLOW. gory: a. Wages or salary? Include commissions, - 2 || || 2 Weeks 6 || || Other – Specif
fits best in the following cate w larv? Includ 2 [...] No – Go to item 6b [T] | pectry,
tips, Armed Forces pay and allowances. 9. What was the gross amount of . . .'s 3 || || Month
Enter one code. Eg last pay and what period of time did [...] Ouart
e 605 What was the amount of income this cover? 4. *" 7 []Twice a month
Manager, professional Code received before any deductions? $ I
01 – Administrator, manager 10. Was there any money deducted from Yes No Amount
92 – Teacher b. Income or loss from ....'s own 1 [ ] Yes . . .'s last pay for — |
O3 -Professional m nonfarm business, partnership, or 2 [ ] No – Go to item 6c If YES – How much was deducted? |
Administrative support, technical, sales professional practice? a. Federal income tax? 629] 1 D 2 [] $ Loo
04 – Administrative support, including ſº r | -
clerical What was the amount of income or |
05 — Sales, retail º loss after expenses? $ b. State and local income tax? 631 1 | | 2 [T] $ — .00
06 – Sales, business goods and services 1 [ ] Loss f Z
07 - Technician | %
Service c. Social Security including Medicare? 633] 1 [ ] I 2 D
f * A
08 – Protective service C. Income or loss from . . .'s own farm? 1 [ ] Yes |
- Lºri s * |
º º 3.2. hold service Wh h f i 2 [ ] No – Go to item 7 d. Railroad Retirement? 634] 1 [] 2 [] $ –
Operator, assembler, laborer at Was the amount of income or |
11 — Machine operator, assembler, loss after expenses? $ G. Government Retirement? 1 || || 2 || $ —
inspector 1 [...] Loss
12 – Transportation operator
13 — Handler, helper, laborer - Private pension fund? 1 [ ] 2 [ ] $ — o
Precision production, craft, repair 7. During the past 12 months, did . . . tº º & & A iſ - ſº %
14 – ...; repairer, precision º: ºn the U.S. Government 9- A: s §§ IS #: No t | |
roduction y – re Social Security payments normally
15 - £ºon, mining a. F Social S itv checks? 1 F . deducted from your paycheck? 640|| 1 T. 2 [T] %
- $ tº - Frolin SOCI&L SOCUITIt V Checks 2
#Tº..." fishing ty O Ask if item 10c or 10g is marked "Yes" —
tº- tº m º º ſº ſº , [I] Y
17 - Forestry, fishing, groundskeeping b. From Railroad Retirement checks? 1 || Yes 11 gº . ...: jºia . [T] º
ºores. 2 || || No portion of Social Security?
C. FIELD REPRESENTATIVE CHECK ITEM e 12. Other than Social Security, did any
b. Was . . . gº ºzº” ſº ºr * † 1 || Yes – Go to item 7d employer or union that . . . worked 642|| 1 || Yes
Is "YES" marked in items 7a and/or 7b2 2 [ ] No – Go to item 8a for during the last 12 months [ ] N
CODE contribute to a pension or ºirement 2 O
1 – An employee of a PRIVATE 607 plan that . . . was enrolled in
company, business, or individual Code d. ºº:::::::: §: e last $ tº w
working for wages or salary? Ask if code 5 and not a Retirement payment received? 13a. During the past 12 months, did . . .
2 – A FEDERAL government employee? farm – Is the business place any money in a retirement plan 643| 1 || Yes
:- ? §§ government . incorporated? e. Is this amount AFTER º deduction 1 [ ] Yes tº **ºccºunt 2 [ ] No
*mºg government employee tº- for a Medicare premium *
5 – Self-employed in OWN business, 1 [ ] Ye 2 [ ] No b * * * m Aſ W. A.- ... If
professional practice, or farm? 608 S . Ask if item 13a is marked "Yes" – 644
6 – working witHouT PAY in family 2 [...] No f. During the past 12 months, how How much? $ —
business or farm? many Social Security or Railroad 623 Number 14. FIELD REPRESENTATIVE CHECK ITEM 645] 1 [ ] Records
FORM CE-802 (9–17–2002)
Page 11
Page 12

Section 4 – WORK EXPERIENCE AND INCOME - Continued
Retirement payments did . . . receive?
Mark (X) the appropriate box based upon
the respondent's use of records in providing
responses to items 6–13.
2 [...] No records used
Part A FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask a separate page in Part A for each CU member 14 years old or over.
1. FIELD REPRESENTATIVE ITEM Pºgg; NS 601 3 Ask if item 2 marked "Did not work" — 8. During the past 12 months, did...
Enter the first name and line 5. What was the main reason ... did rece Ve - 624 || 1 || Yes
number of each CU member not work during the past 12 months? a. Any Supplemental Security Income 2 [ ] No
14 years old and over. 8. NAME Was . . . checks from the U.S. Government?
602 CODE b. Any Supplemental Security Income
b. LINE NUMBER 1 – Retired? Code checks from the State or local 625] 1 Ll Yes
2. In the last 12 months, how many weeks 603 Weeks 3 m §. ºpmetamily, º: d/or 8b ked 2 [ ] No
did . . . work either full-time or part-time, - – Sioing to scnoo Ask if items ea and/or 80 are marke
not counting work around the house? 0 [ ] Did not work – 4 – III, disabled, unable to work? Yes" –
Include paid vacation and paid sick leave. Go to item 5 5 – unable to find work? & How much did . . . receive in
6-Doing something else? – Specifyz Supplemental Security income
3. In the weeks that . . . worked, how many Hours per checks altogether? *] $
hours did . . . usually work per week? week
a- Ask items 9–12 only if item 6a is marked
Show information Booklet, page 6 6. During the past 12 months, did . . . "YES". 627] $
4a. The job in which . . . received the most receive any money in — -
earnings during the past 12 months 1 [ ] Yes If 6a is marked "No," go to item 13a. 628] 1 [ ] Week 5 [...] Year
fits best in the following category: a. Wages or salary? Include commissions, [ ] as 2 [ ] 2 Weeks 6 [ ] Other – Specify
tips, Armed Forces pay and allowances. 2 L No - Go to item 6b |s. What was the gross amount of . . .'s 3 [ ] Month Af
Enter one code. º last pay and what period of time did * [ ]
What was the amount of income Loo this cover? 4 L J Ouarter 7 [ ] Twi th
Manager, professional 605 Code received before any deductions? $—— I VVICé 3 IT. On
01 – Administrator, manager 10. Was there any money deducted from Yes No Amount
oz - Teacher b. Income or loss from . . .'s own 1 [ ] Yes . .'s last pay for — y |
03 - Professional nonfarm business, partnership, or [ ] No - G - If YES – How much was deducted? |
6:"Aiii: support, technical, sales professional practice? 2 O – GO to item 6c a. Federal income tax? 629] 1 [I] 2 D. $
O4 – Administrative support, includin º -
clerical pp. 9 º: : the º of income or $
05 - Sales, retail oss atter expenses ---------- ſº 631 i 632
O6 – #. business goods and services 1 || Loss b. State and local income tax? 1 [ ] —º [ ] $
07 – Technician | %
Service * . C.. I I f * farm? C. Social Security including Medicare? 633 | 1 || || 2 || %
08 – Protective service - In COmē Or LOSS Tronn - - - "S OWIN Tàrnin 1 || || Yes |
O9 – Pri h hol tº a s |
1 O – 3. old service 2 [ ] No – Go to item 7 d. Railroad Retirement? 634] 1 [] 2 [] * —
What was the amount of income or
º tºomber. loss after expenses? *H L G. Government Retirement? 1 [] 2 [ ] $ —
inspector |617 1 OSS
12 – Transportation operator tº is [T] | [ ]
13 – Handler, helper, laborer f. Private pension fund? 1 2 $ —
Precision production, craft, repair 7. During the past 12 months, did.... m º ºs & Aſ A A = }} 2%
14 – Mechanic, repairer, precision receive from the U.S. Government 9- Å; s §§ IS #: No t | |
roduction any money — re Social Security payments normally
1 5 — 8:on. mining a. F Social S itv checks? 1 H . deducted from your paycheck? 1 || 2 [T] %
º * - ſº = |* "OLTD SOC all Seºul º' TV CIM®CKS 2 O
#";.." fishing ty Ask if item 10c or 10g is marked "Yes" –
17 – Forestry, fishing, groundskeeping b. From Railroad Retirement checks? 1 [ ] Yes 11. Does the money deducted for Social 64 1 1 [ ] Yes
Armed forces 2 [ ] No :::::::::::::::::::::::::" 2 [ ] No
18 – Armed forces
c. FIELD REPRESENTATIVE CHECK ITEM - 12. Other than Social Security, did any
b. Was gºv 4” ſº gº g is 1 || Yes – Go to item 7d employer or union that . . . worked 642|| 1 || Yes
[ . tº gº tº ls "YES" marked in items 7a and/or 7b2 2 || No – Go to item 8a for during the last 12 months
º f a PRIVATE º to a pension or retirement 2 [...] No
– An employee or a 607 Code d. What was the amount of the last plan that . . . was enrolled in?
company, business, or individual Social Securit Rai
tº y or Railroad $ _ tº a º
2-#############ove." Ask if code 5 and not a Retirement payment received? *-º-º-º-º-º-v- *** Pºin [ ]
3 - A STATE government employee farm – Is the business º º h Individual Reti A 643| 1 || || Yes
agºg government employee? incorporated? e. Is this amount AFTER the deduction 1 [ ] Yes Such as individual Retirement Account 2 L | No
# tº- § ſº.º.º.º.º. for a Medicare premium? 2 [T] No (IRA & Keogh)? Exclude rollovers.
tº © -emp oye In UISImeSS, tº gº © * gº fg
professional practice, or farm? 1 || Yes b. Ask if item 13a is marked "Yes"— 644
6-working witHouT PAY in family 2 || No f. During the past 12 months, how How much? * —
business or farm? many Social Security or Railroad 623 Number 14. FIELD REPRESENTATIVE CHECK ITEM 645] 1 [ ] Records
FORM CE-802 (9–17–2002)

Section 4 – WORK EXPERIENCE AND IN COME – Continued
Part A FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask a separate page in Part A for each CU member 14 years old or over.
1. FIELD REPRESENTATIVE ITEM Pºgg; NS 601 4. Ask if item 2 marked "Did not work" — 8. During the past 12 months, did...
Enter the first name and line 5. What was the main reason ... did rºCBIVG - t- - 624| 1 || Yes
number of each CU member not work during the past 12 months? 8. Any Supplemental Security income 2 [...] No
14 years old and over. à, NAME Was . . . b checks from the U.S. Government?
CODE - Any Supplemental Security income
b. LINE NUMBER 19% 1 – Retired? 609 Code checks from the State or local 625] 1 [ ] Yes
2. In the last 12 months, how many weeks 603 Week 2 - Taking care of home/family? º:º ment? k 2 [ ] No
did . . . work either full-time or part-time, €6 KS 3 – Going to school? Ask if items 8a and/or 8b are marked
not counting work around the house? 0 [ ] Did not work — 4 – III, disabled, unable to work? Yes" – º
Include paid vacation and paid sick leave. Go to item 5 5 - Unable to find work? & How much did . . . receive in
6-Doing something else?-Specifyz Supplemental Security Income 626
3. In the weeks that . . . worked, how many 604 Hours per checks altogether? $ —
hours did . . . usually work per week? week
tº Ask items 9–12 only if item 6a is marked
Show Information Booklet, page 6 6. During the past 12 months, did . . . "YES". 627] $
4a. The job in which . . . received the most receive any money in - -
earnings during the past 12 months ſº tº 1 [ ] Yes If 6a is marked "No," go to item 13a. 628] 1 [ ] Week 5 || Year
fits best in the following category: a. Wages or salary? Include commissions, [T] s 2 [ ] 2 Weeks 6 || Other – Specify
tips, Armed Forces pay and allowances. 2L No-Go to item 6b | 9. What was the gross amount of . . .'s 3 D J Month 2
Enter one code. What was the amount of income lºgº what period of time did 4 [ ] Ouarter
this cover m
Manager, professional 605 Code received before any deductions? $ i 7 | | Twice a month
3. tº- flºrator. manager b. I f 10. Was there any money deducted from Yes No Amount
– I eacner - Income or loss from . . .'s own . .'s last pav for — |
03 - Professional nonfarm business, partnership, or 1 || || Yes re gº-> pay |
tº º º tº sº º 2 || No – Go to item 6c If YES – How much was deducted?
Administrative support, technical, safes professional practice? 8. Federal income tax? 1 [] / 2 D $ loo
04 – Administrative support, including & = |*@(C ºf ºl. IIT COThe | -
clerical What was the amount of income or |
O5 – Sales, retail loss after expenses? $ b. State and local income tax? 1 || || 2 || $ —
06 - Sales, business goods and services 1 || Loss } %
O7 – Technician | %
Service * c. Social Security including Medicare? 1 | | | 2 || %
08 – Protective service c. Income or loss from ...'s own farm? 1 || || Yes --- I
. E; g s |
º sº gºnoid Serv/ICe What th t of i | 2 | | No – Go to item 7 d. Railroad Retirement? 1 DJ 2 [ ] $ —
Operator, assembler, aborer at Was the amount OT || TCO ſine Or | Loo
1 1 – º: operator, assembler, loss after expenses? *H L e. Government Retirement? 636|| 1 [T] 2 || $ —
inspector |617 1 OSS
12 – Transportation operator |
13 – jº. helper, laborer f. Private pension fund? 638] 1 [T 2 [T] $ — __|.00
Precision production, craft, repair 7. During the past 12 months, did ... gº ºn s & Jº A -- ºf %
14 – Mechanic, repairer, precision receive from the U.S. Government 9- Å; s §§ IS #: No t I |
production any money — [T] re social security payments normally || 6ao [T] | 2 ||
15 – Construction, mining 1 || || Yes deducted from your paycheck? 1 2 Z
tº tº - - a. From Social Securitv checks? 2 [ ] N
#Tº..." fishing ty O Ask if item 10c or 10g is marked "Yes"—
17 – Forestry, fishing, groundskeeping b. From Railroad Retirement checks? |619 1 [T] Yes 1. T tº Does the money deducted for Social 1 [T] Yes
Armed forces 619 [ ] Security §§. only the Medicare 2 [ ] No
2 | | NO portion of Social Security?
18 - Armed forces
C. FIELD REPRESENTATIVE CHECK ITEM - 12. Other than Social Security, did any
b. Was . . . gº º zºº" ºn Fº & ºr 1 || Yes – Go to item 7d employer or union that . . . worked 642|| 1 || || Yes
Is "YES" marked in items 7a and/or 7b2 2 || No – Go to item 8a for during the last 12 months [ ] N
CODE contribute to a pension or ºf rement 2 O
1 – An employee of a PRIVATE 607 plan that . . . was enrolled in
company, business, or individual Code d. What Wąś the amount of the last
tº a Social Security or Railroad $ 13 ind th hs. di
working for wages or salary? Ask if code 5 and not a Retirement payment received? a. During the past 12 months, did . . ;
2 – A FEDERAL government employee? farm – Is the business place any money in a retirement plan 643| 1 || Yes
3 — A STATE government employee? incorporated? e. Is this amount AFTER the deduction 1 [ ] Yes such as Individual Retirement Account 2 [ ] No
4 – A LOCAL government employeeſ? p for a Medicare premium? [ ] (IRA & Keogh)? Exclude rollovers.
5 - Self-employed in OWN business, 1 ||Yes 2 | | NO b gº º is s fº Z – - ſº
professional practice, or farm? 608 - Ask if item 13a is marked "Yes" — 644
6 — §º. Wºr PAY in family 2 [...] No f. .# the º: 12 º: º: How much? $ —
UISINGSS Or Tràrm many Social Security or Railroad 623 Number 14. FIELD REPRESENTATIVE CHECK ITEM
gº º º L 645| 1 || Records
Retirement payments did . . . receive? Mark (X) the appropriate box based upon 2 [ ] No records used
the respondent's use of records in providing
responses to items 6–13.
FORM CE-802 (9–17–2002)
Page 13

Page 14
Section 4 – WORK EXPERIENCE AND INCOME - Continued
Retirement payments did . . . receive?
Mark (X) the appropriate box based upon
the respondent's use of records in providing
responses to items 6–13.
Part A FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask a separate page in Part A for each CU member 14 years old or over.
1. FIELD REPRESENTATIVE ITEM Fºgg; NS 601 5 Ask if item 2 marked "Did not work" – 8. During the past 12 months, did ...
Enter the first name and line 5. What was the main reason ... did reCe V8 - t- 624 || 1 || Yes
number of each CU member 8, NAME W. work during the past 12 months? à- i. jº, ãº. ...; 2 [...] No
14 years old and over. M à$ - - - checks from the U.S. Government
2 CODE b. Any Supplemental Security income
b. LINE NUMBER 1 – Retired? Code 3. from #he State or local 625] 1 || Yes
º tº t
2. In the last 12 months, ho anv weeks 2 – Taking care of home/family? overnmen 2 [ ] No
#d * "º: either łºś. º, — Weeks 3 – Going to school? Ask if items 8a and/or 8b are marked
not counting work around the house? 0 [ ] Did not work – 4 – III, disabled, unable to work? &=
Include paid vacation and paid sick leave. Go to item 5 5 – Unable to find work? ſº How much did - - - receive in
6-Doing something else?-specifyz Supplemental Security Income 626
3. In the weeks that . . . worked, how many 604 Hours per checks altogether? $ —
hours did . . . usually work per week? week -
- ~ * Ask items 9–12 only if item 6a is marked
show information Booklet page 6 6. During the past 12 months, did . . . "YES". 627] $
4a. The job in which . . . received the most receive any money in —
earnings during the past 12 months 1 [ ] Yes If 6a is marked "No," go to item 13a. 628] 1 [ ] Week 5 [ ] Year
fits best in the following category: a. Wages or salary? Include commissions, - 2 [ ] 2 Weeks 6 [] Other — -
ſº | | N G 6b Other – Specify
tips, Armed Forces pay and allowances. 2 O – GO to ſtern 9. What was the gross amount of . . .'s 3 [ ] Month Af
Enter one code. What was the amount of income §: pay jº what period of time did 4 [ ] Ouarter
this cover -
Manager, professional 605 Code received before any deductions? $ I 7 | | Twice a month
01 - Administrator, manager 10. Was there any money deducted from Yes No Amount
02 – Teacher b. Income or loss from . . .'s own 1 || Yes . . .'s last pay for – |
O3 – Professional nonfarm business, partnership, or 2 || No – Go to item 6 If YES – How much was deducted? |
Administrative support, technical, sales professional practice? C a. Federal income tax? 1 [ ] | 2 || $
04 – Administrative support, including tº ſº | -
clerical . . What was the amount of income or $ |
05 – Sales, retail gº loss after expenses? b. State and local income tax? 1 | | | 2 || || $ -
06 - Sales, business goods and services 1 Ll Loss t %
O7 – Technician ! %
Service g C. Social Security including Medicare? 1 || || 2 || %
O8 – Protective service C. Income or loss from . . .'s own farm? 1 || || Yes I
- Pri tº e |
º gºnoid SQLſ"VICE Wh h f : 2 [ ] No – Go to item 7 d. Railroad Retirement? 1 | | | 2 || | $ —
Operator, assembler, laborer at was the amount of income or |
11 — Machine operator, assembler, loss after expenses? *E L e. Government Retirement? 636] 1 [T] 2 || | * —
inspector 617 1 OSS
12 – Transportation operator | Loo
13 – Hj. helper, j - Private pension fund? 638] 1 [T] 2 [ ] * — |oo
Precision production, craft, repair 7. During the past 12 months, did. ... tº ºn tº & & A iſ - ºil %
1*-Mººrepairer, precision ºn the us covernment * 3:4::::::::::::::::::::manorman |
roduction sº y
15 – 8:on. mining a. F Social S itv checks? 1 E . deducted from your paycheck? 1 | 2 [T] %
º tº ſº ºn = |* "Oil SOCŞāl Seº-UITTV (C||CPC ($ 2 O
#TÉ.j". fishing ty Ask if item 10c or 10g is marked "Yes" –
tº- 9 . . . e b. From Railroad Retirement checks? 11. Does the money deducted for Social 1 || Yes
17 – Forestry, fishing, groundskeeping 1 [] Yes Security cover only the Medicare [ ] N
Armed forces 2 [ ] No portion of Social Security? 2 O
18 – Armed forces
C. FIELD REPRESENTATIVE CHECK ITEM g 12. Other than Social Security, did any
b. Was . . . Jº V.Zaº º is * - 1 [ ] Yes – Go to item 7d employer or union that . . . worked 642|| 1 || Yes
ls "YES" marked in items 7a and/or 7b2 2 [...] No – Go to item 8a for during the last 12 months [ ] N
CODE contribute to a pension or retirement 2 O
" ...'...ºvidual ||* code | * ºr ºn plan that . . . was enrolled in?
working for wages or salary? Ask if code 5 and not a #. º: *:::::car 621 $ 13a. During the past 12 months, did...:
2 – A FEDERAL government employee? farm – Is the business place any money in a retirement plan 643| 1 || || Yes
3 – A STATE government employee? incorporated? e. Is this amount AFTER the deduction 1 [ ] Yes such as Individual Retirement Account 2 [ ] No
4 - A LOCAL government employee? tº for a Medicare premium? [ ] (IRA & Keogh)? Exclude rollovers.
5 - Self-employed in QWN business, 608 || 1 || Yes 2 | | No b. Ask if i 13a is ked "Yes"
professional practice, or farm? - ASk if item 13a is marked "Yes" – 644 -
6 – working witHouT PAY in family 2 [ ] No f. During the past 12 months, how How much? $ —
business or farm? - many Social Security or Railroad 623 Number 14. FIELD REPRESENTATIVE CHECK ITEM 645] 1 [ ] Records
2 [...] No records used
FORM CE-802 (9–17–2002)

Section 4 – WORK EXPERIENCE AND INCOME – Continued
Retirement payments did . .
Mark (X) the appropriate box based upon
the respondent's use of records in providing
responses to items 6–13.
Part A FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask a separate page in Part A for each CU member 14 years old or over.
1. FIELD REPRESENTATIVE ITEM Pºgg; NS 601 6 Ask if item 2 marked "Did not work" — 8. During the past 12 months, did ...
Enter the first name and line 5. What was the main reason . . . did rºcº V(t) = ſº 624 || 1 || || Yes
number of each CU member not work during the past 12 months? a. Any Supplemental Security income 2 [ ] No
14 years old and over. à, NAME Was . . . checks from the U.S. Government?
602 CODE b. Any Supplemental Security Income
b. LINE NUMBER 1 - Retired? Code checks from the State or local 625|| 1 || Yes
2. In the last 12 months, how many weeks 603 Week 2 - Taking care of home/family? Government? 2 [ ] No
did . . . work either full-time or part-time, e6 KS 3- Going to school? Ask if items 8a and/or 8b are marked
not counting work around the house? 0 [ ] Did not work — 4 – III, disabled, unable to work? GS." -
Include paid vacation and paid sick leave. Go to itern 5 5 - Unable to find work? ſº How much did . . . receive in
6-Doing something else?-Specifyz Supplemental Security Income 626
3. In the weeks that . . . worked, how many 604 Hours per checks altogether? $ —
hours did . . . usually work per week? week
s Ask items 9–12 only if item 6a is marked
Show information Booklet, page 6 6. During the past 12 months, did . . . "YES". 627] $
4a. The job in which : ... received the most receive any money in – -
earnings during the past 12 months 1 […] Yes If 6a is marked "No," go to item 13a. 628] 1 [ ] Week 5 [ ] Year
fits best in the following category: a. Wages or salary? Include commissions, o 2 [ ] 2 Weeks 6 [ ] Other – Speci
s 2 [ ] No – Go to item 6b pecifyz
tips, Armed Forces pay and allowances. 9. What was the gross amount of . . .'s 3 [ ] Month
Enter one code. What was the amount of income º: pay º what period of time did 4 [ ] Ouarter
thi © e
Manager, professional 605 Code received before any deductions? $ IS COW I 7 || Twice a month
01 – Administrator, manager 10. Was there any money deducted from Yes No Amount
Q2 – Teacher b. Income or loss from . . .'s own 1 || Yes . . .’s last pay for – |
03 – Professional nonfarm business, partnership, or | | No - Go to item 6 If YES – How much was deducted? |
Administrative support, technical, sales professional practice? 2 O O / Te ITT 60 a. Federal i tax? 1 [ ] 2 [ ] $
O4 – Administrative support, including UN e -(BCG) fºl. ITCO Tº tº X | -
clerical What was the amount of income or $ |
Q5 – Sales, retail º loss after expenses? b. State and local income tax? 1 [ ] | 2 || || $
06 – Sales, business goods and services 1 [ ] Loss f
O7 – Technician |615 a L = %
- &m ga E. : * E. ſº Medi 7 633 | %
ãºotective service c. Income or loss from ...'s own farm? |ſsis [...] Yes c. Social Security including Medicare 1 L | 2 [ ] Z
O9 – Private h hold tººl * |
10 – gºnoia service Wh h f : 2 [...] No – Go to item 7 d. Railroad Retirement? 1 DJ 2 […] $
Operator, assembler, laborer at was the amount of income or |
11 — Machine operator, assembler, loss after expenses? $ e. Government Retirement? 1 [ ] | 2 || $ —
inspector 1 [ ] Loss
12 – Transportation operator
13 – Handler, helper, laborer - Private pension fund? 1 [ ] 2 || || $ —
Precision production, craft, repair 7. During the past 12 months, did.... dº ſº dº * %
14 – Mechanic, repairer, precision receive from the U.S. Government 9- Å; s #: IS #: ºnt Ily |
production any money - re Social Security payments norma
15 – Construction, mining a. From Social Securitv checks? |618 E. deducted from your paycheck? stol D 2D %
º tº - = |*L*Oſlº SOC & SCBCU If TV C Tºº CKS 2 O -
#TÉ..." fishing ty Ask if item 10c or 10g is marked "Yes"—
17 - Forestry, fishing, groundskeeping b. From Railroad Retirement checks? 1 [ ] Yes 11. 3. : money ...; º: Social 641 || 1 E Yes
ecurity cover only the Medicare 2 | | No
Armed forces º º tºn
18 – Armed forces 2 [ ] No portion of Social Security?
C. FIELD REPRESENTATIVE CHECK ITEM e 12. Other than Social Security, did any
b. Was Jg ºzº" ºn tº tº gº 1 || Yes – Go to item 7d employer or union that . . . worked 642; 1 DJ Yes
m cope tº E ls "YES" marked in items 7a and/or 7b2 2 [ ] No – Go to item 8a for during the last 12 months [ ] N *
1 – A I f a PRIVATE jº to a pension or ºf rement 2 O
– An employee or a 607 plan that . . . was enrolled in
company, business, or individual Code d. º: #: e last .00 º tº
working for wages or salary? Ask if code 5 and not Retirement paviment received? $ 13a. During the past 12 months, did . . ;
2 – A FEDERAL government employee? farm – Is the bu sin: s: pay place any money in a retirement plan 643| 1 || Yes
3 – A STATE government employee? incorporated? e. Is this amount AFTER the deduction 1 [ ] Yes such as individual Retirement Account 2 [ ] No
4 – § º; government employee? p for a Medicare premium? 2 [ ] No (IRA & Keogh)? Exclude rollovers.
5 — Self-employed in OWN business, * * g. g Af". A – ~ ºf
professional practice, or farm? 1 [ ] Yes b. Ask if item 13a is marked "Yes"— 644
6-working witHouT PAY in family 2 [...] No f. During the past 12 months, how How much? $ —
business or farm? many Social Security or Railroad . 623 Number 14. FIELD REPRESENTATIVE CHECK ITEM 1 [ ] Record
- receive? 645 eCOr CIS
2 [ ] No records used
FORM CE-802 (9–17–2002)
Page 15
Page 16

Section 4 – WORK EXPERIENCE AND IN COME – Continued
FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask a separate page in Part A for each CU member 14 years old or over.
Retirement payments did . . . receive?
Mark (X) the appropriate box based upon
the respondent's use of records in providing
responses to items 6–13. t
Part A
1. FIELD REPRESENTATIVE ITEM Pºgg; NS 601 7 Ask if item 2 marked "Did not work" -- 8. During the past 12 months, did ...
Enter the first name and line 5. What was the main reason ... did f(eCGIVE - gº 624 1 || || Yes
number of each CU member a NAME ºwork during the past 12 months? * ...º.º...? 2 || No
14 years old and over. tº gº tº * ºf ºn
CODE b. Any Supplemental Security Income
b. LINE NUMBER 1 – Retired? Code checks from the State or local 625] 1 || || Yes
2. In the last 12 months, how many weeks 603 2–Taking care of home/family? Govern ment? 2 [ ] No
did . . . work either full-time or part-time, Weeks 3 – Going to school? Ask if items 8a and/or 8b are marked
not counting work around the house? oD Did not work – 4 – III, disabled, unable to work? Yes" — s ſº tº
Include paid vacation and paid sick leave. Go to item 5 5 – Unable to find work? re How much did . . . receive in
6-Doing something else?-specifyz Supplemental Security Income 626
3. In the weeks that . . . worked, how many 604 Hours per checks altogether? $ —
hours did . . . usually work per week? week
- - Ask items 9–12 only if item 6a is marked
Show information Booklet, p age 6 6. During the past 12 months, did ... "YES". 627| $ ſoo
4a. The job in which ... received the most receive any money in –
earnings during the past 12 months e. 1 || Yes If 6a is marked "No," go to item 13a. 628] 1 [ ] Week 5 || Year
fits best in the following category: a. Wages or salary? Include cornmissions, [T] - 2 [ ] 2 Weeks 6 [...] Other – Specify
tips, Armed Forces pay and allowances. 2 L. No - Go to item 6b | 9. What was the gross amount of . . .'s 3 [ ] Month A&
Enter one code. What was the amount of income last pay º what period of time did 4 [ ] Ouarter
this cover s
Manager, professional 605 Code received before any deductions? $ | 7 […] Twice a month
01 – Administrator, manager 10. Was there any money deducted from Yes No Amount
Q2 - Teacher b. Income or loss from . . .'s own 1 || || Yes . . .’s last pay for — |
03 - Professional nonfarm business, partnership, or - tº-
f : g 2 [T] NO – Go to item 6c If YES - How much was deducted? |
Administrative support, technical, sales professional practice? à. Federal income tax? 629| 1 || || 2 || $
O4 – Administrative support, including sº ſ | -
clerical What was the amount of income or |
05 – Sales, retail loss after expenses? $ b. State and local income tax? 631 || 1 [T] 2 D $
06 – Sales, business goods and services 1 Loss - | %
O7 – Technician | %
Service * C. Social Security including Medicare? 633 || 1 || || 2 || %
08 – Protective service C. Income or loss from . . .'s own farm? 1 [...] Yes I
- Pri Ug e |
º mºs gºnoid Service 2 || No – Go to item 7 d. Railroad Retirement? 634|| 1 || || 2 || $ —
What was the amount of income or |
Operator, assembler, laborer 16 Loo
11 — Machine operator, assembler, loss after expenses? *E L e. Government Retirement? 1 [ ] 2 [ ] $
inspector |617 1 OSS
12 – Transportation operator | Loo
13 – Hj. helper, j 7 - Private pension fund? 1 [T] 2 [T] $ — loo
P eci e d ti g ft, re air During the past 12 months, did ſº I Z
ºiºsion ſººn hºus covernment * 3:4:::::::::::::::::::manormany Ø
production dº 640
15 – Construction, mining a. F Social S itv checks? 1 H º deducted from your paycheck? 1 [ ] 2 [T] %
tº - - - - Fºr Onn SOCI3). Security CineCKS 2 O
º Tº..." fishing y Ask if item 10c or 10g is marked "Yes"—
17 – Fº, fishing, groundskeeping b. From Railroad Retirement checks? 1 || Yes 1 1. 2: .gºla 64 1 || 1 E .
Armed forces 2 Li No portion of Social Security? 2 O
18 – Armed forces 12
c. FIELD REPRESENTATIVE CHECK ITEM g - Other than Social Security, did any
b. Was gº º zºº gº ºn s = 1 || Yes – Go to item 7d employer or union that . . . worked 642|| 1 || Yes
| tº º ſº ls "YES" marked in items 7a and/or 7b2 2 [...] No – Go to item 8a for during the last 12 months [ ] N
CODE contribute to a pension or retirement 2 O
'ºvidual 6O7 Code * gºelast plan that . . . was enrolled in?
--- y : Jº ocial Security or Railroad |621 $ º |
working for wages or salary? Ask if code 5 and not a Retirement payment received? 13a. º the past 12 months, did .. i
2 – A FEDERAL government employee? farm – Is the business place any money in a retirement plan 1 [ ] Yes
3 – A STATE government employee? incorporated? 62. Is this amount AFTER the deduction 1 [ ] Yes such as individual Retirement Account 2 [ ] No
4 — § º; 3.º.º.º for a Medicare premium? 2 [ ] No (IRA & Keogh)? Exclude rollovers.
5 – Self-employed in OW usiness, gº a ge & fºr sº
professional practice, or farm? 608] 1 [ ] Yes b. Ask if item 13a is marked "Yes"— 644] $
6 – working witHouT PAY in family 2 [ ] No f. During the past 12 months, how How much? ---
business or farm? many Social Security or Railroad 623 Number 14. FIELD REPRESENTATIVE CHECK ITEM 645 || 1 [ ] Records
2 || No records used
FORM CE-802 (9-17-2002)

Section 4 – WORK EXPERIENCE AND INCOME – Continued
Part B – Ask for entire CU as a group
FIELD REPRESENTATIVE – Complete at Week 2 pickup. Ask these items for the entire CU as a group.
1.
C.
d.
During the past 12 months, did you (or any
members of your CU) receive income from
any of the following —
- Income from unemployment compensation?
If YES - What was the total amount
received by ALL CU members?
[701] 1 DYes
2 [...] No – Go to item 1b
Gºls lº
- Income from worker's compensation or
veteran's benefits including education
benefits, but excluding military retirement?
If YES - What was the total amount
received by ALL CU members?
[703] 1 DYes
2 [...] No – Go to item 16
Gºls lº
Income from public assistance or welfare
including money received from job training
grants such as Jobs Corps?
If YES – What was the total amount
received by ALL CU members?
[705] 1 DYes
2 || | No – Go to item 1d
Gºls ſº
Income from interest on savings accounts
or bonds?
If YES —What was the total amount
received by ALL CU members?
[707] 1 CYes
2 [ ] No – Go to item 1e
Gºls lº
Regular income from dividends, royalties,
estates, or trusts?
If YES – What was the total amount
received by ALL CU members?
1 [...] Yes
2 [ ] No – Go to item 1ſ
Fºls lº
income from pensions or annuities from
private companies, military, or Government,
IRA, or Keogh? .
If YES — What was the total amount
received by ALL CU members?
[711] 1 DYes
2 [ ] No – Go to item 19
GE's ſº
Net income or loss from any type of rental
of rooms or living units?
[713] 1 DYes
2 [ ] No – Go to item 1h
If YES -
(1) How much net income or ioss was
received from roomers or boarders?
Gºls ſº
[715 O D None
1 || Loss
(2) How much net income or loss was
received from payments from other
rental units?
Biels tº
[77] oD None
1 [...] Loss
Income from child support?
[718] 1 [] Yes
2 || No – Go to item 11
If YES —
(1) Did you receive a one time lump
sum payment for child support?
[71] LYes
2 [...] No – Go to
item 1 h (2)
If YES - What was the total amount received
by ALL CU members in last 12 months?
Bºls lº
(2) Did you receive any child support
payments in other than a lump sum
amount?
1 [...] Yes
* [...] No – Go to
item 1 i
If YES —What was the total amount received
by ALL CU members in last 12 months?
22]s
i. Income from regular contributions from — 1 [...] Yes 4. During the past 12 months, did you (or any members
(1) Alimony? 2 [...] No of your CU) pay any – wº
If YES - What was the total amount paid by ALL CU 1 [ ] Yes
(2) Other sources such as from persons 1 DJ Yes members? tº a tº U- 2[] No
outside the CU7 2 [ ] No a. Federal geome tax in addition to that withheld from $
earnings
If YES – for item i(1) or iſ 2) — b. State and local income tax in addition to that 1 [ ] Yes
Altogether what was the total amount withheld from earnings? 2 [...] No
received by ALL CU members? $ $
2. During the past 12 months, did you (or
any members of your CU) receive any – ! E §:
a. Lump sum payments from estates, trusts, loo
royalties, alimony, prizes or games of 1 [...] Yes C. Personal property taxes not reported elsewhere? $ Loo
chance, or from persons outside of the CU7 2 [...] No – Go to item 2b […] Yes – Specify in Not
If YES – What was the total amount 1 €S Tàº. |Motes
received by ALL CU members? $ d. O s 2 [ ] No
. Other taxes not reported elsewhere? Do not include
b. Money from the sale of household |728 [...] Y Social Security tax for the self-employed. [751. *—
furnishings, equipment, clothing, jewelry 728|| 1 €S 5 º tº
& se ty e - During the past 12 months, did you or any member of
pets .# j belongings, sºluding the 2 [ ] No – Go to item 2C your CU have any occupational expenses such as
sale of vehicles or property union dues, tools, uniforms, business or professional 1 [...] Yes
If YES-What was the total amount association dues, licenses, or permits? 2 [ ] No
received by ALL CU members? $ If YES – . the gºal amount of these $
c. Other money income, including money occupational expenses
received from cash scholarships and 6a. During the past 12 months, have any members of your CU ||75|| 1 ||Yes
fellowships, stipends not based on received any free meals at work as part of their navī 4.
working, or from the care of foster 1 [...] Yes - y p pay 2 || No – Go to item 7a
children? 2 [ ] No – Go to item 3 b. About what was the weekly dollar value of such
If YES-What was the total amount [731 meals? $
received by ALL CU members? *— c. How many weeks did members of your CU receive
3. During the past 12 months, did you (or any such meals during the past 12 months? 756 Number
:::::::::::::::: CU) receive any refunds lf CU owns this unit – Go to item 8a. of weeks
rom the Tollowing — 7a. Di ranv members of vour CU receive anv free or
If YES — What was the total amount 1 [ ] Yes al 3. º: or this unit º: form of pay #: the 1 E Yes s
received by ALL CU members? 2 [ ] No past 12 months? 2 | | No – Go to item 8a
a. Federal income tax? $ s
b. º: is the ſenta charge to another tenant for a
1 || Yes similar unit 758] $
2 [ ] No ſ º * *
c. What period of time does this cover? 1 [ ] Week
b. State and local income tax? $ - 2 [ ] 2 Weeks
|736 1 || Yes 3 || || Month
2 [ ] No 4 || Other – Specifyz
c. Overpayment on Social Security? $
8a. During the past 12 months, have any members of your||760. 1 [] Yes
1 E º CU º, Food Stamps? 2 || No – End interview
2 O
d. Insurance policies? |739 $ b. *::::: ºny of the past 12 months were Food Stamps 761 .
m Onth S
1 [ ] Y
2 || . 9a. In the past month, have jºy members of your CU 1 || Yes
O : - -
Loo received any Food Stamps 2 [...] No – End interview
e. Property taxes? $ b. When .# º jº, hich Hº- C
f. Other sources, including any other - * receive ist all dates on whic Month Day Year
taxes? y 1 DYes – Specify z ;: received during the [763 | | $
& Monthſ Day | Year |ool
2 [...] No c. What is the dollar value of the ||764 | | $ Loo
Food Stamps received on (Date Month Day Year
$ in 9b)? [765 | | [768|s
FORM
Page 17
CE-802 (9-17-2002)
Page 18

NOTES
FORM CE-802 (9–17–2002)

Table X – Determing if an Additional Living Ouarters Oualifies as an EXTRA Unit
NUMBER OF
AREA SEGMENTS PERMIT SEGMENTS UNIT SEGMENTS SEPARATENESS EXTRA UNITS
Start Here º
Single Unit Multi-Unit
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Check the listing
sheet. Is the address
of the additional living
quarter already listed?
Are the additional
living quarters within
the area segment
boundaries?
Are the additional
living quarters in a
group quarters?
Are the additional
living quarters within
the same structure and
within the same space
(See Footnote 1)
occupied by the
original sample unit?
Are the additional
living quarters within
the basic address
(house number and
street name) of the
original sample unit?
Are the additional
living quarters within
the same space (See
Footnote 1) occupied by
the original sample
unit?
and
Are the additinal
living quarters the
result of a split
apartment?
Do the occupants or
intended occupants of
the additional living
quarters live and eat
separately from all
other persons on the
property?
Do the occupants or
intended occupants of
the additional living
quarters have direct
access from the
outside or through a
common hall?
Have you found more
than 3 EXTRA units?
[] Yes – Stop Table X.
[ ] No – Go to column (2),
(4), (5) or (6)
depending on
segment type.
[] Yes – Go to column (3).
[ ] No – Stop Table X: do
not interview.
[ ] Yes – Stop Table X, do
not interview.
[...] No – Go to column (7).
DYes – Go to column (7).
[ ] No – Stop Table X, do
not interview.
[ ] Yes – Go to column (7).
[ ] No – Stop Table X: do
not interview.
[] Yes to both questions –
Go to column (7).
[...] No to either question —
Stop Table X; do not
interview.
[] Yes – Go to column (8).
[...] No – Not a separate unit.
Stop Table X.
Include additional
living quarters with
the originial unit
and continue
interview.
DYes – An EXTRA unit. Go
to column (9).
[ ] No – Not a separate unit.
Stop Table X.
Include additional
living quarters with
the originial unit
and continue
interview.
[ ] Yes – Call your RO for
instructions on which
units to interview. Then,
enter the basic address
and unit designation (if
any) of the EXTRA units
onto the listing sheet
and fill out new Control
Cards and
questionnaires for these
units. (See Footnote 2)
D. No – Enter the basic
address and unit
designation (if any) of
the EXTRA units onto
the listing sheet and fill
out new Control Cards
and questionnaires for
these units. (See
Footnote 2)
FOOTNOTES:
1 – Occupation of the "same space" occurs if a housing unit has been split into two or more separate housing units.
2 - if you determine that you have found an EXTRA unit at a single unit address in a UNIT segment (yes in column (5)), you must prepare an INTER-COMM and fill out a BLANK listing sheet listing each unit at the address.
NOTES
UNIVERSITY OF VICHEGAN
——º-º-A—F-º-º-
Tr:F, E, F, Tºº,
FEB 3
2004
FORM CE-802 (9-17-2002)
Page 19
: , Ejº USIT EL BY

Page 20
17. RECORD OF TRAVEL TIME Record travel time and enter reason code for personal contact from list of personal contact codes to the right.
Trip Time Reason OFFICE USE Trip Time Reason OFFICE USETrip Time Reason OFFICE USE
PERSONAL CONTACT CODES
(a) (b) (c) ONLY (a) (b) (c) ONLY (a) (b) (c) ONLY
Began Began Began 4 - Personal visit to collect data
3. Th. 832 833 a. Th. 840 84.1 3. Tºl. 848 849 5 – Personal visit to schedule appointment
p.m. p.m. p.m. 6 – Other personal visit
1 5 9
Ended Ended Ended DIARY PICKUP APPOINTMENTS
3. ſſ. a. [T]. 3. ITT.
p.m. p.m. p.m. Month/Date Time
I | a . ITN.
Began a.m. || 834 835 Began a.m. || |842 843 Began a.m. || |850 851 Week 1 p.m.
p.m. p.m. p.m. | I
| | 3. [T].
Week 2 | | p.m.
* |Ended ° Ended 19|Ended
3. ſſ. 3. IT). 3. ITT). Field Representative name Field Representative
p.m. p.m. p.m. code
|
|
|
Began 3. Th. 836 837 Began a.m. || 844 845 Began 3. ITN. 852 853 NOTES
p.m. p.m. p.m.
* |Ended 7 |Ended "" |Ended
3. ITI. a. [T]. a. [T].
p.m. p.m. p.m.
Began a.m. ||838 839 Began a.m. ||846 847 Began a.m. || |854 855
p.m. p.m. p.m.
* |Ended * |Ended 1* |Ended
3. T. 3. Tſh. a. [T].
p.m. p.m. p.m.
18. RECORD OF INTERVIEW AND OFFICE ACTIVITY TIME -
Time OFFICE USE ONLY
Activity 1st 2nd 3rd
Began Ended Began Ended Began Ended Total minutes
856 =
8. Th. 3. Th. a.m. a. [Y]. a. [Th. a. IT . z=
p.m. p.m. p.m. p.m. p.m. p.m. 5 3
Interviewing T = r
Ö <!-
S sº
e 857 5=\;
. tati a. [T]. 3. IT. a.m. 3. ITT. 3. IT). a. [T]. Fă3
epresentative E F.
review p.m. p.m. p.m. p.m. p.m. p.m. £ to
. UF=C
> O)
V y ſº | =
% - % % % 858 13 Cy)
3. ITN, a. [Th. E
Office edit p.m. p.m. % % % % -
% % % 2% |
FORM CE-802 (9-17-2002)