2011 National Household Survey

StEp
1. print your telephone number: ( )— —

A 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.
No. and street or lot and concession Apt. no.
City, municipality, town, village, Indian reserve Province/territory Postal code
StEp 1. How many persons usually live at this address on may 10, 2011, including yourself?
B 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.
FAmily nAmE GiVEn nAmE
LY
person 1
O N
person 2
I O N
person 3
M AT
FO R
IN
person 4
person 5
FO R
person 6
person 7
person 8
person 9
person 10
StEp 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.)
C
No
Yes — See the instructions on page 3. Add the additional names in Step B, if applicable.
StEp Copy the names in Step B to question 1 on top of page 4.

Keep the same order.
D If more than five persons live here, you will need an extra questionnaire; call 1-877-308-2777.
Visit www.nhs.statcan.gc.ca
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 2 0302
DRAFt OCT 01 07
StEp
1. WHO tO inClUDE in 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
LY
at their parents’ address, even if they live elsewhere while attending school or working
N
at a summer job.
N O
• SpOUSES OR COmmOn-lAW pARtnERS tEmpORARily
I O
AT
mpORAR
mp ORARily
ORAR ily AWA
AWAy
y who stay elsewhere
while working or studying should be listed at the main residence of their family, if they
return periodically.
R M
in
IN
• pERSOnS in An inStitUtiOn
inSStit
titU
Uti
tiO FO
On who have been there for less than six months
FO
usual residence.
R
(for example, in a home for the aged, a hospital or a prison) should be listed at their
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.
Mail this questionnaire in the enclosed envelope today.
DRAFt OCT 01 07 0303 Page 3

Copy the nAmE of each person PERSON 1 PERSON 2
1 in the same order as in Step B.
Then answer the questions
Family name Family name
for each person.
Given name Given name
The questions refer to each person’s situation

on may 10, 2011 unless otherwise specified.
2 SEX Male Male

Female Female
3 DAtE OF BiRtH AnD AGE

Day Month Year
Date of birth
Day Month Year

Date of birth
Day Month Year

Example: 23 02 1974
If exact date is not known, enter best estimate.
For children under

the age of 1, enter 0. Age 37 Age Age
4 mARitAl StAtUS Never legally married

Legally married (and not separated)
Never legally married
Legally married (and not separated)
Mark “ inh” one circle only.
Separated, but still legally married Separated, but still legally married
LY
Divorced Divorced
Widowed Widowed
O N
5 iscommon-law I O N
AT
this person living with a
partner? Yes Yes
Common-law refers to two people who live
RM
NFO
together as a couple but who are not legally No No
married to each other.
R I
6 FO
RElAtiOnSHip tO pERSOn 1 Opposite-sex husband or wife
of Person 1
Opposite-sex common-law partner
For each person usually living of Person 1
here, describe his or her relationship  pERSOn 1
to Person 1. Same-sex married spouse
of Person 1
Mark “  ” or specify one response only. Same-sex common-law partner
of Person 1
Adopted children should be
considered sons and daughters.
Son or daughter of Person 1 only
Children in joint custody should be included Son-in-law or daughter-in-law of Person 1
in the home of the parent where they live most
of the time. Grandchild of Person 1
Children who spend equal time with each Father or mother of Person 1
parent should be included in the home of
the parent with whom they are staying on Father-in-law or mother-in-law of Person 1
May 10, 2011.
Brother or sister of Person 1
For all children, please consider the relationship
to Person 1 and Person 2. Foster child
If none of the choices apply, specify this person’s
relationship to Person 1 under “ Other ”.
Room-mate, lodger or boarder
Other — Specify
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.
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 4 0304
DRAFt OCT 01 07
Male Male Male
Female Female Female
Date of birth Date of birth Date of birth
Day Month Year Day Month Year Day Month Year
Age Age Age
Never legally married Never legally married Never legally married

Legally married (and not separated) Legally married (and not separated) Legally married (and not separated)
Separated, but still legally married Separated, but still legally married Separated, but still legally married
LY
Divorced Divorced Divorced
Widowed Widowed Widowed
O N
I O N
Yes Yes
AT Yes
RM
NFO
No No No
R I
FO
Son or daughter of both Persons 1 and 2 Son or daughter of both Persons 1 and 2 Son or daughter of both Persons 1 and 2
Son or daughter of Person 1 only Son or daughter of Person 1 only Son or daughter of Person 1 only
Son or daughter of Person 2 only Son or daughter of Person 2 only Son or daughter of Person 2 only
Son-in-law or daughter-in-law of Person 1 Son-in-law or daughter-in-law of Person 1 Son-in-law or daughter-in-law of Person 1
Grandchild of Person 1 Grandchild of Person 1 Grandchild of Person 1
Father or mother of Person 1 Father or mother of Person 1 Father or mother of Person 1
Father-in-law or mother-in-law of Person 1 Father-in-law or mother-in-law of Person 1 Father-in-law or mother-in-law of Person 1
Brother or sister of Person 1 Brother or sister of Person 1 Brother or sister of Person 1
Foster child Foster child Foster child
Room-mate, lodger or boarder Room-mate, lodger or boarder Room-mate, lodger or boarder
Other — Specify Other — Specify Other — Specify

ACtiVitiES OF DAily liVinG
7 Does this person have any

difficulty hearing, seeing, Yes, sometimes Yes, sometimes
communicating, walking,
climbing stairs, bending, Yes, often Yes, often
learning or doing any similar No No
activities?
8 Does a physical condition or

mental condition or health
problem reduce the amount
or the kind of activity this
person can do: Yes, sometimes Yes, sometimes
(a) at home? Yes, often Yes, often
No No
(b) at work or at school? Yes, sometimes No

N
Yes, sometimesLY No
No
O
ION
Yes, often Not applicable Yes, often Not applicable
(c) in other activities, for example, Yes, sometimes

A T Yes, sometimes
transportation or leisure?
R M
Yes, often
N F O Yes, often
RI
No No
SOCiOCUltURAl inFORmAtiOn
n
FO Born in Canada
Nfld.Lab. Manitoba
Born in Canada
Nfld.Lab. Manitoba
9 Where was this person born?
P.E.I. Sask. P.E.I. Sask.
Specify one response only, according to N.S. Alberta N.S. Alberta

present boundaries.
N.B. B.C. N.B. B.C.
Quebec Yukon Quebec Yukon
Ontario N.W.T. Ontario N.W.T.
Nunavut Nunavut
Born outside Canada Born outside Canada

Specify country Specify country
10 Ofa citizen?
what country is this person
Canada, by birth Canada, by birth
Indicate more than one citizenship, if applicable. Canada, by naturalization Canada, by naturalization
“Canada, by naturalization” refers to the process
by which an immigrant is granted citizenship of
Other country — Specify Other country — Specify
Canada, under the Citizenship Act.
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 6 0306
DRAFt OCT 01 07
Yes, sometimes Yes, sometimes Yes, sometimes
Yes, often Yes, often Yes, often
No No No
Yes, sometimes Yes, sometimes Yes, sometimes

Yes, often Yes, often Yes, often
No No No
Yes, sometimes No Yes, sometimes No

N LY
Yes, sometimes No
O
ION
Yes, often Not applicable Yes, often Not applicable Yes, often Not applicable
Yes, sometimes Yes, sometimes

A T Yes, sometimes
R M
Yes, often Yes, often
N F O Yes, often
RI
No No No
Born in Canada
Nfld.Lab. Manitoba
FO Born in Canada
Nfld.Lab. Manitoba
Born in Canada
Nfld.Lab. Manitoba
P.E.I. Sask. P.E.I. Sask. P.E.I. Sask.
N.S. Alberta N.S. Alberta N.S. Alberta
N.B. B.C. N.B. B.C. N.B. B.C.
Quebec Yukon Quebec Yukon Quebec Yukon
Ontario N.W.T. Ontario N.W.T. Ontario N.W.T.
Nunavut Nunavut Nunavut
Born outside Canada Born outside Canada Born outside Canada

Specify country Specify country Specify country
Canada, by birth Canada, by birth Canada, by birth

Canada, by naturalization Canada, by naturalization Canada, by naturalization
Other country — Specify Other country — Specify Other country — Specify

11 Ishasthisthisperson now, or
person ever been,
  Go to question 13
a landed immigrant?
No — Go to question 13 No —
A “ landed immigrant ” (permanent resident)
is a person who has been granted the right Yes i Yes
to live in Canada permanently by immigration
authorities.
12 In what year did this person

first become a landed
Year
If exact year is not known,

Year
If exact year is not known,

immigrant? enter best estimate. enter best estimate.
13 Can this person speak

English or French well enough
English only
French only
English only
French only
to conduct a conversation?
Mark “ inh” one circle only. Both English and French Both English and French
LY
Neither English nor French Neither English nor French
14 What language(s), other None None O N

than English or French, OR
I O N OR
AT
can this person speak well
enough to conduct Specify other language(s) Specify other language(s)
a conversation?
R M
IN FO
FO R
15 (a) What language does this
person speak most often
English English
at home? French French

Other — Specify Other — Specify
(b) Does this person speak No No

any other languages
on a regular basis Yes, English Yes, English
at home?
Yes, French Yes, French
Yes, Other — Specify Yes, Other — Specify
16 What is the language that

this person first learned
English English
at home in childhood and French French

still understands? Other — Specify Other — Specify
If this person no longer understands
the first language learned, indicate the second
language learned.
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 8 0308
DRAFt OCT 01 07
i No —  Go to question 13 No —  Go to question 13 No —  Go to question 13
Yes Yes Yes
Year Year Year
If exact year is not known, If exact year is not known, If exact year is not known,
enter best estimate. enter best estimate. enter best estimate.
English only English only English only

French only French only French only
Both English and French Both English and French Both English and French
LY
Neither English nor French Neither English nor French Neither English nor French
i None None None O N

OR OR
I O N OR
Specify other language(s) Specify other language(s)
M AT Specify other language(s)
FO R
R IN
English
FO English English
French French French

No No No
Yes, English Yes, English Yes, English

Yes, French Yes, French Yes, French
Yes, Other — Specify Yes, Other — Specify Yes, Other — Specify
English English English


This question collects information on the
ancestral origins of the population and
provides information about the composition
of Canada’s diverse population.
Specify as many origins as applicable Specify as many origins as applicable
17 What were the ethnic

or cultural origins of
using capital letters. using capital letters.
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.
18 Isperson,
this person an Aboriginal
that is, First Nations
No, not an
Aboriginal person
Continue
with the next
No, not an
Aboriginal person
Continue
with the next
LY
(North American Indian), Métis question question
or Inuk (Inuit)? Yes, First Nations
(North American N
Yes, First Nations
O
(North American
Note: First Nations (North American Indian)
includes Status and Non-Status Indians.
Indian) Go to
I O N Indian) Go to
If “ Yes ”, mark “ inh” the circle(s) that best

Yes, Métis
A
question
uestion 20
T Yes, Métis question 20
describe(s) this person now. Yes, Inuk (Inuit)

R M Yes, Inuk (Inuit)
N F O
19 RI
Is this person: White White
Mark “  ” more than one or specify,

if applicable.
FO South Asian (e.g., East Indian,
Pakistani, Sri Lankan, etc.)
Chinese
South Asian (e.g., East Indian,
Chinese
Black Black
This information is collected in accordance
with the Employment Equity Act and its Filipino Filipino
Regulations and Guidelines to support
programs that promote equal opportunity Latin American Latin American
for everyone to share in the social, cultural,
and economic life of Canada. Arab Arab
Southeast Asian (e.g., Vietnamese, Southeast Asian (e.g., Vietnamese,
Cambodian, Malaysian, Laotian, etc.) Cambodian, Malaysian, Laotian, etc.)
West Asian (e.g., Iranian, West Asian (e.g., Iranian,
Afghan, etc.) Afghan, etc.)
Korean Korean
Japanese Japanese
i No
20 Is(Registered
this person a Status Indian
or Treaty Indian
Yes, Status Indian
i No
Yes, Status Indian
as defined by the Indian Act
of Canada)? (Registered or Treaty) (Registered or Treaty)
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 10 0310
DRAFt OCT 01 07
Specify as many origins as applicable Specify as many origins as applicable Specify as many origins as applicable
using capital letters. using capital letters. using capital letters.
No, not an Continue No, not an Continue No, not an Continue

Aboriginal person with the next Aboriginal person with the next Aboriginal person with the next
LY
question question question
Yes, First Nations

(North American
Yes, First Nations
(North American
O N
Yes, First Nations
(North American
ION
Indian) Go to Indian) Go to Indian) Go to
Yes, Métis question 20 Yes, Métis
A T
question
uestion 20 Yes, Métis question 20
Yes, Inuk (Inuit) Yes, Inuk (Inuit)

M Yes, Inuk (Inuit)
FOR
R IN
White White White
Chinese
FO South Asian (e.g., East Indian,
Chinese
Chinese
Black Black Black
Filipino Filipino Filipino
Latin American Latin American Latin American
Arab Arab Arab
Southeast Asian (e.g., Vietnamese, Southeast Asian (e.g., Vietnamese, Southeast Asian (e.g., Vietnamese,
Cambodian, Malaysian, Laotian, etc.) Cambodian, Malaysian, Laotian, etc.) Cambodian, Malaysian, Laotian, etc.)
West Asian (e.g., Iranian, West Asian (e.g., Iranian, West Asian (e.g., Iranian,
Afghan, etc.) Afghan, etc.) Afghan, etc.)
Korean Korean Korean

Japanese Japanese Japanese
i No i No i No
Yes, Status Indian Yes, Status Indian Yes, Status Indian
(Registered or Treaty) (Registered or Treaty) (Registered or Treaty)

21 IsFirstthisNation/Indian
person a member of a
band?
i No i No
Yes, member of a First Nation/ Yes, member of a First Nation/
If “ Yes ”, which First Nation/Indian band? Indian band Indian band
For example, Musqueam Indian Band, Sturgeon Specify name of First Nation/Indian band. Specify name of First Nation/Indian band.

Lake First Nation, Atikamekw of Manawan.
22 What is this person’s religion? Specify one denomination or religion only. Specify one denomination or religion only.
Indicate a specific denomination or religion

even if this person is not currently a practising
member of that group.
LY
For example, Roman Catholic, United Church,
Anglican, Baptist, Lutheran, Muslim, Presbyterian,
Pentecostal, Jewish, Buddhist, Hindu, Sikh,
No religion
O N
No religion
N
Greek Orthodox, etc.
I O
mOBility
M AT
FO R
23 Where did this person Born after m Born after may 10, 2010
R IN
may
ay 10, 2010
live 1 year ago, that is, on
Lived at the same address as now Lived at the same address as now
FO
may 10, 2010?
Mark “  ” one circle only. Lived at a different address in the Lived at a different address in the
same city, town, village, township, same city, town, village, township,
municipality or Indian reserve municipality or Indian reserve
Note:
For those who mark the fourth circle: Lived in a different city, town, village, Lived in a different city, town, village,
township, municipality or Indian reserve township, municipality or Indian reserve
Please give the name of the city or town in Canada in Canada
rather than the metropolitan area of which
Specify name of: Specify name of:

it is a part.
City, town, village, township, municipality or City, town, village, township, municipality or
For example: Indian reserve Indian reserve
• Saanich rather than Victoria
(metropolitan area);
• St. Albert rather than Edmonton
• Laval rather than Montréal
(metropolitan area).
Province/territory Province/territory
Postal code Postal code
Lived outside Canada Lived outside Canada


or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 12 0312
DRAFt OCT 01 07
i No i No i No
Yes, member of a First Nation/ Yes, member of a First Nation/ Yes, member of a First Nation/
Indian band Indian band Indian band
Specify name of First Nation/Indian band. Specify name of First Nation/Indian band. Specify name of First Nation/Indian band.


Specify one denomination or religion only. Specify one denomination or religion only. Specify one denomination or religion only.
N LY
No religion No religion
N O
No religion
I O
M AT
Born after may 10, 2010
FO
Born after m
R Born after may 10, 2010
R IN
may
ay 10, 2010
Lived at the same address as now Lived at the same address as now Lived at the same address as now
Lived at a different address in the
same city, town, village, township,
municipality or Indian reserve
FO Lived at a different address in the
Lived at a different address in the
Lived in a different city, town, village, Lived in a different city, town, village, Lived in a different city, town, village,
township, municipality or Indian reserve township, municipality or Indian reserve township, municipality or Indian reserve
in Canada in Canada in Canada
Specify name of: Specify name of: Specify name of:

City, town, village, township, municipality or City, town, village, township, municipality or City, town, village, township, municipality or
Indian reserve Indian reserve Indian reserve
Province/territory Province/territory Province/territory
Postal code Postal code Postal code
Lived outside Canada Lived outside Canada Lived outside Canada



24 Where did this person
live 5 years ago, that is, on
may 10, 2006?
Mark “  ” one circle only. Born after may 10, 2006 Born after may 10, 2006
Lived at the same address as now Lived at the same address as now
Note:
Lived at a different address in the Lived at a different address in the
For those who mark the fourth circle: same city, town, village, township, same city, town, village, township,
Please give the name of the city or town municipality or Indian reserve municipality or Indian reserve
it is a part. Lived in a different city, town, village, Lived in a different city, town, village,
township, municipality or Indian reserve township, municipality or Indian reserve
For example: in Canada in Canada
• Saanich rather than Victoria Specify name of: Specify name of:


(metropolitan area); City, town, village, township, municipality or City, town, village, township, municipality or
• St. Albert rather than Edmonton Indian reserve Indian reserve
LY
(metropolitan area).
O N
Province/territory
I O N
Province/territory
M AT
Postal code
FO R
Lived outside Canada
Postal code
R IN
FO

plACE OF BiRtH OF pAREntS
25 Where was each of this

person’s parents born?
(a) Father Father Father
Mark “  ” or specify country according Born in Canada Born in Canada
to present boundaries.
(b) mother mother mother

Mark “  ” or specify country according Born in Canada Born in Canada
to present boundaries.
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 14 0314
DRAFt OCT 01 07
Born after may 10, 2006 Born after may 10, 2006 Born after may 10, 2006
Lived at the same address as now Lived at the same address as now Lived at the same address as now
Lived at a different address in the Lived at a different address in the Lived at a different address in the
same city, town, village, township, same city, town, village, township, same city, town, village, township,
municipality or Indian reserve municipality or Indian reserve municipality or Indian reserve
Lived in a different city, town, village, Lived in a different city, town, village, Lived in a different city, town, village,
township, municipality or Indian reserve township, municipality or Indian reserve township, municipality or Indian reserve
in Canada in Canada in Canada
Specify name of: Specify name of: Specify name of:


N LY
N O
Province/territory Province/territory
I O Province/territory
M AT
Postal code

Postal code
FO R Postal code
R IN
Lived outside Canada Lived outside Canada
FO

Father Father Father
Born in Canada Born in Canada Born in Canada

mother mother mother
Born in Canada Born in Canada Born in Canada


26 Answer questions 27 to 55
for each person aged 15 years Continue only for each person aged 15 years and over
and over. (born before may 10, 1996).
EDUCAtiOn
Secondary (high) school diploma Secondary (high) school diploma
27 Has this person completed
a secondary (high) school
or certificate or certificate
diploma or equivalent? Yes, secondary (high) school diploma Yes, secondary (high) school diploma
Examples of secondary (high) school Yes, secondary (high) school equivalency Yes, secondary (high) school equivalency
equivalency certificates are General certificate certificate
Educational Development (GED) and
Adult Basic Education (ABE). No No

a Registered Apprenticeship
Registered Apprenticeship or trades
certificate or diploma
Registered Apprenticeship or trades
or other trades certificate
or diploma? Yes, Registered Apprenticeship certificate Yes, Registered Apprenticeship certificate
Mark “  ” as many circles as applicable.

(including Certificate of Qualification,
Journeyperson's designation)
N LY
Yes, other trades certificate

N O
For example, hairstyling, cooking, electrician,
or diploma
I O or diploma
AT
carpentry.
No
F O RM No

a college, CEGEp, or other
RI N
College, CEGEp
CEGEp or other non-university
College, CEGEp or other non-university
non-university certificate or
diploma? (Other than certificates
or diplomas reported in Question 28.)
FO Yes, certificate or diploma from
a program of less than 3 months
Yes, certificate or diploma from
Yes, certificate or diploma from a Yes, certificate or diploma from a
Mark “  ” as many circles as applicable. program of 3 months to less than 1 year program of 3 months to less than 1 year
Yes, certificate or diploma from Yes, certificate or diploma from
For example, accounting technology, a program of 1 year to 2 years a program of 1 year to 2 years
real estate agent, industrial engineering
technology, dental hygiene, legal assistant.
i Yes, certificate or diploma from Yes, certificate or diploma from
a program of more than 2 years a program of more than 2 years
No No
30 Has this person completed a

university certificate, diploma
University certificate, diploma or degree
Yes, university certificate or diploma

University certificate, diploma or degree
Yes, university certificate or diploma

or degree? below bachelor level below bachelor level
Yes, bachelor’s degree (including LL.B.) Yes, bachelor’s degree (including LL.B.)
Mark “  ” as many circles as applicable.
Yes, university certificate or diploma Yes, university certificate or diploma
above bachelor level above bachelor level
Yes, master’s degree Yes, master’s degree
Yes, degree in medicine, Yes, degree in medicine,
dentistry, veterinary medicine dentistry, veterinary medicine
or optometry or optometry
Yes, earned doctorate Yes, earned doctorate
No No
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 16 0316
DRAFt OCT 01 07
Continue only for each person aged 15 years and over
(born before may 10, 1996).
Secondary (high) school diploma Secondary (high) school diploma Secondary (high) school diploma
or certificate or certificate or certificate
Yes, secondary (high) school diploma Yes, secondary (high) school diploma Yes, secondary (high) school diploma
Yes, secondary (high) school equivalency Yes, secondary (high) school equivalency Yes, secondary (high) school equivalency
certificate certificate certificate
No No No
Registered Apprenticeship or trades Registered Apprenticeship or trades Registered Apprenticeship or trades

certificate or diploma certificate or diploma certificate or diploma
Yes, Registered Apprenticeship certificate Yes, Registered Apprenticeship certificate Yes, Registered Apprenticeship certificate
N LY
Yes, other trades certificate Yes, other trades certificate

N O
or diploma or diploma
I O or diploma
AT
No No
F O RM No

RI N
College, CEGEp
CEGEp or other non-university

a program of less than 3 months FO Yes, certificate or diploma from
Yes, certificate or diploma from a Yes, certificate or diploma from a Yes, certificate or diploma from a
program of 3 months to less than 1 year program of 3 months to less than 1 year program of 3 months to less than 1 year
Yes, certificate or diploma from Yes, certificate or diploma from Yes, certificate or diploma from
a program of 1 year to 2 years a program of 1 year to 2 years a program of 1 year to 2 years
Yes, certificate or diploma from Yes, certificate or diploma from Yes, certificate or diploma from
a program of more than 2 years a program of more than 2 years a program of more than 2 years
No No No
University certificate, diploma or degree University certificate, diploma or degree University certificate, diploma or degree
Yes, university certificate or diploma Yes, university certificate or diploma Yes, university certificate or diploma
below bachelor level below bachelor level below bachelor level
Yes, bachelor’s degree (including LL.B.) Yes, bachelor’s degree (including LL.B.) Yes, bachelor’s degree (including LL.B.)
Yes, university certificate or diploma Yes, university certificate or diploma Yes, university certificate or diploma
above bachelor level above bachelor level above bachelor level
Yes, master’s degree Yes, master’s degree Yes, master’s degree
Yes, degree in medicine, Yes, degree in medicine, Yes, degree in medicine,
dentistry, veterinary medicine dentistry, veterinary medicine dentistry, veterinary medicine
or optometry or optometry or optometry
Yes, earned doctorate Yes, earned doctorate Yes, earned doctorate
No No No

Remember, these questions are only for persons aged 15 years and over.
31 What was the major field
of study of the highest
certificate, diploma or degree
major field of study of highest certificate, major field of study of highest certificate,
that this person completed? diploma or degree diploma or degree
Please be specific. For example, automobile
mechanics, health care attendant, medical
laboratory technology, early childhood
education, civil engineering, natural resources
conservation, agricultural economics.
Print in capital letters as follows:
COM P U T E R E N
G I N E E R I NG T
LY
OR OR
E C H N O L OG Y No certificate, diploma
O N
No certificate, diploma
ION
or degree (higher than Go to or degree (higher
(higher than Go to
high school) question
uestion 33 high school
school) question 33
A T
R M
F O
32 In what province, territory
IN
FOR
or country did this person iin
n Canada in Canada
complete his or her highest Specify province or territory Specify province or territory
certificate, diploma or degree?
OR OR
Outside Canada Outside Canada
33 September
At any time since
2010, has this At any time since September 2010 At any time since September 2010
person attended a school, Yes, attended elementary, junior high Yes, attended elementary, junior high
college, CEGEP or university? school or high school school or high school
Yes, attended trade school, business Yes, attended trade school, business
Mark “  ” as many circles as applicable. school, community college, technical school, community college, technical
institute, CEGEP or other non-university institute, CEGEP or other non-university
Please include attendance only for institution institution
courses that can be used as credits towards
a certificate, diploma or degree.
Yes, attended university Yes, attended university
No, did not attend school at any time No, did not attend school at any time
since September 2010 since September 2010
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 18 0318
DRAFt OCT 01 07
major field of study of highest certificate, major field of study of highest certificate, major field of study of highest certificate,
diploma or degree diploma or degree diploma or degree
LY
OR OR OR
No certificate, diploma No certificate, diploma

O N
No certificate, diploma
ION
or degree (higher than Go to or degree (higher than Go to or degree ((higher than Go to
high school) question 33 high school) question
uestion 33 high school
school) question 33
A T
R M
F O
IN
FOR
in Canada iin
n Canada in Canada
Specify province or territory Specify province or territory Specify province or territory
OR OR OR
Outside Canada Outside Canada Outside Canada
At any time since September 2010 At any time since September 2010 At any time since September 2010
Yes, attended elementary, junior high Yes, attended elementary, junior high Yes, attended elementary, junior high
school or high school school or high school school or high school
Yes, attended trade school, business Yes, attended trade school, business Yes, attended trade school, business
school, community college, technical school, community college, technical school, community college, technical
institute, CEGEP or other non-university institute, CEGEP or other non-university institute, CEGEP or other non-university
institution institution institution
Yes, attended university Yes, attended university Yes, attended university

No, did not attend school at any time No, did not attend school at any time No, did not attend school at any time
since September 2010 since September 2010 since September 2010

Note:
Many of the following questions refer to the week from Sunday, May 1 to Saturday, May 7, 2011.
Call 1-877-308-2777 for more information.
lABOUR mARKEt ACtiVitiES
34 may
During the week of Sunday,
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: Number of hours (to the nearest hour)
LY
Number of hours (to the nearest hour)
N
• working for wages, salary, tips or
 Go to question 40 O
ION
commission; Go to question 40
• working in his / her own business, farm
or professional practice, alone or in OR
A T OR
 M  Continue
FOR
partnership; Continue with the with the
None None
• working directly towards the operation of next question next question
a family farm or business without formal
pay arrangements (e.g., assisting in
R IN
FO
seeding, doing accounts).
35 toDuring the week of may 1

may 7, was this person
on temporary lay-off or
absent from his / her job No No
or business?
Yes, on temporary lay-off from a job to Yes, on temporary lay-off from a job to
Mark “  ” one circle only. which this person expects to return which this person expects to return
Yes, on vacation, ill, on strike or Yes, on vacation, ill, on strike or

locked out, or absent for other reasons locked out, or absent for other reasons
36 tDuring the week of may 1

o may 7, did this person
have definite arrangements
to start a new job within
the next four weeks? No No
Yes Yes
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 20 0320
DRAFt OCT 01 07
Note:
Many of the following questions refer to the week from Sunday, May 1 to Saturday, May 7, 2011.
Call 1-877-308-2777 for more information.
Number of hours (to the nearest hour) Number of hours (to the nearest hour)
LY
Number of hours (to the nearest hour)
N
 Go to question 40  Go to question 40 O
ION
Go to question 40
OR OR
A T OR
  M  Continue
FOR
Continue with the Continue with the with the
None None None
next question next question next question
R IN
FO
No No No
Yes, on temporary lay-off from a job to Yes, on temporary lay-off from a job to Yes, on temporary lay-off from a job to
which this person expects to return which this person expects to return which this person expects to return
Yes, on vacation, ill, on strike or Yes, on vacation, ill, on strike or Yes, on vacation, ill, on strike or
locked out, or absent for other reasons locked out, or absent for other reasons locked out, or absent for other reasons
No No No
Yes Yes 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,
No —  Go to question 39 No —  Go to question 39
place or answer newspaper ads, etc.?

Yes, looked for full-time work Yes, looked for full-time work
Mark “  ” one circle only. Yes, looked for part-time work Yes, looked for part-time work
(less than 30 hours per week) (less than 30 hours per week)
38 Could this person have

started a job during the week of
N LY
Sunday, may 1 to Saturday,
N O
may 7, 2011 had one
been available?
Yes, could have started a job
T I O
MA
No, already had a job No, already had a job
FOR
Mark “  ” one circle only. No, because of temporary illness No, because of temporary illness
or disability or disability
FO R IN
No, because of personal or family
responsibilities
No, going to school

responsibilities
No, going to school

No, other reasons No, other reasons
39 When did this person

last work for pay or in
self-employment, even
for a few days?
In 2011 In 2011
Continue with Continue with
Mark “  ” one circle only. the next question the next question
In 2010 In 2010
Before 2010 Before 2010

Go to Go to
question 53 question 53
Never Never
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 22 0322
DRAFt OCT 01 07
No —  Go to question 39 No —  Go to question 39 No —  Go to question 39
Yes, looked for full-time work Yes, looked for full-time work Yes, looked for full-time work
Yes, looked for part-time work Yes, looked for part-time work Yes, looked for part-time work
(less than 30 hours per week) (less than 30 hours per week) (less than 30 hours per week)
N LY
N O
Yes, could have started a job Yes, could have started a job
T I O
MA
No, already had a job No, already had a job No, already had a job
FOR
No, because of temporary illness No, because of temporary illness No, because of temporary illness
or disability or disability or disability

responsibilities
No, going to school FO R IN

responsibilities
No, going to school

responsibilities
No, going to school

No, other reasons No, other reasons No, other reasons
In 2011 In 2011 In 2011

Continue with Continue with Continue with
the next question the next question the next question
In 2010 In 2010 In 2010
Before 2010 Before 2010 Before 2010

Go to Go to Go to
question 53 question 53 question 53
Never Never Never

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.
Name of firm, government agency, etc. Name of firm, government agency, etc.
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:
Name of firm, government agency, etc.
A B C CO N C R E T Section, plant, department, etc. (if applicable) Section, plant, department, etc. (if applicable)
E P R OD U C T S
L I M I T E D N LY
N O
I O
41 What kind of business,
AT
RM
industry or service was this? Kind of business, industry or service Kind of business, industry or service
N F O
RI
Please give details. For example:
• primary school
• municipal police
• wheat farm
• shoe store
FO
42 What was this person’s

work or occupation?
Occupation Occupation
Please be specific. For example:

• plumber
• fishing guide
• wood furniture assembler
• secondary school teacher
(If in the Armed Forces, give rank.)
43 Inthisthisperson’s
work, what were
main activities?
Main activities Main activities
Please give details. For example:

• installed residential plumbing
• guided fishing parties
• made wood furniture products
• taught mathematics
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 24 0324
DRAFt OCT 01 07
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.
Name of firm, government agency, etc. Name of firm, government agency, etc. Name of firm, government agency, etc.
Section, plant, department, etc. (if applicable) Section, plant, department, etc. (if applicable) Section, plant, department, etc. (if applicable)
N LY
N O
I O
AT
RM
Kind of business, industry or service Kind of business, industry or service Kind of business, industry or service
N F O
FO RI
Occupation Occupation Occupation
Main activities Main activities Main activities

working for wages, salary, tips or working for wages, salary, tips or
44 Inthisthisperson
job or business, was
mainly: commission? commission?
 Go to question 46  Go to question 46
Mark “  ” one circle only.
working without pay for his/her working without pay for his/her
spouse or another relative in a family spouse or another relative in a family
farm or business? farm or business?
 Go to question 46  Go to question 46
self-employed without paid help self-employed without paid help
(alone or in partnership)? (alone or in partnership)?
self-employed with paid help self-employed with paid help

(alone or in partnership)? (alone or in partnership)?
45 Ifperson’s
self-employed, was this
farm or business No No
incorporated?
LY
Yes Yes
O N
46 Atperson
what address did this
usually work most
Worked at home (including farms)
 Go to question 49
I O N
AT
of the time?
RM
Worked outside Canada Worked outside Canada
 Go to q  Go to question 49
Example: 365 Laurier Ave. West
NFO
question
uestion 49
Number
RI
Name No fixed workplace address No fixed workplace address
 Continue with the next question  Continue with the next question
Type
Direction FO Worked at the address specified below
Specify complete address
Worked at the address specified below
If direction (e.g., North, South, East or West)

Street address (see example) Street address (see example)

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
it is a part. City, town, village, township, municipality or City, town, village, township, municipality or
Indian reserve Indian reserve
For example:
• Saanich rather than Victoria
• St. Albert rather than Edmonton
(metropolitan area). Province/territory Province/territory
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 Postal code Postal code
address of their school, not the address
of the school board).
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 26 0326
DRAFt OCT 01 07
working for wages, salary, tips or working for wages, salary, tips or working for wages, salary, tips or
commission? commission? commission?
 Go to question 46  Go to question 46  Go to question 46

working without pay for his/her working without pay for his/her working without pay for his/her
spouse or another relative in a family spouse or another relative in a family spouse or another relative in a family
farm or business? farm or business? farm or business?
 Go to question 46  Go to question 46  Go to question 46
self-employed without paid help self-employed without paid help self-employed without paid help
(alone or in partnership)? (alone or in partnership)? (alone or in partnership)?
self-employed with paid help self-employed with paid help self-employed with paid help
(alone or in partnership)? (alone or in partnership)? (alone or in partnership)?
No No No
LY
Yes Yes Yes
O N
I O N Worked at home (including farms)
AT
RM
Worked outside Canada Worked outside Canada Worked outside Canada
 Go to question 49  Go to q  Go to question 49
NFO
question
uestion 49
RI
No fixed workplace address No fixed workplace address No fixed workplace address
 Continue with the next question  Continue with the next question  Continue with the next question
FO Worked at the address specified below

Street address (see example) Street address (see example) Street address (see example)
Province/territory Province/territory Province/territory
Postal code Postal code Postal code

47 (a) How did this person usually
get to work?
Car, truck Car, truck
or van — or van —
Continue Continue
If this person used more than one method as a driver as a driver
with with
of travel to work, mark the one used for most question question
Car, truck Car, truck
of the travel distance. or van — 47 (b) or van — 47 (b)
as a passenger as a passenger
Mark “Subway or elevated rail” for:
• Vancouver SkyTrain
• Toronto Subway/RT Bus Bus
• Montréal Metro Subway or elevated rail Subway or elevated rail
Mark “Light rail, streetcar or commuter Light rail, Light rail,
train” for: streetcar or streetcar or
• Vancouver West Coast Express commuter train commuter train
• Calgary CTrain Go to Go to
Passenger ferry Passenger ferry
LY
question question
• Edmonton LRT
48 (a) 48 (a)
• Toronto streetcars
• Toronto GO Train
Walked to work
N
Walked to work
O
• Ottawa O-Train Bicycle
I O N
Bicycle
AT
• Montréal commuter trains Motorcycle, Motorcycle,
scooter or moped scooter or moped
R M
FO
Other method Other method
R IN
FO
(b) How many people, including
this person, usually shared
the ride to work in this car,
truck or van? Drove alone Drove alone
2 people 2 people
3 or more people 3 or more people
48 (a) usually
What time did this person
leave home to go
a.m. a.m.
to work?
: p.m.
: p.m.
hour min hour min
(b) How many minutes did it

usually take this person to
get from home to work?  
Number of minutes Number of minutes
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 28 0328
DRAFt OCT 01 07
Car, truck Car, truck Car, truck

or van — or van — or van —
Continue Continue Continue
as a driver as a driver as a driver
with with with
Car, truck question Car, truck question Car, truck question
or van — 47 (b) or van — 47 (b) or van — 47 (b)
as a passenger as a passenger as a passenger
Bus Bus Bus

Subway or elevated rail Subway or elevated rail Subway or elevated rail
Light rail, Light rail, Light rail,
streetcar or streetcar or streetcar or
commuter train commuter train commuter train
Go to Go to Go to
Passenger ferry Passenger ferry Passenger ferry
LY
question question question
48 (a) 48 (a) 48 (a)
Walked to work Walked to work
N
Walked to work
O
Bicycle Bicycle
I O N
Bicycle
AT
Motorcycle, Motorcycle, Motorcycle,
scooter or moped scooter or moped scooter or moped
R M
FO
Other method Other method Other method
R IN
FO
Drove alone Drove alone Drove alone
2 people 2 people 2 people
3 or more people 3 or more people 3 or more people
a.m. a.m. a.m.

: p.m.
: p.m.
: p.m.
hour min hour min hour min
  
Number of minutes Number of minutes Number of minutes

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

(b) Did this person use any

other languages on a No No
regular basis in this job? Yes, English Yes, English
Yes, French Yes, French
Yes, Other — Specify Yes, Other — Specify
N LY
50 Inthishowperson
many weeks did
N O
work in 2010?
I O
Please enter the total number of weeks
worked for pay or in self-employment at
M AT
all jobs held in 2010.
FO
R Go to — Go to
Include those weeks in which this person:
• was on vacation or sick leave with pay;
RI N None — question 53
None
question 53
FO
• worked full time or part time; OR OR
• worked for wages, salary, tips or
commission; — —
• was self-employed; Number of weeks Number of weeks
• worked directly toward the operation
of a family farm or business without
formal pay arrangements.
51 During most of those weeks,

did this person work full time Full time (30 hours or more per week) Full time (30 hours or more per week)
or part time?
Part time (less than 30 hours per week) Part time (less than 30 hours per week)
52 infor2010, did this person pay

child care, such as day
care or babysitting, so that
this person could work at Yes Yes
his or her paid job(s)?
When child care or day camps help several
$ . 00 $ . 00
people work, enter the amount only once. No No
Answer “ Yes” or “No”.

If “Yes”, also enter the total amount for 2010.
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 30 0330
DRAFt OCT 01 07
English English English
No No No
Yes, English Yes, English Yes, English
Yes, French Yes, French Yes, French
Yes, Other — Specify Yes, Other — Specify Yes, Other — Specify
N LY
N O
I O
M AT
— Go to
F O R
Go to — Go to
IN
None None — None
question 53 question 53 question 53
OR
FO R OR OR
— — —
Number of weeks Number of weeks Number of weeks
Full time (30 hours or more per week) Full time (30 hours or more per week) Full time (30 hours or more per week)
Part time (less than 30 hours per week) Part time (less than 30 hours per week) Part time (less than 30 hours per week)
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No No No

53 inchild
2010, did this person pay
or spousal support
payments to a former spouse
or partner? Yes Yes
Support payments are covered by
an agreement to pay a fixed amount on
a regular basis. Exclude all other gifts or
$ . 00 $ . 00
transfers of money. Include only support No No
payments actually paid.
Answer “ Yes” or “No”.
If “Yes”, also enter the total amount for 2010.
inCOmE in 2010
54 Toin hissaveor time, each person can give Statistics Canada permission to use the income information already available
LY
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.
O N
• Please note that your income tax information will be used for statistical purposes only.
I O N
Does this person give Statistics
Canada permission to use the — M AT —
income information available in
Yes
FO R
Person 1 agrees.
Go to St
S
StEp
tEp E on page 38
Yes Person 2 agrees.
Go to StEp E on page 38

I—N —
his / her income tax files for the year
ending December 31, 2010?
FO R No Continue with the next

question
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:

Yes Yes
(a) Total wages and salaries, including
. 00 . 00
commissions, bonuses, tips, taxable
benefits, research grants, royalties, $ $
etc., before any deductions
No No
(b) net farm income (gross receipts

minus expenses and capital cost Yes Yes
allowance), including grants and
subsidies, marketing board payments,
gross insurance proceeds
$ . 00 $ . 00
No Loss No Loss
(c) net non-farm income from Yes Yes

unincorporated business,
. 00 . 00
professional practice, etc.
(gross receipts minus expenses) $ $
No Loss No Loss
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 32 0332
DRAFt OCT 01 07
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No No No
N LY
N O
I O
— — M AT —
Yes
FO R
Person 4 agrees.
Go to St
S
StEp
tEp E on page 38
— —
IN —
question
FO R No Continue with the next

question
question
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No No No
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No Loss No Loss No Loss
Yes Yes Yes
$ . 00 $ . 00 $ . 00

inCOmE FROm GOVERnmEnt:
(d) Child benefits, such as child tax
benefits, universal child care benefits,
family allowances (federal, provincial
and territorial) Yes Yes
$ . 00 $ . 00
No No
(e) Old Age Security pension,

Guaranteed income Supplement,
Allowance and Allowance for the Yes Yes
Survivor from federal government
only (provincial income supplements
$ . 00 $ . 00
NLY
should be reported in (h))
No No
N O
(f) Benefits from Canada or quebec
pension plan
A T IO
M
FOR
Yes Yes
I$N . 00 $ . 00
FO R No No
(g) Benefits from Employment insurance,

including maternity and parental
benefits paid under the federal
employment insurance plan and the Yes Yes
Quebec Parental Insurance Plan (total
benefits before tax deductions) $ . 00 $ . 00
No 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 Yes
$ . 00 $ . 00
No No
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 34 0334
DRAFt OCT 01 07
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No No No
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No No
O
No
NLY
IO N
A T
M
FOR
Yes Yes Yes
$ . 00 I N
$ . 00 $ . 00
No
FO R No No
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No No No
Yes Yes Yes
$ . 00 $ . 00 $ . 00
No No No

OtHER inCOmE:
(i) Dividends, interest on bonds, Yes Yes
deposits and savings certificates,
$ . 00 $ . 00
and other investment income,
such as net rents from real estate,
interest from mortgages
No Loss No Loss
(j) Capital gains or losses, including

those from mutual funds. Do not
include non-taxable capital gains Yes Yes
on the sale of a principal residence.
Report the full amount, not just
the taxable portion. $ . 00 $ . 00
No Loss No Loss
LY
(k) Retirement pensions,
superannuation and annuities,
including those from RRSPs and Yes
O
Yes N
$N
RRIFs. Do not include withdrawals
. 00 O . 00
from a pension plan or RRSP.
$
AT I
RM
No No
N F O
RI
(l) Other money income, such as
FO
alimony, child support, scholarships
Yes Yes
$ . 00 $ . 00
No No
Yes Yes
tOtAl inCOmE in 2010
from all sources $ . 00 $ . 00
No Loss No Loss
. 00 . 00
inCOmE tAX pAiD on 2010 income
(federal, provincial and territorial)
$ $
note: turn the page and answer the questions about this
Yes
dwelling. No
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 36 0336
DRAFt OCT 01 07 DRAFt OCT 01 07
PERSON 3 PERSON 4 PERSON 5
Family name Family name Family name
Given name Given name Given name
Yes Yes Yes
$ . 00 $ . 00 $ . 00
Yes Yes Yes
$ . 00 $ . 00 $ . 00
N LY
Yes Yes
OYes
$ . 00 $ I O$N
. 00 . 00
AT
RM
No No No
N F O
Yes
FO RI Yes Yes
$ . 00 $ . 00 $ . 00
No No No
Yes Yes Yes
$ . 00 $ . 00 $ . 00
$ . 00 $ . 00 $ . 00
note: turn the page and answer the questions about this dwelling.

StEp Answer questions E1 to E10 about this dwelling.
E 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, Person 1

electricity, etc., for this dwelling?
Person 2
If more than one person contributes to such Person 3

payments, mark “ inh” as many circles as apply. 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: 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
N LY
No
N O
I O
E4 (a) How many rooms are there in this dwelling?
M AT
Include kitchen, bedrooms, finished rooms
FO R —
R IN
in attic or basement, etc. Number of rooms
Do not count bathrooms, halls, vestibules and rooms
FO
used solely for business purposes.
(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 Number of bedrooms
basement bedrooms.
E5 When was this dwelling originally built? 1920 or before 1981-1985 2006-2011
Mark the period in which the building was completed, 1921-1945 1986-1990
not the time of any later remodelling, additions or
conversions. If year is not known, give best estimate. 1946-1960 1991-1995
1961-1970 1996-2000
1971-1980 2001-2005
E6 is this dwelling in need of

No, only regular maintenance is needed (painting, furnace cleaning, etc.)
any repairs?
Do not include desirable Yes, minor repairs are needed (missing or loose floor tiles, bricks or shingles,
defective steps, railing or siding, etc.)
remodelling or additions.
Yes, major repairs are needed (defective plumbing or electrical wiring, structural
repairs to walls, floors or ceilings, etc.)
or call 1-877-308-2777, 8 a.m. to 8 p.m.
Page 38 0338
DRAFt OCT 01 07
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?
LY
Rented without payment of cash rent
N
OR
N $ O . 00 per month
T I O
(b) Is this dwelling subsidized?
M A
Subsidized housing includes rent geared to income,
social housing, public housing, government assisted
F O R Yes
I
housing, non-profit housing, rent supplements, and
N
FOR
housing allowances. No
E10 For OWnERS only, answer parts (a) through (e):

(a) What are the total regular monthly mortgage or None — Go to part (c)
loan payments for this dwelling?
OR $ . 00 per month
(b) Are the property taxes (municipal and school) Yes — Go to part (d)
included in the amount shown in part (a)?
No
(c) What are the estimated yearly property taxes None

(municipal and school) for this dwelling?
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
note:
Turn the page and answer the questions in turn
Step Gthe page to Step F.

StEp
if you are answering on behalf of other people, please consult each person.
F
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)?
person 1 person 2 person 3 person 4 person 5

Yes Yes Yes Yes Yes
No No No No No
StEp if more than five persons live here, you will need an extra questionnaire; call 1-877-308-2777.
G you have now completed your questionnaire. please mail it today.
if you have lost the return envelope, please mail the questionnaire to:
Statistics Canada
N LY
pO BOX 99997 Stn FED-GOVt
Ottawa, On K1A 9Z7
N O
I O
thank you for your cooperation.
M AT
FO
mmE
mm R
COmmEntS
COmm
CO Ent
ntS
S
R IN
FO
tHE lAW pROtECtS WHAt yOU tEll US
The confidentiality of your responses is protected by law. All Statistics Canada employees have taken an
oath of secrecy. Your personal information cannot be given to anyone outside Statistics Canada without
your consent. This is your right.
STC/CMO-025-75462
Page 40 0340
DRAFt OCT 01 07

2011 National Household Survey

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2011 National Household Survey

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StEp

1. print your telephone number: ( )— —

City, municipality, town, village, Indian reserve Province/territory Postal code

FAmily nAmE GiVEn nAmE

StEp Copy the names in Step B to question 1 on top of page 4.

• Canadian citizens, permanent residents (landed immigrants), persons asking

2. WHERE tO inClUDE pERSOnS WitH mORE

iF tHiS ADDRESS iS:

a DWEllinG OCCUpiED Only By RESiDEntS OF AnOtHER COUntRy ViSitinG

the HOmE OF A GOVERnmEnt REpRESEntAtiVE OF AnOtHER COUntRy

a DWEllinG tHAt WAS OCCUpiED By A DiFFEREnt HOUSEHOlD on may 10, 2011

Mail this questionnaire in the enclosed envelope today.

DRAFt OCT 01 07 0303 Page 3

The questions refer to each person’s situation

2 SEX Male Male

3 DAtE OF BiRtH AnD AGE

Day Month Year

Day Month Year

For children under

4 mARitAl StAtUS Never legally married

Date of birth Date of birth Date of birth

Day Month Year Day Month Year Day Month Year

Age Age Age

Never legally married Never legally married Never legally married

DRAFt OCT 01 07 0305 Page 5

7 Does this person have any

8 Does a physical condition or

(b) at work or at school? Yes, sometimes No

(c) in other activities, for example, Yes, sometimes

Specify one response only, according to N.S. Alberta N.S. Alberta

Quebec Yukon Quebec Yukon

Ontario N.W.T. Ontario N.W.T.

Born outside Canada Born outside Canada

Yes, sometimes Yes, sometimes Yes, sometimes

Yes, sometimes No Yes, sometimes No

Yes, sometimes Yes, sometimes

N.S. Alberta N.S. Alberta N.S. Alberta

N.B. B.C. N.B. B.C. N.B. B.C.

Quebec Yukon Quebec Yukon Quebec Yukon

Ontario N.W.T. Ontario N.W.T. Ontario N.W.T.

Nunavut Nunavut Nunavut

Born outside Canada Born outside Canada Born outside Canada

Canada, by birth Canada, by birth Canada, by birth

Other country — Specify Other country — Specify Other country — Specify

DRAFt OCT 01 07 0307 Page 7

12 In what year did this person

If exact year is not known,

If exact year is not known,

13 Can this person speak

14 What language(s), other None None O N

at home? French French

(b) Does this person speak No No

16 What is the language that

at home in childhood and French French

Year Year Year

English only English only English only

i None None None O N

M AT Specify other language(s)

French French French

Yes, English Yes, English Yes, English

English English English

French French French

DRAFt OCT 01 07 0309 Page 9

17 What were the ethnic