Real Estate, Shelter Costs, Dependent Care and Vehicle Costs Topical Module Questionnaire

--------------------------------------------------------------------------------------------------

-REINTRO-

The next questions are about housing costs

and automobile ownership.

PRESS ENTER TO CONTINUE

-REMOBHO-

ASK IF NOT APPARENT:

Is this residence a mobile home?

(1) Yes

(2) No

-HOWNER-

Which persons in this household are the owners of this home?

ENTER LINE NUMBER OF PERSON(S) IN HOUSEHOLD WHO OWN HOME. ENTER (N) FOR NONE/NO MORE

-HBUY-

When was this home purchased?

MONTH: ______

YEAR: ______

-HMORT-

Is there a mortgage, home equity loan, or other debt on this home?

(Include rental properties attached to or located in the residence.)

(1) Yes

(2) No

-NUMMORT-

Altogether, how many mortgages, home equity loans, or other debts are there on this home?

FR NOTE: If respondent reports "0" enter "N" for None.

______ Number

(N) None

-MOR1PR-

First Mortgage

How much principal is currently owed on the first mortgage or loan?

(If possible, please check any records you may have from the lender or mortgage company to obtain the most accurate estimate available.)

$______

-MOR1YR-

First Mortgage

In what year was the first mortgage (loan) obtained?

If the mortgage was assumed, report the original date of the mortgage.

YEAR: ______

-MOR1MO-

First Mortgage

And in which month (was the first mortgage obtained)?

Month: ______

-MOR1AMT-

First Mortgage

What was the amount of the mortgage (loan) when it was obtained or last refinanced?

If the mortgage was assumed, give the original amount of the mortgage.

$______

-MOR1YRS-

First Mortgage

What is the total number of years over which payments are to be made?

______ Number of Years

(N) Not fixed

-MOR1INT-

First Mortgage

What is the current annual interest rate on this mortgage (loan)?

FR INSTRUCTION: ENTER PERCENT FROM 00.00% TO 99.99%

______%

-MOR1VAR-

First Mortgage

Is the interest rate variable or fixed?

(Variable interest rates can change over the term of the mortgage or loan.)

(1) Variable interest rate

(2) Fixed interest rate

-MOR1PGM-

First Mortgage

Was this mortgage obtained through an FHA or VA mortgage program?

(1) Yes - FHA LOAN

(2) Yes - VA LOAN

(3) No

-MOR2PR-

Second Mortgage

How much principal is currently owed on the second mortgage or loan?

(If possible, please check any records you may have from the lender or mortgage company to obtain the most accurate estimate available.)

$______

-MOR2YR-

Second Mortgage

In what year was the second mortgage (loan) obtained?

If the mortgage was assumed, report the original date of the mortgage.

ENTER 4 DIGIT YEAR: ______

-MOR2MO-

Second Mortgage

And in which month (was the second mortgage obtained)?

Month: ______

MOR2AMT-

Second Mortgage

What was the amount of the mortgage (loan) when it was obtained or last refinanced?

If the mortgage was assumed, give the original amount of the mortgage.

$______

-MOR2YRS-

Second Mortgage

What is the total number of years over which payments are to be made?

______ Number of years

(N) Not fixed

-MOR2INT-

Second Mortgage

What is the current annual interest rate on this mortgage (loan)?

FR INSTRUCTION: ENTER A PERCENT FROM 0.01% TO 99.99%

______ %

-MOR2VAR-

Second Mortgage

Is the interest rate variable or fixed?

(Variable interest rates can change over the term of the mortgage or loan.)

(1) Variable interest rate

(2) Fixed interest rate

-MOR2PGM-

Second Mortgage

Was this mortgage obtained through an FHA or VA mortgage program?

(1) Yes - FHA LOAN

(2) Yes - VA LOAN

(3) No

-MOR3PR-

Third+ Mortgage

How much principal is currently owed on all the remaining mortgages or loans not reported previously?

(If possible, please check any records you may have from any other lender or mortgage company to obtain the most accurate estimate available.)

$______

-PROPVAL-

What is the current value of this property; that is, how much do you think it would sell for on today's market if it were for sale? (Include rental properties attached to or located in this residence.)

$______

-MHLOAN-

Mobile Home

Is there a mortgage, installment loan, contract to purchase, or other debt on this mobile home or site?

(1) Yes

(2) No

-MHTYPE-

Mobile Home

Is this mortgage, contract, or other debt for just the site, or does it also apply to this mobile home?

(1) Mobile home only

(2) Site only

(3) Site and home

-MHPR-

Mobile Home

How much principal is currently owed on all mortgages?

$______

-MHVAL-

Mobile Home

How much do you think this mobile home (and site) would sell for today if it were for sale?

$______

-HOMEAMT-

How much was this household's (rent/mortgage (loan) payment) last month? Include any condominium or association fees.

FR NOTE: If respondent reports "0" enter "N" for None.

(N) None

$______

-UTILS-

How much did this household pay for electricity, gas, basic telephone service, and other utilities last month?

(Other utilities include other fuels and water. Exclude utilities that are part of the mortgage or rent payment.)

FR NOTE: If respondent reports "0" enter "N" for None.

$______

-PERSPAY-

Did more than one of the persons living here pay the (rent/mortgage/loan) and utilities last month?

(1) Yes

(2) No

-PERSPYA-

Which person paid?

ENTER LINE NUMBER OF PERSON WHO PAID

-PERSPY2-

Which persons paid and how much did each pay?

ENTER (N) FOR NO MORE

Line number Amount paid last month

Person 1: ____ ________

Person 2: ____ ________

Person 3: ____ ________

-PAYCARE-

Last month, did anyone here pay for the care of a child or a disabled person so that a household member could work, attend training, or look for a job?

(1) Yes

(2) No

-CARECST-

What was the total cost of these care arrangements last month?

$______

-OTHRE-

Other real estate

Does anyone in this household own any other real estate such as a vacation home or undeveloped lot? Exclude rental property previously reported or rental property attached to or located on the same land as your own residence.

(1) Yes

(2) No

-OTHREO-

Other real estate

Which household members own this property?

ENTER LINE NUMBERS OF HOUSEHOLD MEMBERS WHO OWN PROPERTY.

ENTER (N) FOR NONE/NO MORE.

-OTHREVA-

Other real estate

What is the total value of the equity in this real estate?

FR NOTE: Include the total equity owned by all household members.

(Equity is the amount that could be obtained by selling off the property and paying off any debts.)

$______

-AUTOOWN-

Does anyone in this household own a car, van, or truck, excluding recreational vehicles (RV's) and motorcycles?

FR NOTE: Do not include leased vehicles or company cars as being owned by the respondent.

(1) Yes

(2) No

-AUTONUM-

How many cars, trucks, or vans are owned by members of this household?

FR NOTE: Do not include leased vehicles or company cars as being owned by the respondent.

______ Number of motor vehicles

-A1OWN-

Vehicle 1: Newest vehicle

Who owns (this vehicle/the newest motor vehicle)?

ENTER LINE NUMBER OF PERSON(S) WHO OWN MOTOR VEHICLE.

ENTER (N) FOR NO MORE.

-A1YEAR-

Vehicle 1: Newest vehicle

What is the model year of this vehicle?

(ENTER 2 DIGIT YEAR)

19____

-A1MAKE-

Vehicle 1:Newest vehicle

What is the make of this vehicle?

(01) ACURA (16) FORD

(02) ALFA ROMEO (17) FORD TRUCK

(03) AMERICAN MOTORS (18) GEO

(04) AUDI (19) GMC TRUCK

(05) BMW (20) HINO

(06) BUICK (21) HONDA

(07) CADILLAC (22) HYUNDAI

(08) CHEVROLET (23) INFINITI

(09) CHEVROLET TRUCK (24) ISUZU

(10) CHRYSLER (25) ISUZU TRUCK

(11) CHRYSLER TRUCK (26) IVECO

(12) DAIHATSU (27) JAGUAR

(13) DODGE (28) JEEP

(14) DODGE TRUCK (29) JEEP TRUCK

(15) EAGLE (30) KIA

(31) LAND ROVER (46) PLYMOUTH

(32) LEXUS (47) PLYMOUTH TRUCK

(33) LINCOLN (48) PONTIAC

(34) MAZDA (49) PONTIAC TRUCK

(35) MERCEDES-BENZ (50) PORSCHE

(36) MERCURY (51) RANGE ROVER

(37) MERCURY TRUCK (52) SAAB

(38) MERKUR (53) SATURN

(39) MITSUBISHI (54) STERLING

(40) MITSUBISHI FUSO (55) SUBARU

(41) NAVISTAR/ (56) SUZUKI

INTERNATIONAL (57) TOYOTA

(42) NISSAN (58) UD

(43) OLDSMOBILE (59) VOLKSWAGON

(44) OLDSMOBILE TR (99) OTHER

(45) PEUGEOT (99) OTHER MAKE

-A1OTMKE-

Vehicle 1:Newest vehicle

What is the make of this vehicle?

-A1MODEL-

Vehicle 1: Newest Vehicle

What is the model of this vehicle?

[LIST OF VEHICLE MODELS]}

-A1MODOT-

Vehicle 1: Newest Vehicle

What is the model of this vehicle?

-A1OWED-

Vehicle 1: Newest Vehicle

Is this vehicle owned free and clear, or is there still money owed on it?

(1) Money owed

(2) Free and clear

-A1AMT-

Vehicle 1: Newest Vehicle

How much is currently owed for this vehicle?

$______

-A1USE-

Vehicle 1: Newest Vehicle

Is this vehicle used primarily either for business purposes or for the transportation of a disabled person?

(1) Yes

(2) No

-A2OWN-

Vehicle 2: Second newest vehicle

Who owns [the other vehicle/the second newest motor vehicle]?

ENTER LINE NUMBER OF PERSON(S) WHO OWN MOTOR VEHICLE.

ENTER (N) FOR NO MORE.

______ ______

-A2YEAR-

Vehicle 2: Second newest vehicle

What is the model year of this vehicle?

(ENTER 2 DIGIT YEAR)

19___

-A2MAKE-

Vehicle 2: Second newest vehicle

What is the make of this vehicle?

(01) ACURA (16) FORD

(02) ALFA ROMEO (17) FORD TRUCK

(03) AMERICAN MOTORS (18) GEO

(04) AUDI (19) GMC TRUCK

(05) BMW (20) HINO

(06) BUICK (21) HONDA

(07) CADILLAC (22) HYUNDAI

(08) CHEVROLET (23) INFINITI

(09) CHEVROLET TRUCK (24) ISUZU

(10) CHRYSLER (25) ISUZU TRUCK

(11) CHRYSLER TRUCK (26) IVECO

(12) DAIHATSU (27) JAGUAR

(13) DODGE (28) JEEP

(14) DODGE TRUCK (29) JEEP TRUCK

(15) EAGLE (30) KIA

(31) LAND ROVER (46) PLYMOUTH

(32) LEXUS (47) PLYMOUTH TRUCK

(33) LINCOLN (48) PONTIAC

(34) MAZDA (49) PONTIAC TRUCK

(35) MERCEDES-BENZ (50) PORSCHE

(36) MERCURY (51) RANGE ROVER

(37) MERCURY TRUCK (52) SAAB

(38) MERKUR (53) SATURN

(39) MITSUBISHI (54) STERLING

(40) MITSUBISHI FUSO (55) SUBARU

(41) NAVISTAR/ (56) SUZUKI

INTERNATIONAL (57) TOYOTA

(42) NISSAN (58) UD

(43) OLDSMOBILE (59) VOLKSWAGON

(44) OLDSMOBILE TRUCK (60) VOLVO

(45) PEUGEOT (99) OTHER MAKE

-A2OTMKE-

Vehicle 2: Second newest vehicle

What is the make of this vehicle?

-A2MODEL-

Vehicle 2: Second newest vehicle

What is the model of this vehicle?

[LIST OF VEHICLE MODELS]

-A2MODOT-

Vehicle 2: Second newest Vehicle

What is the model of this vehicle?

-A2OWED-

Vehicle 2: Second newest vehicle

Is this vehicle owned free and clear, or is there still money owed on it?

(1) Money owed

(2) Free and clear

-A2AMT-

Vehicle 2: Second newest vehicle

How much is currently owed for this vehicle?

$______

-A2USE-

Vehicle 2: Second newest vehicle

Is this vehicle used primarily either for business purposes or for the transportation of a disabled person?

(1) Yes

(2) No

-A3OWN-

Vehicle 3: Third newest vehicle

Who owns the third newest motor vehicle?

ENTER LINE NUMBER OF PERSON(S) WHO OWNS MOTOR VEHICLE.

ENTER (N) FOR NO MORE.

______ ______

-A3YEAR-

Vehicle 3: Third newest vehicle

What is the model year of this vehicle?

(ENTER 2 DIGIT YEAR)

19___

-A3MAKE-

Vehicle 3: Third newest vehicle

What is the make of this vehicle?

(01) ACURA (16) FORD

(02) ALFA ROMEO (17) FORD TRUCK

(03) AMERICAN MOTORS (18) GEO

(04) AUDI (19) GMC TRUCK

(05) BMW (20) HINO

(06) BUICK (21) HONDA

(07) CADILLAC (22) HYUNDAI

(08) CHEVROLET (23) INFINITI

(09) CHEVROLET TRUCK (24) ISUZU

(10) CHRYSLER (25) ISUZU TRUCK

(11) CHRYSLER TRUCK (26) IVECO

(12) DAIHATSU (27) JAGUAR

(13) DODGE (28) JEEP

(14) DODGE TRUCK (29) JEEP TRUCK

(15) EAGLE (30) KIA

(31) LAND ROVER (46) PLYMOUTH

(32) LEXUS (47) PLYMOUTH TRUCK

(33) LINCOLN (48) PONTIAC

(34) MAZDA (49) PONTIAC TRUCK

(35) MERCEDES-BENZ (50) PORSCHE

(36) MERCURY (51) RANGE ROVER

(37) MERCURY TRUCK (52) SAAB

(38) MERKUR (53) SATURN

(39) MITSUBISHI (54) STERLING

(40) MITSUBISHI FUSO (55) SUBARU

(41) NAVISTAR/ (56) SUZUKI

INTERNATIONAL (57) TOYOTA

(42) NISSAN (58) UD

(43) OLDSMOBILE (59) VOLKSWAGON

(44) OLDSMOBILE TRUCK (60) VOLVO

(45) PEUGEOT (99) OTHER MAKE

-A3OTMKE-

Vehicle 3: Third newest vehicle

What is the make of this vehicle?

-A3MODEL-

Vehicle 3: Third newest vehicle

What is the model of this vehicle?

[LIST OF VEHICLE MODELS]

-A3MODOT-

Vehicle 3: Third newest vehicle

What is the model of this vehicle?

-A3OWED-

Vehicle 3: Third newest vehicle

Is this vehicle owned free and clear, or is there still money owed on it?

(1) Money owed

(2) Free and clear

-A3AMT-

Vehicle 3: Third newest vehicle

How much is currently owed for this vehicle?

$______

-A3USE-

Vehicle 3: Third newest vehicle

Is this vehicle used primarily either for business purposes or for the transportation of a disabled person?

(1) Yes

(2) No

-OTHVEH-

Does anyone in this household own any other type of vehicle, not used for business, such as a motorcycle, boat, or recreational vehicle (RV)?

(1) Yes

(2) No

-OTHVEH2-

Does anyone own:

1=Yes 2=No

(1) A motorcycle: ___

(2) A boat: ___

(3) A recreational vehicle (RV): ___

(4) Another type of vehicle: ___

-OV1OWN-

Other vehicle 1

Which household members own [a motorcycle/a boat/a recreational vehicle (RV)/another type of vehicle]?

ENTER LINE NUMBER FOR HOUSEHOLD MEMBER(S).

ENTER (N) FOR NO MORE.

____ ____

-OV1VAL-

Other vehicle 1

If this vehicle were sold, what would it sell for in its present condition?

$______

-OV1OWE-

Other vehicle 1

Is this vehicle owned free and clear, or is there still money owed on it?

(1) Money owed

(2) Free and clear

-OV1AMT-

Other vehicle 1

How much is currently owed for this vehicle?

$______

-OV2OWN-

Other vehicle 2

Which household members own [a boat/a recreational vehicle (RV)/another type of vehicle]?

ENTER LINE NUMBER FOR HOUSEHOLD MEMBER(S).

ENTER (N) FOR NO MORE.

____ ____

-OV2VAL-

Other vehicle 2

If this vehicle were sold, what would it sell for in its present condition?

$______

-OV2OWE-

Other vehicle 2

Is this vehicle owned free and clear, or is there still money owed on it?

(1) Money owed

(2) Free and clear

-OV2AMT-

Other vehicle 2

How much is currently owed for this vehicle?

$______

End of the Real Estate, Shelter Costs, Dependent Care, and Vehicles Topical Module

Page Last Modified: May 12, 2006

Census Bureau Links: Home · Search · Subjects A-Z · FAQs · Data Tools · Catalog · Census 2000 · Quality · Privacy Policy · Contact Us