[COMPLETE THE COLUMN FOR PERSON 1 BY ASKING Q4-Q12. THEN COMPLETE THE COLUMNS FOR PERSONS 2-5 FOR ALL OTHER HOUSEHOLD MEMBERS IN ORDER OF OLDEST TO YOUNGEST, BY ASKING Q4-Q12 FOR EACH PERSON. IF OTHER HOUSEHOLD MEMBERS ARE PRESENT, ASK EACH INDIVIDUALLY FOR THEIR ANSWERS TO Q4-Q12. IF OTHER HOUSEHOLD MEMBERS ARE NOT PRESENT AT THE TIME OF THE INTERVIEW, PERSON 1 SHOULD ANSWER FOR THEM.] Person 1 Person 2 Person 3 Person 4 Person 5 Child Child Child Child □ □ □ □ Spouse Spouse Spouse Spouse □ □ □ □ Other Family Family Family Other Family □ □ □ □ Non-Married Non-Married Non-Married Non-Married □ □ □ □ How is [FILL INITIALS] related to Self Partner Partner Partner Partner you/Person 1? Other, Other, Other, □ □ □ □ Just to confirm, are you staying Yes Yes Yes Yes [SKIP FOR with [FILL INITIALS OF PERSON 1] No No No No PERSON 1] tonight? DK/REF DK/REF DK/REF DK/REF How old are you/is [FILL INITIALS]? [ENTER NUMBER] 18 Under 18 18 Under 18 Under 18 18-24 18-24 18-24 18-24 18-24 [IF HESITANT ASK:] Are you…? 25 + 25 + 25 + 25 + 25 + DK/REF DK/REF DK/REF DK/REF DK/REF Person 1 Person 2 Person 3 Person 4 Person 5 Male Male Male Male Male Female Female Female Female Female What is your gender? Transgender Transgender Transgender Transgender Transgender DK/REF DK/REF DK/REF DK/REF DK/REF □ □ □ □ □ □ □ □ □ □ Yes No Yes No Yes No Yes No Yes No Are you Hispanic or Latino? □ □ □ □ □ DK/REF DK/REF DK/REF DK/REF DK/REF
[COMPLETE THE COLUMN FOR PERSON 1 BY ASKING Q4-Q12. THEN COMPLETE THE COLUMNS FOR PERSONS 2-5 FOR ALL OTHER HOUSEHOLD MEMBERS IN ORDER OF OLDEST TO YOUNGEST, BY ASKING Q4-Q12 FOR EACH PERSON. IF OTHER HOUSEHOLD MEMBERS ARE PRESENT, ASK EACH INDIVIDUALLY FOR THEIR ANSWERS TO Q4-Q12. IF OTHER HOUSEHOLD MEMBERS ARE NOT PRESENT AT THE TIME OF THE INTERVIEW, PERSON 1 SHOULD ANSWER FOR THEM.] Person 1 Person 2 Person 3 Person 4 Person 5 How is [FILL INITIALS] related to you/Person 1? Self □ Child □ Spouse □ Other Family □ Non-Married Partner □ Other, □ Child □ Spouse □ Family □ Non-Married Partner □ □ Child □ Spouse □ Family □ Non-Married Partner □ Other, □ Child □ Spouse □ Other Family □ Non-Married Partner □ Other, Just to confirm, are you staying with [FILL INITIALS OF PERSON 1] tonight? [SKIP FOR PERSON 1] Yes No DK/REF Yes No DK/REF Yes No DK/REF Yes No DK/REF How old are you/is [FILL INITIALS]? [ENTER NUMBER] [IF HESITANT ASK:] Are you…? 18 18-24 25 + DK/REF Under 18 18-24 25 + DK/REF 18 18-24 25 + DK/REF Under 18 18-24 25 + DK/REF Under 18 18-24 25 + DK/REF Person 1 Person 2 Person 3 Person 4 Person 5 What is your gender? Male Female Transgender DK/REF Male Female Transgender DK/REF Male Female Transgender DK/REF Male Female Transgender DK/REF Male Female Transgender DK/REF Are you Hispanic or Latino? □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF
Sheltered-Count-form-2016.docx