In the realm of the Census

UNITED [stop laughing!] STATES CENSUS 2020

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How many people without a permanent place to stay are in your household? _______

How many (if any) with a permanent place to stay? _________

How many total living in this house, apartment, mobile home, tent, dugout, or packing crate? (If more than 10, use form U.S.C.28-34b, Undocumented Immigrants) ________

PERSON 1

Name _____________________________

What is this person's sex? M [ ] F [ ] G [ ] L [ ] B [ ] T [ ]

What is this person's origin?
[ ] Mexican, Mexican Am., Chicano
[ ] Puerto Rican
[ ] Cuban
[ ] Dominican, Colombian, Nicaraguan, Salvadorean, etc.
[ ] African
[ ] Middle Eastern
[ ] Imperialist American

What is this person's race?
[ ] Black, African Am., or Negro
[ ] American Indian or Alaska Native
[ ] Asian Indian
[ ] Chinese
[ ] Filipino
[ ] Japanese
[ ] Korean
[ ] Vietnamese
[ ] Native Hawaiian
[ ] Guamanian or Chamorro
[ ] Samoan
[ ] Other Pacific Islander
[ ] Haitian
[ ] Hmong
[ ] Laotian
[ ] Pakistani
[ ] Afghani
[ ] Iraqi
[ ] Cambodian
[ ] Somali
[ ] Kenyan
[ ] Nigerian
[ ] African (specify)
[ ] Other

Does Person 1 sometimes live somewhere else?
[ ] No [ ] Yes — Mark X all that apply.
[ ] Jail
[ ] Al Qaeda training camp or United Kingdom
[ ] Al Qaeda underground cell or United Kingdom
[ ] Border tunnel
[ ] Mental rehabilitation facility (sometimes referred to as "madhouse")
[ ] All of the above

Please complete this questionnaire for all other members of the household.

Congratulations! You have helped your tribe get all the entitlements it can get!