H1

29 April

Census 2001

England Household Form

Name

Address
CD
ED
Form number
Postcode
* Form of
* Multi-form households only

 

To the Householder, Joint Householders or members of the household aged 16 or over

The Census is a count every ten years of all people and households in the country. Census information is used by central and local government, health authorities and many other organisations to allocate resources and plan services for everyone. The Office for National Statistics conducts the Census in England and Wales.

Completing your form

Completion of the Census form is compulsory under the Census Act 1920. If you refuse to complete it, or give false information, you may be liable to a fine. This liability does not apply to question 10 on religion. The requirement for
you to return a completed form will not be satisfied until such a form has been received. If you need help please contact the Census Helpline.

Confidentiality

The information you provide is protected by law and treated in strict confidence. The information may only be used for statistical purposes, and anyone using or disclosing Census information improperly will be liable to prosecution. Census
forms will be held securely. Under the current terms of the Public Records Act 1958, the data will be treated as confidential for a period of 100 years.

Thank you for counting yourself in.

Len Cook
REGISTRAR GENERAL FOR ENGLAND AND WALES

  

What you have to do

  • Your household should complete this form in black or blue ink. A household is:

    • one person living alone, or

    • a group of people (not necessarily related) living at the same address with common housekeeping - sharing either a living room or sitting room, or at least one meal a day.

  • This form covers five people. If there are more than five people in your household you will need an extra form.

  • Identify household members in Table 1 (page 2). It will help you to complete the form if you use Table 2 to identify visitors.

  • Answer the questions about your accommodation
    (page 3).

  • Complete the relationship question (pages 4 and 5).

  • Answer the remaining questions for every member of your household.

  • Sign the Declaration and post the form back in the envelope supplied.

Declaration

This form is completed to the best of my knowledge and belief.

Signature/s Date

Page 1

Table 1 Household Members

Person No. First name and surname
Individual Form
Person 1  
Person 2  
Person 3  
Person 4  
Person 5  
If you have more than 5 people in your household, you will need an extra form.
Person 6  
Person 7  
Person 8  
Person 9  
Person 10  

Table 2 Visitors

First name and surname Usual address
   
   
   
   
   

Page 2

How to complete the remaining questions

Remember to use black or blue ink.

Put a tick in the appropriate box, like this . If you mark the wrong box, fill in the box and put a tick in the right one.

 When you are required to write in an answer please use CAPITAL LETTERS and leave one space between each word. Start a new line if a word will not fit.

7 What is your country of birth?

Elsewhere, please write in the present name of the country

Household Accommodation

H1 What type of accommodation does your household occupy?

A whole house or bungalow that is:

Detached
Semi-detached
Terraced (including end-terrace)

A flat, maisonette, or apartment that is:

In a pupose-built block of flats or tenement
Part of a converted or shared house (includes bed-sits)
In a commercial building (for example, in an office building, or hotel, or over a shop)

Mobile or temporary structure:

A caravan or other mobile or temporary structure

H2 Is your household's accommodation self-contained?

  • This means that all the rooms, including the kitchen, bathroom and toilet are behind a door that only your household can use.

Yes, all the rooms are behind a door that only our household can use
No

H3 How many rooms do you have for use only by your household?

  • Do not count bathroom, toilets, halls or landings, or rooms that can only be used for storage such as cupboards.
  • Do count all other roomsa, for example kitchens, living rooms, bedrooms, utility rooms and studies.
  • If two rooms have been converted into one, count them as one room.

Number of rooms

H4 Do you have a bath/shower and toilet for use only by your household?

Yes
No

H5 What is the lowest floor level of your household's living accommodation?

Basement or semi-basement
Ground floor (street level)
First floor (floor above street level)
Second floor
Third or fourth floor
Fifth floor or higher

H6 Does your accommodation have central heating?

  • If you have central heating available tick 'Yes' whether or not you own it.
  • Central heating includes:
    • gas, oil or solid fuel central heating
    • night storage heaters
    • warm air heating
    • underfloor heating

Yes, in some or all rooms
No

H7 How many cars or vans are owned, or available for use, by one or more members of your household?

  • Include any company car or van if available for private use

None
One
Two
Three
Four or more, please write in number

H8 Does your household own or rent the accommodation?

  • Tick one box only

Owns outright

  • Go to H10

Owns with a mortgage or loan

  • Go to H10

Pays part rent and part mortgage (shared ownership)

  • Go to H10

Rents

  • Go to H9

Lives here rent free

  • Go to H9

H9 Who is your landlord?

Council (Local Authority)
Housing Association
Housing Co-operative
Charitable Trust
Registered Social Landlord
Private landlord or letting agency
Employer of a household member
Relative or friend of a household member
Other

H10 Please turn the page.

Page 3

Household Members and their Relationships within the Household

Name of Person 1

First name
Surname

 

 

ENTER NAME OF PERSON 1 ABOVE

Name of Person 2

First name
Surname

Relationship of Person 2
to Person:
1
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister

 

Name of Person 3

First name
Surname

Relationship of Person 3
to Person:
1
2
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister

 

Name of Person 1

First name
Surname

 

 

ENTER NAME OF PERSON 1 ABOVE

Name of Person 2

First name
Surname

Relationship of Person 2
to Person:
1
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister
Mother or father
Step-mother or step-father
Grandchild
Grandparent
Other related
Unrelated

 

Name of Person 3

First name
Surname

Relationship of Person 3
to Person:
1
2
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister
Mother or father
Step-mother or step-father
Grandchild
Grandparent
Other related
Unrelated

 

Page 4

 

Name of Person 4

First name
Surname

Relationship of Person 4
to Person:
1
2
3
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister

 

Name of Person 5

First name
Surname

Relationship of Person 5
to Person:
1
2
3
4
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister

 

 

 

 

Name of Person 4

First name
Surname

Relationship of Person 4
to Person:
1
2
3
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister
Mother or father
Step-mother or step-father
Grandchild
Grandparent
Other related
Unrelated

Name of Person 5

First name
Surname

Relationship of Person 5
to Person:
1
2
3
4
Husband or wife
Partner
Son or daughter
Step-child
Brother or sister
Mother or father
Step-mother or step-father
Grandchild
Grandparent
Other related
Unrelated

Remaining questions should be answered by each member of your household in the same order as Table 1 (page 2 of this Form). Where a household member is completing an Individual Form for privacy reasons, the remaining questions for this person should be left blank.

Page 5

Person 1

1. What is your name? (Person 1 in Table 1)

First name and surname:

9 This question is not applicable in England.

  • Go to 10

10 What is your religion?

  • This question is voluntary.
  • Tick one box only.

None
Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
Buddhist
Hindu
Jewish
Muslim
Sikh
Any other religion, please write in

11 Over the last twelve months would you say your health has on the whole been:

Good?
Fairly good?
Not good?

12 Do you look after, or give any help or support to family members, friends, neighbours or others because of:
• long-term physical or mental ill-health or disability, or
• problems related to old age?

  • Do not count anything you do as part of your paid employment.
  • Tick time spent in a typical week.

No
Yes, 1 - 19 hours a week
Yes, 20 - 49 hours a week
Yes, 50+ hours a week

2. What is your sex?

Male Female

3. What is your date of birth?

Day Month Year

4. What is your marital status (on 29 April 2001)?

Single (never married)
Married (first marriage)
Re-married
Separated (but still legally married)
Divorced
Widowed

5. Are you a schoolchild or student in full-time education?

Yes

• Go to 6
No

• Go to 7

6. Do you live at the address shown on the front of this form during the school, college or university term?

  • Only answer this question if you have answered 'Yes' to Question 5.

Yes, I live at this address during the school/college/university term • Go to 7
No, I live elsewhere during the school/college/university term • Go to 36

7. What is your country of birth?

England Wales
Scotland
Northern Ireland
Republic of Ireland
Elsewhere, please write in the present name of the country

 

8. What is your ethnic group?

  • Choose ONE section from A to E, then tick the appropriate box to indicate your cultural background.

A: White
 British Irish
Any other White background,
please write in

B: Mixed
 White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background,
please write in

C: Asian or Asian British
 Indian Pakistani
Bangladeshi
Any other Asian background,
please write in

D: Black or Black British
 Caribbean African
Any other Black background,
please write in

A: Chinese or other ethnic group
 Chinese
Any other, please write in

 

Page 6

Person 1 - continued

13 Do you have any long-term illness, health problem or disability which limits your daily activities or the work you can do?

  • Include problems which are due to old age.
Yes No

14 What was your usual address one year ago?

  • If you were a child at a boarding school or a student one year ago, give the address at which you were living during the school/college/university term.
  • For a child born after 29 April 2000, tick 'No usual address one year ago'.

The address shown on the front of the form
No usual address one year ago
Elsewhere, please write in below

 

 

Postcode

 

15

If you are aged 16 to 74

• Go to 16

 

If you are aged 15 and under, or 75 and over

• Go to 36

16 Which of these qualifications do you have?

  • Tick all the qualifications that apply or, if not specified, the nearest equivalent
1+ O levels/CSEs/GCSEs (any grades) NVQ Level 1, Foundation GNVQ
5+ O levels, 5+ CSEs (grade 1), 5+ GCSEs (grades A-C), School Certificate NVQ Level 2, Intermediate GNVQ
1+ A levels/AS levels NVQ Level 3, Advanced GNVQ
2+ A levels, 4+ AS levels, Higher School Certificate NVQ Levels 4-5, HNC, HND
First Degree (eg BA, BSc) Other Qualifications (eg City and Guilds, RSA/OCR, BTEC/Edexcel)
Higher Degree (eg MA, PhD, PGCE, post-graduate certificates/diplomas) No Qualifications

17 Do you have any of the following professional qualifications?

  • Tick all the boxes that apply.
No Professional Qualifications Qualified Dentist
Qualified Teacher Status (for schools) Qualified Nurse, Midwife, Health Visitor
Qualified Medical Doctor Other Professional Qualifications

18 Last week, were you doing any work:

  • as an employee, or on a Government sponsored training scheme,
  • as self-employed/freelance, or in your own/family business?

  • Tick 'Yes' if away from work ill, on maternity leave, on holiday or temporarily laid off.
  • Tick 'Yes' for any paid work, including casual or temporary work, even if only for one hour.
  • Tick 'Yes' if you worked, paid or unpaid, in your own/family business.

Yes • Go to 24
No • Go to 19

 

19 Were you actively looking for any kind of paid work during the last 4 weeks?

Yes No

20 If a job had been available last week, could you have started it within 2 weeks?

Yes No

21 Last week, were you waiting to start a job already obtained?

Yes No

22 Last week, were you any of the following?

  • Tick all the boxes that apply.

Retired
Student
Looking after home/family
Permanently sick/disabled
None of the above

23 Have you ever worked?

Yes, please write in the year you last worked
• Go to 24
No, have never worked
• Go to 36

24 Answer the remaining questions for the main job you were doing last week, or if not working last week, your last main job.

  • Your main job is the job in which you usually work the most hours.

25 Do (did) you work as an employee or are (were) you self-employed?

Employee
Self-employed with employees
Self-employed/freelance without employees

26 How many people work (worked) for your employer at the place where you work (worked)?

  • If you are (were) self-employed, tick to show how many people you employ (employed).
1 - 9 10 - 24
25 - 499 500 or more

 

Page 7

Person 1 - continued

27 What is (was) the full title of your main job?

  • For example, PRIMARY SCHOOL TEACHER, STATE REGISTERED NURSE, CAR MECHANIC, TELEVISION SERVICE ENGINEER, BENEFITS ASSISTANT.
  • Civil Servants, Local Government Officers - give job title not grade or pay band.

28 Describe what you do (did) in your main job.

29 Do (did) you supervise any other employees?

  • A supervisor or foreman is responsible for overseeing the work of other employees on a day-to-day basis.
Yes No

30 What is (was) the business of your employer at the place where you work (worked)?

  • For example, MAKING SHOES, REPAIRING CARS, SECONDARY EDUCATION, FOOD WHOLESALE, CLOTHING RETAIL, DOCTOR'S SURGERY.
  • If you are (were) self-employed/freelance or have (had) your own business, what is (was) the nature of your business?
  • Civil Servants. Local Government Officers - please specify your Department.

31

If you were working last week

• Go to 32

 

If you were not working last week

• Go to 36

32 What is the full name of the organisation you work for in your main job?

  • If you have your own business, write in the name.


Self-employed/freelance Work for a private individual

33 What is the address of the place where you work in your main job?

  • If you report to a depot, write in the depot address.
Postcode

Mainly work at or from home Offshore installation
No fixed place  

34 How do you usually travel to work?

  • Tick one box only.
  • Tick the box for the longest party, by distance, of your usual journey to work.

Work mainly at or from home
Underground, metro, light rail, tram
Train
Bus, minibus or coach
Motor cycle, scooter or moped
Driving a car or van
Passenger in a car or van
Taxi
Bicycle
On foot
Other

35 How many hours a week do you usually work in your main job?

  • Answer to the nearest whole hour.
  • Give average for last four weeks.

Number of hours worked a week

36 THERE ARE NO MORE QUESTIONS FOR PERSON 1.

  • Go to questions for Person 2.

  • If there are no more people in your household you do not need to answer any more questions. Please leave the following pages blank.

  • Remember to sign the Declaration on page 1.

 

 

Page 8