2011 National Household Survey Questions


STEP A

1. Print your telephone number:

2. Complete this section if there is no printed address on the front page or if the printed address does not correspond to this dwelling.

  • Number and street or lot and concession   
  • Apartment number
  • City, municipality, town, village, Indian reserve   
  • Province/territory   
  • Postal code

STEP B

1. How many persons usually live at this address on May 10, 2011, including yourself?

Include all persons who have their main residence at this address, even if they are temporarily away. See the instructions on page 3 (joint custody, students, permanent residents, secondary residence, etc.).
___         Number of persons


2. Including yourself, list below the names of these persons who usually live here on May 10, 2011. Begin the list with an adult followed, if applicable, by that person's spouse or common-law partner and by their children. Continue with all other persons who usually live at this address.

  • Person 1 (Family name, Given name)
  • Person 2 (Family name, Given name)
  • Person 3 (Family name, Given name)
  • Person 4 (Family name, Given name)
  • Person 5 (Family name, Given name)
  • Person 6 (Family name, Given name)
  • Person 7 (Family name, Given name)
  • Person 8 (Family name, Given name)
  • Person 9 (Family name, Given name)
  • Person 10 (Family name, Given name)


1. WHO TO INCLUDE IN STEP B

  • All persons who have their main residence at this address on May 10, 2011, including newborn babies, room-mates and persons who are temporarily away;
  • Canadian citizens, permanent residents (landed immigrants), persons asking for refugee status (refugee claimants), persons from another country with a work or study permit and family members living here with them;
  • Persons staying at this address temporarily on May 10, 2011 who have no main residence elsewhere.

2. WHERE TO INCLUDE PERSONS WITH MORE THAN ONE RESIDENCE

  • CHILDREN IN JOINT CUSTODY should be included in the home of the parent where they live most of the time. Children who spend equal time with each parent should be included in the home of the parent with whom they are staying on May 10, 2011.
  • STUDENTS who return to live with their parents during the year should be included at their parents' address, even if they live elsewhere while attending school or working at a summer job.
  • SPOUSES OR COMMON-LAW PARTNERS TEMPORARILY AWAY who stay elsewhere while working or studying should be listed at the main residence of their family, if they return periodically.
  • PERSONS IN AN INSTITUTION who have been there for less than six months (for example, in a home for the aged, a hospital or a prison) should be listed at their usual residence.

IF THIS ADDRESS IS:

  • a SECONDARY RESIDENCE (such as a cottage) for ALL PERSONS who stayed here on May 10, 2011 (all these persons have their main residence elsewhere in Canada), mark this circle. Do not answer other questions.
  • a DWELLING OCCUPIED ONLY BY RESIDENTS OF ANOTHER COUNTRY VISITING CANADA (for example, on vacation or on a business trip), mark this circle. Do not answer other questions.
  • the HOME OF A GOVERNMENT REPRESENTATIVE OF ANOTHER COUNTRY (for example, embassy or high commission) and family members, mark this circle. Do not answer other questions.
  • a DWELLING THAT WAS OCCUPIED BY A DIFFERENT HOUSEHOLD on May 10, 2011 (that is, all persons in your household lived at another address on May 10, 2011), mark this circle. Do not answer other questions.

STEP C

Did you leave anyone out of Step B because you were not sure the person should be listed? (For example, a person living at this address who has another home, a person temporarily away, etc.)


STEP D

Copy the names in Step B to Question 1, on top of page 4.
Keep the same order.


1. Copy the NAME of each person in the same order as in Step B. Then answer the questions for each person.

The questions refer to each person's situation on May 10, 2011 unless otherwise specified.

  • PERSON 1 (Family name, Given name)

2. SEX

  • Male
  • Female

3. DATE OF BIRTH AND AGE

  Day Month Year Age
Example: 23 02 1974 37

If exact date is not known, enter best estimate.
For children under the age of 1, enter 0.

Date of birth

Day   Month   Year   Age



4. MARITAL STATUS

Mark one circle only.

  • Never legally married
  • Legally married (and not separated)
  • Separated, but still legally married
  • Divorced
  • Widowed

5. Is this person living with a common-law partner?

Common-law refers to two people who live together as a couple but who are not legally married to each other.

  • Yes
  • No

6. RELATIONSHIP TO PERSON 1

For each person usually living here, describe his or her relationship to Person 1.

Mark or specify one response only.

Adopted children should be considered sons and daughters.

Children in joint custody should be included in the home of the parent where they live most of the time.

Children who spend equal time with each parent should be included in the home of the parent with whom they are staying on May 10, 2011.

For all children, please consider the relationship to Person 1 and Person 2.

If none of the choices apply, specify this person's relationship to Person 1 under "Other".

Examples of "Other" relationships to Person 1:
· brother-in-law or sister-in-law · niece or nephew · grandfather or grandmother · room-mate's son or daughter · lodger's husband or wife · employee · etc.

  • PERSON 1
    • PERSON 1
  • PERSON 2
    • Opposite-sex husband or wife of Person 1
    • Opposite-sex common-law partner of Person 1
    • Same-sex married spouse of Person 1
    • Same-sex common-law partner of Person 1
    • Son or daughter of Person 1 only
    • Son-in-law or daughter-in-law of Person 1
    • Grandchild of Person 1
    • Father or mother of Person 1
    • Father-in-law or mother-in-law of Person 1
    • Brother or sister of Person 1
    • Foster child
    • Room-mate, lodger or boarder
      Other - Specify
  • PERSON 3, etc.
    • Son or daughter of both Persons 1 and 2
    • Son or daughter of Person 1 only
    • Son or daughter of Person 2 only
    • Son-in-law or daughter-in-law of Person 1
    • Grandchild of Person 1
    • Father or mother of Person 1
    • Father-in-law or mother-in-law of Person 1
    • Brother or sister of Person 1
    • Foster child
    • Room-mate, lodger or boarder
      Other - Specify

ACTIVITIES OF DAILY LIVING

7. Does this person have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?

  • Yes, sometimes
  • Yes, often
  • No

8. Does a physical condition or mental condition or health problem reduce the amount or the kind of activity this person can do:

(a) at home?

  • Yes, sometimes
  • Yes, often
  • No

(b) at work or at school?

  • Yes, sometimes
  • Yes, often
  • No
  • Not applicable

(c) in other activities, for example, transportation or leisure?

  • Yes, sometimes
  • Yes, often
  • No

SOCIOCULTURAL INFORMATION

9. Where was this person born?

Specify one response only, according to present boundaries.

Born in Canada

  • Nfld.Lab.
  • P.E.I.
  • N.S.
  • N.B.
  • Quebec
  • Ontario
  • Manitoba
  • Sask.
  • Alberta
  • B.C.
  • Yukon
  • N.W.T.
  • Nunavut

Born outside Canada

Specify country


10. Of what country is this person a citizen?

Indicate more than one citizenship, if applicable.

"Canada, by naturalization" refers to the process by which an immigrant is granted citizenship of Canada, under the Citizenship Act.

  • Canada, by birth
  • Canada, by naturalization
  • Other country - Specify

11. Is this person now, or has this person ever been, a landed immigrant?

A "landed immigrant" (permanent resident) is a person who has been granted the right to live in Canada permanently by immigration authorities.

  • No         Go to Question 13
  • Yes

12. In what year did this person first become a landed immigrant?

If exact year is not known, enter best estimate.

Year   


13. Can this person speak English or French well enough to conduct a conversation?

Mark one circle only.

  • English only
  • French only
  • Both English and French
  • Neither English nor French

14. What language(s), other than English or French, can this person speak well enough to conduct a conversation?

  • None

OR

Specify other language(s)


15.  (a) What language does this person speak most often at home?

  • English
  • French
  • Other - Specify

(b) Does this person speak any other languages on a regular basis at home?

  • No
  • Yes, English
  • Yes, French
  • Yes, Other - Specify

16. What is the language that this person first learned at home in childhood and still understands?

If this person no longer understands the first language learned, indicate the second language learned.

  • English
  • French
  • Other - Specify

This question collects information on the ancestral origins of the population and provides information about the composition of Canada's diverse population.

17. What were the ethnic or cultural origins of this person's ancestors?

An ancestor is usually more distant than a grandparent.

For example, Canadian, English, French, Chinese, East Indian, Italian, German, Scottish, Irish, Cree, Mi'kmaq, Salish, Métis, Inuit, Filipino, Dutch, Ukrainian, Polish, Portuguese, Greek, Korean, Vietnamese, Jamaican, Jewish, Lebanese, Salvadorean, Somali, Colombian, etc.

Specify as many origins as applicable using capital letters.


18. Is this person an Aboriginal person, that is, First Nations (North American Indian), Métis or Inuk (Inuit)?

Note: First Nations (North American Indian) includes Status and Non-Status Indians.

If "Yes", mark the circle(s) that best describe(s) this person now.

  • No, not an Aboriginal person         Continue with the next question
  • Yes, First Nations (North American Indian)         Go to Question 20
  • Yes, Métis         Go to Question 20
  • Yes, Inuk (Inuit)         Go to Question 20

19. Is this person:

Mark more than one or specify, if applicable.

This information is collected in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.

  • White
  • South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
  • Chinese
  • Black
  • Filipino
  • Latin American
  • Arab
  • Southeast Asian (e.g., Vietnamese, Cambodian, Malaysian, Laotian, etc.)
  • West Asian (e.g., Iranian, Afghan, etc.)
  • Korean
  • Japanese
  • Other - Specify

20. Is this person a Status Indian (Registered or Treaty Indian as defined by the Indian Act of Canada)?

  • No
  • Yes, Status Indian (Registered or Treaty)

21. Is this person a member of a First Nation/Indian band?

If "Yes", which First Nation/Indian band?

For example, Musqueam Indian Band, Sturgeon Lake First Nation, Atikamekw of Manawan.

  • No
  • Yes, member of a First Nation/Indian band

    Specify name of First Nation/Indian band

22. What is this person's religion?

Indicate a specific denomination or religion even if this person is not currently a practising member of that group.

For example, Roman Catholic, United Church, Anglican, Baptist, Lutheran, Muslim, Presbyterian, Pentecostal, Jewish, Buddhist, Hindu, Sikh, Greek Orthodox, etc.

Specify one denomination or religion only.

  • No religion

MOBILITY

23. Where did this person live 1 year ago, that is, on May 10, 2010?

Mark one circle only.
Note:
For those who mark the fourth circle:
Please give the name of the city or town rather than the metropolitan area of which it is a part.
For example:

  • Saanich rather than Victoria (metropolitan area);
  • St. Albert rather than Edmonton (metropolitan area);
  • Laval rather than Montréal (metropolitan area).
  • Born after May 10, 2010
  • Lived at the same address as now
  • Lived at a different address in the same city, town, village, township, municipality or Indian reserve
  • Lived in a different city, town, village, township, municipality or Indian reserve in Canada
  • Specify name of:

  • City, town, village, township, municipality or Indian reserve
  • Province/territory
  • Postal code
  • Lived outside Canada

    Specify country


24. Where did this person live 5 years ago, that is, on May 10, 2006?

Mark one circle only.

Note:
For those who mark the fourth circle:
Please give the name of the city or town rather than the metropolitan area of which it is a part.
For example:

  • Saanich rather than Victoria (metropolitan area);
  • St. Albert rather than Edmonton (metropolitan area);
  • Laval rather than Montréal (metropolitan area).
  • Born after May 10, 2006
  • Lived at the same address as now
  • Lived at a different address in the same city, town, village, township, municipality or Indian reserve
  • Lived in a different city, town, village, township, municipality or Indian reserve in Canada
  • Specify name of:

  • City, town, village, township, municipality or Indian reserve
  • Province/territory
  • Postal code
  • Lived outside Canada

    Specify country


PLACE OF BIRTH OF PARENTS

25. Where was each of this person's parents born?

(a) Father

Mark or specify country according to present boundaries.

Father

  • Born in Canada

Born outside Canada
Specify country

(b) Mother

Mark or specify country according to present boundaries.

Mother

  • Born in Canada

Born outside Canada
Specify country


26. Answer Questions 27 to 55 for each person aged 15 years and over (born before May 10, 1996).


EDUCATION

27. Has this person completed a secondary (high) school diploma or equivalent?

Examples of secondary (high) school equivalency certificates are General Educational Development (GED) and Adult Basic Education (ABE).

Secondary (high) school diploma or certificate

  • Yes, secondary (high) school diploma
  • Yes, secondary (high) school equivalency certificate
  • No

28. Has this person completed a Registered Apprenticeship or other trades certificate or diploma?

Mark as many circles as applicable.

For example, hairstyling, cooking, electrician, carpentry.

Registered Apprenticeship or trades certificate or diploma

  • Yes, Registered Apprenticeship certificate (including Certificate of Qualification, Journeyperson's designation)
  • Yes, other trades certificate or diploma
  • No

29. Has this person completed a college, CEGEP, or other non-university certificate or diploma? (Other than certificates or diplomas reported in Question 28.)

Mark as many circles as applicable.

For example, accounting technology, real estate agent, industrial engineering technology, dental hygiene, legal assistant.

College, CEGEP or other non-university certificate or diploma

  • Yes, certificate or diploma from a program of less than 3 months
  • Yes, certificate or diploma from a program of 3 months to less than 1 year
  • Yes, certificate or diploma from a program of 1 year to 2 years
  • Yes, certificate or diploma from a program of more than 2 years
  • No

30. Has this person completed a university certificate, diploma or degree?

Mark as many circles as applicable.

University certificate, diploma or degree

  • Yes, university certificate or diploma below bachelor level
  • Yes, bachelor's degree (including LL.B.)
  • Yes, university certificate or diploma above bachelor level
  • Yes, master's degree
  • Yes, degree in medicine, dentistry, veterinary medicine or optometry
  • Yes, earned doctorate
  • No

31. What was the major field of study of the highest certificate, diploma or degree that this person completed?

Please be specific. For example, automobile mechanics, health care attendant, medical laboratory technology, early childhood education, civil engineering, natural resources conservation, agricultural economics.

Major field of study of highest certificate, diploma or degree

OR

  • No certificate, diploma or degree (higher than high school)         Go to Question 33

32. In what province, territory or country did this person complete his or her highest certificate, diploma or degree?

In Canada
Specify province or territory

OR
Outside Canada
Specify country


33. At any time since September 2010, has this person attended a school, college, CEGEP or university?

Mark as many circles as applicable.

Please include attendance only for courses that can be used as credits towards a certificate, diploma or degree.

At any time since September 2010

  • Yes, attended elementary, junior high school or high school
  • Yes, attended trade school, business school, community college, technical institute, CEGEP or other non-university institution
  • Yes, attended university
  • No, did not attend school at any time since September 2010

Note:
Many of the following questions refer to the week from Sunday, May 1 to Saturday, May 7, 2011.

LABOUR MARKET ACTIVITIES

34. During the week of Sunday, May 1 to Saturday, May 7, 2011, how many hours did this person spend working for pay or in self-employment?

Please enter the total number of hours worked for pay or in self-employment at all jobs held during the week of May 1 to May 7.

Include:

  • working for wages, salary, tips or commission;
  • working in his/her own business, farm or professional practice, alone or in partnership;
  • working directly towards the operation of a family farm or business without formal pay arrangements (e.g., assisting in seeding, doing accounts).

Number of hours (to the nearest hour)
__________         Go to Question 40

OR

  • None         Continue with the next question

35. During the week of May 1 to May 7, was this person on temporary lay-off or absent from his/her job or business?

Mark one circle only.

  • No
  • Yes, on temporary lay-off from a job to which this person expects to return
  • Yes, on vacation, ill, on strike or locked out, or absent for other reasons

36. During the week of May 1 to May 7, did this person have definite arrangements to start a new job within the next four weeks?

  • No
  • Yes

37. Did this person look for paid work during the four weeks from April 10 to May 7, 2011?

For example, did this person contact an employment centre, check with employers, place or answer newspaper ads, etc.?

Mark one circle only.

  • No         Go to Question 39
  • Yes, looked for full-time work
  • Yes, looked for part-time work (less than 30 hours per week)

38. Could this person have started a job during the week of Sunday, May 1 to Saturday, May 7, 2011 had one been available?

Mark one circle only.

  • Yes, could have started a job
  • No, already had a job
  • No, because of temporary illness or disability
  • No, because of personal or family responsibilities
  • No, going to school
  • No, other reasons

39. When did this person last work for pay or in self-employment, even for a few days?

Mark one circle only.

  • In 2011         Continue with the next question
  • In 2010         Continue with the next question
  • Before 2010         Go to Question 53
  • Never         Go to Question 53

Note: Questions 40 to 49 refer to this person's job or business during the week of May 1 to May 7, 2011. If this person held no job, answer for the job of longest duration since January 1, 2010. If this person held more than one job, answer for the job at which he or she worked the most hours.


40. For whom did this person work?

For self-employed persons, enter the name of their business. If the business does not have a name, enter the person's name.

Print in capital letters as follows:

ABC CONCRETE PRODUCTS LIMITED

Name of firm, government agency, etc.

Section, plant, department, etc. (if applicable)


41. What kind of business, industry or service was this?

Please give details. For example:

  • primary school
  • municipal police
  • wheat farm
  • shoe store

Kind of business, industry or service


42. What was this person's work or occupation?

Please be specific. For example:

  • plumber
  • fishing guide
  • wood furniture assembler
  • secondary school teacher

(If in the Armed Forces, give rank.)

Occupation


43. In this work, what were this person's main activities?

Please give details. For example:

  • installed residential plumbing
  • guided fishing parties
  • made wood furniture products
  • taught mathematics

Main activities


44. In this job or business, was this person mainly:

Mark one circle only.

  • working for wages, salary, tips or commission?         Go to Question 46
  • working without pay for his/her spouse or another relative in a family farm or business?         Go to Question 46
  • self-employed without paid help (alone or in partnership)?
  • self-employed with paid help (alone or in partnership)?

45. If self-employed, was this person's farm or business incorporated?

  • No
  • Yes

46. At what address did this person usually work most of the time?

  Number
Name
Type
Direction
Example: 365 Laurier Ave. West

If direction (e.g., North, South, East or West) is a part of the street address, please include it.

If street address is unknown or if the address is a post office box, specify the building or nearest street intersection. Do not give a post office box number.

Please give the name of the city or town rather than the metropolitan area of which it is a part.

For example:

  • Saanich rather than Victoria (metropolitan area);
  • St. Albert rather than Edmonton (metropolitan area);
  • Laval rather than Montréal (metropolitan area).

If the address of work is different than the address of the employer, please provide the address where this person actually works (e.g., school teachers should provide the address of their school, not the address of the school board).

  • Worked at home (including farms)         Go to Question 49
  • Worked outside Canada         Go to Question 49
  • No fixed workplace address         Continue with the next question
  • Worked at the address specified below:

    Specify complete address

    Street address (see example)

    City, town, village, township, municipality or Indian reserve

    Province/territory

    Postal code


47. (a) How did this person usually get to work?

If this person used more than one method of travel to work, mark the one used for most of the travel distance.

Mark "Subway or elevated rail" for:

  • Vancouver SkyTrain
  • Toronto Subway/RT
  • Montréal Metro

Mark "Light rail, streetcar or commuter train" for:

  • Vancouver West Coast Express
  • Calgary CTrain
  • Edmonton LRT
  • Toronto streetcars
  • Toronto GO Train
  • Ottawa O-Train
  • Montréal commuter trains
  • Car, truck or van - as a driver         Continue with Question 47 (b)
  • Car, truck or van - as a passenger        Continue with Question 47 (b)
  • Bus         Go to Question 48 (a)
  • Subway or elevated rail         Go to Question 48 (a)
  • Light rail, streetcar or commuter train         Go to Question 48 (a)
  • Passenger ferry         Go to Question 48 (a)
  • Walked to work         Go to Question 48 (a)
  • Bicycle         Go to Question 48 (a)
  • Motorcycle, scooter or moped         Go to Question 48 (a)
  • Other method         Go to Question 48 (a)

(b) How many people, including this person, usually shared the ride to work in this car, truck or van?

  • Drove alone
  • 2 people
  • 3 or more people

48. (a) What time did this person usually leave home to go to work?

hour:      min:

  • am
  • pm

(b) How many minutes did it usually take this person to get from home to work?

__________         Number of minutes


49. (a) In this job, what language did this person use most often?

  • English
  • French
  • Other - Specify

(b) Did this person use any other languages on a regular basis in this job?

  • No
  • Yes, English
  • Yes, French
  • Yes, Other - Specify

50. In how many weeks did this person work in 2010?

Please enter the total number of weeks worked for pay or in self-employment at all jobs held in 2010.

Include those weeks in which this person:

  • was on vacation or sick leave with pay;
  • worked full time or part time;
  • worked for wages, salary, tips or commission;
  • was self-employed;
  • worked directly toward the operation of a family farm or business without formal pay arrangements.
  • None         Go to Question 53

OR

_______         Number of weeks


51. During most of those weeks, did this person work full time or part time?

Mark one circle only.

  • Full time (30 hours or more per week)
  • Part time (less than 30 hours per week)

52. In 2010, did this person pay for child care, such as day care or babysitting, so that this person could work at his or her paid job(s)?

When child care or day camps help several people work, enter the amount only once.

Answer "Yes" or "No". If "Yes", also enter the total amount for 2010.

  • Yes         $ ____ ___________ .00
  • No

53. In 2010, did this person pay child or spousal support payments to a former spouse or partner?

Support payments are covered by an agreement to pay a fixed amount on a regular basis. Exclude all other gifts or transfers of money. Include only support payments actually paid.

Answer "Yes" or "No". If "Yes", also enter the total amount for 2010.

  • Yes         $ ____ _________ _________ .00
  • No

INCOME IN 2010

54. To save time, each person can give Statistics Canada permission to use the income information already available in his or her income tax files instead of answering Question 55.

  • This option is only available for persons who filed a tax return for the year ending December 31, 2010.
  • Please note that your income tax information will be used for statistical purposes only.

Does this person give Statistics Canada permission to use the income information available in his/her income tax files for the year ending December 31, 2010?

  • Yes         Person 1 agrees. Go to Step E on page 38
  • No         Continue with the next question

55. During the year ending December 31, 2010, did this person receive any income from the sources listed below?

Answer "Yes" or "No" for all sources. If "Yes", also enter the amount; in case of a loss, also mark "Loss".


INCOME FROM EMPLOYMENT

(a) Total wages and salaries, including commissions, bonuses, tips, taxable benefits, research grants, royalties, etc., before any deductions

  • Yes         $ ____ _________ _________ .00
  • No

(b) Net farm income (gross receipts minus expenses and capital cost allowance), including grants and subsidies, marketing board payments, gross insurance proceeds

  • Yes         $ ____ _________ _________ .00
  • No
  • Loss

(c) Net non-farm income from unincorporated business, professional practice,etc. (gross receipts minus expenses)

  • Yes         $ ____ _________ _________ .00
  • No
  • Loss

INCOME FROM GOVERNMENT

(d) Child benefits, such as child tax benefits, universal child care benefits, family allowances (federal, provincial and territorial)

  • Yes         $ ____ ___________ .00
  • No

(e) Old Age Security Pension, Guaranteed Income Supplement, Allowance and Allowance for the Survivor from federal government only (provincial income supplements should be reported in (h))

  • Yes         $ ____ ___________ .00
  • No

(f) Benefits from Canada or Quebec Pension Plan

  • Yes         $ ____ ___________ .00
  • No

(g) Benefits from Employment Insurance, including maternity and parental benefits paid under the federal employment insurance plan and the Quebec Parental Insurance Plan (total benefits before tax deductions)

  • Yes         $ ____ ___________ .00
  • No

(h) Other income from government sources,such as provincial income supplements and grants, the GST/QST/HST credit, provincial tax credits, workers’ compensation, veterans’ pensions, welfare payments

  • Yes         $ ____ _________ _________ .00
  • No

OTHER INCOME :

(i) Dividends, interest on bonds, deposits and savings certificates, and other investment income, such as net rents from real estate, interest from mortgages

  • Yes         $ ____ _________ _________ .00
  • No
  • Loss

(j) Capital gains or losses,including those from mutual funds. Do not include non-taxable capital gains on the sale of a principal residence. Report the full amount, not just the taxable portion.

  • Yes         $ ____ _________ _________ .00
  • No
  • Loss

(k) Retirement pensions, superannuation and annuities, including those from RRSPs and RRIFs. Do not include withdrawals from a pension plan or RRSP.

  • Yes         $ ____ _________ _________ .00
  • No

(l) Other money income, such as alimony, child support, scholarships

  • Yes         $ ____ _________ _________ .00
  • No

TOTAL INCOME in 2010 from all sources

  • Yes         $ ____ _________ _________ .00
  • No
  • Loss

INCOME TAX PAID on 2010 income (federal, provincial and territorial)

        $ ____ _________ _________ .00


STEP E

Answer Questions E1 to E10 about this dwelling.

The questions refer to May 10, 2011 unless otherwise specified.

A dwelling is a separate set of living quarters with a private entrance from the outside or from a common hallway or stairway inside the building. This entrance should not be through someone else's living quarters.

E1. Who pays the rent or mortgage, taxes, electricity, etc., for this dwelling?

If more than one person contributes to such payments, mark as many circles as apply.

  • Person 1
  • Person 2
  • Person 3
  • Person 4
  • Person 5
  • A person who is listed on another questionnaire for this dwelling
  • A person who does not live here

E2. Is this dwelling:

Mark one circle only.

  • owned by you or a member of this household (even if it is still being paid for)?
  • rented (even if no cash rent is paid)?

E3. Is this dwelling part of a condominium development?

  • Yes
  • No

E4. (a) How many rooms are there in this dwelling?

Include kitchen, bedrooms, finished rooms in attic or basement, etc.

Do not count bathrooms, halls, vestibules and rooms used solely for business purposes.

_______________         Number of rooms

(b) How many of these rooms are bedrooms?

Include all rooms designed as bedrooms, even if they are now used for something else. Also include basement bedrooms.

_______________         Number of bedrooms


E5. When was this dwelling originally built?

Mark the period in which the building was completed, not the time of any later remodelling, additions or conversions. If year is not known, give best estimate.

  • 1920 or before
  • 1921-1945
  • 1946-1960
  • 1961-1970
  • 1971-1980
  • 1981-1985
  • 1986-1990
  • 1991-1995
  • 1996-2000
  • 2001-2005
  • 2006-2011

E6. Is this dwelling in need of any repairs?

Do not include desirable remodelling or additions.

  • No, only regular maintenance is needed (painting, furnace cleaning, etc.)
  • Yes, minor repairs are needed (missing or loose floor tiles, bricks or shingles, defective steps, railing or siding, etc.)
  • Yes, major repairs are needed (defective plumbing or electrical wiring, structural repairs to walls, floors or ceilings, etc.)

E7. Is this dwelling located on an agricultural operation that is operated by a member of this household?

  • Yes         Go to Step F on next page
  • No         Continue this section

Answer Questions E8 to E10 for this dwelling even if you own or rent more than one dwelling.

If the exact amount is not known, please give a best estimate.


E8. For this dwelling, what are the YEARLY payments (last 12 months) for:

(a) electricity?

  • None
  • Included in rent or other payments

OR $ ____ ___________ .00 per year

(b) oil, gas, coal, wood or other fuels?

  • None
  • Included in rent or other payments

OR $ ____ ___________ .00 per year

(c) water and other municipal services?

  • None
  • Included in rent or other payments

OR $ ____ ___________ .00 per year


E9. For RENTERS only, answer parts (a) and (b):

(a) What is the monthly rent paid for this dwelling?

  • Rented without payment of cash rent

OR $ ____ ___________ .00 per month

(b) Is this dwelling subsidized?

Subsidized housing includes rent geared to income, social housing, public housing, government assisted housing, non-profit housing, rent supplements, and housing allowances.

  • Yes
  • No

E10. For OWNERS only, answer parts (a) through (e):

(a) What are the total regular monthly mortgage or loan payments for this dwelling?

  • None         Go to part (c)

OR $ ____ ___________ .00 per month

(b) Are the property taxes (municipal and school) included in the amount shown in part (a)?

  • Yes         Go to part (d)
  • No

(c) What are the estimated yearly property taxes (municipal and school) for this dwelling?

  • None

OR $ ____ ___________ .00 per year

(d) If you were to sell this dwelling now, for how much would you expect to sell it?

$ ____ _________ _________ .00

(e) What are the monthly condominium fees?

  • None

OR $ ____ ___________ .00 per month


STEP F

If you are answering on behalf of other people, please consult each person.

F1. This question is for all persons including children younger than 15.

Only if you mark "YES" to this question will your National Household Survey responses and family history be part of the historical record of Canada. A "YES" means your responses will be available to family members and historical researchers, 92 years after the 2011 National Household Survey, in 2103.

If you mark "NO" or leave the answer blank, your responses will never be made available to future generations.

Does this person agree to make his or her 2011 National Household Survey information available in 2103 (92 years after the National Household Survey)?

  • Yes
  • No

STEP G

You have now completed your questionnaire