FORM CE-302 (4-1-99)
NOTE: Office staff should complete transcription items 1–4 below for interviewed CU’s only.
3a.
Segment number
suffix
A REA CODE SEGMENTI
SEG_SUFF
Sample
designation
Serial
Serial
number suffix
SA M P _DE S SE R IA L
Check
digit
HH No.
HH_NUM
3b.
CU No.
4. Interview No.
CU_NUM
CH E CK
2
3
A L P H A SUF
U.S. DEPARTMENT OF COMMERCE
BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
U.S. DEPARTMENT OF LABOR
BUREAU OF LABOR STATISTICS
CE
ER
M
M
ENT OF C
TM
O
AR
BU
US
CONTROL NUMBER
PSU code Segment
number
R
EA
EN
UO
F TH E C
S
REG_OFF
2.
EP
Regional
Office
code
U.S.
D
1.
QUESTIONNAIRE
QUARTERLY INTERVIEW SURVEY
CONSUMER EXPENDITURE SURVEYS
4
5
OMB No. 1220-0050
Section 1 – GENERAL SURVEY INFORMATION
䊳 Part A – Field Representative Records
1. Regional 2. Control number
Office code PSU code
REG_0 FF
SEG_SUFF
SA MP_DES
Q
Serial suffix
HH No.
CU No.
4.
Check digit
CHECK
SERIA L
A L PHA _SUF
Call
Reason
Call
Reason
Call
Reason
(a)
(b)
(a)
(b)
(a)
(b)
0020
5
PH_CA L
0040
2
HH_NUM
6
0100
REASON FOR
TELEPHONE CONTACT
9 0180
CU_NUM
BUREAU OF LABOR STATISTICS
QUESTIONNAIRE
Interview
No.
2
4
3
5
0120
10 0200
3
0060
7
0140
11 0220
4
0080
8
0160
12 0240
3 Other telephone
call
RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for
reason of visit from list of codes at right.
Trip
Time
(a)
(b)
Reason OFFICE USE
ONLY
(c)
Began
1
a.m.
p.m.
0270
V I SI T
Ended
Trip
Time
(a)
(b)
Began
0280
TM_TRV
5
a.m.
p.m.
2
a.m.
p.m.
0300
Began
0310
6
a.m.
p.m.
3
a.m.
p.m.
0330
Began
0340
7
a.m.
p.m.
4
Ended
a.m.
p.m.
0420
(b)
a.m.
p.m.
0360
0370
8
a.m.
p.m.
Ended
a.m.
p.m.
0510
0520
a.m.
p.m.
11
a.m.
p.m.
12
Office transcription
TM_INTER
0630
TM_REV
0640
TM_EDIT
0650
TM_TRA NS
8. QUESTIONNAIRE DEBRIEFING – Complete at the conclusion of interview.
a. Enter the line number of the respondent who answered the most questionnaire sections – Enter
code 99 for non CU member.
0660
Line number of main respondent
0670
RESPON
0540
0700
0730
0680
0710
0740
0690
0720
0750
OTHRESP
0550
0570
0580
c.
In answering questions about expenses, did the respondent consult bills, receipts, check stubs,
expense books, tax returns, or other records?
Mark (X) one.
Ended
Began
0490
Office edit
0620
b. Enter the line number(s) of all other respondents – Enter code 99 for non CU member.
a.m.
p.m.
0480
Total minutes
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Ended
Began
0460
Ended
Ended
a.m.
p.m.
Began
Reason OFFICE USE
ONLY
(c)
a.m.
p.m.
0450
OFFICE USE ONLY
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Interviewing
Began
10
TIME
Began
Began
0430
7. RECORD OF INTERVIEW AND OFFICE ACTIVITY TIME
Activity
a.m.
p.m.
Ended
a.m.
p.m.
a.m.
p.m.
(a)
a.m.
p.m.
Ended
Began
Time
9
Ended
a.m.
p.m.
OFFICE USE ONLY
Field Representative review
Trip
0400
CONSUMER EXPENDITURE SURVEYS
NOTICE – Your report to the Census Bureau is confidential by law (title 13, U.S. Code). It may be seen
only by sworn Census employees and may be used only for statistical purposes.
REASON FOR VISIT
4 Personal visit to collect data
5 Personal visit to schedule appointment
6 Other personal visit
a.m.
p.m.
Ended
Began
0390
Ended
a.m.
p.m.
Began
Reason OFFICE USE
ONLY
(c)
QUARTERLY INTERVIEW SURVEY
0250
1 Telephone call
to collect data
2 Telephone call to
schedule
appointment
6.
3b.
RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.
1
BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
U.S. DEPARTMENT OF LABOR
3a.
Segment No. Segment number suffix
Sample designation Serial No.
SEGMENTII
A REA CODE
U.S. DEPARTMENT OF COMMERCE
1 01 25 3
S
5.
CE-302
FORM
(4-1-99)
a.m.
p.m.
0760
2
0600
0610
d.
Ended
a.m.
p.m.
1
Always
Almost always
3
4
Mostly
Occasionally
5
6
Almost never
Never
RECORDS
If any bills, receipts, or records were used, which ones did the respondent(s) use to give
cost information?
Mark (X) all that apply.
0770
0780
1
Bills
Checkbook ledger
or stubs
0800
0810
4
2
5
Receipts of purchase (sales slips)
Home file (provided by
Census Bureau)
0790
3
Canceled checks
0820
6
Contracts or agreements
NOTES
9. LAST SECTION COMPLETED
0830
0840
7
8
Bank statements
Other
TY PEREC
PROCESSING USE ONLY
If the respondent did not complete the interview to its conclusion, enter
the last section completed.
0860
0850
Section number
SECTNO
1
9
9
9
FORM_Y R2
OMB No. 1220-0050
Section 1 – GENERAL SURVEY INFORMATION
䊳 Part A – Field Representative Records
1. Regional 2. Control number
Office code PSU code
CE-302
U.S. DEPARTMENT OF LABOR
3a.
Segment No. Segment number suffix Sample designation Serial No.
Serial suffix
HH No.
3b.
CU No.
4.
Check digit
Call
Reason
Call
Reason
Call
Reason
(a)
(b)
(a)
(b)
(a)
(b)
0020
5
0040
2
6
0100
REASON FOR
TELEPHONE CONTACT
9 0180
2
4
3
5
0120
10 0200
3
0060
7
0140
11 0220
4
0080
8
0160
12 0240
3 Other telephone
call
RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for
reason of visit from list of codes at right.
Trip
Time
(a)
(b)
Reason OFFICE USE
ONLY
(c)
Began
1
a.m.
p.m.
0270
Trip
Time
(a)
(b)
Began
0280
5
Ended
a.m.
p.m.
2
a.m.
p.m.
0300
Began
0310
6
a.m.
p.m.
3
a.m.
p.m.
0330
Began
0340
7
a.m.
p.m.
4
Ended
a.m.
p.m.
0420
(b)
a.m.
p.m.
Began
0370
8
a.m.
p.m.
Ended
a.m.
p.m.
0510
0520
a.m.
p.m.
11
a.m.
p.m.
12
Office transcription
0630
0640
0650
8. QUESTIONNAIRE DEBRIEFING – Complete at the conclusion of interview.
a. Enter the line number of the respondent who answered the most questionnaire sections – Enter
code 99 for non CU member.
0660
Line number of main respondent
0540
0670
0700
0730
0680
0710
0740
0690
0720
0750
0550
0570
0580
c.
In answering questions about expenses, did the respondent consult bills, receipts, check stubs,
expense books, tax returns, or other records?
Mark (X) one.
Ended
Began
0490
Office edit
0620
b. Enter the line number(s) of all other respondents – Enter code 99 for non CU member.
a.m.
p.m.
0480
Total minutes
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Ended
Began
0460
Ended
Ended
a.m.
p.m.
0360
Reason OFFICE USE
ONLY
(c)
a.m.
p.m.
0450
OFFICE USE ONLY
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Interviewing
Began
10
TIME
Began
Began
0430
7. RECORD OF INTERVIEW AND OFFICE ACTIVITY TIME
Activity
a.m.
p.m.
Ended
a.m.
p.m.
a.m.
p.m.
(a)
a.m.
p.m.
Ended
Began
Time
9
Ended
a.m.
p.m.
OFFICE USE ONLY
Field Representative review
Trip
0400
CONSUMER EXPENDITURE SURVEYS
NOTICE – Your report to the Census Bureau is confidential by law (title 13, U.S. Code). It may be seen
only by sworn Census employees and may be used only for statistical purposes.
REASON FOR VISIT
4 Personal visit to collect data
5 Personal visit to schedule appointment
6 Other personal visit
a.m.
p.m.
Ended
Began
0390
Ended
a.m.
p.m.
Began
Reason OFFICE USE
ONLY
(c)
QUARTERLY INTERVIEW SURVEY
0250
1 Telephone call
to collect data
2 Telephone call to
schedule
appointment
6.
BUREAU OF LABOR STATISTICS
QUESTIONNAIRE
Interview
No.
RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.
1
BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
1 01 25 3
Q
5.
U.S. DEPARTMENT OF COMMERCE
FORM
(4-1-99)
a.m.
p.m.
0760
2
0600
0610
d.
Ended
a.m.
p.m.
1
Always
Almost always
3
4
Mostly
Occasionally
5
6
Almost never
Never
If any bills, receipts, or records were used, which ones did the respondent(s) use to give
cost information?
Mark (X) all that apply.
0770
0780
1
Bills
Checkbook ledger
or stubs
0800
0810
4
2
5
Receipts of purchase (sales slips)
Home file (provided by
Census Bureau)
0790
3
Canceled checks
0820
6
Contracts or agreements
NOTES
9. LAST SECTION COMPLETED
0830
0840
7
8
Bank statements
Other
PROCESSING USE ONLY
If the respondent did not complete the interview to its conclusion, enter
the last section completed.
0860
0850
Section number
1
9
9
9
OMB No. 1220-0050
Section 1 – GENERAL SURVEY INFORMATION
䊳 Part A – Field Representative Records
1. Regional 2. Control number
Office code PSU code
CE-302
U.S. DEPARTMENT OF LABOR
3a.
Segment No. Segment number suffix Sample designation Serial No.
Serial suffix
HH No.
3b.
CU No.
4.
Check digit
Call
Reason
Call
Reason
Call
Reason
(a)
(b)
(a)
(b)
(a)
(b)
0020
5
0040
2
6
0100
REASON FOR
TELEPHONE CONTACT
9 0180
2
4
3
5
0120
10 0200
3
0060
7
0140
11 0220
4
0080
8
0160
12 0240
3 Other telephone
call
RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for
reason of visit from list of codes at right.
Trip
Time
(a)
(b)
Reason OFFICE USE
ONLY
(c)
Began
1
a.m.
p.m.
0270
Trip
Time
(a)
(b)
Began
0280
5
Ended
a.m.
p.m.
2
a.m.
p.m.
0300
Began
0310
6
a.m.
p.m.
3
a.m.
p.m.
0330
Began
0340
7
a.m.
p.m.
4
Ended
a.m.
p.m.
0420
(b)
a.m.
p.m.
Began
0370
8
a.m.
p.m.
Ended
a.m.
p.m.
0510
0520
a.m.
p.m.
11
a.m.
p.m.
12
Office transcription
0630
0640
0650
8. QUESTIONNAIRE DEBRIEFING – Complete at the conclusion of interview.
a. Enter the line number of the respondent who answered the most questionnaire sections – Enter
code 99 for non CU member.
0660
Line number of main respondent
0540
0670
0700
0730
0680
0710
0740
0690
0720
0750
0550
0570
0580
c.
In answering questions about expenses, did the respondent consult bills, receipts, check stubs,
expense books, tax returns, or other records?
Mark (X) one.
Ended
Began
0490
Office edit
0620
b. Enter the line number(s) of all other respondents – Enter code 99 for non CU member.
a.m.
p.m.
0480
Total minutes
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Ended
Began
0460
Ended
Ended
a.m.
p.m.
0360
Reason OFFICE USE
ONLY
(c)
a.m.
p.m.
0450
OFFICE USE ONLY
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Interviewing
Began
10
TIME
Began
Began
0430
7. RECORD OF INTERVIEW AND OFFICE ACTIVITY TIME
Activity
a.m.
p.m.
Ended
a.m.
p.m.
a.m.
p.m.
(a)
a.m.
p.m.
Ended
Began
Time
9
Ended
a.m.
p.m.
OFFICE USE ONLY
Field Representative review
Trip
0400
CONSUMER EXPENDITURE SURVEYS
NOTICE – Your report to the Census Bureau is confidential by law (title 13, U.S. Code). It may be seen
only by sworn Census employees and may be used only for statistical purposes.
REASON FOR VISIT
4 Personal visit to collect data
5 Personal visit to schedule appointment
6 Other personal visit
a.m.
p.m.
Ended
Began
0390
Ended
a.m.
p.m.
Began
Reason OFFICE USE
ONLY
(c)
QUARTERLY INTERVIEW SURVEY
0250
1 Telephone call
to collect data
2 Telephone call to
schedule
appointment
6.
BUREAU OF LABOR STATISTICS
QUESTIONNAIRE
Interview
No.
RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.
1
BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
1 01 25 3
Q
5.
U.S. DEPARTMENT OF COMMERCE
FORM
(4-1-99)
a.m.
p.m.
0760
2
0600
0610
d.
Ended
a.m.
p.m.
1
Always
Almost always
3
4
Mostly
Occasionally
5
6
Almost never
Never
If any bills, receipts, or records were used, which ones did the respondent(s) use to give
cost information?
Mark (X) all that apply.
0770
0780
1
Bills
Checkbook ledger
or stubs
0800
0810
4
2
5
Receipts of purchase (sales slips)
Home file (provided by
Census Bureau)
0790
3
Canceled checks
0820
6
Contracts or agreements
NOTES
9. LAST SECTION COMPLETED
0830
0840
7
8
Bank statements
Other
PROCESSING USE ONLY
If the respondent did not complete the interview to its conclusion, enter
the last section completed.
0860
0850
Section number
1
9
9
9
OMB No. 1220-0050
Section 1 – GENERAL SURVEY INFORMATION
䊳 Part A – Field Representative Records
1. Regional 2. Control number
Office code PSU code
CE-302
U.S. DEPARTMENT OF LABOR
3a.
Segment No. Segment number suffix Sample designation Serial No.
Serial suffix
HH No.
3b.
CU No.
4.
Check digit
Call
Reason
Call
Reason
Call
Reason
(a)
(b)
(a)
(b)
(a)
(b)
0020
5
0040
2
6
0100
REASON FOR
TELEPHONE CONTACT
9 0180
2
4
3
5
0120
10 0200
3
0060
7
0140
11 0220
4
0080
8
0160
12 0240
3 Other telephone
call
RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for
reason of visit from list of codes at right.
Trip
Time
(a)
(b)
Reason OFFICE USE
ONLY
(c)
Began
1
a.m.
p.m.
0270
Trip
Time
(a)
(b)
Began
0280
5
Ended
a.m.
p.m.
2
a.m.
p.m.
0300
Began
0310
6
a.m.
p.m.
3
a.m.
p.m.
0330
Began
0340
7
a.m.
p.m.
4
Ended
a.m.
p.m.
0420
(b)
a.m.
p.m.
Began
0370
8
a.m.
p.m.
Ended
a.m.
p.m.
0510
0520
a.m.
p.m.
11
a.m.
p.m.
12
Office transcription
0630
0640
0650
8. QUESTIONNAIRE DEBRIEFING – Complete at the conclusion of interview.
a. Enter the line number of the respondent who answered the most questionnaire sections – Enter
code 99 for non CU member.
0660
Line number of main respondent
0540
0670
0700
0730
0680
0710
0740
0690
0720
0750
0550
0570
0580
c.
In answering questions about expenses, did the respondent consult bills, receipts, check stubs,
expense books, tax returns, or other records?
Mark (X) one.
Ended
Began
0490
Office edit
0620
b. Enter the line number(s) of all other respondents – Enter code 99 for non CU member.
a.m.
p.m.
0480
Total minutes
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Ended
Began
0460
Ended
Ended
a.m.
p.m.
0360
Reason OFFICE USE
ONLY
(c)
a.m.
p.m.
0450
OFFICE USE ONLY
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Interviewing
Began
10
TIME
Began
Began
0430
7. RECORD OF INTERVIEW AND OFFICE ACTIVITY TIME
Activity
a.m.
p.m.
Ended
a.m.
p.m.
a.m.
p.m.
(a)
a.m.
p.m.
Ended
Began
Time
9
Ended
a.m.
p.m.
OFFICE USE ONLY
Field Representative review
Trip
0400
CONSUMER EXPENDITURE SURVEYS
NOTICE – Your report to the Census Bureau is confidential by law (title 13, U.S. Code). It may be seen
only by sworn Census employees and may be used only for statistical purposes.
REASON FOR VISIT
4 Personal visit to collect data
5 Personal visit to schedule appointment
6 Other personal visit
a.m.
p.m.
Ended
Began
0390
Ended
a.m.
p.m.
Began
Reason OFFICE USE
ONLY
(c)
QUARTERLY INTERVIEW SURVEY
0250
1 Telephone call
to collect data
2 Telephone call to
schedule
appointment
6.
BUREAU OF LABOR STATISTICS
QUESTIONNAIRE
Interview
No.
RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.
1
BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
1 01 25 3
Q
5.
U.S. DEPARTMENT OF COMMERCE
FORM
(4-1-99)
a.m.
p.m.
0760
2
0600
0610
d.
Ended
a.m.
p.m.
1
Always
Almost always
3
4
Mostly
Occasionally
5
6
Almost never
Never
If any bills, receipts, or records were used, which ones did the respondent(s) use to give
cost information?
Mark (X) all that apply.
0770
0780
1
Bills
Checkbook ledger
or stubs
0800
0810
4
2
5
Receipts of purchase (sales slips)
Home file (provided by
Census Bureau)
0790
3
Canceled checks
0820
6
Contracts or agreements
NOTES
9. LAST SECTION COMPLETED
0830
0840
7
8
Bank statements
Other
PROCESSING USE ONLY
If the respondent did not complete the interview to its conclusion, enter
the last section completed.
0860
0850
Section number
1
9
9
9
OMB No. 1220-0050
Section 1 – GENERAL SURVEY INFORMATION
䊳 Part A – Field Representative Records
1. Regional 2. Control number
Office code PSU code
CE-302
U.S. DEPARTMENT OF LABOR
3a.
Segment No. Segment number suffix Sample designation Serial No.
Serial suffix
HH No.
3b.
CU No.
4.
Check digit
Call
Reason
Call
Reason
Call
Reason
(a)
(b)
(a)
(b)
(a)
(b)
0020
5
0040
2
6
0100
REASON FOR
TELEPHONE CONTACT
9 0180
2
4
3
5
0120
10 0200
3
0060
7
0140
11 0220
4
0080
8
0160
12 0240
3 Other telephone
call
RECORD OF TRAVEL TIME AND REASON FOR VISIT – Record travel time and enter code for
reason of visit from list of codes at right.
Trip
Time
(a)
(b)
Reason OFFICE USE
ONLY
(c)
Began
1
a.m.
p.m.
0270
Trip
Time
(a)
(b)
Began
0280
5
Ended
a.m.
p.m.
2
a.m.
p.m.
0300
Began
0310
6
a.m.
p.m.
3
a.m.
p.m.
0330
Began
0340
7
a.m.
p.m.
4
Ended
a.m.
p.m.
0420
(b)
a.m.
p.m.
Began
0370
8
a.m.
p.m.
Ended
a.m.
p.m.
0510
0520
a.m.
p.m.
11
a.m.
p.m.
12
0630
0640
0650
8. QUESTIONNAIRE DEBRIEFING – Complete at the conclusion of interview.
a. Enter the line number of the respondent who answered the most questionnaire sections – Enter
code 99 for non CU member.
0660
Line number of main respondent
0540
0670
0700
0730
0680
0710
0740
0690
0720
0750
0550
0570
0580
c.
In answering questions about expenses, did the respondent consult bills, receipts, check stubs,
expense books, tax returns, or other records?
Mark (X) one.
Ended
Began
0490
Office transcription
0620
b. Enter the line number(s) of all other respondents – Enter code 99 for non CU member.
a.m.
p.m.
0480
Office edit
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Ended
Began
0460
Total minutes
Ended
Ended
a.m.
p.m.
0360
Reason OFFICE USE
ONLY
(c)
a.m.
p.m.
0450
OFFICE USE ONLY
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Interviewing
Began
10
TIME
Began
Began
0430
7. RECORD OF INTERVIEW AND OFFICE ACTIVITY TIME
Activity
a.m.
p.m.
Ended
a.m.
p.m.
a.m.
p.m.
(a)
a.m.
p.m.
Ended
Began
Time
9
Ended
a.m.
p.m.
OFFICE USE ONLY
Field Representative review
Trip
0400
CONSUMER EXPENDITURE SURVEYS
NOTICE – Your report to the Census Bureau is confidential by law (title 13, U.S. Code). It may be seen
only by sworn Census employees and may be used only for statistical purposes.
REASON FOR VISIT
4 Personal visit to collect data
5 Personal visit to schedule appointment
6 Other personal visit
a.m.
p.m.
Ended
Began
0390
Ended
a.m.
p.m.
Began
Reason OFFICE USE
ONLY
(c)
QUARTERLY INTERVIEW SURVEY
0250
1 Telephone call
to collect data
2 Telephone call to
schedule
appointment
6.
BUREAU OF LABOR STATISTICS
QUESTIONNAIRE
Interview
No.
RECORD OF TELEPHONE CONTACTS AND REASON FOR CONTACT – Enter code for reason of telephone contact from list of codes below.
1
BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
1 01 25 3
Q
5.
U.S. DEPARTMENT OF COMMERCE
FORM
(4-1-99)
a.m.
p.m.
0760
2
0600
0610
d.
Ended
a.m.
p.m.
1
Always
Almost always
3
4
Mostly
Occasionally
5
6
Almost never
Never
If any bills, receipts, or records were used, which ones did the respondent(s) use to give
cost information?
Mark (X) all that apply.
0770
0780
1
Bills
Checkbook ledger
or stubs
0800
0810
4
2
5
Receipts of purchase (sales slips)
Home file (provided by
Census Bureau)
0790
3
Canceled checks
0820
6
Contracts or agreements
NOTES
9. LAST SECTION COMPLETED
0830
0840
7
8
Bank statements
Other
PROCESSING USE ONLY
If the respondent did not complete the interview to its conclusion, enter
the last section completed.
0860
0850
Section number
1
9
9
9
FORM CE-302
Section 1 – GENERAL SURVEY INFORMATION – Continued
Part A.1 – Consumer Unit and Reference Period Explanations
FIELD REPRESENTATIVE NOTE: Read the following paragraphs (control card items 23f and 35b) ONLY if you have NOT read them already.
1.
Consumer Unit
During this interview, I will use the words
consumer unit or CU. A consumer unit is the
(person/group of 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 (is/are):
(READ NAMES OF ALL PERSONS LISTED IN CONTROL
CARD ITEM 18 WITH THE SAME CU MARKED IN
CONTROL CARD ITEM 23g.)
Page 2
2.
NOTES
Reference Period
Most questions that I will be asking refer to a
specific time period. During this interview, the
time period, unless I state otherwise, is for the
past three months, that is, from the first day of
(Month, three months previous to this month) to
today.
Section 1 – Part A.1
Page 2
Page 3
Page 3
–
FIELD
Section 1 – GENERAL SURVEY INFORMATION – Continued
Part B – General Housing Characteristics – For New Consumer Units Only (For Returning Consumer Units, Go to Section 2)
Ask if not apparent.
5. How many rooms are there in
0010 1
Yes – Go to item 2
1a. Is this house in a public
0060
this unit, including all
9.
Number
housing project, that is,
is it owned by a local
housing authority or other
local public agency?
b. If NO
Are your housing
costs lower because the
Federal, State, or local
government is paying part
of the cost?
2.
3.
Ask if not apparent.
Are these living quarters
presently used as student
housing by a college or
university?
Ask if not apparent by
observation.
Information Booklet,
page 5
Which best describes this
building?
2
PUB L HOUS
6.
0020
1
2
0030
1
2
0040
01
02
03
04
05
06
07
08
09
10
11
Yes
No
Yes
No
GOVTCOST
7a.
ST_HOUS
Single family detached (detached
structure with only one primary
residence; however, the structure could
include a rental unit(s) in the basement,
attic, etc.)
Row or townhouse – inner unit (2, 3, or 4
story structure with 2 walls in common
with other units and a private ground
level entrance; it may have a rental unit
as part of the structure)
End row or end townhouse (one common
wall)
Duplex (detached two unit structure with
one common wall between the units)
3-plex or 4-plex (3 or 4 unit structure with
all units occupying the same level or
levels) – Go to item 5
Garden (a multi-unit structure, usually
wider than it is high, having 2, 3, or
possibly 4 floors; characteristically the
units not only have common walls but
are also stacked on top of one another) –
Go to item 5
High-rise (a multi-unit structure which
has 4 or more floors) – Go to item 5
Apartment or flat (a unit not described
above; could be located in the basement,
attic, second floor, or over the garage of
one of the units described above) –
Go to item 5
Mobile home or trailer – Go to item 5
College dormitory – Go to section 1, part C
Other – Specify and go to item 4
B UIL DING
4.
What is the approximate
size of the lot on which
this unit is located?
Lot size (approximate acreage)
0050
01
02
03
04
05
06
X
FORM CE-302
finished living areas and
excluding all bathrooms?
No
1 acre or less – 43,560 sq. ft.
2 acres – 87,120 sq. ft.
3 to 5 acres
L OT_SIZ E
6 to 10 acres
Greater than 10 acres
No lot
Don’t know
b.
8.
a.
How many bedrooms are
there in this unit?
Count all rooms used MAINLY
for sleeping, even if also used
for other purposes.
How many complete
bathrooms are there in this
unit?
A COMPLETE BATHROOM has
a flush toilet, a bathtub or
shower, and a wash basin with
piped water.
How many half bathrooms are
there in this unit?
A HALF BATHROOM has at
least a flush toilet OR bathtub
or shower, but does not have
all the facilities of a complete
bathroom.
What fuel is used most for –
ROOMSQ
0070
1 01 26 1
Information Booklet, page 5
Does this unit have any of
the following?
Mark (X) all that apply.
Number
0
None
B EDROOMQ
0080
01
Swimming pool
0140
02
Off street parking
0150
03
Porch, terrace, patio, or balcony
0160
04
Apartment or guest house
0170
05
Central air conditioning
0180
06
Window air conditioning
SWIMPOOL
OFSTPA RK
PORCH
Number
0
0130
None
A PTMENT
B A THRMQ
0090
CNTRA L A C
WINDOWA C
Number
0
None
10.
HL FB A THQ
0100
01
02
Heating this unit?
03
04
Gas (underground piping)
Electricity
Fuel oil
Other – Specify
About when was this
building originally built?
Do not consider later
remodelings.
0450
01
02
03
04
05
06
07
08
05
X
b.
Heating water in this unit?
0110
01
02
03
04
No fuel used
Don’t know
09
HEA TFUEL
Gas (underground piping)
Electricity
Fuel oil
Other – Specify
10
11
12
13
14
15
16
X
05
X
c.
Cooking?
0120
No fuel used
Don’t know
WA TERHT
01
Gas (underground piping)
02
Electricity
03
Fuel oil
04
Other – Specify
05
No fuel used
X
Don’t know
COOK I NG
NOTES
1990 or later
1985–1989
1980–1984
1975–1979
1970–1974
1965–1969
1960–1964
1955–1959
1950–1954
1945–1949
1940–1944
1930–1939
1920–1929
1910–1919
1900–1909
Before 1900
Don’t know
B UIL T
FORM CE-302
Section 1 – GENERAL SURVEY INFORMATION – Continued
Part C – Major Household Appliances – For New Consumer Units Only
PROCESSING USE ONLY
a
b
Information Booklet, page 6
Does your CU have any of the
following appliances?
If YES –
How
many?
Yes
No
3 01 28 3
NOTES
c
Was this (Were any of
these) –
1. Purchased for own use?
2. Included with own house?
3. Received as a gift?
4. Included with rental unit?
5. Rented separately?
FIELD REPRESENTATIVE –
Mark (X) first box that applies.
A PPL STA T
MA J A PPL Q
0010
Electric cooking stove,
range, or oven
1
2
1
2
3
4
5
0020
Gas cooking stove, range,
or oven
1
2
1
2
3
4
5
0030
Microwave oven
1
2
1
2
3
4
5
0040
Other cooking stove, range,
or oven
1
2
1
2
3
4
5
0050
Refrigerator
1
2
1
2
3
4
5
0060
Home-freezer
1
2
1
2
3
4
5
0070
Built-in dishwasher
1
2
1
2
3
4
5
0080
Portable dishwasher
1
2
1
2
3
4
5
0090
Garbage disposal
1
2
1
2
3
4
5
0100
Clothes washer
1
2
1
2
3
4
5
0110
Clothes dryer
1
2
1
2
3
4
5
0120
Color television
1
2
1
2
3
4
5
0130
Computer, not solely for
games
1
2
1
2
3
4
5
0140
Sound components,
component system, or
compact disc sound system
1
2
1
2
3
4
5
0150
Video tape recorder, video
disc player, or video cassette
recorder (VCR)
1
2
1
2
3
4
5
GO TO SECTION 2
Page 4
Section 1 – Part C
Page 4
Page 5
Page 5
NOTES
FORM CE-302
FORM CE-302
FIELD
Section 2 – RENTED LIVING QUARTERS
Part A – CU Tenure, Rental Payments, Facilities, and Services for the Sample Unit
1. FIELD REPRESENTATIVE CHECK ITEM
4a. Did you (or any members of your CU)
0010 1
Student housing –
receive any reduced or free rent for
Go to item 6
a. Mark (X) appropriate box based upon
this unit as a form of pay since the
section 1, part B, item 2 for first interview
or new consumer units. For subsequent
interviews, this item will be prefilled.
b.
c.
2a.
b.
Are these living quarters owned or
being bought by you (or any members
of your CU)?
ASK IF NOT PREVIOUSLY ANSWERED –
IF PREVIOUSLY ANSWERED MARK (X)
APPROPRIATE BOX.
Do you (or any members of your CU)
pay rent for these living quarters?
RENTAL OF THE SAMPLE UNIT
What is the rental charge to your CU
for this unit, including any extra
charge for garage or parking facilities?
Do not include direct payments by
local, state, or federal agencies.
0020
2
Not student housing
1
Yes – Go to item 6
No
O W N ED
2
0030
2
b.
c.
e.
f.
g.
3.
2
What period of time does this cover?
0310 $
0320
R T R EGX
0040 $
0050
5a.
Month
Other – Specify
4
Since the 1st of (month, 3 months ago),
how many payments have been made?
0060 R T P M T Q Number
Were all the payments in the amount
of (rental charge reported in item 2a)?
0070
b.
If NO – What was the amount of each
payment and how many payments
were made at that amount?
Were any payments made during the
current month?
2
Payment
0080 $
Don’t know
4
9
Month
Other – Specify
X
Don’t know
Is any portion of this unit used for
your own business?
0540
1
R T B SN S
Yes
No – Go to item 6
Page 6
Since the 1st of (month, 3 months ago),
have you (or any members of your
CU) rented any other houses,
apartments, or temporary living
quarters not used for business or
vacation? Do not include college or
university regulated housing.
0550 R T B SN SZ .00 Percent
0620
1
2
Yes – Complete part B
for other rental
property
No – Go to next
section
0090
.00
0110
0120 $
.00
0130
0140 $
.00
0150
1
2
0210 $
a.
b. Gas?
c. Piped-in water?
d. Heating?
e. Trash/Garbage collection?
f. Garage or parking facilities
What percent of the rental payment is
counted as a business expense?
Enter to the nearest whole percent.
R T I R EGQ
R T I R EGX
.00
If YES – How much?
Does the rental payment include the
cost of –
Electricity?
Number
0100 $
0200
6.
Yes – Go to item 2f
No R T P M T R G
1
.00
X
2
What period of time does this cover?
RT CO M PX
.00
Don’t know
X
Yes R T A SP A Y
No – Go to item 5a
RTCMPPD
RN T L PRD
d.
What is the rental charge to another
tenant for a similar unit?
1
R EN T ED
9
c.
NOTES
0300
1st of (month, 3 months ago)?
Yes
No – Go to item 4a
1
1 02 01 2
Yes R T C R EX P
No – Go to item 3
R T C R EX X
.00
Yes
No
0220
1
2
R T EL EC T
0230
1
2
R T GA S
0240
1
2
0250
1
2
0260
1
2
0270
1
2
R T W A T ER
R T H EA T
R T T R A SH
RT PA RK
Section 2 – Part A
Page 6
Page 7
Page 7
f
Section 2 – RENTED LIVING QUARTERS – Continued1
FIELD REPRESENTATIVE – Complete a separate page for each rented unit other than the sample unit.
Part B – Rental Payments, Facilities, and Services for Other Than Sample Unit
RENTAL OF OTHER THAN
SAMPLE UNIT
1a.
b.
PROCESSING
USE ONLY
3a.
1 02 02 0
m
What is the rental charge to your CU
for the other unit, including any extra
charge for garage or parking
facilities?
0010 $
What period of time does this cover?
0020
R T R EGX e
.00
b.
Don’t know t
i
X
Month
Other – Specify
o
4
9
c.
NOTES
Did you or any members of your CU
receive any free or reduced rent for
the unit as a form of pay since the
1st of (month, 3 months ago)?
0250
What is the rental charge to another
tenant for a similar unit?
0260 $
What period of time does this cover?
1
2
0270
R N T Lt P R D
Yes R T A SP A Y
No – Go to item 4
RT CO M PX
X
Don’t know
4
Month
Other – Specify
9
.00
RTCMPPD
c.
d.
e.
f.
g.
2.
Since the 1st of (month, 3 months ago),
how many payments have been made?
Were all the payments in the amount
of (rental charge reported in item 1a)?
If NO – What was the amount of each
payment and how many payments
were made at that amount?
Were any payments made during the
current month?
0030 R T P M T Q oNumber
0040
RT PM T RG
Payment
R T I R EGX
R T I R EGQ 5.
.00
0070 $
.00
0080
0090 $
.00
0100
0110 $
.00
0120
2
If YES – How much?
0180 $
Does the rental payment include the
cost of –
0060
Yes R T C R EX P
No – Go to item 2
R T C R EX X
.00
Yes
No
0190
1
2
R T EL EC T
b. Gas?
0200
1
2
R T GA S
c.
0210
1
2
R T W A T ER
d. Heating?
0220
1
2
R T H EA T
e.
Trash/Garbage collection?
0230
1
2
R T T R A SH
f.
Garage or parking facilities?
0240
1
2
RT PA RK
a.
Electricity?
Piped-in water?
FORM CE-302
b.
Number
0050 $
1
Is any portion of the unit used for
your own business?
0280
1
2
Yes – G
No
1
2
0170
4a.
What percent of the rental payment is
counted as a business expense? Enter
to the nearest whole percent.
Since the 1st of (month, 3 months ago),
have you (or any members of your
CU) rented any other houses,
apartments, or temporary living
quarters not used for business or
vacation? Do not include college or
university regulated housing.
R T B SN S
Yes
No – Go to item 5
0290 R T B SN SZ .00 Percent
0300
1
2
Yes – Complete part B
for other rental
property
No – Go to next
section
FORM CE-302
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE
Part A.1 – Screening Questions (If New Consumer Unit, Go to Part A.2)
If this box is marked – Go to item 3a (no owned properties reported in previous interviews).
FIELD REPRESENTATIVE INSTRUCTIONS
• After completing all screening items (Part A.1) fill the appropriate parts of section 3 for each property owned.
• For each property previously recorded and still owned ("Yes" in item 1, column g), complete part I.
• For each property previously recorded and disposed of within the last 3 months ("No" in item 1, column g), complete parts D and
•
•
•
•
1.
2
1
2
0041
1
2
1
0061
1
2
0081
1
0101
Home equity loan
1
Mortgage
Property number
PROCESSING USE ONLY
1
2
Percent
1
2
$
.00
1
2
Percent
1
2
$
.00
2
1
2
Percent
1
2
$
.00
1
2
1
2
Percent
1
2
$
.00
2
1
2
1
2
Percent
1
2
$
.00
1
2
1
2
1
2
Percent
1
2
$
.00
0121
1
2
1
2
1
2
Percent
1
2
$
.00
0141
1
2
1
2
1
2
Percent
1
2
$
.00
0021
Page 8
Section 3 – Part A.1
YES
NO
o
If "Yes" –
What was the
amount of the
last payment?
If "No," go
to next
property or
loan.
YES
NO
YES
1
2
1
1
2
1
p
Prior to the
last payment,
what was the
total amount
owed?
PRN2 A MTX
2
If paid off,
mark "Yes."
n
Since the
1st of (last
month),
have you (or
your CU)
made any
payments
for your line
of credit
home equity
loan?
PD2 A MTX
1
0001
l
m
Line of Credit Line of Credit
Home Equity Home Equity
Loan (Part H) Loan number
(Part H,
item 1d)
If "No," go to
next property
or loan.
NO
PDL OA N2
2
NO
k
Has your
mortgage
(lump sum
home equity
loan)
payment of
(amount
paid)
changed?
L OA N_NO2
1
YES
O B SN SZ B A
NO
B SN SEX P A
NO
ST I L O W N
YES
PROP_NO2
YES
O W N Y A / OWNY 2
P R O P D I SP
P R O P _N O A
Ask column g for each property listed, except if property has been disposed of previously ("YES" in column b). If mortgage
information (amount paid), column j is recorded for a property, ask column k. If column I is "YES," ask column n.
8 03 00 7
PROPERTY INVENTORY CHART
a
b
c
d
e
f
g
h
i
j
Property
Property
Property type ENTER
Code 300 Do you
Are (Were) If "Yes" in
Mortgage or lump sum home equity information
disposed of
description
PROPERTY
time
still have
any of the column h –
reported in previous interview
(property
(part D
(part B, item 1c) 1. Condo
CODE from
share
expenses
What percent
completed)
part B,
(part B, descripfor this
No mortgage Mortgage
Amount paid
TYPE
of the
2. Co-op
item 1b.
item 13, tion)?
property
or lump sum or loan
from part F,
box 2)
deducted expenses for
home equity number
item 11 or
this property
If "No," go as
3. Something
loan
part G,
else
to column j. business, are (were)
item 11
deducted?
(part B,
farm, or
Go to
item 10)
rental
column l.
expenses? Enter to the
nearest whole
If "No," go percent.
to column j.
2
$
.00
$
.00
1
2
$
.00
$
.00
2
1
2
$
.00
$
.00
1
2
1
2
$
.00
$
.00
1
2
1
2
$
.00
$
.00
1
2
1
2
$
.00
$
.00
1
2
1
2
$
.00
$
.00
1
2
1
2
$
.00
$
.00
Page 8
Page 9
Page 9
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part A.1 – Screening Questions – Continued
2a. Since the 1st of (month, 3 months ago), have you obtained
any additional mortgages, including second mortgages or
home equity loans for any property you own?
b.
c.
1 03 01 0
0010
2
0020
1
2
d.
e.
Mortgage – Mark (X) "Yes" in mortgage
column in item 2g
Home Equity Loan – Continue with item 2d
There are two basic types of home equity loans. I’ll
describe both types. Please tell me which type more
closely describes your loan.
01 A loan where you (your CU) received the entire
lump-sum borrowed when you (your CU) took
out the loan; or
02 A line of credit loan where you (your CU) can
increase the amount borrowed by simply writing a
check or using a special credit card?
Is this new loan a lump sum home equity loan?
0030
Ask or verify.
Is this new loan a line of credit home equity loan?
1
0040
1
Yes – Mark (X) "Yes" in lump sum home
equity loan column in item 2g
No – Continue with item 2f
Yes – Mark (X) "Yes" in line of credit home
equity loan column in item 2g
g. Complete the chart below for each additional mortgage/home equity loan.
Property number
Property code
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
0050
FORM CE-302
1
2
b. Please look at (page 7, Information Booklet). What kind of
property was it (were they)?
ENTER PROPERTY CODE(S) FROM BELOW
100 The home in which you (your CU) currently live(s)
200 A home in which you (your CU) used to live
600 Property for business or investment purposes only
300 A second home, vacation home or recreational property
400 Unimproved land with no buildings on it
500 Other property – Specify
Do you still have this property?
Mark (X) the appropriate box in "still owned" column.
Line of credit home
equity loan
(Complete a part H)
Yes
members of your CU) purchased or otherwise acquired any
property or real estate?
c.
Lump sum home
equity loan
(Complete a part G)
Mortgage
(Complete a part F)
3a. Since the 1st of (month, 3 months ago), have you (or any
FIELD REPRESENTATIVE INSTRUCTION – Refer to the chart below. Complete all appropriate parts for each new property
disposed of in the reference period and for each new property currently owned before moving on to the next property.
PROPERTY STATUS
Currently owned
("Yes" in item 3b)
Disposed of
("No" in item 3b)
B, E, I
B, D, E, I
(NOTE: Do not fill any parts for property code 600.)
NOTES
2
f.
4.
Yes
No – Go to item 3a
Enter the appropriate property number(s)
and property code(s) in item 2g below
from the property inventory chart (items
1a and 1e).
If YES – For which property was this additional mortgage or
home equity loan obtained?
Ask for each property.
Was this a mortgage or a home equity loan?
1
Yes – Ask items 3b and 3c
No – Go to next part or section
Property code
0060
0080
0100
Still owned
0070
1
2
0090
1
2
0110
1
2
Yes
No
Yes
No
Yes
No
FORM CE-302
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE
FIELD REPRESENTATIVE – Ask part A.2 questions 1 through 7 and then complete parts B through I as instructed.
Part A.2 – Screening Questions – For New Consumer Units Only
NOTES
1 03 02 8
1.
2.
3.
Now I want to talk about owned living quarters
and other currently owned real estate. I’ll be
asking separately about each of these types of
property. (Hand respondent Information Booklet,
page 7.) Do you (any members of your CU) own
the home in which you (your CU) currently
live(s)? (Treat land contracts as ownership.)
Property
code
YES
If YES ask – How many
such properties do you
(does your CU) own?
NO
100
0010
1
2
200
0020
1
2
Go to item 3
600
0035
1
2
Go to item 4
Other than property you have already
mentioned, do you (does your CU) own a second
home, vacation home, or recreational property?
300
0040
1
2
Other than property you have already mentioned,
do you (does your CU) own any unimproved land,
that is, land without buildings on it?
400
0060
1
500
0080
1
0100
1
Since the first of (month, 3 months ago), have you
(has anyone in your CU) lived in any other home
that you (any member of your CU) still own(s)?
Do you (Does your CU) own any property only
for business or investment purposes?
0030
Number
Go to item 5
0050
Number
2
Go to item 6
0070
Number
2
Go to item 7a
0090
Number
2
Go to item 8
READ IF "YES" IN ITEM 3 – In the following
questions, please do not include any of the
properties you (your CU) own(s) only for
business or investment purposes.
4.
5.
6.
7a.
b.
c.
8.
Do you (Does your CU) own any other real
estate? – Specify
Since the first of (month, 3 months ago), did you (your CU)
own any real estate or land that you (your CU) no longer
own(s)?
Yes
If YES – How many different properties?
0110
Please look at page 7 in the Information Booklet. What
kind of property(ies) was it (were they)?
Enter property code(s) from below.
100 – The home in which you (your CU) currently live(s)
200 – A home in which you (your CU) used to live
600 – Property for business or investment purposes only
300 – A second home, vacation home, or recreational property
400 – Unimproved land with no buildings on it
500 – Other property – Specify
FIELD REPRESENTATIVE INSTRUCTIONS – Refer to the
chart to the right. Complete all appropriate parts for
each property disposed of in the reference period and
for each property currently owned before moving on to
next property.
Number
0120
0130
0140
0150
0160
0170
0180
0190
0200
0210
0220
0230
PROPERTY STATUS
Currently owned
("YES" in items 1–6)
Disposed of
("YES" in item 7a)
B, E, I
B, D, E, I
Note – Do not fill any parts for property code 600.
Page 10
Section 3 – Part A.2
Page 10
Page 11
Page 11
FIELD REPRESENTATIVE – Complete a column in part B for this property and continue with all
appropriate parts for this property before going to next property.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part B – Detailed Property Description
1. FIELD REPRESENTATIVE CHECK ITEM
PROCESSING USE ONLY
New Consumer Units – Assign a
property number to each property in
consecutive order starting with 1.
Enter the property number in item
1a, the property code in item 1b, a
brief description of the property
(such as "own home") in item 1c,
and appropriate ownership status in
item 1d.
2a.
b.
3a.
b.
4.
a. PROPERTY NUMBER
b. PROPERTY CODE from part A.1,
item 3b or part A.2, items 1–7
1 03 03 6
0010
Number
0020
Code
1 03 04 4
P R O P _N O B
0010
Number
0010
Number
OW NYB
0020
Code
0020
Code
Description
Description
d. CURRENT OWNERSHIP
0030
STATUS from part A.1 or
part A.2
2
Currently owned (from part A.1, item 3c or
part A.2, items 1–6)
Disposed of (from part A.1, item 3c or part A.2, item 7)
1
Yes
1
Now I’m going to ask you some questions about (property description).
Are (Were) any of the expenses for this property deducted as
business, farm, or rental expenses?
0040
What percent of the expenses for this property are (were)
deducted?
0060 O B SN SZ B .00 Percent – If 100%, delete this property.
In what month and year did you (your CU) close or settle on this
property? If land contract – In what month and year did the land
contract begin?
B SN SEX P
2
No – Go to item 3
0080
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box for each property and follow appropriate
skip pattern.
0100
How did you (your CU) acquire this property?
Mark (X) the FIRST answer that applies.
0120
Month
1
2
1
2
5.
Hand the respondent Information Booklet, page 8.
Closing costs include these kinds of things. Not including closing
costs, what was the total price paid for the property?
6.
What was the amount of the down payment?
7.
About how much were the closing costs?
8.
9.
0030
0040
2
Currently owned (from part A.1, item 3c or
part A.2, items 1–6)
Disposed of (from part A.1, item 3c or part A.2, item 7)
1
Yes
1
2
No – Go to item 3
0040
.00 Percent – If 100%, delete this property.
0060
0030
2
Currently owned (from part A.1, item 3c or
part A.2, items 1–6)
Disposed of (from part A.1, item 3c or part A.2, item 7)
1
Yes
1
2
.00 Percent – If 100%, delete this property.
0060
0090
Year
0080
Item 3a is after the 1st of the month 3 months
ago – Go to item 4
Item 3a is before the 1st of the month 3 months
ago – Go to item 8
0100
A purchase, a contract with a builder, or a trade-in?
A gift or inheritance?
 Go to
Other – Specify
 item 8
0120
Month
1
2
1
2
3

0090
Year
0080
Item 3a is after the 1st of the month 3 months
ago – Go to item 4
Item 3a is before the 1st of the month 3 months
ago – Go to item 8
0100
A purchase, a contract with a builder, or a trade-in?
A gift or inheritance?
 Go to
Other – Specify
 item 8
0120
Month
1
2
1
2
3

0090
A purchase, a contract with a builder, or a trade-in?
A gift or inheritance?
 Go to
Other – Specify
 item 8

.00
0130 $
.00
0130 $
.00
0140 $ O W N D P M T X
.00
0140 $
.00
0140 $
.00
0160 $
C L O SEC ST
.00
0160 $
.00
0160 $
.00
About how much do you think this property would sell for on
today’s market?
0190 $
PRO PV A L X
.00
0190 $
.00
0190 $
.00
What are your (your CU’s) annual property taxes for (property
description)?
0200 $
A N PRO PT X
.00
0200 $
.00
0200 $
.00
0210
A condominium
A cooperative
10.
Ask if not apparent. Do not ask for unimproved land (code 400).
Is this property a condominium, cooperative, or something else?
11.
If vacation property/second home (code 300), ask questions 11–13. All
other properties, go to part D or E as appropriate.
Where is (property description) located?
OFFICE USE ONLY
Do you (Does your CU) share ownership of this
property with anyone else outside your CU?
V SH A R ED
2
City or place
3
Something else
V PRO PL O C
State
1
2
A condominium
A cooperative
City or place
3
Something else
State
1
2
0230
1
Share ownership for entire year Go to part D
 or E as
Time-sharing arrangement
 appropriate
0240
1
2
A condominium
A cooperative
City or place
3
Something else
State
0220
No – Go to part D or E as appropriate
Yes
1
Foreign country
0220
1
0210
2
Foreign country
0220
0230
0210
PRO PT Y PE
Foreign country
Do you (Does your CU) share ownership for the entire year, or is this
0240
a time-sharing arrangement where you have (your CU has) ownership
of the property only for a specified time period each year? V T I M ESH R
FORM CE-302
1
Year
Item 3a is after the 1st of the month 3 months
ago – Go to item 4
Item 3a is before the 1st of the month 3 months
ago – Go to item 8
O W N _P U R X
0130 $
No – Go to item 3
A Q U I RY R
A CQ U I RM O
A C Q M ET H
13.
Description
c. DESCRIPTION
3
12.
1 03 05 1
2
No – Go to part D or E as appropriate
0230
1
Share ownership for entire year Go to part D
 or E as
Time-sharing arrangement
 appropriate
0240
1
Yes
2
2
Yes
2
No – Go to part D or E as appropriate
Share ownership for entire year Go to part D
 or E as
Time-sharing arrangement
 appropriate
FORM CE-302
NOTE: As of April 1999, Section 3 Part C no longer exists.
NOTES
Page 12
Section 3 – Part C
Page 12
Page 13
Page 13
FIELD REPRESENTATIVE – Complete a column in part D for this property reported as disposed of in
part A.1, item 1g, or part A.2, item 7, and continue with all appropriate
parts for this property before going to next property.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part D – Disposed of Property
1. FIELD REPRESENTATIVE PROCESSING USE ONLY
ITEM
Complete at the 1st
interview in which the
property is reported as
being disposed of. Enter
the property number in
item 1a, the property
code in item 1b, and a
brief description of the
property in item 1c.
2.
a.
PROPERTY NUMBER
b.
PROPERTY CODE
c.
1 03 33 3
0010
1 03 35 8
1 03 34 1
P R O P _N O D
Number
0020
0010
0020
OW NYD
Code
0010
Number
1 03 36 6
0010
Number
0020
Number
0020
Code
Code
Code
Description
Description
Description
Description
0030
0030
0030
0030
DESCRIPTION
Did you (your CU) sell this property, give it to
someone else (outside your CU), or do
something else with it?
1
2
3
Sold the property
Gave it to someone else
Something else – Specify
1
2
3
Sold the property
Gave it to someone else
Something else – Specify
1
2
3
Sold the property
Gave it to someone else
Something else – Specify
1
2
3
Sold the property
Gave it to someone else
Something else – Specify
D I SP M T H D
Mark property traded-in as "sold."
3.
In what month and year did you (your CU)
(sell/response to item 2) this property?
Month
Mark property traded-in as "sold."
Month
Year
0040
0050
D I SP Y R
If "sold" in item 2, go to item 4; otherwise
go to part E.
4.
6a.
D I SP X
Hand the respondent Information Booklet, page 9.
Here is a list of some of the costs people may
have when selling (trading) property. Looking
at the list may help you remember what
your (your CU’s) expenses were. What were
the total expenses in selling (trading) this
property?
0070 $
D I SP EX P X
Did you (your CU) finance any part of the
sale (trade) for the buyer?
0080
Yes
No – Go to part E
1
2
b.
0050
0040
If "sold" in item 2, go to item 4; otherwise
go to part E.
Mark property traded-in as "sold."
Month
Year
0050
0040
If "sold" in item 2, go to item 4; otherwise
go to part E.
Year
0050
If "sold" in item 2, go to item 4; otherwise
go to part E.
What was the selling price (trade-in value)?
0060 $
5.
Month
Year
0040
D I SP M O
Mark property traded-in as "sold."
What was the amount of the mortgage
that you (your CU) financed?
0090 $
T R U ST X
.00
0060 $
.00
0060 $
.00
0060 $
.00
.00
0070 $
.00
0070 $
.00
0070 $
.00
M O RT H O L D
.00
1
2
Yes
No – Go to part E
0080
NOTES
1
2
.00
0090 $
TX
FORM CE-302
0080
0090 $
Yes
No – Go to part E
0080
1
2
.00
0090 $
Yes
No – Go to part E
.00
FORM CE-302
FIELD REPRESENTATIVE – Ask part E questions 1 through 6 and then complete
parts F, G, and/or H as instructed.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part E – Mortgage/Home Equity Loan Screening Questions
1.
FIELD REPRESENTATIVE
ITEM
a.
PROPERTY NUMBER
Number
Enter the property
number in item 1a, the
property code in item 1b,
and a brief description of
the property in item 1c.
b.
PROPERTY CODE
Code
Number of
mortgages/loans
Complete the
appropriate part for
each loan/mortgage
a.
Enter number of mortgages for this property (from item 3a, 3b, 4a, or 4b)
DESCRIPTION
I want to ask next about any mortgages you
(your CU) had in the last three months on
(property description).
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) appropriate box based upon part B, item 10.
3a.
FIELD REPRESENTATIVE INSTRUCTIONS
F
Description
c.
2.
7.
b. Enter number of lump sum home equity loans for this property
1
2
Co-op property – Go to item 4a
Not co-op
c.
If YES ask –
How many mortgages have you
(has your CU) had on this
property since the 1st of
(month, three months ago)?
Excluding home equity loans, do you (does
your CU) presently have a mortgage on
this property?
G
(from item 6a)
Enter number of line of credit home equity loans for this property
(from item 6b)
H
• After completing the appropriate parts F, G, and/or H, continue with part I
• If no mortgages nor home equity loans on this property, go to part I
NOTES
Yes
No – Go to item 3b
b.
4a.
b.
5.
6.
a.
b.
Have you (Has your CU) had a mortgage on this
property since the 1st of (month, 3 months ago)?
Yes
No – Go to item 5
In addition to your (your CU’s) share of the
cooperative’s total costs, do you (does your
CU) make payments on a mortgage that was
obtained from an outside lender for your
(your CU’s) shares in the cooperative?
Yes
No – Go to item 4b
Since the lst of (month, 3 months ago), have you
(has your CU) made any payments on a
mortgage that was obtained from an outside
lender for your (your CU’s) shares in the
cooperative?
Yes
No – Go to item 5
Do you (Does your CU) have a line of credit
home equity loan?
Page 14
– Go to item 5
Number
– Go to item 5
Number
– Go to item 5
Number
If YES ask –
How many loans like this have
you (has your CU) had on this
property since the 1st of (month,
three months ago)?
Do you (Does your CU) have a home equity
loan or any other loan which gives the lender
claim on this property in case the loan is not
repaid?
Now let’s talk about your (your CU’s) (loan
description). There are two basic types of home
equity loans. I’ll describe both types. Please tell
me which more closely describes your loan.
• A loan where you (your CU) received the entire
lump-sum borrowed when you (your CU) took
out the loan; or
• A line of credit loan where you (your CU) can
increase the amount borrowed by simply
writing a check or using a special credit card.
Do you (Does your CU) have a lump sum home
equity loan?
– Go to item 5
Number
Yes
No – Go to item 7
Number
Yes
No – Go to item 6b
Number
Yes
No – Go to item 7
Number
Section 3 – Part E
Page 14
Page 14a
Page 14a
FIELD REPRESENTATIVE – Ask part E questions 1 through 6 and then complete
parts F, G, and/or H as instructed.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part E – Mortgage/Home Equity Loan Screening Questions – Continued
1.
FIELD REPRESENTATIVE
ITEM
a.
PROPERTY NUMBER
Number
Enter the property
number in item 1a, the
property code in item 1b,
and a brief description of
the property in item 1c.
b.
PROPERTY CODE
Code
Number of
mortgages/loans
a.
Enter number of mortgages for this property (from item 3a, 3b, 4a, or 4b)
I want to ask next about any mortgages you
(your CU) had in the last three months on
(property description).
b. Enter number of lump sum home equity loans for this property
1
2
c.
If YES ask –
How many mortgages have you
(has your CU) had on this
property since the 1st of
(month, three months ago)?
Excluding home equity loans, do you (does
your CU) presently have a mortgage on
this property?
4a.
b.
5.
6.
a.
b.
– Go to item 5
Yes
No – Go to item 3b
Number
Yes
No – Go to item 5
Number
In addition to your (your CU’s) share of the
cooperative’s total costs, do you (does your
CU) make payments on a mortgage that was
obtained from an outside lender for your
(your CU’s) shares in the cooperative?
Yes
No – Go to item 4b
Number
Since the lst of (month, 3 months ago), have you
(has your CU) made any payments on a
mortgage that was obtained from an outside
lender for your (your CU’s) shares in the
cooperative?
Yes
No – Go to item 5
Number
Have you (Has your CU) had a mortgage on this
property since the 1st of (month, 3 months ago)?
Now let’s talk about your (your CU’s) (loan
description). There are two basic types of home
equity loans. I’ll describe both types. Please tell
me which more closely describes your loan.
• A loan where you (your CU) received the entire
lump-sum borrowed when you (your CU) took
out the loan; or
• A line of credit loan where you (your CU) can
increase the amount borrowed by simply
writing a check or using a special credit card.
Do you (Does your CU) have a lump sum home
equity loan?
Do you (Does your CU) have a line of credit
home equity loan?
FORM CE-302
– Go to item 5
– Go to item 5
– Go to item 5
If YES ask –
How many loans like this have
you (has your CU) had on this
property since the 1st of (month,
three months ago)?
Do you (Does your CU) have a home equity
loan or any other loan which gives the lender
claim on this property in case the loan is not
repaid?
G
(from item 6a)
Co-op property – Go to item 4a
Not co-op
Enter number of line of credit home equity loans for this property
(from item 6b)
• After completing the appropriate parts F, G, and/or H, continue with part I
• If no mortgages nor home equity loans on this property, go to part I
NOTES
b.
Complete the
appropriate part for
each loan/mortgage
DESCRIPTION
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) appropriate box based upon part B, item 10.
3a.
FIELD REPRESENTATIVE INSTRUCTIONS
F
Description
c.
2.
7.
Yes
No – Go to item 7
Number
Yes
No – Go to item 6b
Number
Yes
No – Go to item 7
Number
H
FORM CE-302
FIELD REPRESENTATIVE – Ask part E questions 1 through 6 and then complete
parts F, G, and/or H as instructed.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part E – Mortgage/Home Equity Loan Screening Questions – Continued
1.
FIELD REPRESENTATIVE
ITEM
a.
PROPERTY NUMBER
Number
Enter the property
number in item 1a, the
property code in item 1b,
and a brief description of
the property in item 1c.
b.
PROPERTY CODE
Code
Number of
mortgages/loans
Complete the
appropriate part for
each loan/mortgage
a.
Enter number of mortgages for this property (from item 3a, 3b, 4a, or 4b)
DESCRIPTION
I want to ask next about any mortgages you
(your CU) had in the last three months on
(property description).
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) appropriate box based upon part B, item 10.
3a.
FIELD REPRESENTATIVE INSTRUCTIONS
F
Description
c.
2.
7.
b. Enter number of lump sum home equity loans for this property
1
2
Co-op property – Go to item 4a
Not co-op
c.
If YES ask –
How many mortgages have you
(has your CU) had on this
property since the 1st of
(month, three months ago)?
Excluding home equity loans, do you (does
your CU) presently have a mortgage on
this property?
G
(from item 6a)
Enter number of line of credit home equity loans for this property
(from item 6b)
H
• After completing the appropriate parts F, G, and/or H, continue with part I
• If no mortgages nor home equity loans on this property, go to part I
NOTES
Yes
No – Go to item 3b
b.
4a.
b.
5.
6.
a.
b.
Have you (Has your CU) had a mortgage on this
property since the 1st of (month, 3 months ago)?
Yes
No – Go to item 5
In addition to your (your CU’s) share of the
cooperative’s total costs, do you (does your
CU) make payments on a mortgage that was
obtained from an outside lender for your
(your CU’s) shares in the cooperative?
Yes
No – Go to item 4b
Since the lst of (month, 3 months ago), have you
(has your CU) made any payments on a
mortgage that was obtained from an outside
lender for your (your CU’s) shares in the
cooperative?
Yes
No – Go to item 5
Do you (Does your CU) have a line of credit
home equity loan?
Page 14b
– Go to item 5
Number
– Go to item 5
Number
– Go to item 5
Number
If YES ask –
How many loans like this have
you (has your CU) had on this
property since the 1st of (month,
three months ago)?
Do you (Does your CU) have a home equity
loan or any other loan which gives the lender
claim on this property in case the loan is not
repaid?
Now let’s talk about your (your CU’s) (loan
description). There are two basic types of home
equity loans. I’ll describe both types. Please tell
me which more closely describes your loan.
• A loan where you (your CU) received the entire
lump-sum borrowed when you (your CU) took
out the loan; or
• A line of credit loan where you (your CU) can
increase the amount borrowed by simply
writing a check or using a special credit card.
Do you (Does your CU) have a lump sum home
equity loan?
– Go to item 5
Number
Yes
No – Go to item 7
Number
Yes
No – Go to item 6b
Number
Yes
No – Go to item 7
Number
Section 3 – Part E (Continued)
Page 14b
Page 15
Page 15
FIELD REPRESENTATIVE – Complete a separate column for each mortgage at the first interview
in which the mortgage is reported.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part F – Mortgages
1. FIELD REPRESENTATIVE
ITEM
Enter the property
number in item 1a, the
property code in item 1b,
a brief description of the
property in item 1c.
Enter the 3-digit loan
number in item 1d,
beginning with 101 and
assigning loan numbers
consecutively, regardless
of property number.
2.
3.
PROCESSING USE ONLY
1 03 43 2
a.
PROPERTY NUMBER
0010
b.
PROPERTY CODE
0020
Number
Code
5.
6a.
b.
c.
d. LOAN NUMBER
I’d like to ask some additional questions about
your mortgage. In what month and year did you
(your CU) make your (your CU’s) first payment
on this mortgage?
Is this a 30-year mortgage, a 15-year
mortgage, or something else?
F R ST P Y Y R
Code
Description
0035
0055
0045
1
2
30-year
15-year
3
Something else – Specify
0065
0080
Is this a fixed rate mortgage?
0085
1
Yes – Go to item 7
2
No
There are many different kinds of
mortgages. Which one of these (hand
respondent Information Booklet, page 10) comes
closest to yours (your CU’s)?
0090
1
Fixed rate of interest
Variable or adjustable
rate of interest
Graduated payment
Rollover or renegotiable
5
Deferred interest
Other – Specify
N EW M
. RRT
2
3
Have you (Has your CU) refinanced or
renegotiated this mortgage?
0105
1
0130 $
9.
How often are (were) mortgage payments
due?
0170
1
2
3
4
On your (your CU’s) last regular payment,
which of these things were included? (Hand
respondent Information Booklet, page 11.)
Mark (X) all that apply.
0175
1
0190
2
0200
0210
1
2
30-year
15-year
Number
Month
Year
0045
Number of years
What is the current interest rate on your
(your CU’s) mortgage? (Convert fractions to
decimals.)
.
0055
M O R T T ER M
1
0030
Number
0035
0075
O L D M RRT
1
Month
Year
What was the rate of interest at the time the
mortgage was obtained? Enter in two decimal
places, such as 9.50% for 9 1/2%. (Include all FHA
guarantee insurance if applicable.)
Year
0035
3
Something else – Specify
0055
0045
1
2
0065
Number of years
30-year
15-year
3
Something else – Specify
0065
Number of years
Percent
0075
.
Percent
0075
.
Percent
If same as item 4, go to item
Percent 6a. If different, go to item 6b.
0080
.
If same as item 4, go to item
Percent 6a. If different, go to item 6b.
0080
.
If same as item 4, go to item
Percent 6a. If different, go to item 6b.
6
F I X ED R T E
X
1
Yes – Go to item 7
2
No
0085
1
Yes – Go to item 7
2
No
0090
1
Fixed rate of interest
Variable or adjustable
rate of interest
Graduated payment
Rollover or renegotiable
5
Deferred interest
Other – Specify
0090
1
6
Deferred interest
Other – Specify
X
Don’t know
Fixed rate of interest
Variable or adjustable
rate of interest
Graduated payment
Rollover or renegotiable
5
6
X
Don’t know
2
5
6
7
3
Don’t know
O R GM R T X
.00
Weekly
Biweekly
Monthly
Quarterly
0085
PA Y T Y PE
Yes – Read to respondent – The following question
refers to this current
mortgage.
R EF I N ED
No
Semiannually
Annually
Other – Specify
4
0105
Principal and
0220 5
interest P A Y P R I N I
0230 6
Property taxes P A Y
PRO T
Mortgage guarantee
insurance P A Y M O R I N
Any other payments –
XSpecify
3
Property insurance
4
P A Y P RO IN
Life insurance
P A Y L IFIN
0235 $
M RT PM T X
.00
If any of codes 2–6 marked in item 10, ask –
How much of that amount was for principal
and interest?
0245 $
PRI N I N T X
.00
PA Y O T H ER
x
Don’t know
1
2
0170
1
2
.00
3
4
Weekly
Biweekly
Monthly
Quarterly
2
3
Yes – Read to respondent – The following question
refers to this current
mortgage.
No
0130 $
M RT PM PD
On your (your CU’s) last regular payment,
what was the total amount you (your CU)
paid for those things?
FORM CE-302
Number
0020
Code
0030
L O A N _N O F
Number
Month
What was the amount of the mortgage when you
(your CU) obtained it, excluding any interest?
12.
0020
F R ST P Y M O
8.
11.
OW NYF
0010
Number
Description
1
0030
2
10.
0010
1 03 45 7
DESCRIPTION
4
7.
P R O P _N O F
Description
M T ER M
4.
1 03 44 0
4
0105
1
2
Yes – Read to respondent – The following question
refers to this current
mortgage.
No
.00
0130 $
5
6
7
Semiannually
Annually
Other – Specify
0170
1
2
3
4
0175
1
Principal and
interest
0220
5
0190
2
Property taxes
0230
6
0200
3
0210
4
5
6
7
0175
1
Principal and
interest
0220
5
0190
2
Property taxes
0230
6
Property insurance
0200
3
Property insurance
Life insurance
0210
4
Life insurance
0235 $
.00
0245 $
.00
Mortgage guarantee
insurance
Any other payments –
Specify
Weekly
Biweekly
Monthly
Quarterly
x
Don’t know
0235 $
.00
0245 $
.00
Semiannually
Annually
Other – Specify
Mortgage guarantee
insurance
Any other payments –
Specify
x
Don’t know
FORM CE-302
FIELD REPRESENTATIVE – Complete a separate column for each lump sum home equity loan at the
first interview in which the loan is reported.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part G – Lump Sum Home Equity Loans
1. FIELD REPRESENTATIVE PROCESSING USE ONLY
ITEM
Enter the property
number in item 1a, the
property code in item 1b,
a brief description of the
property in item 1c.
Enter the 3-digit loan
number in item 1d,
beginning with 201 and
assigning loan numbers
consecutively, regardless
of property number.
2.
3.
1 03 58 0
a.
PROPERTY NUMBER
0010
b.
PROPERTY CODE
0020
c.
DESCRIPTION
Number
Code
5.
6a.
b.
d. LOAN NUMBER
8.
9.
I’d like to ask some additional questions about
your lump sum home equity loan. In what
month and year did you (your CU) make your
(your CU’s) first payment on this loan?
Is this a 30-year home equity loan, a 15-year
home equity loan, or something else?
L O A N _N O F
Number
0055
2
30-year
15-year
Something else – Specify
0065
0075
What is the current interest rate on your
(your CU’s) home equity loan? (Convert
fractions to decimals.)
0080
Is this a fixed rate home equity loan?
0085
1
Yes – Go to item 7
2
No
There are many different kinds of lump sum
home equity loans. Which one of these (hand
respondent Information Booklet, page 10) comes
closest to yours (your CU’s)?
0090
1
Fixed rate of interest
Variable or adjustable
rate of interest
Graduated payment
Rollover or renegotiable
5
Deferred interest
Other – S
O L D M RRT
.
N EW M
. RRT
2
3
0105
1
2
0130 $
How often are (were) loan payments due?
0170
Mark (X) all that apply.
30-year
15-year
Year
0035
3
Something else – Specify
0055
0045
1
2
0065
Number of years
30-year
15-year
3
Something else – Specify
0065
Number of years
1
0175
1
0190
0200
0210
2
3
4
i
Percent
0075
.
Percent
0075
.
Percent
0080
.
If same as item 4, go to item
Percent 6a. If different, go to item 6b.
0080
.
If same as item 4, go to item
Percent 6a. If different, go to item 6b.
c
If same as iteme4, go to item
Percent 6a. If different, go to item 6b.
6
I X ED R T E
Fp
0085
1
Yes – Go to item 7
2
No
0085
1
Yes – Go to item 7
2
No
0090
1
Fixed rate of interest
Variable or adjustable
rate of interest
Graduated payment
Rollover or renegotiable
5
Deferred interest
Other – Specify
0090
1
6
Deferred interest
Other – Specify
X
Don’t know
Fixed rate of interest
Variable or adjustable
rate of interest
Graduated payment
Rollover or renegotiable
5
6
X
Don’t know
2
PA Y T Y PE
3
X
Don’t know
4
Yes – Read to respondent – The following question
refers to this current
lump sum home equity
ED
N
I
EF
R
No
loan.
O R GM R T X
.00
Weekly
Biweekly
Monthly
Quarterly
5
Principal and
0220
interest P A Y P R I N I
0230
Property taxes
5
6
7
0105
0170
2
3
4
Mortgage guarantee
insurance P A Y M O R I N
6
Any other payments –
P A Y P R O T XSpecify
PA Y O T H ER
Property insurance
P A Y P RO IN
Life insurance
0235 $
M RT PM T X
.00
If any of codes 2–6 marked in item 10, ask –
How much of that amount was for principal
and interest?
0245 $
PRI N I N T X
.00
x
Don’t know
1
.00
0175
1
0190
0200
0210
2
3
4
Weekly
Biweekly
Monthly
Quarterly
Principal and
interest
4
0105
1
2
5
6
7
Semiannually
Annually
Other – Specify
0170
1
2
3
4
5
0230
Property taxes
Property insurance
Life insurance
6
0235 $
.00
0245 $
.00
Yes – Read to respondent – The following question
refers to this current
lump sum home equity
No
loan.
.00
0130 $
0220
Section 3 – Part G
2
3
Yes – Read to respondent – The following question
refers to this current
lump sum home equity
No
loan.
0130 $
Semiannually
Annually
Other – Specify
P A Y L IFIN
1
2
M RT PM PD
On your (your CU’s) last regular payment,
what was the total amount you (your CU)
paid for those things?
Page 16
2
Number
Month
Year
0045
1
2
0030
Number
f
What was the amount of the lump sum home
equity loan when you (your CU) obtained it,
excluding any interest?
On your (your CU’s) last regular payment,
which of these things were included? (Hand
respondent Information Booklet, page 11.)
2
Number y
of years
What was the rate of interest at the time the
home equity loan was obtained? Enter in two
decimal places, such as 9.50% for 9 1/2%. (Include
all FHA guarantee insurance if applicable.)
Have you (Has your CU) refinanced or
renegotiated this lump sum home equity
loan?
0055
M O R T T ER M
Code
Description
0035
3
Number
0020
Code
Month
Year
0045
1
0010
Number
0030
F R ST P Y Y R
0035
4
12.
0020
Month
3
11.
OW NYF
F R ST P Y M O
2
10.
0010
1 03 60 6
Description
2
0030
4
7.
P R O P _N O F
Description
M T ER M
4.
1 03 59 8
Mortgage guarantee
insurance
Any other payments –
Specify
x
Don’t know
0175
1
0190
0200
0210
2
3
4
Weekly
Biweekly
Monthly
Quarterly
Principal and
interest
5
6
7
0220
5
0230
Property taxes
Property insurance
Life insurance
6
0235 $
.00
0245 $
.00
Semiannually
Annually
Other – Specify
Mortgage guarantee
insurance
Any other payments –
Specify
x
Don’t know
Page 16
Page 17
Page 17
FIELD REPRESENTATIVE –
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part H – Line of Credit Home Equity Loans
1.
FIELD REPRESENTATIVE
PROCESSING USE ONLY
ITEM
Enter the property
number in item 1a, the
property code in item 1b,
a brief description of the
property in item 1c.
Enter the 3-digit loan
number in item 1d,
beginning with 301 and
assigning loan numbers
consecutively, regardless
of property number.
2.
3.
4.
a.
PROPERTY NUMBER
0010
b.
PROPERTY CODE
0020
c.
DESCRIPTION
1 03 69 7
P R O P _N O H
d. LOAN NUMBER
If YES – What was the amount of the last
payment?
Prior to the last payment, what was the
total amount owed?
3
0030
0010
Number
0010
Number
Code O W N Y H
0020
Code
0020
Code
0040
1
2
Description
Description
L O A N _N O H
Number
Yes
PA ID L O A N
No – Go to next loan or
part I
3
0030
0040
1
2
NOTES
1 03 70 5
Number
Description
I’d like to ask some additional questions
about your (your CU’s) line of credit home
equity loan. Since the 1st of (last month),
have you (has any member of your CU)
made any payments for this loan?
FORM CE-302
1 03 68 9
Number
0030
Yes
No – Go to next loan or
part I
0040
3
1
2
Number
Yes
No – Go to next loan or
part I
0050 $
PA ID A M T X
.00
0050 $
.00
0050 $
.00
0060 $
PRI N A M T X
.00
0060 $
.00
0060 $
.00
FORM CE-302
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
FIELD REPRESENTATIVE – Complete a separate part I for each property still owned or disposed of
within the past 3 months.
Part I – Ownership Costs
1.
FIELD REPRESENTATIVE
ITEM
Enter the property
number in item 1a, the
property code in item 1b,
and a brief description of
the property in item 1c.
PROCESSING USE ONLY
a.
PROPERTY NUMBER
b.
PROPERTY CODE
c.
2.
3a.
0010
P R O P _N O I
Number
OW NYI
0020
Code
Description
DESCRIPTION
FIELD REPRESENTATIVE CHECK ITEM
0030 1
Mortgage/lump sum
home equity loan
Mark (X) the appropriate box.
No mortgage/no lump
2
If there was a mortgage or lump sum home equity
sum home equity loan –
loan on the property within the past 3 months, mark
box 1; if not, mark box 2.
W A SM O R T Go to item 4a
Now I want to ask about other payments on
(property description) during the last three
months. Since the 1st of (month, 3 months ago),
have you (any members of your CU) paid more
than the amount required on any mortgage or
lump sum home equity loan?
0040
1
2
M O R T SP EC
Yes
No – Go to item 4a
b.
Since the 1st of (month, 3 months ago), what was
the total amount that you (your CU) paid extra?
c.
How much of the (amount in item 3b) did you
(your CU) pay since the 1st of (current month)?
0060 $ SP EC L X C M
Were there any penalty charges as a result of
the extra payments?
0070
d.
0050 $
1
2
e.
f.
4a.
b.
c.
5.
Since the 1st of (month, 3 months ago), how
much were these penalty charges?
7.
0080 $
How much of the (amount in item 3e) did you
(your CU) pay since the 1st of (current month)?
Since the 1st of (month, 3 months ago), have you
(has your CU) made any payments for ground or
land rent for (property description)?
0090 $
0100
1
2
If YES – What was the total amount paid?
0110 $
How much of the (amount in item 4b) was paid
since the 1st of (current month)?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box.
If property is condo, mark box 1.  Refer to part B,
If property is co-op, mark box 2.  item 10 or
A.1, item 1,
If property is neither, mark box 3. part
column d

6.
8.
1 03 77 0
If property is condo, ask –
Are you (Is your CU) required to make regular
payments of condominium fees for general
maintenance or management services?
Page 18
SP P C H C M X
.00
.00
H O C O R G#
Yes
No – Go to item 5
.00
10a.
b.
c.
P A Y H O A SS
0140
1
2
Yes – Go to item 9
No – Go to item 11a
d.
PA Y CO N D O
0150
1
2
02
0180
03
Property insurance
0190
04
Management
0200
05
0210
06
Repairs and maintenance,
including lawn care and snow
removal
Improvements
0220
07
0230
08
0240
09
0250
10
Recreational, including
swimming, golf, and tennis
facilities
Security, including guards and
alarm systems
Utilities: such as gas,
electricity, water, heat
Trash collection
0260
11
Other – Specify
11a.
b.
0270
21
Management
0280
22
0290
23
Repairs and maintenance,
including lawn care and snow
removal
Improvements
0300
24
If property is co-op: Hand
respondent Information
Booklet, page 12.
If property is condo/ something
else: Hand respondent
Information Booklet, page 13.
Have you (Has your CU)
made any SPECIAL
payments to a management
service for any of these
items?
Since the 1st of (month,
3 months ago), what
services were provided?
0310
25
0320
26
Utilities: such as gas,
electricity, water, heat
Parking
0330
27
0340
28
Recreational, including
swimming, golf, and tennis
facilities
Security, including guards and
alarm systems
Maid service
0350
29
Medical services
0360
30
Trash collection
0370
31
Other – Specify
c.
Yes – Go to item 9
No – Go to item 11a
e.
Are any of the costs included in your
(your CU’s) mortgage payment?
If YES – How much per month?
In addition to those costs, since the
1st of (month, 3 months ago), have you
(has your CU) made any other regular
payments for these services?
Since the 1st of (month, 3 months
ago), how much have you (has your
CU) paid for these services?
How much of the (amount in item 10d) was
paid since the 1st of (current month)?
Section 3 – Part I
0380
1
2
Since the 1st of (month,
3 months ago), how much
were these special
payments?
d. Of the (amount in item 11c),
how much was paid since
the 1st of (current month)?
3 months ago), have you (has
your CU) paid any special
assessments by a local
government for construction
or repair of roads, sidewalks,
or other things like that?
Yes
I N C _M O R T
No – Go to item 10d
b. What was the total amount
0390
$
0400
1
M GM O R T X
0410
0420
$
$
Yes
M GO T H ER
No – Go to item 11a
M GO T H ER X
M GO T H R C X
0430
Yes
No – Go to item 12a
1
2
SERVICES FOR CO-OPS
0440
0
0450
0
0460
0
0470
0
0480
0
0490
0
0500
0
0510
0
0520
0
0530
1
0540
1
COOPSP
SERVICES FOR CONDOS/
SOMETHING ELSE
0550
2
0560
2
0570
2
0580
2
0590
2
0600
2
0610
2
0620
2
0630
2
0640
3
0650
3
0660 $
0670 $
SP EC L X
.00
SP EC L C X
.00
.00
.00
13.
0680
1
2
Yes
No – Go to item 13
A SSESSM T
0690 $
A SSESSX
.00
item 12b) was paid since the
1st of (current month)?
0700 $
A SSESSC X
.00
Ask if code 100, 200, or 300 in
item 1b.
If someone were to rent
your home today, how
much do you think it would
rent for monthly,
unfurnished and without
utilities?
0710 $
paid?
.00
c. How much of the (amount in
2
SP C L P A Y
12a. Since the 1st of (month,
.00
Condominium – Go to
item 7
Co-op – Go to item 8
Neither condo nor
co-op – Continue
with item 6
3
0170
Repayment of loans owed by
cooperative
Property taxes
.00
0130
2
If property is not co-op, ask –
Which of the services and privileges
listed (hand the respondent Information
Booklet, page 13) are included in those
payments?
Mark (X) all that apply.
.00
GR N D R T C X
1
9.
GR N D R EN T
GR N D R N T X
01
C O O P R G#
SP P EN C H G
Yes
No – Go to item 4a
SP P EN C H X
0160
H O C O SP
0120 $
T Y P EP R O P
If property is not condo/co-op, ask –
Do you (Does your CU) make regular payments
to a homeowner’s association?
SP EC I A L X
If property is co-op, ask –
Now I’d like to ask you about
payments you make (your CU
makes) directly to the cooperative
for your (your CU’s) share of its
costs. Since the 1st of (month, 3
months ago), for which of the things
on this card (hand the respondent
Information Booklet, page 12) have you
(has your CU) made any payments?
Mark (X) all that apply.
If any entry in boxes 1–11, go to
item 10a.
If no entries in boxes 1–11, go to
item 11a.
X
R N T EQ V X
.00
Don’t know
Page 18
Page 18a
Page 18a
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
FIELD REPRESENTATIVE – Complete a separate part I for each property still owned or disposed of
within the past 3 months.
Part I – Ownership Costs – Continued
1.
FIELD REPRESENTATIVE
ITEM
Enter the property
number in item 1a, the
property code in item 1b,
and a brief description of
the property in item 1c.
PROCESSING USE ONLY
a.
b.
c.
2.
3a.
PROPERTY NUMBER
0010
PROPERTY CODE
0020
Number
Code
Description
DESCRIPTION
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box.
If there was a mortgage or lump sum home equity
loan on the property within the past 3 months, mark
box 1; if not, mark box 2.
Now I want to ask about other payments on
(property description) during the last three
months. Since the 1st of (month, 3 months ago),
have you (any members of your CU) paid more
than the amount required on any mortgage or
lump sum home equity loan?
0030
1
2
0040
1
2
b.
Since the 1st of (month, 3 months ago), what was
the total amount that you (your CU) paid extra?
c.
How much of the (amount in item 3b) did you
(your CU) pay since the 1st of (current month)?
0060 $
Were there any penalty charges as a result of
the extra payments?
0070
d.
f.
4a.
b.
c.
5.
Since the 1st of (month, 3 months ago), how
much were these penalty charges?
How much of the (amount in item 3e) did you
(your CU) pay since the 1st of (current month)?
Since the 1st of (month, 3 months ago), have you
(has your CU) made any payments for ground or
land rent for (property description)?
1
1
2
0110 $
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box.
If property is condo, mark box 1.  Refer to part B,
If property is co-op, mark box 2.  item 10 or
A.1, item 1,
If property is neither, mark box 3. part
column d
0120 $
0130
1
2
3

6.
7.
If property is not condo/co-op, ask –
Do you (Does your CU) make regular payments
to a homeowner’s association?
If property is condo, ask –
Are you (Is your CU) required to make regular
payments of condominium fees for general
maintenance or management services?
FORM CE-302
.00
0140
1
2
0150
1
2
9.
.00
Yes
No – Go to item 4a
If property is not co-op, ask –
Which of the services and privileges
listed (hand the respondent Information
Booklet, page 13) are included in those
payments?
Mark (X) all that apply.
.00
Yes
No – Go to item 5
.00
11a.
01
0170
02
Repayment of loans owed by
cooperative
Property taxes
0180
03
Property insurance
0190
04
Management
0200
05
0210
06
Repairs and maintenance,
including lawn care and snow
removal
Improvements
0220
07
0230
08
0240
09
0250
10
Recreational, including
swimming, golf, and tennis
facilities
Security, including guards and
alarm systems
Utilities: such as gas,
electricity, water, heat
Trash collection
0260
11
Other – Specify
SERVICES FOR CONDOS/
SOMETHING ELSE
0550
2
0560
2
0270
21
Management
0280
22
0290
23
Repairs and maintenance,
including lawn care and snow
removal
Improvements
0300
24
0310
25
0320
26
b.
Yes – Go to item 9
No – Go to item 11a
Yes – Go to item 9
No – Go to item 11a
10a.
b.
c.
d.
e.
Are any of the costs included in your
(your CU’s) mortgage payment?
0330
27
0340
28
Recreational, including
swimming, golf, and tennis
facilities
Security, including guards and
alarm systems
Maid service
0350
29
Medical services
0360
30
Trash collection
0370
31
Other – Specify
If YES – How much per month?
In addition to those costs, since the
1st of (month, 3 months ago), have you
(has your CU) made any other regular
payments for these services?
Since the 1st of (month, 3 months
ago), how much have you (has your
CU) paid for these services?
How much of the (amount in item 10d) was
paid since the 1st of (current month)?
0380
1
2
0390
$
0400
1
Since the 1st of (month,
3 months ago), what
services were provided?
Utilities: such as gas,
electricity, water, heat
Parking
c.
Since the 1st of (month,
3 months ago), how much
were these special
payments?
d. Of the (amount in item 11c),
how much was paid since
the 1st of (current month)?
3 months ago), have you (has
your CU) paid any special
assessments by a local
government for construction
or repair of roads, sidewalks,
or other things like that?
Yes
No – Go to item 10d
b. What was the total amount
0410
0420
$
$
Yes
No – Go to item 12a
1
2
SERVICES FOR CO-OPS
0440
0
0450
0
0460
0
0470
0
0480
0
0490
0
0500
0
0510
0
0520
0
0530
1
0540
1
0570
2
0580
2
0590
2
0600
2
0610
2
0620
2
0630
2
0640
3
0650
3
0660 $
.00
0670 $
.00
Yes
No – Go to item 11a
.00
.00
13.
0680
1
2
Yes
No – Go to item 13
0690 $
.00
item 12b) was paid since the
1st of (current month)?
0700 $
.00
Ask if code 100, 200, or 300 in
item 1b.
If someone were to rent
your home today, how
much do you think it would
rent for monthly,
unfurnished and without
utilities?
0710 $
.00
paid?
.00
c. How much of the (amount in
2
0430
12a. Since the 1st of (month,
.00
Condominium – Go to
item 7
Co-op – Go to item 8
Neither condo nor
co-op – Continue
with item 6
If property is co-op: Hand
respondent Information
Booklet, page 12.
If property is condo/ something
else: Hand respondent
Information Booklet, page 13.
Have you (Has your CU)
made any SPECIAL
payments to a management
service for any of these
items?
0160
.00
0090 $
0100
If property is co-op, ask –
Now I’d like to ask you about
payments you make (your CU
makes) directly to the cooperative
for your (your CU’s) share of its
costs. Since the 1st of (month, 3
months ago), for which of the things
on this card (hand the respondent
Information Booklet, page 12) have you
(has your CU) made any payments?
Mark (X) all that apply.
If any entry in boxes 1–11, go to
item 10a.
If no entries in boxes 1–11, go to
item 11a.
Yes
No – Go to item 4a
0080 $
If YES – What was the total amount paid?
How much of the (amount in item 4b) was paid
since the 1st of (current month)?
Mortgage/lump sum
home equity loan
No mortgage/no lump
sum home equity loan –
Go to item 4a
0050 $
2
e.
8.
1 03 78 8
X
Don’t know
FORM CE-302
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
FIELD REPRESENTATIVE – Complete a separate part I for each property still owned or disposed of
within the past 3 months.
Part I – Ownership Costs – Continued
1.
FIELD REPRESENTATIVE
ITEM
Enter the property
number in item 1a, the
property code in item 1b,
and a brief description of
the property in item 1c.
PROCESSING USE ONLY
a.
PROPERTY NUMBER
b.
PROPERTY CODE
c.
2.
3a.
0010
Number
0020
Code
Description
DESCRIPTION
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box.
If there was a mortgage or lump sum home equity
loan on the property within the past 3 months, mark
box 1; if not, mark box 2.
Now I want to ask about other payments on
(property description) during the last three
months. Since the 1st of (month, 3 months ago),
have you (any members of your CU) paid more
than the amount required on any mortgage or
lump sum home equity loan?
0030
1
2
0040
1
2
b.
Since the 1st of (month, 3 months ago), what was
the total amount that you (your CU) paid extra?
c.
How much of the (amount in item 3b) did you
(your CU) pay since the 1st of (current month)?
0060 $
d.
Were there any penalty charges as a result of
the extra payments?
0070
f.
4a.
b.
c.
5.
Since the 1st of (month, 3 months ago), how
much were these penalty charges?
How much of the (amount in item 3e) did you
(your CU) pay since the 1st of (current month)?
Since the 1st of (month, 3 months ago), have you
(has your CU) made any payments for ground or
land rent for (property description)?
1
1
2
0110 $
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box.
If property is condo, mark box 1.  Refer to part B,
If property is co-op, mark box 2.  item 10 or
A.1, item 1,
If property is neither, mark box 3. part
column d
0120 $
0130
1
2
3

6.
7.
If property is not condo/co-op, ask –
Do you (Does your CU) make regular payments
to a homeowner’s association?
If property is condo, ask –
Are you (Is your CU) required to make regular
payments of condominium fees for general
maintenance or management services?
Page 18b
.00
0140
1
2
0150
1
2
9.
.00
Yes
No – Go to item 4a
If property is not co-op, ask –
Which of the services and privileges
listed (hand the respondent Information
Booklet, page 13) are included in those
payments?
Mark (X) all that apply.
.00
Yes
No – Go to item 5
.00
11a.
01
0170
02
Repayment of loans owed by
cooperative
Property taxes
0180
03
Property insurance
0190
04
Management
0200
05
0210
06
Repairs and maintenance,
including lawn care and snow
removal
Improvements
0220
07
0230
08
0240
09
0250
10
Recreational, including
swimming, golf, and tennis
facilities
Security, including guards and
alarm systems
Utilities: such as gas,
electricity, water, heat
Trash collection
0260
11
Other – Specify
SERVICES FOR CONDOS/
SOMETHING ELSE
0550
2
0560
2
0270
21
Management
0280
22
0290
23
Repairs and maintenance,
including lawn care and snow
removal
Improvements
0300
24
0310
25
0320
26
b.
Yes – Go to item 9
No – Go to item 11a
Yes – Go to item 9
No – Go to item 11a
10a.
b.
c.
d.
e.
Are any of the costs included in your
(your CU’s) mortgage payment?
0330
27
0340
28
Recreational, including
swimming, golf, and tennis
facilities
Security, including guards and
alarm systems
Maid service
0350
29
Medical services
0360
30
Trash collection
0370
31
Other – Specify
If YES – How much per month?
In addition to those costs, since the
1st of (month, 3 months ago), have you
(has your CU) made any other regular
payments for these services?
0380
2
0390
0400
$
1
2
Since the 1st of (month, 3 months
ago), how much have you (has your
CU) paid for these services?
0410
How much of the (amount in item 10d) was
paid since the 1st of (current month)?
0420
Section 3 – Part I (Continued)
1
$
$
Since the 1st of (month,
3 months ago), what
services were provided?
Utilities: such as gas,
electricity, water, heat
Parking
c.
Since the 1st of (month,
3 months ago), how much
were these special
payments?
d. Of the (amount in item 11c),
how much was paid since
the 1st of (current month)?
0430
Yes
No – Go to item 12a
1
2
SERVICES FOR CO-OPS
0440
0
0450
0
0460
0
0470
0
0480
0
0490
0
0500
0
0510
0
0520
0
0530
1
0540
1
0570
2
0580
2
0590
2
0600
2
0610
2
0620
2
0630
2
0640
3
0650
3
0660 $
.00
0670 $
.00
12a. Since the 1st of (month,
3 months ago), have you (has
your CU) paid any special
assessments by a local
government for construction
or repair of roads, sidewalks,
or other things like that?
.00
Condominium – Go to
item 7
Co-op – Go to item 8
Neither condo nor
co-op – Continue
with item 6
If property is co-op: Hand
respondent Information
Booklet, page 12.
If property is condo/ something
else: Hand respondent
Information Booklet, page 13.
Have you (Has your CU)
made any SPECIAL
payments to a management
service for any of these
items?
0160
.00
0090 $
0100
If property is co-op, ask –
Now I’d like to ask you about
payments you make (your CU
makes) directly to the cooperative
for your (your CU’s) share of its
costs. Since the 1st of (month, 3
months ago), for which of the things
on this card (hand the respondent
Information Booklet, page 12) have you
(has your CU) made any payments?
Mark (X) all that apply.
If any entry in boxes 1–11, go to
item 10a.
If no entries in boxes 1–11, go to
item 11a.
Yes
No – Go to item 4a
0080 $
If YES – What was the total amount paid?
How much of the (amount in item 4b) was paid
since the 1st of (current month)?
Mortgage/lump sum
home equity loan
No mortgage/no lump
sum home equity loan –
Go to item 4a
0050 $
2
e.
8.
1 03 79 6
Yes
No – Go to item 10d
b. What was the total amount
.00
.00
13.
2
Yes
No – Go to item 13
.00
item 12b) was paid since the
1st of (current month)?
0700 $
.00
Ask if code 100, 200, or 300 in
item 1b.
If someone were to rent
your home today, how
much do you think it would
rent for monthly,
unfurnished and without
utilities?
0710 $
.00
c. How much of the (amount in
Yes
No – Go to item 11a
1
0690 $
paid?
.00
0680
X
Don’t know
Page 18b
Page 19
Page 19
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
FIELD REPRESENTATIVE – Complete a separate page for each mortgage or lump sum home equity
loan that has changed.
Part J – Change in Mortgage or Lump Sum Home Equity Loan Payment
1.
FIELD REPRESENTATIVE ITEM
Complete a separate page for
each change in the amount of the
mortgage or lump sum home
equity loan payment reported in
part A.1, item 1, column k.
Enter the property number in
item 1a, the property code in
item 1b, the property description
in item 1c, and the mortgage
(loan) number in item 1d. Mark
(X) the appropriate type of loan
in item 1e.
PROCESSING USE ONLY
a.
PROPERTY NUMBER
0010
Number
How often are (were) mortgage (lump sum home equity loan)
payments due?
0090
1
2
3
P R O P _N O J
4
5
b.
PROPERTY CODE
0020
OW NYJ
Code
6
7
Description
c.
DESCRIPTION
d.
MORTGAGE (LOAN) NUMBER
0030
0035
e.
2.
6.
1 03 92 9
1
2
TYPE OF LOAN
What was the reason for the change in the amount of your
mortgage (lump sum home equity loan) payment for (property
description)?
1 – Change in escrow account payment
2 – Change in interest rate
3 – Paid off
4 – Change in amount of the graduated payment for a graduated
payment mortgage (loan)
5 – Mortgage (loan) renegotiated (rollover or renegotiable mortgage
(loan))
6 – Refinanced mortgage (loan) (this includes changing the term
of the mortgage (loan))
7 – Other reasons
8 – More than one of the above
X – Don’t know
Number
L O A N _N O J
7.
Mortgage
L O A N T Y PJ
Lump sum home equity loan
8.
0040
1
2
3
4
5
6
7
8
X
0100
Hand respondent Information Booklet, page 11.
On your (your CU’s) last regular payment, which of these
things were included?
0125
1
Principal and interest
0130
2
Property taxes
0140
3
0150
4
0160
5
0170
6
N EW M R R T J
.
M O RT CH N G
9.
10.
Is this a 30-year mortgage (lump sum home equity loan), a
15-year mortgage (home equity loan), or something else?
0045
1
2
3
30-year
O RW H A T
15-year
Something else – Specify
11.
0050
4a.
Is this a fixed rate mortgage (lump sum home equity loan)?
0055
Number of years
1
2
b.
Hand respondent Information Booklet, page 10.
There are many different kinds of mortgages (lump sum home
equity loans). Which one of these comes closest to yours (your
CU’s)?
0060
1
2
3
4
5
6
Yes – Go to item 5
F I X ED R T J
No
Fixed rate of interest
Variable or adjustable interest rate
Graduated payment
Rollover or renegotiable
Deferred interest
Other – Specify
PA T T Y PJ
X
5.
What was the amount of the mortgage (lump sum home equity
loan) when you (your CU) obtained it, excluding any interest?
FORM CE-302
0070 $
Don’t know
O R GM R T J X
.00
PY PRI N I J
PY PRO T X J
PY PRO I N J
Property insurance
Life insurance P Y L I F I N J
Mortgage guarantee insurance P Y M O R I N J
Any other payments – Specify P Y O T H ER J
0175 $
.00
If any of Codes 2–6 marked in item 8 ask –
How much of that amount was for principal and interest?
0185 $
.00
In what month did the amount of your regular mortgage (lump
sum home equity loan) payment change?
NOTES
M R T T ER M J
Percent
On your (your CU’s) last regular payment, what was the total
amount you (your CU) paid for these things?
X
3.
M RT PM PD J
What is the current interest rate for this mortgage (lump sum
home equity loan)?
Enter in two decimal places, such as "9.50%" for 9 1/2%.
(Include all FHA guarantee insurance if applicable.)
Go to item 8
Go to item 7
Go to item 11
Go to item 8

 Go to item 3

Weekly
Biweekly
Monthly
Quarterly
Semiannually
Annually
Other – Specify
0195
M RT PM T JX
PRI N I N JX
Don’t know
 Go to next property
Month or next section

M O RT CH M O
FORM CE-302
FIELD REPRESENTATIVE – Complete a separate page for each mortgage or lump sum home equity
loan that has changed.
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
Part J – Change in Mortgage or Lump Sum Home Equity Loan Payment – Continued
1.
FIELD REPRESENTATIVE ITEM
Complete a separate page for
each change in the amount of the
mortgage or lump sum home
equity loan payment reported in
part A.1, item 1, column k.
Enter the property number in
item 1a, the property code in
item 1b, the property description
in item 1c, and the mortgage
(loan) number in item 1d. Mark
(X) the appropriate type of loan
in item 1e.
PROCESSING USE ONLY
a.
PROPERTY NUMBER
How often are (were) mortgage (lump sum home equity loan)
payments due?
0090
1
2
3
0010
Number
4
5
b.
PROPERTY CODE
0020
6
Code
7
Description
c.
DESCRIPTION
d.
MORTGAGE (LOAN) NUMBER
0030
0035
e.
2.
6.
1 03 93 7
What was the reason for the change in the amount of your
mortgage (lump sum home equity loan) payment for (property
description)?
1 – Change in escrow account payment
2 – Change in interest rate
3 – Paid off
4 – Change in amount of the graduated payment for a graduated
payment mortgage (loan)
5 – Mortgage (loan) renegotiated (rollover or renegotiable mortgage
(loan))
6 – Refinanced mortgage (loan) (this includes changing the term
of the mortgage (loan))
7 – Other reasons
8 – More than one of the above
X – Don’t know
1
2
TYPE OF LOAN
7.
Number
Mortgage
Lump sum home equity loan
8.
0040
1
2
3
4
5
6
7
8
X
What is the current interest rate for this mortgage (lump sum
home equity loan)?
Enter in two decimal places, such as "9.50%" for 9 1/2%.
(Include all FHA guarantee insurance if applicable.)
Hand respondent Information Booklet, page 11.
On your (your CU’s) last regular payment, which of these
things were included?
Go to item 8
Go to item 7
Go to item 11
Go to item 8

 Go to item 3

9.
10.
0100
.
Is this a 30-year mortgage (lump sum home equity loan), a
15-year mortgage (home equity loan), or something else?
0045
1
2
3
30-year
15-year
Something else – Specify
11.
Percent
0125
1
Principal and interest
0130
2
Property taxes
0140
3
Property insurance
0150
4
Life insurance
0160
5
Mortgage guarantee insurance
0170
6
Any other payments – Specify
On your (your CU’s) last regular payment, what was the total
amount you (your CU) paid for these things?
0175 $
.00
If any of Codes 2–6 marked in item 8 ask –
How much of that amount was for principal and interest?
0185 $
.00
X
3.
Weekly
Biweekly
Monthly
Quarterly
Semiannually
Annually
Other – Specify
In what month did the amount of your regular mortgage (lump
sum home equity loan) payment change?
0195
Don’t know
 Go to next property
Month or next section

NOTES
0050
4a.
Is this a fixed rate mortgage (lump sum home equity loan)?
0055
Number of years
1
2
b.
Hand respondent Information Booklet, page 10.
There are many different kinds of mortgages (lump sum home
equity loans). Which one of these comes closest to yours (your
CU’s)?
0060
1
2
3
4
5
6
X
5.
What was the amount of the mortgage (lump sum home equity
loan) when you (your CU) obtained it, excluding any interest?
Page 19a
0070 $
Yes – Go to item 5
No
Fixed rate of interest
Variable or adjustable interest rate
Graduated payment
Rollover or renegotiable
Deferred interest
Other – Specify
Don’t know
.00
Section 3 – Part J (Continued)
Page 19a
Page 19b
Page 19b
Section 3 – OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE – Continued
FIELD REPRESENTATIVE – Complete a separate page for each mortgage or lump sum home equity
loan that has changed.
Part J – Change in Mortgage or Lump Sum Home Equity Loan Payment – Continued
1.
FIELD REPRESENTATIVE ITEM
Complete a separate page for
each change in the amount of the
mortgage or lump sum home
equity loan payment reported in
part A.1, item 1, column k.
Enter the property number in
item 1a, the property code in
item 1b, the property description
in item 1c, and the mortgage
(loan) number in item 1d. Mark
(X) the appropriate type of loan
in item 1e.
PROCESSING USE ONLY
a.
PROPERTY NUMBER
b.
PROPERTY CODE
0020
6
7
Description
c.
DESCRIPTION
d.
MORTGAGE (LOAN) NUMBER
0030
What was the reason for the change in the amount of your
mortgage (lump sum home equity loan) payment for (property
description)?
1 – Change in escrow account payment
2 – Change in interest rate
3 – Paid off
4 – Change in amount of the graduated payment for a graduated
payment mortgage (loan)
5 – Mortgage (loan) renegotiated (rollover or renegotiable mortgage
(loan))
6 – Refinanced mortgage (loan) (this includes changing the term
of the mortgage (loan))
7 – Other reasons
8 – More than one of the above
X – Don’t know
1
2
TYPE OF LOAN
7.
Number
Mortgage
Lump sum home equity loan
8.
0040
1
2
3
4
5
6
7
8
X
Is this a fixed rate mortgage (lump sum home equity loan)?
Hand respondent Information Booklet, page 10.
There are many different kinds of mortgages (lump sum home
equity loans). Which one of these comes closest to yours (your
CU’s)?
0045
1
2

 Go to item 3

9.
10.
0055
0060
1
1
2
3
5
6
X
FORM CE-302
30-year
15-year
Something else – Specify
Number of years
4
What was the amount of the mortgage (lump sum home equity
loan) when you (your CU) obtained it, excluding any interest?
Hand respondent Information Booklet, page 11.
On your (your CU’s) last regular payment, which of these
things were included?
Go to item 8
Go to item 7
Go to item 11
Go to item 8
11.
Is this a 30-year mortgage (lump sum home equity loan), a
15-year mortgage (home equity loan), or something else?
What is the current interest rate for this mortgage (lump sum
home equity loan)?
Enter in two decimal places, such as "9.50%" for 9 1/2%.
(Include all FHA guarantee insurance if applicable.)
0100
0125
0130
0140
0150
0160
0170
0070 $
Yes – Go to item 5
No
Fixed rate of interest
Variable or adjustable interest rate
Graduated payment
Rollover or renegotiable
Deferred interest
Other – Specify
Don’t know
.00
Weekly
Biweekly
Monthly
Quarterly
Semiannually
Annually
Other – Specify
.
1
2
3
4
5
6
Percent
Principal and interest
Property taxes
Property insurance
Life insurance
Mortgage guarantee insurance
Any other payments – Specify
On your (your CU’s) last regular payment, what was the total
amount you (your CU) paid for these things?
0175 $
.00
If any of Codes 2–6 marked in item 8 ask –
How much of that amount was for principal and interest?
0185 $
.00
X
2
5.
4
Code
0050
b.
1
2
Number
3
4a.
0090
5
e.
3.
How often are (were) mortgage (lump sum home equity loan)
payments due?
3
0010
0035
2.
6.
1 03 94 5
In what month did the amount of your regular mortgage (lump
sum home equity loan) payment change?
NOTES
0195
Don’t know
 Go to next property
Month or next section

FORM CE-302
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES
Part A – Telephone Expenses
1.
2.
PROCESSING USE ONLY
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) received
any bills for telephone services? Do not
include bills for telephones used entirely
for business purposes.
0020
4.
96
Property reported at this interview in
section 3, part B, item 1a
98
How many telephone bills were received
for (property description) from (company
name)?
Complete a separate column for each bill
received since the 1st of (month, 3 months
ago).
5a.
b.
6.
a.
b.
What was the total amount of bill (bill
number)? Exclude any unpaid bills from a
previous billing period.
99
0040
A basic service charge?
Long distance call charges?
98
99
0040
Bill 2
None
0120
0
None
Bill 3
0180
0
Bill 4
None
0240
Name of telephone company
OFFICE USE ONLY
0030
Number
0
Mobile (car) phone
Rented sample unit
Other rented unit
Property not owned or
rented by CU
97
T EL _C O M P
Bill 1
Property number
96
Name of telephone company
OFFICE USE ONLY
0030
0
Number
Bill 1
None
0060
0
Bill 2
None
0120
None
0
Bill 3
0180
0
Bill 4
None
0240
0
None
PRE
T EL C H GX
.00
$
$
Month
In what month was the bill received?
Does the total amount of the bill include –
0020
Mobile (car) phone
Rented sample unit
Other rented unit
Property not owned or
rented by CU
97
0060
Description
Property number
Property previously reported in section 3,
part A.1, item 1, column a
What is the name of the company which
provides telephone services for (property
description)?
NOTES
1 04 02 6
Description
U T L PRO PI
• All other properties – Mark (X) appropriate
box and enter a description of the property.
3.
PROCESSING USE ONLY
Yes
No – Go to part B
What property(ies) was (were) the
telephone bills for?
• Owned properties – Enter a description of the
property and enter a property number for –
1 04 01 8
0130
0080
0140
2
Yes
No
.00
$
Month
0070 T EL M O
1
.00
company
Month
0190
.00
$
Month
0250
.00
$
$
Month
0070
company.00
Month
0130
.00
$
Month
0190
.00
$
Month
1
2
Yes
No
$
1
2
Yes
No
0200
1
2
Yes
No
0260
1
2
Yes
No
0080
1
2
Yes
No
0140
1
2
Yes
No
0200
1
2
Yes
No
0260
1
2
Yes
No
Equipment purchases such as the
purchase of a telephone?
0095
1
2
Yes
No
0150
1
2
Yes
No
0210
Yes
No
0215
1
2
Yes
No
0270
Yes
No
0275
1
2
Yes
No
0090
Yes
No
0095
1
2
Yes
No
0150
Yes
No
0155
1
2
Yes
No
0210
Yes
No
0215
1
2
Yes
No
0270
Yes
No
0275
1
2
0155
1
2
1
2
1
2
1
2
1
2
1
2
1
2
T EL EQ P U R
d.
FIELD REPRESENTATIVE CHECK ITEM
0110
1
2
Was a bill or checkbook used or was an
estimate given?
3
b.
Is any of the total charge to be deducted
as a business expense?
0420
1
Bills
0170
Estimate
Checkbook telephone
Yes
No
Property
Month bill
No. from
received
item 2
from item 5b
Yes
No
Did you (or any members of your CU)
receive any other telephone bills for
telephones that are not used entirely for
business purposes?
Page 20
0440
Total amount
of bill
from item 5a
$
1
2
3
2
Bills
0230
Estimate
Checkbook
1
2
3
Bills
0290
Estimate
Checkbook
No – Go to item 8
1
2
3
T EL B SN S
Bills
Estimate
Checkbook
0110
1
2
3
0420
1
Bills
0170
Estimate
Checkbook telephone
Yes
1
2
3
2
Bills
0230
Estimate
Checkbook
1
2
3
Bills
0290
Estimate
Checkbook
1
2
3
No – Go to item 8
Bills
Estimate
Outlet code
Checkbook
Property
Month bill
No. from
received
item 2
from item 5b
If YES – What percentage will be deducted?
.00 Percent
0430
8.
Yes
Name of telephone company
.00
Name of telephone company
R EC _EST
7a.
.00
Outlet code
T EL N GD I S
c.
Total amount
of bill
from item 5a
0250
T EL B A SI C
0090
Property
Month bill
No. from
received
item 2
from item 5b
T EL B SN Z
.00 Percent
0430
1
Yes – Complete a separate column for each property and each
2
No – Go to part B
0440
Section 4 – Part A
1
Yes – Complete a separate column for each property and each
2
No – Go to part B
Total amount
of bill
from item 5a
$
.00
Name of telephone company
Outlet code
Page 20
Page 21
Page 21
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued
Part A – Telephone Expenses – Continued
PROCESSING USE ONLY
2.
0020
96
Property reported at this interview in
section 3, part B, item 1a
98
99
• All other properties – Mark (X) appropriate
box and enter a description of the property.
What is the name of the company which
provides telephone services for (property
description)?
4.
How many telephone bills were received
for (property description) from (company
name)?
Complete a separate column for each bill
received since the 1st of (month, 3 months
ago).
b.
What was the total amount of bill (bill
number)? Exclude any unpaid bills from a
previous billing period.
0040
98
99
0040
Bill 2
None
0120
0
Bill 3
None
0180
0
Bill 4
None
0240
Name of telephone company
OFFICE USE ONLY
0030
Number
0
Mobile (car) phone
Rented sample unit
Other rented unit
Property not owned or
rented by CU
97
Name of telephone company
Bill 1
Property number
96
OFFICE USE ONLY
0030
0060
0020
Mobile (car) phone
Rented sample unit
Other rented unit
Property not owned or
rented by CU
97
NOTES
1 04 04 2
Description
Property number
Property previously reported in section 3,
part A.1, item 1, column a
3.
PROCESSING USE ONLY
Description
What property(ies) was (were) the
telephone bills for?
• Owned properties – Enter a description of the
property and enter a property number for –
5a.
1 04 03 4
0
Number
Bill 1
None
0060
0
Bill 2
None
0120
Bill 3
None
0
0180
0
Bill 4
None
0240
0
None
PRE
.00
$
$
Month
In what month was the bill received?
0070
.00
$
Month
0130
.00
$
Month
0190
.00
$
Month
0250
.00
$
Month
0070
.00
$
Month
0130
.00
$
Month
0190
.00
Month
Property
Month bill
No. from
received
item 2
from item 5b
Total amount
of bill
from item 5a
0250
$
6.
a.
b.
Does the total amount of the bill include –
0080
1
2
A basic service charge?
0090
1
Equipment purchases such as the
purchase of a telephone?
0095
1
2
d.
FIELD REPRESENTATIVE CHECK ITEM
0110
b.
Is any of the total charge to be deducted
as a business expense?
1
2
Was a bill or checkbook used or was an
estimate given?
7a.
3
0420
1
1
2
Yes
No
0200
1
2
Yes
No
0260
1
2
Yes
No
0080
1
2
Yes
No
0140
1
2
Yes
No
0200
1
2
Yes
No
0260
1
2
Yes
No
Name of telephone company
Yes
No
0150
Yes
No
0155
1
2
1
2
Bills
0170
Estimate
Checkbook
1
Yes
2
2
3
Yes
No
0210
Yes
No
0215
1
2
Bills
0230
Estimate
Checkbook
1
2
1
2
3
Yes
No
0270
Yes
No
0275
1
2
Bills
0290
Estimate
Checkbook
1
2
1
2
3
No – Go to item 8
Yes
No
0090
Yes
No
0095
Bills
Estimate
Checkbook
0110
1
2
1
2
1
2
3
0420
1
Yes
No
0150
Yes
No
0155
1
2
1
2
Bills
0170
Estimate
Checkbook
1
Yes
2
Yes
No
0210
Yes
No
0215
2
3
1
2
Bills
0230
Estimate
Checkbook
1
2
1
2
3
Yes
No
0270
Yes
No
0275
1
2
Bills
0290
Estimate
Checkbook
1
2
1
2
3
No – Go to item 8
Yes
No
Property
Month bill
No. from
received
item 2
from item 5b
Yes
No
.00 Percent
Did you (or any members of your CU)
receive any other telephone bills for
telephones that are not used entirely for
business purposes?
FORM CE-302
0440
1
2
Yes – Complete a separate column for each property and each
telephone company
No – Go to part B
.00 Percent
0430
0440
1
2
Yes – Complete a separate column for each property and each
telephone company
No – Go to part B
Total amount
of bill
from item 5a
$
.00
Name of telephone company
Bills
Estimate
Outlet code
Checkbook
Property
Month bill
Total amount
No. from
received
of bill
item 2
from item 5b
from item 5a
If YES – What percentage will be deducted?
0430
8.
0140
Outlet code
Long distance call charges?
2
c.
Yes
No
.00
$
Name of telephone company
Outlet code
.00
FORM CE-302
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued
Part B – Screening Questions
1. Since the first of (month, 3 months ago), have you (or
1 04 25 7
2a. Since the 1st of (month, 3 months ago), have you (or any members of your
any members of your CU) received any bills for any
of the following utilities, fuels, or services? Do not
include bills for rented vacation properties or
properties used entirely for business.
PRE
CU) received any bills for utilities or fuels for a rented vacation property,
such as a cottage?
TRANSCRIBE LAST 2 BILLS PER PROPERTY FOR EACH UTILITY OR SERVICE REPORTED IN PART C
No – Go to part C
Yes
FIELD REPRESENTATIVE: Read each item in bold listed below.
UTILITY YES NO
CODE
If YES –
b. Which utility or fuel was the charge for? Enter a utility code below for each bill
reported.
Electricity
100
Natural or utility gas
110
1
2
3
Property
number
from
part C,
item 2
Utility
code
from
part C,
item 1a
Month
bill
received
from
part C,
item 7b
4
5
Amount of bill
from part C,
item 7a
Unit-ofQuantity
measure consumed
from
from
part C,
part C,
item 7c
item 7d
6
Name of utility
company or
government agency
from part C, item 3
Company
code
c. In what month was the bill received? Enter month below for each bill reported.
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
d. What was the total amount of the charges? Enter amount below for each bill
Fuel oil
Kerosene
reported.
120
130
140
Bottled or tank gas
150
Wood
160
V A CU T M O
PROCESSING
USE ONLY
Combined gas and electricity
0020
Coal
Other fuels
Combined expenses for items
130–180
170
Utility
code
PRE
V A CU T L X
Amount
Month
$
Utility Month
code
.00
Amount
$
.00
180
0030
190
0040
$
.00
$
.00
0050
$
.00
$
.00
Piped-in water
200
Trash/Garbage collection
210
Sewerage maintenance
220
Combined trash/garbage/
water/sewerage
230
Combined trash/garbage/water
240
Combined trash/garbage/sewerage
250
Combined water/sewerage
260
Water softening service
270
Septic tank cleaning
280
Cable TV, satellite services, or
community antenna
290
Combined electric/water/sewerage
V A CU T L Y
$
.00
$
.00
NOTES
310
Ask item 2, then complete a column in part C for
each utility, fuel, or service reported in item 1.
Page 22
Section 4 – Part B
Page 22
Page 23
Page 23
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued
Part C – Detailed Questions
1. FIELD REPRESENTATIVE
PROCESSING USE ONLY
TRANSCRIPTION ITEM
0010
a. UTILITY CODE
Enter a utility code in item 1a and
a description of utility or fuel in
Description
item 1b from part
itemcodes
1.
for B,
utility
100–130
b. DESCRIPTION OF UTILITY OR FUEL
2.
3.
What property were the charges for?
• Owned properties – Enter a description of the property and enter a
property number for –
Property previously reported in section 3, part A.1, item 1, col. a
Property reported at this interview in section 3, part B, item 1a
• All other properties – Mark (X) appropriate box and enter a description
of the property.
Ask for utility codes 100–120, 200–260, and 290 only.
What is the name of the company or government agency which
provides (utility or fuel description)?
OFFICE USE ONLY
4.
5.
6.
7a.
b.
f.
0060
2
Month
2 months
1
Yes
1
$
9.
Quarter
Other – Specify
3
4
0060
Bill 2
Bill 3
0080 B I L L M O
Unit-of-measure
Bill 4
0210
.00
$
Month
0055
B L P ER I O D
No
2
0140
.00
Month
.00
0220
Unit-of-measure
Unit-of-measure
0165
0235
1
Yes
4
Unit-of-measure
No
2
Bill 2
.00
Bill 3
Bill 4
0210
.00
$
Month
0290
Quarter
Other – Specify
3
0140
$
Month
0150
Month
2 months
0070
$
Month
2
1
Bill 1
0280
$
Number
0280
.00
$
Month
.00
$
Month
Month
0080
0150
0220
0290
Unit-of-measure
Unit-of-measure
Unit-of-measure
0095
0165
0235
Unit-of-measure
UT L UN IT
0095
Quantity
0110
Quantity
Yes
0180
No – Go
I N C L SV C to item 7g
1
2
0130
Yes
No – Go
to item 7g
0190
I N C SV C X .00
0250
0315
1
2
Yes
No – Go
to item 7g
0260
.00
$
0200
Quantity
0245
2
0120
0305
Quantity
0175
1
1
Records
used
2
Estimate
.00
$
0270
0320
1
Records
used
2
Estimate
Records
used
1
2
Yes
No – Go
to item 7g
2
Estimate
0420
1
Yes
0440
1
Yes – Complete a separate column for each property
0110
.00
1
Records
used
1
2
Yes
0180
No – Go
to item 7g
2
Estimate
.00
1
2
Yes
No – Go
to item 7g
Quantity
Quantity
0250
0315
1
2
Yes
No – Go
to item 7g
0260
.00
$
0200
0305
0245
0190
$
0130
Quantity
0175
0120
$
0340
Quantity
0105
0330
1
B I L U SED
8.
0045
Number
U T L C H GX
.00
What was the quantity consumed for bill (bill number)?
FIELD REPRESENTATIVE CHECK ITEM
Was a bill or other record used or was an estimate given?
Checks or checkbooks are not considered records.
99
0030
0070
$
g.
98
Name
Bill 1
What was the unit-of-measure, such as kilowatt hours, gallons,
cubic feet or therms?
How much were these charges?
Property number
Rented sample unit
Other rented unit
Property not owned or
rented by CU
97
0030
In what month was the bill received?
Did the bill include any charges for merchandise, repairs, or other
services which were not part of the cost of (utility or fuel)?
Description
0020
CO M PN A M E
0105 U T I L C O N
e.
Code
Description
Name
0055
OFFICE USE ONLY
d.
99
What period of time was covered by the bill? If period covered
changed for a utility or fuel during the reference period, complete a
separate column for each different period of time.
What was the amount of bill (bill number)?
0010
Description
Property number
Rented sample unit
Other rented unit
Property not owned or
rented by CU
98
0045
Do you have any of these bills or other records showing these
(utility or fuel) charges?
Complete a separate column for each bill received since the 1st of
(month, 3 months ago).
UT IL Y
Code
W H A T PRO P
97
How many bills were received for (utility or fuel) for (property
description)?
Ask items 7c–f
c.
0020
1 04 52 1
1 04 51 3
1
Records
used
2
Estimate
2
.00
Since the 1st of (month, 3 months ago), did you (or any
members of your CU) receive any other utility or fuel bills?
FORM CE-302
No
U T I L B U SN
1
Records
used
2
Estimate
1
Records
used
2
Estimate
0420
1
Yes
2
No
0440
1
Yes – Complete a separate column for each property
2
Yes
No – Go
to item 7g
.00
$
0340
Was any part of the charge deducted as a business expense?
2
1
0330
$
0270
0320
No
2
No
1
Records
used
2
Estimate
FORM CE-302
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued
Part C – Detailed Questions
1. FIELD REPRESENTATIVE
TRANSCRIPTION ITEM
Enter a utility code in item 1a and
a description of utility or fuel in
item 1b from part B, item 1.
2.
3.
PROCESSING USE ONLY
a. UTILITY CODE
5.
6.
7a.
b.
c.
What property were the charges for?
• Owned properties – Enter a description of the property and enter a
property number for –
Property previously reported in section 3, part A.1, item 1, col. a
Property reported at this interview in section 3, part B, item 1a
• All other properties – Mark (X) appropriate box and enter a description
of the property.
Ask for utility codes 100–120, 200–260, and 290 only.
What is the name of the company or government agency which
provides (utility or fuel description)?
Code
97
98
99
0030
0060
2
Month
2 months
1
Yes
1
f.
How much were these charges?
8.
9.
FIELD REPRESENTATIVE CHECK ITEM
Was a bill or other record used or was an estimate given?
Checks or checkbooks are not considered records.
4
2
Quarter
Other – Specify
0055
No
0060
Bill 3
0140
.00
$
Bill 4
0210
.00
$
Month
.00
$
Month
0150
0220
Unit-of-measure
Unit-of-measure
0095
0165
0235
Quantity
0110
2
Yes
0180
No – Go
to item 7g
0120
0130
Quantity
0175
1
2
Yes
No – Go
to item 7g
0190
.00
0305
0250
0315
1
2
Yes
No – Go
to item 7g
.00
1
Records
used
2
Estimate
.00
1
Records
used
2
Estimate
1
Records
used
1
2
Yes
No – Go
to item 7g
2
Estimate
0420
1
Yes
0440
1
Yes – Complete a separate column for each property
.00
1
Records
used
2
Estimate
Quarter
Other – Specify
3
4
No
2
Bill 2
Bill 3
0140
.00
Bill 4
0210
.00
$
0280
.00
$
Month
Month
0080
0150
0220
Unit-of-measure
Unit-of-measure
0095
0165
0235
Quantity
0110
2
Yes
0180
No – Go
to item 7g
.00
1
2
Yes
No – Go
to item 7g
0305
Quantity
Quantity
0250
0315
1
2
Yes
No – Go
to item 7g
0260
.00
$
0200
0290
Unit-of-measure
0245
0190
$
0130
Quantity
0175
1
.00
$
Month
Unit-of-measure
0120
$
0340
Yes
0105
0330
$
0270
0320
1
$
Quantity
0260
$
0200
0290
Quantity
Month
2 months
Month
Unit-of-measure
0245
1
.00
Month
0080
2
1
0070
$
Month
Number
Bill 1
0280
Unit-of-measure
$
g.
3
Bill 2
0070
What was the quantity consumed for bill (bill number)?
Did the bill include any charges for merchandise, repairs, or other
services which were not part of the cost of (utility or fuel)?
0045
Number
Bill 1
In what month was the bill received?
Ask items 7c–f for utility codes 100–130 only if bills, receipts, or other
records are available (code 1, item 6), otherwise go to item 7g.
What was the unit-of-measure, such as kilowatt hours, gallons,
cubic feet or therms?
99
0030
0055
What was the amount of bill (bill number)?
98
Name
What period of time was covered by the bill? If period covered
changed for a utility or fuel during the reference period, complete a
separate column for each different period of time.
Property number
Rented sample unit
Other rented unit
Property not owned or
rented by CU
97
Name
0045
Do you have any of these bills or other records showing these
(utility or fuel) charges?
Complete a separate column for each bill received since the 1st of
(month, 3 months ago).
Description
0020
Property number
Rented sample unit
Other rented unit
Property not owned or
rented by CU
0105
e.
Code
Description
0020
How many bills were received for (utility or fuel) for (property
description)?
OFFICE USE ONLY
d.
0010
Description
b. DESCRIPTION OF UTILITY OR FUEL
OFFICE USE ONLY
4.
1 04 54 7
1 04 53 9
0010
Description
1
Records
used
2
Estimate
1
2
Yes
No – Go
to item 7g
0330
.00
$
0270
0320
1
Records
used
2
Estimate
1
Records
used
2
Estimate
0420
1
Yes
0440
1
Yes – Complete a separate column for each property
.00
$
0340
1
Records
used
2
Estimate
Was any part of the charge deducted as a business expense?
Since the 1st of (month, 3 months ago), did you (or any
members of your CU) receive any other utility or fuel bills?
Page 24
2
No
2
No
2
No
2
No
Page 24
Page 25
Page 25
Section 4 – UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES – Continued
Part C – Detailed Questions
1. FIELD REPRESENTATIVE
TRANSCRIPTION ITEM
Enter a utility code in item 1a and
a description of utility or fuel in
item 1b from part B, item 1.
2.
3.
PROCESSING USE ONLY
a. UTILITY CODE
5.
6.
7a.
b.
c.
What property were the charges for?
• Owned properties – Enter a description of the property and enter a
property number for –
Property previously reported in section 3, part A.1, item 1, col. a
Property reported at this interview in section 3, part B, item 1a
• All other properties – Mark (X) appropriate box and enter a description
of the property.
Ask for utility codes 100–120, 200–260, and 290 only.
What is the name of the company or government agency which
provides (utility or fuel description)?
f.
97
98
99
0030
0055
What was the amount of bill (bill number)?
0060
2
Month
2 months
1
Yes
1
How much were these charges?
8.
9.
FIELD REPRESENTATIVE CHECK ITEM
Was a bill or other record used or was an estimate given?
Checks or checkbooks are not considered records.
3
4
2
Quarter
Other – Specify
0055
No
0060
Bill 2
0070
Bill 3
0140
.00
$
Bill 4
0210
.00
$
Month
.00
$
Month
0220
Unit-of-measure
Unit-of-measure
Unit-of-measure
0095
0165
0235
Quantity
0110
2
Yes
0180
No – Go
to item 7g
0120
0130
Quantity
0175
1
2
Yes
No – Go
to item 7g
0190
.00
0305
0250
0315
1
2
Yes
No – Go
to item 7g
.00
1
Records
used
2
Estimate
.00
1
Records
used
2
Estimate
1
Records
used
1
2
Yes
No – Go
to item 7g
2
Estimate
0420
1
Yes
0440
1
Yes – Complete a separate column for each property
.00
1
Records
used
2
Estimate
Quarter
Other – Specify
3
4
No
2
Bill 2
Bill 3
0140
.00
Bill 4
0210
.00
$
0280
.00
$
Month
Month
0150
0220
Unit-of-measure
Unit-of-measure
Unit-of-measure
0095
0165
0235
Quantity
0110
2
Yes
0180
No – Go
to item 7g
.00
1
2
Yes
No – Go
to item 7g
Unit-of-measure
0305
Quantity
Quantity
0250
0315
1
2
Yes
No – Go
to item 7g
0260
.00
$
0200
0290
0245
0190
$
0130
Quantity
0175
1
.00
$
Month
0080
0120
$
0340
Yes
0105
0330
$
0270
0320
1
$
Quantity
0260
$
0200
Unit-of-measure
Quantity
Month
2 months
Month
0290
0245
1
.00
Month
0150
2
1
0070
$
Month
Number
Bill 1
0280
0080
What was the quantity consumed for bill (bill number)?
Did the bill include any charges for merchandise, repairs, or other
services which were not part of the cost of (utility or fuel)?
0045
Number
Bill 1
In what month was the bill received?
Ask items 7c–f for utility codes 100–130 only if bills, receipts, or other
records are available (code 1, item 6), otherwise go to item 7g.
What was the unit-of-measure, such as kilowatt hours, gallons,
cubic feet or therms?
99
0030
What period of time was covered by the bill? If period covered
changed for a utility or fuel during the reference period, complete a
separate column for each different period of time.
Do you have any of these bills or other records showing these
(utility or fuel) charges?
Complete a separate column for each bill received since the 1st of
(month, 3 months ago).
98
Name
0045
Property number
Rented sample unit
Other rented unit
Property not owned or
rented by CU
97
Name
$
g.
Code
Description
0020
Property number
Rented sample unit
Other rented unit
Property not owned or
rented by CU
0105
e.
0010
Description
Code
Description
0020
How many bills were received for (utility or fuel) for (property
description)?
OFFICE USE ONLY
d.
0010
Description
b. DESCRIPTION OF UTILITY OR FUEL
OFFICE USE ONLY
4.
1 04 56 2
1 04 55 4
1
Records
used
2
Estimate
2
.00
Since the 1st of (month, 3 months ago), did you (or any
members of your CU) receive any other utility or fuel bills?
FORM CE-302
No
1
Records
used
2
Estimate
1
Records
used
2
Estimate
0420
1
Yes
2
No
0440
1
Yes – Complete a separate column for each property
2
Yes
No – Go
to item 7g
.00
$
0340
Was any part of the charge deducted as a business expense?
2
1
0330
$
0270
0320
No
2
No
1
Records
used
2
Estimate
FORM CE-302
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE
OF PROPERTY
FIELD REPRESENTATIVE – In this section,
Part A – Screening Questions
1.
2.
Information Booklet, page 14
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) had
expenses for –?
Dwellings under construction including a vacation or
second home
Information Booklet, page 14
Building an addition to the house or a new structure,
Have there been any expenses for property such as a porch, garage, or new wing
you owned or rented since the 1st of
(month, 3 months ago), for any of the
following jobs? (Renters should not
Finishing a basement or an attic or enclosing a porch
include jobs that have been or will be
totally reimbursed by anyone outside of
their CU.)
Remodeling one or more rooms in the house
JOB
CODE YES NO
PROCESSING USE ONLY
4a.
100
110
b.
3a.
b.
Which of the following?
Have there been any expenses for any other property
(property that you do not own or rent) by you (or any
members of your CU)?
Which jobs were those expenses for?
Enter job code(s) from items 1 through 3.
Yes
No – Go to item 5
0010
0020
0030
0040
120
130
5.
Information Booklet, page 14
Have there been any expenses that deal
with the upkeep or improvement of this
unit or any other unit you owned or rented
since the 1st of (month, 3 months ago)?
(Renters should not include jobs that have
been or will be totally reimbursed by
anyone outside of their CU.)
Yes
No – Go to item 4a
1 05 00 7
Landscaping the ground or planting new shrubs or trees
140
Building outdoor patios, walks, fences, or other
enclosures, driveways, or permanent swimming pools
150
Repairing outdoor patios, walks, fences, driveways, or
permanent swimming pools
160
Inside painting or papering
170
Outside painting
180
Plastering or paneling
190
c.
Plumbing or water heating installations and repairs
200
7a.
6a.
Electrical work
210
Heating or air-conditioning jobs
220
Flooring repair or replacement, including inlaid linoleum
or vinyl tile
230
Insulation
240
b.
FIELD REPRESENTATIVE CHECK ITEM
Job codes items 1, 2, 3, and 4
0050
All "No"
At least one "Yes" marked
1
2
Since the 1st of (month, 3 months ago), excluding the
current month, have you (or any members of your
CU) purchased any materials or supplies for jobs not
yet started?
0060
If YES – What kind of job will the materials be
used for?
Enter a job code.
Description
Yes
No – Go to item 7a
1
2
0070
b.
8.
What was the total cost of these materials and
supplies?
Job code
.00
0080 $
Since the 1st of (month, 3 months ago), excluding the
current month, have you (or any members of your
CU) purchased any materials or supplies not for any
specific job?
0090
Yes
No – Go to item 8
1
2
If YES – What was the total cost?
.00
0100 $
A D V M A T ER
C R M C O D EA
ADVM ATX
M A T N SP EC
M A T N SP C X
FIELD REPRESENTATIVE INSTRUCTION – If any box marked "Yes" in item 1, 2, 3, or 4, fill section 5B.
PRE
Roofing, gutters, or downspouts
Page 26
260
Siding
270
Installation, repair, or replacement of window panes,
screens, storm doors, awnings, and the like
280
Masonry, brick, or stucco work
290
Other improvements or repairs
300
Use only if unable to itemize above – Combined expenses
310
1
2
3
4
5
Job code
from
part B,
item 1
Property
description
from part B,
item 2a
Property
description
code
from part B,
item 2b
Description from
part B, item 3a
Total cost from
part B, item 4
Section 5 – Part A
$
.00
$
.00
$
.00
$
.00
$
.00
Page 26
Page 27
Page 27
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued
Part B – Job Description
1.
PROCESSING USE ONLY
FIELD REPRESENTATIVE
ITEM
JOB NUMBER
Enter the job code from part A. (For combined
jobs use code 310.)
2a.
b.
On which property was the (job description)
done?
0020
What work was done? Description should be
adequate to classify as "alteration," "repair," etc.,
and to identify in next interview.
FIELD REPRESENTATIVE CHECK ITEM
Job classification – Mark (X) one.
1
2
5
5a.
b.
What was the total cost of the job? Include
all costs paid for by you (or any members of
your CU) or by any non-CU member, such as
insurance companies, and so forth.
Did you do all the work yourself or did you
pay someone or contract with a builder to do
all or part of the work?
What was the cost for all labor, materials,
appliances, or equipment THEY PROVIDED IN –
(month, 3 months ago)?
(month, 2 months ago)?
(last month)?
(the current month)?
c.
6.
Since the 1st of (month, 3 months ago), how
much have you paid for labor and any
materials THEY PROVIDED?
If codes 100–130, 200–220, or 300 in item 1, ask
items 6 and 7; for all other codes, go to item 8a.
Information Booklet, page 15
Did the charge(s) include the cost of any
appliances or equipment?
FORM CE-302
Property number
Rented sample unit
Other rented unit
Property not owned or rented
by CU
8a.
b.
Addition
CRM T Y PE
Alteration
Replacement
Maintenance and repair
New construction
9a.
0050
$
0060
1
.00
T O T J B C ST
b.
2
Self only – Go to item 8a
Paid or contracted with
someone else C O N T R A C T
CN T RCT X 3
0080
0090
$
$
$
.00
.00
.00
0100
$
.00
0110
$
.00
0
0120
A P P L _X
Don’t know
X
Description
0150
0160 $
CRM CO D E
0040
0070
.00
OFFICE
USE ONLY
Description
4
OFFICE USE ONLY – Enter detail job codes.
NOTES
CRM PRO PI
97
0030
Description
A PPCD E
0140 $
2
Enter a property number – For owned property
enter the property number from section 3. Mark
(X) the appropriate box for all other properties.
0130
Description
3
4.
1
Code C R M C O D EB
0010
99
b.
OFFICE
USE ONLY
Which of these items did it include and what
was the cost of each?
1
98
3a.
7.
1 05 50 2
1
2
0
None
10a.
CN T RCT X 0
0
1
2
Yes
C R M M A T ER
No – Go to item 9a
SUPPL Y X 3
0260 $
.00
(month, 2 months ago)?
0270 $
.00
(last month)?
0280 $
.00
(the current month)?
0290 $
.00
Have you (or any members of your CU) RENTED any
tools or equipment for doing this job?
What was the total cost for all items rented for this
job in –
(month, 3 months ago)?
0300
1
2
0
None
0
None
0
None
0
None
SUPPL Y X 2
SUPPL Y X 1
SUPPL Y X 0
Yes
T O O L R EN T
No – Go to item 10a
T O O L RT X 3
0310 $
.00
(month, 2 months ago)?
0320 $
.00
(last month)?
0330 $
.00
(the current month)?
0340 $
.00
None
0
T O O L RT X 2
None
0
T O O L RT X 1
None
CO N T RCT X
None – Go to item 8a
M A J _A P P L
Yes
No – Go to item 8a
b.
11a.
Was (Will) any of the total cost of (read entry in
item 4) (be) reimbursed or paid by someone
outside of your CU?
0350
What percent of the total cost was (will be)
reimbursed or paid by someone outside of your CU?
0370
Were (Will) any of these expenses for this job (be)
deducted as a business expense?
0380
b. What percent was (will be) deducted?
1
2
T O O L RT X 0
None
0
Yes
R EI M B R S
No – Go to item 11a
.00 Percent
1
2
0390
None
0
None
CN T RCT X 1
0
What was the total cost for all items purchased for
this job in –
(month, 3 months ago)?
0250
Don’t know
X
None
CN T RCT X 2
0
Have you (or any members of your CU)
PURCHASED any materials, supplies, tools, or
equipment for doing this job?
.00
R E I M B R SZ
Yes
C R M B SN SD
No – Go to next job
C R M B SN SZ
.00 Percent
FORM CE-302
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued
Part B – Job Description – Continued
1.
PROCESSING USE ONLY
FIELD REPRESENTATIVE
ITEM
JOB NUMBER
Enter the job code from part A. (For combined
jobs use code 310.)
2a.
b.
On which property was the (job description)
done?
0010
Enter a property number – For owned property
enter the property number from section 3. Mark
(X) the appropriate box for all other properties.
0020
97
What work was done? Description should be
adequate to classify as "alteration," "repair," etc.,
and to identify in next interview.
FIELD REPRESENTATIVE CHECK ITEM
Job classification – Mark (X) one.
1
2
4
5
OFFICE USE ONLY – Enter detail job codes.
5a.
b.
What was the total cost of the job? Include
all costs paid for by you (or any members of
your CU) or by any non-CU member, such as
insurance companies, and so forth.
Did you do all the work yourself or did you
pay someone or contract with a builder to do
all or part of the work?
What was the cost for all labor, materials,
appliances, or equipment THEY PROVIDED IN –
(month, 3 months ago)?
6.
Page 28
0050
$
0060
1
b.
Addition
Alteration
Replacement
Maintenance and repair
New construction
2
0070
(last month)?
$
Self only – Go to item 8a
Paid or contracted with
someone else
.00
$
.00
$
.00
0100
$
.00
0110
$
.00
0
0120
1
2
Have you (or any members of your CU)
PURCHASED any materials, supplies, tools, or
equipment for doing this job?
What was the total cost for all items purchased for
this job in –
(month, 3 months ago)?
0250
0
0
0
0
None – Go to item 8a
Yes
No – Go to item 8a
1
2
.00
(month, 2 months ago)?
0270 $
.00
(last month)?
0280 $
.00
(the current month)?
0290 $
.00
What was the total cost for all items rented for this
job in –
(month, 3 months ago)?
Don’t know
0300
1
2
X
Don’t know
Yes
No – Go to item 9a
.00
Have you (or any members of your CU) RENTED any
tools or equipment for doing this job?
X
Description
0260 $
.00
b.
0090
If codes 100–130, 200–220, or 300 in item 1, ask
items 6 and 7; for all other codes, go to item 8a.
Information Booklet, page 15
Did the charge(s) include the cost of any
appliances or equipment?
8a.
NOTES
0150
0160 $
9a.
(month, 2 months ago)?
Since the 1st of (month, 3 months ago), how
much have you paid for labor and any
materials THEY PROVIDED?
Property number
Rented sample unit
Other rented unit
Property not owned or rented
by CU
0040
0080
(the current month)?
c.
OFFICE
USE ONLY
Description
0030
.00
0140 $
2
Description
0130
Description
3
4.
1
Code
99
b.
OFFICE
USE ONLY
Which of these items did it include and what
was the cost of each?
2
98
3a.
7.
1 05 51 0
0
None
0
None
0
None
0
None
Yes
No – Go to item 10a
0310 $
.00
(month, 2 months ago)?
0320 $
.00
(last month)?
0330 $
.00
(the current month)?
0340 $
.00
0
None
0
None
0
None
0
None
None
None
None
10a.
None
b.
11a.
Was (Will) any of the total cost of (read entry in
item 4) (be) reimbursed or paid by someone
outside of your CU?
0350
2
What percent of the total cost was (will be)
reimbursed or paid by someone outside of your CU?
0370
Were (Will) any of these expenses for this job (be)
deducted as a business expense?
0380
b. What percent was (will be) deducted?
Section 5 – Part B (Continued)
1
.00 Percent
1
2
0390
Yes
No – Go to item 11a
Yes
No – Go to next job
.00 Percent
Page 28
Page 29
Page 29
Section 5 – CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY – Continued
Part B – Job Description – Continued
1.
PROCESSING USE ONLY
FIELD REPRESENTATIVE
ITEM
JOB NUMBER
Enter the job code from part A. (For combined
jobs use code 310.)
2a.
b.
On which property was the (job description)
done?
Enter a property number – For owned property
enter the property number from section 3. Mark
(X) the appropriate box for all other properties.
b.
FIELD REPRESENTATIVE CHECK ITEM
Job classification – Mark (X) one.
0020
97
5a.
b.
c.
6.
Did you do all the work yourself or did you
pay someone or contract with a builder to do
all or part of the work?
What was the cost for all labor, materials,
appliances, or equipment THEY PROVIDED IN –
(month, 3 months ago)?
Property number
Rented sample unit
Other rented unit
Property not owned or rented
by CU
1
2
Addition
Alteration
Replacement
Maintenance and repair
New construction
0050
0060
$
1
2
.00
.00
(month, 2 months ago)?
0080
$
.00
(last month)?
0090
$
.00
(the current month)?
0100
$
.00
$
.00
FORM CE-302
0110
0
9a.
Self only – Go to item 8a
Paid or contracted with
someone else
$
If codes 100–130, 200–220, or 300 in item 1, ask
items 6 and 7; for all other codes, go to item 8a.
Information Booklet, page 15
Did the charge(s) include the cost of any
appliances or equipment?
b.
b.
1
2
What was the total cost for all items purchased for
this job in –
(month, 3 months ago)?
0250
1
2
.00
.00
(month, 2 months ago)?
0270 $
.00
(last month)?
0280 $
.00
(the current month)?
0290 $
.00
What was the total cost for all items rented for this
job in –
(month, 3 months ago)?
0300
1
2
0310 $
.00
(month, 2 months ago)?
0320 $
.00
0
None
(last month)?
0330 $
.00
None
(the current month)?
0340 $
.00
0
0
None
b.
None – Go to item 8a
Yes
No – Go to item 8a
Was (Will) any of the total cost of (read entry in
item 4) (be) reimbursed or paid by someone
outside of your CU?
0350
2
What percent of the total cost was (will be)
reimbursed or paid by someone outside of your CU?
0370
Were (Will) any of these expenses for this job (be)
deducted as a business expense?
0380
b. What percent was (will be) deducted?
1
2
0390
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
Yes
No – Go to item 11a
.00 Percent
1
Don’t know
Yes
No – Go to item 10a
None
10a.
X
Yes
No – Go to item 9a
0260 $
Have you (or any members of your CU) RENTED any
tools or equipment for doing this job?
Don’t know
Description
0
11a.
0120
Have you (or any members of your CU)
PURCHASED any materials, supplies, tools, or
equipment for doing this job?
X
0150
0160 $
0040
0070
Since the 1st of (month, 3 months ago), how
much have you paid for labor and any
materials THEY PROVIDED?
2
8a.
Description
5
What was the total cost of the job? Include
all costs paid for by you (or any members of
your CU) or by any non-CU member, such as
insurance companies, and so forth.
.00
OFFICE
USE ONLY
4
4.
0130
0140 $
Description
0030
Description
Code
3
OFFICE USE ONLY – Enter detail job codes.
OFFICE
USE ONLY
1
0010
99
What work was done? Description should be
adequate to classify as "alteration," "repair," etc.,
and to identify in next interview.
Which of these items did it include and what
was the cost of each?
3
98
3a.
7.
1 05 52 8
Yes
No – Go to next job
.00 Percent
NOTES
FORM CE-302
FIELD REPRESENTATIVE
Section 6 – APPLIANCES, HOUSEHOLD EQUIPMENT,
AND OTHER SELECTED ITEMS
Part A – Purchase of Household Appliances
1.
b
Information Booklet, page 16
Since the 1st of (month, 3 months ago),
have you (or any members of your CU)
purchased or rented any of the
following items for your CU, or as a gift
to someone outside your CU?
110
Microwave
120
Other
130
REFRIGERATOR
140
HOME-FREEZER
150
Mark (X) box
Month
Were there any
extra charges
for installation?
If "Yes" –
How much?
YES
NO
NO
PRE
Did you
purchase
or rent
any
other . . .?
If "No" go
to next
item in
column a.
YES
NO
1
Description
from column b
and
section 5B
item 6
2
3
Month
from
column e
Cost from
column f
or column g
and
section 5B
item 6
Month
0010
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0020
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0030
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0040
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
DISHWASHER
Built-in
160
0050
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
Portable
170
0060
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0070
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0080
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0090
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0100
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0110
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0120
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0130
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0140
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0150
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0160
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
.00
0170
1
2
3
$
.00 $
.00
1
2
0
$
.00
$
GARBAGE DISPOSAL
180
CLOTHES WASHER
190
CLOTHES DRYER
200
RANGE HOOD
210
Combination of any of
the above items
2.
If code 2 in
Did this
column d –
include
sales tax?
What was
the total
rental
expense
since the
1st of
(month, 3
months ago),
excluding
the current
month?
j
M AJ I N ST X
Gas
What was
the
purchase
price
after any
trade-in
allowance?
i
h
M AJT AX
100
When
did
you
purchase
it?
g
M AJR EN T X
Electric
3 – Purchased
as gift
to others?
f
M AJPUR X
COOKING STOVE,
RANGE, OR OVEN
2 – Rented?
Go to
column g.
e
M AJ_M O
YES NO
Enter a brand name or a brief
description of item.
GF T C_M AJ
ITEM
CODE
d
Was this –
ENTER
ITEM
CODE
1 – Purchased
from
for own
column a.
use?
What type did you purchase
or rent?
M AJAPPL Y
Do not list any appliance previously
reported in section 5B, item 7. If an
appliance is reported in both section 5 and
section 6, probe to verify that they are not
duplicated.
c
PROCESSING USE ONLY
a
8 06 02 6
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
columns b–j.
NOTES
Page 30
220
1 06 01 3
0010
999
Go to
Part B
Section 6 – Part A
.00
Page 30
Page 31
Page 31
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to look at the item list as you
proceed. Ask column a, reading the headings (in bold print). If YES, then read the individual
items and complete a separate line in columns b through i as each item is reported.
Section 6 – APPLIANCES, HOUSEHOLD EQUIPMENT,
AND OTHER SELECTED ITEMS – Continued
Part B – Purchase of Household Appliances and Other Selected Items
a
1.
f
g
h
i
ENTER
ITEM
CODE
from
column a.
Was this –
1 – Purchased for
own use?
2 – Rented?
Go to column g
3 – Purchased
as gift to
others?
Mark (X) box
When did
you
purchase
it?
What did it cost?
(Include delivery
charges, exclude
installation
charges.)
If code 2 in
column d –
What was the
total rental
expense since
the 1st of
(month, 3
months ago),
excluding the
current month?
Did this
include
sales
tax?
Did you
purchase or
rent any
other . . .?
1
2
3
Month
M I N PU RX
Go to column h.
$
.00 $
M I N T AX
e
M I N R EN T X
0010
d
GF T CM I N
230
Enter brand name or
a brief description of
the item.
NOTES
c
M IN APPL Y
ITEM
CODE YES NO
What type did you
purchase or rent?
6 06 04 6
M I N _M O
Information Booklet, pages 16–18
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) purchased
or rented any of the following items for your
CU or as a gift to someone outside your CU?
SMALL HOUSEHOLD
APPLIANCES
Small electrical
kitchen appliances
Electric personal care
appliances
Smoke detectors
Electric floor cleaning
equipment
YES NO
If "No," go
to next item
in column a.
YES
NO
PRE
1
Description
from column b
2
3
Month
from
column
e
Cost from
column f or
column g
Month
.00
1
2
$
.00
.00
1
2
$
.00
.00
1
2
$
.00
240
250
0020
1
2
3
$
.00 $
260
0030
1
2
3
$
.00 $
0040
1
2
3
$
.00 $
.00
1
2
$
.00
0050
1
2
3
$
.00 $
.00
1
2
$
.00
OTHER HOUSEHOLD
APPLIANCES
270
SEWING MACHINES
280
CALCULATORS
590
TELEPHONE AND
ACCESSORIES
660
0060
1
2
3
$
.00 $
.00
1
2
$
.00
TELEPHONE ANSWERING
DEVICES
610
0070
1
2
3
$
.00 $
.00
1
2
$
.00
TYPEWRITERS AND OTHER
OFFICE MACHINES FOR
NON-BUSINESS USE
0080
1
2
3
$
.00 $
.00
1
2
620
$
.00
0090
1
2
3
$
.00 $
.00
1
2
$
.00
0100
1
2
3
$
.00 $
.00
1
2
$
.00
0110
1
2
3
$
.00 $
.00
1
2
$
.00
0120
1
2
3
$
.00 $
.00
1
2
$
.00
0130
1
2
3
$
.00 $
.00
1
2
$
.00
0140
1
2
3
$
.00 $
.00
1
2
$
.00
0150
1
2
3
$
.00 $
.00
1
2
$
.00
0160
1
2
3
$
.00 $
.00
1
2
$
.00
0170
1
2
3
$
.00 $
.00
1
2
$
.00
0180
1
2
3
$
.00 $
.00
1
2
$
.00
0190
1
2
3
$
.00 $
.00
1
2
$
.00
0200
1
2
3
$
.00 $
.00
1
2
$
.00
COMPUTERS, COMPUTER
SYSTEMS AND RELATED
HARDWARE FOR
NON-BUSINESS USE
640
COMPUTER SOFTWARE AND
ACCESSORIES FOR
NON-BUSINESS USE
650
PHOTOGRAPHIC EQUIPMENT
300
LAWNMOWING MACHINERY
AND OTHER YARD
EQUIPMENT
310
TOOLS FOR HOME USE
Power tools
Non-power tools
HEATING AND COOLING
EQUIPMENT
Window air conditioners
Portable cooling and heating
equipment
Use only if unable to itemize
above – Combined expenses
2.
b
PROCESSING USE ONLY
䊳
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
columns b–i.
FORM CE-302
320
330
340
350
800
1 06 03 9
0010
999
Go to
next
page
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to look at the item list as you
proceed. Ask column a, reading the headings (in bold print). If YES, then read the individual
items and complete a separate line in columns b through i as each item is reported.
Section 6 – APPLIANCES, HOUSEHOLD EQUIPMENT,
AND OTHER SELECTED ITEMS – Continued
Part B – Purchase of Household Appliances and Other Selected Items – Continued
1.
b
Information Booklet, page 18
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) purchased
or rented any of the following items for your
CU, or as a gift to someone outside your CU?
ITEM
CODE
YES
NO
TELEVISIONS, RADIO, VIDEO,
SOUND EQUIPMENT (DO NOT
INCLUDE PURCHASES
INSTALLED IN VEHICLES)
Color televisions (portable and
table models)
360
Color televisions consoles and
combinations of TV; large
screen color TV projection
equipment; color monitors and
other items
370
Black and white TV’s and
combinations of TV’s with
other items
380
VCR, video camera, video disc
player, camcorder
Satellite dishes
Radio, all types
390
670
400
Tape recorders and players
420
Sound components, component
systems, and compact disc
sound systems
430
Other sound and video
equipment, including
accessories (audio/video tapes,
etc. should be recorded in
Section 17)
440
Use only if unable to itemize
above – Combined expenses
810
MUSICAL INSTRUMENTS,
SUPPLIES AND
ACCESSORIES
2.
Piano, organ, or keyboard
450
Other
460
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
columns b–i.
Page 32
1 06 05 4
0010
999
Go to
next
page
c
What type did you
purchase or rent?
Enter a brand name
or a brief description
of the item.
PROCESSING USE ONLY
a
d
6 06 06 1
e
Was this –
ENTER
ITEM
1 – Purchased
CODE
for own
from
use?
column a.
2 – Rented?
Go to
column g.
When
did
you
purchase
it?
3 – Purchased
as gift
to others?
Mark (X) box
g
f
What did it cost?
(Include delivery
charges, exclude
installation
charges.)
h
If code 2 in
Did this
column d –
include
sales tax?
What was the
total rental
expense since
the 1st of (month,
3 months ago),
excluding the
current month?
Go to column h.
Month
NOTES
i
YES
NO
Did you
purchase
or rent
any
other . . .?
If "No," go
to next
item in
column a.
YES
NO
PRE
1
2
3
Description
from column b
Month
from
column
e
Cost from
column f
or column g
Month
0010
1
2
3
$
.00 $
.00
1
2
$
.00
0020
1
2
3
$
.00 $
.00
1
2
$
.00
0030
1
2
3
$
.00 $
.00
1
2
$
.00
0040
1
2
3
$
.00 $
.00
1
2
$
.00
0050
1
2
3
$
.00 $
.00
1
2
$
.00
0060
1
2
3
$
.00 $
.00
1
2
$
.00
0070
1
2
3
$
.00 $
.00
1
2
$
.00
0080
1
2
3
$
.00 $
.00
1
2
$
.00
0090
1
2
3
$
.00 $
.00
1
2
$
.00
0100
1
2
3
$
.00 $
.00
1
2
$
.00
0110
1
2
3
$
.00 $
.00
1
2
$
.00
0120
1
2
3
$
.00 $
.00
1
2
$
.00
0130
1
2
3
$
.00 $
.00
1
2
$
.00
0140
1
2
3
$
.00 $
.00
1
2
$
.00
0150
1
2
3
$
.00 $
.00
1
2
$
.00
0160
1
2
3
$
.00 $
.00
1
2
$
.00
0170
1
2
3
$
.00 $
.00
1
2
$
.00
0180
1
2
3
$
.00 $
.00
1
2
$
.00
0190
1
2
3
$
.00 $
.00
1
2
$
.00
0200
1
2
3
$
.00 $
.00
1
2
$
.00
Section 6 – Part B (Continued)
Page 32
Page 33
Page 33
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to look at the item list as you
proceed. Ask column a, reading the headings (in bold print). If YES, then read the individual
items and complete a separate line in columns b through i as each item is reported.
Section 6 – APPLIANCES, HOUSEHOLD EQUIPMENT,
AND OTHER SELECTED ITEMS – Continued
Part B – Purchase of Household Appliances and Other Selected Items – Continued
a
1.
b
Information Booklet, page 19
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) purchased
or rented any of the following items for your
CU or as a gift to someone outside your CU?
SPORTS, RECREATION, AND
EXERCISE EQUIPMENT
General sports equipment
(Include here athletic shoes for
sports related use, such as
football, baseball, soccer, or
bowling)
Enter brand name or
a brief description of
the item.
6 06 08 7
NOTES
c
d
e
f
g
h
i
ENTER
ITEM
CODE
from
column a.
Was this –
1 – Purchased for
own use?
2 – Rented?
Go to column g
3 – Purchased
as gift to
others?
Mark (X) box
When did
you
purchase
it?
What did it cost?
(Include delivery
charges, exclude
installation
charges.)
If code 2 in
column d –
What was the
total rental
expense since the
1st of (month, 3
months ago),
excluding the
current month?
Did this
include
sales
tax?
Did you
purchase or
rent any
other . . .?
Month
Go to column h.
If "No," go
to next item
in column a.
YES NO
YES
NO
PRE
1
Description
from column b
2
3
Month
from
column
e
Cost from
column f or
column g
Month
0010
1
2
3
$
.00 $
.00
1
2
$
.00
470
0020
1
2
3
$
.00 $
.00
1
2
$
.00
Health and exercise equipment
480
0030
1
2
3
$
.00 $
.00
1
2
$
.00
Camping equipment
490
0040
1
2
3
$
.00 $
.00
1
2
$
.00
0050
1
2
3
$
.00 $
.00
1
2
$
.00
0060
1
2
3
$
.00 $
.00
1
2
$
.00
0070
1
2
3
$
.00 $
.00
1
2
$
.00
0080
1
2
3
$
.00 $
.00
1
2
$
.00
0090
1
2
3
$
.00 $
.00
1
2
$
.00
0100
1
2
3
$
.00 $
.00
1
2
$
.00
0110
1
2
3
$
.00 $
.00
1
2
$
.00
0120
1
2
3
$
.00 $
.00
1
2
$
.00
0130
1
2
3
$
.00 $
.00
1
2
$
.00
0140
1
2
3
$
.00 $
.00
1
2
$
.00
0150
1
2
3
$
.00 $
.00
1
2
$
.00
0160
1
2
3
$
.00 $
.00
1
2
$
.00
0170
1
2
3
$
.00 $
.00
1
2
$
.00
0180
1
2
3
$
.00 $
.00
1
2
$
.00
0190
1
2
3
$
.00 $
.00
1
2
$
.00
0200
1
2
3
$
.00 $
.00
1
2
$
.00
Hunting and fishing equipment
500
510
Winter sports equipment
Water sports equipment
520
Outboard motors
530
Bicycles
540
Tricycles and battery powered
riders
550
Playground equipment
560
Other sports and recreation
equipment
570
Use only if unable to itemize
above – Combined expenses
2.
ITEM
CODE YES NO
What type did you
purchase or rent?
PROCESSING USE ONLY
䊳
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
columns b–i.
NOTES
FORM CE-302
820
1 06 07 0
0010
999
Go to
section
7
FORM CE-302
Section 7 – HOUSEHOLD EQUIPMENT REPAIRS, SERVICE CONTRACTS,
AND FURNITURE REPAIR AND REUPHOLSTERING
Part A – Screening Questions
Part B – Household Equipment Repairs and Service Contracts
Information Booklet, page 20
Computers, computer systems, and related
equipment for non-business use
2.
YES
0010
2
1
2
0020
1
2
3
0030
1
2
4
0040
1
110
5
0050
6
In what
What was the
month was
total cost?
(repair
done/service
contract
purchased)?
PRE
Did this
include
sales tax?
Month
YES
1
Description
from column a
2
3
Repair or
service
contract
from
column b
Month
from
column
d
4
Cost from
column e
NO
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
2
$
.00
1
2
$
.00
1
2
$
.00
1
2
$
.00
0060
1
2
$
.00
1
2
$
.00
7
0070
1
2
$
.00
1
2
$
.00
8
0080
1
2
$
.00
1
2
$
.00
NO
100
f
R EPAIR T X
Television, radio, video and sound equipment,
except those installed in automobiles or other
vehicles
NO
1
e
d
SR V CM O B
1a. Repair or 1b. Service
maintenance contracts
YES
Other household appliances, such as washer,
refrigerator, or range/oven
ENTER
ITEM
CODE
from
part A.
APPR PR YB
Yes – Go to column
1b below
No
ITEM
CODE
Garbage disposal, range hood, or built-in
dishwasher
1 – Equipment
repair
2 – Service
contract
Mark (X)
R PAIR T YP
What is/was (repaired/covered
Repair by service contract)?
or
contract Describe the item repaired or the
type of service or equipment
No.
covered by the service contract.
Include all items covered.
b. Did you (or any members of your CU) have
any expenses for service contracts?
c
5 07 02 0
R EPAIR X
you (or any members of your CU) have
any expenses for maintenance or repair
of household equipment?
b
a
Yes – Go to column
1a below
No
PROCESSING
USE ONLY
1a. Since the 1st of (month, 3 months ago), did
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list as you proceed. Read
questions 1a and 1b and complete a line in part B for each item repaired or each service contract.
120
220
Lawn and garden equipment
130
9
0090
1
2
$
.00
1
2
$
.00
Musical instruments and accessories
140
10
0100
1
2
$
.00
1
2
$
.00
Hand or power tools
150
11
0110
1
2
$
.00
1
2
$
.00
12
0120
1
2
$
.00
1
2
$
.00
Photographic equipment
160
13
0130
1
2
$
.00
1
2
$
.00
14
0140
1
2
$
.00
1
2
$
.00
0150
1
2
$
.00
1
2
$
.00
Sport and recreational equipment
170
Termite or pest control treatment
190
15
Heating or air conditioning equipment
200
16
0160
1
2
$
.00
1
2
$
.00
Use only if unable to itemize above –
Combined expenses
17
0170
1
2
$
.00
1
2
210
$
.00
0180
1
2
$
.00
1
2
$
.00
19
0190
1
2
$
.00
1
2
$
.00
20
0200
1
2
$
.00
1
2
$
.00
1 07 01 1
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) box if there are no entries recorded in
columns a–f in part B.
I
0010
999
Go to part C
18
NOTES
Page 34
Section 7 – Part A and Part B
Page 34
Page 35
Page 35
Section 7 – HOUSEHOLD EQUIPMENT REPAIRS, SERVICE CONTRACTS, AND
FURNITURE REPAIR AND REUPHOLSTERING – Continued
FIELD REPRESENTATIVE –
Part C – Screening Question
Did you (or any members of your CU) have
any expenses for repairing, refinishing or
reupholstering furniture, including the costs
for fabric?
Yes – Go to part D
No – Go to next section
4
5
6
7
8
9
10
FORM CE-302
0030
0040
0050
0060
0070
0080
0090
0100
e
220
Did this
include
sales tax?
Month
F R N R EP T X
3
0020
d
In what
How much
month did
did it cost?
you have it
OFFICE repaired or
USE
reupholstered?
ONLY
1
2
3
Description from
column a
Month
from
column c
Cost from
column d
$
.00
$
.00
$
.00
YES
NO
$
.00
$
.00
$
.00
1
2
$
.00
1
2
$
.00
$
.00
1
2
$
.00
220
$
.00
1
2
$
.00
220
$
.00
1
2
$
.00
220
$
.00
1
2
$
.00
220
$
.00
1
2
$
.00
220
$
.00
1
2
$
.00
220
$
.00
1
2
$
.00
220
$
.00
1
2
$
.00
220
220
SR V C M O D
2
0010
c
F U R N R EP Y
1
b
4 07 04 9
F U R N R EP X
Item
No.
What item of furniture was
repaired or reupholstered?
Describe type of furniture.
PROCESSING USE
ONLY
Part D – Furniture Repair or Reupholstering
a
NOTES
PRE
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 8 – HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS
Part A – Purchases
5 08 01 0
b
100
Living room chairs
101
Living room tables
102
Modular wall units, shelves or cabinets
Ping-pong, pool tables and other similar
recreation room items
103
f
ENTER
ITEM
CODE
from
column
a.
In what
month
did you
purchase
it?
Was this
purchased for
your CU or as
a gift to
someone
outside
the CU?
F U R N GF T C
Month
Mark box
What was
the
purchase
price?
1 – For use by
the CU.
2 – As a gift to
someone
outside
CU.
0010
1
2
0020
1
2
0030
1
2
0040
1
2
0050
1
0060
h
Did this
include
sales
tax?
Did you
purchase
any
other . . .?
If "No,"
go to next
item in
column a.
YES NO YES
$
.00
$
.00
$
.00
$
.00
2
$
1
2
0070
1
0080
NOTES
g
FU RN PU RT X
Sofas
e
FU RN PU RX
LIVING, FAMILY, OR RECREATION
ROOM FURNITURE
YES NO
Enter a brief description of
the item purchased.
d
FU RN PU RY
ITEM
CODE
What did you purchase?
PROCESSING USE ONLY
Information Booklet, pages 21 and 22
Since the 1st of (month, 3 months ago), have you (or
any members of your CU) purchased for your CU
or as a gift to someone outside of your CU any of
the following?
c
FU RN M O
a
1
2
1
NO
PRE
1
2
3
Description
from column b
Month
from
column d
Cost from
column f
Month
$
.00
2
$
.00
1
2
$
.00
1
2
$
.00
.00
1
2
$
.00
$
.00
1
2
$
.00
2
$
.00
1
2
$
.00
1
2
$
.00
1
2
$
.00
0090
1
2
$
.00
1
2
$
.00
0100
1
2
$
.00
1
2
$
.00
0110
1
2
$
.00
1
2
$
.00
0120
1
2
$
.00
1
2
$
.00
OFFICE FURNITURE FOR HOME USE
0130
1
2
$
.00
1
2
$
.00
All office furniture for home use. Exclude
any furniture used exclusively for
business
0140
1
2
.00
1
2
$
.00
150
$
Combined furniture expense. Use only if
unable to itemize separately
0150
1
2
$
.00
1
2
160
$
.00
0160
1
2
$
.00
1
2
$
.00
0170
1
2
$
.00
1
2
$
.00
0180
1
2
$
.00
1
2
$
104
Other living room, family or recreation
room furniture including desks
105
Living room furniture combinations
106
DINING ROOM AND KITCHEN
FURNITURE
All dining room and kitchen furniture
110
BEDROOM FURNITURE
Mattress and springs
120
Bedroom furniture other than mattresses
and springs
121
Combined bedroom furniture (codes 120
and 121)
122
INFANTS FURNITURE AND
EQUIPMENT
Infants furniture
130
Infants equipment
OUTDOOR FURNITURE AND
EQUIPMENT
131
Patio, porch or outdoor furniture
140
Outdoor equipment
141
HOUSEHOLD DECORATIVE ITEMS
Clocks
170
Lamps, and other lighting fixtures
171
Other household decorative items
173
Page 36
Section 8 – Part A
.00
Page 36
Page 37
Page 37
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 8 – HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS –
Continued
Part A – Purchases – Continued
5 08 02 8
a
b
ITEM
CODE
CLOSET STORAGE AND TRAVEL
ITEMS
Storage items
180
Travel items
181
DISHES, DINNERWARE, FLATWARE,
GLASSWARE, AND COOKWARE
Plastic dinnerware
190
China and other dinnerware
191
Stainless, silver, and other flatware
192
Glassware
193
Serving pieces other than silver
195
Non-electric cookware
Use only if unable to itemize above –
Combined kitchenware (Codes 190–196)
Silver serving pieces
198
What did you purchase?
Enter a brief description of
the item purchased.
PROCESSING USE ONLY
Information Booklet, pages 23 and 24
Have you (or any members of your CU) purchased
for your CU or as a gift to someone outside of
your CU any of the following?
YES NO
c
d
e
f
ENTER
ITEM
CODE
from
column
a.
In what
month
did you
purchase
it?
Was this
purchased for
your CU or as
a gift to
someone
outside
the CU?
0020
1
2
196
0030
1
2
197
0040
1
2
0050
1
2
0060
1
2
0070
1
2
204
0080
1
2
205
0090
1
2
0100
1
0110
Bathroom linens
201
Kitchen and dining room linens
202
Other linens
Use only if unable to itemize above –
Combined linens (Codes 200–203)
Slipcovers, decorative pillows and
cushions
203
Did you
purchase
any
other . . .?
If "No,"
go to next
item in
column a.
Mark box
Month
2
200
Did this
include
sales
tax?
2 – As a gift to
someone
outside
CU.
1
Bedroom linens
h
1 – For use by
the CU.
0010
HOUSEHOLD LINENS
What was
the
purchase
price?
YES NO YES
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
.00
1
2
$
.00
1
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
2
$
1
2
0120
1
2
FLOOR AND WINDOW COVERINGS
NOTES
g
PRE
1
2
3
Description
from column b
Month
from
column d
Cost from
column f
Month
NO
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
2
$
.00
1
2
$
.00
1
2
$
.00
Original wall-to-wall carpet
210
Repacement wall-to-wall carpet
211
Room size rugs and other nonpermanent floor coverings, including
carpet squares
212
Curtains and drapes
214
0130
1
2
Venetian blinds, window shades, other
window coverings
215
0140
1
2
$
.00
1
2
$
.00
Use only if unable to itemize above –
Combined expenses
220
0150
1
2
$
.00
1
2
$
.00
Part B – Rental or Leasing of Furniture
1a. Since the 1st of (month, 3 months ago), have you
(or any members of your CU) rented or leased
any furniture?
b.
If YES – What was the total expense for renting
or leasing furniture, excluding any expenses for
the current month?
FORM CE-302
1 08 03 5
0010
1
2
0020 $
NOTES
FU RN RN T L
Yes
No –Go to next section
FU RN RN T X
.00
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 9 – CLOTHING AND SEWING MATERIALS
Part A – Clothing
6 09 02 4
1.
b
For whom was it purchased? If
CU member, enter name and line
number from Control Card.
–
–
–
–
Male 16 and over
Female 16 and over
Male 2–15
Female 2–15
P ER SO N Y
How
many
did you
purchase?
In what
month
did you
purchase
it?
Enter
number of
identical
items
purchased.
How much
did it cost?
h
i
Did this
include
sales tax?
Did you
purchase
any
other . . .?
PRE
If "No," go
to next
item in
column a.
1
Description
from column b
2
3
4
Person from
column d
Month
from
column
f
Cost from
column g
Name
Month
Coats, jackets, and
furs
100
Sport coats and
tailored jackets
110
0010
$
.00
1
2
$
.00
Suits
120
0020
$
.00
1
2
$
.00
Vests
130
0030
$
.00
1
2
$
.00
Sweaters and sweater
sets
140
0040
$
.00
1
2
$
.00
Pants, slacks, and
jeans
0050
$
.00
1
2
150
$
.00
Shorts and short sets
Exclude all athletic shorts
0060
$
.00
1
2
160
$
.00
0070
.00
2
170
$
1
Dresses
$
.00
.00
2
180
$
1
Skirts
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0110
$
.00
1
2
$
.00
0120
$
.00
1
2
$
.00
0130
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0170
$
.00
1
2
$
.00
0180
$
.00
1
2
$
.00
Name
Line No.
or code
0080
Shirts, blouses, and
tops
2.
g
CL O T H T X A
90
91
92
93
f
CL O T H X A
If someone outside CU, enter name
and appropriate code as follows:
e
CL O T H Q A
YES NO
Describe briefly the
item purchased.
CL O T H Y A
ITEM
CODE
ENTER
ITEM
CODE
from
column a.
What did you buy?
d
CL O T H M O A
Information Booklet, page 25
Since the 1st of (month, 3 months ago),
have you (or any members of your
CU) purchased any of the following
items, for persons age 2 and over,
either for members of your CU or for
someone outside your CU?
c
PROCESSING USE ONLY
a
FIELD REPRESENTATIVE
CHECK ITEM
0090
1 09 01 7
999
Go to
next
page
0100
0140
0150
0160
Page 38
YES
NO
YES
NO
190
Mark (X) box if there are 0010
no entries recorded in
columns b–i.
NOTES
Month
Section 9 – Part A
Page 38
Page 39
Page 39
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed. Ask
column a and complete columns b through i as each item or set of identical items purchased is reported.
Identical items are those of the SAME TYPE and purchased in the SAME MONTH, for the SAME PERSON.
Section 9 – CLOTHING AND SEWING MATERIALS – Continued
Part A – Clothing – Continued
a
b
Information Booklet, page 26
Have you (or any members of your
CU) purchased any of the following
items, for persons age 2 and over,
either for members of your CU or for
someone outside your CU?
ITEM
CODE
2.
YES
c
ENTER
ITEM
CODE
from
column a.
What did you buy?
Describe briefly the
item purchased.
NO
PROCESSING USE ONLY
1.
6 09 04 0
d
For whom was it purchased? If
CU member, enter name and line
number from Control Card.
If someone outside CU, enter name
and appropriate code as follows:
90
91
92
93
–
–
–
–
Male 16 and over
Female 16 and over
Male 2–15
Female 2–15
Name
Line No.
or code
e
f
How
many
did you
purchase?
In what
month
did you
purchase
it?
g
How much
did it cost?
h
i
Did this
include
sales tax?
Did you
purchase
any
other . . .?
Enter
number of
identical
items
purchased.
PRE
If "No," go
to next
item in
column a.
Month
YES
NO
YES
NO
1
Description
from column b
2
3
4
Person from
column d
Month
from
column
f
Cost from
column g
Name
Month
Undergarments
200
0010
$
.00
1
2
$
.00
Hosiery
210
0020
$
.00
1
2
$
.00
0030
$
.00
1
2
$
.00
0040
$
.00
1
2
$
.00
0050
$
.00
1
2
$
.00
0060
$
.00
1
2
$
.00
0070
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0110
$
.00
1
2
$
.00
0120
$
.00
1
2
$
.00
0130
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0170
$
.00
1
2
$
.00
0180
$
.00
1
2
$
.00
FIELD REPRESENTATIVE
CHECK ITEM
1 09 03 3
Mark (X) box if there are 0010
no entries recorded in
columns b–i.
NOTES
999
Go to
next
page
0080
0090
0100
0140
0150
0160
FORM CE-302
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed. Ask
column a and complete columns b through i as each item or set of identical items purchased is reported.
Identical items are those of the SAME TYPE and purchased in the SAME MONTH, for the SAME PERSON.
Section 9 – CLOTHING AND SEWING MATERIALS – Continued
Part A – Clothing – Continued
a
b
Information Booklet, page 26
Have you (or any members of your
CU) purchased any of the following
items, for persons age 2 and over,
either for members of your CU or for
someone outside your CU?
ITEM
CODE
Nightwear and
loungewear
220
Accessories
230
Active sportswear
240
Uniforms, for which
the cost is not
reimbursed
2.
3.
Costumes
Combined clothing – This
should be used only if
the respondent cannot
itemize clothing
purchases. Specify (in
the Notes) the types of
clothing combined
Footwear
(Include here athletic
shoes not specifically
purchased for sports
related use.)
Have you (or any
members of your CU)
purchased any other
clothing which you
have not previously
mentioned? Do not
include infants
clothing. If YES – probe
and assign an item code.
FIELD REPRESENTATIVE
CHECK ITEM
ENTER
ITEM
CODE
from
column a.
What did you buy?
Describe briefly the
item purchased.
NO
d
For whom was it purchased? If
CU member, enter name and line
number from Control Card.
If someone outside CU, enter name
and appropriate code as follows:
90
91
92
93
–
–
–
–
Male 16 and over
Female 16 and over
Male 2–15
Female 2–15
Name
Line No.
or code
e
f
How
many
did you
purchase?
In what
month
did you
purchase
it?
How much
did it cost?
h
i
Did this
include
sales tax?
Did you
purchase
any
other . . .?
PRE
1
If "No," go
to next
item in
column a.
Enter
number of
identical
items
purchased.
Description
from column b
Month
YES
NO
YES
NO
2
3
4
Person from
column d
Month
from
column
f
Cost from
column g
Name
Month
$
.00
1
2
$
.00
250
0020
$
.00
1
2
$
.00
260
0030
$
.00
1
2
$
.00
0040
$
.00
1
2
$
.00
0050
$
.00
1
2
$
.00
0060
$
.00
1
2
$
.00
0070
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0110
$
.00
1
2
$
.00
0120
$
.00
1
2
$
.00
0130
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0170
$
.00
1
2
$
.00
0180
$
.00
1
2
$
.00
270
280
0080
0090
0100
1 09 05 8
999
Go to
part B
0140
0150
0160
Page 40
g
0010
Mark (X) box if there are 0010
no entries recorded in
columns b–i.
NOTES
YES
c
PROCESSING USE ONLY
1.
6 09 06 5
Section 9 – Part A (Continued)
Page 40
Page 41
Page 41
Section 9 – CLOTHING AND SEWING MATERIALS – Continued
Part A – Clothing – Continued
b
c
What did you buy?
PROCESSING USE ONLY
Describe briefly the
item purchased.
ENTER
ITEM
CODE
from
column
a from
the
preceding
pages.
d
For whom was it purchased?
If CU member, enter name and line
number from Control Card.
If someone outside CU, enter name
and appropriate code as follows:
90
91
92
93
–
–
–
–
Male 16 and over
Female 16 and over
Male 2–15
Female 2–15
Name
Line No.
or code
e
f
How
many
did you
purchase?
In what
month
did you
purchase
it?
g
How much
did it cost?
NOTES
h
i
Did this
include
sales tax?
Did you
purchase
any
other . . .?
PRE
1
If "No," go
to next
item in
column a.
Enter
number of
identical
items
purchased.
Description
from column b
Month
YES
NO
YES
NO
2
3
4
Person from
column d
Month
from
column
f
Cost from
column g
Name
Month
0010
$
.00
1
2
$
.00
0020
$
.00
1
2
$
.00
0030
$
.00
1
2
$
.00
0040
$
.00
1
2
$
.00
0050
$
.00
1
2
$
.00
0060
$
.00
1
2
$
.00
0070
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0110
$
.00
1
2
$
.00
0120
$
.00
1
2
$
.00
0130
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
$
.00
1
2
$
.00
0170
$
.00
1
2
$
.00
0180
$
.00
1
2
$
.00
0080
0090
0100
0140
0150
0160
FORM CE-302
6 09 07 3
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 9 – CLOTHING AND SEWING MATERIALS – Continued
Part B – Infants Clothing, Watches, Jewelry, and Hairpieces
1a.
b
300
Underwear and diapers,
including disposable
310
Sleeping garments
320
In what
month
did you
purchase
it?
Enter
number of
identical
items
purchased.
CU member
Non-CU member
0010
1
2
0020
1
0030
How much
did it cost?
Did this
include
sales tax?
Month
YES
Did you
purchase
any
other . . .?
If "No," go
to next
item in
column a.
NO
1
2
.00
1
$
.00
2
$
1
2
0060
1
0070
YES
1
2
3
Description
from column b
Month
from
column
f
Cost from
column g
NO
.00
2
$
.00
1
2
$
.00
.00
1
2
$
.00
$
.00
1
2
$
.00
2
$
.00
1
2
$
.00
1
2
$
.00
1
2
$
.00
0080
1
2
$
.00
1
2
$
.00
If YES – probe and
assign an item code.
0090
1
2
$
.00
1
2
$
.00
Information Booklet,
page 27
0100
1
2
$
.00
1
2
$
.00
0110
1
2
$
.00
1
2
$
.00
0120
1
2
$
.00
1
2
$
.00
0130
1
2
$
.00
1
2
$
.00
Accessories
Combined clothing for
infants –This should be
used only if the
respondent cannot
itemize clothing
purchases. Specify (in
the Notes) the types of
clothing combined.
330
$
.00
2
$
1
2
0040
1
0050
340
360
b. Have you (or any
members of your CU)
purchased any other
infants clothing which
you have not
previously mentioned?
3.
How
many
did you
purchase?
PRE
$
Layettes
2.
Was this purchased for your CU
or for someone outside of your
CU?
i
CL O T H T X B
Dresses and other
outerwear
ENTER
ITEM
CODE
from
column a.
h
g
CL O T H X B
290
f
CL O T H Q B
Coats, jackets, or
snowsuits
YES NO
e
CL O T H M O B
ITEM
CODE
Describe briefly the
item purchased.
d
CL O T H Y B
Such as –
What did you buy?
c
C L O GF T B
Information Booklet, page 26 and 27
Have you (or any members of your
CU) purchased clothing for infants
under 2 years of age either for
members of your CU or for someone
outside your CU?
PROCESSING USE ONLY
a
6 09 12 3
Have you (or any
members of your CU)
purchased any of the
following items,
either for members
of your CU or for
someone outside
your CU?
Watches
370
0140
1
2
$
.00
1
2
$
.00
Jewelry
380
0150
1
2
$
.00
1
2
Hairpieces, wigs, or
toupees
$
.00
390
0160
1
2
$
.00
1
2
$
.00
0170
1
2
$
.00
1
2
$
.00
0180
1
2
$
.00
1
2
$
.00
FIELD REPRESENTATIVE
CHECK ITEM
1 09 11 6
Mark (X) box if there are 0010
no entries recorded in
columns b–i.
Page 42
999
Go to
part C
Section 9 – Part B
Page 42
Page 43
Page 43
Section 9 – CLOTHING AND SEWING MATERIALS – Continued
Part B – Infants Clothing, Watches, Jewelry, and Hairpieces – Continued
b
c
What did you buy?
PROCESSING USE ONLY
Describe briefly the
item purchased.
FORM CE-302
d
Was this purchased for your CU
ENTER
or for someone outside of your
ITEM
CU?
CODE
from
column
a from
the
preceding
page.
CU member
Non-CU member
e
f
How
many
did you
purchase?
In what
month
did you
purchase
it?
6 09 13 1
g
How much
did it cost?
NOTES
h
i
Did this
include
sales tax?
Did you
purchase
any
other . . .?
PRE
1
2
3
Description
from column b
Month
from
column
f
Cost from
column g
If "No," go
to next
item in
column a.
Enter
number of
identical
items
purchased.
Month
YES
NO
YES
NO
0010
1
2
$
.00
1
2
$
.00
0020
1
2
$
.00
1
2
$
.00
0030
1
2
$
.00
1
2
$
.00
0040
1
2
$
.00
1
2
$
.00
0050
1
2
$
.00
1
2
$
.00
0060
1
2
$
.00
1
2
$
.00
0070
1
2
$
.00
1
2
$
.00
0080
1
2
$
.00
1
2
$
.00
0090
1
2
$
.00
1
2
$
.00
0100
1
2
$
.00
1
2
$
.00
0110
1
2
$
.00
1
2
$
.00
0120
1
2
$
.00
1
2
$
.00
0130
1
2
$
.00
1
2
$
.00
0140
1
2
$
.00
1
2
$
.00
0150
1
2
$
.00
1
2
$
.00
0160
1
2
$
.00
1
2
$
.00
0170
1
2
$
.00
1
2
$
.00
0180
1
2
$
.00
1
2
$
.00
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 9 – CLOTHING AND SEWING MATERIALS – Continued
Part C – Sewing Materials
5 09 22 4
1.
b
If YES , read the list of individual items
below. Complete columns b–h for each
item purchased.
ITEM
Were these –
CODE
Sewing materials for making
slipcovers, curtains, etc., and
for handwork in the home
400
including yarn?
2.
Sewing materials for making
clothes?
410
Sewing notions?
420
Other sewing materials?
430
Use only if unable to itemize
separately – Combined sewing
materials
440
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are no
entries recorded in columns b–h.
NOTES
Page 44
Was this purchased for
ENTER
your CU or for someone
ITEM
outside of your CU?
CODE
from
column a.
SEW GF T C
CU member
In what
month
did you
purchase
it?
f
Month
h
PRE
Did this
Did you
include
purchase
sales tax? any
other . . .?
How much did it
cost?
SEW I N GM O
Non-CU
member
g
YES
If "No," go
to next
item in
column a.
NO
YES
1
2
3
Description
from column b
Month
from
column
e
Cost from
column f
NO
YES NO
1 09 21 5
0010
e
SEW I N GT X
NO – Go to item 2
Describe briefly the
item purchased.
d
SEW I N GX
YES
What did you buy?
SEW I N GY
Information Booklet, page 27
Have you (or any members of your CU)
purchased any sewing materials, either for
members of your CU or for someone outside
your CU?
c
PROCESSING USE ONLY
a
999
0010
1
2
0020
1
2
0030
1
2
0040
1
2
0050
1
2
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
0130
1
2
0140
1
2
0150
1
2
0160
1
2
0170
1
2
0180
1
2
Go to
part D
Section 9 – Part C
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
Page 44
Page 45
Page 45
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 9 – CLOTHING AND SEWING MATERIALS – Continued
Part D – Clothing Services
5 09 32 3
Shoe repair and other shoe
services
Watch or jewelry repair
Clothing rental
470
490
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are no
entries in columns b–h.
NOTES
FORM CE-302
460
480
Clothing storage
2.
450
e
Was this purchased for
ENTER
your CU or for someone
ITEM
outside of your CU?
CODE
from
column a.
C L SV GF T C
CU member
Non-CU
member
0010
1
2
0020
1
2
0030
1
2
0040
1
2
0050
1
2
0060
1
2
1 09 31 4
0010
999
Go to
section
10
In what
month
did you
purchase
it?
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
0130
1
2
0140
1
2
0150
1
2
0160
1
2
0170
1
2
0180
1
2
f
g
h
PRE
Did this
Did you
include
purchase
sales tax? any
other . . .?
How much did it
cost?
Month
YES
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
C L SR V C T X
Repair, alteration, and
tailoring for clothing and
accessories
YES NO
Describe briefly the
item purchased.
d
C L SR V C X
ITEM
CODE
What did you buy?
CL O T H Y D
Information Booklet, page 27
Have you (or any members of your CU) had
expenses for any of the following, either for
members of your CU or for someone outside
your CU?
c
CL O T H M O D
1.
b
PROCESSING USE ONLY
a
If "No," go
to next
item in
column a.
NO
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
YES
1
2
3
Description
from column b
Month
from
column
e
Cost from
column f
NO
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed. Ask question 1 for all
Section 10 – RENTED AND LEASED VEHICLES
Part A.1 – Screening Questions (If New Consumer Unit, Go to Part A.2.)
PROCESSING USE ONLY
Information Booklet, page 28
2. FIELD REPRESENTATIVE ITEM
1a. Since the 1st of (month, 3 months ago),
VEHICLE NUMBER
have you (or any members of your
a. Describe briefly the type of vehicle rented, such as "auto"
CU) rented any vehicles which were
not used ENTIRELY for business? Do
not include leased vehicles.
Yes
No – Go to item 6
If YES – Read the list of individual items
below and mark (X) the appropriate "Yes"
or "No" box.
b.
b. Enter vehicle code from item 1b.
3. Was it rented solely for use on a vacation, overnight
trip, or a trip of 75 miles or more one way?
4.
Truck,
including
vans
110
Motorized
camper-coach
130
Other
attachabletype camper
140
Since the 1st of (month, 3 months ago), excluding (the
current month) what has been your expense for renting
this vehicle?
If periodic payments were made, enter in the notes the
amount of the payment and the number of payments
incurred during the reference period. Compute the total
expense and enter the amount in this item.
cover? Enter to nearest whole percent.
R EN T C O D E
0030
1
0080 $
0130
1
2
0140
C ode
0010
Yes – Go to next rented
vehicle or item 6
No A N Y V A C A T
0030
R EN T EX P X
180
Private plane
190
Any other
vehicle
200
NOTES
.00
A N Y B SN R M
Yes
No – Go to next rented
vehicle or item 6
B SN SP C T Z
Description
Description
.00 Percent
1
2
Code
0010
Yes – Go to next rented
vehicle or item 6
No
0030
.00
0080 $
0130
1
2
Yes
No – Go to next rented
vehicle or item 6
mark
box and go to
item
.006h.Percent
–
0140
1
2
Code
0010
Yes – Go to next rented
vehicle or item 6
No
0030
.00
0080 $
0130
1
2
0140
Code
1
2
Yes – Go to next rented
vehicle or item 6
No
.00
0080 $
Yes
No – Go to next rented
vehicle or item 6
0130
1
2
.00 Percent
Yes
No – Go to next rented
vehicle or item 6
.00 Percent
0140
If this box is marked, no vehicles were previously reported
Ask column f for each vehicle listed, except if vehicle has been disposed of previously ("Yes" in column b below).
7 10 10 3
170
4
LEASED VEHICLES
150
160
1 10 04 9
3
Description
0010
b. If YES – What percent of the total expense will this
6.
Trailer, other
than camper
type, such as
for a boat or
cycle
Page 46
Were (Will) any of the rental expenses (be) deducted
as business expenses, reimbursed, or paid by
someone else?
LEASED VEHICLE INVENTORY CHART
a
b
Vehicle
number
0010
1
0020
L V IN UM
Boat, without
a motor
5a.
PROCESSING
USE ONLY
Motorcycle,
motor scooter,
or moped
(motorized
bicycle)
1 10 03 1
2
Description
120
Trailer-type
camper
Boat, with a
motor
1
2
VEHICLE YES NO HOW
CODE
MANY?
100
1 10 02 3
or "boat."
If YES to an individual item ask – How
many?
Automobile
1 10 01 5
Vehicle
disposed of
YES
e
Vehicle identification
NO
c
d
Vehicle identification from part B, item 2
Vehicle used
for business
from part B,
item 6a
YEAR
MAKE
MODEL
YES
NO
Enter vehicle
code from
part B, item 1b.
L V ICO D E
f
g
How many
Do you still
have vehicle? miles are on
the vehicle?
If NO
Enter and go
L V I H A V E to next vehicle
or to item 7a.
YES
NO
L V IM IL E
h
i
j
What month
Were any
was the lease fees incurred
terminated?
at the
termination
L V I EN D M O of the lease?
T ER M F EE
Month
YES
If YES –
How much?
Enter and go
to next vehicle
or item 7a.
T ER M F EEX
NO
1
2
1
2
$
.00
2
1
2
1
2
$
.00
0030
3
1
2
1
2
$
.00
0040
4
1
2
1
2
$
.00
0050
5
1
2
1
2
$
.00
0060
6
1
2
1
2
$
.00
0070
7
1
2
1
2
$
.00
Section 10 – Part A.1
Page 46
Page 47
Page 47
Section 10 – RENTED AND LEASED VEHICLES – Continued
Part A.1 – Screening Questions – Continued
7a. Since the 1st of (month, 3 months ago), have
you (or any members of your CU) begun
leasing any automobile or truck not used
ENTIRELY for business?
0010
1
2
b.
If YES – What kind of vehicle was it?
Enter vehicle code
VEHICLE
CODE
Automobile
100
Truck, including vans
110
FIELD REPRESENTATIVE INSTRUCTION
Complete part B for each newly leased vehicle.
FORM CE-302
1 10 11 4
Yes
No – Go to section 11
0020
0030
0040
0050
0060
0070
0080
0090
0100
0110
FIELD REPRESENTATIVE – Ask item 7 for all respondents.
NOTES
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed. Ask question 1 for all
Section 10 – RENTED AND LEASED VEHICLES – Continued
Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY
PROCESSING USE ONLY
Information Booklet, page 28
2. FIELD REPRESENTATIVE ITEM
1a. Since the 1st of (month, 3 months ago),
VEHICLE NUMBER
have you (or any members of your
a.
Describe
briefly
the
type
of
vehicle
rented, such as "auto"
CU) rented any vehicles which were
not used ENTIRELY for business? Do
not include leased vehicles.
Yes
No – Go to item 6a
If YES – Read the list of individual items
below and mark (X) the appropriate "Yes"
or "No" box.
b.
Automobile
100
Truck,
including
vans
110
Motorized
camper-coach
120
Trailer-type
camper
130
Other
attachabletype camper
Boat, with a
motor
160
Boat, without
a motor
1 10 14 8
2
1 10 15 5
3
Description
R
EN T C O D E 0010
Code
0010
Yes – Go to next rented
vehicle or item 6
No
A N Y V A CA T
0030
0080 $
R EN T EX P X
0080 $
0130
Yes A N Y B SN R M
No – Go to next rented
vehicle or item 6
0030
trip, or a trip of 75 miles or more one way?
1
2
4.
5a.
Since the 1st of (month, 3 months ago), excluding (the
current month) what has been your expense for renting
this vehicle?
If periodic payments were made, enter in the notes the
amount of the payment and the number of payments
incurred during the reference period. Compute the total
expense and enter the amount in this item.
Were (Will) any of the rental expenses (be) deducted
as business expenses, reimbursed, or paid by
someone else?
0140
LEASED VEHICLES
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) made any
lease payments or begun leasing any
automobile or truck not used ENTIRELY for
business?
If YES – What kind of vehicle was it?
Enter vehicle code
170
VEHICLE
CODE
.00 Percent
4
Description
Description
1
2
0020
0030
0040
0050
0060
0070
180
Private plane
190
0080
0090
Any other
vehicle
200
0100
0110
0120
0130
100
Truck, including vans
110
1
2
0140
0010
Yes – Go to next rented
vehicle or item 6
No
0030
.00
Yes
No – Go to next rented
vehicle or item 6
.00 Percent
1
2
Code
0010
Yes – Go to next rented
vehicle or item 6
No
0030
.00
0080 $
0130
1
2
0140
Yes
No – Go to next rented
vehicle or item 6
.00 Percent
Code
1
2
0080 $
0130
1
2
0140
Yes – Go to next rented
vehicle or item 6
No
.00
Yes
No – Go to next rented
vehicle or item 6
.00 Percent
Yes
No – Go to section 11
Trailer, other
than camper
type, such as
for a boat or
cycle
Automobile
0130
Code
NOTES
1 10 20 5
0010
.00
1
2
B SN SP C T Z
cover? Enter to nearest whole percent.
b.
1
2
b. If YES – What percent of the total expense will this
6a.
150
1
Description
b. Enter vehicle code from item 1b.
3. Was it rented solely for use on a vacation, overnight
140
Motorcycle,
motor scooter,
or moped
(motorized
bicycle)
1 10 13 0
or "boat."
If YES to an individual item ask – How
many?
VEHICLE YES NO HOW
CODE
MANY?
1 10 12 2
NOTES
FIELD REPRESENTATIVE INSTRUCTION
Complete part B on next page for each leased vehicle.
Page 48
Section 10 – Part A.2
Page 48
Page 49
Page 49
Section 10 – RENTED AND LEASED VEHICLES – Continued
Part B – Detailed Questions for Leased Vehicles
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
a. New CU’s – Assign vehicle
b.
2.
numbers in consecutive order
beginning with 1.
2nd through 5th interviews –
Assign the next available vehicle
number from chart in part A.1,
column a.
Enter a vehicle code from part A.1
or A.2.
10a.
1 10 21 3
NOTES
What was the number of payments
contracted for?
N U M PA Y
0190
a.
VEHICLE NUMBER
0010
L SD N U M
Number
b.
In what month and year was the first
payment made?
0020
Code
Year
What is the year, make, and model?
Make
M O D EL Y R
0030
ONTH
PM T M
Month
0200
L SD C O D E
b. VEHICLE CODE
Payments
c.
What is the amount of each payment?
d.
What period is covered by each payment?
Model
M O D EL
0210
0220 $
P A Y EX P X
0230
Week
2 weeks
Month
Quarter
1
2
OFFICE USE ONLY
Enter auto code
3.
How many cylinders does it have?
3
0040
4
0050
Cylinders N U M C Y L
No cylinders (rotary, turbine
or electric)
0
4. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
5a.
b.
No
0060
1
2
ANYAUTO
0070
1
2
A N Y ST EER
0080
1
2
0090
1
2
0100
1
2
A N Y B RA K E
ANYAC
A N Y RO O F
0110
1
2
0120
1
2
0121
1
2
0122
Is it a . . .?
0123
1
4
7.
How many miles are currently on the vehicle?
If YES – How much of the payment is for
these extra charges?
1
2
0250 $
X
11.
12.
Is any of the (period reported in item 10d)
leasing cost paid by an employer?
Was a trade-in allowance received?
0130
D O O RS
Station wagon?
Convertible?
T Y P EV EH
Hatchback?
Other?
1
Yes, used for business
Personal use only – Go to item 7
P R C B SN SZ
0140
Percent
0260
1
2
13a.
Was a cash down payment made? (A down
payment is a capitalized cost reduction.)
b.
Was any portion of the cash down payment
paid by an employer?
8.
Was it new or used when first leased?
0160
1
New
9.
Was this vehicle leased from a –
0170
1
New or used vehicle dealer?
Independent leasing company?
Bank?
Someplace else? – Specify
2
3
4
2
b.
0300
L SD SO U R C
1
2
Yes
S
A N Y EX T R A
No

 Go to item 11
Don’t know
E
EX T R A EX P
Y
Don’t know
f
Yes – I
No
.00
How much? ANYEMPLY–
T R A D EEX P
.00
.00
Yes – If YES – How much? –
No – Go to item 14a A N Y D O W N
D O W N EX P
0320
Yes – If YES – How much? –
A N Y D N EM P
No
1
2
0340
In what month was the lease terminated?
Were any fees incurred at the termination of
the lease?
PA Y T IM E
0310 $
1
D N EM P EX P
.00
.00
Yes – Go to next vehicle or section 11
No
ANYH AVE
Month
L SD EN D M O
0350
c.
7–
Yes – If YES – How much? –
A N Y T RA D E
No
1
2
N
Used EW U SED
6
0280
M I L ESV EH Miles
0150
Semiannually
Annually
Other – Specify
5
EM P L Y EX P
0330 $
Do you still have this vehicle?
.00
0270 $
0290 $
100%, delete
Ifthis
vehicle
and go to
next vehicle.
14a.
(Enter to nearest whole mile)
FORM CE-302
f.
A N Y B U SI N
2
If used for business – What percent of the mileage is
counted as a business expense?
A N Y T U RB O
A N Y D I ESL
A N Y W H EEL
Doors
3
b.
0240
2
(Ask for vehicle code 100)
How many doors does it have?
Is it used for business?
Does the payment include any charges other
than the lease amount such as auto
insurance or maintenance?
X
Yes
2
6a.
e.
Year P M T Y EA R
0360
1
2
0370 $
Yes – If YES – How much? –
No – Go to next vehicle
A N Y F EES
or section 11
F EESEX P
.00
FORM CE-302
Section 10 – RENTED AND LEASED VEHICLES – Continued
Part B – Detailed Questions for Leased Vehicles – Continued
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
1 10 24
a. New CU’s – Assign vehicle
b.
2.
numbers in consecutive order
beginning with 1.
2nd through 5th interviews –
Assign the next available vehicle
number from chart in part A.1,
column a.
Enter a vehicle code from part A.1
or A.2.
10a.
7
NOTES
What was the number of payments
contracted for?
0190
a.
VEHICLE NUMBER
0010
b.
Number
In what month and year was the first
payment made?
Payments
Month
0200
b. VEHICLE CODE
0020
Code
Year
What is the year, make, and model?
Make
c.
What is the amount of each payment?
d.
What period is covered by each payment?
0210
0230
1
2
OFFICE USE ONLY
Enter auto code
3.
How many cylinders does it have?
3
0040
4
0050
0
4. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
5a.
b.
Yes
No
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
0121
1
2
(Ask for vehicle code 100)
How many doors does it have?
0122
Is it a . . .?
0123
1
4
0130
1
2
b.
If used for business – What percent of the mileage is
counted as a business expense?
Does the payment include any charges other
than the lease amount such as auto
insurance or maintenance?
0240
1
2
X
f.
11.
If YES – How much of the payment is for
these extra charges?
Is any of the (period reported in item 10d)
leasing cost paid by an employer?
12.
Was a trade-in allowance received?
Yes, used for business
Personal use only – Go to item 7
Percent
Don’t know
1
Yes – If YES – How much? –
No
How many miles are currently on the vehicle?
8.
Was it new or used when first leased?
0160
1
New
9.
Was this vehicle leased from a –
0170
1
New or used vehicle dealer?
Independent leasing company?
Bank?
Someplace else? – Specify
Miles
(Enter to nearest whole mile)
2
3
4
2
1
Was a cash down payment made? (A down
payment is a capitalized cost reduction.)
0300
1
2
b.
Was any portion of the cash down payment
paid by an employer?
0320
1
2
Yes – If YES – How much? –
No
.00
Yes – If YES – How much? –
No – Go to item 14a
.00
Do you still have this vehicle?
0340
1
2
b.
Yes – If YES – How much? –
No
.00
0330 $
In what month was the lease terminated?
Used
Yes – Go to next vehicle or section 11
No
Month
0350
c.
Were any fees incurred at the termination of
the lease?
0360
1
2
0370 $
Page 50
.00
0310 $
100%, delete
Ifthis
vehicle
and go to
next vehicle.
14a.
7.
0150
13a.
7
Semiannually
Annually
Other – Specify
X
2
0280
6
.00
0250 $
0260
5
Yes
No

 Go to item 11
Don’t know
0290 $
Station wagon?
Convertible?
Hatchback?
Other?
0140
Week
2 weeks
Month
Quarter
0270 $
Doors
3
Is it used for business?
e.
2
2
6a.
Cylinders
No cylinders (rotary, turbine
or electric)
.00
0220 $
Model
0030
Year
Section 10 – Part B (Continued)
Yes – If YES – How much? –
No – Go to next vehicle
or section 11
.00
Page 50
Page 51
Page 51
Section 10 – RENTED AND LEASED VEHICLES – Continued
Part B – Detailed Questions for Leased Vehicles – Continued
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
1 10 27
a. New CU’s – Assign vehicle
b.
2.
numbers in consecutive order
beginning with 1.
2nd through 5th interviews –
Assign the next available vehicle
number from chart in part A.1,
column a.
Enter a vehicle code from part A.1
or A.2.
10a.
0
NOTES
What was the number of payments
contracted for?
0190
a.
VEHICLE NUMBER
0010
b.
Number
In what month and year was the first
payment made?
Payments
Month
0200
b. VEHICLE CODE
0020
Code
Year
What is the year, make, and model?
Make
c.
What is the amount of each payment?
d.
What period is covered by each payment?
0210
0230
1
2
OFFICE USE ONLY
Enter auto code
3.
How many cylinders does it have?
3
0040
4
0050
0
4. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
5a.
b.
Yes
No
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
0121
1
2
(Ask for vehicle code 100)
How many doors does it have?
0122
Is it a . . .?
0123
1
4
0130
1
2
b.
7.
If used for business – What percent of the mileage is
counted as a business expense?
How many miles are currently on the vehicle?
Does the payment include any charges other
than the lease amount such as auto
insurance or maintenance?
0240
1
2
X
f.
11.
If YES – How much of the payment is for
these extra charges?
Is any of the (period reported in item 10d)
leasing cost paid by an employer?
12.
Was a trade-in allowance received?
Yes, used for business
Personal use only – Go to item 7
0150
Percent
Don’t know
1
Yes – If YES – How much? –
No
8.
Was it new or used when first leased?
0160
1
New
9.
Was this vehicle leased from a –
0170
1
New or used vehicle dealer?
Independent leasing company?
Bank?
Someplace else? – Specify
2
3
4
1
Was a cash down payment made? (A down
payment is a capitalized cost reduction.)
0300
1
2
b.
Was any portion of the cash down payment
paid by an employer?
0320
1
2
Yes – If YES – How much? –
No
.00
Yes – If YES – How much? –
No – Go to item 14a
.00
Do you still have this vehicle?
0340
1
2
b.
Yes – If YES – How much? –
No
.00
0330 $
In what month was the lease terminated?
Used
Yes – Go to next vehicle or section 11
No
Month
0350
c.
Were any fees incurred at the termination of
the lease?
0360
1
2
0370 $
FORM CE-302
.00
0310 $
100%, delete
Ifthis
vehicle
and go to
next vehicle.
14a.
Miles
(Enter to nearest whole mile)
2
13a.
7
Semiannually
Annually
Other – Specify
X
2
0280
6
.00
0250 $
0260
5
Yes
No

 Go to item 11
Don’t know
0290 $
Station wagon?
Convertible?
Hatchback?
Other?
0140
Week
2 weeks
Month
Quarter
0270 $
Doors
3
Is it used for business?
e.
2
2
6a.
Cylinders
No cylinders (rotary, turbine
or electric)
.00
0220 $
Model
0030
Year
Yes – If YES – How much? –
No – Go to next vehicle
or section 11
.00
FORM CE-302
FIELD REPRESENTATIVE –
Section 11 – OWNED VEHICLES
Part A.1 – Screening Questions (If New Consumer Unit, Go to Part A.2)
If this box is marked, no vehicles were previously reported – Go to item 2a.
1.
2a.
Ask column h for each vehicle listed, except if vehicle has been disposed of previously ("Yes" in column b).
For each vehicle code 100 through 120 and 150 listed which has not been disposed of, ask column i.
OWNED VEHICLE INVENTORY CHART
a
b
Vehicle identification
Vehicle
disposed
Vehicle of (part C
number completed) Vehicle description
from part B, item 2
Vehicle identification from part B, item 3
YEAR
MAKE
Codes 100– Enter vehicle
120 and
code from
part B,
Vehicle 150 only
item 1b.
used for
Enter
business
mileage
from
from
part B,
part B, O V A C O D E
item 7a
item 10b
or part A.1,
YES NO column i
e
d
MODEL
h
i
Do you
still have
(vehicle)?
If NO –
complete
part C for
all vehicles
disposed of.
NO
1
1
2
0020
2
1
2
0030
3
1
2
0040
4
1
2
0050
5
1
2
0060
6
1
2
0070
7
1
2
0080
8
1
2
0090
9
1
2
0100
10
1
2
0110
11
1
2
0120
12
1
2
0130
13
1
2
0140
14
1
2
0150
15
1
2
0160
16
1
2
0170
17
1
2
0180
18
1
2
Page 52
NO
g
YES
0010
YES
f
OVAH AVE
c
OVANUM
PROCESSING USE ONLY
4 11 00 9
b.
Codes 100–120
and 150 only
How many miles
are currently on
the vehicle?
Enter to nearest
whole mile.
Information Booklet, page 28
Since the 1st of (month, 3 months
ago), have you (or any members of
your CU) purchased or acquired
any vehicle not used exclusively
for business? Include those vehicles
purchased for your own use or as a
gift to others.
0010
If YES – What kind of vehicle
was it?
Enter vehicle code from item 3 below.
0020
0030
0040
0050
0060
0070
0080
0090
0100
0110
O V A M IL E
3.
1 11 01 3
1
2
Yes
No – Go to next part or section
FIELD REPRESENTATIVE INSTRUCTION
Complete part B for each new vehicle.
VEHICLE
CODE
Automobile
Truck, including vans
Motorized camper-coach
Trailer type camper
Other attachable type camper
Motorcycle, motor scooter, or moped (motorized bicycle)
Boat, purchased with a motor
Boat, purchased without a motor
Trailer other than camper type, such as for a boat or cycle
Private plane
Any other vehicle (snowmobile, dune buggy, riding golf cart, etc.)
100
110
120
130
140
150
160
170
180
190
200
NOTES
Section 11 – Part A.1
Page 52
Page 53
Page 53
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to look at the item list as
you proceed. Ask part A.2 questions 1 through 3 for all vehicles and then complete part B
for each vehicle reported. Also complete part C for each vehicle disposed of.
Section 11 – OWNED VEHICLES – Continued
Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY
1.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
2a.
b.
c.
3a.
b.
c.
Information Booklet, page 28
Do you (or any members of your CU) own any of the
following vehicles not used exclusively for business?
VEHICLE
CODE
1 11 02 1
4.
YES
If YES – How many?
NO
Automobile
100
0010
1
2
0020
Truck, including vans
110
0030
1
2
0040
Motorized camper-coach
120
0050
1
2
0060
Trailer type camper
130
0070
1
2
0080
Other attachable type camper
140
0090
1
2
0100
Motorcycle, motor scooter, or moped (motorized bicycle)
150
0110
1
2
0120
Boat, purchased with a motor
160
0130
1
2
0140
Boat, purchased without a motor
170
0150
1
2
0160
Trailer other than camper type, such as for a boat or cycle
180
0170
1
2
0180
Private plane
190
0190
1
2
0200
Any other vehicle
200
0210
1
2
0220
0230
1
Have you (or any members of your CU) purchased any such
vehicles since the 1st of the (month, 3 months ago) as a gift to
someone outside of your CU?
2
NOTES
Yes – Ask items 2b and 2c
No – Go to item 3a
If YES – How many?
What kind of vehicle(s) did you purchase?
Enter a separate code for each vehicle.
Have you (or any members of your CU) disposed of any
automobiles or other vehicles since the 1st of (month,
3 months ago)?
0240
Number
0250
0260
0270
0280
0290
0300
0310
0320
0330
0340
1
2
Yes – Ask items 3b and 3c
No – Go to item 4
If YES – How many?
What kind of vehicle(s) did you dispose of?
Enter a separate code for each vehicle.
FORM CE-302
FIELD REPRESENTATIVE INSTRUCTIONS
Complete part B for each vehicle reported in items 1 and 2.
Complete parts B and C for each vehicle reported in item 3.
0350
Number
0360
0370
0380
0390
0400
0410
0420
0430
0440
0450
0460
0470
FORM CE-302
Section 11 – OWNED VEHICLES – Continued
Part B – Detailed Questions
1. FIELD REPRESENTATIVE ITEM
a. New CU’s – Assign vehicle numbers in
b.
consecutive order beginning with 1.
2nd through 5th interviews – Assign the
next available vehicle number from chart in
part A.1, column a.
Enter a vehicle code from part A.1 or A.2.
PROCESSING USE ONLY
a.
VEHICLE NUMBER
b. VEHICLE CODE
0010
VEHICI B
12a.
Number
0020
Was any portion of the purchase price financed?
0210
0200
1
VEHICY B
Code
Description
b.
Briefly describe the (vehicle).
Year VEHICY R Make
Model
0030
What is the year, make, and model?
OFFICE USE ONLY
Enter auto code
4.
How many cylinders does it have?
MK MDL Y
0040
CY L Q
0050
0
5. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
Cylinders
No cylinders (rotary, turbine, or electric)
Yes
No
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
0121
1
A UTOTRA N
PWRSTEER
PWRB RA K E
A IRCA R
SUNROOF
TURB OCHG
DIESEL
13a.
If YES – On the 1st of (month, 3 months ago), were all
loans on (vehicle) paid off or were there any remaining
payments to be made?
0220
Was a trade-in allowance received?
0230
2
1
2
b.
If YES – How much?
c.
d.
Ask for vehicle code 100.
How many doors does it have?
0122
Is it a . . .?
0123
Doors
1
2
3
4
7a.
Is it used for business?
0130
1
2
b.
If used for business – What percent of the mileage is counted as a
business expense?
0140
Yes, used for business
VEHB SNS
Personal use only – Go to item 8
If 100%, delete this
Percent vehicle and go to
next vehicle.
VEHB SNZ
8.
Was it new or used when acquired?
0150
1
New
9.
Was this vehicle purchased from –
0160
1
Vehicle dealership?
Private individual?
Other? – Specify
2
3
10a.
Was this vehicle –
0170
1
2
3
b.
Ask for item codes 100–120 and 150 only.
How many miles are currently on the vehicle?
Page 54
A UTOTY PE
2
Used
0250 $
.00
NETPURX
Did this price include sales tax?
0260
Was any of the amount or price paid by an employer?
f.
If YES – How much?
0270
2
Yes
No
1
Yes
1
EMPL EX P
Ask items 14 and 15 for credit payments only, "2" marked in item 12b.
What was the amount of the cash down payment?
0290 $
DNPA Y MTX
.00
What was the source of credit?
0300
Auto dealer
Finance company
Bank
Credit Union
b.
Ask if codes "2," "3," or "4" marked in item 15a.
Was this a home equity loan?
c.
How much was borrowed, excluding any interest?
d.
What was the number of payments contracted for?
e.
In what month and year was the first payment made?
0305
1
2
0310 $
Yes
No
What is the amount of each payment?
What period is covered by each payment?
PA Y MENTX
0360
Week
2 weeks
Month
Quarter
1
3
4
Section 11 – Part B
If YES – How much of the payment is for these extra
charges?
7
0370
Insurance company
Individual
Other – Specify
FIN_INST
.00
PMT1 Y R
0340
0350 $
VPURSRCE
i.
6
0320 VEHQPMT Payments
Month
Year
MO
PMT1
2
Does the payment include any charges other than
principal and interest such as auto insurance or credit
life insurance?
5
No – Go to item 14
VEHEQTL N
PRINCIPX
0330
h.
2
.00
1
Don’t know
SA L ESTA X
EMPL EX PX
4
g.
0180 VEHMIL E Miles – If item 10a is
code 3, go to next vehicle
X
0280 $
2
f.
TRA DE
What was the amount paid for it after trade-in
allowance and discount?
VEHNEWU
Purchased for own use? VEHGFTC
Purchased as a gift to others? –
Go to item 11
Received as gift?
Yes
No – Go to item 13c
TRA DEX
NUMDOOR
Station wagon?
Convertible?
Hatchback?
Other?
Paid off – If item 11 is prior to 3 months
ago, go to next vehicle.
Remaining payments
VFINSTA T
.00
e.
14.
15a.
Yes
VFINA NCE
No – If item 11 is prior to 3 months ago, go
to next vehicle. If item 11 is during the
last 3 months, go to item 13a.
0240 $
FRWHL DRV
2
1
3
6a.
b.
Year VEHPURY R
Month
VEHPURMO
2
Complete items 3, 4, and 5 for autos and trucks only
(vehicle codes 100 and 110).
3.
In what month and year was it purchased?
0190
Do not ask for vehicle codes 100 or 110.
2.
11.
1 11 03 9
1
2
X
0380 $
.00
5
6
7
Semiannually
Annually
Other – Specify
PMTPERD
Yes
EX TRA CHG
No
 Go to next vehicle or part

Don’t know or section
EX TRCHGX
.00
X
Don’t know
Page 54
Page 55
Page 55
Section 11 – OWNED VEHICLES – Continued
Part B – Detailed Questions – Continued
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
a. New CU’s – Assign vehicle numbers in
b.
consecutive order beginning with 1.
2nd through 5th interviews – Assign the
next available vehicle number from chart in
part A.1, column a.
Enter a vehicle code from part A.1 or A.2.
a.
VEHICLE NUMBER
b. VEHICLE CODE
12a.
Number
0020
Was any portion of the purchase price financed?
0210
0200
1
Code
b.
Year
Make
Model
13a.
0030
If YES – On the 1st of (month, 3 months ago), were all
loans on (vehicle) paid off or were there any remaining
payments to be made?
0220
Was a trade-in allowance received?
0230
1
2
1
2
OFFICE USE ONLY
Enter auto code
4.
0010
Briefly describe the (vehicle).
What is the year, make, and model?
How many cylinders does it have?
0040
0050
0
5. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
Cylinders
No cylinders (rotary, turbine, or electric)
b.
If YES – How much?
c.
d.
0250 $
.00
Did this price include sales tax?
0260
No
1
2
0070
1
2
e.
Was any of the amount or price paid by an employer?
0080
1
2
f.
If YES – How much?
0090
1
2
0100
1
2
1
2
0120
1
2
0121
1
Ask for vehicle code 100.
How many doors does it have?
0122
Is it a . . .?
0123
0270
Yes
No
X
Don’t know
2
1
Yes
2
No – Go to item 14
1
0280 $
.00
Ask items 14 and 15 for credit payments only, "2" marked in item 12b.
What was the amount of the cash down payment?
0290 $
.00
What was the source of credit?
0300
1
2
2
4
1
3
4
Is it used for business?
0130
1
2
b.
Station wagon?
Convertible?
Hatchback?
Other?
Yes, used for business
Personal use only – Go to item 8
If 100%, delete this
Percent vehicle and go to
next vehicle.
If used for business – What percent of the mileage is counted as a
business expense?
0140
8.
Was it new or used when acquired?
0150
1
New
9.
Was this vehicle purchased from –
0160
1
Vehicle dealership?
Private individual?
Other? – Specify
2
3
10a.
Was this vehicle –
0170
1
2
3
b.
Ask for item codes 100–120 and 150 only.
How many miles are currently on the vehicle?
FORM CE-302
0180
Auto dealer
Finance company
Bank
Credit Union
5
6
7
Insurance company
Individual
Other – Specify
Doors
2
7a.
Yes
No – Go to item 13c
What was the amount paid for it after trade-in
allowance and discount?
Yes
0110
Paid off – If item 11 is prior to 3 months
ago, go to next vehicle.
Remaining payments
.00
0060
14.
15a.
Yes
No – If item 11 is prior to 3 months ago, go
to next vehicle. If item 11 is during the
last 3 months, go to item 13a.
0240 $
3
6a.
b.
Year
0190
Description
Complete items 3, 4, and 5 for autos and trucks only
(vehicle codes 100 and 110).
3.
Month
In what month and year was it purchased?
2
Do not ask for vehicle codes 100 or 110.
2.
11.
1 11 04 7
2
b.
Ask if codes "2," "3," or "4" marked in item 15a.
Was this a home equity loan?
c.
How much was borrowed, excluding any interest?
d.
What was the number of payments contracted for?
e.
In what month and year was the first payment made?
Miles – If item 10a is
code 3, go to next vehicle
1
2
Yes
No
.00
0310 $
0320
Month
Payments
Year
0330
f.
What is the amount of each payment?
Used
Purchased for own use?
Purchased as a gift to others? –
Go to item 11
Received as gift?
0305
g.
What period is covered by each payment?
0340
0360
1
2
3
4
h.
i.
Does the payment include any charges other than
principal and interest such as auto insurance or credit
life insurance?
If YES – How much of the payment is for these extra
charges?
.00
0350 $
0370
1
2
X
0380 $
Week
2 weeks
Month
Quarter
5
6
7
Semiannually
Annually
Other – Specify
Yes
No
 Go to next vehicle or part

Don’t know or section
.00
X
Don’t know
FORM CE-302
Section 11 – OWNED VEHICLES – Continued
Part B – Detailed Questions – Continued
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
a. New CU’s – Assign vehicle numbers in
b.
consecutive order beginning with 1.
2nd through 5th interviews – Assign the
next available vehicle number from chart in
part A.1, column a.
Enter a vehicle code from part A.1 or A.2.
a.
VEHICLE NUMBER
b. VEHICLE CODE
12a.
Number
0020
Was any portion of the purchase price financed?
0210
0200
1
Code
b.
Year
Make
Model
13a.
0030
If YES – On the 1st of (month, 3 months ago), were all
loans on (vehicle) paid off or were there any remaining
payments to be made?
0220
Was a trade-in allowance received?
0230
1
2
1
2
OFFICE USE ONLY
Enter auto code
4.
0010
Description
What is the year, make, and model?
How many cylinders does it have?
0040
0050
0
5. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
Cylinders
No cylinders (rotary, turbine, or electric)
b.
If YES – How much?
c.
d.
0250 $
.00
Did this price include sales tax?
0260
0060
1
2
0070
1
2
e.
Was any of the amount or price paid by an employer?
0080
1
2
f.
If YES – How much?
0090
1
2
0100
1
2
0110
1
2
0120
1
2
1
Ask for vehicle code 100.
How many doors does it have?
0122
Is it a . . .?
0123
0270
Yes
No
X
Don’t know
2
1
Yes
2
No – Go to item 14
1
0280 $
.00
Ask items 14 and 15 for credit payments only, "2" marked in item 12b.
What was the amount of the cash down payment?
0290 $
.00
What was the source of credit?
0300
1
2
2
4
1
3
4
Is it used for business?
0130
1
2
b.
If used for business – What percent of the mileage is counted as a
business expense?
Station wagon?
Convertible?
Hatchback?
Other?
Yes, used for business
Personal use only – Go to item 8
If 100%, delete this
Percent vehicle and go to
next vehicle.
0140
8.
Was it new or used when acquired?
0150
1
New
9.
Was this vehicle purchased from –
0160
1
Vehicle dealership?
Private individual?
Other? – Specify
2
3
10a.
Was this vehicle –
0170
1
2
3
b.
Ask for item codes 100–120 and 150 only.
How many miles are currently on the vehicle?
Page 56
0180
Auto dealer
Finance company
Bank
Credit Union
5
6
7
Insurance company
Individual
Other – Specify
Doors
2
7a.
Yes
No – Go to item 13c
What was the amount paid for it after trade-in
allowance and discount?
No
0121
Paid off – If item 11 is prior to 3 months
ago, go to next vehicle.
Remaining payments
.00
Yes
14.
15a.
Yes
No – If item 11 is prior to 3 months ago, go
to next vehicle. If item 11 is during the
last 3 months, go to item 13a.
0240 $
3
6a.
b.
Year
0190
Briefly describe the (vehicle).
Complete items 3, 4, and 5 for autos and trucks only
(vehicle codes 100 and 110).
3.
Month
In what month and year was it purchased?
2
Do not ask for vehicle codes 100 or 110.
2.
11.
1 11 05 4
2
b.
Ask if codes "2," "3," or "4" marked in item 15a.
Was this a home equity loan?
c.
How much was borrowed, excluding any interest?
d.
What was the number of payments contracted for?
e.
0305
1
2
0320
Month
Payments
Year
0330
f.
g.
What is the amount of each payment?
What period is covered by each payment?
0340
0360
1
3
4
h.
i.
Does the payment include any charges other than
principal and interest such as auto insurance or credit
life insurance?
If YES – How much of the payment is for these extra
charges?
Section 11 – Part B (Continued)
.00
0350 $
2
Miles – If item 10a is
code 3, go to next vehicle
.00
0310 $
In what month and year was the first payment made?
Used
Purchased for own use?
Purchased as a gift to others? –
Go to item 11
Received as gift?
Yes
No
0370
1
2
X
0380 $
Week
2 weeks
Month
Quarter
5
6
7
Semiannually
Annually
Other – Specify
Yes
No
 Go to next vehicle or part

Don’t know or section
.00
X
Don’t know
Page 56
Page 57
Page 57
Section 11 – OWNED VEHICLES – Continued
Part B – Detailed Questions – Continued
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
a. New CU’s – Assign vehicle numbers in
b.
consecutive order beginning with 1.
2nd through 5th interviews – Assign the
next available vehicle number from chart in
part A.1, column a.
Enter a vehicle code from part A.1 or A.2.
a.
VEHICLE NUMBER
b. VEHICLE CODE
12a.
Number
0020
Was any portion of the purchase price financed?
0210
0200
1
Code
b.
Year
Make
Model
13a.
0030
If YES – On the 1st of (month, 3 months ago), were all
loans on (vehicle) paid off or were there any remaining
payments to be made?
0220
Was a trade-in allowance received?
0230
1
2
1
2
OFFICE USE ONLY
Enter auto code
4.
0010
Briefly describe the (vehicle).
What is the year, make, and model?
How many cylinders does it have?
0040
0050
0
5. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
Cylinders
No cylinders (rotary, turbine, or electric)
b.
If YES – How much?
c.
d.
0250 $
.00
Did this price include sales tax?
0260
No
1
2
0070
1
2
e.
Was any of the amount or price paid by an employer?
0080
1
2
f.
If YES – How much?
0090
1
2
0100
1
2
1
2
0120
1
2
0121
1
Ask for vehicle code 100.
How many doors does it have?
0122
Is it a . . .?
0123
0270
Yes
No
X
Don’t know
2
1
Yes
2
No – Go to item 14
1
0280 $
.00
Ask items 14 and 15 for credit payments only, "2" marked in item 12b.
What was the amount of the cash down payment?
0290 $
.00
What was the source of credit?
0300
1
2
2
4
1
3
4
Is it used for business?
0130
1
2
b.
Station wagon?
Convertible?
Hatchback?
Other?
Yes, used for business
Personal use only – Go to item 8
If 100%, delete this
Percent vehicle and go to
next vehicle.
If used for business – What percent of the mileage is counted as a
business expense?
0140
8.
Was it new or used when acquired?
0150
1
New
9.
Was this vehicle purchased from –
0160
1
Vehicle dealership?
Private individual?
Other? – Specify
2
3
10a.
Was this vehicle –
0170
1
2
3
b.
Ask for item codes 100–120 and 150 only.
How many miles are currently on the vehicle?
FORM CE-302
0180
Auto dealer
Finance company
Bank
Credit Union
5
6
7
Insurance company
Individual
Other – Specify
Doors
2
7a.
Yes
No – Go to item 13c
What was the amount paid for it after trade-in
allowance and discount?
Yes
0110
Paid off – If item 11 is prior to 3 months
ago, go to next vehicle.
Remaining payments
.00
0060
14.
15a.
Yes
No – If item 11 is prior to 3 months ago, go
to next vehicle. If item 11 is during the
last 3 months, go to item 13a.
0240 $
3
6a.
b.
Year
0190
Description
Complete items 3, 4, and 5 for autos and trucks only
(vehicle codes 100 and 110).
3.
Month
In what month and year was it purchased?
2
Do not ask for vehicle codes 100 or 110.
2.
11.
1 11 06 2
2
b.
Ask if codes "2," "3," or "4" marked in item 15a.
Was this a home equity loan?
c.
How much was borrowed, excluding any interest?
d.
What was the number of payments contracted for?
e.
In what month and year was the first payment made?
Miles – If item 10a is
code 3, go to next vehicle
1
2
Yes
No
.00
0310 $
0320
Month
Payments
Year
0330
f.
What is the amount of each payment?
Used
Purchased for own use?
Purchased as a gift to others? –
Go to item 11
Received as gift?
0305
g.
What period is covered by each payment?
0340
0360
1
2
3
4
h.
i.
Does the payment include any charges other than
principal and interest such as auto insurance or credit
life insurance?
If YES – How much of the payment is for these extra
charges?
.00
0350 $
0370
1
2
X
0380 $
Week
2 weeks
Month
Quarter
5
6
7
Semiannually
Annually
Other – Specify
Yes
No
 Go to next vehicle or part

Don’t know or section
.00
X
Don’t know
FORM CE-302
Section 11 – OWNED VEHICLES – Continued
Part B – Detailed Questions – Continued
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
a. New CU’s – Assign vehicle numbers in
b.
consecutive order beginning with 1.
2nd through 5th interviews – Assign the
next available vehicle number from chart in
part A.1, column a.
Enter a vehicle code from part A.1 or A.2.
a.
VEHICLE NUMBER
b. VEHICLE CODE
12a.
Number
0020
Was any portion of the purchase price financed?
0210
0200
1
Code
b.
Year
Make
Model
13a.
0030
If YES – On the 1st of (month, 3 months ago), were all
loans on (vehicle) paid off or were there any remaining
payments to be made?
0220
Was a trade-in allowance received?
0230
1
2
1
2
OFFICE USE ONLY
Enter auto code
4.
0010
Description
What is the year, make, and model?
How many cylinders does it have?
0040
0050
0
5. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
Cylinders
No cylinders (rotary, turbine, or electric)
b.
If YES – How much?
c.
d.
0250 $
.00
Did this price include sales tax?
0260
0060
1
2
0070
1
2
e.
Was any of the amount or price paid by an employer?
0080
1
2
f.
If YES – How much?
0090
1
2
0100
1
2
0110
1
2
0120
1
2
1
Ask for vehicle code 100.
How many doors does it have?
0122
Is it a . . .?
0123
0270
Yes
No
X
Don’t know
2
1
Yes
2
No – Go to item 14
1
0280 $
.00
Ask items 14 and 15 for credit payments only, "2" marked in item 12b.
What was the amount of the cash down payment?
0290 $
.00
What was the source of credit?
0300
1
2
2
4
1
3
4
Is it used for business?
0130
1
2
b.
If used for business – What percent of the mileage is counted as a
business expense?
Station wagon?
Convertible?
Hatchback?
Other?
Yes, used for business
Personal use only – Go to item 8
If 100%, delete this
Percent vehicle and go to
next vehicle.
0140
8.
Was it new or used when acquired?
0150
1
New
9.
Was this vehicle purchased from –
0160
1
Vehicle dealership?
Private individual?
Other? – Specify
2
3
10a.
Was this vehicle –
0170
1
2
3
b.
Ask for item codes 100–120 and 150 only.
How many miles are currently on the vehicle?
Page 58
0180
Auto dealer
Finance company
Bank
Credit Union
5
6
7
Insurance company
Individual
Other – Specify
Doors
2
7a.
Yes
No – Go to item 13c
What was the amount paid for it after trade-in
allowance and discount?
No
0121
Paid off – If item 11 is prior to 3 months
ago, go to next vehicle.
Remaining payments
.00
Yes
14.
15a.
Yes
No – If item 11 is prior to 3 months ago, go
to next vehicle. If item 11 is during the
last 3 months, go to item 13a.
0240 $
3
6a.
b.
Year
0190
Briefly describe the (vehicle).
Complete items 3, 4, and 5 for autos and trucks only
(vehicle codes 100 and 110).
3.
Month
In what month and year was it purchased?
2
Do not ask for vehicle codes 100 or 110.
2.
11.
1 11 07 0
2
b.
Ask if codes "2," "3," or "4" marked in item 15a.
Was this a home equity loan?
c.
How much was borrowed, excluding any interest?
d.
What was the number of payments contracted for?
e.
0305
1
2
0320
Month
Payments
Year
0330
f.
g.
What is the amount of each payment?
What period is covered by each payment?
0340
0360
1
3
4
h.
i.
Does the payment include any charges other than
principal and interest such as auto insurance or credit
life insurance?
If YES – How much of the payment is for these extra
charges?
Section 11 – Part B (Continued)
.00
0350 $
2
Miles – If item 10a is
code 3, go to next vehicle
.00
0310 $
In what month and year was the first payment made?
Used
Purchased for own use?
Purchased as a gift to others? –
Go to item 11
Received as gift?
Yes
No
0370
1
2
X
0380 $
Week
2 weeks
Month
Quarter
5
6
7
Semiannually
Annually
Other – Specify
Yes
No
 Go to next vehicle or part

Don’t know or section
.00
X
Don’t know
Page 58
Page 59
Page 59
Section 11 – OWNED VEHICLES – Continued
Part B – Detailed Questions – Continued
1. FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
a. New CU’s – Assign vehicle numbers in
b.
consecutive order beginning with 1.
2nd through 5th interviews – Assign the
next available vehicle number from chart in
part A.1, column a.
Enter a vehicle code from part A.1 or A.2.
a.
VEHICLE NUMBER
b. VEHICLE CODE
12a.
Number
0020
Was any portion of the purchase price financed?
0210
0200
1
Code
b.
Year
Make
Model
13a.
0030
If YES – On the 1st of (month, 3 months ago), were all
loans on (vehicle) paid off or were there any remaining
payments to be made?
0220
Was a trade-in allowance received?
0230
1
2
1
2
OFFICE USE ONLY
Enter auto code
4.
0010
Briefly describe the (vehicle).
What is the year, make, and model?
How many cylinders does it have?
0040
0050
0
5. Does it have –
a. Automatic transmission?
b. Power steering?
c. Power brakes?
d. Air conditioning?
e. Sun roof?
f. Turbo charged engine?
g. Diesel engine?
h. Four wheel drive?
Cylinders
No cylinders (rotary, turbine, or electric)
b.
If YES – How much?
c.
d.
0250 $
.00
Did this price include sales tax?
0260
No
1
2
0070
1
2
e.
Was any of the amount or price paid by an employer?
0080
1
2
f.
If YES – How much?
0090
1
2
0100
1
2
1
2
0120
1
2
0121
1
Ask for vehicle code 100.
How many doors does it have?
0122
Is it a . . .?
0123
0270
Yes
No
X
Don’t know
2
1
Yes
2
No – Go to item 14
1
0280 $
.00
Ask items 14 and 15 for credit payments only, "2" marked in item 12b.
What was the amount of the cash down payment?
0290 $
.00
What was the source of credit?
0300
1
2
2
4
1
3
4
Is it used for business?
0130
1
2
b.
Station wagon?
Convertible?
Hatchback?
Other?
Yes, used for business
Personal use only – Go to item 8
If 100%, delete this
Percent vehicle and go to
next vehicle.
If used for business – What percent of the mileage is counted as a
business expense?
0140
8.
Was it new or used when acquired?
0150
1
New
9.
Was this vehicle purchased from –
0160
1
Vehicle dealership?
Private individual?
Other? – Specify
2
3
10a.
Was this vehicle –
0170
1
2
3
b.
Ask for item codes 100–120 and 150 only.
How many miles are currently on the vehicle?
FORM CE-302
0180
Auto dealer
Finance company
Bank
Credit Union
5
6
7
Insurance company
Individual
Other – Specify
Doors
2
7a.
Yes
No – Go to item 13c
What was the amount paid for it after trade-in
allowance and discount?
Yes
0110
Paid off – If item 11 is prior to 3 months
ago, go to next vehicle.
Remaining payments
.00
0060
14.
15a.
Yes
No – If item 11 is prior to 3 months ago, go
to next vehicle. If item 11 is during the
last 3 months, go to item 13a.
0240 $
3
6a.
b.
Year
0190
Description
Complete items 3, 4, and 5 for autos and trucks only
(vehicle codes 100 and 110).
3.
Month
In what month and year was it purchased?
2
Do not ask for vehicle codes 100 or 110.
2.
11.
1 11 08 8
2
b.
Ask if codes "2," "3," or "4" marked in item 15a.
Was this a home equity loan?
c.
How much was borrowed, excluding any interest?
d.
What was the number of payments contracted for?
e.
In what month and year was the first payment made?
Miles – If item 10a is
code 3, go to next vehicle
1
2
Yes
No
.00
0310 $
0320
Month
Payments
Year
0330
f.
What is the amount of each payment?
Used
Purchased for own use?
Purchased as a gift to others? –
Go to item 11
Received as gift?
0305
g.
What period is covered by each payment?
0340
0360
1
2
3
4
h.
i.
Does the payment include any charges other than
principal and interest such as auto insurance or credit
life insurance?
If YES – How much of the payment is for these extra
charges?
.00
0350 $
0370
1
2
X
0380 $
Week
2 weeks
Month
Quarter
5
6
7
Semiannually
Annually
Other – Specify
Yes
No
 Go to next vehicle or part

Don’t know or section
.00
X
Don’t know
FORM CE-302
Section 11 – OWNED VEHICLES – Continued
Part C – Disposed of Vehicles
1.
2a.
FIELD REPRESENTATIVE
ITEM
Complete a column in the
1st interview in which the
vehicle is disposed of.
Enter vehicle number and
vehicle code.
PROCESSING USE ONLY
a.
VEHICLE NUMBER
b. VEHICLE CODE
How did you dispose of the vehicle?
Mark (X) one box.
1 11 51 8
VEHICIC
0010
Number
0010
Number
0010
Number
0020
Code
VEHICY C
0020
Code
0020
Code
0020
Code
0030
1
2
5
6
4a.
In what month was it (read answer from
item 2a)?
0040
If sold (code 1, item 2a).
How much did you sell it for?
0050 $
If damaged beyond repair (code 4, item 2a)
or stolen (code 5, item 2a).
Were you reimbursed for the value of
the vehicle?
b.
How much did you receive for the vehicle?
c.
Do you expect to be reimbursed for the value
of the vehicle?
0060
1
2
0070 $
0080
5a.
1
2
b.
How much will you receive for the vehicle?
0090 $
Were there any outstanding loans on
the vehicle when it was disposed of?
0100
1
2
3
4
5
6
SA L EX
Yes
No – Go to item 4c
REIMB URX
.00 Go to item 5a
REIMB URS
Yes
No – Go to item 5a
Don’t know
EX REIMB X
0060
0080
FINPA Y MT
Yes
No – Go to next vehicle
0110
0120 $
FINPA Y MX
.00
Yes
No – Go to item 4c
0030
3
4
5
6
X
Yes
No – Go to next vehicle
0100
Yes
No – Go to next vehicle
0110
.00
0120 $
Yes
No – Go to item 4c
0030
3
4
5
6
X
Yes
No – Go to next vehicle
0100
Yes
No – Go to next vehicle
0110
0120 $
.00
Yes
No – Go to item 4c
.00 Go to item 5a
Yes
No – Go to item 5a
Don’t know
.00
0090 $
1
2
1
2
Don’t know
1
1
0070 $
0080
.00
.00 Go to item 5a
0050 $
2
Yes
No – Go to item 5a
Don’t know
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
Other – Specify
Month – If code 3 in item 2a,
go to item 5a
0040
X
2
1
2
0060
.00 Go to item 5a
0090 $
1
2
1
2
Don’t know
1
1
0070 $
0080
.00
.00 Go to item 5a
0050 $
2
Yes
No – Go to item 5a
Don’t know
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
Other – Specify
Month – If code 3 in item 2a,
go to item 5a
0040
X
2
1
2
0060
.00 Go to item 5a
0090 $
0100
If YES – How much was the final payment?
1
X
Yes
L OA NSTA T
No – Go to next vehicle
1
1
2
EX REIMB
.00
.00 Go to item 5a
0070 $
1
Were any final payments made on the loan?
Month – If code 3 in item 2a,
go to item 5a
2
.00 Go to item 5a
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
Other – Specify
0050 $
Don’t know
2
c.
0030
X
2
0110
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
VEHDISP
Other – Specify
Month – If code 3 in item 2a,
go to item 5a VDISPMO 0040
X
d.
1 11 54 2
Number
4
3.
1 11 53 4
0010
3
b.
1 11 52 6
X
Don’t know
1
Yes
No – Go to next vehicle
2
1
2
0120 $
Yes
No – Go to next vehicle
.00
NOTES
Page 60
Section 11 – Part C (Continued)
Page 60
Page 61
Page 61
Section 11 – OWNED VEHICLES – Continued
Part C – Disposed of Vehicles – Continued
1.
2a.
FIELD REPRESENTATIVE
ITEM
Complete a column in the
1st interview in which the
vehicle is disposed of.
Enter vehicle number and
vehicle code.
PROCESSING USE ONLY
a.
VEHICLE NUMBER
b. VEHICLE CODE
How did you dispose of the vehicle?
Mark (X) one box.
1 11 55 9
0010
Number
0010
Number
0010
Number
0020
Code
0020
Code
0020
Code
0020
Code
0030
1
2
5
6
4a.
In what month was it (read answer from
item 2a)?
0040
If sold (code 1, item 2a).
How much did you sell it for?
0050 $
If damaged beyond repair (code 4, item 2a)
or stolen (code 5, item 2a).
Were you reimbursed for the value of
the vehicle?
b.
How much did you receive for the vehicle?
c.
Do you expect to be reimbursed for the value
of the vehicle?
0060
5a.
b.
1
2
.00 Go to item 5a
Yes
No – Go to item 4c
0080
1
2
Were there any outstanding loans on
the vehicle when it was disposed of?
0100
2
3
4
5
6
.00 Go to item 5a
0050 $
1
Yes
No – Go to item 4c
1
2
X
Don’t know
1
Yes
No – Go to next vehicle
0100
Yes
No – Go to next vehicle
0110
2
3
4
5
6
.00 Go to item 5a
0050 $
1
Yes
No – Go to item 4c
1
2
X
Don’t know
1
Yes
No – Go to next vehicle
0100
Yes
No – Go to next vehicle
0110
2
3
4
5
6
.00 Go to item 5a
0050 $
1
Yes
No – Go to item 4c
.00 Go to item 5a
0070 $
0080
1
2
X
.00
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
Other – Specify
Month – If code 3 in item 2a,
go to item 5a
0040
Yes
No – Go to item 5a
Don’t know
.00
0090 $
X
Don’t know
1
Yes
No – Go to next vehicle
0100
Yes
No – Go to next vehicle
0110
2
1
2
Yes
No – Go to item 5a
Don’t know
0090 $
0030
0060
.00 Go to item 5a
0070 $
0080
.00
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
Other – Specify
Month – If code 3 in item 2a,
go to item 5a
0040
X
2
1
2
Yes
No – Go to item 5a
Don’t know
0090 $
0030
0060
.00 Go to item 5a
0070 $
X
2
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
Other – Specify
Month – If code 3 in item 2a,
go to item 5a
0040
0080
.00
0090 $
1
2
Yes
No – Go to item 5a
Don’t know
How much will you receive for the vehicle?
0030
0060
.00 Go to item 5a
0070 $
X
Don’t know
1
Yes
No – Go to next vehicle
2
Were any final payments made on the loan?
0110
1
2
c.
Sold?
Traded in?
Given away to someone outside the
CU, including students away at
school?
Damaged beyond repair?
Stolen?
Other – Specify
Month – If code 3 in item 2a,
go to item 5a
X
d.
1 11 58 3
Number
4
3.
1 11 57 5
0010
3
b.
1 11 56 7
If YES – How much was the final payment?
0120 $
.00
1
2
.00
0120 $
NOTES
FORM CE-302
1
2
0120 $
.00
1
2
0120 $
Yes
No – Go to next vehicle
.00
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 12 – VEHICLE OPERATING EXPENSES
Part A – Vehicle Maintenance and Repair, Parts, and Equipment
b
Oil change, lubrication,
and oil filter
100
Motor tune-up
110
Brake work
120
Battery purchases
and installation
130
Tire purchases
and mounting
140
Tire repair
150
Front end alignment,
wheel balancing and
wheel rotation
160
Steering or front-end
work
170
Electrical system work
180
Engine repair
or replacement
190
Air conditioning work
200
Engine cooling
system work
NO
Which vehicle was it for?
Describe briefly and
enter the vehicle code
from the vehicle code list.
VOPVENY A
Description
Vehicle
code
FIELD REPRESENTATIVE
CHECK ITEM
Page 62
i
Did this
include
sales tax?
VOPEX PX
Month
YES
j
Has any of
IF YES –
this expense
How much?
or will any
of it be
reimbursed?
Did you
have any
other
expenses
for . . .?
If "No", go to
column k.
If "No", go to
next item in
column a.
VOPRMB X A
VOPREIMB
NO
PRE
k
YES
NO
YES
Description
from column b
Month
from
column f
Cost from
column g
$
.00
$
.00
$
.00
$
.00
NO
0010
1
2
$
.00
1
2
1
2
$
.00
$
.00
0020
1
2
$
.00
1
2
1
2
$
.00
$
.00
0030
1
2
$
.00
1
2
1
2
$
.00
$
.00
0040
1
2
$
.00
1
2
1
2
$
.00
$
.00
0050
1
2
$
.00
1
2
1
2
$
.00
$
.00
0060
1
2
$
.00
1
2
1
2
$
.00
$
.00
0070
1
2
$
.00
1
2
1
2
$
.00
$
.00
0080
1
2
$
.00
1
2
1
2
$
.00
0090
1
2
$
.00
1
2
1
2
$
.00
0100
1
2
$
.00
1
2
1
2
$
.00
0110
1
2
$
.00
1
2
1
2
$
.00
0120
1
2
$
.00
1
2
1
2
$
.00
0130
1
2
$
.00
1
2
1
2
$
.00
0140
1
2
$
.00
1
2
1
2
$
.00
0150
1
2
$
.00
1
2
1
2
$
.00
YES NO
210
1 12 01 1
Mark (X) box if there are 0010
no entries recorded in
columns b–k.
h
In what
What was the
month
total cost?
did you
have this
expense?
NOTES
2.
g
VOPTA X
ITEM
CODE
Did this
expense
include
labor?
YES
f
e
VOPMOA
Since the 1st of (month, 3 months ago),
have you (or any members of your
CU) had expenses for any of the
following?
Enter a brief
description.
ENTER
ITEM
CODE
from
column a.
d
VOPL A B OR
1.
What was the
expense for?
c
VOPSERVY
Information Booklet, pages 29 and 30
I will now ask about expenses for
vehicle services, parts, and
equipment. Please do not include
expenses for vehicles used entirely
for business.
PROCESSING USE ONLY
a
8 12 02 4
999
Go to
next
page
Section 12 – Part A
VEHICLE CODES
Automobile
100
Truck
110
Motorized camper
120
Trailer camper
130
Other attachable-type camper
140
Motorcycle, scooter, or moped
150
Boat, with motor
160
Boat, without motor
170
Trailer, other than camper such
as for boat
180
Private plane
190
Any other vehicle
200
Page 62
Page 63
Page 63
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed. Ask
column a and complete columns b through k for each expense reported before going to the next item in
column a. Complete a separate line for each item.
Section 12 – VEHICLE OPERATING EXPENSES – Continued
Part A – Vehicle Maintenance and Repair, Parts, and Equipment
1.
b
Information Booklet, pages 30 and 31
Since the 1st of (month, 3 months ago),
have you (or any members of your
CU) had expenses for any of the
following?
ITEM
CODE
Exhaust system work
300
Clutch or transmission
work
310
Body work and painting
320
Shock absorber
replacement
330
Drive shaft or rear-end
work
340
Audio equipment and
installation
Vehicle accessories and
customizing
Other vehicle services,
parts, and equipment
YES
NO
2.
FIELD REPRESENTATIVE
CHECK ITEM
360
370
500
Enter a brief
description.
ENTER
ITEM
CODE
from
column a.
d
Did this
expense
include
labor?
YES
f
e
NO
Which vehicle was it for?
Describe briefly and
enter the vehicle code
from the vehicle code list.
Description
Vehicle
code
g
h
In what
What was the
month
total cost?
did you
have this
expense?
i
Did this
include
sales tax?
Month
YES
NO
j
Has
IF YES –
any of
this expense How much?
or will any
of it be
reimbursed?
If "No", go to
column k.
YES
PRE
k
Did you
have any
other
expenses
for . . .?
Description
from column b
Month
from
column f
If "No", go to
next item in
column a.
NO
YES
Cost from
column g
$
.00
$
.00
$
.00
$
.00
NO
0010
1
2
$
.00
1
2
1
2
$
.00
$
.00
0020
1
2
$
.00
1
2
1
2
$
.00
$
.00
0030
1
2
$
.00
1
2
1
2
$
.00
$
.00
0040
1
2
$
.00
1
2
1
2
$
.00
$
.00
0050
1
2
$
.00
1
2
1
2
$
.00
$
.00
0060
1
2
$
.00
1
2
1
2
$
.00
$
.00
0070
1
2
$
.00
1
2
1
2
$
.00
$
.00
0080
1
2
$
.00
1
2
1
2
$
.00
0090
1
2
$
.00
1
2
1
2
$
.00
0100
1
2
$
.00
1
2
1
2
$
.00
0110
1
2
$
.00
1
2
1
2
$
.00
0120
1
2
$
.00
1
2
1
2
$
.00
0130
1
2
$
.00
1
2
1
2
$
.00
0140
1
2
$
.00
1
2
1
2
$
.00
0150
1
2
$
.00
1
2
1
2
$
.00
1 12 03 7
Mark (X) box if there are 0010
no entries recorded in
columns b–k.
FORM CE-302
What was the
expense for?
c
350
Use only if unable to
itemize separately.
Combined expenses
(Codes 100–370)
PROCESSING USE ONLY
a
8 12 04 0
999
Go to
Part B
Section 12 – Part A
NOTES
FORM CE-302
FIELD REPRESENTATIVE – Ask column a and complete columns b–f for each expense reported before
going to next item in column a.
Section 12 – VEHICLE OPERATING EXPENSES – Continued
䊳
Part B – Licensing, Registration, and Inspection of Vehicles
1.
b
Since the 1st of (month, 3 months
ago), have you (or any members of
your CU) had expenses for –
Vehicle inspection?
410
Vehicle registration?
Use only if unable to
itemize above –
Combined expenses
420
430
1 12 25 0
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if
0010 999
Go to
there are no
part C
entries recorded
in columns b–f.
0010
0020
0030
0040
NOTES
0050
0060
0070
0080
0090
0100
0110
0120
0130
0140
0150
0160
0170
0180
Page 64
Enter the item description
from column a.
In what
month
did you
have this
expense?
e
f
What was the
total amount of
the expense?
VOPREGX
400
ENTER
ITEM
CODE
from
column a.
d
VOPMO_C
2.
Driver’s license?
c
VOPREGY
ITEM
CODE YES NO
PROCESSING USE ONLY
a
3 12 26 4
Month
Did you
have any
other
expenses
for . . .?
If "No,"
go to next
item in
column a.
YES
$
.00
$
.00
$
.00
$
.00
NOTES
PRE
NO
1
2
3
Description
from
column b
Month
from
column d
Cost from
column e
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
Section 12 – Part B
Page 64
Page 65
Page 65
Section 12 – VEHICLE OPERATING EXPENSES – Continued
Part C – Other Vehicle Operating Expenses
1a. Since the 1st of (month, 3 months ago), what has been the CU’s
b.
1 12 51 6
AVERAGE MONTHLY expense for gasoline and other fuels (including
gasohol) to operate automobiles, trucks, motorcycles, or any other
vehicles?
0010 $
Was any of this expense for the purchase of diesel fuel?
0020
0
1
2
c.
d.
If YES – How much?
0030 $
Was any of the average monthly cost counted as a business expense?
0040
1
2
e.
2a.
b.
c.
How much of the (dollar amount in item 1a) was counted as a business
expense?
Since the 1st of (month, 3 months ago), have you (or any members of
your CU) purchased any oil for operating vehicles, other than oil
included with the purchase of an oil change? Do not include
purchases for vehicles used entirely for business.
3a.
b.
4.
.00
a.
None – Go to item 2a
Yes
VOPDIES
No – Go to item 1d
VOPDIESX
b.
.00
Since the 1st of (month, 3 months ago), have any members of your CU
had expenses for –
Parking, including garage rental, metered parking, and parking lot
fees, except any expenses included in property ownership costs? Do
not include parking expenses that are totally reimbursed or paid
entirely for business.
If YES – How much was paid, excluding any payments made this
month?
0120
1
2
0130 $
0
VOPB SNS
Yes
No – Go to item 2a
c.
Towing charges, excluding contracted or pre-paid towing charges?
0140
1
2
0050 $
0060
1
2
VOPB SNSX
.00
d.
If YES – How much was paid, excluding any payments made in the
current month?
0150 $
0
VOPOIL
Yes
No – Go to item 3a
e.
Docking and landing fees for boats and planes?
0160
1
2
What was the total cost?
0070 $
Was any of this purchased this month?
0080
1
2
d.
VOPGA SX
If YES – How much was purchased this month?
Since the 1st of (month, 3 months ago), excluding (this month), have you
(or any members of your CU) purchased any antifreeze, brake fluid,
transmission fluid, or additives, except if purchased with a tune-up?
Do not include purchases for vehicles used entirely for business.
VOPOIL X
.00
f.
Yes
VOPOIL NT
No – Go to item 3a
0090 $
VOPOIL NX
0100
VOPFL UID
Yes
No – Go to item 4a
5a.
.00
b.
1
2
What was the total cost of these purchases?
0110 $
VOPFL UDX
.00
6a.
b.
NOTES
FORM CE-302
If YES – How much was paid, excluding any payments made in the
current month?
Since the 1st of (month, 3 months ago), excluding (this month), have you
(or any members of your CU) had any expenses for auto repair service
policies? Do not include service policies for vehicles used entirely for
business.
0170 $
0180
.00
None
VOPTOW
Yes
No – Go to item 4e
VOPTOWX
.00
None
VOPDOCK
Yes
No – Go to item 5a
VOPDOCK X
.00
None
1
Yes
VOPPOL CY
No – Go to item 6a
2
0190 $
0200
VOPPA RK X
0
If YES – How much?
Since the 1st of (month, 3 months ago), excluding (this month), have you
(or any members of your CU) had any expenses for bottled or tank gas
for recreational vehicles, including vans, campers, and boats?
VOPPA RK
Yes
No – Go to item 4c
1
2
If YES – How much?
0210 $
VOPPL CY X
.00
TA NK GA S
Yes
No – Go to next section
TA NK GA SX
.00
Page 67
Page 67
Hand the respondent the Information Booklet with instructions to look at the item list as you proceed.
Ask items 1–3 in part A.2 and then complete a column in part B for each policy reported.
Section 13 – INSURANCE OTHER THAN HEALTH – Continued
Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY
1.
a.
Information Booklet, page 32
Do you (or any members of your CU) have any –
Insurance
code
1 13 02 7
YES
NO
If YES – How many policies or plans
does your CU have?
Life insurance or other policies which provide benefits in case
of death or disability?
100
0010
1
2
0020
Number
b.
Automobile or other vehicle insurance?
200
0030
1
2
0040
Number
c.
Insurance protecting your home, furniture, personal effects,
or other property against fire, theft, loss, or damages from
other means –
d.
2a.
(1)
Homeowner’s insurance?
300
0050
1
2
0060
Number
(2)
Tenant’s insurance?
400
0070
1
2
0080
Number
500
0090
1
2
0100
Number
Other types of nonhealth insurance?
Since the 1st of (month, 3 months ago), have you (or any
members of your CU) made any payments for insurance
policies, other than health insurance, which you no
longer have?
0130
1
2
Yes – Ask items 2b and 2c
No – Go to item 3a
Insurance code
b. What kind of insurance policy(ies) was it (were they)?
Enter insurance code from items 1a–d for each policy reported.
c.
3a.
How many?
Have you (or any members of your CU) made any payments
for insurance policies, other than health, for persons not in
your CU?
How many?
0140
0150
Number
0160
0170
Number
0180
0190
Number
0200
0210
Number
0220
0230
Number
0300
1
2
Yes – Ask items 3b and 3c
No – Go to item 4
Insurance code
b. What kind of insurance policy(ies) was it (were they)?
Enter insurance code from items 1a–d for each policy reported.
c.
4.
How many?
How many?
0310
0320
Number
0330
0340
Number
0350
0360
Number
0370
0380
Number
0390
0400
Number
FIELD REPRESENTATIVE INSTRUCTIONS
Complete a column in part B for each policy reported.
Complete a column in part B for each discontinued policy. Be sure to mark the discontinued box, part B, item 1b.
FORM CE-302
NOTES
FORM CE-302
FIELD REPRESENTATIVE – Combine payments if more than one policy is held through the same company for the same type of
insurance (for example: automobile insurance) and for the same time period.
Section 13 – INSURANCE OTHER THAN HEALTH – Continued
Part B – Detailed Questions
1.
FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
New CU’s – Enter policy
numbers in consecutive order
beginning with 1.
a. POLICY NUMBER
2nd through 5th interviews –
Enter the next available policy
b. DISCONTINUED
number from chart in part A.1.
0010
2a.
What type of insurance is (was) it?
Description
b.
3.
Enter insurance code from part A.1 or part A.2.
0030
What is the name of the insurance company?
Enter name of insurance company, not the
insurance agent.
Insurance company name
Insurance company name
Insurance company name
Insurance company name
4.
Ask only for insurance code 200 from item 2b.
Describe briefly what vehicles are covered.
Description
Description
Description
Description
5a.
Ask only for insurance code 300 from item 2b.
Describe briefly the property this policy covers.
Description
Description
Description
Description
Enter property number from section 3, part B.
0160
Are the policy premiums paid . . .?
0220
b.
6a.
1 13 03 5
0020
Number
4
Entirely by CU
P R EM P A I D
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

P A Y D ED P R
Are any premiums paid through payroll
deductions?
0230
1
Yes
How often are premiums on this policy paid?
Mark (X) the appropriate box.
0240
1
Weekly
P R EM P ER D
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
2
3
4
5
6
7
8
9
8a.
PO L ICY Y B
0170I N SP R P Y 0180
1
Since the 1st of (month, 3 months ago), what was
your total expense for this insurance policy?
Enter the actual amount the CU paid, do not include
any expenses paid for the CU by others.
b.
Were any payments made this month?
c.
If YES – How much was paid this month?
Page 68
0250 $
0260
I N SEX P B X
2
No
.00
0020
0010
Number
0020
1
None – Go to next policy
1
2
Yes
No – Go to next policy
I N SN EX X B
.00
0030
0220
0170
1
2
3
4
0180
0220
0230
0240
1
Yes
0240
1
Weekly
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
3
4
5
6
7
8
9
I N SEX P B
0260
0020
1
2
No
.00
0
None – Go to next policy
1
2
Yes
No – Go to next policy
0270 $
Section 13 – Part B
.00
1
0030
0170
0180
Code
0160
0170
0180
Entirely by CU
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

0220
1
Yes
0230
1
Yes
1
Weekly
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
0240
1
Weekly
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
1
2
3
4
2
3
4
5
6
7
8
9
0250 $
0260
Number
Description
Code
0160
Entirely by CU
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

0230
2
0010
Number
0030
Code
0160
1 13 06 8
Description
0250 $
0
0270 $
0010
1 13 05 0
Description
Code
3
7.
PO L ICY IB
P L C Y ST A B
1
2
b.
1 13 04 3
2
No
.00
0
None – Go to next policy
1
2
Yes
No – Go to next policy
0270 $
.00
1
2
3
4
2
3
4
5
6
7
8
9
0250 $
0260
Entirely by CU
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

2
No
.00
0
None – Go to next policy
1
2
Yes
No – Go to next policy
0270 $
.00
Page 68
Page 69
Page 69
FIELD REPRESENTATIVE – Combine payments if more than one policy is held through the same company for the same type of
insurance (for example: automobile insurance) and for the same time period.
Section 13 – INSURANCE OTHER THAN HEALTH – Continued
Part B – Detailed Questions – Continued
1.
FIELD REPRESENTATIVE ITEM
PROCESSING USE ONLY
New CU’s – Enter policy
numbers in consecutive order
beginning with 1.
a. POLICY NUMBER
2nd through 5th interviews –
Enter the next available policy
b. DISCONTINUED
number from chart in part A.1.
0010
2a.
What type of insurance is (was) it?
Description
b.
3.
Enter insurance code from part A.1 or part A.2.
0030
What is the name of the insurance company?
Enter name of insurance company, not the
insurance agent.
Insurance company name
Insurance company name
Insurance company name
Insurance company name
4.
Ask only for insurance code 200 from item 2b.
Describe briefly what vehicles are covered.
Description
Description
Description
Description
5a.
Ask only for insurance code 300 from item 2b.
Describe briefly the property this policy covers.
Description
Description
Description
Description
Enter property number from section 3, part B.
0160
Are the policy premiums paid . . .?
0220
b.
6a.
1 13 07 6
0020
0180
0220
0230
0240
0230
1
Yes
How often are premiums on this policy paid?
Mark (X) the appropriate box.
0240
1
Weekly
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
3
4
5
6
7
8
9
Since the 1st of (month, 3 months ago), what was
your total expense for this insurance policy?
Enter the actual amount the CU paid, do not include
any expenses paid for the CU by others.
b.
Were any payments made this month?
c.
If YES – How much was paid this month?
FORM CE-302
0250 $
0260
2
No
.00
0
None – Go to next policy
1
2
Yes
No – Go to next policy
0270 $
0020
1
.00
0180
0220
1
Yes
0230
1
Weekly
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
0240
3
4
2
3
4
5
6
7
8
9
2
No
.00
0250 $
0260
0020
1
0
None – Go to next policy
1
2
Yes
No – Go to next policy
0270 $
Section 13 – Part B
.00
1
0030
0170
0180
Code
0160
0170
0180
Entirely by CU
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

0220
1
Yes
0230
1
Yes
1
Weekly
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
0240
1
Weekly
Biweekly
Monthly – directly
Monthly – in mortgage payment
Quarterly
Semiannually
Annually
Paid-up policy – Go to next policy
Other – Specify
1
2
3
4
2
3
4
5
6
7
8
9
0250 $
0260
Number
Description
Code
0160
Entirely by CU
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

2
0010
Number
0030
0170
1
1 13 10 0
Description
Code
0160
Entirely by CU
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

Are any premiums paid through payroll
deductions?
2
0010
Number
0030
0170
1
1 13 09 2
Description
Code
4
8a.
0020
1
3
7.
0010
Number
2
b.
1 13 08 4
2
No
.00
0
None – Go to next policy
1
2
Yes
No – Go to next policy
0270 $
.00
1
2
3
4
2
3
4
5
6
7
8
9
0250 $
0260
Entirely by CU
Partially by CU and partially by
someone outside the CU
Entirely by an employer or
 Go to
union
next
Entirely by another group or policy
persons outside the CU

2
No
.00
0
None – Go to next policy
1
2
Yes
No – Go to next policy
0270 $
.00
FORM CE-302
FIELD REPRESENTATIVE – Complete questions 1, 2, and 3 of part A.1 and for each new policy reported, complete part B.
Complete part C for all CU’s.
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE
Part A.1 – Screening Questions (For New Consumer Units, Go to Part A.2)
If this box is marked, no policies were previously reported – Go to item 2a.
1. Complete columns i through m in the "Health Insurance Policy Inventory Chart" below for each policy previously reported, except
policies that were discontinued ("YES" in column f).
HEALTH INSURANCE POLICY INVENTORY CHART
8 14 00 4
Policy number
PROCESSING USE ONLY
0040
h
Expenses reported in
previous interview
Insurance
description
from part B, item 4a
Type
code
from
part B,
item 4a
Name of
insurance company
from part B, item 2
Payroll
Policy
Enter
Enter
deductions discontinued payment
payments
from part B, from part B, from part B, Enter time
made this
item 7.
item 1b
period
month from
item 8a or
covered
part B,
item 10 or
from part B, item 11b or
14A.1
item 8b
14A.1
column k
column m
YES
NO YES
NO
i
j
Since the 1st of
Premium Do you
paid entirely still have (month, 3 months ago),
by someone (policy)? were any payments
made on this policy
outside the
by any member of
CU from
your CU? (Include
part B,
those made by
item 6
payroll deductions.)
(code
If NO – Go to next
3 or 4)
policy
YES
NO
YES NO
YES
2
1
2
1
2
1
2
1
2
1
2
1
$
.00
$
.00
1
$
.00
$
.00
1
$
.00
$
.00
1
4
$
.00
$
.00
1
2
1
2
0050
5
$
.00
$
.00
1
2
1
0060
6
$
.00
$
.00
1
2
0070
7
$
.00
$
.00
1
0080
8
$
.00
$
.00
0090
9
$
.00
$
0100
10
$
.00
0110
11
$
0120
12
$
b.
3a.
b.
4.
Since the 1st of (month, 3 months ago), have you (or any members of your
CU) purchased any (additional) health or hospitalization insurance?
0010
If YES – How many policies did you buy?
Complete a column in part B for each new policy.
0020
Since the 1st of (month, 3 months ago), have you (or any members of your CU)
made any payments for health insurance plans for persons outside of your CU?
0030
If YES – How many policies did you buy?
Complete a column in part B for each policy.
1
2
Were any
payments
made during
the current
month?
If YES – How much
was paid this
month?
If NO – Go to
next policy or
if last policy
go to item 2a
YES
NO
$
.00
1
2
$
.00
2
$
.00
1
2
$
.00
2
$
.00
1
2
$
.00
1
2
$
.00
1
2
$
.00
2
1
2
$
.00
1
2
$
.00
1
2
1
2
$
.00
1
2
$
.00
2
1
2
1
2
$
.00
1
2
$
.00
1
2
1
2
1
2
$
.00
1
2
$
.00
.00
1
2
1
2
1
2
$
.00
1
2
$
.00
$
.00
1
2
1
2
1
2
$
.00
1
2
$
.00
.00
$
.00
1
2
1
2
1
2
$
.00
1
2
$
.00
.00
$
.00
1
2
1
2
1
2
$
.00
1
2
$
.00
NOTES
Yes
No – Go to item 3a
Number
1
2
0040
Since the 1st of
(month, 3 months ago),
what was the total
amount paid by CU
members for this
policy?
NO
m
l
2
1 14 01 7
2a.
k
H H ICM X X A
3
g
H H I C M EX A
0030
f
H H IPD A M T
2
e
H H IA N Y PD
0020
d
H H I PRO U T
1
c
H H I C O D EA
0010
b
H H I ST I L L
H H IPD L IA
a
Yes
No – Go to next part
Number
FIELD REPRESENTATIVE INSTRUCTIONS
Complete a column in part B for each new policy reported. If "No," to items 2 and 3 – Go to part C.
Page 70
Section 14 – Part A.1
Page 70
Page 71
Page 71
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued
䊳
FIELD REPRESENTATIVE – Ask items 1, 2, and 3 and complete part B for each policy reported. Complete part C for all CU’s.
Part A.2 – Screening Questions – FOR NEW CONSUMER UNITS ONLY – Continued
1a. Do you (or any members of your CU) have any hospitalization
0010 1
Yes
or health insurance plans or belong to a plan that pays all or
part of your medical expenses? Please consider any special
purpose plans you may have, such as those listed on page 32a
of the Information Booklet.
b. If YES – How many policies do you have?
2a.
Since the 1st of (month, 3 months ago), have you (or any
members of your CU) made payments for hospitalization or
health insurance policies which you no longer have?
b. If YES – How many policies?
3a.
Have you (or any members of your CU) made any payments for
health insurance plans for persons outside of your CU?
b. If YES – How many policies?
4.
2
0020
0030
Number
1
2
0040
0050
Yes
No – Go to item 3a
Number
1
2
0060
No – Go to item 2a
Yes
No – Go to item 4
Number
FIELD REPRESENTATIVE INSTRUCTIONS
Complete a column in part B for each policy reported.
If the policy was reported in item 2, be sure to mark the discontinued box in part B, item 1b.
If "No," to items 1, 2, and 3 – Go to part C.
FORM CE-302
1 14 02 5
NOTES
FORM CE-302
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued
Part B – Detailed Questions
1. FIELD REPRESENTATIVE ITEM
New CU’s – Enter a policy number in consecutive
order beginning with 1.
2nd thru 5th interviews – Enter policy number in
consecutive order using the next available number in
policy chart in part A.1.
2.
PROCESSING
USE ONLY
a.
POLICY
NUMBER
b. DISCONTINUED
What is the name of the insurance company?
Enter name of insurance company, not the insurance agent.
If Blue Cross/Blue Shield, Mark (X) box.
1 14 03 3
1 14 04 1
0010 H H I P D L I B
Number
0020
1
H H I ST A T B
1
4a.
Information Booklet, page 32a
What type of insurance plan is it?
0061
2
Ask only if item 4a is "1".
b. If, except in the case of an emergency, you go to a doctor other
c.
d.
5.
6.
7.
8a.
1
than one in the group center or your primary care doctor, without
a referral, will the plan pay any of your expenses?
Ask only if item 4a is "2."
Is this fee for service plan a –
1 – Traditional Fee for Service Plan?
2 – Preferred Provider Option Plan
Ask only if item 4a is "4."
Is this special purpose insurance plan–
1 – Dental insurance?
4 – Mental health insurance?
2 – Vision insurance?
5 – Dread disease policy?
3 – Prescription drug insurance? 6 – Other type of special purpose health
insurance?
3
Go to 4b
Go to 4c
Go to 5
Go to 4d
Don’t
know –
Go to 5
4
x
H H ICO D E
0062
1
2
None
0
Yes 
 Go to item 5
No 
1
0061
Number
1
2
3
0062
1
2
0063
1
2
0064
H H I F EET

 Go to item 5

1
4
2
5
3
6
0063
1
2
0064
Specify
o
t
Blue Cross/Blue Shield
0060
H H IPO S
Go to 4b
Go to 4c
Go to 5
0
4
x
None
o
Go to 4d
Don’t
know –
G
Yes 
 Go to item 5
No 
1
4
2
5
3
6
0010
Number
0020
1
Insurance company name
0030
1
0061
Number
1
2
3
1
2
0063
1
2
0064
Specify
Go to 4b
Go to 4c
Go to 5
None
0
Go to 4d
Don’t
know –
Go to 5
4
x
Yes 
 Go to item 5
No 
4
2
5
3
6
0030
0010
Number
0020
1
1
0061
Number
1
2
3
1
2
0063
1
2
0064
Specify
Go to 4b
Go to 4c
Go to 5
None
0
Go to 4d
Don’t
know –
Go to 5
4
x
Yes 
 Go to item 5
No 
4
2
5
3
6
0030
1
1
Blue Cross/Blue Shield
0060
0061
Number
1
2
3
0062
1
2

 Go to item 5

1
Number
Insurance company name
Blue Cross/Blue Shield
0060
0062

 Go to item 5

1
1 14 07 4
Insurance company name
Blue Cross/Blue Shield
0060
0062

 Go to item 5

1 14 06 6
0063
1
2
0064
Specify
Go to 4b
Go to 4c
Go to 5
None
0
Go to 4d
Don’t
know –
Go to 5
4
x
Yes 
 Go to item 5
No 

 Go to item 5

1
4
2
5
3
6
Specify
H H I SP EC T
Was the policy obtained on an individual or group basis?
1 – Individually obtained
3 – Group through other organization
2 – Group through place of employment
0070
Are premiums paid –
1 – Entirely by CU members?
4 – Entirely by another group or
2 – Partially by CU members?
person outside of the CU?
3 – Entirely by an employer or union?
0090
1
2
0070
1
2
0090
1
3
2
4
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
3
0070
1
2
0090
1
3
2
4
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
3
0070
1
2
0090
1
3
2
4
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
3
0070
1
2
0090
1
3
2
4
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
3
3
H H I GR O U P
1
3
2
4
 If code 3 or 4,

 go to next
H H I PRM PD
policy
Are any of the premiums paid through payroll deductions?H H I P R D ED
0100
1
What is your part of the regular health insurance payment,
(including all payroll deductions)?
0110
$ H H I RPM X B
0120
1
b. What period of time is covered by the regular payment?
0030
0010
0020
1
Insurance company name
Blue Cross/Blue Shield
OVQ
0060 H H I CNumber
5
Number
H H IBCBS
0030
How many CU members are covered by this policy?
3 – Commercial Medicare Supplement
4 – Other special purpose plan
0020
Insurance company name
3.
1 – Health Maintenance Organization
2 – Fee for Service Plan
0010
1 14 05 8
2
3
4
Yes
2
Week
2 weeks
Month
Quarter
5
6
7
No
 If code 3 or 4,

 go to next
policy
2
5
4
Week
2 weeks
Month
Quarter
2
2
3
6
7
No
 If code 3 or 4,

 go to next
policy
2
5
4
Week
2 weeks
Month
Quarter
0130
1
Yes
2
0140
1
Yes
2
3
6
7
No
 If code 3 or 4,

 go to next
policy
2
5
4
Week
2 weeks
Month
Quarter
0130
1
Yes
2
0140
1
Yes
2
3
6
7
No
 If code 3 or 4,

 go to next
policy
2
.00
5
4
Week
2 weeks
Month
Quarter
0130
1
Yes
2
0140
1
Yes
2
3
No
6
7
6 months
Year
Other –
Specify
H H I RPM PD
9a.
Since the 1st of (month, 3 months ago), were any payments
made on this policy?
No – Go to
next policy
0130
1
Yes
H H ICPM T B
Yes
No – Go to
0140
1
Yes
How many payments were made?
H H I R P M T B item 10
to
T B  Go
0150 H H I Q P MNumber
 item 11a
0150
Ask only if item 9b is "NO."
What was the total expense paid for this policy?
0160
$
Were any payments made during the current month?
0170
1
b. Was each payment in the amount of (regular payment amount
reported in item 8a)?
c.
10.
11a.
b. If YES – How much was paid during the current month?
Page 72
0130
0140
1
1
Yes
2
2
H H I I R GX B
0160
$
No – Go to
0170
1
H H I C M EX B next policy
0180 $
H H I C M X X B .00
0180
$
Yes
2
.00
2
.00
Yes
2
Section 14 – Part B
No – Go to
next policy
.00
0150
0160
$
0170
1
0180
$
2
.00
Yes
2
No – Go to
next policy
.00
0150
0160
$
0170
1
0180
$
2
.00
Yes
2
No – Go to
next policy
.00
0150
0160
$
0170
1
0180
$
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
2
.00
Yes
2
No – Go to
next policy
.00
Page 72
Page 73
Page 73
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued
Part B – Detailed Questions
1. FIELD REPRESENTATIVE ITEM
New CU’s – Enter a policy number in consecutive
order beginning with 1.
2nd thru 5th interviews – Enter policy number in
consecutive order using the next available number in
policy chart in part A.1.
2.
PROCESSING
USE ONLY
a.
POLICY
NUMBER
b. DISCONTINUED
What is the name of the insurance company?
Enter name of insurance company, not the insurance agent.
If Blue Cross/Blue Shield, Mark (X) box.
1 14 08 2
0010
0020
0030
How many CU members are covered by this policy?
0060
4a.
Information Booklet, page 32a
What type of insurance plan is it?
0061
3 – Commercial Medicare Supplement
4 – Other special purpose plan
Ask only if item 4a is "1".
c.
d.
than one in the group center or your primary care doctor, without
a referral, will the plan pay any of your expenses?
Ask only if item 4a is "2."
Is this fee for service plan a –
1 – Traditional Fee for Service Plan?
2 – Preferred Provider Option Plan
Ask only if item 4a is "4."
Is this special purpose insurance plan–
1 – Dental insurance?
4 – Mental health insurance?
2 – Vision insurance?
5 – Dread disease policy?
3 – Prescription drug insurance? 6 – Other type of special purpose health
insurance?
0020
1
1
1
3
0062
1
2
0063
1
2
0064
Go to 4b
Go to 4c
Go to 5
1
4
2
5
3
6
0070
1
2
6.
Are premiums paid –
1 – Entirely by CU members?
4 – Entirely by another group or
2 – Partially by CU members?
person outside of the CU?
3 – Entirely by an employer or union?
0090
1
3
2
4
Are any of the premiums paid through payroll deductions?
0100
1
Yes
What is your part of the regular health insurance payment,
including all payroll deductions?
0110
$
0120
1
9a.
Since the 1st of (month, 3 months ago), were any payments
made on this policy?
b. Was each payment in the amount of (regular payment amount
reported in item 8a)?
c.
b. If YES – How much was paid during the current month?
0180
$
FORM CE-302
2
4
2
5
3
6
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
6
7
No
2
.00
Yes
1
4
policy
2
No – Go to
next policy
.00
x
0063
1
2
1
4
2
5
3
6
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
6
7
No
2
.00
2
Section 14 – Part B
No – Go to
next policy
.00
x
0063
1
2
1
4
2
5
3
6
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
6
7
No
2
.00
2
No – Go to
next policy
.00
x
1
0063
1
2
1
4
2
5
3
6
4
0100
1
Yes
.00
0110
$
6 months
Year
Other –
Specify
0120
1
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
2
6
7
No
2
.00
2
No – Go to
next policy
.00
x
Specify
3
 If code 3 or 4,

 go to next
policy
2
5
4
0130
1
Yes
2
0140
1
Yes
3
0150
0160
$
0170
1
0180
$
No
.00
Week
2 weeks
Month
Quarter
2
Go to 4d
Don’t
know –
Go to 5
4

 Go to item 5

3
policy
None
0
Yes 
 Go to item 5
No 
2
Yes
$
3
Go to 4b
Go to 4c
Go to 5
1
1
0180
2
0090
0140
Yes
1
2
 If code 3 or 4,

 go to next
2
1
Number
2
Yes
0170
Blue Cross/Blue Shield
1
1
$
1
0070
0130
0160
0061
0062
3
4
0150
1
0060
Specify
5
3
0030
0064
Week
2 weeks
Month
Quarter
2
Go to 4d
Don’t
know –
Go to 5
4

 Go to item 5

4
policy
None
0
Yes 
 Go to item 5
No 
3
Yes
$
1
2
1
0180
3
Go to 4b
Go to 4c
Go to 5
1
0140
Yes
2
0090
2
1
1
2
 If code 3 or 4,

 go to next
Yes
0170
Number
Number
Insurance company name
Blue Cross/Blue Shield
2
1
$
1
1
0130
0160
0020
1
0070
4
0150
0061
0062
3
2
0010
Number
0060
Specify
5
3
0030
0064
Week
2 weeks
Month
Quarter
2
Go to 4d
Don’t
know –
Go to 5
4

 Go to item 5

4
policy
None
0
Yes 
 Go to item 5
No 
3
Yes
$
1
2
1
0180
3
Go to 4b
Go to 4c
Go to 5
1
0140
Yes
2
0090
2
1
1
2
 If code 3 or 4,

 go to next
Yes
0170
Number
1 14 12 4
Insurance company name
Blue Cross/Blue Shield
2
1
$
1
1
0130
0160
0020
1
0070
4
0150
0061
0062
3
2
0010
Number
0060
Specify
5
3
0030
0064
Week
2 weeks
Month
Quarter
2
Go to 4d
Don’t
know –
Go to 5
4

 Go to item 5

3
Yes
1
1
None
0
Yes 
 Go to item 5
No 
2
1
0170
1
1
0140
Were any payments made during the current month?
3
Go to 4b
Go to 4c
Go to 5
0090
2
$
2
0063
 If code 3 or 4,

 go to next
Yes
0160
10.
11a.
1
2
1
0150
Number
1 14 11 6
Insurance company name
Blue Cross/Blue Shield
1
0130
Ask only if item 9b is "NO."
What was the total expense paid for this policy?
1
0070
4
How many payments were made?
0020
1
2
3
5
3
0061
Specify
2
0010
Number
0060
0064
Week
2 weeks
Month
Quarter
2
0030
0062

 Go to item 5

Was the policy obtained on an individual or group basis?
1 – Individually obtained
3 – Group through other organization
2 – Group through place of employment
b. What period of time is covered by the regular payment?
Go to 4d
Don’t
know –
Go to 5
x
Yes 
 Go to item 5
No 
5.
7.
8a.
None
0
4
1 14 10 8
Insurance company name
Blue Cross/Blue Shield
Number
2
b. If, except in the case of an emergency, you go to a doctor other
0010
Number
Insurance company name
3.
1 – Health Maintenance Organization
2 – Fee for Service Plan
1 14 09 0
6
7
6 months
Year
Other –
Specify
No – Go to
next policy
No – Go to
item 10
 Go to
Number 
 item 11a
2
.00
Yes
2
No – Go to
next policy
.00
FORM CE-302
Section 14 – HOSPITALIZATION AND HEALTH INSURANCE – Continued
FIELD REPRESENTATIVE – Ask part C for all CU’s.
Part C – Medicare, Medicaid, and Other Health Insurance Plans Not Directly Paid For By The CU
1a. Are you (or any members of your CU) presently enrolled in
0010 1
Yes
Medicare or have you (or any members of your CU) been enrolled
since the 1st of (month, 3 months ago)? Medicare is the Federal
Health Insurance Plan.
b.
2a.
b.
3.
2
No – Go to item 2a
If YES – How many members of your CU are covered by Medicare?
0020
Is anyone in your CU enrolled in Medicaid or has anyone in your
CU been enrolled since the first of (month, 3 months ago)?
0030
Number
1
2
Yes
No – Go to item 3
1 14 51 2
NOTES
H H M C R EN R
H H M CRCO V
M D C D EN R
If YES – How many members of your CU are covered by Medicaid?
0040
Are you (or any members of your CU) covered by any plan other
than Medicare or Medicaid which provides free health care such
as CHAMPUS or military health care?
Page 74
0050
Number
1
2
Yes
No
M D CD CO V
O T H PL A N
Page 74
Page 75
Page 75
NOTES
FORM CE-302
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet. Read the introduction and definition for payment. Ask part
Section 15 – MEDICAL AND HEALTH EXPENDITURES
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) made
any payments for the following?
Read all bold items below.
Was the person a CU member?
Care/service or item
Person’s name
CU
member
YES NO
0010
1
2
0020
1
2
0030
1
2
0040
1
2
0050
1
2
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
410
0130
1
2
420
0140
1
2
430
0150
1
2
0160
1
2
0170
1
2
ITEM Payments
CODE YES NO
c
d
e
Always ask –
What was the
amount of the
payment?
Did you
make
any
other
payment(s)
for . . .?
If "No,"
go to
next item
in part A.
In what
month
was
(were)
the
payment(s)
made?
M ED P M T X
1.
ENTER Ask if not apparent –
ITEM
CODE What was the (care/service or item)?
from
part A. Who received the (care/service or item)?
M ED P C A R Y
By payments I mean any expenses paid by any
members of your CU directly to a medical
provider by cash, check, or credit card for a
medical service or item. Include all payments,
even those for persons who are not CU
members.
b
a
M ED P M T M O
Now I am going to ask you some questions
about medical payments and reimbursements.
I will begin with your payments.
4 15 02 6
M ED P GF T C
Hand respondent Information Booklet, pages 33 and 34.
Part B – Payments For Medical Expenses
PROCESSING USE ONLY
Part A – Screening Questions for
Payments
Month
YES
PRE
1
Care/service or item
from column b
2
Name from
column b
NO
3
4
Month
from
column c
Total from
column d
Month
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
EYE CARE, such as
Eye examinations,
treatment, or surgery
Purchase of eye glasses or
contact lenses
Combined eye care
services
DENTAL CARE
110
120
130
200
INPATIENT HOSPITAL
CARE, such as
Hospital room
Hospital services
Combined hospital room
and services
SERVICES BY MEDICAL
PROFESSIONALS OTHER
THAN PHYSICIANS
PHYSICIAN SERVICES
Combined hospital care
and physicians’ services
2.
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
part B.
Page 76
310
320
330
1 15 01 4
0010
999
Go to
next
page
NOTES
Section 15 – Part A and Part B
Page 76
Page 77
Page 77
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet. Ask part A, question 1, followed by general category
heading and sub-categories. Complete a separate line in part B for each payment or set of identical
payments. Identical items are those for the SAME SERVICE for the SAME PERSON, in the SAME
MONTH. For combined services complete one line.
Section 15 – MEDICAL AND HEALTH EXPENDITURES – Continued
Hand respondent Information Booklet, pages 34 and 35.
1.
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) made
any payments for the following?
Read all bold items below.
ITEM Payments
CODE YES NO
OTHER MEDICAL CARE
SERVICES, such as
b
a
ENTER Ask if not apparent –
ITEM
CODE What was the (care/service or item)?
from
part A. Who received the (care/service or item)?
Was the person a CU member?
Care/service or item
Person’s name
CU
member
YES NO
0010
1
2
0020
1
2
510
0030
1
2
Care in convalescent or
nursing home
520
0040
1
2
Other medical care
530
0050
1
2
Combined medical
care services
540
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
0130
1
2
Hearing aids
610
Prescribed medicines or
prescribed drugs
620
Rental of supportive or
convalescent equipment
Purchase of supportive or
convalescent equipment
Rental of medical or
surgical equipment for
general use
630
640
650
660
0140
1
2
Combined medicine and
medical supplies
670
0150
1
2
0160
1
2
0170
1
2
FORM CE-302
1 15 04 8
0010
999
Go to
next
page
d
e
Always ask – What was the
amount of the
payment?
In what
month
was
(were)
the
payment(s)
made?
Did you
make
any
other
payment(s)
for . . .?
If "No,"
go to
next item
in part A.
YES
Month
PRE
1
2
Care/service or item
from column b
Name from
column b
NO
3
4
Month
from
column c
Total from
column d
Month
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
NOTES
Purchase of medical or
surgical equipment for
general use
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
part B.
4 15 05 9
c
Lab tests or x-rays
MEDICINE AND MEDICAL
SUPPLIES, such as
2.
Part B – Payments For Medical Expenses – Continued
PROCESSING USE ONLY
Part A – Screening Questions for
Payments – Continued
FORM CE-302
.
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet. Read the introduction and definition for reimbursement. Ask
part C, question 1, followed by general category heading and sub-categories. Complete a separate line in
part D for each reimbursement or set of identical reimbursements. Identical items are those for the SAME
SERVICE for the SAME PERSON, in the SAME MONTH. For combined services complete one line.
Section 15 – MEDICAL AND HEALTH EXPENDITURES – Continued
C
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) received
any reimbursements for the following?
Read all bold items below.
0010
c
Was the person a CU member?
Care/service or item
Person’s name
CU
member
YES NO
1
2
1
2
1
2
0040
1
2
0050
1
2
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
410
0130
1
2
420
0140
1
2
430
0150
1
2
0160
1
2
0170
1
2
ITEM
CODE
Reimburse- 0020
ments
YES NO
0030
d
e
Always ask – What was the
amount of the
reimbursements?
In what
month
was
(were)
the
reimbursement(s)
received?
M ED R M B X
1.
M ED R C A R Y
By reimbursements I mean money received for
any members of your CU from an insurance
company, medical care provider, or non CU
member, for medical expenses which you
previously paid or will pay.
4 15 07 5
M ED R M B M O
Now I am going to ask you some questions
about your reimbursements.
b
ra
ENTER Ask if not apparent –
ITEM
a
CODE What was the (care/service or item)?
from
p
Who received the (care/service or item)?
M ED R GF T C
Hand respondent Information Booklet, pages 33 and 34.
Part tD – Reimbursements For Medical Expenses
PROCESSING USE ONLY
Part C – Screening Questions for
Reimbursements
Did you
receive
any other
reimbursement(s)
for . . .?
If "No,"
go to
next item
in part C.
YES
Month
PRE
1
Care/service or item
from column b
2
Name from
column b
NO
3
4
Month
from
column c
Total from
column d
Month
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
EYE CARE, such as
Eye examinations,
treatment, or surgery
Purchase of eye glasses or
contact lenses
Combined eye care
services
DENTAL CARE
110
120
130
200
INPATIENT HOSPITAL
CARE, such as
Hospital room
Hospital services
Combined hospital room
and services
SERVICES BY MEDICAL
PROFESSIONALS OTHER
THAN PHYSICIANS
PHYSICIAN SERVICES
Combined hospital care
and physicians’ services
2.
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
part D.
Page 78
310
320
330
1 15 06 3
0010
999
Go to
next
page
NOTES
Section 15 – Part C and Part D
Page 78
Page 79
Page 79
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet. Ask part C, question 1, followed by general category
heading and sub-categories. Complete a separate line in part D for each reimbursement or set of
identical reimbursements. Identical items are those for the SAME SERVICE for the SAME PERSON, in
the SAME MONTH. For combined services complete one line.
Section 15 – MEDICAL AND HEALTH EXPENDITURES – Continued
Part C – Screening Questions for
Reimbursements – Continued
Part D – Reimbursements for Medical Expenses – Continued
Since the 1st of (month, 3 months ago), have
you (or any members of your CU) received
any reimbursements for the following?
Read all bold items below.
ITEM
CODE
Reimbursements
YES
NO
OTHER MEDICAL CARE
SERVICES, such as
c
ENTER Ask if not apparent –
ITEM
CODE What was the (care/service or item)?
from
part C. Who received the (care/service or item)?
Was the person a CU member?
Care/service or item
Person’s name
CU
member
YES NO
0010
1
2
0020
1
2
Lab tests or x-rays
510
0030
1
2
Care in convalescent or
nursing home
520
0040
1
2
Other medical care
530
0050
1
2
Combined medical
care services
540
0060
1
2
0070
1
2
0080
1
2
0090
1
2
0100
1
2
0110
1
2
0120
1
2
0130
1
2
MEDICINE AND MEDICAL
SUPPLIES, such as
Hearing aids
610
Prescribed medicines or
prescribed drugs
620
Rental of supportive or
convalescent equipment
Purchase of supportive or
convalescent equipment
Rental of medical or
surgical equipment for
general use
2.
PROCESSING USE ONLY
Hand respondent Information Booklet, pages 34 and 35.
1.
b
a
630
640
650
660
0140
1
2
Combined medicine and
medical supplies
670
0150
1
2
0160
1
2
0170
1
2
FORM CE-302
1 15 08 9
0010
999
Go to
next
page
d
e
Always ask – What was the
amount of the
reimbursements?
In what
month
was
(were)
the
reimbursement(s)
received?
Did you
receive any
other
reimbursement(s)
for . . .?
If "No,"
go to
next item
in part C.
YES
Month
PRE
1
2
Care/service or item
from column b
Name from
column b
NO
3
4
Month
from
column c
Total from
column d
Month
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
NOTES
Purchase of medical or
surgical equipment for
general use
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are
no entries recorded in
part D.
4 15 09 1
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to read the list of items as you proceed.
Section 16 – EDUCATIONAL EXPENSES
7 16 02 7
a
b
ITEM
CODE YES NO
1.
0020
b. If YES – Did you
0030
pay for –
Tuition?
300
0040
0050
Housing while attending
310
school?
0060
Food or board while
attending school?
Use only if unable to
separate – Combined
room and board
(Codes 310 and 320)
320
0070
0080
330
0090
0100
0110
4.
FIELD
REPRESENTATIVE
CHECK ITEM
Mark (X) box if
there are no
entries recorded
in columns b–j.
1 16 01 2
0010
999
Go to
next
page
0120
0130
0140
0150
Page 80
g
h
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
In what
month
was the
payment
made?
How much was
paid?
Has any of
this amount
been or will
any of it be
reimbursed
by an
employer,
agency, or
other
person?
How much was
or will be
reimbursed?
If "No," go to
column j.
YES
5
1
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
5
5
5
5
5
5
5
5
5
5
5
5
5
5
j
If "Yes" in
column h –
EDREIMB
Month
Section 16
i
Did you
make
any
other
payments
for . . .?
PRE
1
Item
If "No," go
code
to next
from
item in
column a. column
b
EDREIMB X
0010
Complete without
asking if information
is known.
If CU member,
enter name and
What kind of
line number from
school was it?
Control Card. If
1
– College or
someone outside
university
CU, enter 99.
2 – Elementary or
high school
EDUCGFTC
3 – Child day
care center
4 – Nursery school
Line
or preschool
Name
No. or 5 – Other school
code
Mark (X) box
Who was it for?
f
EDEX OX A
Have you (or any
members of your CU)
paid for any (other)
school related
expenses for
members of this CU
or other persons?
e
EDMONTHA
Have you (or any
members of your CU)
paid for nursery school
or child day care centers
for members of this CU
200
or other persons?
d
EDSCHL _A
3a.
100
EDUC_A Y
2.
Since the 1st of (month,
3 months ago), have you
(or any members of
your CU) paid for any
recreational lessons or
other instructions for
members of this CU
or other persons?
ENTER
What was the expense for?
ITEM
Describe briefly the expense.
CODE
from
column a.
PROCESSING USE ONLY
Information Booklet,
page 36.
c
NO
YES NO
2
3
4
Name from
column d
Month
from
column f
Cost from
column g
Month
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
Page 80
Page 81
Page 81
Section 16 – EDUCATIONAL EXPENSES – Continued
7 16 04 3
a
b
Information Booklet, page 36.
ENTER
What was the expense for?
ITEM
Describe briefly the expense.
CODE
from
column a.
ITEM
CODE YES NO
340
Purchase of any school
books, supplies, or
equipment which
has not already been
reported?
Other school related
expenses not already
reported?
350
PROCESSING USE ONLY
3b. Did you pay for – (Continued)
Private school bus?
0010
360
0020
Use only if the respondent
is unable to separate
expenses.
0030
Combined expenses for
books and tuition (Codes
300 and 350)
0040
370
0050
Other combined education
expenses (Include any
combined educational
expenses not previously
reported.) (Codes 100,
200, 300, 310, 320,
380
340–360)
0060
0070
0080
0090
0100
0110
4.
FIELD
REPRESENTATIVE
CHECK ITEM
Mark (X) box if
there are no
entries recorded
in columns b–j.
1 16 03 8
0010
999
0120
Go to
next
0130
section
0140
0150
FORM CE-302
c
d
e
Complete without
Who was it for?
asking if information
is known.
If CU member,
enter name and
What kind of
line number from
school was it?
Control Card. If
1 – College or
someone outside
university
CU, enter 99.
2 – Elementary or
high school
3 – Child day
care center
4 – Nursery school
Line
or preschool
Name
No. or 5 – Other school
code
Mark (X) box
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
1
3
2
4
f
g
h
i
In what
month
was the
payment
made?
How much was
paid?
Has any of
this amount
been or will
any of it be
reimbursed
by an
employer,
agency, or
other
person?
j
If "Yes" in
column h –
How much was
or will be
reimbursed?
Did you
make
any
other
payments
for . . .?
PRE
1
Item
If "No," go
code
to next
from
item in
column a. column
b
2
3
4
Name from
column d
Month
from
column f
Cost from
column g
If "No," go to
column j.
Month
YES
5
1
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
5
5
5
5
5
5
5
5
5
5
5
5
5
5
NO
YES NO
Month
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
FORM CE-302
NOTES
Page 82
Page 82
Page 83
Page 83
NOTES
FORM CE-302
FORM CE-302
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS,
AND ENTERTAINMENT EXPENSES
Part A – Subscriptions and Memberships
1.
b
Compact discs, tapes,
videos, or records
purchased from a
mail-order club
300
Magazine or periodical
subscriptions
400
Theater, concert, opera,
or other musical series,
500
season tickets
Season tickets to
sporting events
600
Reference books NOT
in sets
900
Encyclopedias or
other sets of
reference books
2a.
b.
Item code(s)
Complete a separate line for each
gift purchased.
3.
FIELD
REPRESENTATIVE
CHECK ITEM
Mark (X) box if
there are no
entries recorded
in columns b–g.
Page 84
What is the name of the
(subscription, club, or
organization reported
in column a)?
Mark (X)
the
appropriate
box.
What was the
total cost
during this
period?
(Include
shipping and
handling
fees.)
Enter name such as "Daily
News," "Redbook," "Columbia
Record Club," and "Book of the
Month Club."
OWN GIFT
USE
0010
1
2
0020
1
0030
1 17 01 0
0010
999
Go to
next
page
f
g
How much of this
amount was paid
this month?
Did you
purchase
any
other. . .?
None YES
.00 $
.00
2
$
.00 $
.00
1
2
$
.00 $
0040
1
2
$
0050
1
2
0060
1
0070
0
NOTES
PRE
1
If "No," go
to next item Description from
in column a.
column c
$
2
3
4
COST
Item
code
from
column b
Total from
column e
This month
from column f
NO
None
$
.00 $
.00
0
$
.00 $
.00
.00
0
$
.00 $
.00
.00 $
.00
0
$
.00 $
.00
$
.00 $
.00
0
$
.00 $
.00
2
$
.00 $
.00
0
$
.00 $
.00
1
2
$
.00 $
.00
0
$
.00 $
.00
0080
1
2
$
.00 $
.00
0
$
.00 $
.00
0090
1
2
$
.00 $
.00
0
$
.00 $
.00
0100
1
2
$
.00 $
.00
0
$
.00 $
.00
0110
1
2
$
.00 $
.00
0
$
.00 $
.00
0120
1
2
$
.00 $
.00
0
$
.00 $
.00
0130
1
2
$
.00 $
.00
0
$
.00 $
.00
0140
1
2
$
.00 $
.00
0
$
.00 $
.00
0150
1
2
$
.00 $
.00
0
$
.00 $
.00
0160
1
2
$
.00 $
.00
0
$
.00 $
.00
0170
1
2
$
.00 $
.00
0
$
.00 $
.00
0180
1
2
$
.00 $
.00
0
$
.00 $
.00
0190
1
2
$
.00 $
.00
0
$
.00 $
.00
0200
1
2
$
.00 $
.00
0
$
.00 $
.00
700
Have you (or any members of your CU)
purchased any of these as a gift to
someone outside the CU?
YES
NO – Go to item 3
If YES –
What
was
purchased?
e
S1 7 CMEX X
Books purchased from a
200
book club
d
c
S1 7 PURX A
100
Newspaper delivery
S1 7 CODEA
FIELD REPRESENTATIVE – ITEM YES NO
CODE
Read each item listed
below.
ENTER
ITEM
CODE
from
column a.
4 17 02 2
S1 7 GFTCA
Since the 1st of (month, 3 months ago),
have you (or any members of your CU)
purchased any of the following for your
own use?
PROCESSING USE ONLY
a
FIELD REPRESENTATIVE – Ask column a and complete columns b–g for each item before going to the next item.
Section 17 – Part A
Page 84
Page 85
Page 85
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS,
AND ENTERTAINMENT EXPENSES – Continued
FIELD REPRESENTATIVE – Ask column a and complete columns b–g for each item before going to the next item.
Part A – Subscriptions and Memberships – Continued
4.
b
Have you (or any members of your CU)
had any membership costs or other
expenses related to any of the following?
Do not include contributions to or
membership in religious, professional,
business, or other tax deductible
organizations.
FIELD REPRESENTATIVE – ITEM YES NO
CODE
Read each item listed
below.
Country clubs, health
clubs, swimming pools,
tennis clubs, social or
other recreational
organizations
Civic, service, or
fraternal
organizations
Credit card
memberships
FORM CE-302
Enter name such as "Jaycees,"
"Kent Swim and Country
Club," and "Amoco Motor
Club."
1
If "No," go
to next item Description from
in column a.
column c
OWN GIFT
USE
0010
1
2
0020
1
0030
None YES
$
.00 $
.00
2
$
.00 $
.00
1
2
$
.00 $
0040
1
2
$
0050
1
2
0060
1
0070
0
2
3
4
COST
Item
code
from
column b
Total from
column e
This month
from column f
NO
None
.00
.00
0
$
.00 $
.00
.00 $
.00
0
$
.00 $
.00
$
.00 $
.00
0
$
.00 $
.00
2
$
.00 $
.00
0
$
.00 $
.00
1
2
$
.00 $
.00
0
$
.00 $
.00
0080
1
2
$
.00 $
.00
0
$
.00 $
.00
0090
1
2
$
.00 $
.00
0
$
.00 $
.00
0100
1
2
$
.00 $
.00
0
$
.00 $
.00
0110
1
2
$
.00 $
.00
0
$
.00 $
.00
0120
1
2
$
.00 $
.00
0
$
.00 $
.00
0130
1
2
$
.00 $
.00
0
$
.00 $
.00
0140
Go to
the
next
0150
section
1
2
$
.00 $
.00
0
$
.00 $
.00
1
2
$
.00 $
.00
0
$
.00 $
.00
0160
1
2
$
.00 $
.00
0
$
.00 $
.00
0170
1
2
$
.00 $
.00
0
$
.00 $
.00
0180
1
2
$
.00 $
.00
0
$
.00 $
.00
0190
1
2
$
.00 $
.00
0
$
.00 $
.00
0200
1
2
$
.00 $
.00
0
$
.00 $
.00
830
1 17 03 6
999
Did you
purchase
any
other. . .?
.00 $
810
0010
How much of this
amount was paid
this month?
$
memberships
were
purchased?
Complete a separate line for each
gift membership.
NOTES
What was the
total cost
during this
period?
NOTES
PRE
0
Item code(s)
FIELD
REPRESENTATIVE
CHECK ITEM
Mark (X) box if
there are no
entries recorded
in columns b–g.
Mark (X)
the
appropriate
box.
g
.00
b. What
6.
What is the name of the
(subscription, club, or
organization reported
in column a)?
f
.00 $
NO – Go to item 6
If YES –
e
$
Have you (or any members of your CU)
purchased any memberships as a gift to
someone outside the CU?
YES
ENTER
ITEM
CODE
from
column a.
d
c
800
820
Automobile service
clubs
5a.
PROCESSING USE ONLY
a
4 17 04 8
t
i
FORM CE-302
o
t
Section 17 – SUBSCRIPTIONS, MEMBERSHIPS, BOOKS, AND ENTERTAINMENT EXPENSES – Continued
o
Part B – Books and Entertainment Expenses
1a. Since the 1st of (month, 3 months
0010 1
Yes
ago), have you (or any members
of your CU) paid any fees for
participating in sports such as
tennis, golf, bowling,
or swimming?
b. What was the total expense
2
5a.
No – G
Have any CU members bought
any magazines not included in a
subscription?
0130
1
2
b. What was the total expense
for them?
$
SPORTFEEX
.00
c.
How much of the total amount
was spent this month?
0140
0150
$
$
0
c.
Have you (or any members of your
CU) paid any single admissions
to spectator sporting events such
as football, baseball, hockey,
or soccer?
I
2a.
How much of the total amount
was spent this month?
b. What was the total expense
for them?
0030
0040
$
SPFEECMX
.00
0
None
1
Yes
No – Go to item 3a
2
SPORTA DM
0050
$
SPORTA DX
6a.
3a.
How much of the total amount
was spent this month?
Have you (or any members of
your CU) paid any single
admissions to entertainment
activities such as movies, plays,
operas, or concerts?
b. What was the total expense
for them?
c.
4a.
How much of the total amount
was spent this month?
Have you (or any members of
your CU) bought any (other)
books, including paperbacks,
not purchased through a book
club? (Exclude reference books or
school books.)
b. What was the total expense
for them?
0060
0070
$
SPRTA DX C
for them?
c.
.00
None
1
Yes
No – Go to item 4a
c.
0090
0100
$
$
RECA DMX
RECA DMX C
.00
.00
0
None
1
Yes
No – Go to item 5a
2
OTHB OOK S
0110
$
OTHB OOK X
8a.
How much of the total amount
was spent this month?
0120
$
0
OTHB K X CM
None
2
0170
0180
9a.
0190
c.
$
.00
MA GA Z X CM
b.
.00
c.
None
Yes
NEWSPA PR
No – Go to item 7a
NEWSPPRX
NEWSPPX C
.00
1
Yes
No – Go to item 8a
11a.
b.
.00
None
c.
Have any CU members
purchased any video cassettes,
video tapes, or video discs other
than through a mail-order club?
0280
1
2
$
How much of the total amount
was spent this month?
0210
$
Have any CU members purchased
any photographic film?
0220
.00
RECORDX M
.00
None
1
Yes
No – Go to item 9a
2
0230
$
How much of the total amount
was spent this month?
0240
$
0250
RECORDX
0
spent?
Have any CU members paid for
film processing?
V I DEOPUR
Yes
No – Go to item 11a
What was the total expense
for them?
0290
$
VIDOPURX
.00
How much of the total amount
was spent this month?
0300
$
VDPURX CM
.00
Have any CU members rented
any video cassettes, video
tapes, or video discs?
0310
0
None
1
VIDEORNT
Yes
No – Go to next section
2
What was the total expense
for them?
0320
$
How much of the total amount
was spent this month?
0330
$
VIDORNTX
.00
VDRNTX CM
.00
None
NOTES
RECORDY N
FIL MX
FIL MX CM
FIL M
.00
.00
0
None
1
F I L MPRCS
Yes
No – Go to item 10a
2
spent?
0260
$
How much of the total amount
was spent this month?
0270
$
0
Page 86
MA GA Z X
0
2
.00
.00
$
0200
b. What was the total amount
c.
1
for them?
b. What was the total amount
c.
10a.
0
Have any CU members
purchased compact discs, audio
tapes, needles, or records other
than through a mail-order club?
b. What was the total expense
RECA DMIT
0080
How much of the total amount
was spent this month?
0160
.00
0
2
Have any CU members
purchased single copies of
newspapers (non-subscription)?
b. What was the total expense
7a.
c.
Yes
MA GA Z INE
No – Go to item 6a
SPORTFEE
0020
for them?
1 17 26 7
Section 17 – Part B
FL MPRCSX
.00
FL MPRX CM
.00
None
Page 86
Page 87
Page 87
NOTES
FORM CE-302
FORM CE-302
FIELD REPRESENTATIVE – Ask part A items 1–7, filling in item 8 for each trip or set of identical trips reported.
Identical trips are trips taken in the SAME month to the SAME destination which are
reimbursed to the SAME degree (i.e., entirely vs. partially paid for by CU).
Section 18 – TRIPS AND VACATIONS
Part A – Screening Questions
1a. Now I’m going to ask about trips and vacations. First I’d
1 18 01 8
8.
like to ask about trips taken by you (or any members of
your CU) which were paid for by someone else. Since
the 1st of (month, 3 months ago), have you (or any
members of your CU) taken any trips entirely paid for by
anyone outside your CU, such as a business, employer,
or relative?
0010
If YES – How many trips like this did you have?
0020
1
2
Yes
No – Go to
item 2
a
2.
b
Trip Line
not
ended No.
A NY OUTSD
NUMOUTSD
Trips
Go to item 2
FIELD REPRESENTATIVE – Ask if box is marked.
Last interview you reported
trip(s) which had not
yet ended. I’d like to ask about that trip (those trips)
now.
Ask columns c–i for each trip reported in items 2–7b. Do not record any trip more than once. Trips reported in item 1b will be
TR I PL INE
b.
1 18 00 0
Complete items 8e–8i
for each trip checked
in 8a.
1
b.
4a.
b.
5a.
b.
6a.
b.
7a.
b.
(Other than the trips you already mentioned,) Since the
1st of (month, 3 months ago), have you (or any members
of your CU) been away overnight or longer to visit
relatives or friends?
If YES – How many trips were taken to visit relatives or
friends?
(Other than the trips you already mentioned,) Since the
1st of (month, 3 months ago), have you (or any members
of your CU) been away overnight or longer for business?
If YES – How many trips were taken for business?
(Other than the trips you already mentioned,) Since the
1st of (month, 3 months ago), have you (or any members
of your CU) been away overnight or longer for
recreation such as sightseeing, sports events, club or
organizational meetings, or outdoor recreation?
If YES – How many trips were taken for these reasons?
(Other than the trips you already mentioned,) Since the
1st of (month, 3 months ago), have you (or any members
of your CU) been away overnight or longer on any other
kind of trip?
If YES – How many trips were taken for these reasons?
Now let’s talk about times when you (or any members of
your CU) did not stay away overnight, but went
somewhere at least 75 miles away from home. Since the
1st of (month, 3 months ago), have you (or any members
of your CU) taken any trips like that?
If YES – How many such trips were taken?
Page 88
A NY REL S
0030
1
2
0040
1
2
3
5
1
Trips
Ask items 8c–8i for
each trip reported
2
2
2
4
5
Yes
No – Go to
item 5a
2
1
2
3
3
4
5
Yes
No – Go to
item 6a
NUMREC
1
Trips
Ask items 8c–8i for
each trip reported
2
4
1
2
0100
Yes
No – Go to
item 7a
NUMOTHER
Trips
Ask items 8c–8i for
each trip reported
A NY TRP7 5
0110
1
2
0120
Yes
No – Go to
item 9
NUMTRP7 5
Trips
Ask items 8c–8i for
each trip reported
3
4
A NY OTHER
0090
Month
0
Not ended –
Go to next
trip
Trips
(If more than one
trip, go to item 8h)
(If one trip, go to
item 8g)
1
Trips
(If more than one
trip, go to item 8h)
(If one trip, go to
item 8g)
1
2
Yes – Enter "1" in
item 8i – Go to
next trip
No – Enter "1" in
item 8h – Go to
next trip
h
How many of these
trips were paid for
entirely by you
(your CU)?
NUMCUPA Y
Trips paid for entirely
by CU – Enter trip I.D.
No. below. If number
of trips is the same as
in 8f, go to next trip.
5
i
How many of these
trips were or will
be partially paid for
by a business,
employer, or other
non-CU member?
NUMREIMB
Trips partially
reimbursed –
Enter trip I.D.
No. below
identifiTRIPID1Trip identification No. TRIPID2 Trip
cation No.
City or place
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
Month
0
Not ended –
Go to next
trip
2
Yes – Enter "1" in
item 8i – Go to
next trip
No – Enter "1" in
item 8h – Go to
next trip
Trips paid for entirely
by CU – Enter trip I.D.
No. below. If number
of trips is the same as
in 8f, go to next trip.
Trips partially
reimbursed –
Enter trip I.D.
No. below
Trip identification No.
City or place
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
Month
0
Not ended –
Go to next
trip
Trips
(If more than one
trip, go to item 8h)
(If one trip, go to
item 8g)
1
2
Yes – Enter "1" in
item 8i – Go to
next trip
No – Enter "1" in
item 8h – Go to
next trip
Trips paid for entirely
by CU – Enter trip I.D.
No. below. If number
of trips is the same as
in 8f, go to next trip.
Trips partially
reimbursed –
Enter trip I.D.
No. below
Trip identification No.
Trip identification No.
City or place
FROM ITEM –
0080
A NY B Y OTH
NUMTRIPS
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
FROM ITEM –
A NY REC
1
g
Did
or
will a
How many trips did business, employer,
In what month
you (or members
or any other
did this
of your CU) take
non-CU
member
trip end?
to (destination) in
pay any of the
(month
ended)
?
ENDTRPMO
costs for this trip?
Trip identification No.
0060 NUMB SNS Trips
Ask items 8c–8i for
each trip reported
0070
3
f
City or place
FROM ITEM –
NUMREL S
1
Trip type
Where did you (they)
go on this trip?
FROM ITEM –
Yes
No – Go to
item 4a
A NY B SNS
0050
d
TY PETRIP
4
3a.
e
c
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
Month
0
Not ended –
Go to next
trip
Trips
(If more than one
trip, go to item 8h)
(If one trip, go to
item 8g)
1
2
Yes – Enter "1" in
item 8i – Go to
next trip
No – Enter "1" in
item 8h – Go to
next trip
Trips paid for entirely
by CU – Enter trip I.D.
No. below. If number
of trips is the same as
in 8f, go to next trip.
Trip identification No.
9.
TRIP TALLY CHART
• For trips ENTIRELY paid for by someone outside the CU, complete one part D.
• For trips paid for by CU or trips partially paid for by someone outside the CU, fill out the chart below
and complete the appropriate detailed part for each trip.
Trip partially
Trip partially
Trip
Trip paid for
Trip
Trip paid for
paid for by
paid for by
identification
entirely by CU
identification
entirely
by
CU
non-CU members
non-CU members
No.
(from column h)
No.
(from
column
h)
(from column i)
(from column i)
1
Complete part B
Complete part C
5
Complete part B
Complete part C
2
Complete part B
Complete part C
6
Complete part B
Complete part C
3
Complete part B
Complete part C
7
Complete part B
Complete part C
4
Complete part B
Complete part C
8
Complete part B
Complete part C
Section 18 – Part A
Trips partially
reimbursed –
Enter trip I.D.
No. below
Trip identification No.
PRE
1
2
Destination
Month ended
Page 88
Page 89
Page 89
Section 18 – TRIPS AND VACATIONS – Continued
Part A – Screening Questions – Continued
NOTES
8.
a
1 18 02 6
Ask columns c–i for each trip reported in items 2–7b. Do not record any trip more than once. Trips reported in item 1b will be recorded in part D.
b
c
Trip Line
not
ended No.
Trip type
1
2
5
3
4
5
1
2
6
3
4
5
1
2
7
3
4
5
1
2
8
3
4
5
9.
e
f
g
How many trips did you Did or will a business,
employer, or any
Where did you (they) In what month did (or members of your CU)
other non-CU
go on this trip?
this trip end?
take to (destination) in
member pay any of
(month ended)?
the costs for this trip?
City or place
FROM ITEM –
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
City or place
FROM ITEM –
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
City or place
FROM ITEM –
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
City or place
FROM ITEM –
3b (relatives or friends)
4b (business)
State
5b (sightseeing, sports, etc.)
6b (any others)
Foreign country
7b (day trips)
Month
0
Not ended –
Go to next trip
Month
0
Not ended –
Go to next trip
Month
0
Not ended –
Go to next trip
Month
0
Not ended –
Go to next trip
Trips
(If more than one trip,
go to item 8h)
(If one trip, go to item 8g)
Trips
(If more than one trip,
go to item 8h)
(If one trip, go to item 8g)
Trips
(If more than one trip,
go to item 8h)
(If one trip, go to item 8g)
Trips
(If more than one trip,
go to item 8h)
(If one trip, go to item 8g)
1
Yes – Enter "1" in
item 8i – Go to
next trip
2
No – Enter "1" in
item 8h – Go to
next trip
1
Yes – Enter "1" in
item 8i – Go to
next trip
2
No – Enter "1" in
item 8h – Go to
next trip
1
Yes – Enter "1" in
item 8i – Go to
next trip
2
No – Enter "1" in
item 8h – Go to
next trip
1
Yes – Enter "1" in
item 8i – Go to
next trip
2
No – Enter "1" in
item 8h – Go to
next trip
Trip paid for
entirely by CU
(from column h)
Trip partially paid for
by non-CU members
(from column i)
Trip
identification
No.
Trip paid for
entirely by CU
(from column h)
h
i
How many of these trips
were paid for entirely by
you (your CU)?
How many of these trips
were or will be partially
paid for by a business,
employer, or other
non-CU member?
Trips paid for entirely by
CU – Enter trip I.D. No.
below. If number of trips
is the same as in 8f, go
to next trip.
Trip identification No.
Trips paid for entirely by
CU – Enter trip I.D. No.
below. If number of trips
is the same as in 8f, go
to next trip.
Trip identification No.
Trips paid for entirely by
CU – Enter trip I.D. No.
below. If number of trips
is the same as in 8f, go
to next trip.
Trip identification No.
Trips paid for entirely by
CU – Enter trip I.D. No.
below. If number of trips
is the same as in 8f, go
to next trip.
Trip identification No.
NOTES
TRIP TALLY CHART – Continued
• For trips ENTIRELY paid for by someone outside the CU, complete one part D.
• For trips paid for by CU or trips partially paid for by someone outside the CU, fill out the
chart below and complete the appropriate detailed part for each trip.
Trip
identification
No.
FORM CE-302
d
Trip partially paid for
by non-CU members
(from column i)
9
Complete part B
Complete part C
13
Complete part B
Complete part C
10
Complete part B
Complete part C
14
Complete part B
Complete part C
11
Complete part B
Complete part C
15
Complete part B
Complete part C
12
Complete part B
Complete part C
16
Complete part B
Complete part C
Trips partially
reimbursed –
Enter trip I.D.
No. below
Trip identification No.
Trips partially
reimbursed –
Enter trip I.D.
No. below
Trip identification No.
Trips partially
reimbursed –
Enter trip I.D.
No. below
Trip identification No.
Trips partially
reimbursed –
Enter trip I.D.
No. below
Trip identification No.
hT
c
A
FORM CE-302
a
FIELD REPRESENTATIVE – Ask part B for trips paid for entirely by CU. (Ask all questions in part B first
for one trip or set of identical trips before asking questions in this part
about other trips.)
T
Section 18 – TRIPS
AND VACATIONS – Continued
e
Part B – TripsN Paid Entirely By CU
r
1. FIELD REPRESENTATIVE
PROCESSING USE ONLY
ITEM
E
o Trip I.D.
In item 1a, enter
number fromf Trip Tally
Chart in part S
A. Enter trip
destination in item 1b, the
number of (identical) trips
E the month
in item 1c, kand
the trip ended in item 1d.
sR
a
P
e.
f.
g.
2a.
b.
Hand respondent Information Booklet, page 37.
1 18 34 9
3a.
a.
TRIP IDENTIFICATION NUMBER
b.
DESTINATION
Identification number
TRIPDEST
OFFICE USE ONLY
c.
TRIPIDB C
0010
NUMBER OF (IDENTICAL) TRIPS
NUMSA ME
If set of"identical
trips read Since you (your CU) took a set of
E
similar, trips, I will ask about them as a group. Please give the
total of all these trips for each of the following questions.
sR
Now I’d like to ask some additional questions about the trip(s)
you (your CU) took to (destination). If day trip, go to item 2a.
e
CMB USY
Verify
D if already reported. Otherwise, ask – How many nights did
you (or any members of your CU) spend away from home on
Y trip?
this
"L
Sometimes
when people take a trip they have some sort of
package deal that covers some or all of the costs. Was all or
part
E of this trip covered by a package deal?
f
I
I
Did the package deal include . . .
If no codes 1–12 marked, go to item 4.
Nights
1
2
Yes
No – Go to item 3a
Yes
01
$
CML OCA L X
.00
0300
02
$
CMPL A NEX
.00
CMTRA INY
0310
03
$
CMTRA INX
.00
Bus
CMB USY
0320
04
$
CMB USX
.00
Ship
CMSHIPY
0330
05
$
CMSHIPX
.00
01
Local (taxi, etc.)
0130
02
Airplane
0140
03
Train
0150
04
0160
05
CML OCA L Y
CMPL A NEY
RENTED
No
RTCA RY
0340
06
$
RTTRUCK Y
0350
07
$
0360
08
$
0370
09
$
RTPL A NEX
.00
0170
06
Car, jeep
0180
07
Truck, van
0190
08
Motorcycle, moped
RTCA RX
.00
RTTRUCK X
.00
0070 Food and beverages
L ODGDEA L
0080 Lodging
1
2
X
TRA NDEA L
0090 Transportation
1
2
X
0200
09
Private plane
EL SEDEA L
0100 Anything else
1
2
X
0210
10
Boat, trailer
RTB OA TY
0380
10
$
RTB OA TX
.00
0220
11
Camper
RTCA MPY
0390
11
$
RTCA MPX
.00
0230
12
Other vehicles
RTOTHERY
0400
12
$
RTOTHERX
.00
NOTES
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
DK
FOODDEA L
How much did you (or any members of your CU) pay for the
package deal?
0
RENTED
1
Specify
0110 $
PK GTRIPX
2
X
RTMOPEDY
RTPL A NEY
RTMOPEDX
.00
.00
PRIVATE
0240
13
Car owned by CU
0250
14
Vehicle leased by CU
0260
15
Other vehicle owned by CU
0270
16
Vehicle owned by someone else
0280
17
Other transport
4.
Page 90
0290
PK GTRIP
F
c.
COMMERCIAL
COMMERCIAL
0120
NUMNIGHT
0050
0060
Ask for each code 6–12 marked in item 3a.
How much did you (or any members of your CU)
spend for (transportation) not including gas you (or
any members of your CU) bought (other than what
the package deal covered)?
Number
EOTRIPMO
0040
d. MONTH ENDED
How much did you (or any members of your CU)
spend for (transportation) (other than what the
package deal covered)?
Starting at the beginning of this trip, please tell me
all the kinds of transportation you (or any members
of your CU) used from the time you (they) left home
to the time you (they) got back home.
PROBE – Any other kinds of transportation on this
trip?
0020
0030
3b. Ask for each code 1–5 marked in item 3a.
PVCA RY
PVL EA SY
PVOTHERY
PVEL SEY
PVTRA NSY
Codes 6–17: If no codes 6–17 marked in item 3a, go to item 6a.
If any codes 6–17 marked, continue with item 5a.
Section 18 – Part B
Page 90
Page 91
Page 91
Section 18 – TRIPS AND VACATIONS – Continued
Part B – Trips Paid Entirely by CU – Continued
5a. While on the trip did you (or any members of your
0010
CU) stop to buy any gasoline, oil, diesel fuel, or any
other fuels?
b.
c.
d.
e.
How much did you (or any members of your CU)
spend for that?
1 18 35 6
1
2
0020 $
While on the trip, did you (or any members of your
CU) spend anything for tolls?
0030
If YES –
How much did you (or any members of your CU)
spend for tolls?
0040 $
Did you (or any members of your CU) have any
parking fees?
0050
1
2
6a.
b.
7a.
b.
c.
If YES –
How much were they?
Did you (or any members of your CU) spend anything
for hotels, motels, cottages, trailer camps, or other
lodging (not counting what the package deal
covered)?
If YES –
What was the cost, including taxes and tips?
Did you (or any members of your CU) spend anything
for meals, snacks, or drinks at restaurants, bars, or
fast food places (not counting what the package
deal covered)?
If YES –
What was the cost, including taxes and tips?
Was any of the (amount in item 7b) for alcoholic
beverages?
1
0060 $
0070
1
2
0080 $
0090
1
2
8a.
b.
c.
9a.
b.
A NY PA RK
Yes
No – Go to item 6a
PA RK INGX
Did you (or any members of your CU) have any expenses
for this trip such as for souvenirs, passports, tourist
booklets, and so on?
L ODGING
Yes
No – Go to item 7a
L DGCOSTX
13a.
.00
You’ve told me about many expenses you (your CU) had
on this trip. Were any of the expenses you just reported
for anyone outside your CU?
FIELD REPRESENTATIVE – Read each item listed.
TRPFOOD
.00
0130
A NY GROC
Yes
No – Go to item 9a
0150
1
If YES –
What was the cost for alcoholic beverages, including
taxes?
0160 $
Did you (or any members of your CU) have any
expenses for rental of sports equipment (not
counting what the package deal covered)? (Hand
respondent Information Booklet, page 38.)
0170
If YES –
How much did you (or any members of your CU) pay
to rent sports equipment?
0180 $
1
2
0210
1
2
TRSPORTX
.00
Yes
No – Go to item 12a
0220 $
0230
1
2
TRPETRTX
A NY ENTER
.00
A NY MISC
Yes
No – Go to item 13a
TRPGROCX
.00
.00
TRPA L CGX
2
TRPGFTC
Yes
No – Go to next trip; after last trip, go to part D
14a.
YES
NO
DK
FOODOUTS
0260
Food and beverages
1
2
X
L ODGOUTS
0270
Lodging
1
2
X
TRA NOUTS
0280
Transportation
1
2
X
EL SEOUTS
0290
Other expenses
1
2
X
YES
NO
DK
0300 $
TRPGFTCX
.00
If the respondent is unable to break down food and beverages,
lodging, transportation, other expenses, or expenses for others,
enter these expenses. Only those expenses a respondent is not
able to break down should be combined and entered here.
0310 $
TCOMB EST
.00
b. Does this (amount) include anything for . . .?
FOODCOMB
0320
Food and beverages
1
2
X
L ODGCOMB
0330
Lodging
1
2
X
TRA NCOMB
0340
Transportation
1
2
X
EL SECOMB
0350
Other expenses
1
2
X
OTHRCOMB
0360
Expenses for others
1
2
X
.00
A NY SPEQP
Yes
No – Go to item 10a
TRSPRTX
1
.00
for persons outside your CU?
FIELD REPRESENTATIVE – Read each item listed.
A NY A L C
Yes
No – Go to item 9a
0250
TRMISCX
b. Did these expenses include anything for . . .?
Yes
No – Go to item 8a
Did you (or any members of your CU) spend anything
for food or beverages at grocery stores, convenience
stores, or liquor stores on this trip?
0140 $
0200 $
0240 $
c. How much of the total expenses for this trip were
2
2
A NY SPORT
Yes
No – Go to item 11a
If YES –
0120 $
FORM CE-302
Did you (or any members of your CU) spend anything on
this trip for entertainment or admissions (not counting
what the package deal covered)? (Hand respondent
Information Booklet, page 40.)
b. How much were these expenses?
TRPA L CHX
Was any of the (amount in item 8b) for alcoholic
beverages?
12a.
.00
TRPA L CIN
Yes
No – Go to item 8a
1
1
If YES –
0110
1
0190
.00
If YES –
What was the cost for alcoholic beverages, including
taxes and tips?
If YES –
What were the expenses, including taxes?
b. How much did you (or any members of your CU) pay?
11a.
A NY TOL L
Yes
No – Go to item 5e
TRPTOL L X
Did you (or any members of your CU) pay any fees to play
sports or exercise (not counting what the package deal
covered)? (Hand respondent Information Booklet, page 39.)
If YES –
.00
TRPFOODX
2
d.
GA SOIL X
0100 $
2
d.
10a.
A NY GA S
Yes
No – Go to item 5c
b. How much did you (or any members of your CU) spend?
2
f.
NOTES
.00
GO TO NEXT TRIP; AFTER LAST TRIP, GO TO PART D.
FORM CE-302
FIELD REPRESENTATIVE – Ask part B for trips paid for entirely by CU. (Ask all questions in part B first
for one trip or set of identical trips before asking questions in this part
about other trips.)
Section 18 – TRIPS AND VACATIONS – Continued
Part B – Trips Paid Entirely By CU – Continued
1. FIELD REPRESENTATIVE
PROCESSING USE ONLY
ITEM
In item 1a, enter Trip I.D.
number from Trip Tally
Chart in part A. Enter trip
destination in item 1b, the
number of (identical) trips
in item 1c, and the month
the trip ended in item 1d.
3a.
a.
TRIP IDENTIFICATION NUMBER
b.
DESTINATION
OFFICE USE ONLY
c.
NUMBER OF (IDENTICAL) TRIPS
f.
g.
2a.
0010
Identification number
Number
Nights
1
2
Yes
$
.00
02
Airplane
0300
02
$
.00
0140
03
Train
0310
03
$
.00
0150
04
Bus
0320
04
$
.00
0160
05
Ship
0330
05
$
.00
0130
No
0170
06
Car, jeep
0340
06
$
.00
0180
07
Truck, van
0350
07
$
.00
0190
08
Motorcycle, moped
0360
08
$
.00
0070 Food and beverages
X
0080 Lodging
1
2
X
0090 Transportation
1
2
X
0200
09
Private plane
0370
09
$
.00
0100 Anything else
1
2
X
0210
10
Boat, trailer
0380
10
$
.00
0220
11
Camper
0390
11
$
.00
0230
12
Other vehicles
0400
12
$
.00
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
.00
PRIVATE
0240
13
Car owned by CU
0250
14
Vehicle leased by CU
0260
15
Other vehicle owned by CU
0270
16
Vehicle owned by someone else
0280
17
Other transport
4.
Page 91a
None
DK
2
0110 $
0
RENTED
1
Specify
NOTES
01
01
RENTED
FIELD REPRESENTATIVE – Read each item listed.
How much did you (or any members of your CU) pay for the
package deal?
Local (taxi, etc.)
0290
0120
Yes
No – Go to item 3a
b. If "Yes," ask for each item: Did the package deal include . . .
c.
COMMERCIAL
COMMERCIAL
0050
0060
Ask for each code 6–12 marked in item 3a.
How much did you (or any members of your CU)
spend for (transportation) not including gas you (or
any members of your CU) bought (other than what
the package deal covered)?
If no codes 1–12 marked, go to item 4.
0030
Now I’d like to ask some additional questions about the trip(s)
you (your CU) took to (destination). If day trip, go to item 2a.
Sometimes when people take a trip they have some sort of
package deal that covers some or all of the costs. Was all or
part of this trip covered by a package deal?
How much did you (or any members of your CU)
spend for (transportation) (other than what the
package deal covered)?
PROBE – Any other kinds of transportation on this
trip?
0020
If set of identical trips read – Since you (your CU) took a set of
similar trips, I will ask about them as a group. Please give the
total of all these trips for each of the following questions.
Verify if already reported. Otherwise, ask – How many nights did
you (or any members of your CU) spend away from home on
this trip?
3b. Ask for each code 1–5 marked in item 3a.
Starting at the beginning of this trip, please tell me
all the kinds of transportation you (or any members
of your CU) used from the time you (they) left home
to the time you (they) got back home.
0040
d. MONTH ENDED
e.
Hand respondent Information Booklet, page 37.
1 18 36 4
Codes 6–17: If no codes 6–17 marked in item 3a, go to item 6a.
If any codes 6–17 marked, continue with item 5a.
Section 18 – Part B (Continued)
Page 91a
Page 91b
Page 91b
Section 18 – TRIPS AND VACATIONS – Continued
Part B – Trips Paid Entirely by CU – Continued
5a. While on the trip did you (or any members of your
0010
CU) stop to buy any gasoline, oil, diesel fuel, or any
other fuels?
b.
c.
d.
e.
How much did you (or any members of your CU)
spend for that?
1 18 37 2
1
2
6a.
0030
If YES –
How much did you (or any members of your CU)
spend for tolls?
0040 $
Did you (or any members of your CU) have any
parking fees?
0050
b.
7a.
b.
c.
Did you (or any members of your CU) spend anything
for hotels, motels, cottages, trailer camps, or other
lodging (not counting what the package deal
covered)?
If YES –
What was the cost, including taxes and tips?
Did you (or any members of your CU) spend anything
for meals, snacks, or drinks at restaurants, bars, or
fast food places (not counting what the package
deal covered)?
If YES –
What was the cost, including taxes and tips?
Was any of the (amount in item 7b) for alcoholic
beverages?
1
2
8a.
b.
1
c.
0070
1
2
9a.
b.
0090
1
2
1
2
Yes
No – Go to item 11a
0110
1
Yes
No – Go to item 6a
12a.
.00
Did you (or any members of your CU) have any expenses
for this trip such as for souvenirs, passports, tourist
booklets, and so on?
Yes
No – Go to item 7a
13a.
.00
2
You’ve told me about many expenses you (your CU) had
on this trip. Were any of the expenses you just reported
for anyone outside your CU?
FIELD REPRESENTATIVE – Read each item listed.
Yes
No – Go to item 8a
.00
Yes
No – Go to item 8a
.00
Yes
No – Go to item 9a
.00
0140 $
0150
1
If YES –
What was the cost for alcoholic beverages, including
taxes?
0160 $
Did you (or any members of your CU) have any
expenses for rental of sports equipment (not
counting what the package deal covered)? (Hand
respondent Information Booklet, page 38.)
0170
If YES –
How much did you (or any members of your CU) pay
to rent sports equipment?
0180 $
1
2
1
2
Yes
No – Go to item 12a
.00
0220 $
0230
1
2
Yes
No – Go to item 13a
0250
1
2
Yes
No – Go to next trip; after last trip, go to part D
YES
NO
DK
0260
Food and beverages
1
2
X
0270
Lodging
1
2
X
0280
Transportation
1
2
X
0290
Other expenses
1
2
X
YES
NO
DK
for persons outside your CU?
0300 $
.00
If the respondent is unable to break down food and beverages,
lodging, transportation, other expenses, or expenses for others,
enter these expenses. Only those expenses a respondent is not
able to break down should be combined and entered here.
0310 $
.00
b. Does this (amount) include anything for . . .?
FIELD REPRESENTATIVE – Read each item listed.
Yes
No – Go to item 9a
.00
0240 $
b. Did these expenses include anything for . . .?
14a.
1
0210
If YES –
c. How much of the total expenses for this trip were
0130
.00
0200 $
If YES –
0100 $
Did you (or any members of your CU) spend anything
for food or beverages at grocery stores, convenience
stores, or liquor stores on this trip?
FORM CE-302
0190
.00
0080 $
2
d.
Did you (or any members of your CU) spend anything on
this trip for entertainment or admissions (not counting
what the package deal covered)? (Hand respondent
Information Booklet, page 40.)
b. How much were these expenses?
0120 $
Was any of the (amount in item 8b) for alcoholic
beverages?
b. How much did you (or any members of your CU) pay?
11a.
Yes
No – Go to item 5e
0060 $
If YES –
What was the cost for alcoholic beverages, including
taxes and tips?
If YES –
What were the expenses, including taxes?
.00
b. How much did you (or any members of your CU) spend?
2
d.
Did you (or any members of your CU) pay any fees to play
sports or exercise (not counting what the package deal
covered)? (Hand respondent Information Booklet, page 39.)
If YES –
2
f.
10a.
Yes
No – Go to item 5c
0020 $
While on the trip, did you (or any members of your
CU) spend anything for tolls?
If YES –
How much were they?
NOTES
0320
Food and beverages
1
2
X
0330
Lodging
1
2
X
0340
Transportation
1
2
X
0350
Other expenses
1
2
X
0360
Expenses for others
1
2
X
.00
Yes
No – Go to item 10a
.00
GO TO NEXT TRIP; AFTER LAST TRIP, GO TO PART D.
FORM CE-302
FIELD REPRESENTATIVE – Ask part B for trips paid for entirely by CU. (Ask all questions in part B first
for one trip or set of identical trips before asking questions in this part
about other trips.)
Section 18 – TRIPS AND VACATIONS – Continued
Part B – Trips Paid Entirely By CU – Continued
1. FIELD REPRESENTATIVE
PROCESSING USE ONLY
ITEM
In item 1a, enter Trip I.D.
number from Trip Tally
Chart in part A. Enter trip
destination in item 1b, the
number of (identical) trips
in item 1c, and the month
the trip ended in item 1d.
3a.
a.
TRIP IDENTIFICATION NUMBER
b.
DESTINATION
OFFICE USE ONLY
c.
NUMBER OF (IDENTICAL) TRIPS
f.
g.
2a.
0010
Identification number
Number
Nights
1
2
Yes
$
.00
02
Airplane
0300
02
$
.00
0140
03
Train
0310
03
$
.00
0150
04
Bus
0320
04
$
.00
0160
05
Ship
0330
05
$
.00
0130
No
0170
06
Car, jeep
0340
06
$
.00
0180
07
Truck, van
0350
07
$
.00
0190
08
Motorcycle, moped
0360
08
$
.00
0070 Food and beverages
X
0080 Lodging
1
2
X
0090 Transportation
1
2
X
0200
09
Private plane
0370
09
$
.00
0100 Anything else
1
2
X
0210
10
Boat, trailer
0380
10
$
.00
0220
11
Camper
0390
11
$
.00
0230
12
Other vehicles
0400
12
$
.00
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
.00
PRIVATE
0240
13
Car owned by CU
0250
14
Vehicle leased by CU
0260
15
Other vehicle owned by CU
0270
16
Vehicle owned by someone else
0280
17
Other transport
4.
Page 91c
None
DK
2
0110 $
0
RENTED
1
Specify
NOTES
01
01
RENTED
FIELD REPRESENTATIVE – Read each item listed.
How much did you (or any members of your CU) pay for the
package deal?
Local (taxi, etc.)
0290
0120
Yes
No – Go to item 3a
b. If "Yes," ask for each item: Did the package deal include . . .
c.
COMMERCIAL
COMMERCIAL
0050
0060
Ask for each code 6–12 marked in item 3a.
How much did you (or any members of your CU)
spend for (transportation) not including gas you (or
any members of your CU) bought (other than what
the package deal covered)?
If no codes 1–12 marked, go to item 4.
0030
Now I’d like to ask some additional questions about the trip(s)
you (your CU) took to (destination). If day trip, go to item 2a.
Sometimes when people take a trip they have some sort of
package deal that covers some or all of the costs. Was all or
part of this trip covered by a package deal?
How much did you (or any members of your CU)
spend for (transportation) (other than what the
package deal covered)?
PROBE – Any other kinds of transportation on this
trip?
0020
If set of identical trips read – Since you (your CU) took a set of
similar trips, I will ask about them as a group. Please give the
total of all these trips for each of the following questions.
Verify if already reported. Otherwise, ask – How many nights did
you (or any members of your CU) spend away from home on
this trip?
3b. Ask for each code 1–5 marked in item 3a.
Starting at the beginning of this trip, please tell me
all the kinds of transportation you (or any members
of your CU) used from the time you (they) left home
to the time you (they) got back home.
0040
d. MONTH ENDED
e.
Hand respondent Information Booklet, page 37.
1 18 38 0
Codes 6–17: If no codes 6–17 marked in item 3a, go to item 6a.
If any codes 6–17 marked, continue with item 5a.
Section 18 – Part B (Continued)
Page 91c
Page 91d
Page 91d
Section 18 – TRIPS AND VACATIONS – Continued
Part B – Trips Paid Entirely by CU – Continued
5a. While on the trip did you (or any members of your
0010
CU) stop to buy any gasoline, oil, diesel fuel, or any
other fuels?
b.
c.
d.
e.
How much did you (or any members of your CU)
spend for that?
1 18 39 8
1
2
6a.
0030
If YES –
How much did you (or any members of your CU)
spend for tolls?
0040 $
Did you (or any members of your CU) have any
parking fees?
0050
b.
7a.
b.
c.
Did you (or any members of your CU) spend anything
for hotels, motels, cottages, trailer camps, or other
lodging (not counting what the package deal
covered)?
If YES –
What was the cost, including taxes and tips?
Did you (or any members of your CU) spend anything
for meals, snacks, or drinks at restaurants, bars, or
fast food places (not counting what the package
deal covered)?
If YES –
What was the cost, including taxes and tips?
Was any of the (amount in item 7b) for alcoholic
beverages?
1
2
8a.
b.
1
c.
0070
1
2
9a.
b.
0090
1
2
1
2
Yes
No – Go to item 11a
0110
1
Yes
No – Go to item 6a
12a.
.00
Did you (or any members of your CU) have any expenses
for this trip such as for souvenirs, passports, tourist
booklets, and so on?
Yes
No – Go to item 7a
13a.
.00
2
You’ve told me about many expenses you (your CU) had
on this trip. Were any of the expenses you just reported
for anyone outside your CU?
FIELD REPRESENTATIVE – Read each item listed.
Yes
No – Go to item 8a
.00
Yes
No – Go to item 8a
.00
Yes
No – Go to item 9a
.00
0140 $
0150
1
If YES –
What was the cost for alcoholic beverages, including
taxes?
0160 $
Did you (or any members of your CU) have any
expenses for rental of sports equipment (not
counting what the package deal covered)? (Hand
respondent Information Booklet, page 38.)
0170
If YES –
How much did you (or any members of your CU) pay
to rent sports equipment?
0180 $
1
2
1
2
Yes
No – Go to item 12a
.00
0220 $
0230
1
2
Yes
No – Go to item 13a
0250
1
2
Yes
No – Go to next trip; after last trip, go to part D
YES
NO
DK
0260
Food and beverages
1
2
X
0270
Lodging
1
2
X
0280
Transportation
1
2
X
0290
Other expenses
1
2
X
YES
NO
DK
for persons outside your CU?
0300 $
.00
If the respondent is unable to break down food and beverages,
lodging, transportation, other expenses, or expenses for others,
enter these expenses. Only those expenses a respondent is not
able to break down should be combined and entered here.
0310 $
.00
b. Does this (amount) include anything for . . .?
FIELD REPRESENTATIVE – Read each item listed.
Yes
No – Go to item 9a
.00
0240 $
b. Did these expenses include anything for . . .?
14a.
1
0210
If YES –
c. How much of the total expenses for this trip were
0130
.00
0200 $
If YES –
0100 $
Did you (or any members of your CU) spend anything
for food or beverages at grocery stores, convenience
stores, or liquor stores on this trip?
FORM CE-302
0190
.00
0080 $
2
d.
Did you (or any members of your CU) spend anything on
this trip for entertainment or admissions (not counting
what the package deal covered)? (Hand respondent
Information Booklet, page 40.)
b. How much were these expenses?
0120 $
Was any of the (amount in item 8b) for alcoholic
beverages?
b. How much did you (or any members of your CU) pay?
11a.
Yes
No – Go to item 5e
0060 $
If YES –
What was the cost for alcoholic beverages, including
taxes and tips?
If YES –
What were the expenses, including taxes?
.00
b. How much did you (or any members of your CU) spend?
2
d.
Did you (or any members of your CU) pay any fees to play
sports or exercise (not counting what the package deal
covered)? (Hand respondent Information Booklet, page 39.)
If YES –
2
f.
10a.
Yes
No – Go to item 5c
0020 $
While on the trip, did you (or any members of your
CU) spend anything for tolls?
If YES –
How much were they?
NOTES
0320
Food and beverages
1
2
X
0330
Lodging
1
2
X
0340
Transportation
1
2
X
0350
Other expenses
1
2
X
0360
Expenses for others
1
2
X
.00
Yes
No – Go to item 10a
.00
GO TO NEXT TRIP; AFTER LAST TRIP, GO TO PART D.
FORM CE-302
FIELD REPRESENTATIVE – Ask part B for trips paid for entirely by CU. (Ask all questions in part B first
for one trip or set of identical trips before asking questions in this part
about other trips.)
Section 18 – TRIPS AND VACATIONS – Continued
Part B – Trips Paid Entirely By CU – Continued
1. FIELD REPRESENTATIVE
PROCESSING USE ONLY
ITEM
In item 1a, enter Trip I.D.
number from Trip Tally
Chart in part A. Enter trip
destination in item 1b, the
number of (identical) trips
in item 1c, and the month
the trip ended in item 1d.
3a.
a.
TRIP IDENTIFICATION NUMBER
b.
DESTINATION
OFFICE USE ONLY
c.
NUMBER OF (IDENTICAL) TRIPS
f.
g.
2a.
0010
Identification number
Number
Nights
1
2
Yes
$
.00
02
Airplane
0300
02
$
.00
0140
03
Train
0310
03
$
.00
0150
04
Bus
0320
04
$
.00
0160
05
Ship
0330
05
$
.00
0130
No
0170
06
Car, jeep
0340
06
$
.00
0180
07
Truck, van
0350
07
$
.00
0190
08
Motorcycle, moped
0360
08
$
.00
0070 Food and beverages
X
0080 Lodging
1
2
X
0090 Transportation
1
2
X
0200
09
Private plane
0370
09
$
.00
0100 Anything else
1
2
X
0210
10
Boat, trailer
0380
10
$
.00
0220
11
Camper
0390
11
$
.00
0230
12
Other vehicles
0400
12
$
.00
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
.00
PRIVATE
0240
13
Car owned by CU
0250
14
Vehicle leased by CU
0260
15
Other vehicle owned by CU
0270
16
Vehicle owned by someone else
0280
17
Other transport
4.
Page 91e
None
DK
2
0110 $
0
RENTED
1
Specify
NOTES
01
01
RENTED
FIELD REPRESENTATIVE – Read each item listed.
How much did you (or any members of your CU) pay for the
package deal?
Local (taxi, etc.)
0290
0120
Yes
No – Go to item 3a
b. If "Yes," ask for each item: Did the package deal include . . .
c.
COMMERCIAL
COMMERCIAL
0050
0060
Ask for each code 6–12 marked in item 3a.
How much did you (or any members of your CU)
spend for (transportation) not including gas you (or
any members of your CU) bought (other than what
the package deal covered)?
If no codes 1–12 marked, go to item 4.
0030
Now I’d like to ask some additional questions about the trip(s)
you (your CU) took to (destination). If day trip, go to item 2a.
Sometimes when people take a trip they have some sort of
package deal that covers some or all of the costs. Was all or
part of this trip covered by a package deal?
How much did you (or any members of your CU)
spend for (transportation) (other than what the
package deal covered)?
PROBE – Any other kinds of transportation on this
trip?
0020
If set of identical trips read – Since you (your CU) took a set of
similar trips, I will ask about them as a group. Please give the
total of all these trips for each of the following questions.
Verify if already reported. Otherwise, ask – How many nights did
you (or any members of your CU) spend away from home on
this trip?
3b. Ask for each code 1–5 marked in item 3a.
Starting at the beginning of this trip, please tell me
all the kinds of transportation you (or any members
of your CU) used from the time you (they) left home
to the time you (they) got back home.
0040
d. MONTH ENDED
e.
Hand respondent Information Booklet, page 37.
1 18 40 6
Codes 6–17: If no codes 6–17 marked in item 3a, go to item 6a.
If any codes 6–17 marked, continue with item 5a.
Section 18 – Part B (Continued)
Page 91e
Page 91f
Page 91f
Section 18 – TRIPS AND VACATIONS – Continued
Part B – Trips Paid Entirely by CU – Continued
5a. While on the trip did you (or any members of your
0010
CU) stop to buy any gasoline, oil, diesel fuel, or any
other fuels?
b.
c.
d.
e.
How much did you (or any members of your CU)
spend for that?
1 18 41 4
1
2
6a.
0030
If YES –
How much did you (or any members of your CU)
spend for tolls?
0040 $
Did you (or any members of your CU) have any
parking fees?
0050
b.
7a.
b.
c.
Did you (or any members of your CU) spend anything
for hotels, motels, cottages, trailer camps, or other
lodging (not counting what the package deal
covered)?
If YES –
What was the cost, including taxes and tips?
Did you (or any members of your CU) spend anything
for meals, snacks, or drinks at restaurants, bars, or
fast food places (not counting what the package
deal covered)?
If YES –
What was the cost, including taxes and tips?
Was any of the (amount in item 7b) for alcoholic
beverages?
1
2
8a.
b.
1
c.
0070
1
2
9a.
b.
0090
1
2
1
2
Yes
No – Go to item 11a
0110
1
Yes
No – Go to item 6a
12a.
.00
Did you (or any members of your CU) have any expenses
for this trip such as for souvenirs, passports, tourist
booklets, and so on?
Yes
No – Go to item 7a
13a.
.00
2
You’ve told me about many expenses you (your CU) had
on this trip. Were any of the expenses you just reported
for anyone outside your CU?
FIELD REPRESENTATIVE – Read each item listed.
Yes
No – Go to item 8a
.00
Yes
No – Go to item 8a
.00
Yes
No – Go to item 9a
.00
0140 $
0150
1
If YES –
What was the cost for alcoholic beverages, including
taxes?
0160 $
Did you (or any members of your CU) have any
expenses for rental of sports equipment (not
counting what the package deal covered)? (Hand
respondent Information Booklet, page 38.)
0170
If YES –
How much did you (or any members of your CU) pay
to rent sports equipment?
0180 $
1
2
1
2
Yes
No – Go to item 12a
.00
0220 $
0230
1
2
Yes
No – Go to item 13a
0250
1
2
Yes
No – Go to next trip; after last trip, go to part D
YES
NO
DK
0260
Food and beverages
1
2
X
0270
Lodging
1
2
X
0280
Transportation
1
2
X
0290
Other expenses
1
2
X
YES
NO
DK
for persons outside your CU?
0300 $
.00
If the respondent is unable to break down food and beverages,
lodging, transportation, other expenses, or expenses for others,
enter these expenses. Only those expenses a respondent is not
able to break down should be combined and entered here.
0310 $
.00
b. Does this (amount) include anything for . . .?
FIELD REPRESENTATIVE – Read each item listed.
Yes
No – Go to item 9a
.00
0240 $
b. Did these expenses include anything for . . .?
14a.
1
0210
If YES –
c. How much of the total expenses for this trip were
0130
.00
0200 $
If YES –
0100 $
Did you (or any members of your CU) spend anything
for food or beverages at grocery stores, convenience
stores, or liquor stores on this trip?
FORM CE-302
0190
.00
0080 $
2
d.
Did you (or any members of your CU) spend anything on
this trip for entertainment or admissions (not counting
what the package deal covered)? (Hand respondent
Information Booklet, page 40.)
b. How much were these expenses?
0120 $
Was any of the (amount in item 8b) for alcoholic
beverages?
b. How much did you (or any members of your CU) pay?
11a.
Yes
No – Go to item 5e
0060 $
If YES –
What was the cost for alcoholic beverages, including
taxes and tips?
If YES –
What were the expenses, including taxes?
.00
b. How much did you (or any members of your CU) spend?
2
d.
Did you (or any members of your CU) pay any fees to play
sports or exercise (not counting what the package deal
covered)? (Hand respondent Information Booklet, page 39.)
If YES –
2
f.
10a.
Yes
No – Go to item 5c
0020 $
While on the trip, did you (or any members of your
CU) spend anything for tolls?
If YES –
How much were they?
NOTES
0320
Food and beverages
1
2
X
0330
Lodging
1
2
X
0340
Transportation
1
2
X
0350
Other expenses
1
2
X
0360
Expenses for others
1
2
X
.00
Yes
No – Go to item 10a
.00
GO TO NEXT TRIP; AFTER LAST TRIP, GO TO PART D.
FORM CE-302
FIELD REPRESENTATIVE – Ask part C for partially reimbursed trips. (Ask all questions in part C first for one trip or set of
identical trips before asking questions in this part about other trips.)
Section 18 – TRIPS AND VACATIONS – Continued
Part C – Partially Reimbursed Trips
1. FIELD REPRESENTATIVE
PROCESSING USE ONLY
ITEM
In item 1a, enter Trip I.D.
number from Trip Tally
Chart in part A. Enter trip
destination in item 1b, the
number of (identical) trips
in item 1c, and the month
the trip ended in item 1d.
3a.
a.
TRIP IDENTIFICATION NUMBER
b.
DESTINATION
NUMBER OF (IDENTICAL) TRIPS
g.
2a.
Identification number
NUMSA ME
0030
Sometimes when people take a trip they have some sort of
package deal that covers some or all of the costs. Was all or
part of this trip covered by a package deal?
0060
1
2
Yes
No
$
CML OCA L X
.00
0300
02
$
CMPL A NEX
.00
CMTRA INY
0310
03
$
CMTRA INX
.00
Local (taxi, etc.)
0130
02
Airplane
0140
03
Train
0150
04
Bus
CMB USY
0320
04
$
CMB USX
.00
0160
05
Ship
CMSHIPY
0330
05
$
CMSHIPX
.00
CMPL A NEY
06
Car, jeep
0180
07
Truck, van
0190
08
Motorcycle, moped
0200
09
Private plane
RTTRUCK Y
RTMOPEDY
0070 Food and beverages
1
2
X
0080 Lodging
1
2
X
0090 Transportation
1
2
X
0210
10
Boat, trailer
RTB OA TY
TRA NDEA L
EL SEDEA L
0100 Anything else
1
2
X
0220
11
Camper
RTCA MPY
0230
12
Other vehicles
L ODGDEA L
Specify
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
RENTED
RTCA RY
0170
DK
FIELD REPRESENTATIVE – Read each item listed.
FOODDEA L
01
CML OCA L Y
01
RENTED
PK GTRIP
b. If "Yes," ask for each item: Did the package deal include . . .
0290
0120
Nights
Yes
No – Go to item 3a
COMMERCIAL
COMMERCIAL
You told me that someone outside your CU paid for part of the
trip(s) you (your CU) took to (trip destination). In the next
questions I’m interested only in the costs you (your CU) had to
pay, not those paid or to be paid by a business or employer. If
day trip, go to item 2a.
0050
Ask for each code 6–12 marked in item 3a.
How much did you (or any members of your CU)
spend for (transportation) not including gas you (or
any members of your CU) bought (other than what
the package deal covered)?
If no codes 1–12 marked, go to item 4.
EOTRIPMO
NUMNIGHT
How much did you (or any members of your CU)
spend for (transportation) (other than what the
package deal covered)?
Starting at the beginning of this trip, please tell me
all the kinds of transportation you (or any members
of your CU) used from the time you (they) left home
to the time you (they) got back home.
Number
If set of identical trips read Since you (your CU) took a set of
similar trips, I will ask about them as a group. Please give the
total of all these trips for each of the following questions.
Verify if already reported. Otherwise, ask – How many nights did
you (or any members of your CU) spend away from home on
this trip?
3b. Ask for each code 1–5 marked in item 3a.
PROBE – Any other kinds of transportation on this
trip?
0020
0040
d. MONTH ENDED
f.
TRIPIDB C
0010
TRIPDEST
OFFICE USE ONLY
c.
e.
Hand respondent Information Booklet, page 37.
1 77 01 4
RTPL A NEY
RTOTHERY
RTCA RX
.00
RTTRUCK X
.00
0340
06
$
0350
07
$
0360
08
$
0370
09
$
RTPL A NEX
.00
0380
10
$
RTB OA TX
.00
0390
11
$
RTCA MPX
.00
0400
12
$
RTOTHERX
.00
RTMOPEDX
.00
PRIVATE
c.
How much did you (or any members of your CU) pay for the
package deal?
NOTES
0110 $
PK GTRIPX
.00
0240
13
Car owned by CU
0250
14
Vehicle leased by CU
0260
15
Other vehicle owned by CU
0270
16
Vehicle owned by someone else
0280
17
Other transport
4.
Page 92
PVCA RY
PVL EA SY
PVOTHERY
PVEL SEY
PVTRA NSY
Codes 6–17: If no codes 6–17 marked in item 3a, go to item 6a.
If any codes 6–17 marked, continue with item 5a.
Section 18 – Part C
Page 92
Page 93
Page 93
Section 18 – TRIPS AND VACATIONS – Continued
Part C – Partially Reimbursed Trips – Continued
5a. While on the trip did you (or any members of your
0010 1
CU) stop to buy any gasoline, oil, diesel fuel, or any
other fuels?
b.
c.
d.
e.
What costs for gasoline or other fuels won’t be
reimbursed?
While on the trip, did you (or any members of your
CU) spend anything for tolls?
If YES –
What costs for tolls won’t be reimbursed?
Did you (or any members of your CU) have any
parking fees?
2
0020 $
0030
1
2
0040 $
0050
1
2
f.
6a.
b.
7a.
b.
c.
If YES –
What costs for parking fees won’t be reimbursed?
0060 $
0070
If YES –
What costs for lodging, including taxes and tips,
won’t be reimbursed?
0080 $
Did you (or any members of your CU) spend anything
for meals, snacks, or drinks at restaurants, bars, or
fast food places (not counting what the package
deal covered)?
0090
Was any of the (amount in item 7b) for alcoholic
beverages?
1
2
1
2
0100 $
0110
1
2
d.
8a.
b.
c.
9a.
b.
10a.
A NY GA S
Yes
No – Go to item 5c
.00
0
None
A NY TOL L
Yes
No – Go to item 5e
TRPTOL L X
.00
0
A NY PA RK
Yes
No – Go to item 6a
.00
PA RK INGX
0
L ODGING
Yes
No – Go to item 7a
L DGCOSTX
.00
0
None
0190
1
2
0200 $
0210
1
2
If YES –
reimbursed?
12a.
Did you (or any members of your CU) have any expenses
for this trip such as for souvenirs, passports, tourist
booklets, and so on?
b. What costs for these things won’t be reimbursed?
0220 $
0230
1
2
Yes
No – Go to item 11a
TRSPORTX
Yes
No – Go to item 12a
TRPETRTX
A NY SPORT
.00
0
Yes
No – Go to item 13a
None
A NY ENTER
.00
TRPFOODX
.00
0
You’ve told me about many non-reimbursed expenses you
(your CU) had on this trip. Were any of these expenses
you just reported for anyone outside your CU?
FIELD REPRESENTATIVE – Read each item listed.
None
0
None
A NY MISC
A NY GROC
Yes
No – Go to item 9a
1
2
0140 $
0150
1
If YES –
What cost for alcoholic beverages, including taxes,
won’t be reimbursed?
0160 $
Did you (or any members of your CU) have any
expenses for rental of sports equipment (not
counting what the package deal covered)? (Hand
respondent Information Booklet, page 38.)
0170
1
2
0180 $
TRPGROCX
.00
0
Yes
A NY A L C
No – Go to item 9a
TRPA L CGX
.00
0
None
A NY SPEQP
Yes
No – Go to item 10a
TRSPRTX
.00
0
None
2
TRPGFTC
Yes
No – Go to next trip; after last trip, go to part D
YES
NO
DK
2
X
L ODGOUTS
0270
Lodging
1
2
X
0280
Transportation
1
2
X
0290
Other expenses
1
2
X
YES
NO
DK
this trip were for persons outside your CU?
0300 $
If the respondent is unable to break down food and beverages,
lodging, transportation, other expenses, or expenses for others,
enter the expenses that won’t be reimbursed. Only those
non-reimbursed expenses a respondent is not able to break
down should be combined and entered here
0310 $
TRPGFTCX
TCOMB EST
b. Does this (amount) include anything for . . .?
FIELD REPRESENTATIVE – Read each item listed.
None
1
EL SEOUTS
14a.
0
Food and beverages
None
None
1
.00
0260
c. How much of the total non-reimbursed expenses for
0
0250
TRMISCX
FOODOUTS
TRA NOUTS
TRPA L CIN
Yes
No – Go to item 8a
.00
0240 $
b. Did these expenses include anything for . . .?
TRPFOOD
Yes
No – Go to item 8a
0130
FORM CE-302
Did you (or any members of your CU) spend anything on
this trip for entertainment or admissions (not counting
what the package deal covered)? (Hand respondent
Information Booklet, page 40.)
b. What costs for entertainment and admissions won’t be
13a.
Did you (or any members of your CU) spend anything
for food or beverages at grocery stores, convenience
stores, or liquor stores on this trip?
If YES –
What costs for renting sports equipment won’t be
reimbursed?
11a.
None
TRPA L CHX
Was any of the (amount in item 8b) for alcoholic
beverages?
b. What costs for playing sports won’t be reimbursed?
None
0120 $
If YES –
What costs, including taxes, won’t be reimbursed?
Did you (or any members of your CU) pay any fees to play
sports or exercise (not counting what the package deal
covered)? (Hand respondent Information Booklet, page 39.)
If YES –
GA SOIL X
If YES –
What costs for alcoholic beverages, including taxes
and tips, won’t be reimbursed?
2
d.
NOTES
If YES –
Did you (or any members of your CU) spend anything
for hotels, motels, cottages, trailer camps, or other
lodging (not counting what the package deal
covered)?
If YES –
What costs for these things won’t be reimbursed?
1 77 02 2
.00
.00
FOODCOMB
0320
Food and beverages
1
2
X
L ODGCOMB
0330
Lodging
1
2
X
TRA NCOMB
0340
Transportation
1
2
X
EL SECOMB
0350
Other expenses
1
2
X
OTHRCOMB
0360
Expenses for others
1
2
X
GO TO NEXT TRIP; AFTER LAST TRIP, GO TO PART D.
FORM CE-302
FIELD REPRESENTATIVE – Ask part C for partially reimbursed trips. (Ask all questions in part C first for one trip or set of
identical trips before asking questions in this part about other trips.)
Section 18 – TRIPS AND VACATIONS – Continued
Part C – Partially Reimbursed Trips – Continued
1. FIELD REPRESENTATIVE
PROCESSING USE ONLY
ITEM
In item 1a, enter Trip I.D.
number from Trip Tally
Chart in part A. Enter trip
destination in item 1b, the
number of (identical) trips
in item 1c, and the month
the trip ended in item 1d.
3a.
a.
TRIP IDENTIFICATION NUMBER
b.
DESTINATION
OFFICE USE ONLY
c.
NUMBER OF (IDENTICAL) TRIPS
f.
g.
2a.
0010
Identification number
Number
COMMERCIAL
COMMERCIAL
0050
0060
Ask for each code 6–12 marked in item 3a.
How much did you (or any members of your CU)
spend for (transportation) not including gas you (or
any members of your CU) bought (other than what
the package deal covered)?
If no codes 1–12 marked, go to item 4.
0030
You told me that someone outside your CU paid for part of the
trip(s) you (your CU) took to (trip destination). In the next
questions I’m interested only in the costs you (your CU) had to
pay, not those paid or to be paid by a business or employer. If
day trip, go to item 2a.
Sometimes when people take a trip they have some sort of
package deal that covers some or all of the costs. Was all or
part of this trip covered by a package deal?
How much did you (or any members of your CU)
spend for (transportation) (other than what the
package deal covered)?
PROBE – Any other kinds of transportation on this
trip?
0020
If set of identical trips read – Since you (your CU) took a set of
similar trips, I will ask about them as a group. Please give the
total of all these trips for each of the following questions.
Verify if already reported. Otherwise, ask – How many nights did
you (or any members of your CU) spend away from home on
this trip?
3b. Ask for each code 1–5 marked in item 3a.
Starting at the beginning of this trip, please tell me
all the kinds of transportation you (or any members
of your CU) used from the time you (they) left home
to the time you (they) got back home.
0040
d. MONTH ENDED
e.
Hand respondent Information Booklet, page 37.
1 77 03 0
2
b. If "Yes," ask for each item: Did the package deal include . . .
Yes
No
0130
02
Airplane
0300
02
$
.00
0140
03
Train
0310
03
$
.00
0150
04
Bus
0320
04
$
.00
0160
05
Ship
0330
05
$
.00
06
Car, jeep
0340
06
$
.00
0180
07
Truck, van
0350
07
$
.00
0190
08
Motorcycle, moped
0360
08
$
.00
0200
09
Private plane
0370
09
$
.00
0070 Food and beverages
1
2
X
0080 Lodging
1
2
X
0090 Transportation
1
2
X
0210
10
Boat, trailer
0380
10
$
.00
0100 Anything else
1
2
X
0220
11
Camper
0390
11
$
.00
0230
12
Other vehicles
0400
12
$
.00
Specify
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
0
None
RENTED
0170
DK
FIELD REPRESENTATIVE – Read each item listed.
.00
Local (taxi, etc.)
RENTED
Yes
No – Go to item 3a
$
01
Nights
1
01
0120
0290
PRIVATE
c.
How much did you (or any members of your CU) pay for the
package deal?
NOTES
0110 $
.00
0240
13
Car owned by CU
0250
14
Vehicle leased by CU
0260
15
Other vehicle owned by CU
0270
16
Vehicle owned by someone else
0280
17
Other transport
4.
Page 93a
Codes 6–17: If no codes 6–17 marked in item 3a, go to item 6a.
If any codes 6–17 marked, continue with item 5a.
Section 18 – Part C (Continued)
Page 93a
Page 93b
Page 93b
Section 18 – TRIPS AND VACATIONS – Continued
Part C – Partially Reimbursed Trips – Continued
5a. While on the trip did you (or any members of your
0010 1
CU) stop to buy any gasoline, oil, diesel fuel, or any
other fuels?
b.
c.
d.
e.
What costs for gasoline or other fuels won’t be
reimbursed?
While on the trip, did you (or any members of your
CU) spend anything for tolls?
If YES –
What costs for tolls won’t be reimbursed?
Did you (or any members of your CU) have any
parking fees?
2
f.
6a.
b.
7a.
b.
c.
Did you (or any members of your CU) spend anything
for hotels, motels, cottages, trailer camps, or other
lodging (not counting what the package deal
covered)?
0030
1
2
8a.
b.
0050
1
c.
9a.
b.
0070
1
2
1
2
b. What costs for playing sports won’t be reimbursed?
11a.
.00
0
None
Yes
No – Go to item 6a
Did you (or any members of your CU) spend anything on
this trip for entertainment or admissions (not counting
what the package deal covered)? (Hand respondent
Information Booklet, page 40.)
1
2
Yes
No – Go to item 11a
12a.
0
.00
0200 $
0210
1
2
0
None
0
None
0
None
Yes
No – Go to item 12a
If YES –
reimbursed?
.00
None
Yes
No – Go to item 7a
0110
1
13a.
.00
0
None
Did you (or any members of your CU) have any expenses
for this trip such as for souvenirs, passports, tourist
booklets, and so on?
.00
0220 $
0230
1
2
Yes
No – Go to item 13a
You’ve told me about many non-reimbursed expenses you
(your CU) had on this trip. Were any of these expenses
you just reported for anyone outside your CU?
FIELD REPRESENTATIVE – Read each item listed.
.00
0
None
Yes
No – Go to item 8a
c. How much of the total non-reimbursed expenses for
0120 $
Did you (or any members of your CU) spend anything
for food or beverages at grocery stores, convenience
stores, or liquor stores on this trip?
0130
.00
0
2
Yes
No – Go to item 9a
.00
0140 $
0150
1
If YES –
What cost for alcoholic beverages, including taxes,
won’t be reimbursed?
0160 $
Did you (or any members of your CU) have any
expenses for rental of sports equipment (not
counting what the package deal covered)? (Hand
respondent Information Booklet, page 38.)
0170
If YES –
What costs for renting sports equipment won’t be
reimbursed?
0180 $
1
2
0
None
Yes
No – Go to item 9a
0
0
2
Yes
No – Go to next trip; after last trip, go to part D
YES
NO
DK
0260
Food and beverages
1
2
X
0270
Lodging
1
2
X
0280
Transportation
1
2
X
0290
Other expenses
1
2
X
YES
NO
DK
.00
If the respondent is unable to break down food and beverages,
lodging, transportation, other expenses, or expenses for others,
enter the expenses that won’t be reimbursed. Only those
non-reimbursed expenses a respondent is not able to break
down should be combined and entered here
0310 $
.00
b. Does this (amount) include anything for . . .?
0320
Food and beverages
1
2
X
0330
Lodging
1
2
X
0340
Transportation
1
2
X
0350
Other expenses
1
2
X
0360
Expenses for others
1
2
X
None
Yes
No – Go to item 10a
.00
1
0300 $
FIELD REPRESENTATIVE – Read each item listed.
.00
0250
this trip were for persons outside your CU?
None
14a.
1
.00
0240 $
b. Did these expenses include anything for . . .?
Yes
No – Go to item 8a
0100 $
If YES –
What costs for alcoholic beverages, including taxes
and tips, won’t be reimbursed?
FORM CE-302
0190
If YES –
2
d.
None
b. What costs for these things won’t be reimbursed?
0090
Was any of the (amount in item 8b) for alcoholic
beverages?
0
Yes
No – Go to item 5e
0060 $
Did you (or any members of your CU) spend anything
for meals, snacks, or drinks at restaurants, bars, or
fast food places (not counting what the package
deal covered)?
If YES –
What costs, including taxes, won’t be reimbursed?
Did you (or any members of your CU) pay any fees to play
sports or exercise (not counting what the package deal
covered)? (Hand respondent Information Booklet, page 39.)
b. What costs for entertainment and admissions won’t be
2
d.
.00
0040 $
0080 $
Was any of the (amount in item 7b) for alcoholic
beverages?
10a.
If YES –
If YES –
What costs for lodging, including taxes and tips,
won’t be reimbursed?
If YES –
What costs for these things won’t be reimbursed?
NOTES
Yes
No – Go to item 5c
0020 $
2
If YES –
What costs for parking fees won’t be reimbursed?
1 77 04 8
None
GO TO NEXT TRIP; AFTER LAST TRIP, GO TO PART D.
FORM CE-302
Section 18 – TRIPS AND VACATIONS – Continued
Part D – 100% Reimbursed Trips
1.
2a.
b.
FIELD REPRESENTATIVE CHECK ITEM
Enter number of trips ENTIRELY paid for by
NON-CU member from part A, item 1a or 1b.
You told me that you (your CU) had
(number from item 1) trip(s) entirely paid for
by non-CU members. Even on trips entirely
paid for by non-CU members there are
sometimes miscellaneous expenses which
are not paid for. Did you (your CU) have
any expenses on this trip (these trips) that
will not be covered by a business,
employer, or other non-CU member?
1 77 67 5
NUMY UPD
0010
0020
NOTES
Trips
0
None – Go to part E
1
Yes
No – Go to part E
2
A NY Y UPD
Did these expenses include anything for – ?
FOODY UPD
c.
FIELD REPRESENTATIVE – Complete item 1 for all CU’s.
YES
NO
DK
FIELD REPRESENTATIVE – Read each item listed.
0030 Food and beverages . . .
1
2
X
L ODGY UPD
0040 Lodging . . . . . . . . . . . . .
1
2
X
TRA NY UPD
0050 Transportation . . . . . . .
1
2
X
EL SEY UPD
0060 Anything else – Specify
1
2
X
What was the total amount for these
expenses?
0070 $
TOTY UPDX
.00
GO TO PART E
Page 94
Section 18 – Part D
Page 94
Page 95
Page 95
Section 18 – TRIPS AND VACATIONS – Continued
Part E – Trip Expenses for Non-CU Members
1a. Sometimes people in a CU don’t take a trip
themselves, but pay for part or all of a trip
that someone else takes. Since the 1st of
(month, three months ago), have you (has your
CU) paid for part or all of such a trip for any
non-CU members?
0010
2
If Yes –
0020
b.
How many trips was that?
c.
Did these expenses include anything for – ?
1
FIELD REPRESENTATIVE – Ask part E for all CU’s.
1 77 68 3
Yes
No – Go to part F
NUMNONCU
A NY NONCU
Trips
FOODNOCU 0030 Food and beverages . . .
FIELD REPRESENTATIVE – Read each item listed.
d.
YES
NO
DK
1
2
X
L ODGNOCU
0040 Lodging . . . . . . . . . . . . .
1
2
X
TRA NNOCU
0050 Transportation . . . . . . .
1
2
X
EL SENOCU
0060 Anything else – Specify
1
2
X
What was the total amount that you (your
CU) paid for that trip (those trips)?
0070 $
GO TO PART F
FORM CE-302
NOTES
TRNONCUX
.00
FORM CE-302
FIELD REPRESENTATIVE – Ask part F for all CU’s.
(Ask all questions in this part for one stay before asking about other stays.)
Section 18 – TRIPS AND VACATIONS – Continued
Part F – Local Overnight Stays
1.
1 77 69 1
We’ve talked about many different kinds of trips.
Sometimes people don’t take a trip, but they stay
overnight in a local hotel or motel such as for
holidays or family getaways. Since the 1st of
(month, 3 months ago), have you (or any members of
your CU) stayed overnight in a local hotel or motel?
0010
2
6a.
A NY L OC
Yes
No – Go to next section
1
3a.
b.
VERIFY IF ALREADY REPORTED, OTHERWISE ASK –
How many nights did you (or any members of your
CU) spend away from home on this stay?
Sometimes when people stay away from home
overnight they have some sort of package deal
that covers some or all of the costs. Was all or
part of this stay covered by anything like that?
NUML OC
0020
0030
Nights
c.
2
YES
NO
DK
0040 Food and beverages . . . . . . . . . . .
1
2
X
Was any of the (amount in item 6b) for alcoholic
beverages?
L OCGROCX
0170
Yes
No – Go to item 7a
1
0050 Lodging . . . . . . . . . . . . . . . . . . . . .
1
2
X
ENTRL CDL
0060 Entertainment . . . . . . . . . . . . . . . .
1
2
X
EL SEL CDL
0070 Anything else – Specify
1
2
X
b.
(Hand respondent Information Booklet, page 40.)
Did you (or any members of your CU) spend anything
on this stay for entertainment or admissions (not
counting what the package deal covered)?
0190
1
2
How much did you (or any members of your CU)
pay for the package deal?
0080
4a.
b.
Did you (or any members of your CU) spend
anything for hotels, motels, cottages, trailer
camps, or other lodging (not counting what the
package deal covered)?
0090
L OCDEA L X
8.
.00
What was the cost, including taxes and tips?
Did you (or any members of your CU) spend
anything for meals, snacks, or drinks at
restaurants, bars, or fast food places (not
counting what the package deal covered)?
If the respondent is unable to break down food and
beverages, lodging, entertainment, or other expenses, enter
these expenses. Only those expenses a respondent is not
able to break down should be combined and entered here.
L OCL ODGX
1
2
.00
A NY A DMI S
Yes
No – Go to item 8
L OCA DMSX
X
0210 $ L OCCOMB
.00
.00
Yes
No – Go to item 6a
A NY MEA L
YES
NO
DK
0220 Food and beverages . . . . . . . . . . .
1
2
X
L ODGL CCM
0230 Lodging . . . . . . . . . . . . . . . . . . . .
1
2
X
ENTRL CCM
0240 Entertainment . . . . . . . . . . . . . . .
1
2
X
EL SEL CCM
0250 Other expenses . . . . . . . . . . . . . .
1
2
X
.00
9.
0110
A NY A L CGR
Did the (amount) include anything for . . .? FOODL CCM
FIELD REPRESENTATIVE – Read each item listed.
$
A L CGROCX
A NY L ODGE
Yes
No – Go to item 5a
1
2
0100
5a.
$
.00
How much did you (or any members of your CU) pay?
0200 $
c.
A NY L CGR
What was the cost for alcoholic beverages,
including taxes?
0180 $
7a.
Yes
No – Go to item 7a
0160 $
2
d.
Ask for each item – Did the package deal include
anything for . . .?
FOODL CDL
L ODGL CDL
FIELD REPRESENTATIVE – Read each item listed.
1
What were the expenses, including taxes?
A NY L OCDL
Yes
No – Go to item 4a
1
0150
2
b.
2.
Did you (or any members of your CU) spend
anything for food or beverages at grocery stores,
convenience stores, or liquor stores?
Did you (or any members of your CU) have any other
stays at local hotels or motels?
0260
1
2
Yes – Complete part F for each stay
No – Go to next section
NOTES
b.
c.
What was the cost, including taxes and tips?
Was any of the (amount in item 5b) for alcoholic
beverages?
0120
$
0130
1
2
d.
What was the cost for alcoholic beverages,
including taxes and tips?
0140
Page 96
L OCMEA L X
Yes
No – Go to item 6a
A L CMEA L X
$
.00
A NY A L CML
.00
Section 18 – Part F
Page 96
Page 97
Page 97
FIELD REPRESENTATIVE – Ask part F for all CU’s.
(Ask all questions in this part for one stay before asking about other stays.)
Section 18 – TRIPS AND VACATIONS – Continued
Part F – Local Overnight Stays – Continued
1.
We’ve talked about many different kinds of trips.
Sometimes people don’t take a trip, but they stay
overnight in a local hotel or motel such as for
holidays or family getaways. Since the 1st of
(month, 3 months ago), have you (or any members of
your CU) stayed overnight in a local hotel or motel?
0010
1 77 70 9
6a.
Yes
No – Go to next section
1
2
3a.
b.
VERIFY IF ALREADY REPORTED, OTHERWISE ASK –
How many nights did you (or any members of your
CU) spend away from home on this stay?
Sometimes when people stay away from home
overnight they have some sort of package deal
that covers some or all of the costs. Was all or
part of this stay covered by anything like that?
Ask for each item – Did the package deal include
anything for . . .?
FIELD REPRESENTATIVE – Read each item listed.
c.
0020
Nights
b.
0030
b.
2
NO
DK
0040 Food and beverages . . . . . . . . . . .
1
2
X
0050 Lodging . . . . . . . . . . . . . . . . . . . . .
1
2
X
0060 Entertainment . . . . . . . . . . . . . . . .
1
2
X
0070 Anything else – Specify
1
2
X
0090
.00
7a.
b.
8.
2
0170
(Hand respondent Information Booklet, page 40.)
Did you (or any members of your CU) spend anything
on this stay for entertainment or admissions (not
counting what the package deal covered)?
If the respondent is unable to break down food and
beverages, lodging, entertainment, or other expenses, enter
these expenses. Only those expenses a respondent is not
able to break down should be combined and entered here.
.00
9.
0110
1
2
Yes
No – Go to item 6a
0190
0130
1
Yes
No – Go to item 6a
What was the cost for alcoholic beverages,
including taxes and tips?
0140 $
FORM CE-302
.00
1
2
.00
Yes
No – Go to item 8
Did you (or any members of your CU) have any other
stays at local hotels or motels?
0200 $
.00
0210 $
.00
YES
NO
DK
0220 Food and beverages . . . . . . . . . . .
1
2
X
0230 Lodging . . . . . . . . . . . . . . . . . . . .
1
2
X
0240 Entertainment . . . . . . . . . . . . . . .
1
2
X
0250 Other expenses . . . . . . . . . . . . . .
1
2
X
0260
1
2
NOTES
.00
Yes
No – Go to item 7a
How much did you (or any members of your CU) pay?
FIELD REPRESENTATIVE – Read each item listed.
What was the cost, including taxes and tips?
Was any of the (amount in item 5b) for alcoholic
beverages?
1
What was the cost for alcoholic beverages,
including taxes?
Did the (amount) include anything for . . .?
What was the cost, including taxes and tips?
Did you (or any members of your CU) spend
anything for meals, snacks, or drinks at
restaurants, bars, or fast food places (not
counting what the package deal covered)?
Was any of the (amount in item 6b) for alcoholic
beverages?
.00
0180 $
Yes
No – Go to item 5a
1
2
d.
d.
YES
0120 $
c.
c.
Yes
No – Go to item 4a
1
0100 $
5a.
Yes
No – Go to item 7a
What were the expenses, including taxes?
2
How much did you (or any members of your CU)
pay for the package deal?
Did you (or any members of your CU) spend
anything for hotels, motels, cottages, trailer
camps, or other lodging (not counting what the
package deal covered)?
1
0160 $
0080 $
4a.
0150
2
b.
2.
Did you (or any members of your CU) spend
anything for food or beverages at grocery stores,
convenience stores, or liquor stores?
Yes – Complete part F for each stay
No – Go to next section
FORM CE-302
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to look at the list of items as
you proceed. Ask column a and complete columns b through g for each "YES" response. For
continuing expenses such as "housekeeping" or "babysitting," mark the box in column d and
enter the total expense for the reference period, excluding the current month.
Section 19 – MISCELLANEOUS EXPENSES
a
1.
b
FUNERALS, BURIALS,
OR CREMATION
100
120
CATERED AFFAIRS
130
FRESH FLOWERS OR
POTTED PLANTS
140
0030
0040
0050
LEGAL FEES
Do not include legal fees
related to real estate
closing costs which were
reported in section 3.
ACCOUNTING FEES
0060
150
0070
0080
160
0090
HOME SERVICES
g.
Gardening or lawn care
services
Housekeeping– services
170
0110
0130
190
Was this expense
for your CU or
someone outside
of your CU?
1 – For CU
2 – For someone
outside your CU
Continuous
expense
CU
What was the total Did you
have any
amount of the
other
expense?
expenses
for . . .?
For continuing
expenses, do not
include expenses for
the current month.
Outside CU
YES NO
2
$
2
$
2
$
1
2
13
1
13
NOTES
PRE
1
Description
from column b
2
3
Month or
code from
column d
Expense from
column f
Month
.00
$
.00
.00
$
.00
.00
$
.00
$
.00
$
.00
2
$
.00
$
.00
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
13
1
13
1
13
0140
220
0150
0160
200
350
PROFESSIONAL
PHOTOGRAPHY FEES
360
HOME SECURITY
SYSTEM SERVICE FEES
370
Page 98
0120
210
ADULT DAY CARE
CENTERS
FIELD
REPRESENTATIVE
CHECK ITEM
Mark (X) box if there
are no entries recorded
in columns b
In what month did
you have this
expense?
If it is a continuous
expense throughout
the reference period,
mark box.
g
180
Other home services and
small repair jobs around
the house, not previously
reported
Babysitting or other child
care in your own home
Babysitting or other child
care in someone else’s
home
Care for invalids,
convalescents, handicapped
or elderly persons in the
home
2.
0100
ENTER
ITEM
CODE
from
column a.
Month
f
MI SCEX PX
COMBINATIONS OF THE
ABOVE
Use only if cannot itemize
the above
0020
e
M I SCGFTC
110
d
MISCMO
0010
PURCHASE OR UPKEEP
OF CEMETERY LOTS OR
VAULTS
c
MISCCODE
Information Booklet, pages 41 and 42
What was the expense for?
Since the 1st of (month, 3 months ago), Describe briefly.
have you (or any members of your CU)
had expenses for any of the following,
either for your CU or for someone
outside your CU?
ITEM
CODE YES NO
PROCESSING USE ONLY
4 19 02 8
0170
0180
0190
1 19 01 6
0010
999
Go to
next
page
0200
0210
0220
Section 19
Page 98
Page 99
Page 99
Section 19 – MISCELLANEOUS EXPENSES – Continued
a
3.
b
Information Booklet, page 42
What was the expense for?
Describe briefly.
Since the 1st of (month, 3 months
ago), have you (or any members of
your CU) had expenses for any of
the following, either for your CU or
for someone outside your CU?
ITEM
CODE YES NO
COMPUTER
INFORMATION
SERVICES
TV COMPUTER
GAMES AND
COMPUTER GAME
SOFTWARE
HAND HELD
COMPUTER
GAMES AND
COMPUTER BOARD
GAMES
280
0010
0020
290
0030
0040
0050
300
TOYS AND
GAMES
330
HOBBIES
340
MOVING, STORAGE,
AND FREIGHT
EXPRESS
PROCESSING USE ONLY
4 19 04 4
0060
0070
0080
0090
230
0100
PURCHASE OF
PETS, PET
SUPPLIES, AND
MEDICINE
FOR PETS
240
PET SERVICES
250
0110
0120
0130
VETERINARIAN
EXPENSES
FOR PETS
260
ALIMONY
310
CHILD
SUPPORT
320
MONEY GIVEN TO
NON-CU MEMBERS,
CHARITIES, AND
OTHER
ORGANIZATIONS
4.
0150
0160
0170
0180
270
1 19 03 2
FIELD
REPRESENTATIVE
CHECK ITEM
0010 999
Go to
Mark (X) box if
section
there are no
20
entries recorded
in columns b–g.
FORM CE-302
0140
0190
0200
0210
0220
c
ENTER
ITEM
CODE
from
column a.
d
e
In what month did
you have this
expense?
If it is a continuous
expense throughout
the reference period,
mark box.
Month
Continuous
expense
f
Was this expense
for your CU or
someone outside
of your CU?
1 – For CU
2 – For someone
outside your CU
CU
g
What was the
total amount of
the expense?
For continuing
expenses, do not
include expenses
for the current
Outside CU month.
PRE
NOTES
Did you
have any
other
expenses
for . . .?
1
Description
from column b
YES
NO
2
3
Month or
code from
column d
Expense from
column f
Month
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
13
1
2
$
.00
$
.00
FORM CE-302
Section 20 – EXPENSE PATTERNS FOR FOOD, BEVERAGES, AND OTHER SELECTED ITEMS
usual WEEKLY expense at the grocery store or supermarket?
1 20 01 4
0010 $
0
b.
2a.
b.
3a.
About how much of this amount was for nonfood items, such
as paper products, detergents, home cleaning supplies, pet
foods, and alcoholic beverages?
Have you (or any members of your CU) purchased any food or
nonalcoholic beverages from places other than grocery stores,
such as home delivery, specialty stores, bakeries, convenience
stores, dairy stores, vegetable stands, or farmers’ markets?
Include any large purchases made for freezing or canning.
What was your usual WEEKLY expense at these places?
Do you (or any members of your CU) ever buy alcoholic
beverages to be served at home?
0020 $
0030
1
4a.
0060 $
6a.
7a.
0080
b.
c.
2
c.
1
A L COHOL
Yes
No – Go to item 4a
0190 $
Since the 1st of (month, 3 months ago), how many weeks did
members of your CU receive such meals?
FREEFOOD
Yes MEA L SPA Y
No – Go to item 10a
ML PA Y WK X
.00
ML PY QWK S
0200
Number of weeks
Ask only if preschool or school age students; otherwise mark "No."
10a.
B RWINMOX
.00
None
OTHA L MOX
.00
0090 $
A L C_OUTX
0100
Yes
No – Go to item 6a
1
2
0120
1
0130 $
.00
DINEOUT
DINE_MOX
.00
B OA RD
Yes
No – Go to item 7a
B OA RDX
0210
Since the 1st of (month, 3 months ago), excluding (this month),
have you (or members of your CU) purchased any meals at
school or in a preschool program for preschool or school age
children?
1
2
Yes
No – Go to part B
meals at school?
Enter the name of each CU member purchasing meals at school in
column a, then ask columns b through d for each name entered.
0010
0020
0030
0040
.00
0050
0140
0150
1
Yes FD_STA MP
2
No – Go to item 8
1
2
3
4
1 month
2 months
3 months
4 months
What was the value of all food stamps received?
Page 100
b. About what was the WEEKLY dollar value of such meals?
.00
Yes A L C_OUT
No – Go to item 5a
What was the usual MONTHLY expense?
For how many months since the 1st of (month, 3 months ago),
were food stamps received?
OSTORWK X
1
0110 $
Have you (or any members of your CU) received any food
stamps?
OTHSTOR
None
2
b.
0180
at work as part of your pay?
2
0
What was the usual MONTHLY expense for these purchases?
Have you (or any members of your CU) paid for board not
received in a boarding house?
2
Yes
No
0160 $
0060
FD_STPRD
FD_STMPX
0070
0080
.00
0090
Section 20 – Part A
a
Name
3 20 02 8
b
Enter
line
number
from
Control
Card.
c
d
What is the
usual WEEKLY
expense for the
meals . . .
purchased at
school?
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
How many
weeks
did . . .
purchase
meals?
Enter
number of
weeks.
SCHML WK Q
b.
0070 $
What was the usual MONTHLY expense?
Have you (or any members of your CU) purchased dinners,
other meals or snacks in restaurants, cafeterias, cafes,
drive-ins, or other such places?
1
SCHML WK X
5a.
0170
9a. Have you (or any members of your CU) received any free meals
MEMB NUM
b.
Have you (or any members of your CU) purchased any
alcoholic beverages in restaurants, taverns, or cocktail
lounges?
NOTES
Have you (or any members of your CU) received any free food,
beverages, or meals through public or private welfare
agencies, including religious organizations? Do not include free
meals in school or preschool programs.
b. If YES – What are the names of all CU members who purchased
What was your usual MONTHLY expense for beer and wine?
What was your usual MONTHLY expense for other alcoholic
beverages?
.00
Yes
No – Go to item 3a
0
c.
OTHSTUFX
1
0040 $
8.
None – Go to item 2a
None
2
b.
.00
0
2
0050
GROCWEK X
PROCESSING USE ONLY
Part A – Food and Beverages
1a. Since the 1st of (month, 3 months ago), what has been your
Page 100
Page 101
Page 101
Section 20 – EXPENSE PATTERNS FOR FOOD, BEVERAGES, AND OTHER SELECTED ITEMS – Continued
Part B – Selected Services and Goods
1a. Since the 1st of (month, 3 months ago), excluding (this month),
1 20 03 0
0010
have you (or any members of your CU) used public pay phone
service?
b.
2a.
b.
c.
1
2
0020 $
1
Yes
No – Go to item 3a
7a.
Have you (or any members of your CU) used coin-operated
laundry or dry cleaning machines?
0030
2
What was the total cost for these machines?
0040 $
Was any of this amount for items other than clothes?
0050
1
How much?
What was the total cost for dry cleaning or laundry services?
c.
Was any of this amount for items other than clothes?
0070
1
2
0080 $
0090
1
2
How much?
0100 $
X
Do any members of your CU use tobacco products, such as –
0110
1
2
a.
Cigarettes?
b.
If YES – What is the usual WEEKLY expense for cigarettes?
c.
Cigars, pipe tobacco, or other tobaccos, including chewing
tobacco?
d.
5.
L NDRY X
L NDROMA T
b.
.00
Yes
No – Go to item 3a
OTHL NDRX
8a.
OTHL NDRY
b.
9a.
.00
Don’t know
b.
Have you (or any members of your CU) sent clothes or other
items to the dry cleaners or laundry?
b.
4.
6a.
.00
None
X
d.
PA Y PHONX
0
0060 $
3a.
PA Y PHONE
b.
What was the total expense?
2
d.
Yes
No – Go to item 2a
If YES – What is the usual WEEKLY expense for cigars, pipe
tobacco, or other tobaccos?
What is the usual MONTHLY expense for haircutting, styling,
and other related services for all members of your CU?
DRY CL NX
OTHDCL NX
Yes
No – Go to item 5
2
OTHDRCL N
CIGA RETT
.00
OTHTOB A C
.00
HA IRMOX
.00
None
1
2
0180 $
0190
B A NK SRVC
Yes
No – Go to item 8a
1
2
If YES – What was the total expense?
0220 $
Do you (or any members of your CU) use mass transportation
services such as a bus, subway, mini-busIor train, including
commuter bus and train service?
0300
.00
1
2
0210
SA FDPSTX
SA FEDPST
None
0200 $
Since the 1st of (month, 3 months ago), have you (or any
members of your CU) used taxis or limousines for
nonbusiness purposes, except those used while on a trip?
Yes
No – Go to item 7a
0
What is the usual MONTHLY charge?
1
2
B A NK MOX
.00
Yes
No – Go to item 9a
TX L IMX
TX L IMSRV
.00
Yes
MA SSTRA N
No – Go to next section
What is the usual MONTHLY cost to use mass transit
to go to –
(1) Work?
0330 $
TRA NWRK X
.00
(2) School?
0350 $
TRA NSCHX
.00
(3) Other places?
0370 $
NOTES
0140 $ OTHTB A CX
0150 $
Do you (or any members of your CU) have any expenses for
checking accounts or other banking services?
.00
Yes
No – Go to item 4c
0130
What was the total rental expense for the safe deposit box
since the 1st of (month, 3 months ago)?
0170
.00
Don’t know
CIGA RETX
1
DRY CL EA N
Yes
No – Go to item 4a
0120 $
0
FORM CE-302
Yes
No – Go to item 4a
Do you (or any members of your CU) rent a safe deposit box
located in a bank or a similar financial institution?
TRA NOTHX
.00
FORM CE-302
Section 21 – CREDIT LIABILITY
FIELD REPRESENTATIVE – Complete columns b through e for each store, bank, credit account, etc., reported in column a.
Part A.1 – Credit Balances – Second Quarter Only
1.
b
On the 1st of (the current month), did you (or any
members of your CU) owe any money to any of
the following? Do not include mortgage, home equity
loans, automobile loans, or business related loans.
ITEM
CODE YES NO
Revolving credit accounts
including store, gasoline, and
general purpose credit cards,
such as Sears, Amoco, Visa,
MasterCard, etc. . . . . . . . . . . . . . . .
Stores for installment credit
accounts . . . . . . . . . . . . . . . . . . . . .
2.
c
What is the name of the (credit source)
to which you owe money?
Did any member of
your CU owe any
money to any other
(credit source)?
How much was owed to
(credit source)?
Enter name of store, credit card, finance
company, bank, credit union, insurance
company, etc.
If "No," go to next
credit source in
column a.
Don’t
know
0010
$
.00
X
0020
$
.00
X
0030
$
.00
X
0040
$
.00
X
Credit unions . . . . . . . . . . . . . . . . .
400
Finance companies . . . . . . . . . . . . .
500
0050
$
.00
X
Insurance companies (Do not
include insurance
premium payments) . . . . . . . . . . . . .
600
0060
$
.00
X
0070
$
.00
X
0080
$
.00
X
0090
$
.00
X
0100
$
.00
X
0110
$
.00
X
0120
$
.00
X
0130
$
.00
X
0140
$
.00
X
$
.00
X
Doctors, dentists, hospitals, or
other medical practitioners for
expenses not covered
by insurance . . . . . . . . . . . . . . . . . .
700
Other credit sources . . . . . . . . . . . .
800
1 21 01 2
0010
999
Go to
next
section
0150
Page 102
NO
200
300
Mark (X) box if there are no entries
recorded in columns b–e.
YES
100
Banks and savings and loan
companies . . . . . . . . . . . . . . . . . . . .
FIELD REPRESENTATIVE
CHECK ITEM
NOTES
e
d
CREDITX 1
CREDIT SOURCE
ENTER
ITEM
CODE
from
column a
CREDITR1
Read each item listed below. Complete a separate line
for each individual store, credit card, etc.
PROCESSING USE ONLY
a
1 21 02 0
Section 21 – Part A
Page 102
Page 103
Page 103
Section 21 – CREDIT LIABILITY – Continued
FIELD REPRESENTATIVE – Complete columns b through e for each store, bank, credit account, etc., reported in column a.
Part A.1 – Credit Balances – Continued – Second Quarter Only
CREDIT SOURCE
Revolving credit accounts
including store, gasoline, and
general purpose credit cards,
such as Sears, Amoco, Visa,
MasterCard, etc. . . . . . . . . . . . . . . .
Stores for installment credit
accounts . . . . . . . . . . . . . . . . . . . . .
b
ITEM
CODE
PROCESSING USE ONLY
a
ENTER
ITEM
CODE
from
column a
1 21 03 8
c
What is the name of the (credit source)
to which you owe money?
Did any member of
your CU owe any
money to any other
(credit source)?
How much was owed to
(credit source)?
Enter name of store, credit card, finance
company, bank, credit union, insurance
company, etc.
If "No," go to next
credit source in
column a.
Don’t
know
0010
$
.00
X
0020
$
.00
X
0030
$
.00
X
0040
$
.00
X
100
200
Banks and savings and loan
companies . . . . . . . . . . . . . . . . . . . .
300
Credit unions . . . . . . . . . . . . . . . . .
400
Finance companies . . . . . . . . . . . . .
500
0050
$
.00
X
Insurance companies (Do not
include insurance
premium payments) . . . . . . . . . . . . .
600
0060
$
.00
X
0070
$
.00
X
0080
$
.00
X
0090
$
.00
X
0100
$
.00
X
0110
$
.00
X
0120
$
.00
X
0130
$
.00
X
0140
$
.00
X
0150
$
.00
X
Doctors, dentists, hospitals, or
other medical practitioners for
expenses not covered
by insurance . . . . . . . . . . . . . . . . . .
700
Other credit sources . . . . . . . . . . . .
800
FORM CE-302
NOTES
e
d
Skip to Section 22A
YES
NO
FORM CE-302
Section 21 – CREDIT LIABILITY
FIELD REPRESENTATIVE – Complete columns b through f for each store, bank, credit account, etc., reported in column a.
Part A.2 – Credit Balances – Fifth Quarter Only
1.
b
Revolving credit accounts
including store, gasoline, and
general purpose credit cards,
such as Sears, Amoco, Visa,
MasterCard, etc. . . . . . . . . . . . .
100
Stores for installment credit
accounts . . . . . . . . . . . . . . . . . . .
How much was owed to
(credit source)?
Enter name of store, credit card, finance
company, bank, credit union, insurance
company, etc.
Did any member of
your CU owe any
money to any other
(credit source)?
What was the total amount owed
on the 1st of (current month, one
year ago)?
If "No," go to next
credit source in
column a.
Don’t
know
None
Don’t
know
.00
X
$
.00
0
X
200
0020
$
.00
X
$
.00
0
X
Banks and savings and loan
companies . . . . . . . . . . . . . . . . .
300
0030
$
.00
X
$
.00
0
X
Credit unions . . . . . . . . . . . . . . .
400
0040
$
.00
X
$
.00
0
X
0050
$
.00
X
$
.00
0
X
0060
$
.00
X
$
.00
0
X
0070
$
.00
X
$
.00
0
X
0080
$
.00
X
$
.00
0
X
0090
$
.00
X
$
.00
0
X
0100
$
.00
X
$
.00
0
X
0110
$
.00
X
$
.00
0
X
0120
$
.00
X
$
.00
0
X
0130
$
.00
X
$
.00
0
X
0140
$
.00
X
$
.00
0
X
$
.00
X
$
.00
0
X
NO
600
700
Other credit sources . . . . . . . . .
800
On the 1st day of (current month, one year ago), did
you (or any members of your CU) owe money to
any creditor that you did not owe money to on the
1st day of (the current month, the current year)?
NO
What was the source of
the credit? . . . . . . . . . .
Item code(s)
Complete columns b, c, e,
and f for each credit source
reported.
FIELD REPRESENTATIVE
CHECK ITEM
Mark (X) box if there are no
entries recorded in columns b–f.
1 21 10 3
0010
999
Go to
part B
0150
Page 104
YES
500
Doctors, dentists, hospitals, or
other medical practitioners for
expenses not covered
by insurance . . . . . . . . . . . . . . .
YES
3.
Ask if "Yes" in item 1.
$
Insurance companies (Do not
include insurance
premium payments) . . . . . . . . . . .
b.
What is the name of the (credit source)
to which you owed money?
NOTES
f
e
0010
Finance companies . . . . . . . . . .
2a.
ITEM
CODE YES NO
d
OWEMONEY
CREDIT SOURCE
CREDITR5
Read each item listed below. Complete a separate line
for each individual store, credit card, etc.
ENTER
ITEM
CODE
from
column a
c
CREDITX 5
On the 1st of (the current month), did you (or any
members of your CU) owe any money to any of
the following? Do not include mortgage, home equity
loans, automobile loans, or business related loans.
PROCESSING USE ONLY
a
1 21 11 1
Section 21 – Part A
Page 104
Page 105
Page 105
Section 21 – CREDIT LIABILITY – Continued
FIELD REPRESENTATIVE – Complete columns b through f for each store, bank, credit account, etc., reported in column a.
Part A.2 – Credit Balances – Continued – Fifth Quarter Only
CREDIT SOURCE
Revolving credit accounts
including store, gasoline, and
general purpose credit cards,
such as Sears, Amoco, Visa,
MasterCard, etc. . . . . . . . . . . . . . . .
Stores for installment credit
accounts . . . . . . . . . . . . . . . . . . . . .
b
ITEM
CODE
PROCESSING USE ONLY
a
ENTER
ITEM
CODE
from
column a
1 21 12 9
c
What is the name of the (credit source)
to which you owed money?
d
Ask if "Yes" in item 1.
Did any member of
your CU owe any
money to any other
(credit source)?
What was the total amount owed
on the 1st of (current month, one
year ago)?
How much was owed to
(credit source)?
Enter name of store, credit card, finance
company, bank, credit union, insurance
company, etc.
If "No," go to next
credit source in
column a.
Don’t
know
None
Don’t
know
0010
$
.00
X
$
.00
0
X
0020
$
.00
X
$
.00
0
X
0030
$
.00
X
$
.00
0
X
0040
$
.00
X
$
.00
0
X
100
200
Banks and savings and loan
companies . . . . . . . . . . . . . . . . . . . .
300
Credit unions . . . . . . . . . . . . . . . . .
400
Finance companies . . . . . . . . . . . . .
500
0050
$
.00
X
$
.00
0
X
Insurance companies (Do not
include insurance
premium payments) . . . . . . . . . . . . .
600
0060
$
.00
X
$
.00
0
X
0070
$
.00
X
$
.00
0
X
0080
$
.00
X
$
.00
0
X
0090
$
.00
X
$
.00
0
X
0100
$
.00
X
$
.00
0
X
0110
$
.00
X
$
.00
0
X
0120
$
.00
X
$
.00
0
X
0130
$
.00
X
$
.00
0
X
-140
$
.00
X
$
.00
0
X
0150
$
.00
X
$
.00
0
X
Doctors, dentists, hospitals, or
other medical practitioners for
expenses not covered
by insurance . . . . . . . . . . . . . . . . . .
700
Other credit sources . . . . . . . . . . . .
800
FORM CE-302
NOTES
f
e
YES
NO
FORM CE-302
FIELD REPRESENTATIVE – Ask items a through h and record the total amount of finance charges or interest paid during the past 12
months for each item.
Section 21 – CREDIT LIABILITY – Continued
Part B – Finance Charges – Fifth Quarter Only
1 21 20 2
During the past 12 months, have you (or any
members of your CU) paid any finance charges,
interest charges or late fees to any of the following
except for mortgage, home equity loans, or
automobile loans?
a. Revolving credit accounts including store, gasoline
and general purpose credit cards, such as Sears,
Amoco, Visa, MasterCard, etc.?
Do not include yearly fees.
If YES – How much was paid for finance, interest
and late charges?
0010
b.
0030
Stores for installment credit accounts?
NOTES
1
2
0020 $
Don’t know
1
Yes INSTA L L
No
If YES – How much was paid for finance, interest
and late charges?
0040 $
INSTA L L X
X
Don’t know
Banks and Savings and Loans?
0050
1
Yes
B A NK
No
2
d.
If YES – How much was paid for finance, interest
and late charges?
0060 $
Credit unions?
0070
1
Yes CRDUNION
No
If YES – How much was paid for finance, interest
and late charges?
0080 $
CDUNIONX
X
Don’t know
Finance companies?
0090
1
Yes
No
If YES – How much was paid for finance, interest
and late charges?
0100 $
Insurance companies?
0110
h.
1
Yes
No
0120 $
Doctors, dentists, hospitals, or other medical
practitioners for expenses not covered by
insurance?
0130
If YES – How much was paid for finance, interest
and late charges?
0140 $
Other credit sources?
0150
Page 106
.00
INSURE
INSUREX
.00
X
Don’t know
1
Yes
MEDICA L
No
2
MEDICA L X
X
Don’t know
1
Yes
No
2
If YES – How much was paid for finance, interest
and late charges?
FINI NT
Don’t know
If YES – How much was paid for finance, interest
and late charges?
.00
FINA NCE
X
2
g.
.00
Don’t know
2
f.
B A NK X
.00
X
2
e.
CRDCA RDX .00
X
2
c.
Yes
CREDCA RD
No
.00
OTHER
0160 $ PDOTHERX
X
Don’t know
.00
Section 21 – Part B
Page 106
Page 107
Page 107
NOTES
FORM CE-302
FORM CE-302
Section 22 – WORK EXPERIENCE AND INCOME
FIELD REPRESENTATIVE – Ask a separate page of part A for each CU member 14 years old and over.
Part A – Second Quarter, Fifth Quarter or New Consumer Units Only
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 22 01 0
M EM B N O
0010
I N C W EEK Q
0020
0
0030
5.
Weeks
Did not work –
Go to item 5
I N C _H R SQ
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
Page 108
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100 I N C N O N W KCode
0200
1
2
Yes SA L A R Y ST
No – Go to item 6b
0210 $
SA L A R Y X
0220
1
Yes N O N F A R M
2
No – Go to item 6c
9.
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
0230 $ N O N F A R M X .00
0240 3
Loss
N F R M L O SS
O CCU CO D E
0070
c.
Code
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0250
1
2
Yes F A R M I N C
No – Go to item 7
0260 $ F A R M I N C X .00
0270
3
Loss
F A R M L O SS
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
I N C O M EY
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
Yes
No
d.
e.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
0300
2
SO C SEC I N
Yes
No R R R ET I N C
Yes – Go to item 7d
No – Go to item 8a
What was the amount of the last
Social Security or Railroad
Retirement payment received?
0310 $ R R R ET I R X
Is this amount AFTER the deduction
for a Medicare premium?
0320
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
1
2
I N CO RP
f.
1
Yes
No
0330
.00
Yes
No I N C M ED C R
SS_R R Q
Section 22 – Part A
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
.00
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
Yes
No
1
2
0350
2
Yes
No
State and local income tax?
0410
Social Security including
Medicare?
0430
d.
Railroad Retirement?
0390
1
1
0400 $
A M T F ED
.00
2
0420 $
SL T A X X
.00
2
0450 $ R R R D ED X
.00
2
0470 $ GO V R ET X
.00
2
0490 $ P R I V P EN X
.00
SSD ED
1
2
R R R D ED
0440
1
GO V R ET
0460
e.
Government Retirement?
f.
Private pension fund?
0480
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
SSN O R M
1
P R I V P EN S
12.
13a.
b.
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
Amount
2
SL T A X
11.
.00
0370 $ GR O SP A Y X .00
0380 1
Week
5
Year
2 Weeks 6
2
Other – Specify
Month
3
P A Y P ER D
Quarter
4
7
Twice a month
b.
c.
g.
SL SSI
SSI X
0360 $
F ED T A X
a.
SU P P L I N C
Yes
No
1
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
14.
Number
0340
1
0500
1
0501
1
2
0510
1
2
0520
1
2
0530 $
0540
1
2
2
Yes
No
Yes
No
M ED I C O V
EM P L C O N T
I N D R ET A C
Yes
No – Go to item 14
I N D R ET X
.00
Records
No records used
R EC SU SED
Page 108
Page 109
Page 109
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Ask a separate page of part A for each CU member 14 years old and over.
Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 22 06 9
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
FORM CE-302
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
0200
Code
1
2
Yes
No – Go to item 6b
0210 $
9.
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
0330
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
3
4
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
.00
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
.00
Yes
No
12.
13a.
b.
14.
Number
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
FORM CE-302
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Ask a separate page of part A for each CU member 14 years old and over.
Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 22 11 9
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
Page 110
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
0200
Code
1
2
Yes
No – Go to item 6b
0210 $
9.
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
0330
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
3
4
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
.00
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
.00
Yes
No
12.
13a.
b.
14.
Number
Section 22 – Part A (Continued)
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
Page 110
Page 111
Page 111
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Ask a separate page of part A for each CU member 14 years old and over.
Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 22 16 8
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
FORM CE-302
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
0200
Code
1
2
Yes
No – Go to item 6b
0210 $
9.
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
0330
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
3
4
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
.00
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
.00
Yes
No
12.
13a.
b.
14.
Number
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
FORM CE-302
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Ask a separate page of part A for each CU member 14 years old and over.
Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 22 21 8
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
Page 112
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
0200
Code
1
2
Yes
No – Go to item 6b
0210 $
9.
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
0330
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
3
4
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
.00
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
.00
Yes
No
12.
13a.
b.
14.
Number
Section 22 – Part A (Continued)
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
Page 112
Page 113
Page 113
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Ask a separate page of part A for each CU member 14 years old and over.
Part A – Second Quarter, Fifth Quarter or New Consumer Units Only – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 22 26 7
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
FORM CE-302
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
0200
Code
1
2
Yes
No – Go to item 6b
0210 $
9.
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
0330
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
3
4
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
.00
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
.00
Yes
No
12.
13a.
b.
14.
Number
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
FORM CE-302
FIELD
Section 22 – WORK EXPERIENCE AND INCOME – Continued
Part B – Second Quarter, Fifth Quarter or New Consumer Units – Ask for entire CU as a group.
1. During the past 12 months, did you PROCESSING USE 1 2 2 9 7 8
1h. Income from child support?
0155
a.
(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?
ONLY
2
0005
1
2
0020
$
Yes UNEMPCM P
No – Go to item 1b
UNEMPL X
(1)
.00
If YES – What was the total amount
received by ALL CU members?
c.
Income from public assistance or
welfare including money received
from job training grants such as
Job Corps?
If YES – What was the total amount
received by ALL CU members?
0025
1
2
0030
0035
$
1
2
0040
$
d. Income from interest on savings
accounts or bonds?
0050
1
2
If YES – What was the total amount
received by ALL CU members?
e.
Regular income from dividends,
royalities, estates, or trusts?
0060
0070
$
1
2
f.
If YES – What was the total amount
received by ALL CU members?
0080
$
Income from pensions or annuities
from private companies, military,
Government, IRA, or Keogh?
0090
1
If YES – What was the total amount
received by ALL CU members?
g. Net income or loss from any type
of rental of rooms or living units?
2
0100
0110
$
1
2
Yes
COMPENSN
No – Go to item 1c
COMPENSX
(2) Did you receive any child support
payments in other than a lump
sum amount?
If YES –
What was the total amount
received by ALL CU members in
last 12 months?
.00
WEL FA RE
Yes
No – Go to item 1d
WEL FA REX
.00
i.
Yes I NTEA RN
No – Go to item 1e
INTEA RNX
(2) Other sources such as from
FI N I N CX
.00
2.
a.
P EN SI O N S
Yes
No – Go to item 1g
P EN SI O N X
.00
was received from roomers or
boarders?
0120
Yes
I N C _L O SS
No – Go to item 1h
0130
$ I N C L O SSA
0
1
(2) How much net income or loss
was received from payments
from other rental units?
0140
$
0150
0
1
None
Loss
I N C L O SSB
None
Loss
.00
I N C L O SSN
.00
I N C L O SB N
During the past 12 months, did
you (or any members of your CU)
receive any –
Lump sum payments from estates,
trusts, royalties, alimony, prizes or
games of chance, or from persons
outside of the CU?
If YES – What was the total amount
received by ALL CU members?
b.
Money from the sale of household
furnishings, equipment, clothing,
jewelry, pets, or other belongings,
excluding the sale of vehicles or
property?
If YES – What was the total amount
received by ALL CU members?
c.
1
2
Other money income, including
money received from cash
scholarships and fellowships,
stipends not based on working, or
from the care of foster children?
If YES – What was the total amount
received by ALL CU members?
Yes C H D SU P
No – Go to item 1i
CH D L M P
Yes
No – Go to item 1h(2)
3.
a.
During the past 12 months, did you (or any
members of your CU) receive any refunds
from the following –
If YES – What was the total amount
received by ALL CU members?
Federal income tax?
b. State and local income tax?
0165
$
0170
1
2
CH D L M PX
0250
2
0260
$
F ED R F N D X
0270
1
2
.00
Yes C H D SP O T H
No – Go to item 1i
c. Overpayment on Social Security?
0175
0180
$
1
2
1
CH D O T H X
.00
0280
$
0290
1
Yes
No
e. Property taxes?
.00
$
1
2
0200
$
f.
Yes L U M P SU M
No – Go to item 2b
L U M P SU M X .00
Other sources, including any other taxes?
Specify in notes.
2
0220
0230
$
1
2
0240
$
1
0320
$
0330
1
If YES – What was the total amount PAID by
ALL CU members?
a. Federal income tax in addition to that
withheld from earnings?
Yes
SA L EI N C
No – Go to item 2c
SA L E I N C X
.00
Yes O T H ER I N C
No – Go to item 3
O T H RI N CX
.00
0340
$
0350
1
2
0360
$
0370
1
Yes
No
.00
SL R EF U N D
SL R F U N D X .00
Yes
No
SSO V ER P M
SSO V ER P X
Yes
No
I N SR F N D
I N SR F N D X
Yes
No
.00
PT A X RFN D
PTA X RFDX
Yes
No
.00
.00
O T H RFN D
O T H RFN D X
.00
During the past 12 months, did you (or any
members of your CU) pay any –
that withheld from earnings?
1
0310
2
b. State and local income tax in addition to
0210
$
O T H CO N T
4.
0190
0300
2
Yes
No A L I M SU P
A L IO T H X
0188
d. Insurance policies?
F ED R EF N O
Yes
No
1
2
2
If YES – for item i(1) or i(2) –
Altogether what was the total
amount received by ALL CU
members?
FI N A N I N G
0160
0185
persons outside the CU?
If YES –
(1) How much net income or loss
Income from regular contributions
from –
(1) Alimony?
.00
Yes
No – Go to item 1f
If YES –
Did you receive a one time lump
sum payment for child support?
If YES –
What was the total amount
received by ALL CU members in
last 12 months?
b. Income from worker’s compensation
or veteran’s benefits including
education benefits, but excluding
military retirement?
1
c. Personal property taxes not reported
elsewhere?
d. Other taxes not reported elsewhere?
Do not include Social Security tax for the
self-employed – Specify in notes.
P D F ED T A X
2
Yes
No
0380
$
F ED T A X X
0390
1
P D SL T A X
2
Yes
No
0400
$
SL O C T A X X
0410
1
2
0420
$
0430
1
2
0440
$
Yes
No
.00
.00
T A X PRO P
T A X P R O P X .00
Yes
No
M I SC T A X
M I SC T A X X
.00
NOTES
Page 114
Section 22 – Part B
Page 114
Page 115
Page 115
NOTE: As of January, 1996, Section 22 Part C no longer exists.
NOTES
FORM CE-302
FORM CE-302
Section 22 – WORK EXPERIENCE AND INCOME – Continued
Part D – Third and Fourth Quarter – CU Members 14 Years Old and Over who previously did not work
1.
OFFICE TRANSCRIPTION ITEMS
PROCESSING USE ONLY
CU members who previously
reported not working.
a.
3.
Since the 1st of (month, 3 months ago), did. . . earn any
income from wages, or salary from a business,
partnership, professional practice, or farm?
FIELD REPRESENTATIVE ITEM
Enter the name and line number
of all new CU members recorded
on the control card for the first
time in this interview who are 14
years old or older.
a.
1 23 14 1
1 23 15 8
1 23 16 6
1 23 17 4
1 23 18 2
NAME
b. LINE NUMBER
2.
1 23 13 3
0010
0020
0010
1
2
Yes
No
0020
0010
Yes
No
1
2
0020
0010
1
2
Yes
No
0020
0010
1
2
Yes
No
0020
0010
1
2
Yes
No
0020
1
2
Yes
No
NAME
b. LINE NUMBER
0030
0030
0030
0030
0030
0030
• Complete a page in part E for each "Yes" response in item 2 and for each new CU member listed in item 3.
1.
OFFICE TRANSCRIPTION ITEMS
PROCESSING USE ONLY
CU members who previously
reported not working.
a.
3.
Since the 1st of (month, 3 months ago), did. . . earn any
income from wages, or salary from a business,
partnership, professional practice, or farm?
FIELD REPRESENTATIVE ITEM
Enter the name and line number
of all new CU members recorded
on the control card for the first
time in this interview who are 14
years old or older.
a.
1 23 20 8
1 23 21 6
1 23 22 4
1 23 23 2
1 23 24 0
NAME
b. LINE NUMBER
2.
1 23 19 0
0010
0020
0010
1
2
Yes
No
0020
0010
1
2
Yes
No
0020
0010
1
2
Yes
No
0020
0010
1
2
Yes
No
0020
0010
1
2
Yes
No
0020
1
2
Yes
No
NAME
b. LINE NUMBER
0030
0030
0030
0030
0030
0030
• Complete a page in part E for each "Yes" response in item 2 and for each new CU member listed in item 3.
NOTES
Page 116
Section 22 – Part D
Page 116
Page 117
Page 117
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Complete a separate page of part E for each new CU member 14 years old or older, for each CU
member who turned 14 years old since the last interview, and for all CU members who have not
reported income in previous interviews.
Part E – Third and Fourth Quarter
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 23 25 7
5.
M EM B N O
0010
I N C W EEK Q
0020
0
0030
Weeks
Did not work –
Go to item 5
I N C H R SQ
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
FORM CE-302
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100 I N C N O N W K Code
9.
0200
1
2
0210 $
Yes SA L A RY ST
No – Go to item 6b
SA L A R Y X
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
0220
2
0070
c.
Code
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
Yes N O N F A R M
No – Go to item 6c
0230 $ N O N F A R M X.00
0240
O CCU CO D E
1
0250
3
Loss
N F R M L O SS
1
2
Yes F A R M I N C
No – Go to item 7
0260 $ F A R M I N C X .00
0270 3
Loss
F A R M L O SS
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
I N C O M EY
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
Yes
No
d.
e.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
0300
2
What was the amount of the last
Social Security or Railroad
Retirement payment received?
0310 $
Is this amount AFTER the deduction
for a Medicare premium?
0320
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
1
2
I N CO RP
f.
1
0330
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–11 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
.00
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
Yes
SO C SEC I N
No
Yes
R R R ET I N C
No
Yes – Go to item 7d
No – Go to item 8a
RRRETIRX .00
Yes
I N C M ED C R
No
a.
Number
1
2
0350
1
2
Yes
No
SUPPL INC
Yes
No
SL SSI
SSI X
0360 $
.00
0370 $ GR O SP A Y X .00
0380 1
Week
5
Year
2 Weeks 6
2
Other – Specify
Month
3
P A Y P ER D
Quarter
4
7
Twice a month
Yes
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
State and local income tax?
0410
Social Security including
Medicare?
0430
No
Amount
FEDTA X
1
2
0400 $
2
0420 $
SL T A X
b.
c.
d.
Railroad Retirement?
1
e.
Government Retirement?
f.
Private pension fund?
1
11.
12.
13a.
b.
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
SL T A X X
.00
.00
2
R R R D ED
0440
1
2
0450 $
0460
1
2
0470 $
2
0490 $
P R I V P EN S
g.
A M T F ED
SSD ED
GO V R ET
14.
SS R R Q
0340
0480
1
R R R D ED X
GO V R ET X
PRIVPENX
.00
.00
.00
SSNORM
0500
1
0501
1
2
0510
1
2
0520
1
2
0530 $
0540
1
2
2
Yes
No
Yes
No
MEDICOV
EM P L C O N T
I N D R ET A C
Yes
No – Go to item 14
I N D R ET X
.00
Records
No records used
R EC SU SED
FORM CE-302
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Complete a separate page of part E for each new CU member 14 years old or older, for each CU
member who turned 14 years old since the last interview, and for all CU members who have not
reported income in previous interviews.
Part E – Third and Fourth Quarter – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 23 30 7
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
Page 118
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
Code
9.
0200
1
2
Yes
No – Go to item 6b
0210 $
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
4
.00
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
3
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
.00
Yes
No
12.
13a.
b.
14.
0330
Section 22 – Part E (Continued)
Number
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
Page 118
Page 119
Page 119
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Complete a separate page of part E for each new CU member 14 years old or older, for each CU
member who turned 14 years old since the last interview, and for all CU members who have not
reported income in previous interviews.
Part E – Third and Fourth Quarter – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 23 35 6
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
FORM CE-302
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
Code
9.
0200
1
2
Yes
No – Go to item 6b
0210 $
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
4
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
.00
Yes
No
12.
13a.
b.
14.
0330
1
2
.00
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
3
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
Number
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
FORM CE-302
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Complete a separate page of part E for each new CU member 14 years old or older, for each CU
member who turned 14 years old since the last interview, and for all CU members who have not
reported income in previous interviews.
Part E – Third and Fourth Quarter – Continued
1.
2.
3.
FIELD
REPRESENTATIVE
ITEM
Enter the first name
and line number of
each CU member 14
years old and over.
PROCESSING USE
ONLY
a.
NAME
b.
LINE NUMBER
In the last 12 months, how many
weeks did . . . work either full time or
part time, not counting work around
the house? Include paid vacation and
paid sick leave.
In the weeks that . . . worked, how
many hours did . . . usually work per
week?
1 23 40 6
5.
0010
0020
0
Weeks
Did not work –
Go to item 5
0030
Hours per
week
6.
a.
4a.
b.
Information Booklet, page 44
The job in which . . . received the most
earnings during the past 12 months
fits best in the following category:
Manager, professional
01 – Administrator, manager
02 – Teacher
03 – Professional
Administrative support, technical, sales
04 – Administrative support, including
clerical
05 – Sales, retail
06 – Sales, business goods and services
07 – Technician
Service
08 – Protective service
09 – Private household service
10 – Other service
Operator, assembler, laborer
11 – Machine operator, assembler,
inspector
12 – Transportation operator
13 – Handler, helper, laborer
Precision production, craft, repair
14 – Mechanic, repairer, precision
production
15 – Construction, mining
Farming, forestry, fishing
16 – Farming
17 – Forestry, fishing, groundskeeping
Armed forces
18 – Armed forces
Was . . .
CODE
1 – An employee of a PRIVATE
company, business, or individual
working for wages or salary?
2 – A Federal government employee?
3 – A State government employee?
4 – A local government employee?
5 – Self-employed in OWN business,
professional practice, or farm?
6 – Working WITHOUT PAY in family
business or farm?
Page 120
Ask if item 2 marked "Did not work" –
What was the main reason . . . did
not work during the past 12 months?
Was . . .
CODE
1 – Retired?
2 – Taking care of home/family?
3 – Going to school?
4 – Ill, disabled, unable to work?
5 – Unable to find work?
6 – Doing something else? – Specify
During the past 12 months, did . . .
receive any money in –
Wages or salary? Include commissions,
tips, Armed Forces pay and allowances.
What was the amount of income
received before any deductions?
8.
a.
b.
0100
Code
9.
0200
1
2
Yes
No – Go to item 6b
0210 $
c.
0070
Code
Income or loss from . . .’s own
nonfarm business, partnership, or
professional practice?
What was the amount of income or
loss after expenses?
Income or loss from . . .’s own farm?
What was the amount of income or
loss after expenses?
0220
1
2
0230 $
0240 3
0250
1
2
0260 $
0270 3
7.
0280
a.
During the past 12 months, did . . .
receive from the U.S. Government
any money –
From Social Security checks?
b.
From Railroad Retirement checks?
0290
1
2
1
2
c.
0080
Code
Ask if code 5 and not a
farm – Is the business
incorporated?
0090
1
2
d.
e.
Yes
No
f.
FIELD REPRESENTATIVE CHECK ITEM
Is "Yes" marked in items 7a and/or 7b?
What was the amount of the last
Social Security or Railroad
Retirement payment received?
Is this amount AFTER the deduction
for a Medicare premium?
During the past 12 months, how
many Social Security or Railroad
Retirement payments did . . . receive?
0300
1
2
Yes
No – Go to item 6c
1
2
1
2
0350
1
2
Yes
No
Yes
No
0360 $
.00
0370 $
0380 1
.00
2
4
.00
Yes
Week
2 Weeks
Month
Quarter
6
Year
Other – Specify
7
Twice a month
5
No
Amount
Was there any money deducted from
. . .’s last pay for –
If YES – How much was deducted?
Federal income tax?
0390
1
2
0400 $
.00
b.
c.
State and local income tax?
0410
1
2
0420 $
.00
Social Security including
Medicare?
0430
1
2
d.
Railroad Retirement?
0440
1
2
0450 $
.00
e.
Government Retirement?
0460
1
2
0470 $
.00
f.
Private pension fund?
0480
1
2
0490 $
.00
If NO in item 10c – Are Social Security
payments normally deducted from
your paycheck?
0500
1
2
0501
1
a.
.00
Loss
Yes
No – Go to item 7
.00
Loss
g.
Yes
No
11.
Yes
No
Yes – Go to item 7d
No – Go to item 8a
0310 $
0320
Any Supplemental Security Income
checks from the State or local
Government?
If YES in items 8a and/or 8b –
How much did . . . receive in
Supplemental Security Income
checks altogether?
Ask items 9–12 only if item 6a is YES
(code 1).
What was the gross amount of . . .’s
last pay and what period of time did
this cover?
0340
3
10.
b.
During the past 12 months, did
. . . receive –
Any Supplemental Security Income
checks from the U.S. Government?
.00
Yes
No
12.
13a.
b.
14.
0330
Section 22 – Part E (Continued)
Number
Ask if "Yes" in item 10c or 10g
Does the money deducted for Social
Security cover only the Medicare
portion of Social Security?
Other than Social Security, did any
employer or union that . . . worked
for during the last 12 months
contribute to a pension or retirement
plan that . . . was enrolled in?
During the past 12 months, did . . .
place any money in a retirement plan
such as Individual Retirement Account
(IRA & Keogh)? Exclude rollovers.
If YES – How much?
FIELD REPRESENTATIVE CHECK ITEM
Mark (X) the appropriate box based upon
the respondent’s use of records in providing
responses to items 6–13.
2
0510
1
2
0520
1
2
0530 $
0540
1
2
Yes
No
Yes
No
Yes
No – Go to item 14
.00
Records
No records used
Page 120
Page 121
Page 121
NOTES
FORM CE-302
FORM CE-302
Section 22 – WORK EXPERIENCE AND INCOME – Continued
FIELD REPRESENTATIVE – Ask these items for the entire CU as a group in the Fifth Quarter.
Part F – Occupational Expenses and Contributions – Fifth Quarter Only
1.
2.
During the past 12 months, did you (or any
members of your CU) have any occupational
expenses such as union dues, tools, uniforms,
business or professional association dues, licenses,
or permits?
If YES – What was the total amount of these
occupational expenses?
During the past 12 months, did you (or any
members of your CU) make any –
a. Cash contributions for support of persons not in
the CU, including alimony, child support, or
students living away at college?
If YES – How much?
(1)
b.
How much of this amount was for
alimony?
0010
1
2
0030
1
2
e.
0041 $
X
.00
Don’t know
How much of this amount was for child
support?
0042 $ C H L D SU P X .00
X
Don’t know
(3)
How much of this amount was for the
expenses of college or university students
while attending school away from home?
0060 $ C O L L EX P X
X
Don’t know
Gifts of cash, bonds, or stocks to persons not in
the CU?
0070
1
.00
Yes C B SGI F T
No – Go to item 2c
.00
If YES – How much?
0080 $
C B SGF T X
Contributions to charities, such as United Way,
Red Cross, etc.?
0090
Yes C N T R C H A R
No – Go to item 2d
1
.00
If YES – How much?
0100 $C N T R C H R X
Contributions to church and other religious
organizations, excluding parochial school
expenses?
0110
If YES – How much?
0120 $ C N T R EL GX .00
Contributions to educational organizations?
If YES – How much?
1
2
0130
1
Political contributions?
If YES – How much?
Other contributions? – Specify in "Notes"
0150
1
Page 122
Yes C N T R ED O R
No – Go to item 2f
Yes C N T R P O L
No – Go to item 2g
0160 $ C N T R P O L X .00
0170
1
2
If YES – How much?
Yes C N T R EL G
No – Go to item 2e
0140 $ C N T ED O R X .00
2
g.
A L IM O X
(2)
2
f.
Yes C SH C N T R B
No – Go to item 2b
0040 $ C SH C N T B X .00
2
d.
Yes O C C EX P N
No – Go to item 2a
0020 $ O C C EX P N X .00
2
c.
NOTES
1 22 98 6
Yes M I SC C N T R
No – Go to next part
0180 $ M I SC C N T R X .00
Section 22 – Part F
Page 122
Page 123
Page 123
FIELD REPRESENTATIVE – Ask these items for the entire CU as a group in the Fifth Quarter.
Section 22 – WORK EXPERIENCE AND INCOME – Continued
Part G – Changes In Assets – Fifth Quarter Only
1.
a.
b.
c.
Savings accounts in banks, savings and loans,
credit unions and similar accounts?
Checking accounts, brokerage accounts and other
similar accounts?
0010 $
0
U.S. Savings bonds?
0030 $
How does the amount your CU had at the end of
the last day of (last month) compare with the
amount your CU had on the last day of (last month,
one year ago) in –
0040
b.
Savings accounts?
Checking accounts?
1
2
3
If more or less – How much more (less)?
a.
SA V A C C T X .00
None
0020 $ C K B K A C T X .00
0
None
0
2.
5.
1 22 99 4
On the last day of (last month), what was the total
amount your CU had in –
U SB N D X
1
2
3
0160
If YES – What was the net amount received from
sales after subtracting broker fees?
0170 $ SEL L SEC X
During the past 12 months, did you (or any
members of your CU) make any investments to
your own business or farm?
0180
If YES – How much did you invest?
0190 $ B SI N V ST X
During the past 12 months, did you (or any
members of your CU) withdraw any assets from
your own business or farm?
0200
If YES – What was the value of such assets?
0210 $ W D B SA ST X .00
During the past 12 months, were any goods or
services from your own business or farm
withdrawn for personal use?
0220
None
7.
Same – Go to item 2b
More C O M P SA V
Less
U.S. Savings bonds?
Same – Go to item 3a
More C O M PeB N D
t
3
Less
i
0090 $ C O M P B N D X .00
0080
b.
1
9a.
2
3a.
b.
c.
Did you (or any members of your CU) own any
securities, such as stocks, mutual funds, private
bonds, government bonds or Treasury notes on
the last day of (last month)?
0100
If YES – What was the estimated value of all such
securities on the last day of (last month)?
o
0110 $ SECESTX
How does this compare with the value of such
securities your CU held on the last day of (last
month, one year ago)?
1
2
1
2
3
If more or less – How much more (less)?
b.
o
Yes
No – Go to item
4
t
10.
During the past 12 months, did you (or any
members of your CU) purchase any stocks,
mutual funds or bonds?
If YES – What was the total purchase price
including broker fees?
FORM CE-302
0140
1
2
Yes B SI N V ST
No – Go to item 7
.00
What was the value of these goods or services?
On the last day of (last month), did anyone outside
of your CU owe money to you or any member of
your CU?
1
2
1
2
W D B SA ST
Yes
No – Go to item 8a
Yes W D B SGD S
No – Go to item 9a
0230 $ W D B SGD SX .00
0240
1
2
Yes
No – Go to item 10
How does the amount owed to your CU on the
last day of (last month) compare with the amount
owed to your CU by persons outside your CU on
the last day of (last month, one year ago)?
0250
If more or less – How much more (less)?
0260 $C O M P O W D X .00
Did anyone outside of your CU owe money to you
or any member of your CU on the last day of (last
month, one year ago)?
0270
If YES – How much was owed?
0280 $M O N Y O W D X .00
During the past 12 months, did you (or any
members of your CU) receive settlement on
surrender of any insurance policies (life or
annuity)?
0290
1
2
3
Same – Go to item 10
More
CO M PO W D
Less
1
2
Yes M O N Y O W D
No – Go to item 11
.00
11a.
4.
2
.00
Same – G
More C O M P SEC
Less
0130 $ C O M P SEC X
1
.00
M ONYOW E
SEC O W N D
0120
2
Yes
SEL L SEC
No – Go to item 6
S
Same – Go to item 2c
4
More C O M P C K G
Less
8a.
0070 $ C O M P C K GX .00
m
c.
1
.00
0050 $ C O M P SA V X .00
0060
6.
During the past 12 months, did you (or any
members of your CU) sell any stocks, mutual
funds or bonds?
P U R SSEC
Yes
No – Go to item 5
0150 $ P U R S SEC X .00
If YES – How much did you receive?
1
2
Yes
No
SET L I N S
0300 $ SET L I N SX
.00
NOTES
FORM CE-302
Section 24 – TOTAL CU INCOME – For New Consumer Units Only
TOTAL CU INCOME
Information Booklet, page 43
1. Which category represents
the total combined income of
this CU during the past 12
months? This includes money
from jobs, net income from
business, farm or rent,
pensions, dividends, interest,
social security payments, and
any other money income
received by all CU members
14 years of age or older.
NOTES
1 24 01 6
0010
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
X
Page 124
FIELD REPRESENTATIVE – Hand the respondent the Information Booklet with instructions to look at the item list as you
proceed. Ask the question and read each income range category beginning with code 1.
CUI NCOME
Loss
Under $3,000
$3,000–5,999
$6,000–7,499
$7,500–9,999
$10,000–12,999
$13,000–14,999
$15,000–19,999
$20,000–24,999
$25,000–29,999
$30,000–34,999
$35,000–49,999
$50,000–74,999
$75,000+
Refused
Don’t know
Section 24
Page 124
GENERAL SURVEY INFORMATION
Section 1
RENTED LIVING QUARTERS
Section 2
OWNED LIVING QUARTERS AND OTHER OWNED REAL ESTATE
Section 3
UTILITIES AND FUELS FOR OWNED AND RENTED PROPERTIES
Section 4
CONSTRUCTION, REPAIRS, ALTERATIONS, AND MAINTENANCE OF PROPERTY
Section 5
APPLIANCES, HOUSEHOLD EQUIPMENT, AND OTHER SELECTED ITEMS
Section 6
HOUSEHOLD EQUIPMENT REPAIRS, SERVICE CONTRACTS, AND FURNITURE REPAIR AND REUPHOLSTERING
Section 7
HOME FURNISHINGS AND RELATED HOUSEHOLD ITEMS
Section 8
CLOTHING AND SEWING MATERIALS
Section 9
RENTED AND LEASED VEHICLES
Section 10
OWNED VEHICLES
Section 11
VEHICLE OPERATING EXPENSES
Section 12
INSURANCE OTHER THAN HEALTH
Section 13
HOSPITALIZATION AND HEALTH INSURANCE
Section 14
MEDICAL AND HEALTH EXPENDITURES
Section 15
EDUCATIONAL EXPENSES
Section 16
SUBSCRIPTIONS, MEMBERSHIPS, BOOKS, AND ENTERTAINMENT EXPENSES
Section 17
TRIPS AND VACATIONS
Section 18
MISCELLANEOUS EXPENSES
Section 19
EXPENSE PATTERNS FOR FOOD, BEVERAGES, AND OTHER SELECTED ITEMS
Section 20
CREDIT LIABILITY
Section 21
WORK EXPERIENCE AND INCOME
Section 22
TOTAL CU INCOME
Section 24